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Gaudieri V, Mannarino T, Zampella E, Assante R, D'Antonio A, Nappi C, Cantoni V, Green R, Petretta M, Arumugam P, Cuocolo A, Acampa W. Prognostic value of coronary vascular dysfunction assessed by rubidium-82 PET/CT imaging in patients with resistant hypertension without overt coronary artery disease. Eur J Nucl Med Mol Imaging 2021; 48:3162-3171. [PMID: 33594472 PMCID: PMC8426234 DOI: 10.1007/s00259-021-05239-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/01/2021] [Indexed: 12/24/2022]
Abstract
Purpose The identification of coronary vascular dysfunction may enhance risk stratification in patients with resistant hypertension (RH). We evaluated if impaired coronary vascular function, assessed by rubidium-82 (82Rb) positron emission tomography/computed tomography (PET/CT) imaging, is associated with increased cardiovascular risk in patients with hypertension without overt coronary artery disease (CAD). Methods We studied 517 hypertensive subjects, 26% with RH, without overt CAD, and with normal stress-rest myocardial perfusion imaging at 82Rb PET/CT. The outcome end points were cardiac death, nonfatal myocardial infarction, coronary revascularization, and admission for heart failure. Results Over a median of 38 months (interquartile range 26 to 50), 21 cardiac events (4.1% cumulative event rate) occurred. Patients with RH were older (p < 0.05) and had a higher prevalence of left ventricular hypertrophy (p < 0.001), a lower hyperemic myocardial blood flow (MBF), and myocardial perfusion reserve (MPR) (both p < 0.001) compared to those without. Conversely, coronary artery calcium content and baseline MBF were not different between patients with and without RH. At univariable Cox regression analysis, age, RH, left ventricular ejection fraction, coronary artery calcium score, and reduced MPR were significant predictors of events. At multivariable analysis, age, RH, and reduced MPR (all p < 0.05) were independent predictors of events. Patients with RH and reduced MPR had the highest risk of events and the major risk acceleration over time. Conclusion The findings suggest that the assessment of coronary vascular function may enhance risk stratification in patients with hypertension.
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Affiliation(s)
- Valeria Gaudieri
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Teresa Mannarino
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Adriana D'Antonio
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Valeria Cantoni
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Roberta Green
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | | | - Parthiban Arumugam
- Department of Nuclear Medicine, Central Manchester Foundation Trust, Manchester, UK
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy. .,Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy.
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Farsalinos K, Cibella F, Caponnetto P, Campagna D, Morjaria JB, Battaglia E, Caruso M, Russo C, Polosa R. Effect of continuous smoking reduction and abstinence on blood pressure and heart rate in smokers switching to electronic cigarettes. Intern Emerg Med 2016; 11:85-94. [PMID: 26749533 PMCID: PMC4747988 DOI: 10.1007/s11739-015-1361-y] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/16/2015] [Indexed: 12/21/2022]
Abstract
We present prospective blood pressure (BP) and hear rate (HR) changes in smokers invited to switch to e-cigarettes in the ECLAT study. BP and HR changes were compared among (1) different study groups (users of high, low, and zero nicotine products) and (2) pooled continuous smoking phenotype classification (same phenotype from week 12 to -52), with participants classified as quitters (completely quit smoking), reducers (≥50% reduction in smoking consumption) and failures (<50% or no reduction in smoking consumption). Additionally, the latter comparison was repeated in a subgroup of participants with elevated BP at baseline. No significant changes were observed among study groups for systolic BP, diastolic BP, and HR. In 145 subjects with a continuous smoking phenotype, we observed lower systolic BP at week 52 compared to baseline but no effect of smoking phenotype classification. When the same analysis was repeated in 66 subjects with elevated BP at baseline, a substantial reduction in systolic BP was observed at week 52 compared to baseline (132.4 ± 12.0 vs. 141.2 ± 10.5 mmHg, p < 0.001), with a significant effect found for smoking phenotype classification. After adjusting for weight change, gender and age, reduction in systolic BP from baseline at week 52 remains associated significantly with both smoking reduction and smoking abstinence. In conclusion, smokers who reduce or quit smoking by switching to e-cigarettes may lower their systolic BP in the long term, and this reduction is apparent in smokers with elevated BP. The current study adds to the evidence that quitting smoking with the use of e-cigarettes does not lead to higher BP values, and this is independently observed whether e-cigarettes are regularly used or not.
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Affiliation(s)
| | - Fabio Cibella
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology, Palermo, Italy
| | - Pasquale Caponnetto
- Centro Per La Prevenzione e Cura Del Tabagismo, Azienda Ospedaliero, Universitaria "Policlinico-V. Emanuele", Università di Catania, Catania, Italy.
