1
|
Nsugbe E. A cybernetic framework for predicting preterm and enhancing care strategies: A review. BIOMEDICAL ENGINEERING ADVANCES 2021. [DOI: 10.1016/j.bea.2021.100024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
|
2
|
Williams DP, Thayer JF, Halbert JD, Wang X, Kapuku G. Higher cardiac vagal activity predicts lower peripheral resistance 6 years later in European but not African Americans. Am J Physiol Heart Circ Physiol 2021; 320:H2058-H2065. [PMID: 33769914 PMCID: PMC8163650 DOI: 10.1152/ajpheart.00023.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/26/2021] [Accepted: 03/23/2021] [Indexed: 11/22/2022]
Abstract
African American (AA) individuals are at a greater risk for the development of cardiovascular complications, such as hypertension, compared with European Americans (EAs). Higher vagally mediated heart rate variability (HRV) is typically associated with lower blood pressure (BP) and total peripheral resistance (TPR). However, research has yet to examine the differential impact of HRV on longitudinal hemodynamic activity between AAs and EAs. We sought to rectify this in a sample of 385 normotensive youths (207 AAs, 178 EAs; mean age 23.16 ± 2.9 yr). Individuals participated in two laboratory evaluations spanning approximately 6 yr. Bioimpedance was used to assess HRV at time 1 and cardiac output at both time 1 and time 2. Mean arterial pressure (MAP) was measured at both time points via an automated BP machine. TPR was calculated as MAP divided by cardiac output. Results showed AAs to have higher BP and higher TPR at time 2 compared with EAs, independent of several important covariates. Also, higher HRV at time 1 significantly predicted both lower TPR and BP at time 2 among EAs only; these associations were attenuated and not significant in AAs. HRV did not significantly predict cardiac output at time 2 in the full sample or split by ethnicity. Our findings highlight that AAs show TPR mediated long-term increases in BP irrespective of resting HRV, providing a physiological pathway linking AAs with a greater risk for mortality and morbidity from hypertension and potentially other cardiovascular disease.NEW & NEWSWORTHY African Americans and European Americans differ in hemodynamics underlying long-term blood pressure regulation. Over 6 yr, African Americans show total peripheral resistance-mediated increases in blood pressure compared with European Americans. Higher heart rate variability predicts lower blood pressure and total peripheral resistance 6 yr later in European Americans but not African Americans.
Collapse
Affiliation(s)
- DeWayne P Williams
- Department of Psychological Science, University of California, Irvine, California
| | - Julian F Thayer
- Department of Psychological Science, University of California, Irvine, California
| | - James D Halbert
- Department of Medicine, Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Xiaoling Wang
- Department of Medicine, Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Gaston Kapuku
- Department of Medicine, Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia
| |
Collapse
|
3
|
Hill LK, Thayer JF, Williams DP, Halbert JD, Hao G, Robinson V, Harshfield G, Kapuku G. Ethnic and sex differences in the longitudinal association between heart rate variability and blood pressure. Blood Press 2021; 30:165-171. [PMID: 33504215 DOI: 10.1080/08037051.2021.1876517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Elevated blood pressure is a risk factor for increased cardiovascular morbidity and mortality. Decreased vagally-mediated heart rate variability has previously been prospectively linked with increased blood pressure; however, to date, no such prospective data exist regarding this relationship among Blacks. MATERIALS AND METHODS We examined this association in 387 normotensive young adults (mean age, 23 years, 52% female, 54% Black) who participated in two laboratory evaluations spanning approximately six years. Blood pressure was measured at both timepoints with a non-invasive oscillometric device and heart rate variability was assessed via bio-impedance. RESULTS In the total sample, heart rate variability significantly predicted systolic (p = .022) and diastolic (p < .001) blood pressure increases six years into the future. However, this pattern varied as a function of ethnicity and sex with the effect of heart rate variability on Time 2 systolic blood pressure only significant among White males (p = .007). Heart rate variability was also predictive of Time 2 diastolic blood pressure in White males (p = .038) as well as among both White (p = .032) and Black (p = .015) females, but was not related to blood pressure among Black males. CONCLUSION We report for the first time significant ethnic and sex differences in the prospective relationship between heart rate variability and blood pressure change. These findings may give clues as to the underlying mechanisms that are involved in the well-known health disparities in blood pressure and hypertension-related cardiovascular diseases.
Collapse
Affiliation(s)
- LaBarron K Hill
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.,Center for Biobehavioral Health Disparities Research, Duke University, Durham, NC, USA
| | - Julian F Thayer
- Department of Psychological Science, University of California, Irvine, CA, USA
| | - DeWayne P Williams
- Department of Psychological Science, University of California, Irvine, CA, USA
| | - James D Halbert
- Departments of Population Health Sciences and Medicine (Cardiology), Augusta University, Augusta, GA, USA
| | - Guang Hao
- Departments of Population Health Sciences and Medicine (Cardiology), Augusta University, Augusta, GA, USA
| | - Vincent Robinson
- Departments of Population Health Sciences and Medicine (Cardiology), Augusta University, Augusta, GA, USA
| | - Gregory Harshfield
- Departments of Population Health Sciences and Medicine (Cardiology), Augusta University, Augusta, GA, USA
| | - Gaston Kapuku
- Departments of Population Health Sciences and Medicine (Cardiology), Augusta University, Augusta, GA, USA
| |
Collapse
|
4
|
Kapuku G, Howie M, Ghosh S, Doshi V, Bykhovsky M, Ange B, Halbert JD, Robinson V, Bagi Z, Harshfield G, George V. Effects of Race, Cardiac Mass, and Cardiac Load on Myocardial Function Trajectories from Childhood to Young Adulthood: The Augusta Heart Study. J Am Heart Assoc 2021; 10:e015612. [PMID: 33459030 PMCID: PMC7955424 DOI: 10.1161/jaha.119.015612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background The overall goal of this longitudinal study was to determine if the Black population has decreased myocardial function, which has the potential to lead to the early development of congestive heart failure, compared with the White population. Methods and Results A total of 673 subjects were evaluated over a period of 30 years including similar percentages of Black and White participants. Left ventricular systolic function was probed using the midwall fractional shortening (MFS). A longitudinal analysis of the MFS using a mixed effect growth curve model was performed. Black participants had greater body mass index, higher blood pressure readings, and greater left ventricular mass compared with White participants (all P<0.01). Black participants had a 0.54% decrease of MFS compared with White participants. As age increased by 1 year, MFS increased by 0.05%. As left ventricular mass increased by 1 g, MFS decreased by 0.01%. As circumferential end systolic stress increased by 1 unit, MFS decreased by 0.04%. The MFS trajectories for race differed from early age to young adulthood. Conclusions Changes in myocardial function mirror the race‐dependent variations in blood pressure, afterload, and cardiac mass, suggesting that myocardial function depression occurs early in childhood in populations at high cardiovascular risk such as Black participants.
Collapse
Affiliation(s)
- Gaston Kapuku
- Departments of Medicine Georgia Prevention InstituteMedical College of GeorgiaAugusta University Augusta GA.,Department of Pediatrics Medical College of GeorgiaAugusta University Augusta GA.,Department of Population Health Sciences Medical College of GeorgiaAugusta University Augusta GA
| | - Melissa Howie
- Department of Population Health Sciences Medical College of GeorgiaAugusta University Augusta GA
| | - Santu Ghosh
- Department of Population Health Sciences Medical College of GeorgiaAugusta University Augusta GA
| | - Vishal Doshi
- Departments of Medicine Georgia Prevention InstituteMedical College of GeorgiaAugusta University Augusta GA
| | - Michael Bykhovsky
- Department of Pediatrics Medical College of GeorgiaAugusta University Augusta GA
| | - Brittany Ange
- Department of Population Health Sciences Medical College of GeorgiaAugusta University Augusta GA
| | - James D Halbert
- Departments of Medicine Georgia Prevention InstituteMedical College of GeorgiaAugusta University Augusta GA.,Department of Leadership and Applied Psychology Adler University Chicago IL
| | - Vincent Robinson
- Departments of Medicine Georgia Prevention InstituteMedical College of GeorgiaAugusta University Augusta GA
| | - Zsolt Bagi
- Department of Physiology Medical College of GeorgiaAugusta University Augusta GA
| | - Gregory Harshfield
- Departments of Medicine Georgia Prevention InstituteMedical College of GeorgiaAugusta University Augusta GA.,Department of Pediatrics Medical College of GeorgiaAugusta University Augusta GA.,Department of Population Health Sciences Medical College of GeorgiaAugusta University Augusta GA
| | - Varghese George
- Department of Population Health Sciences Medical College of GeorgiaAugusta University Augusta GA
| |
Collapse
|
5
|
Serum 25-Hydroxyvitamin D Concentrations Are Associated with Mental Health and Psychosocial Stress in Young Adults. Nutrients 2020; 12:nu12071938. [PMID: 32629761 PMCID: PMC7400417 DOI: 10.3390/nu12071938] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 12/14/2022] Open
Abstract
We aimed to test the hypothesis that serum 25-hydroxyvitamin D3 (25(OH)D) concentration is associated with mental health and life stress measures in young adults and investigate gender and racial disparities in these associations. This study comprised 327 black and white participants. Depression, trait anxiety, perceived stress, and hostility were measured by the following validated instruments: Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS), and Cook–Medley Hostility Scale (CMHS). Linear regression was used to estimate correlations between serum 25(OH)D concentration and mental health measurements in the total population and in subgroups stratified by gender and race. In this sample (28.2 ± 3.1 years, 52% female, 53% black), serum 25(OH)D concentration was negatively related to BDI, STAI, PSS, total CMHS score, and the majority of CMHS subscale scores (p-values < 0.05). Stratified by gender, most of these associations remained significant only in women (p-values < 0.05). Stratified by race, higher 25(OH)D concentrations in white participants were significantly related to lower BDI, STAI, PSS, and CMHS-cynicism subscales (p-values < 0.05); 25(OH)D concentrations in the black participants were only inversely associated with CMHS and most CMHS subscales (p-values < 0.05) but not with BDI, STAI, and PSS. We present novel findings of consistent inverse relationships between serum 25(OH)D concentration and various measures of mental health and life stress. Long-term interventional studies are warranted in order to investigate the roles of vitamin D supplementation in the prevention and mitigation of depression, anxiety, and psychological stress in young adults.
