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Velarde G, Bravo‐Jaimes K, Brandt EJ, Wang D, Douglass P, Castellanos LR, Rodriguez F, Palaniappan L, Ibebuogu U, Bond R, Ferdinand K, Lundberg G, Thamman R, Vijayaraghavan K, Watson K. Locking the Revolving Door: Racial Disparities in Cardiovascular Disease. J Am Heart Assoc 2023; 12:e025271. [PMID: 36942617 PMCID: PMC10227271 DOI: 10.1161/jaha.122.025271] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Racial disparities in cardiovascular disease are unjust, systematic, and preventable. Social determinants are a primary cause of health disparities, and these include factors such as structural and overt racism. Despite a number of efforts implemented over the past several decades, disparities in cardiovascular disease care and outcomes persist, pervading more the outpatient rather than the inpatient setting, thus putting racial and ethnic minority groups at risk for hospital readmissions. In this article, we discuss differences in care and outcomes of racial and ethnic minority groups in both of these settings through a review of registries. Furthermore, we explore potential factors that connote a revolving door phenomenon for those whose adverse outpatient environment puts them at risk for hospital readmissions. Additionally, we review promising strategies, as well as actionable items at the policy, clinical, and educational levels aimed at locking this revolving door.
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Affiliation(s)
- Gladys Velarde
- Department of CardiologyUniversity of FloridaJacksonvilleFL
| | | | | | - Daniel Wang
- Division of CardiologyUniversity of CaliforniaLos AngelesCA
| | - Paul Douglass
- Division of CardiologyWellstar Atlanta Medical CenterAtlantaGA
| | | | - Fatima Rodriguez
- Division of Cardiology and the Cardiovascular InstituteStanford University School of MedicinePalo AltoCA
| | | | - Uzoma Ibebuogu
- Division of CardiologyUniversity of Tennessee Health Science CenterMemphisTN
| | - Rachel Bond
- Division of CardiologyDignity HealthGilbertAZ
- Division Cardiology, Department of Internal MedicineCreighton University School of MedicineOmahaNE
| | - Keith Ferdinand
- Division of CardiologyTulane School of MedicineNew OrleansLA
| | | | - Ritu Thamman
- Division of CardiologyUniversity of PittsburghPittsburghPA
| | | | - Karol Watson
- Division of CardiologyUniversity of CaliforniaLos AngelesCA
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Carnethon MR, Pu J, Howard G, Albert MA, Anderson CAM, Bertoni AG, Mujahid MS, Palaniappan L, Taylor HA, Willis M, Yancy CW. Cardiovascular Health in African Americans: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e393-e423. [PMID: 29061565 DOI: 10.1161/cir.0000000000000534] [Citation(s) in RCA: 660] [Impact Index Per Article: 94.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Population-wide reductions in cardiovascular disease incidence and mortality have not been shared equally by African Americans. The burden of cardiovascular disease in the African American community remains high and is a primary cause of disparities in life expectancy between African Americans and whites. The objectives of the present scientific statement are to describe cardiovascular health in African Americans and to highlight unique considerations for disease prevention and management. METHOD The primary sources of information were identified with PubMed/Medline and online sources from the Centers for Disease Control and Prevention. RESULTS The higher prevalence of traditional cardiovascular risk factors (eg, hypertension, diabetes mellitus, obesity, and atherosclerotic cardiovascular risk) underlies the relatively earlier age of onset of cardiovascular diseases among African Americans. Hypertension in particular is highly prevalent among African Americans and contributes directly to the notable disparities in stroke, heart failure, and peripheral artery disease among African Americans. Despite the availability of effective pharmacotherapies and indications for some tailored pharmacotherapies for African Americans (eg, heart failure medications), disease management is less effective among African Americans, yielding higher mortality. Explanations for these persistent disparities in cardiovascular disease are multifactorial and span from the individual level to the social environment. CONCLUSIONS The strategies needed to promote equity in the cardiovascular health of African Americans require input from a broad set of stakeholders, including clinicians and researchers from across multiple disciplines.
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Gupta-Malhotra M, Hashmi SS, Barratt MS, Milewicz DM, Shete S. Childhood-Onset Essential Hypertension and the Family Structure. J Clin Hypertens (Greenwich) 2016; 18:431-8. [PMID: 26435293 PMCID: PMC4821812 DOI: 10.1111/jch.12701] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 07/31/2015] [Accepted: 08/07/2015] [Indexed: 11/28/2022]
Abstract
The prevalence and effect of single-parent families in childhood-onset essential hypertension (EH) is unknown. Children with EH and age-, sex-, and ethnicity-matched controls were enrolled. Family structure data were obtained by in-person interview. A total of 148 families (76 hypertension probands, 72 control probands; median 14 years) were prospective-ly enrolled in the study. Single-parent status was seen in 42% of the families--with and without EH (38% vs 46%, P=.41; odds ratio, 0.7; 95% confidence interval, 0.4-1.4). After multivariable analysis, a statistically significant sociofamilial contributor to the development of childhood-onset EH was not identified. A significant number of single-parent families (42%), the majority with single mothers, were found in our pedigree study. Sociofamilial factors are known to contribute to the expression of adult-onset EH, but findings in our study suggest that they appear to contribute less in the expression of childhood-onset EH.