- Dipartimento di Biomedicina Clinica e Molecolare, Università di Catania, Azienda Ospedaliero, Universitaria "Policlinico-Vittorio Emanuele", Università di Catania, Catania, Italy.
| | - Davide Campagna
- Centro Per La Prevenzione e Cura Del Tabagismo, Azienda Ospedaliero, Universitaria "Policlinico-V. Emanuele", Università di Catania, Catania, Italy
- Dipartimento di Biomedicina Clinica e Molecolare, Università di Catania, Azienda Ospedaliero, Universitaria "Policlinico-Vittorio Emanuele", Università di Catania, Catania, Italy
| | - Jaymin Bhagwanji Morjaria
- Division of Cardiovascular and Respiratory Studies, Hull York Medical School, Castle Hill Hospital, University of Hull, Cottingham, UK
| | - Eliana Battaglia
- Centro Per La Prevenzione e Cura Del Tabagismo, Azienda Ospedaliero, Universitaria "Policlinico-V. Emanuele", Università di Catania, Catania, Italy
- Dipartimento di Biomedicina Clinica e Molecolare, Università di Catania, Azienda Ospedaliero, Universitaria "Policlinico-Vittorio Emanuele", Università di Catania, Catania, Italy
| | - Massimo Caruso
- Dipartimento di Biomedicina Clinica e Molecolare, Università di Catania, Azienda Ospedaliero, Universitaria "Policlinico-Vittorio Emanuele", Università di Catania, Catania, Italy
| | - Cristina Russo
- Centro Per La Prevenzione e Cura Del Tabagismo, Azienda Ospedaliero, Universitaria "Policlinico-V. Emanuele", Università di Catania, Catania, Italy
- Dipartimento di Biomedicina Clinica e Molecolare, Università di Catania, Azienda Ospedaliero, Universitaria "Policlinico-Vittorio Emanuele", Università di Catania, Catania, Italy
| | - Riccardo Polosa
- Centro Per La Prevenzione e Cura Del Tabagismo, Azienda Ospedaliero, Universitaria "Policlinico-V. Emanuele", Università di Catania, Catania, Italy.
- Dipartimento di Biomedicina Clinica e Molecolare, Università di Catania, Azienda Ospedaliero, Universitaria "Policlinico-Vittorio Emanuele", Università di Catania, Catania, Italy.
- UOC di Medicina Interna e d'Urgenza, Edificio 4, Piano 3, AOU ''Policlinico-V. Emanuele'', Via S. Sofia 78, 95123, Catania, Italy.
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Walia HK, Li H, Rueschman M, Bhatt DL, Patel SR, Quan SF, Gottlieb DJ, Punjabi NM, Redline S, Mehra R. Association of severe obstructive sleep apnea and elevated blood pressure despite antihypertensive medication use. J Clin Sleep Med 2014; 10:835-43. [PMID: 25126027 DOI: 10.5664/jcsm.3946] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
RATIONALE We hypothesized that untreated severe obstructive sleep apnea (OSA) is associated with elevated ambulatory blood pressure (BP) in subjects with high cardiovascular disease (CVD) risk despite medical management. METHODS Data from the baseline examination of the Heart Biomarker Evaluation in Apnea Treatment (HeartBEAT) study, a 4-site randomized controlled trial were analyzed. Individuals with moderate-severe OSA (apnea hypopnea index, AHI = 15-50) and cardiovascular risk were recruited from cardiology practices. Those with hypertension were included. Intensive antihypertensive regimen (IAR) was defined as ≥ 3 antihypertensives including a diuretic. Definitions were: controlled BP (BP < 130/80), uncontrolled elevated BP (BP ≥ 130/80 not on IAR) and resistant elevated BP (BP ≥ 130/80 mm Hg despite IAR). Associations of untreated severe OSA (AHI ≥ 30) and uncontrolled and resistant elevated BP were evaluated using logistic regression analyses adjusted for age, sex, race, body mass index, smoking status, diabetes, and CVD. RESULTS Among the 284 participants (mean age 63.1 ± 7.2 years, 23.6% with severe OSA), 61.6% had controlled BP, 28.5% had uncontrolled elevated BP, and 9.9% had resistant elevated BP. Among participants prescribed IAR, resistant elevated BP was more prevalent in those with severe compared to moderate OSA (58.3% vs. 28.6%, p = 0.01). Participants with severe OSA had a 4-fold higher adjusted odds of resistant elevated BP (OR 4.1, 95% CI: 1.7-10.2), a finding not reproduced in the absence of IAR use. CONCLUSIONS Among patients with increased cardiovascular risk and moderate to severe OSA, untreated severe compared to moderate OSA was associated with elevated BP despite IAR suggesting untreated severe OSA contributes to poor BP control despite aggressive medication use. COMMENTARY A commentary on this article appears in this issue on page 845.