Collapse
|
6
|
Jeong JH, Hanevold C, Harris RA, Kapuku G, Pollock J, Pollock D, Harshfield G. Angiotensin II receptor blocker attenuates stress pressor response in young adult African Americans. J Clin Hypertens (Greenwich) 2019; 21:1191-1199. [PMID: 31328876 DOI: 10.1111/jch.13625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 05/17/2019] [Accepted: 05/27/2019] [Indexed: 01/10/2023]
Abstract
African Americans (AAs) are susceptible to hypertension (HTN) and its associated organ damage leading to adverse cardiovascular (CV) outcomes. Psychological stress is proposed to contribute to the development of HTN; however, the potential role of the renin-angiotensin system (RAS) in stress-related HTN in AAs is largely unknown. In this study, we tested the hypothesis that activation of RAS is a potential contributing factor for altered CV responses to stress, and suppression of angiotensin II (Ang II) activity will improve hemodynamic responses to a prolonged mental stressor in healthy young AAs. Utilizing a double-blind, randomized, crossover study design, 132 normotensive AAs (25 ± 7 years) were treated with either a placebo (PLC) or 150 mg/d irbesartan (an Ang II type 1 receptor blocker; ARB) for 1 week. On the final day of each treatment, hemodynamic measures and urinary sodium excretion (UNaV) were collected before, during and after a 45 minute-mental stress. The magnitude of stress-induced increase in blood pressure with ARB was blunted and delayed compared to PLC. Systolic blood pressure at the end of recovery on ARB was significantly lower compared to either PLC (110 ± 13 vs 117 ± 12 mm Hg respectively; P < 0.001) or the prestress level on ARB (P = 0.02). ARB treatment reduced overall vasoconstriction and improved poststress UNaV. ARB attenuated blood pressure responses to mental stress and improved the poststress BP recovery process which were partly linked to reduced overall vasoconstriction and improved stress-induced UNaV in young adult AAs prior to the development of disease conditions. These results suggest that treatment approaches that inhibit RAS action could have significant relevance to potentially lower susceptibility to stress responses and eventually the premature development of HTN in AAs.
Collapse
Affiliation(s)
- Jin Hee Jeong
- Department of Population Health Sciences, Georgia Prevention Institute, Augusta University, Augusta, Georgia
| | - Coral Hanevold
- Department of Pediatrics, Division of Nephrology, University of Washington, Seattle, Washington
| | - Ryan A Harris
- Department of Population Health Sciences, Georgia Prevention Institute, Augusta University, Augusta, Georgia
| | - Gaston Kapuku
- Department of Population Health Sciences, Georgia Prevention Institute, Augusta University, Augusta, Georgia
| | - Jennifer Pollock
- Department of Medicine, University of Alabama, Birmingham, Alabama
| | - David Pollock
- Department of Medicine, University of Alabama, Birmingham, Alabama
| | - Gregory Harshfield
- Department of Population Health Sciences, Georgia Prevention Institute, Augusta University, Augusta, Georgia
| |
Collapse
|
7
|
Abstract
Young and middle-aged adults (ages ≤50 years) are increasingly prone to stroke, kidney disease, and worsening cardiovascular disease (CVD) mortality. An alarming increase in the prevalence of high blood pressure (BP) may underlie the adverse trend. However, there is often uncertainty in BP management for young and middle-aged adults. Isolated systolic hypertension (ISH) is one such example. Whether ISH in young and middle-aged adults represents "pseudo" or "spurious" hypertension is still being debated. ISH in young and middle-aged adults is a heterogeneous entity; some individuals appear to have increased stroke volume, whereas others have stiffened aortae, or both. One size does not seem to fit all in the clinical management of ISH in young and middle-aged adults. Rather than treating ISH as a monolithic condition, detailed phenotyping of ISH based on (patho)physiology and in the context of individual global cardiovascular risks would seem to be most useful to assess an individual expected net benefit from therapy. This review provides an overview of the current understanding of ISH in young and middle-aged adults, including the prevalence, pathophysiology, and treatment.
Collapse
Affiliation(s)
- Yuichiro Yano
- Department of Preventive Medicine, Northwestern University Clinical and Translational Sciences (NUCATS) Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Clinical and Translational Sciences (NUCATS) Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| |
Collapse
|
8
|
Fonkoue IT, Schwartz CE, Wang M, Carter JR. Sympathetic neural reactivity to mental stress differs in black and non-Hispanic white adults. J Appl Physiol (1985) 2018; 124:201-207. [PMID: 28970198 DOI: 10.1152/japplphysiol.00134.2017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Black adults have a higher risk of hypertension compared with non-Hispanic white (NHW) adults, but physiological mechanisms underlying this predisposition remain unclear. This study compared muscle sympathetic nerve activity (MSNA) responses to mental stress in a group of young black and NHW participants. We hypothesized that the sympathoexcitation associated with mental stress would be greater in black adults compared with NHW participants. Thirty-five male adults (19 black, 23 ± 1 yr; 16 NHW, 22 ± 1 yr) were examined during 5-min supine baseline and 5 min of mental stress (via mental arithmetic). Baseline mean arterial pressure (80 ± 2 vs. 82 ± 1 mmHg), heart rate (61 ± 4 vs. 61 ± 2 beats/min), MSNA (13 ± 1 vs. 15 ± 2 bursts/min), and sympathetic baroreflex sensitivity (-1.1 ± 0.4 vs. -1.5 ± 0.3 bursts·100 heart beats-1·mmHg-1) were not significantly different between NHW and black adults ( P > 0.05), respectively. MSNA reactivity to mental stress was significantly higher in NHW compared with black adults (time × race, P = 0.006), with a particularly divergent responsiveness during the first minute of mental stress in NHW (Δ4 ± 1 burst/min) and black (Δ-2 ± 2 burst/min; P = 0.022) men. Blood pressure and heart rate reactivity to mental stress were similar between groups. In summary, black participants demonstrated a lower MSNA responsiveness to mental stress compared with NHW adults. These findings suggest that, despite a higher prevalence of hypertension, black subjects do not appear to have higher neural and cardiovascular responsiveness to mental stress compared with NHW. NEW & NOTEWORTHY Black men have a blunted muscle sympathetic nerve activity response to mental stress compared with non-Hispanic white (NHW) men, especially at the onset of mental stress when muscle sympathetic nerve activity decreased in blacks and increased in NHW men. Thus, despite a high prevalence of hypertension in blacks, normotensive NHW men display a greater peripheral sympathetic neural reactivity to mental stress than black men.
Collapse
Affiliation(s)
| | | | - Min Wang
- 1 Michigan Technological University
| | | |
Collapse
|
9
|
Washburn LK, Nixon PA, Snively BM, Russell GB, Shaltout HA, South AM, O’Shea TM. Antenatal corticosteroids and cardiometabolic outcomes in adolescents born with very low birth weight. Pediatr Res 2017; 82:697-703. [PMID: 28574979 PMCID: PMC5599338 DOI: 10.1038/pr.2017.133] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 05/24/2017] [Indexed: 01/01/2023]
Abstract
BackgroundExposure to antenatal corticosteroids (ANCS) is associated with adverse cardiometabolic outcomes in animal models; however, long-term outcomes in clinical studies are not well characterized. We hypothesized that exposure to ANCS would be associated with markers of increased cardiometabolic risk in adolescents born with very low birth weight (VLBW).MethodsIn an observational cohort of 186 14-year-old adolescents born with VLBW, we measured resting blood pressure (BP), BP response to cold, ambulatory BP, and anthropometrics; performed dual-energy X-ray absorptiometry; and analyzed blood samples for uric acid, cholesterol, glycated hemoglobin, and high-sensitivity C-reactive protein. Multivariate analyses were used to evaluate associations with ANCS, adjusting for race, sex, and maternal hypertensive pregnancy.ResultsThere were no ANCS group differences in BP measures or blood biomarkers. Compared with adolescents unexposed to ANCS, those exposed to ANCS were taller (exposed-unexposed mean difference 3.1 cm (95% confidence interval (CI) 0.7, 5.5)) and had decreased waist-to-height ratio (exposed-unexposed mean difference -0.03 (95% CI -0.058, -0.002)). Males exposed to ANCS had lower total cholesterol (exposed-unexposed mean difference -0.54 mmol/l (95%CI -0.83, -0.06)).ConclusionAmong adolescents born with VLBW, ANCS exposure was not associated with markers of increased cardiometabolic risk.
Collapse
Affiliation(s)
- Lisa K. Washburn
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC,Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, NC
| | - Patricia A. Nixon
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC,Health and Exercise Science, Wake Forest University, Winston-Salem, NC
| | - Beverly M. Snively
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Gregory B. Russell
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Hossam A. Shaltout
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, NC,Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, NC,Department of Pharmacology and Toxicology, School of Pharmacy, University of Alexandria, Alexandria, Egypt
| | - Andrew M. South
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC,Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, NC
| | - T. Michael O’Shea
- Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| |
Collapse
|
10
|
Koelewijn JM, Sluijs AM, Vrijkotte TGM. Possible relationship between general and pregnancy-related anxiety during the first half of pregnancy and the birth process: a prospective cohort study. BMJ Open 2017; 7:e013413. [PMID: 28490549 PMCID: PMC5623367 DOI: 10.1136/bmjopen-2016-013413] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The rate of interventions during childbirth has increased dramatically during the last decades. Maternal anxiety might play a role in the progress of the labour process and interventions during labour. This study aimed to identify associations between anxiety in the first half of pregnancy and the birth process, including any interventions required during labour. In addition, differences in the associations by parity and ethnicity were explored. DESIGN Prospective cohort study. SETTING Primary care midwifery practices and secondary/tertiary care obstetric practices in Amsterdam, participating in the multiethnic ABCD (Amsterdam Born Children and their Development) study (participation rate 96%; response 8266/12 373 (67%)). PARTICIPANTS Included were women with singletons, alive at labour start, with a gestational age ≥24 weeks (n=6443). INDEPENDENT VARIABLE General anxiety (State-Trait Anxiety Inventory state) and pregnancy-related anxiety (Pregnancy-Related Anxieties Questionnaire (PRAQ)) were self-reported in the first half of pregnancy. OUTCOMES Associations between both forms of anxiety and several indicators of the birth process were analysed. Subgroup analyses were performed for parity and ethnicity. RESULTS The prevalence of high general anxiety (State-Trait Anxiety Inventory score ≥43) and pregnancy-related anxiety (PRAQ score ≥P90) were 30.9% and 11.0%, respectively. After adjustment, in nulliparae, both general anxiety and pregnancy-related anxiety were associated with pain relief and/or sedation (OR for general anxiety 1.23; 95% CI 1.02 to 1.48; OR for pregnancy-related anxiety 1.45; 95% CI 1.14 to 1.85). In multiparae, general anxiety was associated with induction of labour (OR 1.53; 95% CI 1.16 to 2.03) and pregnancy-related anxiety was associated with primary caesarean section (OR 1.66; 95% CI 1.02 to 2.70). Associations were largely similar for all ethnicities. CONCLUSIONS High levels of general and pregnancy-related anxiety in early pregnancy contribute modestly to more interventions during the birth process with similar associations between ethnic groups, but with some differences between nulliparae and multiparae.
