1
|
Zhang W, Chen Y, Hu LX, Xia JH, Ye XF, Cheng YB, Wang Y, Guo QH, Li Y, Lowres N, Freedman B, Wang JG. New-onset hypertension as a contributing factor to the incidence of atrial fibrillation in the elderly. Hypertens Res 2024; 47:1490-1499. [PMID: 38438728 DOI: 10.1038/s41440-024-01617-7] [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: 10/22/2023] [Revised: 01/20/2024] [Accepted: 01/27/2024] [Indexed: 03/06/2024]
Abstract
Hypertension and atrial fibrillation are closely related. However, hypertension is already prevalent in young adults, but atrial fibrillation usually occurs in the elderly. In the present analysis, we investigated incident atrial fibrillation in relation to new-onset hypertension in an elderly Chinese population. Our study participants were elderly (≥65 years) hypertensive residents, recruited from community health centers in the urban Shanghai (n = 4161). Previous and new-onset hypertension were defined as the use of antihypertensive medication or elevated systolic/diastolic blood pressure (≥140/90 mmHg), respectively, at entry and during follow-up on ≥ 2 consecutive clinic visits. Atrial fibrillation was detected by a 30-s single-lead electrocardiography (ECG, AliveCor® Heart Monitor) and further evaluated with a regular 12-lead ECG. During a median of 2.1 years follow-up, the incidence rate of atrial fibrillation was 7.60 per 1000 person-years in all study participants; it was significantly higher in patients with new-onset hypertension (n = 368) than those with previous hypertension (n = 3793, 15.76 vs. 6.77 per 1000 person-years, P = 0.02). After adjustment for confounding factors, the hazard ratio for the incidence of atrial fibrillation was 2.21 (95% confidence interval 1.15-4.23, P = 0.02) in patients with new-onset hypertension versus those with previous hypertension. The association was even stronger in those aged ≥ 75 years (hazard ratio 2.70, 95% confidence interval 1.11-6.56, P = 0.03). In patients with previous hypertension, curvilinear association (P for non-linear trend = 0.04) was observed between duration of hypertension and the risk of incident atrial fibrillation, with a higher risk in short- and long-term than mid-term duration of hypertension. Our study showed a significant association between new-onset hypertension and the incidence of atrial fibrillation in elderly Chinese. In an elderly Chinese population with previous and new-onset hypertension, we found that the new-onset hypertension during follow-up, compared with previous hypertension, was associated with a significantly higher risk of incident atrial fibrillation. In patients with previous hypertension, curvilinear association was observed between duration of hypertension and the risk of incident atrial fibrillation, with a higher risk in short- and long-term than mid-term duration of hypertension.
Collapse
Affiliation(s)
- Wei Zhang
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Chen
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei-Xiao Hu
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia-Hui Xia
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Fei Ye
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Bang Cheng
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Wang
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian-Hui Guo
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Li
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nicole Lowres
- Heart Research Institute, Sydney Medical School, Charles Perkins Center, and Cardiology Department, Concord Hospital, The University of Sydney, Sydney, Australia
| | - Ben Freedman
- Heart Research Institute, Sydney Medical School, Charles Perkins Center, and Cardiology Department, Concord Hospital, The University of Sydney, Sydney, Australia
| | - Ji-Guang Wang
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
2
|
Puteikis K, Ažukaitis K, Dadurkevičienė D, Simanauskas K, Šileikienė V, Jankauskienė A, Mameniškienė R. Primary Arterial Hypertension Associated with Cognitive Dysfunction in Young Adults: Results from a Cross-Sectional Controlled Study. Behav Sci (Basel) 2024; 14:321. [PMID: 38667117 PMCID: PMC11047524 DOI: 10.3390/bs14040321] [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: 02/26/2024] [Revised: 04/04/2024] [Accepted: 04/09/2024] [Indexed: 04/29/2024] Open
Abstract
Despite evidence of primary hypertension (PH)-associated cognitive dysfunction in pediatric, middle-aged, and older adult populations, respective data in young adults remains scarce. We aimed to define differences in cognitive performance between individuals with PH and healthy controls in early adulthood. A convenience sample of young adults (age 18-45 years) with PH and their healthy sex, age, education, and household income matched counterparts were cross-sectionally tested for verbal fluency, verbal memory, general intelligence, reaction speed, attention, visual memory, and executive functioning. Between-group differences were determined using Student's t and Mann-Whitney U tests. Sensitivity analysis was performed by adjusting for body mass index (BMI) in analysis of covariance (ANCOVA) and regression models. Thirty-three adults with PH (22, 66.7% male, median age 38.8, interquartile range (IQR) = 33.2-41.6 years) and twenty-two healthy controls (9, 40.9% male, median age 36.1, IQR = 27.5-39.8 years) completed the neuropsychological assessment. Participants with PH performed worse on computerized tasks of reaction time (median response time (Z = -2.019, p = 0.044), median time for release of response button (Z = -2.509, p = 0.012)) and sustained attention (signal detection measure, RVPA (t = 2.373, p = 0.021), false alarms ÷ (false alarms + correct rejections), RVPPFA (Z = -2.052, p = 0.040)). The group variable was not a statistically significant predictor of performance in these domains after adjustment for BMI (p > 0.05). In regression analyses, high office systolic blood pressure (oSBP) was independently associated with poor sustained attention (βSBP(st.) = -0.283, multiple R2 = 0.252 (RVPA), βSBP(st.) = 0.551, multiple R2 = 0.386 (RVPPFA)). Young adults with PH were found to perform worse in tasks of response speed and sustained attention. While the difference between neuropsychological evaluation results in PH and control groups was confounded by BMI, oSBP measures were independently related to sustained attention. The selectivity of PH-associated cognitive profile in young adults has to be confirmed in larger trials.
Collapse
Affiliation(s)
- Kristijonas Puteikis
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, 08406 Vilnius, Lithuania
| | - Karolis Ažukaitis
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, 08406 Vilnius, Lithuania
| | | | - Kazys Simanauskas
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, 08406 Vilnius, Lithuania
| | - Vaida Šileikienė
- Vilnius University Hospital Santaros Klinikos, 08406 Vilnius, Lithuania
| | - Augustina Jankauskienė
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, 08406 Vilnius, Lithuania
| | - Rūta Mameniškienė
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, 08406 Vilnius, Lithuania
| |
Collapse
|
3
|
Wankhar D, Prabu Kumar A, Vijayakumar V, A V, Balakrishnan A, Ravi P, Rudra B, K M. Effect of Meditation, Mindfulness-Based Stress Reduction, and Relaxation Techniques as Mind-Body Medicine Practices to Reduce Blood Pressure in Cardiac Patients: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e58434. [PMID: 38765359 PMCID: PMC11099499 DOI: 10.7759/cureus.58434] [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] [Accepted: 03/29/2024] [Indexed: 05/22/2024] Open
Abstract
Elevated blood pressure is one of the major risk factors for cardiovascular diseases. Available evidence on mind-body medicine (MBM) techniques on blood pressure is inconclusive and provides conflicting results. The objective of the current systematic review and meta-analysis is to evaluate the effect of MBM techniques on blood pressure in patients with cardiovascular disease. Randomized control trials (RCTs) done between the years 2000 and 2020 on cardiovascular disease, using MBM techniques such as meditation, mindfulness-based stress reduction and relaxation techniques were searched through electronic databases such as PubMed, Cumulative Index to Nursing & Allied Health (CINAHL), EMBASE and Cochrane Library. Three authors independently performed article selection, data extraction and validation. Meta-analysis was performed using a random effect model and standardized mean difference (SMD) with 95% confidence interval (CI) estimated for the effect size. Fifteen RCTs with 927 patients were included in the meta-analysis. Heterogeneity among the studies was very high for all analyses (I2>94%). For studies comparing systolic blood pressure, MBM interventions show a significant (p=0.01) effect when compared to conventional treatment, an overall estimated effect size of SMD - 0.78 (95% CI: -1.36, -0.20). For studies comparing the diastolic blood pressure, MBM intervention did not show any significant effect when compared to the conventional treatment, an overall effect size of SMD -0.26 (95% CI: -0.91, 0.39). The findings of the meta-analysis suggest that MBM interventions may improve systolic blood pressure alone in patients with cardiac diseases. With high heterogeneity and low quality of the included studies, more robust evidence is required before suggesting MBM as an effective treatment modality for reducing blood pressure in cardiovascular diseases.