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Affiliation(s)
- Harneet K Walia
- Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Hong Li
- Center for Clinical Investigation, Case Western Reserve University, Cleveland, OH
| | | | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA
| | - Sanjay R Patel
- Brigham and Women's Hospital, Boston, MA; ; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | - Daniel J Gottlieb
- Brigham and Women's Hospital, Boston, MA; ; VA Boston Healthcare System, Harvard Medical School, Boston, MA
| | | | - Susan Redline
- Brigham and Women's Hospital, Boston, MA; ; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Reena Mehra
- Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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Er LK, Chen YL, Pei D, Lau SC, Kuo SW, Hsu CH. Increased incidence of metabolic syndrome in older men with high normotension. Aging Male 2012; 15:227-32. [PMID: 23035946 DOI: 10.3109/13685538.2012.720742] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Hypertension and prehypertension are correlated with future cardiovascular disease (CVD) and diabetes. Whether these harmful effects of the blood pressure (BP) could be found in normotensive is of interest. METHODS In this cross-sectional study, totally 2388 normotensive older men aged 65-80 years undergoing routine health examinations were enrolled. To eliminate the influence of age on BP, subjects were initially grouped in each age stratum. Then in each age-stratum, subjects were further grouped into low, middle and high-tertile systolic BP (SBP) subgroups. Finally, all the low-tertile subgroups in each age stratum were gathered to form Group-1. Similarly, Group-2 (middle-tertile) and Group-3 (high-tertile) were also created. Metabolic syndrome (MetS) was regarded as having risks for future CVD and diabetes. RESULTS Age, waist circumstance (WC), fasting plasma glucose (FPG) and log triglyceride (TG) were independently and significantly correlated with SBP by multiple linear regression analysis. On the other hand, logistic regression showed that Group-3 had significant higher odds ratios (ORs) for having abnormal WC, FPG and TG. In addition, Group-3 presented a 1.55-fold OR (p < 0.001) for having MetS than Group-1. CONCLUSIONS In normotensive older men, the risk for having MetS was significantly associated with higher SBP. Primary prevention of hypertension should be stressed.
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Affiliation(s)
- Leay-Kiaw Er
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Buddhist Tzu Chi General Hospital, Taipei, Taiwan
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Yoon NS, Jeong MH, Ahn Y, Kim JH, Chae SC, Kim YJ, Hur SH, Seong IW, Hong TJ, Choi D, Cho MC, Kim CJ, Seung KB, Chung WS, Jang YS, Cho JG, Park SJ. Impact of high-normal blood pressure measured in emergency room on adverse cardiac events in acute myocardial infarction. Korean Circ J 2012; 42:304-10. [PMID: 22701132 PMCID: PMC3369961 DOI: 10.4070/kcj.2012.42.5.304] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 09/01/2011] [Accepted: 11/07/2011] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives Prehypertension according to JNC7 is common and is associated with increased vascular mortality. The importance of management in high-normal blood pressure (BP) is underemphasized. Subjects and Methods We analyzed major adverse cardiac events (MACEs) in the Korea Acute Myocardial Infarction Registry in normal BP (group I) and high-normal BP (group II) patients. Results Among 14871 patients, 159 (61±12.3 years, 122 males) satisfied the study indication. Six-month and one-year clinical follow-up rate was 88.9% and 85.8%, respectively. Group I had 78 patients (60.9±12.4 years). Group II had 81 patients (61.6±12.5 years). Demographics of patients were not different between groups. Treatment strategy was not different. Initial Thrombolysis in Myocardial Infarction flow grade 0 was less frequent in group II (n=32, 47.1%) than in group I (n=16, 21.9%) (p=0.001). Successful intervention rate was not different between group II (93.8%) and group I (97.1%) (p=0.590). Six-month MACE occurred in 3 patients in group I (4.4%) and 10 in group II (15.6%) (p=0.031). Compared with normal BP, the odds ratio for patients with high-normal BP was 1.147 (p=0.045, 95% confidence interval 1.011-1.402) for 6-month MACE. Conclusion Even though high-normal BP patients had a better baseline clinical status, the prognosis was poorer than patients with normal BP. Therapeutic BP target goal for the patients with acute myocardial infarction should be <140/90 mm Hg, which is recommended in JNC7.
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Affiliation(s)
- Nam Sik Yoon
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
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Páll D, Juhász M, Lengyel S, Molnár C, Paragh G, Fülesdi B, Katona É. Assessment of target-organ damage in adolescent white-coat and sustained hypertensives. J Hypertens 2010; 28:2139-44. [DOI: 10.1097/hjh.0b013e32833cd2da] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Páll D, Lengyel S, Komonyi É, Molnár C, Paragh G, Fülesdi B, Katona É. Impaired cerebral vasoreactivity in white coat hypertensive adolescents. Eur J Neurol 2010; 18:584-9. [DOI: 10.1111/j.1468-1331.2010.03209.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
The guidelines of the Joint National Committee 7 from the USA on hypertension have unified the normal and high-normal blood pressure categories into a single entity termed ;prehypertension'. In contrast, The European Guidelines for the management of hypertension in 2007 considered ;prehypertensive' to be divided into normal and high-normal blood pressure. These patients with high-normal blood pressure or prehypertension might progress to hypertension over time. Previous studies have shown that high-normal blood pressure is a risk factor for cardiovascular disease (CVD) in Western countries and Japan. The combination of high-normal blood pressure and other cardiovascular risk factors increases the risks of CVD. Recently, metabolic syndrome has also been shown to be a risk factor for CVD. In Japan, the association between metabolic syndrome and CVD was also found to be significant. The risks for CVD incidence were similar among participants who had the same number of components, regardless of the presence of abdominal obesity. In the Japanese guidelines for the management of hypertension published in 2009, patients are considered to be in a high-risk group if they have diabetes, chronic kidney disease, 3 or more risk factors, target organ damage or CVD, even if they have only high-normal blood pressure, and appropriate antihypertensive therapy should be initiated.
