FAMILY HISTORY, BLOOD PRESSURE AND LIFE STYLE. RESULTS FROM EHUH STUDY

Prevalence of and Factors Associated With High Blood Pressure at 15 Years of Age: A Birth Cohort Study

BACKGROUND

Arterial hypertension is the greatest cause of morbidity and mortality worldwide. Our aim was to investigate the prevalence of and factors associated with high blood pressure (HBP) among adolescents.

METHODS AND RESULTS

The Pelotas 2004 Birth Cohort included 4231 newborns from hospital births in Pelotas, Brazil. A digital automatic OMRON sphygmomanometer (model HEM 742) was used to measure blood pressure on 3 occasions (at 6, 11, and 15 years of age). Those with blood pressure ≥95th percentile for age, height, and sex on each of the 3 occasions were considered as presenting HBP. Independent variables included family (income and history of arterial hypertension), maternal (schooling, age, pregestational body mass index, and smoking during pregnancy), and adolescent characteristics at birth (sex, skin color, gestational age, intrauterine growth, and systolic and diastolic genetic factors), and at 15 years (sleep, physical activity, sodium intake, screen time, work, body mass index, fat mass index, fat-free mass index, growth pattern, and puberty status). The prevalence of HBP (95% CI) was calculated. Crude and adjusted odds ratios (ORs) stratified by sex were obtained by logistic regression. A total of 1417 adolescents with complete information on blood pressure on the 3 occasions were analyzed. The prevalence of HBP was 3.2% (95% CI, 1.9%-4.5%) in female adolescents and 4.3% (95% CI, 2.8%-5.8%) in male adolescents. Female adolescents with a family history of arterial hypertension had a 3 times higher chance of HBP than their counterparts (OR, 3.1 [95% CI, 1.26-7.54]). In male adolescents, excessive maternal pregestational weight was associated with a 2.3-fold increase in the chance of HBP. In both sexes, excessive adolescent weight was associated with HBP (ORs, 3.5 and 5.0, for female and male adolescents, respectively). A higher fat mass index and fat-free mass index in female (ORs, 1.4 and 1.2, respectively) and male adolescents (ORs, 2.5 and 3.0, respectively) increased the chance of HBP. Among male adolescents, the chance of HBP was higher among those with rapid weight gain between 48 months and 6 years and between 6 and 11 years and rapid height gain between 6 and 11 years.

CONCLUSIONS

Higher fat mass in both sexes and rapid weight gain in male adolescents are risk factors for HBP in adolescents aged 15 years, potentially amenable to prevention.

Prevalence and Factors Associated with Prehypertension and Hypertension Among Adults: Baseline Findings of PURE Malaysia Cohort Study

Background

Although prehypertension and hypertension can be detected at the primary healthcare level and low-cost treatments can effectively control its complications, hypertension is still the world's leading preventable risk factor. Therefore, the present study aimed to determine its prevalence and its risk factors among Malaysian adults.

Methods

A cross-sectional study involving 7585 adults was performed covering the rural and urban areas. Respondents with systolic blood pressure (SBP) of 120-139 mmHg and/or diastolic blood pressure (DBP) of 80-89 mmHg were categorized as prehypertensive, and hypertensive categorization was used for respondents with an SBP of ≥140 mmHg and/or DBP of ≥90 mmHg.

Results

Respondents reported to have prehypertension and hypertension were 40.7% and 38.0%, respectively. Those residing in a rural area, older age, male, family history of hypertension, and overweight or obese were associated with higher odds of prehypertension and hypertension. Unique to hypertension, the factors included low educational level (AOR: 1.349; 95% CI: 1.146, 1.588), unemployment (1.350; 1.16, 1.572), comorbidity of diabetes (1.474; 1.178, 1.844), and inadequate fruit consumption (1.253; 1.094, 1.436).

Conclusions

As the prehypertensive state may affect the prevalence of hypertension, proactive strategies are needed to increase early detection of the disease among specific group of those residing in a rural area, older age, male, family history of hypertension, and overweight or obese.

Prevalence, Awareness, and Control of Hypertensive Disorders amongst Pregnant Women Seeking Healthcare in Ghana

Hypertensive disorders in pregnancy (HDPs) are no longer seen as "transitory diseases cured by delivery." It accounts for up to 50% of maternal deaths. Information concerning HDPs is less in developing countries like Ghana. This study was conducted to find out the prevalence, awareness, risk factors, control, and the birth outcomes of HDPs. This was a retrospective cohort study conducted among pregnant women seeking care in selected health facilities in the Ashanti Region. Data on demographics, HDPs, and its associated birth outcomes were collected. Logistic regression models were used to examine the association of the independent variables with HDPs. The burden of HDPs was 37.2% among the 500 mothers enrolled with chronic hypertension superimposed with preeclampsia accounting for 17.6%, chronic hypertension, 10.2%, and preeclampsia 6.8% whilst gestational hypertension was 2.6%. It was observed that 44% (220) of the mothers had excellent knowledge on HDPs. Oral nifedipine and methyldopa were frequently used for HDP management, and it resulted in a significant reduction in HDP burden from 37.2% to 26.6%. Factors that influenced the increased risk of HDPs were grand multigravida (AOR = 4.53; CI = 1.42-14.42), family history of hypertension (AOR = 3.61; CI = 1.89-6.90), and the consumption of herbal preparations (AOR = 2.92; CI = 1.15-7.41) and alcohol (AOR = 4.10; CI = 1.34-12.62) during pregnancy. HDPs increased the risk of preterm delivery (AOR = 2.66; CI = 1.29-5.89), stillbirth (AOR = 12.47; CI = 2.72-57.24), and undergoing caesarean section (AOR = 1.70; CI = 1.10-2.61) amongst mothers during delivery. The burden of HDPs is high amongst pregnant mothers seeking care in selected facilities. There is the need for intensified campaign on HDPs in the Ashanti Region of Ghana.