Collapse
Affiliation(s)
- Dapkupar Wankhar
- Physiology, People's College of Medical Sciences and Research Centre, Bhanpur, IND
| | - Archana Prabu Kumar
- College of Medicine and Medical Science, Arabian Gulf University, Manama, BHR
| | | | - Velan A
- Yoga, International Institute of Yoga and Naturopathy Medical Sciences, Chengalpattu, IND
| | - Arthi Balakrishnan
- Naturopathy, International Institute of Yoga and Naturopathy Medical Sciences, Chennai, IND
| | - Poornima Ravi
- Yoga, Government Yoga and Naturopathy Medical College and Hospital, Chennai, IND
| | | | - Maheshkumar K
- Physiology and Biochemistry, Government Yoga and Naturopathy Medical College and Hospital, Chennai, IND
| |
Collapse
|
4
|
Komnenov D, Al-Hadidi M, Ali H, Al-Jamal M, Salami K, Shelbaya S, Tayeb K, Domin D, Elhamzawy R. Dietary Fructose and Sodium Consumed during Early Mid-Life Are Associated with Hypertensive End-Organ Damage by Late Mid-Life in the CARDIA Cohort. Nutrients 2024; 16:913. [PMID: 38612947 PMCID: PMC11013729 DOI: 10.3390/nu16070913] [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: 02/29/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
We aimed to investigate how dietary fructose and sodium impact blood pressure and risk of hypertensive target organ damage 10 years later. Data from n = 3116 individuals were obtained from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Four groups were identified based on the four possible combinations of the lower and upper 50th percentile for sodium (in mg) and fructose (expressed as percent of total daily calories). Differences among groups were ascertained and logistic regression analyses were used to assess the risk of hypertensive target organ damage (diastolic dysfunction, coronary calcification and albuminuria). Individuals in the low-fructose + low-sodium group were found to have lower SBP compared to those in the low-fructose + high-sodium and high-fructose + high-sodium groups (p < 0.05). The highest risk for hypertensive target organ damage was found for albuminuria only in the high-fructose + high-sodium group (OR = 3.328, p = 0.006) while female sex was protective across all groups against coronary calcification. Our findings highlight that sodium alone may not be the culprit for hypertension and hypertensive target organ damage, but rather when combined with an increased intake of dietary fructose, especially in middle-aged individuals.
Collapse
Affiliation(s)
- Dragana Komnenov
- Physiology and Internal Medicine, Nephrology and Hypertension, Wayne State University School of Medicine, Detroit, MI 48201, USA; (M.A.-H.); (H.A.); (M.A.-J.); (K.S.); (K.T.); (R.E.)
- John D. Dingell VA Medical Center, Detroit, MI 48201, USA
| | - Mohammad Al-Hadidi
- Physiology and Internal Medicine, Nephrology and Hypertension, Wayne State University School of Medicine, Detroit, MI 48201, USA; (M.A.-H.); (H.A.); (M.A.-J.); (K.S.); (K.T.); (R.E.)
| | - Hamza Ali
- Physiology and Internal Medicine, Nephrology and Hypertension, Wayne State University School of Medicine, Detroit, MI 48201, USA; (M.A.-H.); (H.A.); (M.A.-J.); (K.S.); (K.T.); (R.E.)
| | - Malik Al-Jamal
- Physiology and Internal Medicine, Nephrology and Hypertension, Wayne State University School of Medicine, Detroit, MI 48201, USA; (M.A.-H.); (H.A.); (M.A.-J.); (K.S.); (K.T.); (R.E.)
| | - Kassim Salami
- Physiology and Internal Medicine, Nephrology and Hypertension, Wayne State University School of Medicine, Detroit, MI 48201, USA; (M.A.-H.); (H.A.); (M.A.-J.); (K.S.); (K.T.); (R.E.)
| | - Samy Shelbaya
- Physiology and Internal Medicine, Nephrology and Hypertension, Wayne State University School of Medicine, Detroit, MI 48201, USA; (M.A.-H.); (H.A.); (M.A.-J.); (K.S.); (K.T.); (R.E.)
| | - Kareem Tayeb
- Physiology and Internal Medicine, Nephrology and Hypertension, Wayne State University School of Medicine, Detroit, MI 48201, USA; (M.A.-H.); (H.A.); (M.A.-J.); (K.S.); (K.T.); (R.E.)
| | - Daniel Domin
- Physiology and Internal Medicine, Nephrology and Hypertension, Wayne State University School of Medicine, Detroit, MI 48201, USA; (M.A.-H.); (H.A.); (M.A.-J.); (K.S.); (K.T.); (R.E.)
| | - Rana Elhamzawy
- Physiology and Internal Medicine, Nephrology and Hypertension, Wayne State University School of Medicine, Detroit, MI 48201, USA; (M.A.-H.); (H.A.); (M.A.-J.); (K.S.); (K.T.); (R.E.)
| |
Collapse
|
5
|
Sabapathy K, Mwita FC, Dauya E, Bandason T, Simms V, Dziva Chikwari C, Doyle AM, Ross D, Shah A, Hayes RJ, Schutte AE, Kranzer K, Ferrand RA. Prevalence of hypertension and high-normal blood pressure among young adults in Zimbabwe: findings from a large, cross-sectional population-based survey. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:101-111. [PMID: 38070533 DOI: 10.1016/s2352-4642(23)00287-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Hypertension is the greatest driver of cardiovascular mortality and onset might be in youth. We aimed to investigate the prevalence of and risk factors for elevated blood pressure (hypertension ≥140 mm Hg systolic, ≥90 mm Hg diastolic, or both) and high-normal blood pressure (130-139 mm Hg systolic, 85-89 mm Hg diastolic, or both) among youth in Zimbabwe. METHODS A population-based, cross-sectional survey of randomly sampled youth aged 18-24 years from 24 urban and peri-urban communities in three provinces (Harare, Bulawayo, and Mashonaland East) in Zimbabwe was conducted between Oct 4, 2021, and June 2, 2022. Standardised questionnaires were used by research assistants to collect sociodemographic, behavioural, and clinical data. Height, bodyweight, and blood pressure were recorded. Three seated blood pressure measurements were taken at standardised timepoints during participant interview using a digital sphygmomanometer and cuffs sized on mid-upper arm circumference. The association of potential risk factors with elevated blood pressure was examined using multivariable logistic regression. FINDINGS 17 682 (94·4%) of 18 729 eligible participants were recruited, 17 637 (99·7%) of whom had complete data, and 16 883 (95·7%) of whom were included in the final study sample after excluding 754 (4·3%) pregnant women. The median age was 20 years (IQR 19-22), 9973 (59·1%) participants were female, and 6910 (40·9%) were male. The prevalence of hypertension was 7·4% (95% CI 7·0-7·8) and high-normal blood pressure was 12·2% (11·7-12·7). Overall, prevalence of hypertension was higher in men (8·7% [95% CI 8·2-9·6]) than in women (6·6% [6·0-6·9]), but with age increased to similar levels (at age 18 years 7·3% [6·2-8·6] and 4·3% [3·5-5·2]; at age 23-24 years 10·9% [9·3-12·6] and 9·5% [8·4-10·7] in men and women, respectively). After adjusting for factors associated with hypertension in the crude analysis, hypertension was associated with male sex (adjusted odds ratio 1·53 [95% CI 1·36-1·74]), increasing age (age 19-20 years 1·20 [1·00-1·44]; age 21-22 years 1·45 [1·20-1·75]; age 23-24 years 1·90 [1·57-2·30], vs age 18 years), and BMI of 30·0 kg/m2 or more (1·94 [1·53-2·47] vs 18·5-24·9 kg/m2). A BMI of 18·5 kg/m2 or less (0·79 [0·63-0·98] vs 18·5-24·9 kg/m2) and living with HIV (0·71 [0·55-0·92]) were associated with lower odds of hypertension. INTERPRETATION Prevalence of elevated blood pressure is high among urban and peri-urban youth in Zimbabwe and increases rapidly with age. Further research is needed to understand drivers of blood pressure elevation and the extent of target organ damage in youth in Zimbabwe and similar sub-Saharan African settings, to guide implementation of prevention and management strategies. FUNDING Wellcome Trust.
