Relative roles of heredity and physical activity in adolescence and adulthood on blood pressure

Influence of Hostility on 24-Hour Diastolic Blood Pressure Load in Hypertension Patients with Depressive Disorders

BACKGROUND Hostility in hypertension patients combined with depressive disorders indicates a worse outcome for hypertension management. This study was designed to explore the influence of hostility on 24-h diastolic blood pressure in hypertension patients who also had depressive disorders. MATERIAL AND METHODS A total of 130 people with primary hypertension and depressive disorders were collected through unstructured psychiatric interview by a professional psychiatrist and ambulatory blood pressure monitor in this cross-sectional study. During the study, dynamic blood pressure was examined for 24 h by ambulatory blood pressure monitoring. Patients were divided into 3 groups according to the hostility level. Hostility was defined by hostile factors of the Symptom Checklist 90. The association between hostility and 24-h dynamic blood pressure was analyzed by multivariable logistic regression. RESULTS 30.8% (40 of 130) patients had a high level of 24-h dynamic blood pressure load (>30%), in which 14.6% was for male and 16.2% for female respectively. In male, the proportion of high 24 h DBP load (>30%) in highest hostility group was greater than that of low hostility group and median hostility group significantly (p=0.03). No significant differences were revealed among 3 groups in female. The age-adjusted odds-ratio (OR) 95% confidence interval of diastolic blood pressure across the categories of hostility were: in males, 1.44 (0.60, 3.47) (1 for reference), and in females, 5.86 (0.58, 59.06) (P for trend=0.04). CONCLUSIONS Our results showed that hostility may be a risk factor for increased 24-h diastolic blood pressure in hypertension patients who also have depressive disorders, especially in males. The clinical meaning of the study is that hypertension management should contain psychological interventions for better effects.

Translating Genomic Advances to Physical Therapist Practice: A Closer Look at the Nature and Nurture of Common Diseases

The Human Genome Project and the International HapMap Project have yielded new understanding of the influence of the human genome on health and disease, advancing health care in significant ways. In personalized medicine, genetic factors are used to identify disease risk and tailor preventive and therapeutic regimens. Insight into the genetic bases of cellular processes is revealing the causes of disease and effects of exercise. Many diseases known to have a major lifestyle contribution are highly influenced by common genetic variants. Genetic variants are associated with increased risk for common diseases such as cardiovascular disease and osteoarthritis. Exercise response also is influenced by genetic factors. Knowledge of genetic factors can help clinicians better understand interindividual differences in disease presentation, pain experience, and exercise response. Family health history is an important genetic tool and encourages clinicians to consider the wider client-family unit. Clinicians in this new era need to be prepared to guide patients and their families on a variety of genomics-related concerns, including genetic testing and other ethical, legal, or social issues. Thus, it is essential that clinicians reconsider the role of genetics in the preservation of wellness and risk for disease to identify ways to best optimize fitness, health, or recovery. Clinicians with knowledge of the influence of genetic variants on health and disease will be uniquely positioned to institute individualized lifestyle interventions, thereby fulfilling roles in prevention and wellness. This article describes how discoveries in genomics are rapidly evolving the understanding of health and disease by highlighting 2 conditions: cardiovascular disease and osteoarthritis. Genetic factors related to exercise effects also are considered.

Early origins of ethnic disparities in cardiovascular risk factors

BACKGROUND

Not much is known about the ethnic differences in cardiovascular risk factors during childhood in European countries. We examined the ethnic differences in childhood cardiovascular risk factors in the Netherlands.

METHODS

In a multi-ethnic population-based prospective cohort study, we measured blood pressure, left ventricular mass, and levels of cholesterol, triglyceride and insulin at the median age of 6.2years.

RESULTS

As compared to Dutch children, Cape Verdean and Turkish children had a higher blood pressure, whereas Cape Verdean, Surinamese-Creole and Turkish children had higher total-cholesterol levels (p-values<0.05). Turkish children had higher triglyceride levels, but lower insulin levels than Dutch children (p-values<0.05). As compared to Dutch children, only Turkish children had an increased risk of clustering of cardiovascular risk factors (odds ratio: 2.45 (95% confidence interval 1.18, 3.37)). Parental pre-pregnancy factors explained up to 50% of the ethnic differences in childhood risk factors. In addition to these factors, pregnancy and childhood factors and childhood BMI explained up to 50%, 12.5% and 61.1%, respectively.

CONCLUSIONS

Our results suggest that compared to Dutch children, Cape Verdean, Surinamese-Creole and Turkish children have an adverse cardiovascular profile. These differences are largely explained by parental pre-pregnancy factors, pregnancy factors and childhood BMI.