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Affiliation(s)
- Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cardiovascular Center, Suita, Japan.
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Is prehypertension an independent predictor of target organ changes in young-to-middle-aged persons of African descent? J Hypertens 2008; 26:2279-87. [DOI: 10.1097/hjh.0b013e328311f296] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kokubo Y, Kamide K, Okamura T, Watanabe M, Higashiyama A, Kawanishi K, Okayama A, Kawano Y. Impact of High-Normal Blood Pressure on the Risk of Cardiovascular Disease in a Japanese Urban Cohort. Hypertension 2008; 52:652-9. [DOI: 10.1161/hypertensionaha.108.118273] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Few prospective studies have examined the association between high-normal blood pressure and cardiovascular disease (CVD) in Asia. We examined the impact of high-normal blood pressure on the incidence of CVD in a general urban population cohort in Japan. We studied 5494 Japanese individuals (ages 30 to 79 years without CVD at baseline) after completing a baseline survey who received follow-up through December 2005. Blood pressure categories were defined on the basis of the ESH-ESC 2007 criteria. In 64 391 person-years of follow-up, we documented the incidence of 346 CVD events. The frequencies of high-normal blood pressure and hypertension Stage 1 and Stage ≥2 were 18.0%, 20.1%, and 10.1% for men and 15.9%, 15.6%, and 8.8% for women, respectively. Antihypertensive drug users were also classified into the baseline blood pressure categories. Compared with the optimal blood pressure group, the multivariable hazard ratios (95% confidence intervals) of CVD for normal and high-normal blood pressure and hypertension Stage 1 and Stage ≥2 were 2.04 (1.19 to 3.48), 2.46 (1.46 to 4.14), 2.62 (1.59 to 4.32), and 3.95 (2.37 to 6.58) in men and 1.12 (0.59 to 2.13), 1.54 (0.85 to 2.78), 1.35 (0.75 to 2.43), and 2.86 (1.60 to 5.12) in women, respectively. The risks of myocardial infarction and stroke for each blood pressure category were similar to those of CVD. Population-attributable fractions of high-normal blood pressure and hypertension for CVD were 12.2% and 35.3% in men and 7.1% and 23.4% in women, respectively. In conclusion, high-normal blood pressure is a risk factor for the incidence of stroke and myocardial infarction in a general urban population of Japanese men.
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Affiliation(s)
- Yoshihiro Kokubo
- From the Department of Preventive Cardiology (Y. Kokubo, T.O., M.W., A.H., A.O.) and the Division of Hypertension and Nephrology (K. Kamide, Y. Kawano), National Cardiovascular Center, Osaka, Japan; The Suita Medical Association (K. Kawanishi), Osaka, Japan; and the Japan Anti-Tuberculosis Association (A.O.), Tokyo, Japan
| | - Kei Kamide
- From the Department of Preventive Cardiology (Y. Kokubo, T.O., M.W., A.H., A.O.) and the Division of Hypertension and Nephrology (K. Kamide, Y. Kawano), National Cardiovascular Center, Osaka, Japan; The Suita Medical Association (K. Kawanishi), Osaka, Japan; and the Japan Anti-Tuberculosis Association (A.O.), Tokyo, Japan
| | - Tomonori Okamura
- From the Department of Preventive Cardiology (Y. Kokubo, T.O., M.W., A.H., A.O.) and the Division of Hypertension and Nephrology (K. Kamide, Y. Kawano), National Cardiovascular Center, Osaka, Japan; The Suita Medical Association (K. Kawanishi), Osaka, Japan; and the Japan Anti-Tuberculosis Association (A.O.), Tokyo, Japan
| | - Makoto Watanabe
- From the Department of Preventive Cardiology (Y. Kokubo, T.O., M.W., A.H., A.O.) and the Division of Hypertension and Nephrology (K. Kamide, Y. Kawano), National Cardiovascular Center, Osaka, Japan; The Suita Medical Association (K. Kawanishi), Osaka, Japan; and the Japan Anti-Tuberculosis Association (A.O.), Tokyo, Japan
| | - Aya Higashiyama
- From the Department of Preventive Cardiology (Y. Kokubo, T.O., M.W., A.H., A.O.) and the Division of Hypertension and Nephrology (K. Kamide, Y. Kawano), National Cardiovascular Center, Osaka, Japan; The Suita Medical Association (K. Kawanishi), Osaka, Japan; and the Japan Anti-Tuberculosis Association (A.O.), Tokyo, Japan
| | - Katsuyuki Kawanishi
- From the Department of Preventive Cardiology (Y. Kokubo, T.O., M.W., A.H., A.O.) and the Division of Hypertension and Nephrology (K. Kamide, Y. Kawano), National Cardiovascular Center, Osaka, Japan; The Suita Medical Association (K. Kawanishi), Osaka, Japan; and the Japan Anti-Tuberculosis Association (A.O.), Tokyo, Japan
| | - Akira Okayama
- From the Department of Preventive Cardiology (Y. Kokubo, T.O., M.W., A.H., A.O.) and the Division of Hypertension and Nephrology (K. Kamide, Y. Kawano), National Cardiovascular Center, Osaka, Japan; The Suita Medical Association (K. Kawanishi), Osaka, Japan; and the Japan Anti-Tuberculosis Association (A.O.), Tokyo, Japan
| | - Yuhei Kawano