Collapse
Affiliation(s)
- Kalpana Sabapathy
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK.
| | | | - Ethel Dauya
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tsitsi Bandason
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Victoria Simms
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK; The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Chido Dziva Chikwari
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK; The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Aoife M Doyle
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK; The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - David Ross
- Institute for Life Course Health Research, Stellenbosch University, Tygerberg, South Africa
| | - Anoop Shah
- Department of Noncommunicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard J Hayes
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Aletta E Schutte
- School of Population Health, University of New South Wales, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia
| | - Katharina Kranzer
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Rashida Abbas Ferrand
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| |
Collapse
|
6
|
Wang K, Shafique S, Wang N, Walter SM, Xie X, Piamjariyakul U, Winstanley EL. Early-onset alcohol, tobacco, and illicit drug use with age at onset of hypertension: a survival analysis. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02596-9. [PMID: 38104055 DOI: 10.1007/s00127-023-02596-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE To examine the associations of age when first substance use and early-onset substance use before age 18 with age at onset (AAO) of hypertension. METHODS This study included 19,270 individuals with AAO of hypertension from the 2015-2019 National Survey on Drug Use and Health. Age when first use of 10 substance use variables included alcohol, daily cigarettes, cigars, smokeless tobacco, marijuana, cocaine, hallucinogens, lysergic acid diethylamide (LSD), inhalants, and methamphetamine use. The outcome was AAO of hypertension and variable cluster analysis was used to classify the exposures and outcome. Substance use status was classified into three categories: early-onset substance use (first used substance before age 18), late-onset substance use (first used substance after age 18), and never used. RESULTS The mean AAO of hypertension was 42.7 years. Age when first use of 10 substance use variables had significant correlations with AAO of hypertension (all p values < 0.001). Individuals with early-onset alcohol, cigars, smokeless tobacco, marijuana, hallucinogens, inhalants, cocaine, LSD, and methamphetamine use revealed significantly earlier onset of hypertension than those never used. Compared with never used substances, the Cox regression model showed that early-onset alcohol, smokeless tobacco, marijuana, inhalants, and methamphetamine use had an increased risk of AAO of hypertension [hazard ratio (HR) (95%CI) = 1.22 (1.13, 1.31), 1.36 (1.24, 1.49), 1.85 (1.75, 1.95), 1.41 (1.30, 1.52), and 1.27 (1.07,1.50), respectively]. CONCLUSION These findings suggest that intervention strategies or programs focusing on preventing early-onset substance use before age 18 may delay the onset of adult hypertension.
Collapse
Affiliation(s)
- Kesheng Wang
- Department of Family and Community Health, School of Nursing, Health Sciences Center, West Virginia University, 64 Medical Center Drive, Morgantown, WV, 26506, USA.
| | - Saima Shafique
- Department of Family and Community Health, School of Nursing, Health Sciences Center, West Virginia University, 64 Medical Center Drive, Morgantown, WV, 26506, USA
- Office of Research and Scholarly Activities, School of Nursing, Health Sciences Center, West Virginia University, 64 Medical Center Drive, Morgantown, WV, 26506, USA
| | - Nianyang Wang
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, MD, 20742, USA
| | - Suzy Mascaro Walter
- Department of Family and Community Health, School of Nursing, Health Sciences Center, West Virginia University, 64 Medical Center Drive, Morgantown, WV, 26506, USA
| | - Xin Xie
- Department of Economics and Finance, College of Business and Technology, East Tennessee State University, Johnson City, TN, 37614, USA
| | - Ubolrat Piamjariyakul
- Office of Research and Scholarly Activities, School of Nursing, Health Sciences Center, West Virginia University, 64 Medical Center Drive, Morgantown, WV, 26506, USA
| | - Erin L Winstanley
- Department of Behavioral Medicine and Psychiatry, School of Medicine, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, 26506, USA
- Department of Neuroscience, West Virginia University, Morgantown, WV, 26506, USA
| |
Collapse
|
7
|
Lo CJ, Lee L, Yu W, Tai ES, Yew TW, Ding IL. Mindsets and self-efficacy beliefs among individuals with type 2 diabetes. Sci Rep 2023; 13:20383. [PMID: 37990071 PMCID: PMC10663547 DOI: 10.1038/s41598-023-47617-4] [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: 02/15/2023] [Accepted: 11/16/2023] [Indexed: 11/23/2023] Open
Abstract
Growth mindsets and self-efficacy beliefs have been known to predict and promote resilience, challenge seeking, and improved outcomes in areas such as education and intelligence. However, little is known about the role of these two potentially influential beliefs in the context of type 2 diabetes (T2D), specifically in terms of whether and in which domains (i.e., beliefs toward general life, general health, or condition-specific domains) these beliefs-or lack thereof-is prevalent among individuals with T2D. Given the lifelong challenges that individuals with diabetes often encounter with managing their disease, many may slip into a conceding negative belief that their diabetes is "too difficult to control" or simply "out of their hands," inhibiting proactive self-management efforts. Results from our study (n = 893) revealed that individuals with T2D had a significantly lower growth mindset towards their blood glucose level and lower self-efficacy towards their general health, blood glucose, and cholesterol levels compared to those without T2D. Among participants with T2D, further analyses showed a pattern of higher HbA1c among those with lower growth mindsets and self-efficacy toward their general health or blood glucose level. These findings identify the belief-domains that may pose barriers to necessary self-care behaviors, informing future interventions to promote improved diabetes care and management.
Collapse
Affiliation(s)
- Carolyn J Lo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- LRF Institute for the Public Understanding of Risk, National University of Singapore, Singapore, Singapore.
| | - Leonard Lee
- LRF Institute for the Public Understanding of Risk, National University of Singapore, Singapore, Singapore
- Department of Marketing, NUS Business School, National University of Singapore, Singapore, Singapore
| | - Weichang Yu
- School of Mathematics and Statistics, University of Melbourne, Melbourne, Australia
| | - E Shyong Tai
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Medicine, National University Hospital, Singapore, Singapore
| | - Tong Wei Yew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Medicine, National University Hospital, Singapore, Singapore
| | - Isabel L Ding
- Warwick Business School, University of Warwick, Coventry, UK
| |
Collapse
|
8
|
Liu T, Liu CA, Zhang QS, Zhang Q, Wang YM, Song MM, Lin SQ, Deng L, Wu SL, Shi HP. Association of the age of onset of metabolic syndrome with the risk of all cancer types. Diabetes Metab Syndr 2023; 17:102896. [PMID: 37913630 DOI: 10.1016/j.dsx.2023.102896] [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: 09/06/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND The association between the age at onset of metabolic syndrome and cancer risk remains unknown. This study explored the association between age at metabolic syndrome onset and the risk of overall and site-specific cancer incidence. METHODS This study included 31,688 participants with new-onset metabolic syndrome and 31,688 participants matched according to sex, age (±1 y), and examination year among the 179,328 participants who underwent Kailuan health examinations from 2006 to 2017 in Tangshan, China. Weighted Cox regression was used to calculate the hazard ratios and 95% confidence intervals of new-onset metabolic syndrome for overall and site-specific cancer incidence across age groups. Population-attributable risk proportions were used to estimate the number of cases that could be prevented by eliminating the risk factors from the population. RESULTS During an average follow-up period of 10.22 y, we identified 2,710 cases of cancer and 4,218 deaths that occurred before the diagnosis of cancer. With an increase in metabolic syndrome onset age, the hazards of overall cancer incidence were gradually attenuated. The average hazard ratios (95% confidence intervals) of overall cancer were 1.94 (1.25-2.99) for metabolic syndrome onset age <45 year old, 1.41 (1.15-1.71) for age 45-54 years old, 1.38 (1.11-1.73) for age 55-64 years old, and 1.07 (0.89-1.28) for age ≥65 years old, respectively (p for interaction = 0.005). Similar results were obtained for colorectal, liver, and breast cancers in the site-specific analysis. CONCLUSIONS New-onset metabolic syndrome was associated with a higher risk of overall cancer and incidence of several types of cancer, and the associations were stronger with a younger age of onset. TRIAL REGISTRATION Kailuan Study, ChiCTR2000029767 (Registered February 12, 2020, https://www.chictr.org.cn/showprojEN.html?proj=48316).
Collapse
Affiliation(s)
- Tong Liu
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; Laboratory for Clinical Medicine, Capital Medical University, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Chen-An Liu
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; Laboratory for Clinical Medicine, Capital Medical University, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Qing-Song Zhang
- Department of General Surgery, Kailuan General Hospital, Tangshan, 063000, China
| | - Qi Zhang
- Department of Genetics, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Yi-Ming Wang
- Department of Hepatobiliary Surgery, Kailuan General Hospital, Tangshan, 063000, China
| | - Meng-Meng Song
- Cardiovascular Research Institute, University of California, San Francisco, CA, 94158, USA
| | - Shi-Qi Lin
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; Laboratory for Clinical Medicine, Capital Medical University, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Li Deng
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; Laboratory for Clinical Medicine, Capital Medical University, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China.
| | - Shou-Ling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, 063000, China.
| | - Han-Ping Shi
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; Laboratory for Clinical Medicine, Capital Medical University, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China.
| |
Collapse
|
9
|
Jiang X, Zhang MJ, Zhang Y, Durvasula A, Inouye M, Holmes C, Price AL, McVean G. Age-dependent topic modeling of comorbidities in UK Biobank identifies disease subtypes with differential genetic risk. Nat Genet 2023; 55:1854-1865. [PMID: 37814053 PMCID: PMC10632146 DOI: 10.1038/s41588-023-01522-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 08/31/2023] [Indexed: 10/11/2023]
Abstract
The analysis of longitudinal data from electronic health records (EHRs) has the potential to improve clinical diagnoses and enable personalized medicine, motivating efforts to identify disease subtypes from patient comorbidity information. Here we introduce an age-dependent topic modeling (ATM) method that provides a low-rank representation of longitudinal records of hundreds of distinct diseases in large EHR datasets. We applied ATM to 282,957 UK Biobank samples, identifying 52 diseases with heterogeneous comorbidity profiles; analyses of 211,908 All of Us samples produced concordant results. We defined subtypes of the 52 heterogeneous diseases based on their comorbidity profiles and compared genetic risk across disease subtypes using polygenic risk scores (PRSs), identifying 18 disease subtypes whose PRS differed significantly from other subtypes of the same disease. We further identified specific genetic variants with subtype-dependent effects on disease risk. In conclusion, ATM identifies disease subtypes with differential genome-wide and locus-specific genetic risk profiles.