Top 10 research questions related to growth and maturation of relevance to physical activity, performance, and fitness

Growth, maturation, and development dominate the daily lives of children and adolescents for approximately the first 2 decades of life. Growth and maturation are biological processes, while development is largely a behavioral process. The 3 processes occur simultaneously and interact. They can be influenced by physical activity and also can influence activity, performance, and fitness. Allowing for these potential interactions, 10 questions on growth and maturation that have relevance to physical activity, performance, and fitness are presented. The questions are not mutually exclusive and address several broadly defined topical areas: exercise and growth, body weight status (body mass index, adiposity rebound, "unhealthy weight gain"), movement proficiency (hypothesized barrier, role in obesity), individual differences, tracking, maturity-associated variation in performance, and corresponding variation in physical activity. Central to the discussion of each is the need for a biocultural approach recognizing the interactions of biology and behavior as potential influences on the variables of interest.

Lack of exercise is a major cause of chronic diseases

Chronic diseases are major killers in the modern era. Physical inactivity is a primary cause of most chronic diseases. The initial third of the article considers: activity and prevention definitions; historical evidence showing physical inactivity is detrimental to health and normal organ functional capacities; cause versus treatment; physical activity and inactivity mechanisms differ; gene-environment interaction (including aerobic training adaptations, personalized medicine, and co-twin physical activity); and specificity of adaptations to type of training. Next, physical activity/exercise is examined as primary prevention against 35 chronic conditions [accelerated biological aging/premature death, low cardiorespiratory fitness (VO2max), sarcopenia, metabolic syndrome, obesity, insulin resistance, prediabetes, type 2 diabetes, nonalcoholic fatty liver disease, coronary heart disease, peripheral artery disease, hypertension, stroke, congestive heart failure, endothelial dysfunction, arterial dyslipidemia, hemostasis, deep vein thrombosis, cognitive dysfunction, depression and anxiety, osteoporosis, osteoarthritis, balance, bone fracture/falls, rheumatoid arthritis, colon cancer, breast cancer, endometrial cancer, gestational diabetes, pre-eclampsia, polycystic ovary syndrome, erectile dysfunction, pain, diverticulitis, constipation, and gallbladder diseases]. The article ends with consideration of deterioration of risk factors in longer-term sedentary groups; clinical consequences of inactive childhood/adolescence; and public policy. In summary, the body rapidly maladapts to insufficient physical activity, and if continued, results in substantial decreases in both total and quality years of life. Taken together, conclusive evidence exists that physical inactivity is one important cause of most chronic diseases. In addition, physical activity primarily prevents, or delays, chronic diseases, implying that chronic disease need not be an inevitable outcome during life.

Clustering of body composition, blood pressure and physical activity in Portuguese families

AIM

The purposes of this study were: (i) to identify familial resemblances in body fat, blood pressure (BP) and total physical activity (TPA); (ii) to estimate the magnitude of their genetic and environmental influences; and (iii) to investigate shared familial aggregation among these phenotypes.

SUBJECTS AND METHODS

The sample comprised 260 nuclear families from Portugal. Body fat was assessed by bioelectrical impedance. BP was measured by an oscillometric device. TPA was estimated by the Baecke questionnaire. Familial correlation analyses were performed using Generalized Estimating Equations. Quantitative genetic modelling was used to estimate maximal heritability, genetic and environmental correlations.

RESULTS

Familial intra-trait correlations ranged from 0.15-0.38. Genetic and common environmental factors explained from 30%--44% of fat mass depots and BP and 24% of TPA. Genetic correlations were significant between BP and the fat mass traits (p < 0.05). Environmental correlations were statistically significant between diastolic BP and total body fat, trunk fat and arm fat (p < 0.05) and TPA and other phenotypes.

CONCLUSIONS

The results suggest familial resemblance in the variation of body fat, BP and TPA, showing partial pleiotropic effects in the variation in body fat phenotypes and BP. TPA only shares common environmental influences with BP and body fat traits.