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Affiliation(s)
- Monesha Gupta-Malhotra
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Health Science Center, Houston, TX
| | - Syed Shahrukh Hashmi
- Pediatric Research Center, Department of Pediatrics, The University of Texas Health Science Center, Houston, TX
| | - Michelle S Barratt
- Divisions of Community and General Pediatrics and Adolescent Medicine, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Health Science Center, Houston, TX
| | - Dianna M Milewicz
- Division of Medical Genetics, Department of Internal Medicine, The University of Texas Health Science Center, Houston, TX
| | - Sanjay Shete
- Department of Biostatistics, MD Anderson Cancer Center, The University of Texas Health Science Center, Houston, TX
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Associations of common variants at APLN and hypertension in Chinese subjects with and without diabetes. EXPERIMENTAL DIABETES RESEARCH 2012; 2012:917496. [PMID: 23316219 PMCID: PMC3534217 DOI: 10.1155/2012/917496] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 11/13/2012] [Accepted: 11/13/2012] [Indexed: 11/23/2022]
Abstract
Background. Apelin, the endogenous ligand for the APJ receptor, has a potent hypotensive effect via a nitric oxide-dependent mechanism in vivo. The aim of the study was to investigate the association between the common variants of apelin gene (APLN) and hypertension, which was reported recently in a Chinese Han population with and without diabetes. Methods. Three single nucleotide polymorphisms (SNPs) on APLN were genotyped in 3156 diabetic patients and 3736 nondiabetic individuals. For non-diabetic subjects, 1779 were enrolled in stage 1 and 1757 were recruited for validation. A meta-analysis combining the two stages was carried out to obtain the overall effect. Results. In diabetic patients, no significant associations of the three SNPs with hypertension were observed. In contrast, we found that rs2235306 was associated with hypertension in non-diabetic males after adjusting for covariates (OR = 1.19, P = 0.039) while rs2235307 and rs3115759 displayed no evidence of association in both genders. One haplotype, C-C-A, also showed an association with hypertension (OR = 1.47, P = 0.032) only in men. However, analysis in stage 2 and meta-analysis did not support these findings. Conclusions. We conclude that common variants on APLN are not associated with the prevalence of hypertension in the Chinese.
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Flynn JT, Urbina EM. Pediatric ambulatory blood pressure monitoring: indications and interpretations. J Clin Hypertens (Greenwich) 2012; 14:372-82. [PMID: 22672091 DOI: 10.1111/j.1751-7176.2012.00655.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The prevalence of hypertension in children and adolescents is increasing, especially in obese and ethnic children. The adverse long-term effects of hypertension beginning in youth are known; therefore, it is important to identify young patients who need intervention. Unfortunately, measuring blood pressure (BP) is difficult due to the variety of techniques available and innate biologic variation in BP levels. Ambulatory BP monitoring may overcome some of the challenges clinicians face when attempting to categorize a young patient's BP levels. In this article, the authors review the use of ambulatory BP monitoring in pediatrics, discuss interpretation of ambulatory BP monitoring, and discuss gaps in knowledge in usage of this technique in the management of pediatric hypertension.
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Affiliation(s)
- Joseph T Flynn
- Division of Nephrology, Seattle Children's Hospital, Seattle, WA 98105, USA.