Collapse
Affiliation(s)
- Johanna Maria Koelewijn
- Sanquin Research and Landsteiner Laboratory, Department of Experimental Immunohematology, University of Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anne Marie Sluijs
- Department of Obstetrics and Gynecology, Leiden University Medical Center, University of Leiden, Leiden, The Netherlands
| | - Tanja G M Vrijkotte
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
11
|
McClure FH, Myers HF. Cardiovascular Responses to Conflict Stress in African American Mother-Daughter Dyads. JOURNAL OF BLACK PSYCHOLOGY 2016. [DOI: 10.1177/0095798499025001001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study evaluated the effect of family conflict interactions on cardiovascular responses of African American hypertensive and normotensive mother-daughter dyads and determined degree of mother-daughter concordance of physiologic response. Sixteen African American hypertensive mothers and 21 African American normotensive mothers and their teenage daughters discussed 2 topics, one involving no conflict and the other involving participant-identified conflict. Differences in blood pressure (BP), both systolic and diastolic, and heart rate (HR) were examined. As expected, hypertensive mothers and their daughters had higher BP levels (responsivity) than did their normotensive counterparts. For mothers, differences were due largely to group differences at baseline. For daughters, differences were due largely to group differences in body mass. BP reactivity (change) did not differ significantly between the groups. Few HR effects were observed. There was moderate BP concordance and low HR concordance. The findings suggest that conflict management and body mass may be important factors to consider among families at risk for hypertension.
Collapse
Affiliation(s)
| | - Hector F. Myers
- University of California, Los Angeles Biobehavioral Research Center, Charles R. Drew University of Medicine & Science
| |
Collapse
|
12
|
Mpinda J, Tumbo J, Govender I, Mills B. The knowledge and beliefs of hypertensive patients attending Katleho District Hospital in Free State province, South Africa, about their illness. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786190.2014.953887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
13
|
Wright LB, Treiber FA, Davis H, Strong WB. Relationship of John Henryism to cardiovascular functioning at rest and during stress in youth. Ann Behav Med 2013; 18:146-50. [PMID: 24203765 DOI: 10.1007/bf02883390] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
John Henryism, a coping style characterized by a strong predisposition to confront daily psychosocial stressors in an active and effortful manner, has been associated with cardiovascular (CV) disease risk in adults. This study examined the relationship of John Henryism to CV functioning at rest and during laboratory stressors (i.e. forehead cold stimulation, postural change, and treadmill exercise) in 173 normotensive 10-to 17-year-old African-American and White children. High John Henry scores were associated with higher blood pressure, higher total peripheral resistance, and lower cardiac index at rest. These relationships were qualified by an interaction with socioeconomic status (SES) such that those from lower SES backgrounds who were high on John Henryism had particularly high levels of resting CV measures. No significant associations were observed with CV reactivity to the stressors. Findings are discussed in terms of possible impact of coping styles to environmental stress upon physiological functioning and health.
Collapse
Affiliation(s)
- L B Wright
- University of Kentucky, 229 Dickey Hall, 40506-0017, Lexington, KY
| | | | | | | |
Collapse
|
14
|
Maternal depressive symptoms in relation to perinatal mortality and morbidity: results from a large multiethnic cohort study. Psychosom Med 2010; 72:769-76. [PMID: 20668282 DOI: 10.1097/psy.0b013e3181ee4a62] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To explore whether 1) maternal depressive symptoms during pregnancy are associated with preterm birth (PTB), small for gestational age (SGA), a low Apgar score and child loss; 2) maternal smoking mediates the associations; and 3) the associations differ by ethnic background. METHODS Pregnant women in Amsterdam were approached during their first prenatal visit to participate in the Amsterdam Born Children and their Development study. They filled out a questionnaire covering sociodemographic data, life-style, and (psychosocial) health. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression scale. The baseline sample consisted of 8,052 women; the main ethnic groups were: Dutch, Creole, Turkish, and Moroccan. RESULTS The prevalence of perinatal outcomes was: 5.4% (PTB); 12.3% (SGA); l 1.5% (low Apgar score); and 1.4% (child loss). The prevalence of high depressive symptomatology was 30.6%. After adjustment for maternal age, parity, education, ethnicity, prepregnancy body mass index, hypertension, alcohol and drug use, and a small mediation effect of maternal smoking, high versus low levels of depressive symptoms were associated with SGA (odds ratio [OR], 1.19; p = .02) and a low Apgar score (OR, 1.74; p = .01), but not with PTB (OR, 1.16; p = .18) and child loss (OR, 1.28; p = .24). Stratified analyses by ethnic background showed a tendency toward higher risks, although insignificant, among Creole women. CONCLUSIONS Several pathways may explain the detrimental effects of maternal depressive symptomatology on perinatal health outcomes, including a psychoendocrinological pathway involving the hormone cortisol or mediation effects by maternal risk behaviors. Further research should explore the underlying pathways, in particular among ethnic subgroups.
Collapse
|
15
|
|
16
|
Borusiak P, Bouikidis A, Liersch R, Russell JB. Cardiovascular effects in adolescents while they are playing video games: a potential health risk factor? Psychophysiology 2007; 45:327-32. [PMID: 17995909 DOI: 10.1111/j.1469-8986.2007.00622.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We analyzed heart rate (HR), systolic and diastolic blood pressure (SBP, DBP), oxygen consumption, and carbon dioxide production in 17 male adolescents during a racing simulation video game (VG) and compared to resting state (RS) and exercise testing (ET) measures. We were able to demonstrate a significant (p<.005) increase from RS to VG concerning HR (+13.1 bpm), SBP (+20.8 mmHg), and DBP (+12.1 mmHg) with SBP and DBP elevations exceeding 2 SD in all children and 14/17 children, respectively. The energy consumption during VG (max 1.71 kcal/min) was unaltered compared to RS and significantly lower compared to ET even at the starting strain of 25 W (1.94 kcal/min). Hemodynamic parameters tested demonstrated lower HR, unchanged SBP, and higher DBP during the VG compared with ET. Comparing all measured parameters it can be said that the relation of blood pressure and energy consumption during VG might not be favorable.
Collapse
Affiliation(s)
- Peter Borusiak
- Zentrum für Kinder- und Jugendmedizin, Helios Klinikum Wuppertal, Wuppertal, Germany.
| | | | | | | |
Collapse
|
17
|
Podolsky RH, Barbeau P, Kang HS, Zhu H, Treiber FA, Snieder H. Candidate genes and growth curves for adiposity in African- and European-American youth. Int J Obes (Lond) 2007; 31:1491-9. [PMID: 17621313 DOI: 10.1038/sj.ijo.0803673] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Obesity is associated with multiple health problems and often originates in childhood. This study investigated the association of genes with the development of general and central obesity from childhood into adulthood. DESIGN Individual growth curves for measures of general adiposity were examined in an 11-year (1987-1998) cohort study. Single-nucleotide polymorphisms (SNPs) in 11 candidate genes were genotyped. SUBJECTS Five hundred and twenty-six subjects classified by race (49% African American (AA)), sex (47% male) and socio-economic status (SES). RESULTS AA female carriers of the 27Glu allele in the ADRB2 gene had a larger waist circumference (P<0.05). Subjects of high SES with the ApoB 4145Lys allele had a larger mean waist circumference than those without this allele (P<0.05). Only in the presence of an adverse environment (low SES) did carriers of the NOS3 298Asp allele have a larger mean body mass index, waist circumference and sum of skinfolds (P<0.05). CONCLUSION These results suggest that several polymorphisms are associated with the mean level of adiposity, with the effects depending on other factors such as race, sex and/or SES.
Collapse
Affiliation(s)
- R H Podolsky
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta, GA 30912, USA.
| | | | | | | | | | | |
Collapse
|
18
|
Wang X, Poole JC, Treiber FA, Harshfield GA, Hanevold CD, Snieder H. Ethnic and Gender Differences in Ambulatory Blood Pressure Trajectories. Circulation 2006; 114:2780-7. [PMID: 17130344 DOI: 10.1161/circulationaha.106.643940] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Cross-sectional studies demonstrated ethnic and gender differences in ambulatory blood pressure patterns, but little is known about the longitudinal development of these differences.
Methods and Results—
Twenty-four-hour ambulatory blood pressure was measured up to 12 times (5 times on average) over a 15-year period in 312 African Americans (AAs) and 351 European Americans aged 7 to 30 years. Multivariate individual growth curves across age were created for daytime and nighttime blood pressure jointly. For both daytime and nighttime systolic blood pressure (SBP), AAs and males had higher levels (
P
<0.001) than European Americans and females. Males also showed a greater increase with age (
P
<0.001) than females. For nighttime SBP, a faster increase of SBP with age (
P
<0.01) in AAs was additionally observed. The ethnic difference in nighttime SBP levels and its increase with age were significantly larger than in daytime SBP. For daytime and nighttime diastolic blood pressure, AAs had higher levels than European Americans (
P
<0.001), and this difference was significantly larger at night. From late adolescence onward, males showed a greater increase in diastolic blood pressure with age than females. Ethnic and gender differences persisted after adjustment for height, body mass index, socioeconomic status, and stress-related coping styles. Family history of essential hypertension explained ethnic differences in daytime SBP.
Conclusions—
We observed significant ethnic and gender differences in longitudinal trajectories of ambulatory blood pressure in youth and young adults. The blunted nocturnal decline and its exacerbation with age in AAs corroborate and extend findings of cross-sectional studies.