Genetic and environmental influences on blood pressure and physical activity: a study of nuclear families from Muzambinho, Brazil

Blood pressure (BP) and physical activity (PA) levels are inversely associated. Since genetic factors account for the observed variation in each of these traits, it is possible that part of their association may be related to common genetic and/or environmental influences. Thus, this study was designed to estimate the genetic and environmental correlations of BP and PA phenotypes in nuclear families from Muzambinho, Brazil. Families including 236 offspring (6 to 24 years) and their 82 fathers and 122 mothers (24 to 65 years) were evaluated. BP was measured, and total PA (TPA) was assessed by an interview (commuting, occupational, leisure time, and school time PA). Quantitative genetic modeling was used to estimate maximal heritability (h²), and genetic and environmental correlations. Heritability was significant for all phenotypes (systolic BP: h² = 0.37 ± 0.10, P < 0.05; diastolic BP: h² = 0.39 ± 0.09, P < 0.05; TPA: h² = 0.24 ± 0.09, P < 0.05). Significant genetic (r g) and environmental (r e) correlations were detected between systolic and diastolic BP (r g = 0.67 ± 0.12 and r e = 0.48 ± 0.08, P < 0.05). Genetic correlations between BP and TPA were not significant, while a tendency to an environmental cross-trait correlation was found between diastolic BP and TPA (r e = -0.18 ± 0.09, P = 0.057). In conclusion, BP and PA are under genetic influences. Systolic and diastolic BP share common genes and environmental influences. Diastolic BP and TPA are probably under similar environmental influences.

Digital Dermatoglyphic Heritability Differences as Evidenced by a Female Twin Study

The genetic and environmental contributions to determine digital dermatoglyphic traits were investigated by using female dizygotic and monozygotic twin pairs to estimate heritability indexes (h2). The evaluated sample was composed by 20 monozygotic twin pairs and 13 dizygotic twin pairs. A significant heritability (h2 = 0.65 to 0.96) was observed for 12 dermatoglyphic characteristics (delta indexes and ridge counts for right hand, left hand and both hands, and ridge counts for most individual fingers). A negative correlation between the ridge counts and heritability indexes from individual fingers was found for the left hand, which appears to be associated to a higher arch pattern frequency in most left-hand fingers, since this frequency was negatively correlated with ridge counts and positively correlated with heritability indexes. Heritability indexes of right-hand fingers were positively correlated with loop pattern frequency and negatively correlated with whorl pattern frequency. The low heritability of ridge counts from left thumb, ring and little fingers (h2 = 0.11 to 0.32) indicates a higher chance that the chorion type had an influence in the intra-pair variance of monozygotic twins. Results confirmed the predominant genetic influence on the total ridge count. The heritability indexes varied in up to 8 times between different fingers and its association to ridge counts and pattern frequency was very variable between hands, evidencing that the use of dermatoglyphic traits from individual fingers as indicators of genetic influences to other human traits should consider this variability.

Racial/ethnic discrepancies in the metabolic syndrome begin in childhood and persist after adjustment for environmental factors

BACKGROUND AND AIMS

Evaluation of metabolic syndrome (MetS) characteristics across an age spectrum from childhood to adulthood has been limited by a lack of consistent MetS criteria for children and adults and by a lack of adjustment for environmental factors. We used the pediatric and adult International Diabetes Federation (IDF) criteria to determine whether gender-specific and race-specific differences in MetS and its components are present in adolescents as in adults after adjustment for socio-economic status (SES) and lifestyle factors.

METHODS AND RESULTS

Waist circumference, blood pressure, triglycerides, HDL cholesterol, and fasting glucose measures were obtained from 3100 adolescent (12-19 years) and 3419 adult (20-69 years) non-Hispanic white, non-Hispanic black, and Mexican-American participants of the 1999-2006 National Health and Nutrition Examination Surveys. We compared odds of having MetS and its components across racial/ethnic groups by age group, while adjusting for income, education, physical activity and diet quality. After adjusting for possible confounding influences of SES and lifestyle, non-Hispanic-black adolescent males exhibited a lower odds of MetS and multiple components (abdominal obesity, hypertriglyceridemia, low HDL, hyperglycemia) compared to non-Hispanic-white and Mexican-American adolescents. Compared to non-Hispanic-white adolescent males, Mexican-American adolescent males had less hypertension. There were no differences in MetS prevalence among adolescent females, though non-Hispanic-black girls exhibited less hypertriglyceridemia.

CONCLUSION

Racial/ethnicity-specific differences in MetS and its components are present in both adolescence and adulthood, even after adjusting for environmental factors. These data help strengthen arguments for developing racial/ethnic-specific MetS criteria to better identify individuals at risk for future cardiovascular disease.

Physical activity and prevalence of hypertension in a population-based sample of Brazilian adults and elderly

OBJECTIVES

a) To determine the prevalence of hypertension and its associated factors and b) to establish the impact of past (i.e. adolescence) and current physical activity on hypertension.