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Kidambi S, Ghosh S, Kotchen JM, Grim CE, Krishnaswami S, Kaldunski ML, Cowley AW, Patel SB, Kotchen TA. Non-replication study of a genome-wide association study for hypertension and blood pressure in African Americans. BMC MEDICAL GENETICS 2012; 13:27. [PMID: 22494468 PMCID: PMC3349540 DOI: 10.1186/1471-2350-13-27] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 04/11/2012] [Indexed: 01/11/2023]
Abstract
Background A recent genome wide association study in 1017 African Americans identified several single nucleotide polymorphisms that reached genome-wide significance for systolic blood pressure. We attempted to replicate these findings in an independent sample of 2474 unrelated African Americans in the Milwaukee metropolitan area; 53% were women and 47% were hypertensives. Methods We evaluated sixteen top associated SNPs from the above genome wide association study for hypertension as a binary trait or blood pressure as a continuous trait. In addition, we evaluated eight single nucleotide polymorphisms located in two genes (STK-39 and CDH-13) found to be associated with systolic and diastolic blood pressures by other genome wide association studies in European and Amish populations. TaqMan MGB-based chemistry with fluorescent probes was used for genotyping. We had an adequate sample size (80% power) to detect an effect size of 1.2-2.0 for all the single nucleotide polymorphisms for hypertension as a binary trait, and 1% variance in blood pressure as a continuous trait. Quantitative trait analyses were performed both by excluding and also by including subjects on anti-hypertensive therapy (after adjustments were made for anti-hypertensive medications). Results For all 24 SNPs, no statistically significant differences were noted in the minor allele frequencies between cases and controls. One SNP (rs2146204) showed borderline association (p = 0.006) with hypertension status using recessive model and systolic blood pressure (p = 0.02), but was not significant after adjusting for multiple comparisons. In quantitative trait analyses, among normotensives only, rs12748299 was associated with SBP (p = 0.002). In addition, several nominally significant associations were noted with SBP and DBP among normotensives but none were statistically significant. Conclusions This study highlights the importance of replication to confirm the validity of genome wide association study results.
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Affiliation(s)
- Srividya Kidambi
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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Haarmark C, Kyvik KO, Vedel-Larsen E, Budtz-Jørgensen E, Kanters JK. Heritability of Tpeak-Tend interval and T-wave amplitude: a twin study. ACTA ACUST UNITED AC 2011; 4:516-22. [PMID: 21836130 DOI: 10.1161/circgenetics.111.959551] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Tpeak-Tend interval (TpTe) and T-wave amplitude (Tamp) carry diagnostic and prognostic information regarding cardiac morbidity and mortality. Heart rate and QT interval are known to be heritable traits. The heritability of T-wave morphology parameters such as TpTe and Tamp is unknown. TpTe and Tamp were evaluated in a large sample of twins. METHODS AND RESULTS Twins from the GEMINAKAR study (611 pairs, 246 monozygotic, 365 dizygotic; mean age, 38±11 years; 49% men) who had an ECG performed during 1997 to 2000 were included. Tamp was measured in leads V1 and V5. Duration variables (RR interval, QTpeak and QTend interval) were measured and averaged over 3 consecutive beats in lead V5. TpTe was calculated as the QTend- and QTpeak-interval difference. Heritability was assessed using structural equation models adjusting for age, sex, and body mass index. All models were reducible to a model of additive genetics and unique environment. All variables had considerable genetic components. Adjusted heritability estimates were as follows: TpTe, 46%; Tamp lead V1, 34%; Tamp lead V5, 47%; RR interval, 55%; QT interval, 67%; and Bazett-corrected QT interval, 42%. CONCLUSIONS RR interval, QT interval, Tamp, and TpTe interval are heritable ECG parameters.
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Affiliation(s)
- Christian Haarmark
- Laboratory of Experimental Cardiology, University of Copenhagen, Copenhagen, Denmark
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Wang X, Ding X, Su S, Harshfield G, Treiber F, Snieder H. Genetic influence on blood pressure measured in the office, under laboratory stress and during real life. Hypertens Res 2010; 34:239-44. [PMID: 21068740 DOI: 10.1038/hr.2010.218] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
To determine to what extent the genetic influences on blood pressure (BP) measured in the office, under psychologically stressful conditions in the laboratory and during real life are different from each other. Office BP, BP during a video game challenge and a social stressor interview, and 24-h ambulatory BP were measured in 238 European American and 186 African American twins. BP values across the two tasks were averaged to represent stress levels. Genetic model fitting showed no ethnic or gender differences for any of the measures. The model fitting resulted in heritability estimates of 63, 75 and 71% for office, stress and 24-h systolic BP (SBP) and 59, 67 and 69% for diastolic BP (DBP), respectively. Up to 81% of the heritability of office SBP and 71% of office DBP were attributed to genes that also influenced stress BP. However, only 45% of the heritability of 24-h SBP and 49% of 24-h DBP were attributed to genes that also influence office BP. Similarly, about 39% of the heritability of 24-h SBP and 42% of 24-h DBP were attributed to genes that also influence stress BP. Substantial overlap exists between genes that influence BP measured in the office, under laboratory stress and during real life. However, significant genetic components specific to each BP measurement also exist. These findings suggest that partly different genes or sets of genes contribute to BP regulation in different conditions.
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Affiliation(s)
- Xiaoling Wang
- Department of Pediatrics, Medical College of Georgia, Georgia Prevention Institute, Augusta, GA, USA.