Collapse
Affiliation(s)
- Xiaoling Wang
- Medical College of Georgia, Georgia Prevention Institute, Bldg HS-1640, Augusta, GA 30912, USA.
| | | | | | | | | | | |
Collapse
|
19
|
Covelli MM. The relationship of blood pressure and cortisol reactivity to family history of hypertension of African American adolescents. J Cardiovasc Nurs 2006; 21:347-53. [PMID: 16966911 DOI: 10.1097/00005082-200609000-00004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Ethnicity and family history of hypertension (FHH) have been associated with the development of hypertension. Blood pressure and cortisol reactivity during physiologic stress are hypothesized to function as biologic markers for hypertension. The purpose of this study was to explore the relationship of blood pressure and cortisol reactivity physiologic to FHH in a selected sample of African American adolescents. METHODS Demographic data and physiologic measurements were obtained from 48 African American adolescents (14-17 years). Reactivity was induced by a cold pressor test of hand immersion in cold water. chi, t tests, and multivariate repeated-measures analysis were used to determine relationships. RESULTS Thirty-one (65%) subjects reported an FHH. Thirty (63%) subjects demonstrated cardiovascular reactivity. Although the mean systolic blood pressure was 4 mm Hg higher, t tests indicated no significance between group in systolic blood pressure (P = .32), diastolic pressure (P = .73), and cortisol (P =.81). Blood pressure reactivity of the FHH group was significantly different than the no family history group (P = .0338). Cortisol levels for the total group were markedly elevated (19 nmol/dL) and there was no significant difference in reactivity. CONCLUSION African American adolescents with FHH demonstrate increased blood pressure reactivity. Cortisol levels were elevated for all participants. This study adds support to the association of blood pressure reactivity, a biologic marker of HTN and FHH.
Collapse
|
20
|
Girdler SS, Jammer LD, Shapiro D. Hostility, testosterone, and vascular reactivity to stress: effects of sex. Int J Behav Med 2006; 4:242-63. [PMID: 16250731 DOI: 10.1207/s15327558ijbm0403_4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This study investigated the association of personality with cardiovascular stress reactivity (CVR) in men and women. Also, the degree to which testosterone and estradiol reactivity were related to personality and CVR measures was examined. Twenty-six men and 44 women completed the Cook-Medley Hostility Scale, the Beck Depression Inventory, and the Spielberger Trait Anxiety Inventory before speech, Stroop, and math stress. Testosterone (men) and estradiol (subset of women) were sampled once after an initial rest period and again after the last stressor. Cardiovascular reactivity, including cardiac output and total peripheral resistance (TPR), was assessed during stressors. For men, testosterone increased significantly with stress, and testosterone reactivity to stressors was significantly correlated with hostility. However, stepwise multiple regression revealed that hostility was the only independent predictor of CVR to speech, math, and Stroop stress in men, accounting for 13%-32% of the variance in TPR. Baseline systolic blood pressure explained 22% of the variance in TPR reactivity to speech preparation. No evidence was obtained to suggest that hostility, depressive mood, or anxiety predicted CVR in women, and estradiol did not show stress-sensitive effects. These data provide evidence that increased vascular reactivity may be one mechanism linking hostility to increased cardiovascular mortality in men and support the notion that hostility may have different implications for CVR in women.
Collapse
Affiliation(s)
- S S Girdler
- Department of Psychiatry, University of North Carolina at Chapel Hill, NC, USA
| | | | | |
Collapse
|
21
|
Abstract
BACKGROUND High ambulatory blood pressure (ABP) predicts cardiovascular events, even after controlling for clinic BP and other established risk factors. PURPOSE This study examined whether chronic or discrete stress in the past year was associated with greater ABP in adolescents. METHOD Participants were 217 male and female Black and White adolescents who wore ABP monitors on 2 consecutive school days and completed a survey of life events. RESULTS Report of discrete, negative events was not associated with ABP. Adolescents experiencing greater numbers of chronic, negative life events exhibited greater systolic blood pressure (SBP), independent of ethnicity; sex; body mass index; and location, position, physical activity, and consumption of food/caffeine/nicotine at time of measurement. Greater numbers of chronic, negative events were associated with greater diastolic blood pressure (DBP) among boys. When resting clinic BP was introduced into the model, the main effect of chronic, negative life events on ambulatory SBP became nonsignificant, whereas the effect of chronic, negative life events on male adolescents' DBP persisted. CONCLUSIONS Chronic stress is associated with greater ambulatory SBP among male and female adolescents and with greater ambulatory DBP among male adolescents. The latter association persisted after controlling for clinic BP, suggesting that males may be more vulnerable to chronic stress as a determinant of BP regulation than females early in life.
Collapse
|
22
|
D'Angelo G, Pollock JS, Pollock DM. Endogenous endothelin attenuates the pressor response to acute environmental stress via the ETA receptor. Am J Physiol Heart Circ Physiol 2004; 288:H1829-35. [PMID: 15563533 DOI: 10.1152/ajpheart.00844.2004] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Clinical studies have documented an abrupt rise in plasma endothelin-1 (ET-1) coincident with an increase in mean arterial pressure (MAP) during the response to acute stress. We therefore examined the ET(A) and ET(B) receptor-dependent effects of ET-1 on the pressor response to acute environmental stress in ET-1-dependent hypertension. Stress was induced by administration of air jet pulses (3 min) in ET(B) receptor-deficient (ET(B) sl/sl) rats fed normal salt (NS; 0.8% NaCl), high salt (HS; 8% NaCl), and HS plus the ET(A) receptor antagonist ABT-627 (5 mg.kg(-1).day(-1)) on successive weeks. MAP was chronically monitored by telemetry. Total pressor response (area under the curve) was significantly reduced in ET(B) sl/sl rats maintained on a HS vs. NS diet [-6.8 mmHg (SD 18.7) vs. 29.3 mmHg (SD 8.1) x 3 min, P < 0.05]. Conversely, the total pressor response was augmented in both wild-type [34.2 mmHg (SD 29.2) x 3 min, P < 0.05 vs. NS] and ET(B) sl/sl rats [49.1 mmHg (SD 11.8) x 3 min, P < 0.05 vs. NS] by ABT-627. Blockade of ET(B) receptors in Sprague-Dawley rats caused an increase in basal MAP that was enhanced by HS and lowered by mixed ET(A)/ET(B) receptor antagonism; none of these treatments, however, had any effect on the pressor response. These data demonstrate that increasing endogenous ET-1 suppresses the pressor response to acute stress through ET(A) receptor activation in a genetic model of ET-1-dependent hypertension. These results are consistent with reports that ET-1 can attenuate sympathetically mediated responses.
Collapse
Affiliation(s)
- Gerard D'Angelo
- Vascular Biology Center and Department of Physiology, Medical College of Georgia, 1459 Laney Walker Blvd., Augusta, GA 30912-2500, USA.
| | | | | |
Collapse
|
23
|
Dekkers JC, Podolsky RH, Treiber FA, Barbeau P, Gutin B, Snieder H. Development of general and central obesity from childhood into early adulthood in African American and European American males and females with a family history of cardiovascular disease. Am J Clin Nutr 2004; 79:661-8. [PMID: 15051612 DOI: 10.1093/ajcn/79.4.661] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Obesity is associated with multiple health problems, often originating in childhood. OBJECTIVE The objective was to investigate differences in the development of adiposity from childhood to adulthood as related to race, sex, and socioeconomic status (SES). DESIGN Individual growth curve modeling for waist circumference, body mass index, and sum of skinfold thicknesses (triceps, subscapular, and suprailiac) was performed in an 11-y cohort study of 622 African Americans and European Americans aged 4.2-27.5 y. We examined the development of adiposity in 2 ways: 1) differences related to race, sex, and parents' education (SES), and 2) differences between obese, overweight, and normal-weight persons at the end of their childhood (> 17 y of age). RESULTS The sum of skinfold thicknesses was greater in females than in males, with a larger increase with age. Race, sex, and SES showed a complex relation with body mass index and the sum of skinfold thicknesses. The low-SES group showed the fastest increase in waist circumference with age. The obese group showed the most rapid increase in the 3 measures of adiposity. Growth curves for the obese group were distinguishable from those for the normal-weight persons at an earlier age for African Americans than for European Americans. CONCLUSIONS The development rate of adiposity from childhood into early adulthood is influenced by sex and SES but not by race. However, race, sex, and SES had joint effects on adiposity levels. The development of obesity can begin to be distinguished in midchildhood, but the age at which this distinction becomes apparent depends on race.
Collapse
Affiliation(s)
- J Caroline Dekkers
- Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta 30912-3710, USA
| | | | | | | | | | | |
Collapse
|
24
|
Dekkers JC, Treiber FA, Kapuku G, Snieder H. Differential influence of family history of hypertension and premature myocardial infarction on systolic blood pressure and left ventricular mass trajectories in youth. Pediatrics 2003; 111:1387-93. [PMID: 12777557 DOI: 10.1542/peds.111.6.1387] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine the influence of genetic susceptibility to essential hypertension (EH) and the genetic susceptibility to premature myocardial infarction (MI) on longitudinal development of systolic blood pressure (SBP) and left ventricular mass (LVM) in youth. METHODS Individual SBP and LVM growth curves across age were created for a sample of 745 subjects (age range: 4.9-27.5 years) and a sample of 687 subjects (age range: 8.2-27.5 years), respectively. Each sample had an approximately equal proportion of African American and European American males and females, with annual assessments over a 10-year period. Family history (FH) of EH and FH of premature MI were used as measures of genetic susceptibility to EH and to premature MI, respectively. Positive FH (FH(+)) of EH and of premature MI were defined, respectively, as verified EH in 1 or both biological parents, and verified MI in any biological parent or grandparent before 55 years of age. RESULTS Subjects with an FH(+) of EH had higher SBP levels and stronger increases in SBP over time than subjects with a negative FH (FH(-)) of EH. Subjects with an FH(+) of EH also showed higher LVM levels than subjects with an FH(-) of EH. In addition, the effect of an FH(+) of EH on LVM was stronger in females than males. The effects of FH of EH on SBP and LVM could not be explained by differences in socioeconomic status, but the effect on LVM was no longer significant after adjustment for BMI. FH of MI had no significant effects on SBP or LVM. CONCLUSIONS Effects of genetic susceptibility to EH on SBP and LVM trajectories were observed in childhood, whereas no such effects were found for FH of MI. Genetic markers of EH may improve the understanding of individual differences in susceptibility to develop hypertension and LV hypertrophy.