METHODS

A cross-sectional study of people aged 40 years or more living in the urban area of Pelotas - Brazil (2003). Hypertension was assessed by self-report of medical diagnosis. Individuals were considered active in adolescence if they reported regular physical activity practice between the ages 10 and 19 years. In adulthood, individuals who performed > or =150 min/week of leisure-time physical activities were considered active. Other variables studied included skin color, age, smoking, body mass index and socioeconomic status.

RESULTS

1696 individuals were interviewed (response rate >95%). Prevalence of hypertension was 34.4% (CI(95%) 32.1-36.7) and varied considerably among population subgroups. Current physical activity showed no association with hypertension. Physical activity in adolescence was associated with a decreased risk of adulthood hypertension in the crude analyses for women (p<0.001). However, after adjusting for potential confounders and mediators, this protection was no longer significant 1.20 (CI(95%) 0.93-1.55).

CONCLUSIONS

Prevalence of hypertension is high among Brazilians and markedly different among population subgroups. There was no robust evidence of association between adolescence physical activity practice and hypertension in later life.

Age- and pathology-specific measures of disc degeneration

STUDY DESIGN

: A measurement study.

OBJECTIVE

: To develop more accurate and specific measures of disc degeneration, which could better capture and distinguish systemic effects of aging and isolated disc irregularities using routine magnetic resonance imaging (MRI) and to examine their construct validity.

SUMMARY OF BACKGROUND DATA

: Knowledge of the etiopathogenesis of disc degeneration and pathology is fundamental to advancements in common spinal disorders. The quality of measures of disc degeneration is currently limited progress in this area.

METHODS

: Subjects were 519 twins, 35 to 70 years old, from a population-based cohort. Lumbar structures were traced and image software measured selected disc areas and T2 signal parameters of sagittal and axial images of lumbar spine with 1.5 Tesla MRI scanners. All signal measures were adjusted by adjacent cerebrospinal fluid signal. The mean adjusted disc signal, its standard deviation, and an irregularity measure were used to estimate the overall desiccation stage and signal variation across the disc. Associations with risk factors were examined to support or refute measurement validity.

RESULTS

: The signal-based measures introduced were highly reproducible (inter-rater reliability ICC = 0.95-1.00). Age explained more of the signal-based disc measures (AR2 = 16%-32%) than did the qualitative measures of disc degeneration in common use (AR2 = 3%-8%) in L1-L4 discs, supporting the validity of the new measures. The signal-based measures were also more highly associated with physical loading and familial aggregation, further supporting their validity. Age and physical loading had higher associations with the sagittal than the axial measures and with upper rather than lower lumbar discs. Adjustment of signal-based measures by cerebrospinal fluid is critical and increased the associations between age and the measures by 2- to 10-fold.

CONCLUSION

: The new signal-based measures show promise in their potential to better capture and perhaps distinguish aspects of disc degeneration than current assessment methods using standard MRI. Their use may enhance research on potential determinants of disc degeneration.

Sport therapy for hypertension: why, how, and how much?

Exercise may prevent or reduce the effects of metabolic and cardiovascular diseases, including arterial hypertension. Both acute and chronic exercise, alone or combined with lifestyle modifications, decrease blood pressure and avoid or reduce the need for pharmacologic therapy in patients with hypertension. The hypotensive effect of exercise is observed in a large percentage of subjects, with differences due to age, sex, race, health conditions, parental history, and genetic factors. Exercise regulates autonomic nervous system activity, increases shear stress, improves nitric oxide production in endothelial cells and its bioavailability for vascular smooth muscle, up-regulates antioxidant enzymes. Endurance training is primarily effective, and resistance training can be combined with it. Low-to-moderate intensity training in sedentary patients with hypertension is necessary, and tailored programs make exercise safe and effective also in special populations. Supervised or home-based exercise programs allow a nonpharmacological reduction of hypertension and reduce risk factors, with possible beneficial effects on cardiovascular morbidity.