Collapse
Affiliation(s)
- Xilin Jiang
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK.
- Department of Statistics, University of Oxford, Oxford, UK.
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK.
| | - Martin Jinye Zhang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Yidong Zhang
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
- Chinese Academy of Medical Sciences Oxford Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Arun Durvasula
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Genetics, Harvard Medical School, Cambridge, MA, USA
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, USA
| | - Michael Inouye
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- British Heart Foundation Cambridge Centre of Research Excellence, Department of Clinical Medicine, University of Cambridge, Cambridge, UK
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- The Alan Turing Institute, London, UK
| | - Chris Holmes
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
- Department of Statistics, University of Oxford, Oxford, UK
- The Alan Turing Institute, London, UK
| | - Alkes L Price
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Gil McVean
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK.
| |
Collapse
|
10
|
Tung EL, Wroblewski KE, Makelarski JA, Glasser NJ, Lindau ST. Childhood Parental Incarceration and Adult-Onset Hypertension and Cardiovascular Risk. JAMA Cardiol 2023; 8:927-935. [PMID: 37647038 PMCID: PMC10469273 DOI: 10.1001/jamacardio.2023.2672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 06/30/2023] [Indexed: 09/01/2023]
Abstract
Importance Parental incarceration is an adverse childhood experience that disproportionately affects racially minoritized individuals and has been associated with long-term health risks. Although cardiovascular disease remains the primary cause of mortality differences between Black and White individuals in the US, the association between parental incarceration and cardiovascular risk remains poorly understood. Objective To examine the association between parental incarceration during childhood and incident cardiovascular risk in adulthood. Design, Setting, and Participants This population-based cohort study included data from waves IV (2008-2009) and V (2016-2018) of the US National Longitudinal Study of Adolescent to Adult Health. Participants represented US adults transitioning from young adulthood to adulthood. Data were analyzed from October 28, 2021, to May 1, 2023. Main Outcomes and Measures Parental incarceration was defined as a parent or parent-like figure going to jail or prison when participants were aged younger than 18 years. Outcome measures included self-reported diagnoses of obesity, hyperlipidemia, hypertension, diabetes, or heart disease as well as serum elevations in non-high-density lipoprotein cholesterol (≥160 mg/dL) and high-sensitivity C-reactive protein (hsCRP >3 mg/L), a marker of inflammation used to estimate risk of future coronary events. Using sampling weights, incident development of each outcome was modeled as a function of parental incarceration, adjusting for participant- and neighborhood-level characteristics. Results This study included 9629 participants representing 16 077 108 US adults. Approximately half of participants were women (5498 [weighted 50.3%]) and the majority (5895 [weighted 71.4%]) were White. The mean participant age was 37.8 years (95% CI, 37.5 to 38.0 years) in wave V compared with 28.9 years (95% CI, 28.6 to 29.1 years) in wave IV. In wave V, those with childhood exposure to parental incarceration had lower educational attainment (91 [weighted 8.2%] vs 245 [weighted 4.2%] completing less than high school), had higher rates of public insurance (257 [weighted 20.6%] vs 806 [weighted 11.0%]), and were disproportionately Black (374 [weighted 22.5%] vs 1488 [weighted 13.6%]). Parental incarceration was associated with 33% higher adjusted odds (95% CI, 1.05 to 1.68) of developing hypertension and 60% higher adjusted odds (95% CI, 1.03 to 2.48) of developing elevated hsCRP. Associations between childhood parental incarceration and other diagnoses (ie, obesity, hyperlipidemia, diabetes, or heart disease) and serum lipid levels were not observed. Conclusions and Relevance In this cohort study of US adults transitioning from young adulthood to adulthood, an increased incidence of hypertension and high-risk hsCRP, but not other cardiovascular risk factors, was observed among those exposed to parental incarceration during childhood. These findings suggest possible transgenerational health consequences of mass incarceration.
Collapse
Affiliation(s)
- Elizabeth L. Tung
- Section of General Internal Medicine, University of Chicago, Chicago, Illinois
- Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois
| | | | | | | | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
- Department of Medicine-Geriatrics, MacLean Center on Clinical Medical Ethics and Comprehensive Cancer Center, University of Chicago, Chicago, Illinois
| |
Collapse
|
11
|
Wu J, Han X, Sun D, Zhang J, Li J, Qin G, Deng W, Yu Y, Xu H. Age-specific association of stage of hypertension at diagnosis with cardiovascular and all-cause mortality among elderly patients with hypertension: a cohort study. BMC Cardiovasc Disord 2023; 23:270. [PMID: 37221473 DOI: 10.1186/s12872-023-03250-7] [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: 01/24/2023] [Accepted: 04/19/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Hypertension affects 31.1% of adults worldwide, with higher prevalence of great than 60% in elderly. Advanced hypertension stage was associated with the higher risk of mortality. However, little is known about the age-specific association of stage of hypertension at diagnosis on cardiovascular mortality or all-cause mortality. Therefore, we aim to explore this age-specific association among the hypertensive elderly through stratified and interaction analyses. METHODS This cohort study included 125,978 elderly hypertensive patients aged 60+ years from Shanghai of China. Cox regression was used to estimate the independent and joint effect of hypertension stage and age at diagnosis on cardiovascular and all-cause mortality. Interactions were evaluated both additively and multiplicatively. Multiplicative interaction was examined by the Wald test of the interaction term. Additive interaction was assessed by relative excess risk due to interaction (RERI). All analyses were performed stratified by sex. RESULTS 28,250 patients died during the follow-up up to 8.85 years, and 13,164 died of cardiovascular events. Older age and advanced hypertension stage were risk factors of cardiovascular mortality and all-cause mortality. Besides, smoking, rarely exercise, BMI < 18.5 and diabetes were also the risk factors. When we compared stage 3 hypertension with stage 1 hypertension, hazard ratios (95% confidence interval) of cardiovascular mortality and all-cause mortality were 1.56(1.41-1.72) and 1.29(1.21-1.37) for males aged 60-69 years, 1.25(1.14-1.36) and 1.13(1.06-1.20) for males aged 70-85 years, 1.48(1.32-1.67) and 1.29(1.19-1.40) for females aged 60-69 years, and 1.19(1.10-1.29) and 1.08(1.01-1.15) for females aged 70-85 years, respectively. Negative multiplicative interaction and positive additive interaction between age at diagnosis and stage of hypertension at diagnosis on cardiovascular mortality were observed in males (HR: 0.81, 95% CI: 0.71-0.93 RERI: 0.59, 95% CI: 0.09-1.07) and females (HR: 0.81, 95% CI: 0.70-0.93 RERI: 0.66, 95% CI: 0.10-1.23). CONCLUSIONS Diagnosed with stage 3 hypertension was associated with higher risks of cardiovascular mortality and all-cause mortality, which were stronger among patients with age at diagnosis of 60-69 years compared with those with age at diagnosis of 70-85 years. Therefore, for the younger part of the elderly, the Department of Health should pay more attention to treating patients with stage 3 hypertension.
Collapse
Affiliation(s)
- Jingyi Wu
- Department of Biostatistics, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Xiaojie Han
- The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Di Sun
- Department of Cardiology, Shengli Oilfield Central Hospital, Dongying, Shandong, China
| | - Jie Zhang
- Department of Public Health, Aarhus University, Aarhus, Denmark
- NCRR-National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Jiong Li
- Department of Clinical Medicine-Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Guoyou Qin
- Department of Biostatistics, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Wei Deng
- Department of Biostatistics, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.
- , 130 Dong'an Road, Shanghai, 200032, China.
| | - Yongfu Yu
- Department of Biostatistics, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.
- , 130 Dong'an Road, Shanghai, 200032, China.
| | - Huilin Xu
- Shanghai Minhang Center for Disease Control and Prevention, Shanghai, China.
