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Vriend EMC, Galenkamp H, van Valkengoed IGM, van den Born BJH. Sex disparities in hypertension prevalence, blood pressure trajectories and the effects of anti-hypertensive treatment. Blood Press 2024; 33:2365705. [PMID: 38953911 DOI: 10.1080/08037051.2024.2365705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/01/2024] [Indexed: 07/04/2024]
Abstract
INTRODUCTION Sex differences in blood pressure (BP), hypertension and hypertension mediated cardiovascular complications have become an increasingly important focus of attention. This narrative review gives an overview of current studies on this topic, with the aim to provide a deeper understanding of the sex-based disparities in hypertension with essential insights for refining prevention and management strategies for both men and women. METHODS AND RESULTS We searched Medline, Embase and the Cochrane libray on sex differences in BP-trajectories and hypertension prevalence. In the past decade various population-based studies have revealed substantial sex-disparities in BP-trajectories throughout life with women having a larger increase in hypertension prevalence after 30 years of age and a stronger association between BP and cardiovascular disease (CVD). In general, the effects of antihypertensive treatment appear to be consistent across sexes in different populations, although there remains uncertainty about differences in the efficacy of BP lowering drugs below 55 years of age. CONCLUSION The current uniform approach to the diagnosis and management of hypertension in both sexes neglects the distinctions in hypertension, while the differences underscore the need for sex-specific recommendations, particularly for younger individuals. A major limitation hampering insights into sex differences in BP-related outcomes is the lack of sex-stratified analyses or an adequate representation of women. Additional large-scale, longitudinal studies are imperative.
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Affiliation(s)
- Esther M C Vriend
- Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health Research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam Public Health Research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Irene G M van Valkengoed
- Department of Public and Occupational Health, Amsterdam Public Health Research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bert-Jan H van den Born
- Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health Research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Suwannakhan A, Sangkongmuang O, Samanchai A, Thaitonglang S, Pattum P, Monkong W, Tuntiseranee K, Senarai T. Anatomical investigation of the morphometry of the cerebral arteries using digital subtraction angiography in the Thai population. Surg Radiol Anat 2024:10.1007/s00276-024-03484-w. [PMID: 39292256 DOI: 10.1007/s00276-024-03484-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 09/09/2024] [Indexed: 09/19/2024]
Abstract
PURPOSE The main purpose of this study was to investigate the dimensions of cerebral arteries in the Thai population using digital subtraction angiography (DSA), with a focus on the anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA). The research aimed to explore anatomical variations in diameters and lengths of these arteries across different sexes and age groups, which are crucial for cerebrovascular interventions. METHODS This retrospective study measured the diameters and lengths of the ACA, MCA, and PCA in 177 Thai patients with an average age of 47.6 years (range: 11-82 years) with normal cerebral angiograms. Digital subtraction angiography (DSA) was used for the measurements. RESULTS The study found significant sex-based differences in the mean diameters of the left ACA (males: 2.12 ± 0.28 mm, females: 1.92 ± 0.20 mm; p < 0.01), right MCA (males: 2.50 ± 0.25 mm, females: 2.31 ± 0.17 mm; p < 0.01), and left MCA (males: 2.44 ± 0.19 mm, females: 2.30 ± 0.17 mm; p < 0.01) with males exhibiting larger diameters. The right ACA length was significantly longer in males (15.46 ± 1.74 mm) compared to females (13.98 ± 1.92 mm; p < 0.01). While no significant age-related differences were observed in diameters, a significant increase in length with age was noted for the left ACA in the ≥ 60 years group (13.61 ± 1.64 mm) compared to the < 60 years group (12.63 ± 1.36 mm; p < 0.01). Among others, significant correlations were found between the diameters of the left ACA and right MCA (r = 0.699; p < 0.01), and a strong correlation between left ACA length and left PCA diameter (r = 0.975; p < 0.01). CONCLUSION The findings provide invaluable data for tailoring neurosurgical approaches and designing angiographic equipment for the Thai population, emphasizing the importance of considering anatomical variations in clinical practice. These results highlight the necessity for personalized medical care based on anatomical differences to improve cerebrovascular intervention outcomes.
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Affiliation(s)
- Athikhun Suwannakhan
- Department of Anatomy, Faculty of Science, Mahidol University, Bangkok, Thailand
| | | | - Apichaya Samanchai
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sararat Thaitonglang
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Panuwat Pattum
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Waranon Monkong
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Thanyaporn Senarai
- Electron Microscopy Unit, Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
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Baker-Smith CM. Tracking of blood pressure levels from childhood. Pediatr Nephrol 2024:10.1007/s00467-024-06485-4. [PMID: 39196350 DOI: 10.1007/s00467-024-06485-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 07/23/2024] [Accepted: 07/24/2024] [Indexed: 08/29/2024]
Abstract
The overall goal of this review is to summarize what is currently known regarding the tracking of blood pressure levels from early childhood into later adulthood and to describe the factors contributing to increased hypertension prevalence across the lifespan. This review describes 4 theoretical constructs of blood pressure trajectory across the lifespan: forward development, forward tracking, forward reversal, and maintenance of normal blood pressure levels.
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Affiliation(s)
- Carissa M Baker-Smith
- Nemours Center for Cardiovascular Research and Innovation, Nemours Cardiac Center, Nemours Children's Health, Preventive Cardiology Program, 1600 Rockland Road, Wilmington, DE, 19803, USA.
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Wang C, Liu S, Miao W, Ye N, Xie Z, Qiao L, Ouyang N, Yin Y, Sun Y, Sun G. Intensive blood pressure control in isolated systolic hypertension: a post hoc analysis of a cluster randomized trial. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 48:101127. [PMID: 39040034 PMCID: PMC11262169 DOI: 10.1016/j.lanwpc.2024.101127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/09/2024] [Accepted: 06/12/2024] [Indexed: 07/24/2024]
Abstract
Background The isolated systolic hypertension (ISH) is of high prevalence, with a relatively poor prognosis. However, there is still no direct evidence to demonstrate the benefits of intensive blood pressure (BP) control among these patients. We aimed to evaluate intensive BP control with the target of <130/80 mmHg in ISH. Methods This was a post hoc analysis of patients with ISH in the China Rural Hypertension Control Project (CRHCP), defined as systolic blood pressure (SBP) ≥ 140 mmHg and diastolic blood pressure (DBP) < 90 mmHg. The primary outcome was cardiovascular disease (CVD) including stroke, myocardial infarction, heart failure, and CVD death. Mixed-effect Cox proportional regression and generalized estimating equation models were used for analysis. Findings In total, 7981 patients were randomly assigned to the intervention group and 8005 to the usual care group between May 8 and November 27, 2018. The median follow-up was 3.02 years (25-75%: 2.98-3.06). Mean systolic/diastolic BP at the end of 36 months follow-up was 126.5/71.2 mmHg in the intensive BP control group and 148.1/78.6 mmHg in the usual care group. The intervention group presented a substantially lower rate of composite CVD compared with the usual care group (1.52% versus 2.30%/year; multiple-adjusted hazard ratio (HR): 0.64; 95% confidence interval (CI): 0.57-0.72; P < 0.001), especially for stroke (multiple-adjusted HR: 0.61; 95% CI: 0.53-0.70; P < 0.001), HF (multiple-adjusted HR: 0.57; 95% CI: 0.36-0.91; P = 0.017) and CVD death (multiple-adjusted HR: 0.64; 95% CI: 0.50-0.83; P < 0.001). The primary composite outcome was substantially reduced by 36% in the intervention group compared with the usual care group. The further interaction analysis revealed that the reduction of primary outcome by intervention was consistent across subgroups of sex, age, education level, history of CVD, use of antihypertensive medication and baseline DBP (P > 0.05 for all interaction test). The incidences of symptomatic hypotension, syncope injurious falls and renal outcomes did not differ between the two groups, even though hypotension was increased in intervention group (RR:1.71; 95% CI: 1.28-2.28; P < 0.001). Interpretation Intensive BP control (<130/80 mmHg) was effective and safe in patients with ISH for the prevention of CVD events. Funding The Ministry of Science and Technology (China) of China and the Science and Technology Program of Liaoning Province, China.
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Affiliation(s)
- Chang Wang
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Songyue Liu
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Wei Miao
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Ning Ye
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Ziyi Xie
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Lixia Qiao
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Nanxiang Ouyang
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Yangzhi Yin
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Yingxian Sun
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Guozhe Sun
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning 110001, China
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Skåra KH, Hernáez Á, Næss Ø, Fraser A, Lawlor DA, Burgess S, Brumpton BM, Magnus MC. Cardiovascular disease risk factors and infertility: multivariable analyses and one-sample Mendelian randomization analyses in the Trøndelag Health Study. Hum Reprod Open 2024; 2024:hoae033. [PMID: 38911051 PMCID: PMC11190059 DOI: 10.1093/hropen/hoae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 05/03/2024] [Indexed: 06/25/2024] Open
Abstract
STUDY QUESTION Are cardiovascular disease (CVD) risk factors causally associated with higher risk of infertility among women and men? SUMMARY ANSWER We found evidence to support a causal relationship between smoking initiation and history of infertility in women. WHAT IS KNOWN ALREADY Several CVD risk factors are associated with history of infertility. Previous studies using Mendelian randomization (MR) further support a causal relationship between BMI and infertility in women. STUDY DESIGN SIZE DURATION We used data from the Trøndelag Health Study (HUNT) in Norway, a prospective population-based cohort study, including 26 811 women and 15 598 men participating in three survey collections in 1995-1997 (HUNT2), 2006-2008 (HUNT3), and 2017-2019 (HUNT4). PARTICIPANTS/MATERIALS SETTING METHODS Our outcome was women's self-reported history of infertility, defined as ever having tried to conceive for 12 months or more or having used ART. We assigned the history of infertility reported by women to their male partners; therefore, the measure of infertility was on the couple level. We used both conventional multivariable analyses and one-sample MR analyses to evaluate the association between female and male CVD risk factors (including BMI, blood pressure, lipid profile measurements, and smoking behaviours) and history of infertility in women and men, separately. MAIN RESULTS AND THE ROLE OF CHANCE A total of 4702 women (18%) and 2508 men (16%) were classified with a history of infertility. We found a higher risk of infertility among female smokers compared to non-smokers in both multivariable and MR analyses (odds ratio (OR) in multivariable analysis, 1.20; 95% CI, 1.12-1.28; OR in MR analysis, 1.13; CI, 1.02-1.26), and potentially for higher BMI (OR in multivariable analysis, 1.13; CI, 1.09-1.18; OR in MR analysis, 1.11, CI, 0.92-1.34). In multivariable analysis in women, we also found evidence of associations between triglyceride levels, high-density lipoprotein cholesterol, lifetime smoking index, and smoking intensity with higher risk of infertility. However, these results were not consistent in MR analyses. We found no robust or consistent associations between male CVD risk factors and infertility. LIMITATIONS REASONS FOR CAUTION Our main limitation was that the CVD risk factors measured might not adequately capture the relevant time periods for when couples were trying to conceive. Additionally, we did not have information on causes of infertility in either women or men. WIDER IMPLICATIONS OF THE FINDINGS Women with infertility could have a worse CVD risk factor profile and thus public health interventions aimed at reducing the impact of some CVD risk factors, such as smoking and BMI, could reduce the burden of infertility. However, additional MR studies of the relationship between CVD risk factors and infertility with a larger sample size would be of value. STUDY FUNDING/COMPETING INTERESTS The study was supported by a grant from the European Research Council under the European Union's Horizon 2020 research and innovation program (grant agreements no. 947684). This research was also supported by the Research Council of Norway through its Centres of Excellence funding scheme (project no. 262700) and partly funded by the Research Council of Norway, project: Women's fertility-an essential component of health and well-being (project no. 320656). D.A.L. and A.F. work in a unit that is supported by the University of Bristol and the UK Medical Research Council (MC_UU_00011/6). D.A.L.'s contribution to the article is supported by the European Research Council (101021566), the British Heart Foundation (CH/F/20/90003 and AA/18/7/34219). S.B.'s contribution to the article is supported by the Wellcome Trust (225790/Z/22/Z). B.M.B. is funded by The Liaison Committee for education, research and innovation in Central Norway; and the Joint Research Committee between St. Olavs Hospital and the Faculty of Medicine and Health Sciences, NTNU. The genotyping in HUNT was financed by the National Institute of Health (NIH); University of Michigan; The Research Council of Norway; The Liaison Committee for education, research and innovation in Central Norway; and the Joint Research Committee between St. Olavs Hospital and the Faculty of Medicine and Health Sciences, NTNU. None of the funding organizations influenced the study design, reporting, or interpretation of results. The views expressed in the present article are those of the authors and not necessarily any acknowledged funding organization. D.A.L. reports grants from Medtronic Ltd and Roche Diagnostics outside the submitted work. The other authors have no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Karoline H Skåra
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Álvaro Hernáez
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Consorcio CIBER, M.P. Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
- Blanquerna School of Health Sciences, Universitat Ramon Llull, Barcelona, Spain
| | - Øyvind Næss
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Abigail Fraser
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Stephen Burgess
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ben M Brumpton
- HUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Levanger, Norway
- HUNT Research Centre, Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Levanger, Norway
- Clinic of Medicine, St Olavs Hospital, Trondheim University, Trondheim, Norway
| | - Maria C Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
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Haring B, Andrews CA, Hovey K, Shadyab AH, LaCroix A, Martin LW, Rosal MC, Kuller LH, Salmoirago-Blotcher E, Saquib N, Koo P, Laddu D, Stefanick ML, Manson JE, Wassertheil-Smoller S, LaMonte MJ. Systolic Blood Pressure and Survival to Very Old Age: Results From the Women's Health Initiative. Circulation 2024; 149:1568-1577. [PMID: 38623761 DOI: 10.1161/circulationaha.123.067302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 03/19/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND The relationship between systolic blood pressure (SBP) and longevity is not fully understood. We aimed to determine which SBP levels in women ≥65 years of age with or without blood pressure medication were associated with the highest probability of surviving to 90 years of age. METHODS The study population consisted of 16 570 participants enrolled in the Women's Health Initiative who were eligible to survive to 90 years of age by February 28, 2020, without a history of cardiovascular disease, diabetes, or cancer. Blood pressure was measured at baseline (1993 through 1998) and then annually through 2005. The outcome was defined as survival to 90 years of age with follow-up. Absolute probabilities of surviving to 90 years of age were estimated for all combinations of SBP and age using generalized additive logistic regression modeling. The SBP that maximized survival was estimated for each age, and a 95% CI was generated. RESULTS During a median follow-up of 19.8 years, 9723 of 16 570 women (59%) survived to 90 years of age. Women with an SBP between 110 and 130 mm Hg at attained ages of 65, 70, 75, and 80 years had a 38% (95% CI, 34%-48%), 54% (52%-56%), 66% (64%-67%), or 75% (73%-78%) absolute probability to survive to 90 years of age, respectively. The probability of surviving to 90 years of age was lower for greater SBP levels. Women at the attained age of 80 years with 0%, 20%, 40%, 60%, 80%, or 100% time in therapeutic range (defined as an SBP between 110 and 130 mm Hg) had a 66% (64%-69%), 68% (67%-70%), 71% (69%-72%), 73% (71%-74%), 75% (72%-77%), or 77% (74%-79%) absolute survival probability to 90 years of age. CONCLUSIONS For women >65 years of age with low cardiovascular disease and other chronic disease risk, an SBP level <130 mm Hg was found to be associated with longevity. These findings reinforce current guidelines targeting an SBP target <130 mm Hg in older women.