- From the Department of Preventive Cardiology (Y. Kokubo, T.O., M.W., A.H., A.O.) and the Division of Hypertension and Nephrology (K. Kamide, Y. Kawano), National Cardiovascular Center, Osaka, Japan; The Suita Medical Association (K. Kawanishi), Osaka, Japan; and the Japan Anti-Tuberculosis Association (A.O.), Tokyo, Japan
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Aiyer AN, Kip KE, Mulukutla SR, Marroquin OC, Hipps L, Reis SE. Predictors of significant short-term increases in blood pressure in a community-based population. Am J Med 2007; 120:960-7. [PMID: 17976423 DOI: 10.1016/j.amjmed.2007.06.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Revised: 06/05/2007] [Accepted: 06/18/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Blood pressure predicts the risk of cardiovascular disease events in a linear, graded manner. Factors associated with significant short-term increases in blood pressure are not well established. We aimed to identify predictors of a significant increase in blood pressure over a 1-year period among nonhypertensive, community-dwelling adults. METHODS From the community-based Heart Strategies Concentrating on Risk Evaluation study, 509 nonhypertensive adults (mean age 58 years; 68% were female; 24% were black) had baseline and 1-year assessments of blood pressure. Demographics, medical history, anthropometrics, lipids/lipoproteins, physical activity, and psychologic status were measured at both intervals. A "significant" increase in blood pressure was defined as an increase in systolic blood pressure of greater than 20 mm Hg, diastolic blood pressure of greater than 10 mm Hg, or initiation of antihypertensive medication. RESULTS At 1 year, 22% of participants had a significant increase in blood pressure. In multivariable analysis, baseline body mass index (BMI) and a greater than 5% increase in weight or waist circumference were associated with a significant increase in blood pressure (adjusted relative risk 2.09; 95% confidence interval, 1.35-3.21). The adverse effect of an increase in weight and waist circumference on blood pressure was evident in subgroup analyses by age, race, baseline BMI, and regular exercise. CONCLUSIONS Baseline BMI and a greater than 5% increase in weight or waist circumference over 1 year are associated with a significant increase in blood pressure. These data emphasize the need for weight maintenance. They also serve to stratify individuals who may benefit from close clinical observation and preventive intervention.
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Affiliation(s)
- Aryan N Aiyer
- The Cardiovascular Institute, University of Pittsburgh, University Center, Pittsburgh, Pa 15213, USA.
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Kwok RK, Mendola P, Liu ZY, Savitz DA, Heiss G, Ling HL, Xia Y, Lobdell D, Zeng D, Thorp JM, Creason JP, Mumford JL. Drinking water arsenic exposure and blood pressure in healthy women of reproductive age in Inner Mongolia, China. Toxicol Appl Pharmacol 2007; 222:337-43. [PMID: 17509635 DOI: 10.1016/j.taap.2007.04.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Revised: 04/02/2007] [Accepted: 04/09/2007] [Indexed: 11/24/2022]
Abstract
The extremely high exposure levels evaluated in prior investigations relating elevated levels of drinking water arsenic and hypertension prevalence make extrapolation to potential vascular effects at lower exposure levels very difficult. A cross-sectional study was conducted on 8790 women who had recently been pregnant in an area of Inner Mongolia, China known to have a gradient of drinking water arsenic exposure. This study observed increased systolic blood pressure levels with increasing drinking water arsenic, at lower exposure levels than previously reported in the literature. As compared to the referent category (below limit of detection to 20 microg of As/L), the overall population mean systolic blood pressure rose 1.29 mm Hg (95% CI 0.82, 1.75), 1.28 mm Hg (95% CI 0.49, 2.07), and 2.22 mm Hg (95% CI 1.46, 2.97) as drinking water arsenic concentration increased from 21 to 50, 51 to 100, and >100 microg of As/L, respectively. Controlling for age and body weight (n=3260), the population mean systolic blood pressure rose 1.88 mm Hg (95% CI 1.03, 2.73), 3.90 mm Hg (95% CI 2.52, 5.29), and 6.83 mm Hg (95% CI 5.39, 8.27) as drinking water arsenic concentration increased, respectively. For diastolic blood pressure effect, while statistically significant, was not as pronounced as systolic blood pressure. Mean diastolic blood pressure rose 0.78 mm Hg (95% CI 0.39, 1.16), 1.57 mm Hg (95% CI 0.91, 2.22) and 1.32 mm Hg (95% CI 0.70, 1.95), respectively, for the overall population and rose 2.11 mm Hg (95% CI 1.38, 2.84), 2.74 mm Hg (95% CI 1.55, 3.93), and 3.08 mm Hg (95% CI 1.84, 4.31), respectively, for the adjusted population (n=3260) at drinking water arsenic concentrations of 21 to 50, 51 to 100, and >100 microg of As/L. If our study results are confirmed in other populations, the potential burden of cardiovascular disease attributable to drinking water arsenic is significant.