- , 965 Zhong Yi Road, Shanghai, 201101, China.
| |
Collapse
|
12
|
Shin D, Choi J, Lee HY. Suboptimal control status of young hypertensive population. Clin Hypertens 2023; 29:13. [PMID: 37122032 PMCID: PMC10150511 DOI: 10.1186/s40885-023-00237-6] [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: 08/08/2022] [Accepted: 03/15/2023] [Indexed: 05/02/2023] Open
Abstract
The prevalence of hypertension (HT) among young adults aged 18 to 39 years is estimated to be 3.7% to 8.6% worldwide. Although the prevalence of HT in young adults is lower than that of the overall population, those with HT are at substantially increased risk of cardiovascular events compared to those without HT. HT in young adults should be taken with even more caution as longer exposure to higher blood pressure leads to a higher lifetime risk of HT-mediated organ damage. However, young patients with HT show low awareness of HT compared to older patients. Also, they are more prone to show low treatment adherence despite the good efficacy of the treatment. Other risk factors that hinder HT control among young adults include alcohol intake, smoking, low physical activity, emotional stress, job stress, metabolic syndrome, and obesity. This review aimed to illustrate the suboptimal control status of the young hypertensive population and to propose strategies for improvement.
Collapse
Affiliation(s)
- Donghun Shin
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | - JungMin Choi
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hae-Young Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
13
|
Martín-Fernández J, Alonso-Safont T, Polentinos-Castro E, Esteban-Vasallo MD, Ariza-Cardiel G, González-Anglada MI, Sánchez-Perruca L, Rodríguez-Martínez G, Rotaeche-del-Campo R, Bilbao-González A. Impact of hypertension diagnosis on morbidity and mortality: a retrospective cohort study in primary care. BMC PRIMARY CARE 2023; 24:79. [PMID: 36959558 PMCID: PMC10037862 DOI: 10.1186/s12875-023-02036-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 03/13/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Hypertension is responsible for a huge burden of disease. The aim of this study was to evaluate the impact of newly diagnosed hypertension on the occurrence of kidney or cardiovascular events (K/CVEs) and on mortality among community dwellers. METHODS Retrospective cohort study, conducted from January, 2007, to December, 2018. All patients (age > 18) newly diagnosed with hypertension and no previous K/CVEs in 2007 and 2008, in the primary care centers of Madrid (Spain) (n = 71,770), were enrolled. The control group (n = 72,946) included patients without hypertension, matched by center, sex and age. The occurrence of kidney or CV events, including mortality from these causes and total mortality were evaluated using Cox regression and multistate models. Data were collected from three sources: personal data from administrative records, clinical data from medical records, and mortality data from regional and national databases. RESULTS The median follow-up was 138.61 months (IQR: 124.68-143.97 months). There were 32,896 K/CVEs (including 3,669 deaths from these causes) and 12,999 deaths from other causes. Adjusted for sex, smoking, diabetes and socioeconomic status, K/CVEs HR was 4.36 (95% CI: 3.80-5.00) for diagnoses before 45 years of age, 2.45(95% CI: 2.28- 2.63) for diagnosis between 45 to 54 years, and HR decreased to 1.86 (95% CI: 1.64-210) for diagnoses over age 85. Total mortality risk was only higher for hypertension diagnosed before 55 years of age (HR: 2.47, 95% CI: 1.90-3.19 for ages 18 to 44; and HR: 1.14, 95% CI: 1.02-1.28 for ages 45 to 54). CONCLUSION The diagnosis of hypertension in the community environment, in patients without evidence of previous kidney or CV disease, is associated with a large increase in the risk of K/CVEs, but especially in individuals diagnosed before the age of 55. This diagnosis is only associated with an increase in kidney or cardiovascular mortality or overall mortality when it occurs before age 55.
Collapse
Affiliation(s)
- Jesus Martín-Fernández
- Oeste Family and Community Care Teaching Unit, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain
- Department of Medical Specialties and Public Health, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
- Health Services Research Network in Chronic Diseases, REDISSEC- ISCIII, Madrid, Spain
- Research Network On Chronicity, Primary Care and Health Promotion-RICAPPS (RICORS), ISCIII, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
| | - Tamara Alonso-Safont
- Technical Directorate of Health Information Systems, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain
| | - Elena Polentinos-Castro
- Department of Medical Specialties and Public Health, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
- Health Services Research Network in Chronic Diseases, REDISSEC- ISCIII, Madrid, Spain
- Research Network On Chronicity, Primary Care and Health Promotion-RICAPPS (RICORS), ISCIII, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
- Research Unit, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain
| | | | - Gloria Ariza-Cardiel
- Oeste Family and Community Care Teaching Unit, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain
- Health Services Research Network in Chronic Diseases, REDISSEC- ISCIII, Madrid, Spain
- Research Network On Chronicity, Primary Care and Health Promotion-RICAPPS (RICORS), ISCIII, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
| | - Mª Isabel González-Anglada
- Department of Medical Specialties and Public Health, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
- Internal Medicine Service, Alcorcón Foundation University Hospital, Madrid, Spain
| | - Luis Sánchez-Perruca
- Technical Directorate of Health Information Systems, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain
| | - Gemma Rodríguez-Martínez
- Don Luis Infant Health Center, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain
| | - Rafael Rotaeche-del-Campo
- Alza Health Center, Osakidetza, OSI Donostia, Research Group in AP IIS Biodonostia, San Sebastián, Spain
| | - Amaia Bilbao-González
- Health Services Research Network in Chronic Diseases, REDISSEC- ISCIII, Madrid, Spain
- Research Network On Chronicity, Primary Care and Health Promotion-RICAPPS (RICORS), ISCIII, Madrid, Spain
- Osakidetza, Basque Health Service, Basurto University Hospital, Research and Innovation Unit, Bilbao, Spain
- Kronikgune Health Services Research Institute, Barakaldo, Spain
- Department of Medicine, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| |
Collapse
|
14
|
Kaneko H, Yano Y, Okada A, Itoh H, Suzuki Y, Yokota I, Morita K, Fujiu K, Michihata N, Jo T, Yamaguchi S, Takeda N, Morita H, Node K, Yamauchi T, Nangaku M, Kadowaki T, McEvoy JW, Lam CSP, Yasunaga H, Komuro I. Age-Dependent Association Between Modifiable Risk Factors and Incident Cardiovascular Disease. J Am Heart Assoc 2023; 12:e027684. [PMID: 36628975 PMCID: PMC9939069 DOI: 10.1161/jaha.122.027684] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background There have been limited data examining the age-dependent relationship of wide-range risk factors with the incidence of each subtype of cardiovascular disease (CVD) event. We assessed age-related associations between modifiable risk factors and the incidence of CVD. Methods and Results We analyzed 3 027 839 participants without a CVD history enrolled in the JMDC Claims Database (mean age, 44.8±11.0 years; 57.6% men). Each participant was categorized as aged 20 to 49 years (n=2 008 559), 50 to 59 years (n=712 273), and 60 to 75 years (n=307 007). Using Cox proportional hazards models and the relative risk reduction, we identified associations between risk factors and incident CVD, consisting of myocardial infarction, angina pectoris, stroke, and heart failure (HF). We assessed whether the association of risk factors for developing CVD would be modified by age category. Over a mean follow-up of 1133 days, 6315 myocardial infarction, 56 447 angina pectoris, 28 079 stroke, and 56 369 HF events were recorded. The incidence of myocardial infarction, angina pectoris, stroke, and HF increased with age category. Hazard ratios of obesity, hypertension, and diabetes in the multivariable Cox regression analyses for myocardial infarction, angina pectoris, stroke, and HF decreased with age category. The relative risk reduction of obesity, hypertension, and diabetes for CVD events decreased with age category. For example, the relative risk reduction of hypertension for HF decreased from 59.2% in participants aged 20 to 49 years to 38.1% in those aged 60 to 75 years. Conclusions The contribution of modifiable risk factor to the development of CVD is greater in younger compared with older individuals. Preventive efforts for risk factor modification may be more effective in younger people.