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Genome-wide association studies of hypertension: have they been fruitful? J Cardiovasc Transl Res 2010; 3:189-96. [PMID: 20560039 DOI: 10.1007/s12265-010-9183-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Accepted: 03/03/2010] [Indexed: 01/11/2023]
Abstract
Over the last two decades candidate gene association studies and genome-wide linkage scans have met with little success in characterizing risk variants for hypertension. Several factors could be responsible for the relative lack of success, although our understanding of the genetics has evolved to support the belief that there are multiple common risk variants, which are associated with hypertension with modest effect sizes. Genome-wide association studies (GWAS) have successfully identified risk loci for several complex polygenic disease states. Until recently, the productivity of GWAS with respect to identifying risk loci for hypertension was limited. In this paper we describe the recent success of GWAS of hypertension in identifying over a dozen loci associated with essential hypertension. We will review these findings, and place these results in the context of the future potential of pharmocogenetics of hypertension.
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Urbina E, Alpert B, Flynn J, Hayman L, Harshfield GA, Jacobson M, Mahoney L, McCrindle B, Mietus-Snyder M, Steinberger J, Daniels S. Ambulatory blood pressure monitoring in children and adolescents: recommendations for standard assessment: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee of the council on cardiovascular disease in the young and the council for high blood pressure research. Hypertension 2008; 52:433-51. [PMID: 18678786 DOI: 10.1161/hypertensionaha.108.190329] [Citation(s) in RCA: 355] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Elaine Urbina
- American Heart Association, Public Information, 7272 Greenville Ave, Dallas, TX75231-4596, USA
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Waterhouse J, Atkinson G, Reilly T, Jones H, Edwards B. Chronophysiology of the cardiovascular system. BIOL RHYTHM RES 2007. [DOI: 10.1080/09291010600906109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kupper N, Willemsen G, Riese H, Posthuma D, Boomsma DI, de Geus EJC. Heritability of daytime ambulatory blood pressure in an extended twin design. Hypertension 2004; 45:80-5. [PMID: 15557390 DOI: 10.1161/01.hyp.0000149952.84391.54] [Citation(s) in RCA: 156] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present study estimated the genetic influences on ambulatory systolic and diastolic blood pressure, and on hypertensive status derived from ambulatory levels, in a family sample of 535 twins and 257 singleton siblings. This "extended twin design" was used to explicitly test the possibility that results obtained in singleton siblings are different from those obtained in twins. To examine the effects of excluding (medicated) hypertensive subjects, the genetic analyses were first performed under strict exclusion (medication and/or blood pressure >135/85 mm Hg), then without the medicated subjects, and, finally, without any exclusion. For the latter analysis, the untreated blood pressure values in subjects using antihypertensive medication were estimated by augmenting the observed blood pressure by the published efficacy of the specific antihypertensive medication used. No evidence was found for differential means, variances, or covariances of ambulatory blood pressure in singletons compared with twins. This indicates that estimates of heritability of ambulatory blood pressure from twin studies can be generalized to the singleton population. Heritability of hypertension, defined as a mean daytime blood pressure >135/85 mm Hg or antihypertensive medication use, was 61%. Genetic contribution to ambulatory blood pressure was highest when all subjects were included (systolic, 44% to 57%; diastolic, 46% to 63%) and lowest under strict exclusion (systolic, 32% to 50%; diastolic, 31% to 55%). We conclude that exclusion of (medicated) hypertensives removes part of the true genetic variance in ambulatory blood pressure.
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Affiliation(s)
- Nina Kupper
- Department of Biological Psychology, Vrije Universiteit, van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.
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Dubreuil E, Ditto B, Dionne G, Pihl RO, Tremblay RE, Boivin M, Pérusse D. Familiality of heart rate and cardiac-related autonomic activity in five-month-old twins: The Québec newborn twins study. Psychophysiology 2003; 40:849-62. [PMID: 14986838 DOI: 10.1111/1469-8986.00103] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The familiality of infant sleeping heart rate (HR) and cardiac-related autonomic activity, as indexed by spectral analysis of HR variability (HRV) and response to postural change, was investigated in 322 5-month-old twin pairs. The postural change elicited only minor changes in cardiovascular activity. As a result, analyses focused on supine cardiovascular activity. Multivariate genetic modeling indicated that individual differences in sleeping HR and high frequency (HF) HRV were determined by unique environmental and distinct additive genetic factors. These variables, along with low frequency (LF) HRV, were also affected by overlapping familial environmental influences. Familial influences in HF HRV were more pronounced for baby girls than boys. Estimates of relative LF and HF HRV were determined by common (familial) and unique environmental factors; familial influences on these estimates did not overlap with familial influences on sleeping HR.
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Affiliation(s)
- Etienne Dubreuil
- Research Unit on Children's Psychosocial Maladjustment (GRIP), Université de Montreal, Montréal, Québec, Canada.