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Affiliation(s)
- Richard K Kwok
- RTI International, PO Box 12194, 3040 Cornwallis Rd., Research Triangle Park, NC 27709-2194, USA.
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Abstract
Systolic blood pressure (BP) of less than 140 mm Hg and diastolic BP of less than 90 mm Hg were previously considered normal. However, there was some evidence that even BP in the high reference range was associated with an increased risk of cardiovascular disease. The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure defined a new BP category "prehypertension" for systolic and diastolic BP: 120 to 139 mm Hg and 85 to 89 mm Hg, respectively. This new category is a continuum to hypertension and is a risk factor for cardiovascular disease. The progression of prehypertension to hypertension can be delayed or may be prevented by lifestyle changes.
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Affiliation(s)
- M Fareed K Suri
- Cerebrovascular Program, Division of Epidemiology and Outcomes Research, Zeenat Qureshi Stroke Research Center, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA
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14
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Qureshi AI, Suri MFK, Kirmani JF, Divani AA, Mohammad Y. Is prehypertension a risk factor for cardiovascular diseases? Stroke 2005; 36:1859-63. [PMID: 16081866 DOI: 10.1161/01.str.0000177495.45580.f1] [Citation(s) in RCA: 181] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The Joint National Committee on High Blood Pressure identified a new category of blood pressure in adults termed prehypertension. Our objective was to determine the long-term risk of cardiovascular diseases associated with this new category in a well-defined cohort of adults. METHODS We evaluated the association of prehypertension (120 to 139/80 to 89 mm Hg) and hypertension (>140/90 mm Hg) with the incidence of atherothrombotic brain infarction (ABI), all strokes, myocardial infarction (MI), and coronary artery disease (CAD) using pooled repeated measures and Cox proportional hazards analyses during follow-up after adjusting for age, gender, obesity, diabetes mellitus, hypercholesterolemia, cigarette smoking, and study period in a cohort of 5181 persons who participated in the Framingham Study. RESULTS Among the 11,116 person observations with a mean follow-up period of 9.9+/-1.0 years, prehypertension was not associated with an increased risk for ABI (relative risk [RR], 2.2; 95% CI, 0.5 to 9.3). Among the 11,802 person observations with a mean follow-up period of 9.7+/-1.5 years, prehypertension was associated with an increased risk for MI (RR, 3.5; 95% CI, 1.6 to 7.5). Prehypertension was also associated with an increased risk of CADs among the 11,570 person observations (RR, 1.7; 95% CI, 1.2 to 2.4). CONCLUSIONS Prehypertension appears to be associated with an increased risk of MI and CAD but not stroke. Further studies are required to confirm the anticipated benefits of identifying and intervening in persons with prehypertension.
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Affiliation(s)
- Adnan I Qureshi
- Zeenat Qureshi Stroke Research Center, Department of Neurology and Neurosciences, University of Medicine and Dentistry of New Jersey, Newark, USA.