Collapse
Affiliation(s)
- J Caroline Dekkers
- Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta, Georgia 30912-3710, USA
| | | | | | | |
Collapse
|
25
|
Dekkers JC, Snieder H, Van Den Oord EJCG, Treiber FA. Moderators of blood pressure development from childhood to adulthood: a 10-year longitudinal study. J Pediatr 2002; 141:770-9. [PMID: 12461492 DOI: 10.1067/mpd.2002.128113] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To examine the effect of ethnicity on the development of blood pressure (BP) from childhood into early adulthood within the context of height, sex, adiposity, and socioeconomic status (SES). STUDY DESIGN Individual growth curves of systolic BP (SBP) and diastolic BP (DBP) were created for 745 black and white male and female youths, with annual assessments over a 10-year period (age range, 4.9-27.5 years). RESULTS Blacks had higher SBP levels (P <0.01) than whites, respectively. Moreover, black female subjects showed a greater SBP increase over time (P <.05) than white female subjects. Black male and female subjects also showed higher DBP levels (P <.001) than white male and female subjects, respectively, but the rate of change of DBP did not differ. Ethnic differences in BP trajectories persisted after adjusting for SES and/or changes in height and/or adiposity in both male and female subjects. CONCLUSIONS Ethnic differences in SBP become manifest in childhood in girls, in early adolescence in boys, and tend to increase with age. Ethnic differences in DBP become manifest in childhood in both boys and girls and remain stable over time. The ethnic differences cannot be entirely explained by individual differences in SES, growth, or adiposity. Identification of mechanisms responsible for increase of BP in childhood will improve prevention of hypertension in adulthood.
Collapse
Affiliation(s)
- J Caroline Dekkers
- Georgia Prevention Institute, Medical College of Georgia, Augusta 30912, USA
| | | | | | | |
Collapse
|
26
|
Harshfield GA, Treiber FA, Wilson ME, Kapuku GK, Davis HC. A longitudinal study of ethnic differences in ambulatory blood pressure patterns in youth. Am J Hypertens 2002; 15:525-30. [PMID: 12074354 DOI: 10.1016/s0895-7061(02)02267-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Many studies demonstrated an ethnic difference in ambulatory blood pressure (BP) patterns. We examined: 1) the stability of this difference; 2) demographic and anthropometric characteristics that predict the difference over 2 years; and 3) the clinical significance of the difference. METHODS Recordings were performed 2 years apart on 94 African American and 92 European American youths with a positive family history of hypertension, aged 14 +/- 2 years at initial testing. RESULTS African Americans had higher nighttime systolic BP (SBP) on the initial (109 +/- 9 v 105 +/- 8 mm Hg; P < .001) and follow-up (110 +/- 10 v 105 +/- 8 mm Hg; P < .0001) visits despite similar daytime SBP. This was associated with greater left ventricular mass/height2.7 (LVM/height2.7) during the initial (31 +/- 8 v 28 +/- 6 g/height2.7; P < .01) and follow-up (32 +/- 8 v 28 +/- 8 g/height2.7; P < .02) visits. Sex accounted for 17% (P < .0001) of the variance of follow-up daytime SBP in African Americans, and age for an additional 10% (P < .001). In comparison, initial height accounted for 11% (P < .001) of the variance in European Americans. Sex accounted for 18% (P < .0001) of the variance of follow-up nighttime SBP in African Americans, age for an additional 12% (P < .0001), and initial LVM/height2.7 an additional 6% (P < .02). In contrast, sex accounted for 13% of the variance of follow-up nighttime SBP in European Americans, and initial height accounted for an additional 8% (P < .004). CONCLUSIONS The pattern of higher nighttime BP despite similar daytime BP in African Americans is stable over time, with sex as the most important predictor of nighttime BP in both groups. This study provides confirmatory data on the clinical significance of the differences.
Collapse
Affiliation(s)
- Gregory A Harshfield
- Department of Pediatrics, Georgia Prevention Institute, Medical College of Georgia, Augusta 30912-4534, USA.
| | | | | | | | | |
Collapse
|
27
|
Dekkers C, Treiber FA, Kapuku G, Van Den Oord EJCG, Snieder H. Growth of left ventricular mass in African American and European American youth. Hypertension 2002; 39:943-51. [PMID: 12019274 DOI: 10.1161/01.hyp.0000015612.73413.91] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Increased left ventricular mass has been established as a strong risk factor for cardiovascular morbidity and mortality. To evaluate growth of left ventricular mass from childhood into early adulthood and its possible sociodemographic, anthropometric, and hemodynamic moderators, individual growth curves across age of left ventricular mass were created for 687 African American and European American males and females with a maximum of 10 annual assessments (age, 8.2 to 27.5 years). African Americans and males had significantly greater left ventricular mass (P<0.001) than did European Americans and females, respectively. Males also showed a larger rate of change in left ventricle mass than did girls (P<0.001). The ethnicity and gender effects on left ventricular mass only became apparent in early adolescence, and they persisted when controlling for socioeconomic status and anthropometric and hemodynamic variables. Body mass index and height were the strongest anthropometric predictors, and pulse pressure was the strongest hemodynamic predictor of left ventricular mass. Although significant, the contribution of pulse pressure to the prediction of left ventricular mass was small, once body mass index and height were entered into the model. The results of the present study suggest that increased left ventricular mass in boys and African Americans has its origin in late childhood. Apart from these ethnicity and gender effects, individual differences in cardiac growth can mainly be explained by body growth and increases in general adiposity.
Collapse
Affiliation(s)
- Caroline Dekkers
- Georgia Prevention Institute, Medical College of Georgia, Augusta
| | | | | | | | | |
Collapse
|
28
|
Barnes VA, Treiber FA, Davis H. Impact of Transcendental Meditation on cardiovascular function at rest and during acute stress in adolescents with high normal blood pressure. J Psychosom Res 2001; 51:597-605. [PMID: 11595248 PMCID: PMC3216051 DOI: 10.1016/s0022-3999(01)00261-6] [Citation(s) in RCA: 128] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study examined the impact of the Transcendental Meditation (TM) program on cardiovascular (CV) reactivity in adolescents with high normal BP. METHOD Thirty-five adolescents [34 African Americans (AAs), 1 Caucasian American (CA); ages 15-18 years] with resting systolic blood pressure (SBP) between the 85th and 95th percentile for their age and gender on three consecutive occasions, were randomly assigned to either TM (n=17) or health education control (CTL, n=18) groups. The TM group engaged in 15-min meditation twice each day for 2 months including sessions during school lunch break. Primary CV outcome measures were changes in blood pressure (BP), heart rate (HR), and cardiac output (CO) at rest and in response to two laboratory stressors, a simulated car driving stressor and an interpersonal social stressor interview. RESULTS The TM group exhibited greater decreases in resting SBP (P<.03) from pre- to postintervention, compared to the CTL group. The TM group exhibited greater decreases from pre- to postintervention in SBP, HR, and CO reactivity (P's<.03) to the simulated car driving stressor, and in SBP reactivity (P<.03) to the social stressor interview. CONCLUSION The TM program appears to have a beneficial impact upon CV functioning at rest and during acute laboratory stress in adolescents at-risk for hypertension.
Collapse
Affiliation(s)
- V A Barnes
- Department of Pediatrics, Georgia Institute for Prevention of Human Diseases and Accidents, Building HS1640, Medical College of Georgia, Augusta, GA 30912, USA.
| | | | | |
Collapse
|
29
|
Treiber FA, Musante L, Kapuku G, Davis C, Litaker M, Davis H. Cardiovascular (CV) responsivity and recovery to acute stress and future CV functioning in youth with family histories of CV disease: a 4-year longitudinal study. Int J Psychophysiol 2001; 41:65-74. [PMID: 11239698 DOI: 10.1016/s0167-8760(00)00183-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Blood pressure (BP) and heart rate (HR) data obtained during supine rest, in response to and recovery from four laboratory stressors in a baseline year were used to predict supine resting BP and HR values obtained during each of four consecutive annual follow-up evaluations. Subjects were 385 normotensive youth [95 African American (AA) males, 106 AA females, 92 European American (EA) males, 92 EA females] (mean age 12.7+/-2.6 at baseline year) with a positive family history of cardiovascular disease (CVD). During the baseline evaluation subjects were presented with four laboratory stressors (namely, postural change, video game challenge, social competence interview, and parent--child conflict discussion). The BP and HR values taken during each of the laboratory stressors and during the post stressor recovery periods were converted to z-scores which were averaged to yield aggregate measures for systolic and diastolic BP and HR responsivity and recovery. The data obtained during the baseline evaluation were subsequently used to predict the follow-up values of supine resting BP and HR. The prediction models were fairly consistent across each of the 4 follow-up years. Responsivity or recovery accounted for up to 6% of the total variance after accounting for baseline values. Within the prediction models responsivity or recovery accounted for 4--56% of the variance. The predictive value of the derived models did not decline from one annual evaluation to the next over the length of the study. CV recovery may supplement resting and responsivity in the prediction of future development of CVD
Collapse
Affiliation(s)
- F A Treiber
- Georgia Prevention Institute, Medical College of Georgia, Augusta, GA 30912, USA.
| | | | | | | | | | | |
Collapse
|
30
|
Stein CM, Lang CC, Xie HG, Wood AJ. Hypertension in black people: study of specific genotypes and phenotypes will provide a greater understanding of interindividual and interethnic variability in blood pressure regulation than studies based on race. PHARMACOGENETICS 2001; 11:95-110. [PMID: 11266083 DOI: 10.1097/00008571-200103000-00001] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hypertension is more frequent and more severe in some Black populations. Although many studies have focused on hypertension in black people in an attempt to understand the genetic and environmental factors that regulate blood pressure, this approach has not been productive. Study of the relationship between specific phenotypes and genotypes, both within and across ethnic groups, is more likely to advance our understanding of the regulation of blood pressure than studies focused on race and blood pressure.