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Affiliation(s)
- Bernhard Haring
- Department of Medicine III, Saarland University, Homburg, Germany (B.H.)
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (B.H., S.W.-S.)
| | - Chris A Andrews
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-SUNY, Buffalo, NY (C.A.A., K.H., M.J.L.)
| | - Kathleen Hovey
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-SUNY, Buffalo, NY (C.A.A., K.H., M.J.L.)
| | - Aladdin H Shadyab
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine (A.H.S.), University of California, San Diego, La Jolla
- Herbert Wertheim School of Public Health and Human Longevity Science (A.H.S., A.L.), University of California, San Diego, La Jolla
| | - Andrea LaCroix
- Herbert Wertheim School of Public Health and Human Longevity Science (A.H.S., A.L.), University of California, San Diego, La Jolla
| | - Lisa Warsinger Martin
- Division of Cardiology, George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.)
| | - Milagros C Rosal
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.C.R.)
| | - Lewis H Kuller
- Department of Epidemiology, University of Pittsburgh, PA (L.H.K.)
| | | | - Nazmus Saquib
- College of Medicine, Sulaiman AlRajhi University, Saudi Arabia (N.S.)
| | - Patrick Koo
- Department of Pulmonary, Critical Care, and Sleep Medicine, Baroness Erlanger Hospital, University of Tennessee College of Medicine Chattanooga (P.K.)
| | - Deepika Laddu
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago (D.L.)
| | - Marcia L Stefanick
- Department of Medicine, Stanford University Medical Center, Palo Alto, CA (M.L.S.)
- Departments of Obstetrics and Gynecology, Stanford University, Palo Alto, CA (M.L.S.)
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.)
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (B.H., S.W.-S.)
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-SUNY, Buffalo, NY (C.A.A., K.H., M.J.L.)
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Leiherer A, Brozek W, Muendlein A, Ulmer H, Saely CH, Fraunberger P, Nagel G, Zitt E, Drexel H, Concin H. The value of earlier-in-life systolic and diastolic blood pressure for cardiovascular risk prediction. iScience 2024; 27:109097. [PMID: 38384855 PMCID: PMC10879708 DOI: 10.1016/j.isci.2024.109097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/20/2023] [Accepted: 01/30/2024] [Indexed: 02/23/2024] Open
Abstract
Blood pressure (BP) varies over a lifetime. This cardiovascular observation study (OS) compared the predictive value of earlier- and later-in-life blood pressure (BP) in 1,497 cardiovascular disease patients utilizing readings taken during a health survey (HS) and 15 years later from the same subjects at the baseline of this OS. Prediction of the cardiovascular risk during the OS follow-up (21 years) was significantly more effective if the earlier BP readings at HS were used instead of recent OS readings (NRI = 0.30, p < 0.001). For HS readings, each 10 mm Hg increase of systolic and diastolic BP was associated with a 17% and 20% higher risk, respectively. At OS, systolic BP lost significance and diastolic BP reversed its association. Noteworthy, different BP categorizations (European vs. US guidelines) yielded similar results. This study highlights the poor predictive power of BP readings in elderly cardiovascular disease patients but emphasizes the significant prognostic value of earlier-in-life BP.
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Affiliation(s)
- Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
- Medical Central Laboratories, Feldkirch, Austria
| | | | - Axel Muendlein
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Hanno Ulmer
- Agency for Preventive and Social Medicine, Bregenz, Austria
- Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph H. Saely
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Department of Internal Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Peter Fraunberger
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
- Medical Central Laboratories, Feldkirch, Austria
| | - Gabriele Nagel
- Agency for Preventive and Social Medicine, Bregenz, Austria
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine, Bregenz, Austria
- Department of Internal Medicine III, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
- Landeskrankenhausbetriebsgesellschaft, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Hans Concin
- Agency for Preventive and Social Medicine, Bregenz, Austria
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Jensen LJ. Functional, Structural and Proteomic Effects of Ageing in Resistance Arteries. Int J Mol Sci 2024; 25:2601. [PMID: 38473847 DOI: 10.3390/ijms25052601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
The normal ageing process affects resistance arteries, leading to various functional and structural changes. Systolic hypertension is a common occurrence in human ageing, and it is associated with large artery stiffening, heightened pulsatility, small artery remodeling, and damage to critical microvascular structures. Starting from young adulthood, a progressive elevation in the mean arterial pressure is evidenced by clinical and epidemiological data as well as findings from animal models. The myogenic response, a protective mechanism for the microcirculation, may face disruptions during ageing. The dysregulation of calcium entry channels (L-type, T-type, and TRP channels), dysfunction in intracellular calcium storage and extrusion mechanisms, altered expression of potassium channels, and a change in smooth muscle calcium sensitization may contribute to the age-related dysregulation of myogenic tone. Flow-mediated vasodilation, a hallmark of endothelial function, is compromised in ageing. This endothelial dysfunction is related to increased oxidative stress, lower nitric oxide bioavailability, and a low-grade inflammatory response, further exacerbating vascular dysfunction. Resistance artery remodeling in ageing emerges as a hypertrophic response of the vessel wall that is typically observed in conjunction with outward remodeling (in normotension), or as inward hypertrophic remodeling (in hypertension). The remodeling process involves oxidative stress, inflammation, reorganization of actin cytoskeletal components, and extracellular matrix fiber proteins. Reactive oxygen species (ROS) signaling and chronic low-grade inflammation play substantial roles in age-related vascular dysfunction. Due to its role in the regulation of vascular tone and structural proteins, the RhoA/Rho-kinase pathway is an important target in age-related vascular dysfunction and diseases. Understanding the intricate interplay of these factors is crucial for developing targeted interventions to mitigate the consequences of ageing on resistance arteries and enhance the overall vascular health.
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Affiliation(s)
- Lars Jørn Jensen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, DK-1870 Frederiksberg C, Denmark
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Guan T, Cao M, Zheng C, Zhou H, Wang X, Chen Z, Zhang L, Cao X, Tian Y, Guo J, Han X, Wang Z. Dose-response association between physical activity and blood pressure among Chinese adults: a nationwide cross-sectional study. J Hypertens 2024; 42:360-370. [PMID: 38037282 PMCID: PMC10763713 DOI: 10.1097/hjh.0000000000003587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 08/25/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVES The aim of this study was to examine the dose-response associations of physical activity with blood pressure (BP) and hypertension risk among Chinese adults. METHODS Derived from the national community-based China Hypertension Survey database during 2012--2015, a total of 203 108 residents aged at least 18 years were included. Individual-level physical activity was evaluated using a standardized questionnaire, and minutes of metabolic equivalent tasks per week (MET-min/week) were calculated, integrating domain, intensity, frequency, and duration. Multivariable linear and logistic regressions were used to estimate associations of physical activity with BP and hypertension risk, and restricted cubic spline regressions were performed for their nonlinear dose-response relationships. RESULTS Overall, the median total physical activity (TPA) was 3213.0 MET-min/week and the prevalence of physical inactivity was 14.8%. TPA was negatively associated with BP. Increasing TPA levels was related to a steep decrease in systolic BP, up to approximately 2500 MET-min/week, with more modest benefits above that level of TPA. Higher levels of domain-specific and intensity-specific physical activity were found to be associated with lower BP levels and hypertension risk, except for the association between vigorous-intensity physical activity and systolic BP. We found that TPA within the range of 2000--4000 MET-min/week, a higher frequency and shorter duration were inversely associated with diastolic BP levels. CONCLUSION Total, domain-specific, and intensity-specific physical activity were inversely related to BP levels, respectively, in a dose-response fashion. Of a given amount, higher-frequency, shorter-duration, and lower-intensity physical activity produced more beneficial effects.
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Affiliation(s)
| | - Man Cao
- School of Health Policy and Management
| | - Congyi Zheng
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital
| | - Haoqi Zhou
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital
| | - Xin Wang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital
| | - Zuo Chen
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital
| | - Linfeng Zhang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital
| | - Xue Cao
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital
| | - Yixin Tian
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital
| | - Jian Guo
- Medical Research Center
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | | | - Zengwu Wang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital
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10
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Yari-Boroujeni R, Farjad MF, Olazadeh K, Cheraghi L, Parvin P, Azizi F, Amiri P. The association between leisure-time physical activity and blood pressure changes from adolescence to young adulthood: Tehran Lipid and Glucose Study. Sci Rep 2023; 13:20965. [PMID: 38017282 PMCID: PMC10684687 DOI: 10.1038/s41598-023-48253-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 11/23/2023] [Indexed: 11/30/2023] Open
Abstract
The effectiveness of long-term leisure time physical activity (LTPA) on blood pressure (BP) changes is still under debate. Since adolescence lifestyle behaviors shape the adulthood health profile, this study aimed to investigate the sex-specific impact of LTPA on BP changes from adolescence to young adulthood. This longitudinal study uses the data of 1412 adolescents (52% females) aged 12-18 years through a median follow-up of 12.2 years in the Tehran Lipid and Glucose Study (TLGS) framework. LTPA was calculated using the reliable and valid Iranian version of the modified activity scale (MAQ), and BP was measured at least twice by trained physicians. The linear mixed model was used to examine the study variables, considering individual and intrapersonal differences during the study. The majority of participants consistently demonstrated insufficient LTPA throughout the follow-up assessments, ranging from 54.7 to 67.1% for males and 77.7-83.4% for females. Despite a declining trend in LTPA (β = - 2.77 for males and β = - 1.43 for females), an increasing trend was noticeable in SBP, DBP, and BMI (β = 1.38, β = 1.81, β = 0.97 for males, and β = 0.10, β = 0.20, β = 0.97 for females, respectively). The unadjusted model revealed a significant trend in all variables for both sexes, except for female BP (P = 0.45 for SBP and P = 0.83 for DBP). Using the adjusted model, no significant association was observed between LTPA and changes in BP over time in both sexes. Our study indicates no association between LTPA and BP changes from adolescence to young adulthood. Insufficient LTPA levels, particularly among Iranian females, are likely the primary factor. Further research is crucial to identify appropriate LTPA levels to promote cardiovascular health and implement targeted interventions to achieve optimal LTPA levels in the Iranian population.
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Affiliation(s)
- Reza Yari-Boroujeni
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O.Box: 19395-4763, Tehran, Iran
| | - Mohammad-Farid Farjad
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O.Box: 19395-4763, Tehran, Iran
| | - Keyvan Olazadeh
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O.Box: 19395-4763, Tehran, Iran
- Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Cheraghi
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O.Box: 19395-4763, Tehran, Iran
- Department of Epidemiology and Biostatistics, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parnian Parvin
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O.Box: 19395-4763, Tehran, Iran
| | - Fereidoun Azizi
- Research Institute for Endocrine Sciences, Endocrine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parisa Amiri
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O.Box: 19395-4763, Tehran, Iran.
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11
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Wang S, Adamian R, Heredia K, Elahi A, McCleary P, Hopkins W. Cardiovascular Youth for Life: Prevalence of Acquired Cardiovascular Diseases in the Adult Population With Down Syndrome. Am J Cardiol 2023; 207:10-12. [PMID: 37722195 DOI: 10.1016/j.amjcard.2023.08.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/20/2023]
Affiliation(s)
- Sean Wang
- Larner College of Medicine, University of Vermont, Burlington, Vermont.
| | - Robert Adamian
- Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Kiana Heredia
- Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Aria Elahi
- Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Paul McCleary
- Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - William Hopkins
- Department of Medicine, Cardiovascular Medicine, University of Vermont Medical Center, Burlington, Vermont
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12
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Öhlin J, Liv P, Andersson M, Järvholm B, Slunga Järvholm L, Stjernbrandt A, Wahlström V. Occupational physical activity and resting blood pressure in male construction workers. Int Arch Occup Environ Health 2023; 96:1283-1289. [PMID: 37725195 PMCID: PMC10560137 DOI: 10.1007/s00420-023-02006-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/01/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE This study investigated the association between occupational physical activity (OPA) and resting blood pressure in a cohort of Swedish construction workers. METHODS The final sample included 241,176 male construction workers. Occupations with low OPA were foremen and white-collar workers. The most frequent occupations in the medium OPA group were electricians, pipe workers, and machine operators, and in the high OPA group woodworkers, concrete workers, and painters. RESULTS Mixed effects models showed higher systolic and lower diastolic blood pressure with higher OPA, but the associations varied depending on the year of participation and participant age as shown by significant interaction terms (OPA*age, OPA*calendar year, age*calendar year). Age-stratified linear regression analyses showed a pattern of slightly higher systolic (1.49, 95% confidence interval: 1.08-1.90 mmHg) and lower diastolic (0.89, 95% confidence interval: 0.65-1.13 mmHg) blood pressure when comparing low with high OPA, but not among the oldest age groups. CONCLUSION Despite a rather large contrast in OPA, the differences in systolic and diastolic blood pressure according to OPA were small.