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Fagard RH, Loos RJ, Beunen G, Derom C, Vlietinck R. Influence of chorionicity on the heritability estimates of blood pressure: a study in twins. J Hypertens 2003; 21:1313-8. [PMID: 12817178 DOI: 10.1097/00004872-200307000-00019] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A basic assumption of the twin design is that environmental influences including prenatal experiences are equal across twin types. However, the intra-uterine environment may differ according to the chorionicity of the monozygotic twins, which may have biased previous heritability estimates of blood pressure. OBJECTIVE The aim of the present study was to assess whether the heritability of blood pressure, derived from measurements in monozygotic and dizygotic twins, differs according to the chorionicity of the monozygotic twins. METHODS Conventional and 24-h ambulatory blood pressures were measured in 125 dizygotic twin pairs and in 97 dichorionic and 128 monochorionic monozygotic twin pairs at the age of 18-34 years. The twin sample was drawn from the East Flanders Prospective Twin Survey, in which perinatal data were collected at birth. Intra-pair correlation coefficients were calculated and compared between both types of monozygotic twin pairs. Heritability was estimated from model-fitting and path analysis, based on the dizygotic twins and, respectively, all monozygotic twins and the two subtypes. RESULTS Intra-pair correlation coefficients for the various blood pressures, after adjustment for body mass index, ranged from 0.45 to 0.71 in the monozygotic twin pairs and did not differ significantly according to chorionicity. Heritability estimates of blood pressure were between 52 and 64%, and were similar when calculated from dizygotic twins and, respectively, dichorionic and monochorionic monozygotic twins. CONCLUSIONS Heritability estimates of conventional and ambulatory blood pressure do not differ significantly according to the chorionicity of the monozygotic twins.
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Affiliation(s)
- Robert H Fagard
- Hypertension and Cardiovascular Rehabilitation Unit, Faculty of Medicine, University of Leuven, KU Leuven, Belgium.
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Snieder H, Harshfield GA, Barbeau P, Pollock DM, Pollock JS, Treiber FA. Dissecting the genetic architecture of the cardiovascular and renal stress response. Biol Psychol 2002; 61:73-95. [PMID: 12385670 DOI: 10.1016/s0301-0511(02)00053-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We review the evidence for a genetic basis of the cardiovascular and renal stress response. A bio-behavioral model of stress-induced hypertension is presented that explains how repeated exposure to stress in combination with genetic susceptibility might lead to the development of hypertension. In this model, we focus on three underlying physiological systems that mediate the stress response of the heart, vasculature and kidney: the sympathetic nervous system (SNS), the renin-angiotensin-aldosterone system (RAAS) and the endothelial system (ES). We then review the evidence for a genetic influence on cardiovascular reactivity to psychological stress and stress-induced sodium retention using data from twin and family studies and a limited number of candidate gene studies. Finally, by describing the underlying physiological systems of our model and their genetic underpinning we emphasize the importance of inclusion of genetic measurements in any future studies testing the reactivity hypothesis.
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Affiliation(s)
- Harold Snieder
- Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Building HS-1640, Augusta, GA 30912, USA.
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Harshfield GA, Wilson ME, Treiber FA, Alpert BS. A comparison of ambulatory blood pressure patterns across populations. Blood Press Monit 2002; 7:265-9. [PMID: 12409885 DOI: 10.1097/00126097-200210000-00003] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Black individuals are characterized by a blunted nocturnal decline (i.e. dipping) in blood pressure compared with whites. The resulting increase in cardiovascular load has been hypothesized to contribute to ethnic differences in hypertension and its sequelae. OBJECTIVE To examine data from two different locations and determine factors related to ethnic differences in ambulatory blood pressure pattern. METHODS Ambulatory blood pressure recordings were performed on 300 youths from Memphis, Tennessee and 195 youths from Augusta, Georgia, USA. Stepwise regressions were performed to determine the factors associated with daytime and night-time blood pressure and the nocturnal decline in blood pressure. The factors examined were recording location, ethnicity, gender, age, height, weight and genetic predisposition. RESULTS Significant factors in the model for the nocturnal decline in systolic blood pressure included location (R(2) = 0.031, P < 0.001), followed by ethnicity (R(2) change = 0.015, P < 0.006) and height (R(2) change = 0.009,P < 0.03). Significant factors in the model for the nocturnal decline in diastolic blood pressure included location ( R(2) = 0.176, P < 0.001), followed by ethnicity ( R(2) change = 0.016, P < 0.002) and height (R(2) change = 0.02, P < 0.001). The nocturnal decline was greater in the Augusta subjects because of higher daytime systolic (P < 0.002) and diastolic (P < 0.001) blood pressure. Weight contributed significantly to the models for resting blood pressure and daytime blood pressure. Gender was the only variable that contributed to the model for resting systolic blood pressure. CONCLUSIONS Both genetic and environmental factors contribute to individual differences in ambulatory blood pressure patterns. Much of the variance of ambulatory blood pressure levels and patterns remains, however, unexplained.