Collapse
Affiliation(s)
- C M Stein
- Division of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, TN 37232-6602, USA
| | | | | | | |
Collapse
|
31
|
Kelsey RM, Patterson SM, Barnard M, Alpert BS. Consistency of hemodynamic responses to cold stress in adolescents. Hypertension 2000; 36:1013-7. [PMID: 11116117 DOI: 10.1161/01.hyp.36.6.1013] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Laboratory research on hypertension often is performed with cold stress to elicit vasoconstriction and increases in blood pressure. Several studies have shown that cardiovascular responses to the cold pressor test predict the development of hypertension. We extended this research by comparing cardiovascular responses to a traditional forehead cold pressor test and a naturalistic whole-body cold exposure. We evaluated blood pressure and impedance cardiographic measures of cardiac output and total peripheral resistance in healthy black (n=69) and white (n=47) adolescents (mean age, 14.7 years) during forehead cold pressor (3 degrees C to 4 degrees C) and passive whole-body exposure to a cold chamber (8 degrees C to 10 degrees C). Both tasks elicited increases in vascular resistance and blood pressure, but forehead cold elicited an increase in cardiac output, whereas whole-body cold elicited a decrease in cardiac output (P<0.05). Consistent with previous research, there was a tendency toward greater vasoconstrictive reactivity to cold stress in blacks than in whites, particularly during whole-body cold exposure (P<0.05). Cardiovascular reactivity correlated significantly between tasks, but substantial intertask consistency occurred only for cardiac and vascular reactivity in male subjects (r>0.30) but not in female subjects (r<0.15). These gender differences might reflect diminished adrenergic receptor function in female subjects. We conclude that whole-body cold exposure offers a viable, relatively naturalistic alternative to traditional cold pressor tests for the assessment of cardiovascular reactivity.
Collapse
Affiliation(s)
- R M Kelsey
- University of Tennessee College of Medicine, Memphis.
| | | | | | | |
Collapse
|
32
|
Perregaux D, Chaudhuri A, Rao S, Airen A, Wilson M, Sung BH, Dandona P. Brachial vascular reactivity in blacks. Hypertension 2000; 36:866-71. [PMID: 11082158 DOI: 10.1161/01.hyp.36.5.866] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Endothelial function was studied ultrasonographically in a healthy subset of African Americans (blacks) because they have an increased risk of hypertension and vascular disease. Twenty-four healthy black and 28 well-matched white subjects were investigated. Ischemia was induced by inflating a cuff over the forearm to 40 mm Hg higher than systolic pressure for 5 minutes. Brachial artery diameter and blood flow velocity were measured at baseline and at 15, 45, and 60 seconds after deflation by use of an Acuson 128XP10 ultrasonograph with a 7.5 MHz transducer. Mean postischemic dilatation, an index of endothelial function, was 1.76+/-0.56% in blacks and 8.79+/-1.22% in whites (P<0.001). Median postischemic vasodilatation in black men [0% (0% to 2.86%)] was not significantly different to that in black women [0.82% (0% to 3.14%)], whereas white women [11.48% (8.70% to 14.29%)] dilated significantly more than white men [4.20% (2.13% to 5.56%)] (P<0.05). Both groups dilated significantly over baseline diameter to sublingual nitroglycerin administration 18.7+/-2.5% (blacks) and 20.2+/-3.2% (whites; P=NS). Mean hyperemic responses did not differ significantly between the 2 subject groups, nor did they differ between men and women of both ethnic groups. We conclude that endothelium-dependent vasodilatation is significantly impaired in healthy, young blacks compared with whites and that gender differences are not seen in blacks with regard to this phenomenon. An impairment in endothelium-dependent NO generation may be a contributing factor to future hypertension and vascular disease in healthy blacks.
Collapse
Affiliation(s)
- D Perregaux
- Divisions of Endocrinology, State University of New York at Buffalo, USA
| | | | | | | | | | | | | |
Collapse
|
33
|
Schiffman SS, Graham BG, Sattely-Miller EA, Peterson-Dancy M. Elevated and sustained desire for sweet taste in african-americans: a potential factor in the development of obesity. Nutrition 2000; 16:886-93. [PMID: 11054593 DOI: 10.1016/s0899-9007(00)00403-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Oral habituation is a relatively long-lasting decrease in oral responsiveness that results from the repeated presentation of a single stimulus. The purpose of this study was to evaluate the degree of habituation to sweet-tasting foods and to determine whether there are differences in the rate of habituation between African Americans and European Americans. These two groups were compared because the prevalence of obesity and obesity-related disorders such as diabetes and hypertension is significantly higher among African Americans than among European Americans. Nine different commercial foods and beverages that differed in sweetness intensity and caloric density served as stimuli. Subjects tasted and rated each food once per minute for a 30-min period on scales related to desire for another taste of the same sample and desire for a different taste. The stimuli and portion size for each of the 30 samples were two candy bars (Ultra Slim-Fast Cocoa Almond Crunch Bar, 1/16 of a bar; Natural Nectar Peanut Butter Granola Bar, 1/16 of a bar), three beverages (Nestea Lemon Flavored Instant Tea with NutraSweet, 5 mL; Welch's Grape Juice, 5 mL; Pink Swimmingo Kool-Aid, 5 mL), two gelatin desserts (Cherry Flavored Jell-O Gelatin, 5 g; Cherry Flavored Jell-O Gelatin with NutraSweet, 5 g), one enteral nutrition drink (Vanilla Ensure Plus, 5 mL), and one pudding (Ultra Slim-Fast Chocolate Pudding, 5 g). Subjects consumed the entire portion of each sample. Habituation occurred for seven of the nine foods as judged by a decrease in the desire for another taste of the same food. The degree of habituation for European Americans and African Americans was similar except for the sweetest food (Cherry Flavored Jell-O Gelatin with NutraSweet), for which African Americans showed no habituation. The degree of habituation in both groups was unrelated to caloric density. Overall, young African Americans had a significantly greater desire for another taste of the same food than did young European Americans for seven of the nine foods, and this desire was strongly correlated with the sweetness intensity for young African Americans but not for young European Americans. Furthermore, young African Americans had a greater desire than young European Americans for a different taste for seven of nine foods. The greater desire for intense sweet tastes may be a factor in the elevated incidence of obesity and diabetes in African Americans. In addition, young African Americans had greater perceived stress in this study than did young European Americans. If African Americans use sweet taste to compensate for feelings of stress, this compensation may also contribute to weight gain.
Collapse
Affiliation(s)
- S S Schiffman
- From the Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710, USA.
| | | | | | | |
Collapse
|
34
|
Ergul A. Hypertension in black patients: an emerging role of the endothelin system in salt-sensitive hypertension. Hypertension 2000; 36:62-7. [PMID: 10904013 DOI: 10.1161/01.hyp.36.1.62] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The prevalence of essential hypertension in blacks is much higher than that in whites. In addition, the pathogenesis of hypertension appears to be different in black patients. For example, black patients present with a salt-sensitive hypertension characterized by low renin levels. Racial differences in renal physiology and socioeconomic factors have been suggested as possible causes of this difference, but reasons for this difference remain unclear. Endothelial cells are important in the regulation of vascular tonus and homeostasis, in part through the secretion of vasoactive substances. One of these factors, endothelin-1 (ET-1), is a 21 amino acid residue peptide with potent vasopressor actions. In addition to its contractile effects, it has been shown to stimulate mitogenesis in a number of cell types. Moreover, ET-1 displays modulatory effects on the endocrine system, including stimulation of angiotensin II and aldosterone production and inhibition of antidiuretic hormone in the kidney. Recent data from several laboratories indicate that ET-1 is overexpressed in the vasculature in several salt-sensitive models of experimental hypertension. Moreover, circulating plasma ET-1 levels are significantly increased in black hypertensives compared with white hypertensives. Thus, the ET system might be particularly important in the development or maintenance of hypertension in this population.
Collapse
Affiliation(s)
- A Ergul
- Department of Surgery, Medical University of South Carolina, Charleston 29425, USA.
| |
Collapse
|
35
|
Kelsey RM, Alpert BS, Patterson SM, Barnard M. Racial differences in hemodynamic responses to environmental thermal stress among adolescents. Circulation 2000; 101:2284-9. [PMID: 10811596 DOI: 10.1161/01.cir.101.19.2284] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous studies by our laboratory and others have shown that blood pressure (BP) responses to many short-term laboratory stressors are greater in black than in white children. We sought to determine the cardiac and vascular contributions to these differences in BP reactivity and whether racial differences in vascular reactivity involve excessive vasoconstriction or deficient vasodilation. METHODS AND RESULTS We evaluated BP, heart rate, and impedance cardiographic measures of preejection period (PEP) and total peripheral resistance (TPR) in healthy black (n=76) and white (n=60) adolescents (mean age, 14.8 years) during passive exposure to a vasoconstrictive cold chamber (8 degrees C to 10 degrees C) and a vasodilatory heat chamber (40 degrees C to 42 degrees C). Results indicated greater decreases in PEP and increases in TPR in blacks than whites during cold exposure (P<0.05) but no group differences during heat exposure. Covariance analyses indicated that the racial differences during cold exposure probably reflected greater beta-adrenergic cardiac reactivity and alpha-adrenergic vasoconstrictive reactivity in blacks than whites. CONCLUSIONS Blacks and whites exhibited comparable myocardial and vasodilatory responses to heat stress, but blacks exhibited heightened myocardial and vasoconstrictive reactivity to cold stress. These results suggest that the locus of racial differences in vascular reactivity involves vasoconstrictive rather than vasodilatory function. The pattern of racial differences during cold stress raises the possibility that both myocardial and vasoconstrictive mechanisms may contribute to the increased risk of hypertension in blacks.
Collapse
Affiliation(s)
- R M Kelsey
- University of Tennessee College of Medicine, Memphis, USA.
| | | | | | | |
Collapse
|
36
|
Treiber FA, Jackson RW, Davis H, Pollock JS, Kapuku G, Mensah GA, Pollock DM. Racial differences in endothelin-1 at rest and in response to acute stress in adolescent males. Hypertension 2000; 35:722-5. [PMID: 10720585 DOI: 10.1161/01.hyp.35.3.722] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Blacks exhibit greater vasoconstriction-mediated blood pressure (BP) increases in response to stress than do whites. Endothelin-1 (ET-1), a potent vasoconstrictive peptide, has been proposed as having a role in racial differences in stress reactivity. We evaluated the hemodynamic and plasma ET-1 levels of 41 (23 whites, 18 blacks, mean age 18.6 years) normotensive adolescent males at rest and in response to a video game challenge and forehead cold stimulation. Measurements were performed at catheter insertion and before and immediately after the 2 stressors, which were separated by 20-minute rest periods. Blacks exhibited higher absolute levels of diastolic blood pressure, total peripheral resistance index, or both in response to catheter insertion and to the video game challenge and during recovery from video game challenge and cold stimulation (P<0. 05 for all). Blacks exhibited higher absolute levels of ET-1 at every evaluation point (P<0.05 for all) and greater increases in ET-1 in response to both stressors (ps<0.05). These findings suggest that altered endothelial function may be involved in racial differences in hemodynamic reactivity to stress and possibly in the development of essential hypertension.