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Affiliation(s)
- Jerry Öhlin
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden.
| | - Per Liv
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Martin Andersson
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Bengt Järvholm
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Lisbeth Slunga Järvholm
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Albin Stjernbrandt
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Viktoria Wahlström
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
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13
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Maier JA, Andrés V, Castiglioni S, Giudici A, Lau ES, Nemcsik J, Seta F, Zaninotto P, Catalano M, Hamburg NM. Aging and Vascular Disease: A Multidisciplinary Overview. J Clin Med 2023; 12:5512. [PMID: 37685580 PMCID: PMC10488447 DOI: 10.3390/jcm12175512] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
Vascular aging, i.e., the deterioration of the structure and function of the arteries over the life course, predicts cardiovascular events and mortality. Vascular degeneration can be recognized before becoming clinically symptomatic; therefore, its assessment allows the early identification of individuals at risk. This opens the possibility of minimizing disease progression. To review these issues, a search was completed using PubMed, MEDLINE, and Google Scholar from 2000 to date. As a network of clinicians and scientists involved in vascular medicine, we here describe the structural and functional age-dependent alterations of the arteries, the clinical tools for an early diagnosis of vascular aging, and the cellular and molecular events implicated. It emerges that more studies are necessary to identify the best strategy to quantify vascular aging, and to design proper physical activity programs, nutritional and pharmacological strategies, as well as social interventions to prevent, delay, and eventually revert the disease.
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Affiliation(s)
- Jeanette A. Maier
- Department of Biomedical and Clinical Sciences, Università di Milano, 20157 Milano, Italy;
- VAS-European Independent foundation in Angiology/Vascular Medicine, 20157 Milano, Italy; (M.C.); (N.M.H.)
| | - Vicente Andrés
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Sara Castiglioni
- Department of Biomedical and Clinical Sciences, Università di Milano, 20157 Milano, Italy;
| | - Alessandro Giudici
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, 6229 ER Maastricht, The Netherlands;
- GROW School for Oncology and Reproduction, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Emily S. Lau
- Division of Cardiology Massachusetts General Hospital, Boston, MA 02114, USA;
| | - János Nemcsik
- Health Service of Zugló (ZESZ), Department of Family Medicine, Semmelweis University, Stáhly u. 7-9, 1085 Budapest, Hungary;
| | - Francesca Seta
- Vascular Biology Section, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA;
| | - Paola Zaninotto
- UCL Research Department of Epidemiology & Public Health, University College London, London WC1E 6BT, UK;
| | - Mariella Catalano
- VAS-European Independent foundation in Angiology/Vascular Medicine, 20157 Milano, Italy; (M.C.); (N.M.H.)
- Inter-University Research Center on Vascular Disease, Università di Milano, 20157 Milano, Italy
| | - Naomi M. Hamburg
- VAS-European Independent foundation in Angiology/Vascular Medicine, 20157 Milano, Italy; (M.C.); (N.M.H.)
- Vascular Biology Section, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA;
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14
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Liu H, Wang Y, Zhang B, Liu J, Huo Y, Cao S, Wu S, Wan Y, Xie X, Zeng L, Yan H, Dang S, Mi B. Associations between long-term blood pressure trajectory and all-cause and CVD mortality among old people in China. Front Cardiovasc Med 2023; 10:1157327. [PMID: 37663420 PMCID: PMC10471127 DOI: 10.3389/fcvm.2023.1157327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
Background Optimal blood pressure (BP) management strategy among the elderly remains controversial, with insufficient consideration of long-term BP trajectory. This study aimed to identify BP trajectory patterns as well as terminal BP trajectory among the Chinese elderly and to explore the relationships between BP trajectories and all-cause mortality and cardiovascular disease (CVD) mortality. Methods We included 11,181 participants older than 60 at baseline (mean age, 80.98 ± 10.71) with 42,871 routine BP measurements from the Chinese Longitudinal Healthy Longevity Survey. Latent class trajectory analysis and Cox proportional hazard model were conducted to identify trajectory patterns and their associations with mortality. Furthermore, we also applied mixed-effects model to identify terminal BP trajectories among the elderly. Results Compared with stable at normal high level trajectory, excess systolic BP (SBP) trajectory with decreasing trend was associated with a 34% (HR = 1.34, 95% CI: 1.23-1.45) higher risk of all-cause mortality. Considering the competing risk of non-CVD death, excess BP trajectory with decreasing trend had a more pronounced effect on CVD mortality, in which HR (95% CI) was 1.67 (1.17, 2.37). Similar results were also found in diastolic BP (DBP), pulse pressure (PP), and mean arterial pressure (MAP) trajectories. We further conducted a mixed-effects model and observed that SBP and PP trajectories first increased and began to decline slightly six years before death. In contrast, DBP and MAP showed continuous decline 15 years before death. Conclusion Long-term BP trajectory was associated with all-cause mortality, especially CVD mortality. Keeping a stable BP over time may be an important way for CVD prevention among the elderly.
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Affiliation(s)
- Huimeng Liu
- Department of Occupational and Environmental Health, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi’an, China
| | - Yutong Wang
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi’an, China
- Global Health Institute, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Binyan Zhang
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi’an, China
- Global Health Institute, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Jingchun Liu
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi’an, China
- Global Health Institute, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Yating Huo
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi’an, China
- Global Health Institute, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Suixia Cao
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi’an, China
- Global Health Institute, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Shaowei Wu
- Department of Occupational and Environmental Health, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Yong Wan
- Department of Geriatric Surgery, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Xinming Xie
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi'an, China
| | - Lingxia Zeng
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi’an, China
- Global Health Institute, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Hong Yan
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi’an, China
- Global Health Institute, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Shaonong Dang
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi’an, China
- Global Health Institute, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Baibing Mi
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi’an, China
- Global Health Institute, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Department of Geriatric Surgery, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, China
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi'an, China
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15
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Bager JE, Manhem K, Andersson T, Hjerpe P, Bengtsson-Boström K, Ljungman C, Mourtzinis G. Hypertension: sex-related differences in drug treatment, prevalence and blood pressure control in primary care. J Hum Hypertens 2023; 37:662-670. [PMID: 36658330 PMCID: PMC10403353 DOI: 10.1038/s41371-023-00801-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 12/15/2022] [Accepted: 01/05/2023] [Indexed: 01/20/2023]
Abstract
Antihypertensive treatment is equally beneficial for reducing cardiovascular risk in both men and women. Despite this, the drug treatment, prevalence and control of hypertension differ between men and women. Men and women respond differently, particularly with respect to the risk of adverse events, to many antihypertensive drugs. Certain antihypertensive drugs may also be especially beneficial in the setting of certain comorbidities - of both cardiovascular and extracardiac nature - which also differ between men and women. Furthermore, hypertension in pregnancy can pose a considerable therapeutic challenge for women and their physicians in primary care. In addition, data from population-based studies and from real-world data are inconsistent regarding whether men or women attain hypertension-related goals to a higher degree. In population-based studies, women with hypertension have higher rates of treatment and controlled blood pressure than men, whereas real-world, primary-care data instead show better blood pressure control in men. Men and women are also treated with different antihypertensive drugs: women use more thiazide diuretics and men use more angiotensin-enzyme inhibitors and calcium-channel blockers. This narrative review explores these sex-related differences with guidance from current literature. It also features original data from a large, Swedish primary-care register, which showed that blood pressure control was better in women than men until they reached their late sixties, after which the situation was reversed. This age-related decrease in blood pressure control in women was not, however, accompanied by a proportional increase in use of antihypertensive drugs and female sex was a significant predictor of less intensive antihypertensive treatment.
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Affiliation(s)
- Johan-Emil Bager
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Emergency Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Karin Manhem
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Emergency Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tobias Andersson
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Regionhälsan R&D Centre, Skaraborg Primary Care, Skövde, Sweden
| | - Per Hjerpe
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Regionhälsan R&D Centre, Skaraborg Primary Care, Skövde, Sweden
| | - Kristina Bengtsson-Boström
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Regionhälsan R&D Centre, Skaraborg Primary Care, Skövde, Sweden
| | - Charlotta Ljungman
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Georgios Mourtzinis
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine and Emergency Mölndal, Sahlgrenska University Hospital, Gothenburg, Sweden
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16
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Elfassy T, German C, Muntner P, Choi E, Contreras G, Shimbo D, Yang E. Blood Pressure and Cardiovascular Disease Mortality Among US Adults: A Sex-Stratified Analysis, 1999-2019. Hypertension 2023; 80:1452-1462. [PMID: 37254774 PMCID: PMC10330349 DOI: 10.1161/hypertensionaha.123.21228] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/03/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Most research examining the association between blood pressure (BP) and cardiovascular disease (CVD) is sex-agnostic. Our goal was to assess sex-specific associations between BP and CVD mortality. METHODS We combined ten cycles of the National Health and Nutrition Examination Survey (1999-2018), N=53 289. Blood pressure was measured 3× and averaged. Data were linked to National Death Index data, and CVD mortality through December 31, 2019, was defined from International Classification of Diseases, Tenth Revision codes. We estimated sex-stratified, multivariable-adjusted incidence rate ratios (IRRs) for CVD mortality. RESULTS Over a median follow-up of 9.5 years, there were 2405 CVD deaths. Associations between categories of systolic blood pressure (SBP) and diastolic blood pressure (DBP) with CVD mortality differed by sex (P<0.01). Among men, compared with SBP of 100 to <110 mm Hg, CVD mortality was 76% higher with SBP ≥160 mm Hg (IRR, 1.76 [95% CI, 1.27-2.44]). Among women, compared with SBP 100 to < 110 mm Hg, CVD mortality was 61% higher with SBP 130 to 139 mm Hg (IRR, 1.61 [95% CI, 1.02-2.55]), 75% higher with SBP 140 to 159 mm Hg (IRR, 1.75 [95% CI, 1.09-2.80]), and 113% higher with SBP≥160 mm Hg (IRR, 2.13 [95% CI, 1.35-3.36]). Compared with DBP 70 to <80 mm Hg, CVD mortality was higher with DBP <70 mm Hg and DBP≥80 mm Hg among men, and higher with DBP <50 mm Hg and DBP≥80 mm Hg among women. CONCLUSIONS The association between BP and CVD mortality differed by sex, with increased CVD mortality risk present at lower levels of systolic blood pressure among women compared with men.
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Affiliation(s)
- Tali Elfassy
- Katz Family Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Charles German
- Department of Medicine, University of Chicago Medicine, Chicago, IL
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham AL
| | - Eunhee Choi
- Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Gabriel Contreras
- Katz Family Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Daichi Shimbo
- Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Eugene Yang
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA
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17
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Haring B, Andrews CA, Hovey K, Shadyab AH, LaCroix A, Martin LW, Rosal MC, Kuller LH, Salmoirago-Blotcher E, Saquib N, Koo P, Laddu D, Stefanick ML, Manson JE, Wassertheil-Smoller S, LaMonte MJ. Systolic Blood Pressure and Survival to Very Old Age. Results from the Women's Health Initiative. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.22.23291783. [PMID: 37425845 PMCID: PMC10327241 DOI: 10.1101/2023.06.22.23291783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Background The association between systolic blood pressure (SBP) and longevity is not fully understood. We aimed to determine survival probabilities to age 90 for various SBP levels among women aged ≥ 65 years with or without BP medication. Methods We analyzed blood pressure data from participants in the Women's Health Initiative (n=16,570) who were aged 65 or older and without history of cardiovascular disease, diabetes or cancer. Blood pressure was measured at baseline (1993-1998) and then annually through 2005. The outcome was defined as survival to age 90 with follow-up until February 28, 2020. Results During a follow-up of 18 years, 9,723 (59%) of 16,570 women survived to age 90. The SBP associated with the highest probability of survival was about 120mmHg regardless of age. Compared to an SBP between 110 and 130 mmHg, women with uncontrolled SBP had a lower survival probability across all age groups and with or without BP medication. A 65-year-old women on BP medication with an interpolated SBP between 110 and 130 mmHg in 80% of the first 5 years of follow-up had a 31% (95% confidence interval, 24%, 38%) absolute survival probability. For those with 20% time in range, the probability was 21% (95% confidence interval, 16%, 26%). Conclusions An SBP level below 130 mmHg was found to be associated with longevity among older women. The longer SBP was controlled at a level between 110 and 130 mmHg, the higher the survival probability to age 90. Preventing age-related rises in SBP and increasing the time with controlled BP levels constitute important measures for achieving longevity.