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Affiliation(s)
- Gregory A Harshfield
- Department of Pediatrics and Georgia Prevention Institute, Medical College of Georgia, Augusta, 30912-4534, USA.
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Abstract
The heritability of self-reported sleep patterns was investigated with 86 identical and 78 fraternal same-sex and 51 fraternal mixed-gender adult twin pairs who were paid to maintain 7-day diaries. Linear structural modeling was applied to investigate the nature and degree of genetic and environmental influences and revealed significant genetic influences on the time that individuals went to sleep and woke up, how often the individual woke up during the night, the duration of sleep and wakefulness, and how alert the individual felt upon waking and over the day, accounting for 21% to 41% of the variance. These influences of heredity were present for sleep-wake behavior over the entire week and also when the sleep-wake pattern was analyzed separately for weekdays and weekends. Further, it was demonstrated that there were multiple independent influences of heredity on sleep-wake behavior. The results suggest that sleep-wake patterns are not learned but result in part from multiple heritable influences.
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Affiliation(s)
- John M de Castro
- Neuropsychology and Behavioral Neuroscience Program, Department of Psychology, College of Arts and Sciences, Georgia State University, University Plaza, Atlanta, GA 30303-3083, USA.
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Iliadou A, Lichtenstein P, Morgenstern R, Forsberg L, Svensson R, de Faire U, Martin NG, Pedersen NL. Repeated blood pressure measurements in a sample of Swedish twins: heritabilities and associations with polymorphisms in the renin-angiotensin-aldosterone system. J Hypertens 2002; 20:1543-50. [PMID: 12172316 DOI: 10.1097/00004872-200208000-00017] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Twin and family studies have shown that genetic effects explain a relatively high amount of the phenotypic variation in blood pressure. However, many studies have not been able to replicate findings of association between specific polymorphisms and diastolic and systolic blood pressure. METHODS In a structural equation-modelling framework the authors investigated longitudinal changes in repeated measures of blood pressures in a sample of 298 like-sexed twin pairs from the population-based Swedish Twin Registry. Also examined was the association between blood pressure and polymorphisms in the angiotensin-I converting enzyme and the angiotensin II receptor type 1 with the 'Fulker' test. Both linkage and association were tested simultaneously revealing whether the polymorphism is a Quantitative Trait Locus (QTL) or in linkage disequilibrium with the QTL. RESULTS Genetic influences explained up to 46% of the phenotypic variance in diastolic and 63% of the phenotypic variance in systolic blood pressure. Genetic influences were stable over time and contributed up to 78% of the phenotypic correlation in both diastolic and systolic blood pressure. Non-shared environmental effects were characterised by time specific influences and little transmission from one time point to the next. There was no significant linkage and association between the polymorphisms and blood pressure. CONCLUSIONS There is a considerable genetic stability in both diastolic and systolic blood pressure for a 6-year period of time in adult life. Non-shared environmental influences have a small long-term effect. Although associations with the polymorphisms could not be replicated, results should be interpreted with caution due to power considerations.
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Affiliation(s)
- Anastasia Iliadou
- Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden.
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19
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Abstract
OBJECTIVES The time of day of meal ingestion, the number of people present at the meal, the subjective state of hunger, and the estimated before-meal contents in the stomach have been established as influences on the amount eaten in a meal, and this influence has been shown to be heritable. Because these factors intercorrelate, the possibility that the calculated heritabilities for some of these variables could result indirectly from their convariation with one of the other heritable variables was assessed. METHODS The independence of the heritability of the influence of these four factors was investigated with 110 identical and 102 fraternal same-sex and 53 fraternal mixed-sex adult twin pairs who were paid to maintain 7-d food intake diaries. From the diary reports, the meal sizes were calculated and subjected to multiple regression analysis using the estimated before-meal stomach contents, the reported number of other people present, the subjective hunger ratings, and the time of day of the meal as predictors. Linear structural modeling was applied to the beta coefficients from the multiple regression to investigate whether the heritability of the influences of these four variables was independent. RESULTS Significant genetic effects were found for the beta coefficients for all four variables, indicating that the heritability of their relationship with intake is to some extent heritable. CONCLUSIONS These results suggest that the influences of multiple factors on intake are influenced by the genes and become part of the total package of genetically determined physiologic, sociocultural, and psychological processes that regulate energy balance.
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Affiliation(s)
- J M de Castro
- Neuropsychology and Behavioral Neuroscience Program, Department of Psychology, Georgia State University, Atlanta, Georgia 30303-3083, USA.