Collapse
Affiliation(s)
- F A Treiber
- Georgia Prevention Institute, the Vascular Biology Center, Departments of Pediatrics and Psychiatry , and Office of Biostatistics, Medical College of Georgia, Augusta, GA 30912-3710, USA.
| | | | | | | | | | | | | |
Collapse
|
37
|
Bedi M, Varshney VP, Babbar R. Role of cardiovascular reactivity to mental stress in predicting future hypertension. Clin Exp Hypertens 2000; 22:1-22. [PMID: 10685721 DOI: 10.1081/ceh-100100058] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Hypertension (HT) has been known since times immemorial to be one of the major causes of morbidity and mortality. It contributes to atherosclerotic cardiovascular disease, increasing its risk 2-3 times and is also associated with dyslipidemia, insulin resistance, glucose intolerance and obesity (1). The age of onset of hypertension is now earlier than before, making it essential that early detection of people who could be future hypertensives is done. Therefore, cardiovascular reactivity to stress in predicting future hypertension becomes important. In this fast paced age most people are exposed to mental stress which is the most common and prevalent form of stress. Increase in blood pressure (BP) in response to emotional arousal is well known, but support for this hypothesis of reactivity in predicting future hypertension is limited. We are attempting here to put forth a review of the various endeavours done so far to support this hypothesis.
Collapse
Affiliation(s)
- M Bedi
- Department of Physiology, Maulana Azad Medical College, Bahadur Shah Jafar Marg, New Delhi, India
| | | | | |
Collapse
|
38
|
Kapuku GK, Treiber FA, Davis HC, Harshfield GA, Cook BB, Mensah GA. Hemodynamic function at rest, during acute stress, and in the field: predictors of cardiac structure and function 2 years later in youth. Hypertension 1999; 34:1026-31. [PMID: 10567177 DOI: 10.1161/01.hyp.34.5.1026] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Left ventricular hypertrophy is an independent predictor of cardiovascular morbidity and mortality. However, predictors of cardiac structure and function in youth are not completely understood. On 2 occasions (2.3 years apart), we examined 146 youth aged initially 10 to 19 years (mean age, 14.2+/-1.8 years). On the initial visit, hemodynamic function was assessed at rest, during laboratory stress (ie, orthostasis, car-driving simulation, video game, and forehead cold), and in the field (ie, ambulatory blood pressure). Quantitative M-mode echocardiograms were obtained on both visits. On both visits, black compared with white youth had higher resting laboratory systolic blood pressure (P<0.02), greater relative wall thickness (P<0.003), greater left ventricular mass indexed by either body surface area or height(2.7) (P<0.01 for both), and lower midwall fractional shortening ratio (P<0.05). Hierarchical stepwise regression analysis indicated that significant independent predictors of follow-up left ventricular mass/height(2. 7) were the initial evaluation of left ventricular mass/height(2.7), body mass index, gender (males more than females), and supine resting total peripheral resistance (final model R(2)=0.53). Left ventricular mass/body surface area was predicted by initial left ventricular mass/body surface area, weight, gender, mean supine resting total peripheral resistance, and systolic pressure response to car-driving simulation (final model R(2)=0.48). Midwall fractional shortening was predicted by initial midwall fractional shortening, race (white more than black), and lower mean supine total peripheral resistance (final model R(2)=0.13). The clinical significance of these findings and their implications for improved prevention of cardiovascular diseases are yet to be determined.
Collapse
Affiliation(s)
- G K Kapuku
- Georgia Prevention Institute, Medical College of Georgia, Augusta 30912-3710, USA
| | | | | | | | | | | |
Collapse
|
39
|
Barnes VA, Treiber FA, Davis H, Kelley TR, Strong WB. Central adiposity and hemodynamic functioning at rest and during stress in adolescents. Int J Obes (Lond) 1998; 22:1079-83. [PMID: 9822945 PMCID: PMC3291955 DOI: 10.1038/sj.ijo.0800730] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the impact of central adiposity upon hemodynamic functioning at rest and during stress in adolescents. DESIGN Cross-sectional, correlational study. SUBJECTS 46 White and 49 Black normotensive adolescents with family histories of essential hypertension. MEASUREMENTS Systolic and diastolic blood pressure (SBP, DBP), cardiac output and total peripheral resistance responses were assessed at rest, during postural change, video game challenge and forehead cold stimulation. Specific lower and higher waist-to-hip ratio (WHR) tertiles were created for each gender and then integrated for analyses. This resulted in a lower WHR tertile of 11 Whites and 21 Blacks and an upper WHR tertile of 15 Whites and 17 Blacks. RESULTS No differences in age, gender or ethnicity proportions were found between tertile groups (all P > 0.21). The upper WHR group showed greater body weight, waist and hip circumferences, body mass index (BMI), triceps skinfold and body surface area (all P < 0.001). Controlling for peripheral (that is, triceps skinfold) and overall (that is, BMI) adiposity, the upper WHR group exhibited greater SBP (that is, peak response minus mean pre-stressor level) to all three stressors and greater DBP reactivity to postural change and cold pressor (all P < 0.05). CONCLUSION Central adiposity appears to adversely influence hemodynamic functioning during adolescence. Underlying mechanisms responsible for these associations require exploration.
Collapse
Affiliation(s)
- V A Barnes
- Georgia Institute for Prevention of Human Disease and Accidents, Medical College of Georgia, Augusta 30912, USA
| | | | | | | | | |
Collapse
|
40
|
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.
Collapse
Affiliation(s)
- J D Del Rosario
- Department of Pediatrics and Psychiatry, Medical College of Georgia, Augusta, USA
| | | | | | | | | |
Collapse
|
41
|
Allen MT, Matthews KA, Sherman FS. Cardiovascular reactivity to stress and left ventricular mass in youth. Hypertension 1997; 30:782-7. [PMID: 9336373 DOI: 10.1161/01.hyp.30.4.782] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We studied the relationships of cardiovascular reactivity during mental stress with left ventricular mass index in a group of prepubertal children 8 to 10 years old and in a group of peripubertal or postpubertal adolescents 15 to 17 years old. One hundred fifteen participants, varying in age group, sex, and race (black and white), took part in a laboratory stress protocol consisting of a reaction-time task, a mirror tracing task, a cold forehead challenge, and a stress interview. Cardiovascular measures included blood pressure and heart rate, as well as cardiac output, stroke volume, total peripheral resistance, and preejection period obtained noninvasively with impedance cardiography. Measures of left ventricular mass were made by echocardiography. Results indicated that across all participants, left ventricular mass index was associated with cardiovascular responses during the mirror tracing and cold forehead tasks, especially with those responses reflecting increased vasoconstriction. Subgroup analyses showed that these associations were significant for males and sometimes adolescents but not for females and children. As mirror tracing and cold forehead tasks most consistently produce alpha-adrenergic activation, the results suggest a model in which vasoconstriction due to mental stress is related to increased left ventricular mass in susceptible individuals, even at a young age.
Collapse
Affiliation(s)
- M T Allen
- Department of Psychiatry, University of Pittsburgh, Pa 15213, USA
| | | | | |
Collapse
|
42
|
Saab PG, Llabre MM, Schneiderman N, Hurwitz BE, McDonald PG, Evans J, Wohlgemuth W, Hayashi P, Klein B. Influence of ethnicity and gender on cardiovascular responses to active coping and inhibitory-passive coping challenges. Psychosom Med 1997; 59:434-46. [PMID: 9251164 DOI: 10.1097/00006842-199707000-00014] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The goal of this study was to evaluate how black and white men and women responded physiologically to specific laboratory challenges. METHODS Hemodynamic responses to an active coping (evaluated speaking) and two inhibitory-passive coping (mirror tracing, cold pressor) tasks were examined in 138 black and white men and women. RESULTS Significant ethnicity by gender interactions occurred for the evaluated speaking task. Black men responded with lower blood pressure, cardiac output or heart rate, or both, than black women, white men, and white women, who did not differ from each other. Black men, relative to the other subgroups, also reported more inhibitory-passive coping, hostility, and pessimism, and less social support. Whites also responded with greater increases in systolic blood pressure during mirror tracing than blacks. CONCLUSIONS These findings indicate that black-white differences in physiological responsivity obtained for men may have limited generalizability for women. The results also suggest that environmental and social factors rather than genetic or constitutional factors may play a role in black-white reactivity differences.
Collapse
Affiliation(s)
- P G Saab
- Department of Psychology, University of Miami, Coral Gables, FL 33124-2070, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Sorof JM, Forman A, Cole N, Jemerin JM, Morris RC. Potassium intake and cardiovascular reactivity in children with risk factors for essential hypertension. J Pediatr 1997; 131:87-94. [PMID: 9255197 DOI: 10.1016/s0022-3476(97)70129-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Our study objectives were as follows: (1) to determine whether urinary excretion of potassium is lower in black than in white children, (2) to determine whether cardiovascular reactivity (CVR) varies inversely with dietary intake of potassium, and (3) to confirm that CVR is greater in black than in white children, and in children with a family history of hypertension than in those without such a history. STUDY DESIGN Baseline measurements included 24-hour urinary sodium, potassium, and creatinine levels and food intake (by questionnaire). Resting and stress blood pressure were measured during blood sampling, cold water foot immersion, and a video game before and after 1 week each of supplementation with potassium citrate, 1.5 mmol/kg per day, and placebo administered in random order. RESULTS Thirty-nine children aged 7 to 15 years were studied. White subjects had higher baseline excretion of potassium than black subjects (p < 0.001) and higher vegetable intake (p < 0.01), which were positively correlated (r = 0.53, p < 0.001). At baseline, the 24-hour urinary potassium/creatinine ratio varied inversely with diastolic CVR to the video game stressor in white children (r = -0.55, p = 0.02). Cardiovascular reactivity was not attenuated measurably by potassium supplementation compared with placebo. The CVR was greater in children with a family history of hypertension than in those without, but was not greater in black children than in white children. CONCLUSIONS The urinary potassium/creatinine ratio is higher in white than black children because their intake of vegetables is greater; dietary potassium intake may modulate CVR, particularly in white children with a family history of hypertension, but may need to be supplemented for more than 1 week to demonstrate attenuation of CVR; and a family history of hypertension may be a stronger predictor of enhanced CVR than is race.