Collapse
Affiliation(s)
- Hidehiro Kaneko
- Department of Cardiovascular MedicineThe University of TokyoJapan,Department of Advanced CardiologyThe University of TokyoJapan
| | - Yuichiro Yano
- YCU Center for Novel and Exploratory Clinical TrialsYokohama City University HospitalYokohamaJapan,Department of Family Medicine and Community HealthDuke UniversityDurhamNC
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle‐Related Diseases, Graduate School of MedicineThe University of TokyoJapan
| | - Hidetaka Itoh
- Department of Cardiovascular MedicineThe University of TokyoJapan
| | - Yuta Suzuki
- Department of Cardiovascular MedicineThe University of TokyoJapan
| | - Isao Yokota
- Department of Biostatistics, Faculty of MedicineHokkaido UniversitySapporoJapan
| | - Kojiro Morita
- Global Nursing Research Center, Graduate School of MedicineThe University of TokyoJapan
| | - Katsuhito Fujiu
- Department of Cardiovascular MedicineThe University of TokyoJapan,Department of Advanced CardiologyThe University of TokyoJapan
| | | | - Taisuke Jo
- Department of Health Services ResearchThe University of TokyoJapan
| | - Satoko Yamaguchi
- Department of Prevention of Diabetes and Lifestyle‐Related Diseases, Graduate School of MedicineThe University of TokyoJapan
| | - Norifumi Takeda
- Department of Cardiovascular MedicineThe University of TokyoJapan
| | - Hiroyuki Morita
- Department of Cardiovascular MedicineThe University of TokyoJapan
| | - Koichi Node
- Department of Cardiovascular MedicineSaga UniversitySagaJapan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of MedicineThe University of TokyoJapan
| | - Masaomi Nangaku
- Division of Nephrology and EndocrinologyThe University of Tokyo Graduate School of MedicineTokyoJapan
| | - Takashi Kadowaki
- Department of Diabetes and Metabolic Diseases, Graduate School of MedicineThe University of TokyoJapan,Toranomon HospitalTokyoJapan
| | - John W. McEvoy
- National Institute for Prevention and Cardiovascular HealthNational University of IrelandGalwayIreland,Johns Hopkins Ciccarone Center for Cardiovascular Disease PreventionJohns Hopkins University School of MedicineBaltimoreMD
| | - Carolyn S. P. Lam
- National Heart Centre SingaporeSingapore,Duke‐NUS Medical SchoolSingapore,Department of CardiologyUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public HealthThe University of TokyoJapan
| | - Issei Komuro
- Department of Cardiovascular MedicineThe University of TokyoJapan
| |
Collapse
|
15
|
Souček M. In the prevention of dementia, the focus should be on early and consistent treatment of hypertension. VNITRNI LEKARSTVI 2023; 69:249-253. [PMID: 37468294 DOI: 10.36290/vnl.2023.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
The brain is among the target organs of hypertension. Patients with hypertension have a higher risk of developing stroke as well as experiencing a decline in cognitive functions and dementia. Changes in the white matter and atrophy of the grey matter of the brain induced by high blood pressure develop insidiously since the onset of hypertension, even in young individuals. The effect of high blood pressure on the vessel wall cumulates in time; therefore, hypertension in younger people implies an increased risk of dementia in older age. Hypertension in young age cannot be considered a benign condition. Hypertension in middle age increases the risk of dementia by 61 %. Consistent and early hypertension control can reverse the adverse development towards dementia and lack of self-sufficiency in the patient. Data comparing individual antihypertensive drugs in terms of preventing dementia are scarce. However, renin angiotensin system blockers have been found to protect against Alzheimer's disease more than other classes of antihypertensive drugs. To achieve rapid and effective hypertension control, a combination of antihypertensive drugs is usually required. Using a fixed-dose triple combination of perindopril, indapamide, and amlodipine, blood pressure targets of < 130/80 mm Hg can be achieved within three months in 93 % of patients.
Collapse
|
16
|
Zheng Y, Gao X, Jia HY, Li FR, Ye H. Influence of hypertension duration and blood pressure levels on cardiovascular disease and all-cause mortality: A large prospective cohort study. Front Cardiovasc Med 2022; 9:948707. [PMID: 36324752 PMCID: PMC9618611 DOI: 10.3389/fcvm.2022.948707] [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: 05/20/2022] [Accepted: 09/30/2022] [Indexed: 11/30/2022] Open
Abstract
Background and objects A longer duration of hypertension (HTN) has been suggested to be associated with a greater risk of cardiovascular disease (CVD). Whether such an association is similar for mortality risk, and whether HTN duration is associated with CVD/mortality beyond blood pressure (BP) control levels are yet to be assessed. We aimed to examine the associations of HTN duration and the combination of HTN duration and systolic blood pressure (SBP)/diastolic blood pressure (DBP) with risks of CVD and all-cause mortality. Methods We used data on ∼450,000 UK residents. Participants were categorized by HTN status and HTN duration. The primary outcome was a composite of non-fatal myocardial infarction, non-fatal stroke and CVD death. We also explored the results for the above-mentioned CVD outcomes separately. All-cause mortality was also used as a secondary outcome. The age at HTN diagnosis was obtained by self-report. HTN duration was calculated as baseline age minus age at diagnosis. Results Among all participants, compared with non-hypertensive participants, those with a longer HTN duration had increased risks of CVD and all-cause mortality. These associations persisted among hypertensive patients. Specifically, compared with patients with HTN durations of < 5 y, patients with a HTN duration of 5 to < 10 y, 10 to < 15 y, and ≥ 15 y had adjusted HRs (95% CI) of 1.09 (1.03, 1.17), 1.21 (1.13, 1.31), and 1.38 (1.29, 1.48) for composite CVD (P-trend < 0.001); and 1.03 (0.97, 1.08), 1.09 (1.02, 1.16), and 1.17 (1.11, 1.24) for all-cause mortality (P-trend < 0.001). When compared with hypertensive patients with BP < 140/90 mmHg and a HTN duration of < 5 y, adjusted HRs of CVD and all-cause mortality were 1.35 (1.15, 1.57) and 1.26 (1.11, 1.42) for those with BP < 140/90 mmHg and a duration of ≥ 15 y, and 1.43 (1.26, 1.60) and 1.13 (1.03, 1.25) for those with BP ≥ 140/90 mmHg and durations of ≥ 15 y, respectively. Conclusion A longer HTN duration was associated with increased risks of CVD and overall death in a linear fashion, and these associations were independent of BP control levels.
Collapse
Affiliation(s)
- Yan Zheng
- The Fourth Affiliated Hospital Zhejiang University School of Medicine, Zhejiang, China
| | - Xiang Gao
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Hai-Yi Jia
- Zhongshan Hospital of Fudan University, Shanghai, China
| | - Fu-Rong Li
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
- *Correspondence: Fu-Rong Li,
| | - Hui Ye
- The Second Affiliated Hospital Zhejiang University School of Medicine, Zhejiang, China
| |
Collapse
|
17
|
Guía práctica sobre el diagnóstico y tratamiento de la hipertensión arterial en España, 2022. Sociedad Española de Hipertensión - Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA). HIPERTENSION Y RIESGO VASCULAR 2022; 39:174-194. [DOI: 10.1016/j.hipert.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/06/2022] [Indexed: 01/08/2023]
|
18
|
Jaeschke L, Becher M, Velásquez IM, Ahrens W, Bächle C, Baurecht H, Fricke J, Greiser KH, Günther K, Heier M, Karch A, Kluttig A, Krist L, Leitzmann M, Michels K, Mikolajczyk R, Peters A, Schipf S, Völzke H, Pischon T, Becher H. The bias from heaping on risk estimation: Effect of age at diagnosis of hypertension on risk of subsequent cardiovascular comorbidities. Ann Epidemiol 2022; 74:84-96. [DOI: 10.1016/j.annepidem.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/14/2022] [Accepted: 07/30/2022] [Indexed: 11/01/2022]
|
19
|
Association between Age of Onset of Hypertension and Incident Atrial Fibrillation. J Pers Med 2022; 12:jpm12071186. [PMID: 35887683 PMCID: PMC9317856 DOI: 10.3390/jpm12071186] [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: 06/29/2022] [Revised: 07/16/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
We investigated whether age at hypertension (HTN) onset was associated with the risk of atrial fibrillation (AF) in the general population. This prospective longitudinal community-based cohort study included 9892 participants without AF at baseline, who underwent biennial electrocardiography for a median duration of 11.5 years. The participants were divided into five groups, consisting of a normotensive group (Group-N) and four HTN groups based on HTN onset age: <45 years (Group-H1); 45−54 years (Group-H2); 55−64 years (Group-H3); and ≥65 years (Group-H4). A multivariate Cox proportional hazards model showed that the presence of HTN at baseline was associated with higher AF risk (hazard ratio [HR], 1.93; 95% confidence interval [CI] 1.32−2.80). The participants in Group-H1 had the highest risk of AF (HR 3.18; CI 1.74−5.82), and the risk of AF decreased as HTN onset age increased across the four HTN groups (p for trend = 0.014). The AF onset age was significantly younger in participants in Group-H1 than in Groups-H2−H4. Early-onset HTN was associated with an increased risk of AF, and younger onset of AF in the general population. Surveillance for AF should be considered at a younger age in individuals with HTN.