Adolescent physical activity and health: a systematic review

Physical activity in adolescence may contribute to the development of healthy adult lifestyles, helping reduce chronic disease incidence. However, definition of the optimal amount of physical activity in adolescence requires addressing a number of scientific challenges. This article reviews the evidence on short- and long-term health effects of adolescent physical activity. Systematic reviews of the literature were undertaken using a reference period between 2000 and 2004, based primarily on the MEDLINE/PubMed database. Relevant studies were identified by examination of titles, abstracts and full papers, according to inclusion criteria defined a priori. A conceptual framework is proposed to outline how adolescent physical activity may contribute to adult health, including the following pathways: (i) pathway A--tracking of physical activity from adolescence to adulthood; (ii) pathway B--direct influence of adolescent physical activity on adult morbidity; (iii) pathway C--role of physical activity in treating adolescent morbidity; and (iv) pathway D - short-term benefits of physical activity in adolescence on health. The literature reviews showed consistent evidence supporting pathway 'A', although the magnitude of the association appears to be moderate. Thus, there is an indirect effect on all health benefits resulting from adult physical activity. Regarding pathway 'B', adolescent physical activity seems to provide long-term benefits on bone health, breast cancer and sedentary behaviours. In terms of pathway 'C', water physical activities in adolescence are effective in the treatment of asthma, and exercise is recommended in the treatment of cystic fibrosis. Self-esteem is also positively affected by adolescent physical activity. Regarding pathway 'D', adolescent physical activity provides short-term benefits; the strongest evidence refers to bone and mental health. Appreciation of different mechanisms through which adolescent physical activity may influence adult health is essential for drawing recommendations; however, the amount of exercise needed for achieving different benefits may vary. Physical activity promotion must start in early life; although the 'how much' remains unknown and needs further research, the lifelong benefits of adolescent physical activity on adult health are unequivocal.

Do adolescent leisure-time physical activities foster health and well-being in adulthood? Evidence from two British birth cohorts

BACKGROUND

Calls for public health initiatives to increase adolescent leisure-time physical activity suggest that increasing activity in this age group will reduce social inequalities in health. While the public health benefits of exercise are undisputed, there is little evidence on its role in reducing health inequalities. The paper examines the extent to which adolescent leisure-time physical activity promotes adult health and well-being and explores whether adolescent leisure-time physical activity can act to reduce health inequalities arising from material deprivation during childhood.

METHODS

This is a longitudinal study of the 1958 British birth cohort followed from age 16 to age 33 years (N = 15,452) and the 1970 British birth cohort followed to age 30 years (N = 14,018). Adult self-rated general health and Malaise Inventory scores are regressed on self-reports of leisure time physical activity. Analyses are conducted separately for men and women controlling for adolescent body mass index (BMI) and psychosocial problems.

RESULTS

There was a consistent relationship between leisure-time physical activity in adolescence and psychological well-being approximately 15 years later for both the cohorts. This relationship was independent of adolescent BMI and psychosocial problems. More physical activity in adolescence predicted better adult self-assessed health in the 1958 cohort only. Leisure-time physical activity did not affect inequalities in health.

CONCLUSIONS

Policies aimed at increasing participation in leisure-time physical activities in youth may improve population health but are unlikely to prevent the development of social inequalities in health.

Family History of Stroke in Patients With Transient Ischemic Attack in Relation to Hypertension and Other Intermediate Phenotypes

Background and Purpose— Family history of stroke (FHx stroke ) is a risk factor for ischemic stroke, but there are insufficient data on the relationship with stroke subtypes and intermediate phenotypes (IPs), such as hypertension. Specifically, there are no reliable data on the associations of FHx stroke in patients with transient ischemic attack (TIA) in whom relationships with IPs are likely to be determined most reliably.

Methods— We studied FHx stroke and FHx of myocardial infarction (FHx MI ) in TIA patients from 2 population-based incidence studies and 2 prospective consecutive hospital-referred series. We related the presence of FHx to baseline characteristics, clinical subtype, and IPs.

Results— Results were similar in the 4 cohorts, and so data on all 783 patients were pooled. FHx stroke was less common than FHx MI (189 versus 254; P =0.0003). FHx stroke and FHx MI were strongly related to history of hypertension in the proband (odds ratio [OR], 1.78; 95% CI, 1.28 to 2.48; P =0.0008; and OR, 2.10, 95% CI, 1.55 to 2.85; P <0.0001, respectively). Highest recorded premorbid systolic and diastolic blood pressures (mm Hg) were significantly higher in cases with FHx stroke than those without and increased with the number of affected first-degree relatives (0 181/100; 1 185/104; ≥2 198/109; P =0.03). There was no association between FHx stroke and age, diabetes, smoking, plasma glucose, cholesterol, or territory of TIA, but FHx stroke was less common in patients with ocular TIA than in cases with cerebral TIA (OR, 0.53; 95% CI, 0.34 to 0.82; P =0.004), although the association was no longer significant after adjustment for hypertension.

Conclusions— The strong association between hypertension and FHx stroke suggests that familial susceptibility to cerebral ischemia is attributable, at least partly, to familial predisposition to hypertension. This should be taken into account in studies of the genetics of ischemic stroke.