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20
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Vinck WJ, Fagard RH, Loos R, Vlietinck R. The impact of genetic and environmental influences on blood pressure variance across age-groups. J Hypertens 2001; 19:1007-13. [PMID: 11403347 DOI: 10.1097/00004872-200106000-00003] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The purpose of the present investigation was to examine the age-dependency of blood pressure heritability by use of the twin method in different age groups. DESIGN In 272 (150 monozygous and 122 dizygous) twin pairs, aged 18 to 76 years, both conventional and ambulatory blood pressure were measured. After correction for possible confounders, model fitting was used to estimate heritability and 95% confidence limits in three age groups of similar size, i.e. 18-29, 30-39 and > or = 40 years. RESULTS Heritability estimates were significant in each age group, ranging from 35 to 67% for the various blood pressure measurements. The estimates tended to decrease with increasing age, except for conventional diastolic blood pressure, but the intergroup differences did not reach statistical significance, despite adequate power. CONCLUSIONS In conclusion, blood pressure heritability is significant in various age groups, but does not substantially change with advancing age. Twin analysis does not indicate that models for blood pressure regulation in various age groups should take into account the possibility of age-related changes in the expression of relevant genes, in the presence of relevant environmental agents, or in the susceptibility to the latter (gene-environment interaction).
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Affiliation(s)
- W J Vinck
- Department of Molecular and Cardiovascular Research, Faculty of Medicine, University of Leuven, Belgium.
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21
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Snieder H, Hayward CS, Perks U, Kelly RP, Kelly PJ, Spector TD. Heritability of central systolic pressure augmentation: a twin study. Hypertension 2000; 35:574-9. [PMID: 10679500 DOI: 10.1161/01.hyp.35.2.574] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Less than 50% of the variance in left ventricular mass is explained by conventional factors such as age, blood pressure, and body size. Genetic influences may account for part of the unexplained variance. The central (aortic) pressure augmentation index has been suggested as a noninvasive measure of pulsatile load, which is a likely determinant of left ventricular mass. We quantified the genetic influence on augmentation index and determined the extent to which this influence is dependent on the effects of age, height, heart rate, and blood pressure. We performed a classical twin study composed of 225 monozygotic and 594 dizygotic female white twin pairs aged 18 to 73 years. Augmentation index and mean arterial pressure were based on the central pressure wave derived from the radial waveform as measured by applanation tonometry. Quantitative genetic modeling techniques were used to analyze the data. The heritability of augmentation index was 37%, whereas heritabilities for blood pressure traits varied between 13% and 25%. Most of the variance in augmentation index could be explained by genetic and environmental factors specifically influencing augmentation index. Only a relatively small part of the total variance in augmentation index could be attributed to genes in common with height (3.1%), heart rate (4.6%), and mean arterial pressure (5.6%). Age explained 19% of the total variation in augmentation index. In conclusion, augmentation index has a significant heritable component, which is largely independent of the influence of blood pressure, heart rate, height, and age. Finding genes for the augmentation index could help to unravel pathophysiological mechanisms causing left ventricular hypertrophy and lead to improvements in prevention, diagnosis, and treatment of at-risk populations.
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Affiliation(s)
- H Snieder
- Twin Research and Genetic Epidemiology Unit, St Thomas' Hospital, London, UK.
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22
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Ellsworth DL, Manolio TA. The Emerging Importance of Genetics in Epidemiologic Research III. Bioinformatics and statistical genetic methods. Ann Epidemiol 1999; 9:207-24. [PMID: 10332927 DOI: 10.1016/s1047-2797(99)00007-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To outline potential benefits of integrating recent developments in bioinformatics and statistical genetics with traditional epidemiologic studies to localize genes influencing complex phenotypes and examine genetic effects on disease susceptibility. METHODS An overview of bioinformatic and statistical approaches for localizing disease-susceptibility genes as well as challenges associated with identifying functional DNA variants and context-dependent genetic effects concludes this three-part series on the importance of genetics in epidemiologic research. RESULTS Rapidly evolving bioinformatic and statistical methods are providing invaluable information on newly-discovered genes and molecular variation influencing human diseases that is readily available to epidemiologic researchers. CONCLUSIONS Integrating bioinformatics and molecular biotechnology with epidemiologic methods of assessing disease risk is rapidly expanding our ability to identify genetic influences on complex human diseases. These technological advances are likely to have a profound impact on current knowledge of complex disease etiology, and may reveal novel approaches to disease treatment and prevention.