Collapse
|
20
|
Jackson AM, Benson L, Savarese G, Hage C, Jhund PS, Petrie MC, Dahlström U, McMurray JJV, Lund LH. Apparent Treatment-Resistant Hypertension Across the Spectrum of Heart Failure Phenotypes in the Swedish HF Registry. JACC. HEART FAILURE 2022; 10:380-392. [PMID: 35654522 DOI: 10.1016/j.jchf.2022.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/02/2022] [Accepted: 04/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Hypertension is common in patients with heart failure (HF), but less is known about resistant hypertension. OBJECTIVES This study sought to investigate apparent treatment-resistant hypertension (aTRH) in patients with HF in the SwedeHF (Swedish Heart Failure Registry), across the spectrum of HF phenotypes (heart failure with reduced ejection fraction [HFrEF], heart failure with mildly reduced ejection fraction [HFmrEF], and heart failure with preserved ejection fraction [HFpEF]). METHODS aTRH was defined as systolic blood pressure ≥140 mm Hg (≥135 mm Hg in diabetes) despite treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, or sacubitril-valsartan, as well as a calcium-channel blocker and a diuretic; non-treatment-resistant hypertension (TRH) was defined as systolic blood pressure above these thresholds but not on the 3-drug combination; and normal blood pressure was defined as under these thresholds. In each left ventricular ejection fraction (LVEF) category, patient factors associated with aTRH and non-TRH and outcomes (HF hospitalization and cardiovascular death composite, its components, and all-cause death) according to hypertension category were examined. RESULTS Among 46,597 patients, aTRH was present in 2,693 (10%), 1,514 (14%), and 1,450 (17%) patients with HFrEF, HFmrEF, and HFpEF, respectively. Older age, obesity, diabetes, and kidney disease were associated with a greater likelihood of aTRH and non-TRH (vs normal blood pressure). Associations were generally similar irrespective of LVEF category. Compared with normal blood pressure, aTRH was associated with a lower adjusted risk of the composite outcome in HFrEF and HFmrEF (HR: 0.79 [95% CI: 0.74-0.85] and HR: 0.86 [95% CI: 0.77-0.96]) but not in HFpEF (HR: 0.93 [95% CI: 0.84-1.04]). CONCLUSIONS aTRH was most common in HFpEF and least common in HFrEF. Associated patient characteristics were similar irrespective of LVEF category. aTRH (vs normal blood pressure) was associated with a lower risk of first HF hospitalization or cardiovascular death in HFrEF and HFmrEF but not in HFpEF.
Collapse
Affiliation(s)
- Alice M Jackson
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Lina Benson
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Gianluigi Savarese
- Department of Medicine, Karolinska Institute, Stockholm, Sweden; Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Camilla Hage
- Department of Medicine, Karolinska Institute, Stockholm, Sweden; Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Pardeep S Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Mark C Petrie
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Ulf Dahlström
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Lars H Lund
- Department of Medicine, Karolinska Institute, Stockholm, Sweden; Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden.
| |
Collapse
|
21
|
Yang X, Zhou B, Zhou L, Cui L, Zeng J, Wang S, Shi W, Zhang Y, Luo X, Xu C, Xue Y, Chen H, Chen S, Wang G, Guo L, Jose PA, Wilcox CS, Wu S, Wu G, Zeng C. Development and Validation of Prediction Models for Hypertensive Nephropathy, the PANDORA Study. Front Cardiovasc Med 2022; 9:794768. [PMID: 35360013 PMCID: PMC8960139 DOI: 10.3389/fcvm.2022.794768] [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: 10/14/2021] [Accepted: 02/17/2022] [Indexed: 11/13/2022] Open
Abstract
ImportanceHypertension is a leading cause of end-stage renal disease (ESRD), but currently, those at risk are poorly identified.ObjectiveTo develop and validate a prediction model for the development of hypertensive nephropathy (HN).Design, Setting, and ParticipantsIndividual data of cohorts of hypertensive patients from Kailuan, China served to derive and validate a multivariable prediction model of HN from 12, 656 individuals enrolled from January 2006 to August 2007, with a median follow-up of 6.5 years. The developed model was subsequently tested in both derivation and external validation cohorts.VariablesDemographics, physical examination, laboratory, and comorbidity variables.Main Outcomes and MeasuresHypertensive nephropathy was defined as hypertension with an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 and/or proteinuria.ResultsAbout 8.5% of patients in the derivation cohort developed HN after a median follow-up of 6.5 years that was similar in the validation cohort. Eight variables in the derivation cohort were found to contribute to the risk of HN: salt intake, diabetes mellitus, stroke, serum low-density lipoprotein, pulse pressure, age, hypertension duration, and serum uric acid. The discrimination by concordance statistics (C-statistics) was 0.785 (IQR, 0.770-0.800); the calibration slope was 1.129, the intercept was –0.117; and the overall accuracy by adjusted R2 was 0.998 with similar results in the validation cohort. A simple points scale developed from these data (0, low to 40, high) detected a low morbidity of 7% in the low-risk group (0–10 points) compared with >40% in the high-risk group (>20 points).Conclusions and RelevanceA prediction model of HN over 8 years had high discrimination and calibration, but this model requires prospective evaluation in other cohorts, to confirm its potential to improve patient care.
Collapse
Affiliation(s)
- Xiaoli Yang
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
| | - Bingqing Zhou
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
| | - Li Zhou
- Department of Epidemiology, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Liufu Cui
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Jing Zeng
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
| | - Shuo Wang
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
| | - Weibin Shi
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
| | - Ye Zhang
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
| | - Xiaoli Luo
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
| | - Chunmei Xu
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
| | - Yuanzheng Xue
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
| | - Hao Chen
- Department of Epidemiology, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Guodong Wang
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Li Guo
- Department of Endocrinology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Pedro A. Jose
- Division of Renal Disease & Hypertension, The George Washington University School of Medicine & Health Sciences, Washington, DC, United States
| | - Christopher S. Wilcox
- Division of Nephrology and Hypertension, Department of Medicine and Center for Hypertension, Kidney and Vascular Health, Georgetown University, Washington, DC, United States
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
- *Correspondence: Shouling Wu,
| | - Gengze Wu
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
- Gengze Wu,
| | - Chunyu Zeng
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
- State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, The Third Military Medical University, Chongqing, China
- Cardiovascular Research Center of Chongqing College, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Chongqing, China
- Chunyu Zeng,
| |
Collapse
|
22
|
Suvila K, Niiranen TJ. Interrelations Between High Blood Pressure, Organ Damage, and Cardiovascular Disease: No More Room for Doubt. Hypertension 2022; 79:516-517. [PMID: 35138870 DOI: 10.1161/hypertensionaha.121.18786] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Karri Suvila
- Department of Medicine, Turku University Hospital and University of Turku, Finland (K.S., T.J.N.)
| | - Teemu J Niiranen
- Department of Medicine, Turku University Hospital and University of Turku, Finland (K.S., T.J.N.).,Department of Public Health Solutions, Finnish Institute for Health and Welfare, Turku, Finland (T.J.N.)
| |
Collapse
|
23
|
Abstract
PURPOSE OF REVIEW The prevalence of hypertension in adolescents and young adults has increased in part due to the obesity epidemic. The clinical impact and future cardiovascular risk of this underestimated public health problem is an evolving field. RECENT FINDINGS The development of hypertension is predicted by tracking of elevated blood pressure from childhood to adulthood. Young hypertensive individuals have lower awareness, slower diagnosis rates, and poorer blood pressure control than older patients. Increased awareness, appropriate screening, early identification, and individualized treatment approaches for elevated blood pressure could prevent development of hypertension in adulthood and cardiovascular events in later life. The optimal blood pressure management for young adults with a low 10-year risk of atherosclerotic cardiovascular disease of < 10% remains challenging due to lack of randomized controlled trials. Evidence-based recommendations are needed to implement appropriate measures for time of treatment initiation, preferred antihypertensive drug class to be used and optimal target blood pressure level from childhood through young adulthood.
Collapse
|
24
|
Khalid K, Padda J, Ismail D, Abdullah M, Gupta D, Pradeep R, Hameed W, Cooper AC, Jean-Charles G. Correlation of Coronary Artery Disease and Left Ventricular Hypertrophy. Cureus 2021; 13:e17550. [PMID: 34646607 PMCID: PMC8479854 DOI: 10.7759/cureus.17550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2021] [Indexed: 12/23/2022] Open
Abstract
Ischemic heart disease (IHD) is the leading cause of death worldwide, and it is defined as an imbalance between myocardial oxygen supply and demand. Coronary artery disease (CAD) and left ventricular hypertrophy (LVH) are two common causes of IHD that independently result in myocardial ischemia. CAD decreases myocardial blood and oxygen supply whereas LVH increases myocardial oxygen demand. The coexistence of both CAD and LVH results in a significant increase in oxygen demand while simultaneously lowering oxygen supply. Since hypertension is a shared predisposing condition for both CAD and LVH, the left ventricular (LV) mass on noninvasive echocardiography can reflect on the severity of coronary artery stenosis. In clinical practice, it can help physicians decide whether to perform invasive cardiac catheterization to visualize the extent of the coronary block. Although, both CAD and LVH are directly proportional to mortality risk, the addition of eccentric LVH can further increase morbidity and mortality due to myocardial infarction. Therefore, the latest management of both the acute and chronic phases of CAD places an increased emphasis on controlling the predisposing factors to prevent or reverse LVH. For example, angiotensin-converting enzyme inhibitors and diuretics reduce LV mass by lowering the cardiac preload and afterload. This article aims to investigate the deleterious effects of the collaboration between CAD and LVH, establish a causal relationship, and explore the new prevention and management strategies.