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Affiliation(s)
- Bernhard Haring
- Department of Medicine III, Saarland University Hospital, Homburg, Saarland, Germany
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Chris A. Andrews
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo – SUNY, Buffalo, NY, USA
| | - Kathleen Hovey
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo – SUNY, Buffalo, NY, USA
| | - Aladdin H. Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA
| | - Andrea LaCroix
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA
| | - Lisa Warsinger Martin
- Division of Cardiology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Milagros C. Rosal
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Lewis H. Kuller
- Department of Epidemiology, University of Pittsburgh, PA, USA
| | | | - Nazmus Saquib
- College of Medicine, Sulaiman AlRajhi University, Saudi Arabia
| | - Patrick Koo
- Department of Pulmonary, Critical Care, and Sleep Medicine, Baroness Erlanger Hospital, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
| | - Deepika Laddu
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Marcia L. Stefanick
- Department of Medicine Stanford University Medical Center Palo Alto CA. Departments of Obstetrics and Gynecology, Stanford University, Palo Alto, CA
| | - JoAnn E. Manson
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Michael J. LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo – SUNY, Buffalo, NY, USA
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18
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Wakabayashi I. Effects of age on polycythemia, cardiometabolic risk and their associations in middle-aged men. J Diabetes Metab Disord 2023; 22:287-295. [PMID: 37255804 PMCID: PMC10225414 DOI: 10.1007/s40200-022-01130-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/17/2022] [Accepted: 09/15/2022] [Indexed: 06/01/2023]
Abstract
Background Polycythemia has been reported to be associated with cardiometabolic risk factors. However, it remains to be determined whether age affects their associations. Methods The subjects were 11,261 men at ages of 30 ~ 65 years who had received annual health checkup examinations. They were divided by age into four groups of 30 ~ 39, 40 ~ 49, 50 ~ 59 and 60 ~ 65 years. Variables related to polycythemia and cardiometabolic risk and their associations were compared in the different age groups. Results The prevalences of polycythemia and metabolic syndrome tended to be lower and higher, respectively, with an increase of age. Odds ratios (ORs) of subjects with vs. subjects without polycythemia for high LDL-C/HDL-C ratio and metabolic syndrome were significantly high in the age group of 30 ~ 39 years when compared with the reference level (OR with 95% confidence interval: 3.21 [2.35 ~ 4.37] [high LDL-C/HDL-C ratio] and 3.49 [2.38 ~ 5.12] [metabolic syndrome]) and tended to be lower with an increase of age (60 ~ 65 years, OR with 95% confidence interval: 1.36 [0.63 ~ 2.93] [high LDL-C/HDL-C ratio] and 1.88 [1.16 ~ 3.03] [metabolic syndrome]). Conclusion The prevalence of polycythemia was higher and its associations with cardiometabolic risk such as high LDL-C/HDL-C ratio and metabolic syndrome were stronger in the youngest group than in the older groups. The results suggest that early detection and correction of polycythemia are more effective than its later correction for prevention of cardiovascular disease in middle-aged men.
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Affiliation(s)
- Ichiro Wakabayashi
- Department of Environmental and Preventive Medicine, School of Medicine, Hyogo Medical University, Mukogawa-cho 1-1, 663-8501 Nishinomiya, Hyogo Japan
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19
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Koirala T, B C UB, Shrestha C, Paudel U, Dhital R, Pokharel S, Subedi M. Arterial hypertension and its covariates among nomadic Raute hunter-gatherers of Western Nepal: a mixed-method study. BMJ Open 2023; 13:e067312. [PMID: 36997254 PMCID: PMC10069499 DOI: 10.1136/bmjopen-2022-067312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVES To determine the prevalence of, and understand the factors associated with, hypertension among the nomadic Raute hunter-gatherers of Western Nepal. DESIGN A mixed-method study. SETTING The study was carried out at Raute temporary campsites in the Surkhet District of Karnali Province between May and September 2021. PARTICIPANTS The questionnaire-based survey included all males and non-pregnant females of the nomadic Raute group aged 15 years and above. In-depth interviews were conducted among purposively selected 15 Raute participants and four non-Raute key informants to help explain and enrich the quantitative findings. OUTCOME MEASURES The prevalence of hypertension (defined as brachial artery blood pressure of systolic ≥140 mm Hg and/or diastolic ≥90 mm Hg) and its sociodemographic, anthropometric and behavioural covariates. RESULTS Of the 85 eligible participants, 81 (median age 35 years (IQR: 26-51), 46.9% female) were included in the final analysis. Hypertension was found in 10.5% of females, 48.8% of males and 30.9% of the total population. Current alcohol and tobacco use were high (91.4% and 70.4%, respectively), with concerning high rates among youths. Males, older people, current drinkers and current tobacco users were more likely to have hypertension. Our qualitative analysis suggests that the traditional forest-based Raute economy is gradually transitioning into a cash-based one that heavily relies on government incentives. Consumption of commercial foods, drinks and tobacco products is increasing as their market involvement grows. CONCLUSION This study found a high burden of hypertension, alcohol and tobacco use among nomadic Raute hunter-gatherers facing socioeconomic and dietary transitions. Further research is needed to assess the long-term impact of these changes on their health. This study is expected to help appraise concerned policymakers of an emerging health concern and formulate context-specific and culturally sensitive interventions to limit hypertension-related morbidities and mortalities in this endangered population.
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Affiliation(s)
- Tapendra Koirala
- Dasharathpur Primary Health Care Center, Surkhet, Karnali Province, Nepal
- Department of Health Services, Ministry of Health and Population, Kathmandu, Bagmati Province, Nepal
| | - Udaya Bahadur B C
- Public Health Service Office Surkhet, Ministry of Social Development, Surkhet, Karnali Province, Nepal
| | - Carmina Shrestha
- Health Action and Research Pvt. Ltd, Kathmandu, Bagmati Province, Nepal
| | - Ujjawal Paudel
- Department of Health Services, Ministry of Health and Population, Kathmandu, Bagmati Province, Nepal
- Jibjibe Primary Health Care Center, Rasuwa, Bagmati Province, Nepal
| | - Rolina Dhital
- Health Action and Research Pvt. Ltd, Kathmandu, Bagmati Province, Nepal
| | - Sunil Pokharel
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Madhusudan Subedi
- Department of Community Health Sciences, Patan Academy of Health Sciences, Lalitpur, Bagmati Province, Nepal
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Abstract
PURPOSE OF REVIEW Acute aortic syndromes include acute aortic dissection, intramural hematoma, and penetrating aortic ulcer, and are associated with high mortality and morbidity. This review focuses on recent findings and current understanding of gender-related and sex-related differences in acute aortic syndromes. RECENT FINDINGS Large international and national registries, population studies, and multicentre national prospective cohort studies show evidence of sex differences in acute aortic syndromes. Recent studies of risk factors, aorta remodelling, and genetics provide possible biological basis for sex differences. The 2022 American College of Cardiology/American Heart Association Guidelines for the Diagnosis and Management of Aortic Disease revise recommendations for surgical management for aortic root and ascending aorta dilatation, which could impact outcome differences between the sexes. SUMMARY Acute aortic syndromes affect men more frequently than women. The prevalence of acute aortic syndromes and prevalence of many risk factors rise sharply with age in women leading to higher age at presentation for women. Times from symptom onset to presentation and presentation to diagnosis are delayed in female patients. Females with type A dissection are also more commonly treated conservatively than male counterparts. These factors likely contribute to higher early mortality and complications in women.
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21
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Halama D, Merkel H, Werdehausen R, Gaber K, Schob S, Quäschling U, Ziganshyna S, Hoffmann KT, Lindner D, Richter C. Reference Values of Cerebral Artery Diameters of the Anterior Circulation by Digital Subtraction Angiography: A Retrospective Study. Diagnostics (Basel) 2022; 12:2471. [PMID: 36292160 PMCID: PMC9600370 DOI: 10.3390/diagnostics12102471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/10/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022] Open
Abstract
A threshold-based classification of cerebral vasospasm needs reference values for intracranial vessel diameters on digital subtraction angiography (DSA). We aimed to generate adjusted reference values for this purpose by retrospectively analyzing angiograms and potential influencing factors on vessel diameters. Angiograms of the anterior circulation were evaluated in 278 patients aged 18−81 years. The vessel diameters of 453 angiograms (175 bilateral) were gathered from nine defined measuring sites. The effect sizes of physical characteristics (i.e., body weight and height, body mass index, gender, age, and cranial side) and anatomical variations were calculated with MANOVA. Segments bearing aneurysms were excluded for the calculation of reference values. Adjusted vessel diameters were calculated via linear regression analysis of the vessel diameter data. Vessel diameters increased with age and body height. Male and right-sided vessels were larger in diameter. Of the anatomical variations, only the hypoplastic/aplastic A1 segment had a significant influence (p < 0.05) on values of the anterior cerebral artery and the internal carotid artery with a small effect size (|ω2| > 0.01) being excluded from the reference values. We provide gender-, age-, and side-adjusted reference values and nomograms of arterial vessel diameters in the anterior circulation.
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Affiliation(s)
- Dirk Halama
- Department of Oral and Maxillofacial Surgery, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Helena Merkel
- Department of Neuroradiology, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Robert Werdehausen
- Department of Anesthesiology and Intensive Care Medicine, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Khaled Gaber
- Department of Neurosurgery, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Stefan Schob
- Department of Radiology, Halle University Hospital, 06120 Halle, Germany
| | - Ulf Quäschling
- Department of Radiology, Kantonsspital Baselland, 4410 Liestal, Switzerland
| | - Svitlana Ziganshyna
- Transplant Coordinator Unit, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Karl-Titus Hoffmann
- Department of Oral and Maxillofacial Surgery, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Dirk Lindner
- Department of Neurosurgery, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Cindy Richter
- Department of Oral and Maxillofacial Surgery, University of Leipzig Medical Center, 04103 Leipzig, Germany
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22
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Lin YT, Chen YR, Wei YC. Evaluating Sex Differences in the Effect of Increased Systolic Blood Pressure on the Risk of Cardiovascular Disease in Asian Populations: A Systematic Review and Meta-Analysis. Glob Heart 2022; 17:70. [PMID: 36382163 PMCID: PMC9541122 DOI: 10.5334/gh.1159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 09/09/2022] [Indexed: 11/20/2022] Open
Abstract
Background Cardiovascular disease (CVD) is a serious health concern worldwide, and half of the cases of CVD occur in Asia. Because hypertension or high blood pressure has been confirmed to be an important risk factor for CVD, controlling blood pressure is helpful for CVD prevention. Although many studies have shown a sex difference in the impact of blood pressure on the risk of CVD, the risk threshold of blood pressure remained the same for both sexes in the latest global guidelines. Objective The study aimed to evaluate sex differences in the effect of increased blood pressure on the risk of CVD in Asian populations. Methods In this study, we performed a systematic review via PubMed, Embase, and MEDLINE to select studies conducted with Asian populations published before 30 June 2021. Results Six female and eleven male effect sizes for CVD risk from six articles were identified. The unadjusted pooled effect size for CVD risk per 10-mmHg increase in systolic blood pressure was estimated to be 1.20 for females (95% confidence interval: [1.10, 1.32]) and 1.19 for males (95% confidence interval: [1.11, 1.27]). Furthermore, using meta-regression to adjust for the significant effect of smoking, we showed that the impact of a 10-mmHg systolic blood pressure increase on CVD risk among females was 1.232 times that among males, corresponding to a significant sex difference (95% confidence interval: [1.065, 1.426]; P = 0.02). In summary, the effect of an increased systolic blood pressure on the risk of CVD in females was significantly higher than that in males in the Asian population.
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Affiliation(s)
- Yu-Ting Lin
- Institute of Public Health, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Yun-Ru Chen
- Institute of Public Health, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Yu-Chung Wei
- Institute of Public Health, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
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23
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Craighead DH, Tavoian D, Freeberg KA, Mazzone JL, Vranish JR, DeLucia CM, Seals DR, Bailey EF. A multi-trial, retrospective analysis of the antihypertensive effects of high-resistance, low-volume inspiratory muscle strength training. J Appl Physiol (1985) 2022; 133:1001-1010. [PMID: 36107991 PMCID: PMC9550580 DOI: 10.1152/japplphysiol.00425.2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/31/2022] [Accepted: 09/08/2022] [Indexed: 11/22/2022] Open
Abstract
Above-normal blood pressure (BP) is a primary risk factor for cardiovascular diseases. In a retrospective analysis of five pilot trials, we assessed the BP-lowering effects of high-resistance inspiratory muscle strength training (IMST) in adults aged 18-82 years and the impact of IMST on maximal inspiratory pressure (PIMAX), a gauge of inspiratory muscle strength and independent disease risk factor. Participants were randomized to high-resistance IMST (75% PIMAX) or low-resistance sham (15% PIMAX) training (30 breaths/day, 5-7 days/wk, 6 wk). IMST (n = 67) reduced systolic BP (SBP) by 9 ± 6 mmHg (P < 0.01) and diastolic BP (DBP) by 4 ± 4 mmHg (P < 0.01). IMST-related reductions in SBP and DBP emerged by week 2 of training (-4 ± 8 mmHg and -3 ± 6 mmHg; P ≤ 0.01, respectively) and continued across the 6-wk intervention. SBP and DBP were unchanged with sham training (n = 61, all P > 0.05). Select subject characteristics slightly modified the impact of IMST on BP. Greater reductions in SBP were associated with older age (β = -0.07 ± 0.03; P = 0.04) and greater reductions in DBP associated with medication-naïve BP (β = -3 ± 1; P = 0.02) and higher initial DBP (β = -0.12 ± 0.05; P = 0.04). PIMAX increased with high-resistance IMST and low-resistance sham training, with a greater increase from high-resistance IMST (+20 ± 17 vs. +6 ± 14 cmH2O; P < 0.01). Gains in PIMAX had a modest inverse relation with age (β = -0.20 ± 0.09; P = 0.03) and baseline PIMAX (β = -0.15 ± 0.07; P = 0.04) but not to reductions in SBP or DBP. These compiled findings from multiple independent trials provide the strongest evidence to date that high-resistance IMST evokes clinically significant reductions in SBP and DBP, and increases in PIMAX, in adult men and women.NEW & NOTEWORTHY In young-to-older adult men and women, 6 wk of high-resistance inspiratory muscle strength training lowers casual systolic and diastolic blood pressure by 9 mmHg and 4 mmHg, respectively, with initial reductions observed by week 2 of training. Given blood pressure outcomes with the intervention were only slightly altered by subject baseline characteristics (i.e., age, blood pressure medication, and health status), inspiratory muscle strength training is effective in lowering blood pressure in a broad range of adults.