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15
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Moser M. A "touch" of high blood pressure. J Clin Hypertens (Greenwich) 2002; 4:10-2. [PMID: 11821632 PMCID: PMC8099345 DOI: 10.1111/j.1524-6175.2002.01101.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Vasan RS, Larson MG, Leip EP, Evans JC, O'Donnell CJ, Kannel WB, Levy D. Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med 2001; 345:1291-7. [PMID: 11794147 DOI: 10.1056/nejmoa003417] [Citation(s) in RCA: 1235] [Impact Index Per Article: 53.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Information is limited regarding the absolute and relative risk of cardiovascular disease in persons with high-normal blood pressure (systolic pressure of 130 to 139 mm Hg, diastolic pressure of 85 to 89 mm Hg, or both). METHODS We investigated the association between blood-pressure category at base line and the incidence of cardiovascular disease on follow-up among 6859 participants in the Framingham Heart Study who were initially free of hypertension and cardiovascular disease. RESULTS A stepwise increase in cardiovascular event rates was noted in persons with higher baseline blood-pressure categories. The 10-year cumulative incidence of cardiovascular disease in subjects 35 to 64 years of age who had high-normal blood pressure was 4 percent (95 percent confidence interval, 2 to 5 percent) for women and 8 percent (95 percent confidence interval, 6 to 10 percent) for men; in older subjects (those 65 to 90 years old), the incidence was 18 percent (95 percent confidence interval, 12 to 23 percent) for women and 25 percent (95 percent confidence interval, 17 to 34 percent) for men. As compared with optimal blood pressure, high-normal blood pressure was associated with a risk-factor-adjusted hazard ratio for cardiovascular disease of 2.5 (95 percent confidence interval, 1.6 to 4.1) in women and 1.6 (95 percent confidence interval, 1.1 to 2.2) in men. CONCLUSIONS High-normal blood pressure is associated with an increased risk of cardiovascular disease. Our findings emphasize the need to determine whether lowering high-normal blood pressure can reduce the risk of cardiovascular disease.
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Affiliation(s)
- R S Vasan
- Framingham Heart Study, Mass 01702, USA.
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17
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Affiliation(s)
- J D Kay
- Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA.
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18
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Affiliation(s)
- A M Valente
- Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC 27710, USA.
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19
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Affiliation(s)
- A R Sinaiko
- University of Minnesota, Minneapolis 55455, USA.
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20
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Plavnik FL, Ajzen S, Kohlmann O, Tavares A, Zanella MT, Ribeiro AB, Ramos OL. Intima-media thickness evaluation by B-mode ultrasound. Correlation with blood pressure levels and cardiac structures. Braz J Med Biol Res 2000; 33:55-64. [PMID: 10625875 DOI: 10.1590/s0100-879x2000000100008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to analyze the thickness of the intima-media complex (IMC) using a noninvasive method. The carotid and femoral common arteries were evaluated by noninvasive B-mode ultrasound in 63 normotensive and in 52 hypertensive subjects and the thickness of the IMC was tested for correlation with blood pressure, cardiac structures and several clinical and biological parameters. The IMC was thicker in hypertensive than in normotensive subjects (0.67 +/- 0.13 and 0.62 +/- 0.16 vs 0.54 +/- 0.09 and 0.52 +/- 0.11 mm, respectively, P<0.0001). In normotensive patients, the simple linear regression showed significant correlations between IMC and age, body mass index and 24-h systolic blood pressure for both the carotid and femoral arteries. In hypertensives the carotid IMC was correlated with age and 24-h systolic blood pressure while femoral IMC was correlated only with 24-h diastolic blood pressure. Forward stepwise regression showed that age, body mass index and 24-h systolic blood pressure influenced the carotid IMC relationship (r2 = 0.39) in normotensives. On the other hand, the femoral IMC relationship was influenced by 24-h systolic blood pressure and age (r2 = 0.40). In hypertensives, age and 24-h systolic blood pressure were the most important determinants of carotid IMC (r2 = 0.37), while femoral IMC was influenced only by 24-h diastolic blood pressure (r2 = 0.10). There was an association between carotid IMC and echocardiographic findings in normotensives, while in hypertensives only the left posterior wall and interventricular septum were associated with femoral IMC. We conclude that age and blood pressure influence the intima-media thickness, while echocardiographic changes are associated with the IMC.
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Affiliation(s)
- F L Plavnik
- Nefrologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Davis PH, Dawson JD, Mahoney LT, Lauer RM. Increased carotid intimal-medial thickness and coronary calcification are related in young and middle-aged adults. The Muscatine study. Circulation 1999; 100:838-42. [PMID: 10458720 DOI: 10.1161/01.cir.100.8.838] [Citation(s) in RCA: 111] [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: 11/16/2022]
Abstract
BACKGROUND Increased carotid intimal-medial thickness (IMT) and coronary artery calcification (CAC) are used as 2 markers of early atherosclerosis. Our objectives were to assess whether increased IMT and CAC are related and to determine the relationship between cardiovascular risk factors and carotid IMT in young adults. METHODS AND RESULTS A sample of 182 men and 136 women aged 33 to 42 years living in Muscatine, Iowa, underwent B-mode carotid ultrasound to determine the mean of 12 measurements of maximal carotid IMT. CAC was defined as calcification in the proximal coronary arteries in >/=3 contiguous pixels with a density of >/=130 HU. The mean IMT was 0.788 mm (SD 0.127) for men and 0.720 mm (SD 0.105) for women. CAC was present in 27% of men and 14% of women and was significantly associated with IMT in men (P<0.025) and women (P<0.005). With multivariate analysis, after adjustment for age, significant risk factors for carotid IMT were LDL cholesterol (P<0.001) and pack-years of smoking (P<0.05) in men and LDL cholesterol (P<0.001) and systolic blood pressure (P<0.01) in women. These risk factors remained significant after CAC was included in the multivariate model. CONCLUSIONS There is an association between increased carotid IMT and CAC and between cardiovascular risk factors and increased IMT in young adults. Carotid IMT may provide information in addition to CAC that can be used to identify young adults with premature atherosclerosis.