BMI mediates the association of family medical history with self-reported hypertension and diabetes among older adults: Evidence from baseline wave of the longitudinal aging study in India

Background

This study explored the association between family history of hypertension and diabetes with their diagnosis among older Indian adults. The study further examined the role of body mass index (BMI) as a potential mediator in these associations.

Methods

Data from the Longitudinal Ageing Study in India (LASI, 2017-18), wave-1 were used. The sample for the study included 31,464 older adults aged 60 years and above. Descriptive statistics and bivariate analysis has been conducted to assess the prevalence of self-reported hypertension and diabetes. Further, multivariable logistic regression models were used to test the research hypotheses of this study. The Karlson-Holm-Breen (KHB) mediation analysis was conducted to recover the direct and indirect effects of BMI in the association of family medical history and diagnosis of hypertension and diabetes.

Results

A proportion of 32.70% of older adults were diagnosed with hypertension and 14.23% of older adults were diagnosed with diabetes. A proportion of 19.48% and 14.69% of older adults had a family history of hypertension and diabetes, respectively. Also, 16.57% and 5.53% of older adults were overweight and obese, respectively in the current study. Older adults who had family history of hypertension had higher odds of being diagnosed with hypertension [aOR: 2.23, CI: 2.07-2.39] than those who had no such family history. This association was mediated by BMI (percent mediated: 6.31%). Similarly, older adults who had family history of diabetes had higher odds of being diagnosed with diabetes [aOR: 2.63, CI: 2.41-2.88] than those who had no such family history. This association was mediated by BMI (percent effect mediated: 6.66%).

Conclusion

The study highlights the relevance of using family medical history data along with information on BMI as potential source for the control and management of hypertension and diabetes among older population.

Familial genetic and environmental risk profile and high blood pressure event: a prospective cohort of cardio-metabolic and genetic study

BACKGROUND AND AIMS

High blood pressure is the heritable risk factor for cardiovascular diseases. We investigated whether the presence of familial genetic and environmental risk factors are associated with increased risk of high blood pressure.

METHODS

A total of 4,559 individuals from 401 families were included in this study. Familial aggregation analysis was carried out on systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI) and waist circumference (WC), and heritability was estimated for SBP and DBP. The association between familial risk factors and blood pressure traits including, incidence of hypertension, SBP and DBP was estimated separately using regression-based two-level Haseman-Elston (HE) method, with individual and familial BMI and WC as environmental exposures and familial genetic profile of known variants as genetic risk factors in 210 index families (≥2 hypertensive cases). Models were adjusted for the two nested sets of covariates.

RESULTS

During a follow-up of 15 years, the SBP, DBP, BMI and WC were highly correlated in inter class of mother-offspring and intraclass of sister-sister with heritability of 30 and 25% for DBP and SBP, respectively. Among index families, those whose members with higher familial BMI or WC had significantly increased risk of hypertension and consistent, strong signals of rs2493134 (AGT) linked with SBP and DBP, rs976683 (NLGN1) linked with SBP and HTN, and epistasis of rs2021783 (TNXB) and known genetic variants linked with all blood pressure traits.

CONCLUSIONS

Findings from this study show that familial genetic and environmental risk profile increase risk for high blood pressure beyond the effect of the individuals' own risk factors.

Epidemiologic Profile of Hypertension in Northern Iranian Population: The PERSIAN Guilan Cohort Study (PGCS)

Background

Estimates region-related prevalence of hypertension and attempts to identify its related factors at the district levels are required for prevention and management of hypertension.

Objective

The aim of this study was to investigate the epidemic features and related factors of hypertension and its awareness, treatment, and control rates among the northern Iranian population.

Methods

It was a community based cross-sectional study based on data from PERSIAN Guilan Cohort Study (PGCS). In total, 10,520 participants (aged 35-70 years) from the Guilan Province in northern Iran included in this study, between October 8, 2014, and January 20, 2017. Hypertension was defined as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg or a prior diagnosis of hypertension or being on antihypertensive medication. Potential correlates of hypertension and its awareness, treatment and control were analyzed by multivariate logistic regression adjusted for demographic factors, anthropometric characteristics, lifestyle variables, past medical history, and laboratory data.

Results

The prevalence of hypertension was 43.2% and the hypertension awareness, treatment, and control rate were 53.4%, 49.8%, and 73.7%, respectively. The multivariate logistic regression analyses revealed that older age, urbanization, lower education, overweight and obesity, lower physical activity, prediabetes and diabetes, cardiovascular disease, psychiatric disorder, positive family history of hypertension and raised serum creatinine were independently associated with presence of hypertension. Awareness of hypertension was greater in the female sex, older age, rural residency, higher education and patient with comorbidities. Older age, rural residency and comorbidities were associated with treatment of hypertension. Control of hypertension was better among younger age, higher education, normal weight and higher physical activity.

Conclusion

Hypertension is highly prevalent in the northern Iranian population. About half of affected persons are unaware of their disease and untreated. Modifying risk factors (such as weight lose and increase physical activity) and increasing hypertension awareness (by screening) is essential for primary and secondary prevention of high blood pressure in this population, especially in urban areas and among males, younger ages, and less educated.