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Affiliation(s)
- Daniel H Craighead
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Dallin Tavoian
- Department of Physiology, University of Arizona College of Medicine, Tucson, Arizona
| | - Kaitlin A Freeberg
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Josie L Mazzone
- Department of Physiology, University of Arizona College of Medicine, Tucson, Arizona
| | - Jennifer R Vranish
- Department of Integrative Physiology and Health Science, Alma College, Alma, Michigan
| | - Claire M DeLucia
- Department of Physiology, University of Arizona College of Medicine, Tucson, Arizona
| | - Douglas R Seals
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - E Fiona Bailey
- Department of Physiology, University of Arizona College of Medicine, Tucson, Arizona
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24
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Giger M, Anliker M, Bartelt G. [Polypharmacy and Neuroleptics in Swiss Nursing Homes in the Years 2019 and 2020]. PRAXIS 2022; 111:612-617. [PMID: 35975411 DOI: 10.1024/1661-8157/a003909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Polypharmacy and Neuroleptics in Swiss Nursing Homes in the Years 2019 and 2020 Abstract. We present data from 92404 clinical assessments from 619 Swiss nursing homes . The data were collected in 2019 and 2020 from over 65-year-old residents. Two-thirds of those studied had severe cognitive limitations, one quarter had significant behavioral disorders and just over half of the assessed patients showed signs of emotional instability or depression. 46% were treated with nine or more different drugs, 37% received a neuroleptic in 85% for more than 90 days. There is a positive correlation between the number of drugs taken, age, cognitive impairment and susceptibility to falls. Since neuroleptics are administered in 30% under uncertain indication and the susceptibility to falls is increased by 40% under neuroleptics, their use should be reduced in the course of structured interprofessional processes.
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25
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Zheng Y, You T, Du R, Zhang J, Peng T, Liang J, Zhao B, Ou H, Jiang Y, Feng H, Yilifate A, Lin Q. The Effect of Non-immersive Virtual Reality Exergames Versus Band Stretching on Cardiovascular and Cerebral Hemodynamic Response: A Functional Near-Infrared Spectroscopy Study. Front Hum Neurosci 2022; 16:902757. [PMID: 35903784 PMCID: PMC9314640 DOI: 10.3389/fnhum.2022.902757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background Exercise is one of the effective ways to improve cognition. Different forms of exercises, such as aerobic exercise, resistance exercise, and coordination exercise, have different effects on the improvement of cognitive impairment. In recent years, exergames based on Non-Immersive Virtual Reality (NIVR-Exergames) have been widely used in entertainment and have gradually been applied to clinical rehabilitation. However, the mechanism of NIVR-Exergames on improving motor cognition has not been clarified. Therefore, the aim of this study is to find whether NIVR-Exergames result in a better neural response mechanism to improve the area of the cerebral cortex related to motor cognition under functional near-infrared spectroscopy (fNIRS) dynamic monitoring in comparison with resistance exercise (resistance band stretching). Methods A cross-over study design was adopted in this study, and 15 healthy young subjects (18–24 years old) were randomly divided into group A (n = 8) and group B (n = 7) according to a computerized digital table method. Task 1 was an NIVR-Exergame task, and Task 2 was resistance band stretching. Group A first performed Task 1, rested for 30 min (i.e., a washout period), and then performed Task 2. Group B had the reverse order. The fNIRS test was synchronized in real time during exercise tasks, and heart rate measurements, blood pressure measurements, and 2-back task synchronization fNIRS tests were performed at baseline, Post-task 1, and Post-task 2. The primary outcomes were beta values from the general linear model (GLM) in different regions of interest (ROIs), and the secondary outcomes were heart rate, blood pressure, reaction time of 2-back, and accuracy rate of 2-back. Results The activation differences of Task 1 and Task 2 in the right premotor cortex (PMC) (P = 0.025) and the left PMC (P = 0.011) were statistically significant. There were statistically significant differences in the activation of the right supplementary motor area (SMA) (P = 0.007), left dorsolateral prefrontal cortex (DLPFC) (P = 0.031), left and right PMC (P = 0.005; P = 0.002) between baseline and Post-task 1. The differences in systolic pressure (SBP) between the two groups at three time points among women were statistically significant (P1 = 0.009, P2 < 0.001, P3 = 0.044). Conclusion In this study, we found that NIVR-Exergames combined with motor and challenging cognitive tasks can promote the activation of SMA, PMC and DLPFC in healthy young people compared with resistance exercise alone, providing compelling preliminary evidence of the power for the rehabilitation of motor and cognitive function in patients with central nervous system diseases.
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Affiliation(s)
- Yuxin Zheng
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Rehabilitation Medicine, The Fifth College of Guangzhou Medical University, Guangzhou, China
| | - Tingting You
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Rehabilitation Medicine, The Fifth College of Guangzhou Medical University, Guangzhou, China
| | - Rongwei Du
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Rehabilitation Medicine, The Fifth College of Guangzhou Medical University, Guangzhou, China
| | - Jiahui Zhang
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Rehabilitation Medicine, The Fifth College of Guangzhou Medical University, Guangzhou, China
| | - Tingting Peng
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Rehabilitation Medicine, The Fifth College of Guangzhou Medical University, Guangzhou, China
| | - Junjie Liang
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Rehabilitation Medicine, The Fifth College of Guangzhou Medical University, Guangzhou, China
| | - Biyi Zhao
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Rehabilitation Medicine, The Fifth College of Guangzhou Medical University, Guangzhou, China
| | - Haining Ou
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Rehabilitation Medicine, The Fifth College of Guangzhou Medical University, Guangzhou, China
| | - Yongchun Jiang
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Rehabilitation Medicine, The Fifth College of Guangzhou Medical University, Guangzhou, China
| | - Huiping Feng
- Department of Clinical Nutrition, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Huiping Feng,
| | - Anniwaer Yilifate
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Rehabilitation Medicine, The Fifth College of Guangzhou Medical University, Guangzhou, China
- Anniwaer Yilifate,
| | - Qiang Lin
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Rehabilitation Medicine, The Fifth College of Guangzhou Medical University, Guangzhou, China
- *Correspondence: Qiang Lin,
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Craighead DH, Freeberg KA, Maurer GS, Myers VH, Seals DR. Translational Potential of High-Resistance Inspiratory Muscle Strength Training. Exerc Sport Sci Rev 2022; 50:107-117. [PMID: 35394978 PMCID: PMC9203907 DOI: 10.1249/jes.0000000000000293] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Age-associated cardiovascular (CV) dysfunction increases the risk for CV diseases. Aerobic exercise training can improve CV function, but only a minority of adults meet aerobic exercise guidelines. High-resistance inspiratory muscle strength training is a time-efficient lifestyle intervention that may promote adherence and improve CV function. However, further investigation is needed to translate inspiratory muscle strength training into the public health domain.
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Affiliation(s)
- Daniel H. Craighead
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Kaitlin A. Freeberg
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Grace S. Maurer
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | | | - Douglas R. Seals
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
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Caraballo C, Mahajan S, Gu J, Lu Y, Spatz ES, Dreyer RP, Zhang M, Sun N, Ren Y, Zheng X, Zhao H, Lu H, Ma ZJ, Krumholz HM. Hemodynamic differences between women and men with elevated blood pressure in China: A non-invasive assessment of 45,082 adults using impedance cardiography. PLoS One 2022; 17:e0269777. [PMID: 35700163 PMCID: PMC9197037 DOI: 10.1371/journal.pone.0269777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 05/31/2022] [Indexed: 11/19/2022] Open
Abstract
Background Whether there are sex differences in hemodynamic profiles among people with elevated blood pressure is not well understood and could guide personalization of treatment. Methods and results We described the clinical and hemodynamic characteristics of adults with elevated blood pressure in China using impedance cardiography. We included 45,082 individuals with elevated blood pressure (defined as systolic blood pressure of ≥130 mmHg or a diastolic blood pressure of ≥80 mmHg), of which 35.2% were women. Overall, women had a higher mean systolic blood pressure than men (139.0 [±15.7] mmHg vs 136.8 [±13.8] mmHg, P<0.001), but a lower mean diastolic blood pressure (82.6 [±9.0] mmHg vs 85.6 [±8.9] mmHg, P<0.001). After adjusting for age, region, and body mass index, women <50 years old had lower systemic vascular resistance index (beta-coefficient [β] -31.7; 95% CI: -51.2, -12.2) and higher cardiac index (β 0.07; 95% CI: 0.04, 0.09) than men of their same age group, whereas among those ≥50 years old women had higher systemic vascular resistance index (β 120.4; 95% CI: 102.4, 138.5) but lower cardiac index (β -0.15; 95% CI: -0.16, -0.13). Results were consistent with a propensity score matching sensitivity analysis, although the magnitude of the SVRI difference was lower and non-significant. However, there was substantial overlap between women and men in the distribution plots of these variables, with overlapping areas ranging from 78% to 88%. Conclusions Our findings indicate that there are sex differences in hypertension phenotype, but that sex alone is insufficient to infer an individual’s profile.
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Affiliation(s)
- César Caraballo
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, United States of America
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America
| | - Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, United States of America
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America
| | - Jianlei Gu
- SJTU-Yale Joint Center for Biostatistics, School of Life Science and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Engineering Research Center for Big Data in Pediatric Precision Medicine, Shanghai, China
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, United States of America
| | - Erica S. Spatz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, United States of America
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America
| | - Rachel P. Dreyer
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - MaoZhen Zhang
- iKang Healthcare Group, Inc., Shanghai, China
- Department of Cardiology, Xinhua Hospital Affiliated with Shanghai Jiao Tong University, Shanghai, China
| | - NingLing Sun
- Department of Hypertension at Heart Center, Peking University People’s Hospital, Beijing, China
| | - Yihong Ren
- The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xin Zheng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongyu Zhao
- SJTU-Yale Joint Center for Biostatistics, School of Life Science and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
- Department of Biostatistics, School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Hui Lu
- SJTU-Yale Joint Center for Biostatistics, School of Life Science and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
- Center for Biomedical Informatics, Shanghai Children’s Hospital, Shanghai, China
| | - Zheng J. Ma
- SJTU-Yale Joint Center for Biostatistics, School of Life Science and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
- Department of Biostatistics, School of Public Health, Yale University, New Haven, Connecticut, United States of America
- Beijing Li-Heng Medical Technologies, Ltd, Beijing, China
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, United States of America
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, United States of America
- * E-mail:
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Attenuation of the Counter-Regulatory Glucose Response in CVLM C1 Neurons: A Possible Explanation for Anorexia of Aging. Biomolecules 2022; 12:biom12030449. [PMID: 35327640 PMCID: PMC8945993 DOI: 10.3390/biom12030449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/03/2022] [Indexed: 12/19/2022] Open
Abstract
This study aimed to determine the effect of age on CVLM C1 neuron glucoregulatory proteins in the feeding pathway. Male Sprague Dawley rats aged 3 months and 24 months old were divided into two subgroups: the treatment group with 2-deoxy-d-glucose (2DG) and the control group. Rat brains were dissected to obtain the CVLM region of the brainstem. Western blot was used to determine protein expression of tyrosine hydroxylase (TH), phosphorylated TH at Serine40 (pSer40TH), AMP-activated protein kinase (AMPK), phosphorylated AMPK (phospho AMPK), and neuropeptide Y Y5 receptors (NPY5R) in CVLM samples. Immunofluorescence was used to determine TH-, AMPK-, and NPY5R-like immunoreactivities among other brain coronal sections. Results obtained denote a decrease in basal TH phosphorylation levels and AMPK proteins and an increase in TH proteins among aged CVLM neurons. Increases in the basal immunoreactivity of TH+, AMPK+, NPY5R+, TH+/AMPK+, and TH+/NPY5R+ were also observed among old rats. Young treatment-group rats saw a decrease in TH phosphorylation and AMPK proteins following 2DG administration, while an increase in AMPK phosphorylation and a decrease in TH proteins were found among the old-treatment-group rats. These findings suggest the participation of CVLM C1 neurons in counter-regulatory responses among young and old rats. Altering protein changes in aged CVLM C1 neurons may attenuate responses to glucoprivation, thus explaining the decline in food intake among the elderly.
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Time-varying association between body mass index and all-cause mortality in patients with hypertension. Int J Obes (Lond) 2022; 46:316-324. [PMID: 34697410 DOI: 10.1038/s41366-021-00994-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/21/2021] [Accepted: 10/11/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Relationship between BMI and all-cause mortality in patients with hypertension remains controversial. This study aimed to evaluate the time-varying association between BMI in patients with hypertension and all-cause mortality. METHODS This population-based cohort study included 212,394 Chinese adults with hypertension from 2007 to 2015 and was followed up until death, loss-to-follow-up, or December 31, 2018. According to the World Health Organization criteria for Asians, BMI was categorized into five groups: underweight (BMI < 18.5 kg/m2), normal weight (18.5-22.9 kg/m2), overweight (23-24.9 kg/m2), class I obesity (25-29.9 kg/m2) and class II obesity (BMI ≥ 30 kg/m2). Cox model was used to estimate the time-varying association of BMI on the risk of mortality by including the interaction term between BMI and time using restricted cubic spline. RESULTS Compared with normal weight, underweight and class II obesity were associated with higher mortality (Hazard ratio [HRs] at 1 and 10 years of follow-up: 1.51 [95% CI: 1.39-1.65], and 1.27 (1.15-1.41) for underweight, respectively; 1.08 (0.96-1.21), and 1.16 (1.03-1.30) for class II obesity, respectively). However, overweight and class I obesity were associated with lower mortality, although the protective effects gradually attenuated over time (HRs at 1 and 10 years of follow-up: 0.85 (0.81-0.90), and 0.96 (0.91-1.02) for overweight, respectively; 0.80 (0.76-0.84), and 1.04 (0.99-1.10) for class I obesity, respectively). CONCLUSIONS We found increased mortality among hypertensive patients with underweight and class II obesity while decreased mortality with overweight and class I obesity was observed during the first 5 years of follow-up. Management efforts for hypertension may target controlling body weight in a reasonable range for patients, and probably more attention should be given to underweight patients.