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Affiliation(s)
- D L Ellsworth
- Epidemiology and Biometry Program, Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892-7934, USA
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23
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Frisina N, Pedullà M, Mento G, Morano E, Lanuzza B, Buemi M. Normotensive offspring with non-dipper hypertensive parents have abnormal sleep pattern. Blood Press 1998; 7:76-80. [PMID: 9657533 DOI: 10.1080/080370598437439] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The objective of this study was to determine whether abnormal microstructure of sleep in non-dipper hypertensive patients was present in their offspring. Subjects included 11 normotensive offspring of non-dipper hypertensive parents (FH + ND), 6 of dipper hypertensive parents (FH + D) and 5 of normotensive parents (Controls). We measured blood pressure beat-to-beat by Finapres and all stages of sleep by polysomnographically recording simultaneously during spontaneous nocturnal sleep. We analysed blood pressure pattern for 4-min long random periods while the subjects were awake and during all stages of sleep; sleep efficiency (SE), sleep latency (SL), delta-sleep latency (delta-SL), REM sleep latency (REM-SL), Stage 1, Stage 2, Stage 3, Stage 4 and REM duration and percentage values, and microstructural aspects of sleep (arousal and microarousal temporization and features). FH + D and controls showed a fall in blood pressure greater than 10% in all stages of NREM sleep and in the FH + ND blood pressure fall in less than 10% of waking values in all NREM stages. REM sleep and heart rate were similar in the three groups during all stages of sleep. FH + ND showed the same number of arousals but more microarousals than FH + D and controls (p < 0.0001). Microarousals induced several stage shifts through lighter sleep. For this reason, FH + ND spent more time in stage 2 than FH + D and controls. In conclusion, offspring of non-dipper hypertension parents showed a greater number of microarousals than the other two groups.
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Affiliation(s)
- N Frisina
- Internal Medicine, University of Messina, Italy
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24
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Abstract
OBJECTIVE The objective of this study was to determine the predictors of future ambulatory blood pressure in normotensive youths with family histories of essential hypertension. STUDY DESIGN Eighty-eight healthy youths (mean age 10.9 +/- 2.5 years; 52 blacks, 36 whites; 45 boys) were studied. During an initial visit anthropometric variables and hemodynamics were measured at rest and before, during, and after three laboratory stressors: postural change, forehead cold, and video game challenge. The subjects' ambulatory blood pressure was monitored for 24 hours as part of a follow-up evaluation an average of 2.5 years later. RESULTS Anthropometric and demographic variables and measures of reactivity to laboratory stressors were related to future daytime and nighttime ambulatory blood pressure. CONCLUSION These findings provide important information on the predictors of ambulatory blood pressure and underscore the importance of resting blood pressure and adiposity. These results support the guidelines of the Second Task Force, which recommend the measurement of blood pressure and adiposity in the context of ongoing health care.
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Affiliation(s)
- J D Del Rosario
- Department of Pediatrics and Psychiatry, Medical College of Georgia, Augusta, USA
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25
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Beige J, Zilch O, Hohenbleicher H, Ringel J, Kunz R, Distler A, Sharma AM. Genetic variants of the renin-angiotensin system and ambulatory blood pressure in essential hypertension. J Hypertens 1997; 15:503-8. [PMID: 9170002 DOI: 10.1097/00004872-199715050-00005] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine whether the angiotensinogen M235T and angiotensin converting enzyme insertion/deletion (I/D) variants are related to the severity of hypertension in patients with established essential hypertension. DESIGN A cross-sectional study. SETTING The hypertension clinic of the Benjamin Franklin University Hospital, Free University of Berlin. PARTICIPANTS Three hundred and forty-three consecutive Caucasian patients who presented with treated or untreated (n = 115) hypertension were enrolled into the study. Twenty-two patients were excluded from analysis because they had secondary hypertension. MAIN OUTCOME MEASURES Angiotensinogen M235T and angiotensin-converting enzyme I/D genotypes, 24 h ambulatory blood pressure values, the number of antihypertensive medications administered and left ventricular dimensions assessed by two-dimensional echocardiography. RESULTS Neither the angiotensinogen nor the angiotensin converting enzyme genotype was related significantly to the average ambulatory blood pressure and left ventricular dimensions in hypertensives. Furthermore, neither the number of antihypertensive medications administered to treated patients nor blood pressure levels in untreated patients (n = 115) differed significantly between the genotypic groups. CONCLUSIONS These results do not support the hypothesis that the studied molecular variants of the renin-angiotensin system may represent clinically useful markers of the severity of hypertension in Caucasians with established essential hypertension.
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Affiliation(s)
- J Beige
- Department of Internal Medicine, Universitätsklinikum Benjamin Franklin, Free University of Berlin, Germany
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Portaluppi F, Waterhouse J, Minors D. The rhythms of blood pressure in humans. Exogenous and endogenous components and implications for diagnosis and treatment. Ann N Y Acad Sci 1996; 783:1-9. [PMID: 8853629 DOI: 10.1111/j.1749-6632.1996.tb26703.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- F Portaluppi
- Hypertension Unit, First Institute of Internal Medicine, University of Ferrara, Italy
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