Collapse
Affiliation(s)
- J M Sorof
- Department of Pediatrics, University of California-San Francisco, USA
| | | | | | | | | |
Collapse
|
44
|
Sudhir K, Forman A, Yi SL, Sorof J, Schmidlin O, Sebastian A, Morris RC. Reduced dietary potassium reversibly enhances vasopressor response to stress in African Americans. Hypertension 1997; 29:1083-90. [PMID: 9149670 DOI: 10.1161/01.hyp.29.5.1083] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Acute vasopressor responses to stress are adrenergically mediated and hence potentially subject to differential modulation by dietary potassium and sodium. The greater vasopressor responsiveness in blacks compared with whites might then be consequent not only to a high dietary salt intake but also to a marginally reduced dietary potassium intake. Under controlled metabolic conditions, we compared acute vasopressor responses to cold and mental stress in black and white normotensive men during three successive dietary periods: (1) while dietary potassium was reduced (30 mmol K+/70 kg per day) and salt was restricted (10 to 14 days); (2) while salt was loaded (15 to 250 mmol Na+/70 kg per day) (7 days); and (3) while salt loading was continued and potassium was either supplemented (70 mmol K+/70 kg per day) (7 to 21 days) in 9 blacks and 6 whites or continued reduced (30 mmol K+/70 kg per day) (28 days) in 4 blacks (time controls). At the lower potassium intake, cold-induced increase in forearm vascular resistance in blacks was twice that in whites during both salt restriction and salt loading. Normalization of dietary potassium attenuated cold-induced increases in both forearm vascular resistance and systolic and diastolic blood pressures in blacks but only in systolic pressure in whites. In blacks but not in whites, normalization of dietary potassium attenuated mental stress-induced increases in systolic and diastolic pressures. In normotensive blacks but not whites, a marginally reduced dietary intake of potassium reversibly enhances adrenergically mediated vasopressor responsiveness to stress. That responsiveness so enhanced over time might contribute to the pathogenesis of hypertension in blacks.
Collapse
Affiliation(s)
- K Sudhir
- Department of Medicine, General Clinical Research Center, University of California, San Francisco, USA
| | | | | | | | | | | | | |
Collapse
|
45
|
Treiber FA, Turner JR, Davis H, Strong WB. Prediction of resting cardiovascular functioning in youth with family histories of essential hypertension: a 5-year follow-up. Int J Behav Med 1997; 4:278-91. [PMID: 16250719 DOI: 10.1207/s15327558ijbm0404_2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Two hundred forty-six children (96 Whites, of whom 51 were males; 150 African- Americans, of whom 69 were males) with a familial history of essential hypertension (EH) were re-evaluated 5 years after an initial evaluation. During the initial visit anthropometric, demographic, and resting cardiovascular (CV) parameters (designated initial baseline levels) were assessed. These CV parameters (systolic and diastolic blood pressure [BP], heart rate, cardiac output index [CI], and total peripheral resistance index [TPRI] were also measured during postural challenge, a video game challenge, and a cold pressor task. At follow-up, resting CV parameters were again evaluated, and designated as follow-up resting levels. Moderate temporal stability (r range = .43-.56) was observed for all resting CV parameters. Mean stress responses for each CV parameter for all 3 stressors during the initial visit were positively related to the respective CV follow-up resting level. BP stress responses to postural change and video game challenge to be significant independent predictors of future resting BP after controlling for standard EH risk factors. Follow-up resting CI was not predicted by any stress responses, whereas follow-up resting TPRI was predicted by TPRI responses to the video game after controlling for standard Eh risk factors. These results contrast with those from an earlier 1-year follow-up, where stress responses for neither CI nor TPRI predicted follow-up resting levels. It appears that, as children get older, TPRI stress responses play a stronger role in vasoconstrictive function.
Collapse
Affiliation(s)
- F A Treiber
- Department of Pediatrics and Psychiatry, Georgia Prevention Institute, Medical College of Georgia, Augusta 30912, USA
| | | | | | | |
Collapse
|
46
|
Daniels SR, Kimball TR, Khoury P, Witt S, Morrison JA. Correlates of the hemodynamic determinants of blood pressure. Hypertension 1996; 28:37-41. [PMID: 8675261 DOI: 10.1161/01.hyp.28.1.37] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The purpose of this study was to investigate the association of sex, race, lean body mass, and fat mass with the hemodynamic determinants of blood pressure, including stroke volume, heart rate, and total peripheral vascular resistance. The study included 201 subjects aged 6 to 17 years, 105 of whom were male and 98 of whom were black. Lean body mass and fat mass were both significant (P < .05) independent determinants of stroke volume, cardiac output, and total peripheral vascular resistance. However, the direction of the effect of lean body mass was opposite for stroke volume and cardiac output compared with that of total peripheral vascular resistance. The direct relationship of lean body mass with systolic blood pressure (SBP) and diastolic blood pressure (DBP) (regression coefficients, 0.55 +/- 0.05 for SBP and 0.47 +/- 0.05 for DBP) indicates that the effect of lean body mass on cardiac output may predominate. Lean body mass explained substantially more of the variance of the hemodynamic variables than did fat mass. After control for the effects of body size, male subjects had higher heart rate and cardiac output, and female subjects had higher vascular resistance. White subjects had higher stroke volume and cardiac output, and black subjects had higher peripheral vascular resistance. This study demonstrates that lean body mass is a more important correlate of the hemodynamic determinants of blood pressure than is fat mass and that sex and race have significant independent relationships with the hemodynamic determinants of blood pressure in children and adolescents.
Collapse
Affiliation(s)
- S R Daniels
- Department of Pediatrics, University of Cincinnati, College of Medicine, Ohio, USA
| | | | | | | | | |
Collapse
|
47
|
Mills PJ, Nelesen RA, Ziegler MG, Parry BL, Berry CC, Dillon E, Dimsdale JE. Menstrual cycle effects on catecholamine and cardiovascular responses to acute stress in black but not white normotensive women. Hypertension 1996; 27:962-7. [PMID: 8613275 DOI: 10.1161/01.hyp.27.4.962] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This study examined cardiovascular and catecholamine responses to two standardized laboratory stressors in 33 healthy age- and weight-matched black and white normotensive women (mean age, 32 years) during two phases of the menstrual cycle. Subjects were studied in a randomized order at the same time of day on two separate occasions approximately six weeks apart, once during the follicular phase (days 7 to 10 after menses) and once during the luteal phase (days 7 to 10 after the leutenizing hormone surge) of the menstrual cycle. Black women has higher systolic (P=.01) and diastolic (P=.01) pressures compared with white women. Black women showed greater diastolic pressure (P <.01) and plasma epinephrine (P <.05) responses to stress during the follicular compared with the luteal phase of the menstrual cycle; white women showed no significant changes in these variables. The findings extend the literature on race differences in responsivity to stress and indicate that in contrast to white women, reproductive hormones do influence cardiovascular and catecholamine responsivity to stress in black women.
Collapse
Affiliation(s)
- P J Mills
- Department of Psychiatry, University of California, San Diego, USA
| | | | | | | | | | | | | |
Collapse
|
48
|
Sherwood A, Turner JR. Hemodynamic responses during psychological stress: Implications for studying disease processes. Int J Behav Med 1995; 2:193-218. [PMID: 16250774 DOI: 10.1207/s15327558ijbm0203_1] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Investigation of the physiological correlates of psychological stress is of interest in relation to the putative impact of stress in the etiology of cardiovascular disease. Although the assessment of blood pressure and heart rate responses to psychological stress has been very informative, the addition of cardiac output measurement has added a further dimension to this research field. In recent studies, a more complete hemodynamic picture of the stress response has been documented in terms of cardiac output and systemic vascular resistance components of blood pressure changes. Different stressors have been shown to produce similar blood pressure increases due to quite different hemodynamic mechanisms. Furthermore, when faced with the same stressor, different individuals may exhibit pressor responses that are very different hemodynamically. There is growing evidence that these hemodynamic response patterns to psychological stress are stable individual traits. Response stability is a prerequisite for considering how stress-related hemodynamic changes may be implicated in the pathophysiology of cardiovascular diseases. Observations that hemodynamic response patterns in individuals at higher risk for the development of hypertension differ from those of lower risk individuals show that specific patterns of hemodynamic response are associated with disease processes. Although it is as yet unclear whether they represent markers or mechanisms. Overall. hemodynamic studies appear to he helping to refine our understanding of how stress can impact cardiovascular disease processes.
Collapse
Affiliation(s)
- A Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA
| | | |
Collapse
|
49
|
Treiber F, Raunikar RA, Davis H, Fernandez T, Levy M, Strong WB. 1-Year stability and prediction of cardiovascular functioning at rest and during laboratory stressors in youth with family histories of essential hypertension. Int J Behav Med 1994; 1:335-53. [PMID: 16250794 DOI: 10.1207/s15327558ijbm0104_4] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Blood pressure (BP). heart rate, cardiac index, and total peripheral resistance index were measured at rest and in response to postural change, forehead cold stimulation, and a video game challenge in a sample of 128 White and 155 African-American normotensive youth with family histories of essential hypertension (EH). These measurements were readministered 1 year later (12.5 +/- 3.2 months). Moderate temporal stability was observed for all resting and absolute stress responses. Reliability estimates for reactivity change scores were lower, although some were within acceptable ranges. African-American youth exhibited greater BP and peripheral resistance index reactivity to forehead cold on both evaluations. After controlling for various anthropometric and demographic parameters and the pertinent previous year's resting cardiovascular (CV) parameter, mean video game systolic blood pressure (SBP) responses were predictive of resting SBP whereas absolute forehead cold and video game diastolic responses predicted resting diastolic blood pressure (DBP) 1 year later. Mean video game DBP responses were also predictive of resting peripheral resistance index after controlling for significant demographic and anthropometric measures. CV reactivity is discussed with regard to possible value in prediction of changes in resting BP and cardiac structure prior lo establishment of EH.
Collapse
Affiliation(s)
- F Treiber
- Georgia Prevention Institute and Department of Pediatrics, Medical College of Georgia, Augusta 30912, USA
| | | | | | | | | | | |
Collapse
|
50
|
Affiliation(s)
- N M Kaplan
- Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, 75235-8899
| |
Collapse
|