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Graham LA, Lee SJ, Steinman MA, Peralta CA, Rubinsky AD, Jing B, Fung KZ, Odden MC. Exploring the Dynamics of Week-to-Week Blood Pressure in Nursing Home Residents Before Death. Am J Hypertens 2022; 35:65-72. [PMID: 34505872 DOI: 10.1093/ajh/hpab142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/25/2021] [Accepted: 09/09/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Aging is accompanied by an overall dysregulation of many dynamic physiologic processes including those related to blood pressure (BP). While year-to-year BP variability is associated with cardiovascular events and mortality, no studies have examined this trend with more frequent BP assessments. Our study objective is to take the next step to examine week-to-week BP dynamics-pattern, variability, and complexity-before death. METHODS Using a retrospective study design, we assessed BP dynamics in the 6 months before death in long-term nursing home residents between 1 October 2006 and 30 September 2017. Variability was characterized using SD and mean squared error after adjusting for diurnal variations. Complexity (i.e., amount of novel information in a trend) was examined using Shannon's entropy (bits). Generalized linear models were used to examine factors associated with overall BP variability. RESULTS We identified 17,953 nursing home residents (98.0% male, 82.5% White, mean age 80.2 years, and mean BP 125.7/68.6 mm Hg). Despite a slight trend of decreasing systolic week-to-week BP over time (delta = 7.2 mm Hg), week-to-week complexity did not change in the 6 months before death (delta = 0.02 bits). Average weekly BP variability was stable until the last 3-4 weeks of life, at which point variability increased by 30% for both systolic and diastolic BP. Factors associated with BP variability include average weekly systolic/diastolic BP, days in the nursing home, days in the hospital, and changes to antihypertensive medications. CONCLUSIONS Week-to-week BP variability increases substantially in the last month of life, but complexity does not change. Changes in care patterns may drive the increase in BP variability as one approaches death.
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Affiliation(s)
- Laura A Graham
- Health Economics Resource Center, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Sei J Lee
- San Francisco Health Care System, San Francisco, California, USA
- Division of Geriatrics, University of California, San Francisco, California, USA
| | - Michael A Steinman
- San Francisco Health Care System, San Francisco, California, USA
- Division of Geriatrics, University of California, San Francisco, California, USA
| | - Carmen A Peralta
- San Francisco Health Care System, San Francisco, California, USA
- Kidney Research Collaborative, University of California, San Francisco, California, USA
- Cricket Health, Inc., San Francisco, California, USA
| | - Anna D Rubinsky
- San Francisco Health Care System, San Francisco, California, USA
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Bocheng Jing
- San Francisco Health Care System, San Francisco, California, USA
- Division of Geriatrics, University of California, San Francisco, California, USA
| | - Kathy Z Fung
- San Francisco Health Care System, San Francisco, California, USA
- Division of Geriatrics, University of California, San Francisco, California, USA
| | - Michelle C Odden
- Department of Epidemiology and Population Health, Stanford University, Stanford, California, USA
- Geriatric Research Education and Clinical Center VA Palo Alto Health Care System, Palo Alto, California, USA
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Coiado OC, Yerrabelli RS, Christensen AP, Wozniak M, O'Brien WD. Investigation of the Effects of Cardiovascular Therapeutic Ultrasound Applied in Female and Male Rats' Hearts of Different Ages. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:166-180. [PMID: 34543195 PMCID: PMC8848473 DOI: 10.1109/tuffc.2021.3113867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This study investigates the role of age and sex on the cardiovascular effects of 3.5-MHz pulsed ultrasound (US) in a rat model. Ultrasonic bursts of 2.0-MPa peak rarefactional pressure amplitude (equivalent to an in vitro spatial-peak temporal-peak intensity of ~270 W/cm2 and a mechanical index of 1.1) were delivered in five consecutive 10-s intervals, one interval for each pulse repetition frequency (PRF) (6, 5, 4, 5, and 6 Hz; always the same order) for a total exposure duration of 50 consecutive seconds. Sixty F344 rats were split into 12 groups in a 3×2×2 factorial design (three ages, male versus female, and US application versus control). This study is the first study on US-induced cardiac effects that contains data across three age groups of rats (premenopause, fertile, and postmenopause) to mimic the fertile and nonfertile human window. US was applied transthoracically, while heart rate, stroke volume, ejection fraction, temperature, and other physiologic parameters were recorded at baseline and after exposure. Significant decreases in cardiac output compared to respective control groups were observed in multiple experimental groups, spanning both females and males. A negative chronotropic effect was observed in young male (~7%) and female (~16%) rats, in five-month-old male (~9%) and female (~15%) rats, and in old rats where the effect was not statistically significant. Younger groups and, to a lesser extent, lower weight groups generally had more significant effects. The pathophysiology of US-induced cardiovascular effects appears to be multifactorial and not strictly related to hormones, menopause, weight, sex, or age, individually.
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Stevens D, Lane DA, Harrison SL, Lip GYH, Kolamunnage-Dona R. Modelling of longitudinal data to predict cardiovascular disease risk: a methodological review. BMC Med Res Methodol 2021; 21:283. [PMID: 34922465 PMCID: PMC8684210 DOI: 10.1186/s12874-021-01472-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 11/15/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The identification of methodology for modelling cardiovascular disease (CVD) risk using longitudinal data and risk factor trajectories. METHODS We screened MEDLINE-Ovid from inception until 3 June 2020. MeSH and text search terms covered three areas: data type, modelling type and disease area including search terms such as "longitudinal", "trajector*" and "cardiovasc*" respectively. Studies were filtered to meet the following inclusion criteria: longitudinal individual patient data in adult patients with ≥3 time-points and a CVD or mortality outcome. Studies were screened and analyzed by one author. Any queries were discussed with the other authors. Comparisons were made between the methods identified looking at assumptions, flexibility and software availability. RESULTS From the initial 2601 studies returned by the searches 80 studies were included. Four statistical approaches were identified for modelling the longitudinal data: 3 (4%) studies compared time points with simple statistical tests, 40 (50%) used single-stage approaches, such as including single time points or summary measures in survival models, 29 (36%) used two-stage approaches including an estimated longitudinal parameter in survival models, and 8 (10%) used joint models which modelled the longitudinal and survival data together. The proportion of CVD risk prediction models created using longitudinal data using two-stage and joint models increased over time. CONCLUSIONS Single stage models are still heavily utilized by many CVD risk prediction studies for modelling longitudinal data. Future studies should fully utilize available longitudinal data when analyzing CVD risk by employing two-stage and joint approaches which can often better utilize the available data.
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Affiliation(s)
- David Stevens
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, L7 8TX, UK.,Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, L7 8TX, UK. .,Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK. .,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Stephanie L Harrison
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, L7 8TX, UK.,Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, L7 8TX, UK.,Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ruwanthi Kolamunnage-Dona
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
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Ramezankhani A, Azizi F, Momenan AA, Hadaegh F. Sex Differences in Cumulative Exposure to Metabolic Risk Factors Before Hypertension Onset: The Cohort of the Tehran Lipid and Glucose Study. J Am Heart Assoc 2021; 10:e021922. [PMID: 34779244 PMCID: PMC9075390 DOI: 10.1161/jaha.121.021922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Previous studies have shown a sex difference in the association between hypertension and cardiovascular disease; however, the precise mechanism remains unclear. Because there are strong associations between metabolic risk factors (MRFs) and hypertension, a sex‐specific analysis of MRFs before hypertension onset could offer new insights and expand our understanding of sex differences in cardiovascular disease. We evaluated cumulative exposure to major MRFs and rate of change of those factors, including body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, fasting plasma glucose, total cholesterol, triglycerides, and high‐density lipoprotein cholesterol among individuals who did and did not develop hypertension at follow‐up. Methods and Results We included 5374 participants (2191 men) initially without hypertension with age range of 20–50 years at baseline who participated in the Tehran Lipid and Glucose Study, and had been examined at least 3 times during the study period (1999–2018). In both sexes, the cumulative exposure to all MRFs (except for fasting plasma glucose and high‐density lipoprotein cholesterol in men) were higher in those who developed hypertension, compared with those who did not develop hypertension. However, women experienced greater cumulative exposure to major MRFs, compared with their male counterparts. Also, they experienced a faster increase in waist circumference, systolic blood pressure, diastolic blood pressure, and high‐density lipoprotein cholesterol than men. Furthermore, rapid increase in systolic blood pressure began earlier in women than men, at the age of 30 years. We also found that those men who developed hypertension experienced unfavorable change in major MRFs during young adulthood (<50 years of age). Conclusions Women exhibited more metabolic disturbances than men before onset of hypertension, which may explain the stronger impact of hypertension for major types of cardiovascular disease in women, compared with men.
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Affiliation(s)
- Azra Ramezankhani
- Prevention of Metabolic Disorders Research Center Research Institute for Endocrine Sciences Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Fereidoun Azizi
- Endocrine Research Center Research Institute for Endocrine Sciences Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Amir Abbas Momenan
- Prevention of Metabolic Disorders Research Center Research Institute for Endocrine Sciences Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center Research Institute for Endocrine Sciences Shahid Beheshti University of Medical Sciences Tehran Iran
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Harraz OF, Jensen LJ. Vascular calcium signalling and ageing. J Physiol 2021; 599:5361-5377. [PMID: 34705288 PMCID: PMC9002240 DOI: 10.1113/jp280950] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/12/2021] [Indexed: 02/05/2023] Open
Abstract
Changes in cellular Ca2+ levels have major influences on vascular function and blood pressure regulation. Vascular smooth muscle cells (SMCs) and endothelial cells (ECs) orchestrate vascular activity in distinct ways, often involving highly specific fluctuations in Ca2+ signalling. Ageing is a major risk factor for cardiovascular diseases, but the impact of ageing per se on vascular Ca2+ signalling has received insufficient attention. We reviewed the literature for age-related changes in Ca2+ signalling in relation to vascular structure and function. Vascular tone dysregulation in several vascular beds has been linked to abnormal expression or activity of SMC voltage-gated Ca2+ channels, Ca2+ -activated K+ channels or TRPC6 channels. Some of these effects were linked to altered caveolae density, microRNA expression or 20-HETE abundance. Intracellular store Ca2+ handling was suppressed in ageing mainly via reduced expression of intracellular Ca2+ release channels, and Ca2+ reuptake or efflux pumps. An increase in mitochondrial Ca2+ uptake, leading to oxidative stress, could also play a role in SMC hypercontractility and structural remodelling in ageing. In ECs, ageing entailed diverse effects on spontaneous and evoked Ca2+ transients, as well as structural changes at the EC-SMC interface. The concerted effects of altered Ca2+ signalling on myogenic tone, endothelium-dependent vasodilatation, and vascular structure are likely to contribute to blood pressure dysregulation and blood flow distribution deficits in critical organs. With the increase in the world's ageing population, future studies should be directed at solving specific ageing-induced Ca2+ signalling deficits to combat the imminent accelerated vascular ageing and increased risk of cardiovascular diseases.
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Affiliation(s)
- Osama F. Harraz
- Department of Pharmacology, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA,Vermont Center for Cardiovascular and Brain Health, University of Vermont, Burlington, Vermont, USA
| | - Lars Jørn Jensen
- Pathobiological Sciences, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg C, Denmark
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Rabaglino MB, Wakabayashi M, Pearson JT, Jensen LJ. Effect of age on the vascular proteome in middle cerebral arteries and mesenteric resistance arteries in mice. Mech Ageing Dev 2021; 200:111594. [PMID: 34756926 DOI: 10.1016/j.mad.2021.111594] [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] [Received: 05/05/2021] [Revised: 10/11/2021] [Accepted: 10/26/2021] [Indexed: 10/20/2022]
Abstract
Aging is associated with hypertension and brain blood flow dysregulation, which are major risk factors for cardiovascular and neurodegenerative diseases. Structural remodeling, endothelial dysfunction, or hypercontractility of resistance vessels may cause increased total peripheral resistance and hypertension. Recent studies showed that G protein- and RhoA/Rho-kinase pathways are involved in increased mean arterial pressure (MAP) and arterial tone in middle-aged mice. We aimed to characterize the age-dependent changes in the vascular proteome in normal laboratory mice using mass spectrometry and bioinformatics analyses on middle cerebral arteries and mesenteric resistance arteries from young (3 months) vs. middle-aged (14 months) mice. In total, 31 proteins were significantly affected by age whereas 172 proteins were differentially expressed by vessel type. Hierarchical clustering revealed that 207 proteins were significantly changed or clustered by age. Vitamin B6 pathway, Biosynthesis of antibiotics, Regulation of actin cytoskeleton and Endocytosis were the top enriched KEGG pathways by age. Several proteins in the RhoA/Rho-kinase pathway changed in a manner consistent with hypertension and dysregulation of cerebral perfusion. Although aging had a less profound effect than vessel type on the resistance artery proteome, regulation of actin cytoskeleton, including the RhoA/Rho-kinase pathway, is an important target for age-dependent hypertension.
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Affiliation(s)
- Maria Belen Rabaglino
- Dept. of Applied Mathematics and Computer Science, Danish Technical University, Denmark
| | - Masaki Wakabayashi
- Omics Research Center, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - James Todd Pearson
- Dept. of Cardiac Physiology, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan; Monash Biomedicine Discovery Institute and Department of Physiology, Monash University, Clayton, Australia
| | - Lars Jørn Jensen
- Dept. of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
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Zhang Z, Zhang T, Zhao E, Ding S, Kang X, Zhang W, Liu B, Liu H, Cheng A, Li G, Wang Q. Interaction of sex, age, body mass index and race on hypertension risk in the American population: a cross-sectional study. Eur J Public Health 2021; 31:1042-1047. [PMID: 34410370 DOI: 10.1093/eurpub/ckab107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The joint effects of sex, age, body mass index (BMI) and race on hypertension have not been fully addressed. Herein, we carried out this study aiming to investigate the possible effects of the interaction of sex, age, BMI and race on risk of hypertension. METHODS By using the data of a sample-adjusted 2656 women and 2515 men in American National Health and Nutrition Examination Survey 2015-16, we analyzed the interaction of sex, age, BMI and race by logistic regression models, followed by strata-specific analyses. Hypertension was defined as a systolic blood pressure ≥130 mmHg/diastolic blood pressure ≥80 mmHg or taking anti-hypertensive medication. RESULTS A total of 5171 participants were included in analysis, and the prevalence of hypertension was 53.68%. The interactive effect of sex and age, BMI and age, race and age were statistically significant on hypertension. Strata-specific analyses showed that female at 40 years and above were positively associated with hypertension than those at 20-39 years. The associations also persistence in male. The risk estimates for age ≥40 on hypertension were consistently positive across all overweight/obesity and race groups. The effect was most prominent among overweight populations aged 60-80 years and Other Hispanic aged 40 years and above. CONCLUSION There exists interactive effect of sex and age, BMI and age, race and age on hypertension in American population. The effect of age on hypertension was more prominent in female, overweight populations and Other Hispanic populations. Differences in age, BMI and race should be considered when providing corresponding antihypertensive measures.