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Affiliation(s)
- P H Davis
- Division of Cerebrovascular Diseases, Department of Neurology, College of Medicine, Iowa City, Iowa, USA.
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Pauletto P, Palatini P, Da Ros S, Pagliara V, Santipolo N, Baccillieri S, Casiglia E, Mormino P, Pessina AC. Factors underlying the increase in carotid intima-media thickness in borderline hypertensives. Arterioscler Thromb Vasc Biol 1999; 19:1231-7. [PMID: 10323774 DOI: 10.1161/01.atv.19.5.1231] [Citation(s) in RCA: 69] [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
To define the role played by various risk and behavioral factors in the increase of carotid intima-media thickness (IMT) observed in borderline hypertensives. Using B-mode ultrasonography, we compared 97 borderline hypertensives enrolled in the HARVEST study to 27 normotensive controls. Intima-media thickness was measured in the right and left common carotid artery, bulb, and internal carotid artery. Mean IMT (m-IMT), maximum IMT (M-IMT), the mean of M-IMT (M-MAX), and the prevalence of raised lesions (IMT>1 mm) were established. Compared to the controls, higher systolic BP, diastolic BP, mean arterial blood pressure levels and body mass index (BMI) were present in the borderline hypertensives, whereas age, smoking, physical activity, serum cholesterol, and triglycerides were similar. After adjusting for age, sex, heart rate, BMI, smoking, serum cholesterol, triglycerides, and physical activity, higher values of m-IMT and M-IMT were present in most carotid segments of borderline hypertensives compared with controls. After further adjustment for systolic BP and diastolic BP, differences were no longer significant. The adjusted M-MAX was 0.59+/-0.12 in borderline hypertensives compared with 0.50+/-0.10 in controls (P<0.001). After adjustment for systolic BP and diastolic BP it was 0.58+/-0.11 in borderline hypertensives compared with 0.50+/-0.12 in controls (P<0.005). In the various carotid segments, the prevalence of raised lesions was 1. 2% in borderline hypertensives compared with 0.3% in controls (P<0. 001). In the multivariate analysis m-IMT, M-IMT, and M-MAX were related to ambulatory mean arterial pressure, systolic BP and diastolic BP, serum cholesterol and triglycerides, BMI, age, and physical activity. Higher IMT values were found in subjects who were physically active than in those who were sedentary. In borderline hypertensives, an increase in IMT takes place not only in the common carotid artery but also in the bulb and the internal carotid segment. Blood pressure levels are a main determinant of m-IMT while the interaction of BP with other risk factors such as age and plasma lipids is more relevant for advanced intima-media thickening such as M-MAX.
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Affiliation(s)
- P Pauletto
- Dipartimento di Medicina Clinica e Sperimentale, Clinica Medica IV, Università degli Studi di Padova, Italy.
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Bonithon-Kopp C, Touboul PJ, Berr C, Magne C, Ducimetière P. Factors of carotid arterial enlargement in a population aged 59 to 71 years: the EVA study. Stroke 1996; 27:654-60. [PMID: 8614925 DOI: 10.1161/01.str.27.4.654] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND PURPOSE Factors of carotid arterial enlargement are not well known in general populations. The purpose of this study was to assess the cross-sectional associations of arterial wall lesions and cardiovascular risk factors with carotid lumen diameter in elderly subjects. METHODS B-mode ultrasound examinations of the carotid arteries and risk factor assessment were made in 1272 participants in the EVA (Etude sur le vieillissement artériel) Study, a longitudinal study designed to evaluate vascular and cognitive aging in men and women aged 59 to 71 years. Ultrasound examinations included measurements of intima-media thickness (IMT) and interadventitial and lumen diameters of the common carotid arteries and quantification of atherosclerotic plaques in extracranial carotid arteries. RESULTS Men showed greater IMT interadventitial and lumen diameters of the common carotid arteries than did women. In both sexes, common IMT and plaque score were positively associated with common interadventitial and lumen diameters. Stepwise multiple regression analysis showed that male sex, body height and weight, common IMT, plaque score, systolic blood pressure, and alcohol consumption were positively and independently related to lumen diameter. On the other hand, an independent negative association was observed between low density lipoprotein cholesterol and lumen diameter. CONCLUSIONS In 59- to 71-year-old subjects, increased IMT and atherosclerotic plaques were accompanied by an increase in lumen diameter of the common carotid arteries, indicating an overcompensation. Luminal enlargement observed with several risk factors and with high blood pressure in particular might be partially counteracted by high lipid levels.
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