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Affiliation(s)
- Zhenhong Zhang
- Public Health School, Medical College of Qingdao University, Qingdao, China
| | - Tao Zhang
- Qingdao Fuwai Cardiovascular Hospital, Qingdao, China
| | - Enhui Zhao
- Public Health School, Medical College of Qingdao University, Qingdao, China
| | - Shihan Ding
- Public Health School, Medical College of Qingdao University, Qingdao, China
| | - Xiao Kang
- Public Health School, Medical College of Qingdao University, Qingdao, China
| | - Wenwen Zhang
- Public Health School, Medical College of Qingdao University, Qingdao, China
| | - Bingkun Liu
- Public Health School, Medical College of Qingdao University, Qingdao, China
| | - Haoran Liu
- Public Health School, Medical College of Qingdao University, Qingdao, China
| | - Anlan Cheng
- Public Health School, Medical College of Qingdao University, Qingdao, China
| | - Guoju Li
- Qingdao Women and Children's Hospital, Qingdao University, Qingdao, China
| | - Qiuzhen Wang
- Public Health School, Medical College of Qingdao University, Qingdao, China
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Nwabuo CC, Appiah D, Moreira HT, Vasconcellos HD, Yano Y, Reis JP, Shah RV, Murthy VL, Allen NB, Sidney S, Muntner P, Lewis CE, Lloyd-Jones DM, Schreiner PJ, Gidding SS, Lima JA. Long-term cumulative blood pressure in young adults and incident heart failure, coronary heart disease, stroke, and cardiovascular disease: The CARDIA study. Eur J Prev Cardiol 2021; 28:1445-1451. [PMID: 34695218 PMCID: PMC8653578 DOI: 10.1177/2047487320915342] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/05/2020] [Indexed: 11/02/2023]
Abstract
AIMS Cumulative blood pressure (BP) is a measure that incorporates the severity and duration of BP exposure. The prognostic significance of cumulative BP in young adults for cardiovascular diseases (CVDs) in comparison to BP severity alone is, however, unclear. METHODS AND RESULTS We investigated 3667 Coronary Artery Risk Development in Young Adults participants who attended six visits over 15 years (year-0 (1985-1986), year-2, year-5, year-7, year-l0, and year-15 exams). Cumulative BP was calculated as the area under the curve (mmHg × years) from year 0 through year 15. Cox models assessed the association between cumulative BP (year 0 through year 15), current BP (year 15), and BP change (year 0 and year 15) and CVD outcomes. Mean (standard deviation) age at year 15 was 40.2 (3.6) years, 44.1% were men, and 44.1% were African-American. Over a median follow-up of 16 years, there were 47 heart failure (HF), 103 coronary heart disease (CHD), 71 stroke, and 191 CVD events. Cumulative systolic BP (SBP) was associated with HF (hazard ratio (HR) = 2.14 (1.58-2.90)), CHD (HR = 1.49 (1.19-1.87)), stroke (HR = 1.81 (1.38-2.37)), and CVD (HR = 1.73 (1.47-2.05)). For CVD, the C-statistic for SBP (year 15) was 0.69 (0.65-0.73) and change in C-statistic with the inclusion of SBP change and cumulative SBP was 0.60 (0.56-0.65) and 0.72 (0.69-0.76), respectively. For CVD, using year-15 SBP as a reference, the net reclassification index (NRI) for cumulative SBP was 0.40 (p < 0.0001) and the NRI for SBP change was 0.22 (p = 0.001). CONCLUSIONS Cumulative BP in young adults was associated with the subsequent risk of HF, CHD, stroke, and CVD. Cumulative BP provided incremental prognostic value and improved risk reclassification for CVD, when compared to single BP assessments or changes in BP.
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Affiliation(s)
| | - Duke Appiah
- Department of Public Health, Texas Tech University Health Sciences Center, USA
| | | | | | - Yuichiro Yano
- Department of Family Medicine and Community Health, Duke University, USA
| | | | | | | | | | - Stephen Sidney
- Kaiser Permanente Northern California, Division of Research, USA
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Mutz J, Lewis CM. Lifetime depression and age-related changes in body composition, cardiovascular function, grip strength and lung function: sex-specific analyses in the UK Biobank. Aging (Albany NY) 2021; 13:17038-17079. [PMID: 34233295 PMCID: PMC8312429 DOI: 10.18632/aging.203275] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/19/2021] [Indexed: 12/27/2022]
Abstract
Individuals with depression, on average, die prematurely, have high levels of physical comorbidities and may experience accelerated biological ageing. A greater understanding of age-related changes in physiology could provide novel biological insights that may help inform strategies to mitigate excess mortality in depression. We used generalised additive models to examine age-related changes in 15 cardiovascular, body composition, grip strength and lung function measures, comparing males and females with a lifetime history of depression to healthy controls. The main dataset included 342,393 adults (mean age = 55.87 years, SD = 8.09; 52.61% females). We found statistically significant case-control differences for most physiological measures. There was some evidence that age-related changes in body composition, cardiovascular function, lung function and heel bone mineral density followed different trajectories in depression. These differences did not uniformly narrow or widen with age and differed by sex. For example, BMI in female cases was 1.1 kg/m2 higher at age 40 and this difference narrowed to 0.4 kg/m2 at age 70. In males, systolic blood pressure was 1 mmHg lower in depression cases at age 45 and this difference widened to 2.5 mmHg at age 65. These findings suggest that targeted screening for physiological function in middle-aged and older adults with depression is warranted to potentially mitigate excess mortality.
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Affiliation(s)
- Julian Mutz
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, Greater London SE5 8AF, United Kingdom
| | - Cathryn M. Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, Greater London SE5 8AF, United Kingdom
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King’s College London, London, Greater London SE1 9RT, United Kingdom
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Association of age and blood pressure among 3.3 million adults: insights from China PEACE million persons project. J Hypertens 2021; 39:1143-1154. [PMID: 33967218 DOI: 10.1097/hjh.0000000000002793] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the association between blood pressure (BP) with age and its heterogeneity across various sociodemographic subgroups in China. METHODS In this cross-sectional study, we analysed the data from nearly 3.3 million individuals aged 35-75 years from all 31 provinces in mainland China collected from September 2014 through August 2019. On the basis of possible combinations of eight characteristics and antihypertensive status, subgroups of at least 10 000 individuals were created and the age--blood pressure relationship was determined for each group. RESULTS The study included 3 291 058 participants (59.6% women), with a mean age of 55.8 ± 9.8 years. The prevalence of hypertension was 47.6%, of which 30.0% were taking antihypertensive medications. The mean SBP was 135.9 ± 20.2 mmHg. SBP increased at a mean unadjusted rate of 0.639 ± 0.001 mmHg/year. For 95% of the 25 145 subgroups, the SBP increased by 0.28--0.85 mmHg/year. The most common characteristics in the subgroups with the steepest association were female sex, rural area, low education, low-income family, Tibet region, and farmer occupation. The increase in SBP ranged from 0.13 to 0.41 mmHg/year for 95% of the treated subgroups and from 0.33 to 0.82 mmHg/year for 95% of the untreated subgroups. CONCLUSION Blood pressure is positively associated with age in this study, with almost three-fold variation across subgroups, indicating subgroup differences in biology, behaviour, or exposures. Antihypertension strongly blunts the association of age and blood pressure and diminishes the variation.
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40
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Bundy JD, Jaeger BC, Huffman MD, Knox SS, Thomas SJ, Shimbo D, Booth JN, Lewis CE, Edwards LJ, Schwartz JE, Muntner P. Twenty-Five-Year Changes in Office and Ambulatory Blood Pressure: Results From the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Hypertens 2021; 34:494-503. [PMID: 33201230 PMCID: PMC8140654 DOI: 10.1093/ajh/hpaa189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/09/2020] [Accepted: 11/10/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Blood pressure (BP) measured in the office setting increases from early through later adulthood. However, it is unknown to what extent out-of-office BP derived via ambulatory BP monitoring (ABPM) increases over time, and which participant characteristics and risk factors might contribute to these increases. METHODS We assessed 25-year change in office- and ABPM-derived BP across sex, race, diabetes mellitus (DM), and body mass index (BMI) subgroups in the Coronary Artery Risk Development in Young Adults study using multivariable-adjusted linear mixed effects models. RESULTS We included 288 participants who underwent ABPM at the Year 5 Exam (mean [SD] age, 25.1 [3.7]; 45.8% men) and 455 participants who underwent ABPM at the Year 30 Exam (mean [SD] age, 49.5 [3.7]; 42.0% men). Office, daytime, and nighttime systolic BP (SBP) increased 12.8 (95% confidence interval [CI], 7.6-17.9), 14.7 (95% CI, 9.7-19.8), and 16.6 (95% CI, 11.4-21.8) mm Hg, respectively, over 25 years. Office SBP increased 6.5 (95% CI, 2.3-10.6) mm Hg more among black compared with white participants. Daytime SBP increased 6.3 (95% CI, 0.2-12.4) mm Hg more among participants with a BMI ≥25 vs. <25 kg/m2. Nighttime SBP increased 4.7 (95% CI, 0.5-8.9) mm Hg more among black compared with white participants, and 17.3 (95% CI, 7.2-27.4) mm Hg more among participants with vs. without DM. CONCLUSIONS Office- and ABPM-derived BP increased more from early through middle adulthood among black adults and participants with DM and BMI ≥25 kg/m2.
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Affiliation(s)
- Joshua D Bundy
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
- Tulane University Translational Science Institute, New Orleans, Louisiana, USA
| | - Byron C Jaeger
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mark D Huffman
- Department of Preventive Medicine and Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Sarah S Knox
- Department of Epidemiology, West Virginia University School of Public Health, Morgantown, West Virginia, USA
| | - S Justin Thomas
- Department of Psychiatry, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Daichi Shimbo
- Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - John N Booth
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- CTI Clinical Trials and Consulting Services, Inc., Covington, Kentucky, USA
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lloyd J Edwards
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Joseph E Schwartz
- Department of Psychiatry, Stony Brook University, New York, New York, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Moonen JE, Sabayan B, Sigurdsson S, van Buchem MA, Gudnason V, Meirelles O, Launer LJ. Contributions of Cerebral Blood Flow to Associations Between Blood Pressure Levels and Cognition: The Age, Gene/Environment Susceptibility-Reykjavik Study. Hypertension 2021; 77:2075-2083. [PMID: 33866797 DOI: 10.1161/hypertensionaha.120.16894] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Justine E Moonen
- From the Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, National Institute of Health, Baltimore, MD (J.E.M., O.M., L.J.L.)
| | - Behnam Sabayan
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Massachusetts General Hospital, Harvard Medical School, Boston (B.S.)
| | - Sigurdur Sigurdsson
- Icelandic Heart Association Research Institute, Kópavogur, Iceland (S.S., V.G.)
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, the Netherlands (M.A.v.B.)
| | - Vilmundur Gudnason
- Icelandic Heart Association Research Institute, Kópavogur, Iceland (S.S., V.G.).,University of Iceland, Reykjavik, Iceland (V.G.)
| | - Osorio Meirelles
- From the Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, National Institute of Health, Baltimore, MD (J.E.M., O.M., L.J.L.)
| | - Lenore J Launer
- From the Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, National Institute of Health, Baltimore, MD (J.E.M., O.M., L.J.L.)
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Khajavi A, Zayeri F, Ramezankhani A, Nazari A, Azizi F, Hadaegh F. Age and aging effects on blood pressure: 15 years follow-up of Tehran lipid and glucose study. J Clin Hypertens (Greenwich) 2021; 23:1205-1211. [PMID: 33720477 PMCID: PMC8678670 DOI: 10.1111/jch.14238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 11/28/2022]
Abstract
Age is a known predictor of blood pressure (BP); however, the literature mostly includes cross‐sectional investigations. This prospective cohort study aimed to decompose the cross‐sectional and longitudinal age effects on BP. The secondary data were obtained from the Tehran lipid and glucose study, which comprised six repeated measurements of participants, with median follow‐up of 15.8 (interquartile range of 14.2‐16.9) years. The sample is representative of the metropolitan area of Tehran, Iran, containing 7,460 participants aged 20‐70. The cross‐sectional and longitudinal effects of age (age at baseline and aging, respectively) were fitted in the mixed effects models, taking systolic, diastolic, and pulse BPs as response, adjusting for adiposity, smoking, diabetes, and antihypertensive medication, and stratifying for sex and 10‐year age‐groups. The mean age at baseline was 41.3 (SD = 12.9) years, and 41.7% of the participants were male. Age at baseline and aging were directly associated with BP, aging owned the weaker effect, and the largest distinction were for systolic blood pressure of men aged 40‐49 years (0.75 vs 0.10, p‐value < .001). Moreover, the aging effects on systolic and diastolic BPs were higher in men than women, in the age groups 40‐49 and 30‐39 years (0.35 vs 0.10 and 0.30 vs 0.07, p‐values < .001), respectively. Adjusting for adiposity remarkably declined the impact of aging on BP, among the < 50 years old.
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Affiliation(s)
- Alireza Khajavi
- Student Research Committee, Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Zayeri
- Department of Biostatistics, Proteomics Research Center, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azra Ramezankhani
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Nazari
- Barcelona School of Management, Pompeu Fabra University, Barcelona, Spain
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Adji A, O'Rourke MF. Tracking of brachial and central aortic systolic pressure over the normal human lifespan: insight from the arterial pulse waveforms. Intern Med J 2021; 51:13-19. [DOI: 10.1111/imj.14815] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 03/02/2020] [Accepted: 03/09/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Audrey Adji
- St Vincent's Clinic/Faculty of Medicine University of New South Wales Sydney Australia
- Cardiac Mechanics Laboratory, Victor Chang Cardiac Research Institute Sydney Australia
- Faculty of Medicine and Health Sciences, Department of Biomedical Engineering Macquarie University Sydney New South Wales Australia
| | - Michael F. O'Rourke
- St Vincent's Clinic/Faculty of Medicine University of New South Wales Sydney Australia
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Kooijman MN, Jaddoe VWV, Steegers EAP, Gaillard R. Associations of maternal metabolic profile with placental and fetal cerebral and cardiac hemodynamics. Eur J Obstet Gynecol Reprod Biol 2020; 257:51-58. [PMID: 33360239 DOI: 10.1016/j.ejogrb.2020.12.011] [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] [Received: 07/16/2020] [Revised: 11/12/2020] [Accepted: 12/05/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Maternal obesity and metabolic health affect pregnancy outcomes. We examined whether maternal metabolic profiles are associated with placental and fetal hemodynamics. STUDY DESIGN In a population-based prospective cohort study among 1175 women we examined the associations of an adverse maternal metabolic profile in early pregnancy with placental, fetal cerebral and cardiac hemodynamic development. We obtained maternal pre-pregnancy BMI by questionnaire and measured blood pressure, cholesterol, triglycerides and glucose concentrations at a median gestational age of 12.6 (95 % range 9.6-17.1) weeks. An adverse maternal metabolic profile was defined as ≥4 risk factors. Placental and fetal hemodynamics were measured by pulsed-wave-Doppler at a median gestational age of 30.3 (95 % range 28.8-32.3) weeks. RESULTS An adverse maternal metabolic profile was associated with a 0.29 Z-score higher (95 %CI 0.08-0.50) fetal cerebral middle artery pulsatility index (PI), but not with placental or fetal cardiac hemodynamic patterns. When the individual components of an adverse maternal metabolic profile were assessed, we observed that higher maternal total cholesterol and triglyceride concentrations were associated with a higher cerebral middle artery PI (Z-score, 0.09 (95 %CI 0.02-0.15), 0.09 (95 %CI 0.03-0.15) per Z-score increase). Higher total and HDL maternal cholesterol concentrations were also associated with a higher aorta ascendens peak systolic velocity (PSV) Z-score, 0.08 (95 %CI 0.01-0.14)), and a larger left cardiac output (Z-score, 0.08 (95 %CI 0.00-0.15), respectively). CONCLUSION An adverse maternal metabolic profile, especially higher cholesterol and triglycerides concentrations, are associated with increased fetal cerebral vascular resistance and larger fetal aorta ascendens diameter, PSV and left cardiac output, but not with placental vascular resistance indices. Further studies are needed to identify long-term consequences of the observed associations.
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Affiliation(s)
- Marjolein N Kooijman
- The Generation R Study Group, the Netherlands; Department of Pediatrics, the Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, the Netherlands; Department of Pediatrics, the Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Romy Gaillard
- The Generation R Study Group, the Netherlands; Department of Pediatrics, the Netherlands.
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Harraz OF, Jensen LJ. Aging, calcium channel signaling and vascular tone. Mech Ageing Dev 2020; 191:111336. [PMID: 32918949 PMCID: PMC8511598 DOI: 10.1016/j.mad.2020.111336] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/13/2020] [Accepted: 08/21/2020] [Indexed: 02/08/2023]
Abstract
Calcium signaling in vascular smooth muscle is crucial for arterial tone regulation and vascular function. Several proteins, including Ca2+ channels, function in an orchestrated fashion so that blood vessels can sense and respond to physiological stimuli such as changes in intravascular pressure. Activation of the voltage-dependent Ca2+ channel, Cav1.2, leads to Ca2+ influx and consequently arterial tone development and vasoconstriction. Unique among Ca2+ channels, the vascular Cav3.2 T-type channel mediates feedback inhibition of arterial tone-and therefore causes vasodilation-of resistance arteries by virtue of functional association with hyperpolarizing ion channels. During aging, several signaling modalities are altered along with vascular remodeling. There is a growing appreciation of how calcium channel signaling alters with aging and how this may affect vascular function. Here, we discuss key determinants of arterial tone development and the crucial involvement of Ca2+ channels. We next provide an updated view of key changes in Ca2+ channel expression and function during aging and how these affect vascular function. Further, this article synthesizes new questions in light of recent developments. We hope that these questions will outline a roadmap for new research, which, undoubtedly, will unravel a more comprehensive picture of arterial tone dysfunction during aging.
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Affiliation(s)
- Osama F. Harraz
- Dept. of Pharmacology, Larner College of Medicine, University of Vermont, Burlington, VT, 05405 USA,Corresponding author. (O.F. Harraz)
| | - Lars Jørn Jensen
- Pathobiological Sciences, Dept. of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, DK-1870 Frederiksberg C, Denmark
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46
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Justina VD, Giachini FR, Sullivan JC, Webb RC. Toll-Like Receptors Contribute to Sex Differences in Blood Pressure Regulation. J Cardiovasc Pharmacol 2020; 76:255-266. [PMID: 32902942 PMCID: PMC7751064 DOI: 10.1097/fjc.0000000000000869] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Toll-like receptors (TLRs) play an important role in the innate immune system, and recently, they have been shown to be involved in the regulation of blood pressure. The incidence of hypertension is higher in men, and it increases in postmenopausal women. In fact, premenopausal women are protected from cardiovascular disease compared with age-matched men, and it is well established that this protective effect is lost with menopause. However, the molecular mechanisms underlying this protection in women are unknown. Whether or not it could be related to differential activation of the innate immune system remains to be elucidated. This review focuses on (1) the differences between men and women in TLR activation and (2) whether TLR activation may influence the regulation of blood pressure in a sex-dependent manner.
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Affiliation(s)
- Vanessa Dela Justina
- Graduate Program in Biological Sciences, Federal University of Goiás, Goiânia, Brazil
| | - Fernanda R. Giachini
- Graduate Program in Biological Sciences, Federal University of Goiás, Goiânia, Brazil
- Institute of Health Sciences and Health, Universidad Federal De Mato Grosso, Barra Do Garcas, Brazil
| | - Jennifer C. Sullivan
- Department of Physiology, Medical College of Georgia at Augusta University, Augusta, GA
| | - R. Clinton Webb
- Department of Physiology, Medical College of Georgia at Augusta University, Augusta, GA
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Thompson P, Logan I, Tomson C, Sheerin N, Ellam T. Obesity, Sex, Race, and Early Onset Hypertension. Hypertension 2020; 76:859-865. [DOI: 10.1161/hypertensionaha.120.15557] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Investigation for secondary causes is recommended in early onset hypertension. However, obesity is associated with higher blood pressure (BP), so investigation for alternative secondary causes may not be necessary in all obese patients. We sought to define a rational approach to investigation across strata of age, body mass index (BMI) sex and race, based on BP distributions in the US National Health and Nutrition Examination Surveys 2005 to 2016. The majority (71% [95% CI, 59%–79%] and 64% [95% CI, 57%–69%] by European and US definitions respectively) of early onset hypertension cases were attributable to BP distribution shifts accompanying obesity and male sex. Male versus female sex, BMI>40 versus 18.2<BMI≤25 and Black versus White race were accompanied by adjusted mean systolic BP differences of 9 (95% CI, 8–9) mm Hg, 13 (95% CI, 12–15) mm Hg, and 3 (95% CI, 2–4) mm Hg respectively. Normal BMI women above the age cutoff for investigation were less likely to be hypertensive than obese younger men meeting current investigation criteria (
P
<0.001). Targeting investigations to combinations of sex, BMI, and age with low hypertension prevalence would reduce the number investigated while still identifying as many secondary cases. Limiting investigations to patients with a BP exceeded by ≤5% of their respective sex/BMI/age category would give investigation thresholds ranging from ≥130/≥80 and ≥140/≥90 for normal BMI women and men, respectively, at age 20 to 30 years, to ≥160/≥100 and ≥170/≥105 for women and men with BMI ≥40 at age 30 to 40 years. In conclusion, we propose refined strategies for investigation of early onset hypertension in the context of an obesity epidemic.
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Affiliation(s)
- Philip Thompson
- From the Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, United Kingdom (P.T., I.L., C.T., N.S., T.E.)
| | - Ian Logan
- From the Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, United Kingdom (P.T., I.L., C.T., N.S., T.E.)
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom (I.L., N.S., T.E.)
| | - Charles Tomson
- From the Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, United Kingdom (P.T., I.L., C.T., N.S., T.E.)
| | - Neil Sheerin
- From the Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, United Kingdom (P.T., I.L., C.T., N.S., T.E.)
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom (I.L., N.S., T.E.)
| | - Timothy Ellam
- From the Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, United Kingdom (P.T., I.L., C.T., N.S., T.E.)
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom (I.L., N.S., T.E.)
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Abstract
PURPOSE OF REVIEW To review the current evidence on research related to age of hypertension onset-its definition, correlates, heritability, and association with adverse outcomes. We also propose a framework for implementing assessment of hypertension onset age into clinical practice. RECENT FINDINGS Prior studies have used both objective measurements and self-report to determine age of hypertension onset or early-onset hypertension. Yet, no criterion for standard definition currently exists for either. Data from epidemiological and clinical studies demonstrate that early-onset hypertension is a highly heritable trait that confers an increased risk for cardiovascular death and end-organ damage compared with late-onset hypertension. Literature to date suggests that (parental) age of hypertension onset can be feasibly assessed for estimating (1) risk of future hypertension in non-hypertensive persons; and (2) the propensity for cardiovascular disease in individuals with established hypertension.
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Affiliation(s)
- Karri Suvila
- Division of Medicine, Turku University Hospital, Turku, Finland.
- Department of Internal Medicine, University of Turku, Turku, Finland.
| | - Ville Langén
- Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Geriatrics, University of Turku, Turku, Finland
| | - Susan Cheng
- The Framingham Heart Study, Framingham, MA, USA
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Teemu J Niiranen
- Department of Internal Medicine, University of Turku, Turku, Finland
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Turku, Finland
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49
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Gupta N, Ganesan V, Gao TM, Zabell J, Campbell SC, Haber GP. The effect of partial nephrectomy on blood pressure in patients with solitary kidney. World J Urol 2020; 39:1577-1582. [PMID: 32728886 DOI: 10.1007/s00345-020-03354-1] [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] [Received: 04/07/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To determine the effect of partial nephrectomy (PN) in the solitary kidney on systolic and diastolic blood pressures (SBP and DBP, respectively), and use of antihypertensive medications. METHODS We performed a retrospective cohort study of solitary kidney patients who underwent PN for kidney cancer from 1999-2015. Primary outcomes evaluated were blood pressure (BP) and antihypertensive medication changes from baseline up to 5 years postoperatively. Using a multivariable mixed-effects model to account for repeated measurements, we evaluated the effect of PN on the outcome measurements while controlling for baseline patient, pathologic, and perioperative characteristics. RESULTS 292 patients who underwent PN on solitary kidneys met inclusion criteria (median [range] age, 63 [24-84] years; 179 men [61%]). SBP decreased immediately postoperatively (- 1.7 mmHg [- 2.6, - 0.7], p < 0.001), and further decreased by 0.04 mmHg per year (p = 0.01) postoperatively, for a total change of - 1.9 [- 3.9, 0.2] mmHg at 5 years (p = 0.01). DBP decreased immediately postoperatively (- 2.2 mmHg [- 2.7, - 1.7], p < 0.001), and then rebounded by 0.37 mmHg per year (p = 0.003) postoperatively, for a total change of - 0.4 [- 1.5, 0.7] mmHg at 5 years (p = 0.003). Antihypertensive medication use increased at 5 years (0.35 more medications per patient, p < 0.001). CONCLUSIONS Our results suggest a minimal change in BP after PN, although patients increased antihypertensive medication use. This data suggests damage to renal parenchyma or hilar nerves during PN did not significantly impact BP regulation in our cohort.
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Affiliation(s)
- Nikhil Gupta
- Glickman Urological and Kidney Institute, Cleveland Clinic, Euclid Avenue, Q10-1, Cleveland, OH, 44195, USA
| | - Vishnu Ganesan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tian-Min Gao
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph Zabell
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Steven C Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Euclid Avenue, Q10-1, Cleveland, OH, 44195, USA
| | - Georges-Pascal Haber
- Glickman Urological and Kidney Institute, Cleveland Clinic, Euclid Avenue, Q10-1, Cleveland, OH, 44195, USA.
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Liao W, Wu J. The ACE2/Ang (1-7)/MasR axis as an emerging target for antihypertensive peptides. Crit Rev Food Sci Nutr 2020; 61:2572-2586. [PMID: 32551837 DOI: 10.1080/10408398.2020.1781049] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Food protein-derived bioactive peptides, particularly antihypertensive peptides, are important constituents of functional foods or nutraceuticals. Most antihypertensive are identified as the inhibitors of angiotensin converting enzyme (ACE), a key enzyme responsible for the generation of angiotensin II (Ang II), which is a vasoconstricting peptide. Hence, ACE has long been used as a universal target to identify antihypertensive peptides. Angiotensin converting enzyme 2 (ACE2), is a homolog of ACE but uses Ang II as its key substrate to produce angiotensin (1-7), exerting vasodilatory activity via the mas receptor (MasR). Therefore, ACE2 functions in the opposite way as ACE and is an emerging novel target for cardiovascular therapy. The potential of food protein-derived bioactive peptides in targeting ACE2 has been rarely explored. While, recently we found that IRW, an egg white ovotransferrin-derived antihypertensive peptide, reduced blood pressure in spontaneously hypertensive rats via the ACE2/Ang (1-7)/MasR axis, indicating a new mechanism of food protein-derived bioactive peptides in reducing blood pressure. The objectives of this review are to summarize the functions of the ACE2/Ang (1-7)/MasR axis and to examine its potential roles in the actions of food protein-derived antihypertensive peptides. The interaction between antihypertensive peptides and the ACE2/Ang (1-7)/MasR axis will also be discussed.
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Affiliation(s)
- Wang Liao
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Jianping Wu
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
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