Collapse
Affiliation(s)
- Khizer Khalid
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | - Jaskamal Padda
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | - Dina Ismail
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | | | - Dhriti Gupta
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | - Roshini Pradeep
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | - Warda Hameed
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | | | - Gutteridge Jean-Charles
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA.,Internal Medicine, AdventHealth & Orlando Health Hospital, Orlando, USA
| |
Collapse
|
25
|
Suvila K, Niiranen TJ. Age of Hypertension Onset: Potential for Improving Risk Estimation and Hypertension Management? Hypertension 2021; 78:1475-1477. [PMID: 34644170 DOI: 10.1161/hypertensionaha.121.18197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Karri Suvila
- Department of Medicine, Turku University Hospital and University of Turku, Finland (K.S., T.J.N)
| | - Teemu J Niiranen
- Department of Medicine, Turku University Hospital and University of Turku, Finland (K.S., T.J.N).,Department of Public Health Solutions, Finnish Institute for Health and Welfare, Turku, Finland (T.J.N.)
| |
Collapse
|
26
|
Suvila K, Lima JAC, Cheng S, Niiranen TJ. Clinical Correlates of Early-Onset Hypertension. Am J Hypertens 2021; 34:915-918. [PMID: 33904901 PMCID: PMC8457426 DOI: 10.1093/ajh/hpab066] [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] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 04/25/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Early-onset hypertension has been established as a heritable trait and a risk factor for cardiovascular disease outcomes. However, the clinical correlates of early-onset hypertension remain unidentified. METHODS In this study, we assessed the demographic characteristics and lifestyle factors related to hypertension onset age in a sample of 3,286 Coronary Artery Risk Development in Young Adults (CARDIA) study participants (mean baseline age 25 ± 4 years, 57% women). We examined the association between the participants’ baseline characteristics and age of hypertension onset subgroups (<35, 35‒44, or ≥45 years) using a multinomial logistic regression model with those who did not develop hypertension as the reference group. Hypertension onset was defined as blood pressure ≥140/90 mm Hg or antihypertensive medication use on 2 consecutively attended follow-up visits. RESULTS In the multinomial logistic regression model, individuals who were black (odds ratio [OR], 5.08; 95% confidence interval [CI], 3.17–8.14), were more obese (OR, 1.57; 95% CI, 1.32–1.88), or had higher total cholesterol (OR, 1.34; 95% CI, 1.13–1.60 per SD) had increased odds of early-onset hypertension (onset at <35 years) vs. not developing hypertension. In contrast, 1-SD higher high-density lipoprotein (HDL)-cholesterol was related to decreased odds of early-onset hypertension (OR, 0.71; 95% CI, 0.57–0.89). The odds for having earlier hypertension onset increased linearly across age of onset categories in black individuals and individuals with lower HDL-cholesterol (P < 0.05 for trend for both). CONCLUSIONS Our findings suggest that individuals who are black, obese, have higher total cholesterol, or have lower HDL-cholesterol level, are potentially at an increased risk of having early-onset hypertension.
Collapse
Affiliation(s)
- Karri Suvila
- Division of Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Susan Cheng
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Framingham Heart Study, Framingham, Massachusetts, USA
| | - Teemu J Niiranen
- Division of Medicine, Turku University Hospital and University of Turku, Turku, Finland
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Turku, Finland
| |
Collapse
|
27
|
Body Mass Index Trajectories during 6-18 Years Old and the Risk of Hypertension in Young Adult: A Longitudinal Study in Chinese Population. Int J Hypertens 2021; 2021:6646868. [PMID: 34327015 PMCID: PMC8302370 DOI: 10.1155/2021/6646868] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 06/23/2021] [Indexed: 11/17/2022] Open
Abstract
Background Overweight/obesity in childhood is suggested to increase the risk of hypertension later in life. We aimed to assess whether and how body mass index (BMI) trajectories during 6–18 years of age are associated with hypertension in young adulthood (18–37 years) in the Chinese population. Methods Based on the China Health and Nutrition Survey (CHNS), a total of 1,872 participants who received ≥2 measurements of BMI during 6–18 years and had assessment of blood pressure (BP) in young adulthood were included. BMI trajectories were explored using latent class growth mixture models, and associations between identified trajectories with hypertension in young adulthood were examined by logistic regression analyses. Results Five heterogeneous BMI trajectories were identified: the low slow-increasing (20.03%), low moderate-increasing (56.14%), low rapid-increasing (17.04%), moderate-increasing (3.63%), and elevated-decreasing (3.15%) groups. Compared with the low slow-increasing group, another three increasing groups had gradually elevated risk of hypertension, yielding maximally adjusted odds ratio (95% confidence interval) (OR (95% CI)) of 2.48 (1.39–4.42), 3.24 (1.66–6.31), and 3.28 (1.19–9.08), respectively, whereas the elevated-decreasing group reversed overweight/obesity to normal weight in childhood, rendering its association with hypertension as not statistically significant (OR (95% CI) = 2.74 (0.98–7.65)). Conclusion Our study indicates that there are varied BMI trajectories from childhood to adulthood and that an elevated BMI trajectory during childhood is related with an increased risk of hypertension in young adulthood. In contrast, weight loss of children with high initial BMI may mitigate or reverse the risk. Our findings emphasize the importance of BMI continuous monitoring during early life.
Collapse
|
28
|
Yano Y. Blood Pressure in Young Adults and Cardiovascular Disease Later in Life. Am J Hypertens 2021; 34:250-257. [PMID: 33821946 DOI: 10.1093/ajh/hpab005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/08/2020] [Accepted: 01/08/2021] [Indexed: 11/14/2022] Open
Abstract
Cardiovascular disease (CVD) mortality has declined markedly over the past several decades among middle-age and older adults in the United States. However, young adults (18-39 years of age) have had a lower rate of decline in CVD mortality. This trend may be related to the prevalence of high blood pressure (BP) having increased among young US adults. Additionally, awareness, treatment, and control of hypertension are low among US adults between 20 and 39 years of age. Many young adults and healthcare providers may not be aware of the impact of high BP during young adulthood on their later life, the associations of BP patterns with adverse outcomes later in life, and benefit-to-harm ratios of pharmacological treatment. This review provides a synthesis of the related resources available in the literature to better understand BP-related CVD risk among young adults and better identify BP patterns and levels during young adulthood that are associated with CVD events later in life, and lastly, to clarify future challenges in BP management for young adults.
Collapse
Affiliation(s)
- Yuichiro Yano
- Center for Novel and Exploratory Clinical Trials, Yokohama City University, Kanagawa, Japan
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
| |
Collapse
|
29
|
Low admission blood pressure as a marker of poor 1-year survival in patients with revascularized critical limb ischemia. J Hypertens 2021; 39:1611-1620. [PMID: 33710168 DOI: 10.1097/hjh.0000000000002821] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To contrast the association between blood pressure (BP) level and antihypertensive medications at hospital admission with 1-year mortality in patients undergoing revascularization for critical limb ischemia (CLI). METHODS From November 2013 to May 2019, 315 consecutive patients were retrospectively included. A median of seven (IQR 3-13) separate readings were recorded for each patient before revascularization procedure and the average represented patient's mean BP. BP-lowering medications, clinical and biological parameters were recorded at baseline. The main outcome was total 1-year mortality. RESULTS The cohort included 172 men (55%) and 143 women (45%), with a mean age of 77.9 ± 11.9 years. Treated hypertension was present in 245 (78%) patients; 288 (91%) patients had BP-lowering drug prescriptions (2.1 ± 1.3 medications at baseline). Mean SBP, DBP, mean BP (MBP) and pulse pressure (PP) were 132 ± 18, 70 ± 8, 90 ± 10 and 62 ± 16mmHg. During 1-year follow-up, 80 (25.4%) patients died. In single-pressure multivariate analysis, SBP (hazard ratio 0.97; 95% CI 0.96-0.99; P = 0.005), MBP (hazard ratio 0.96; 95% CI 0.92-0.99; P = 0.01), PP (hazard ratio 0.97; 95% CI 0.95-0.99; P = 0.009), but not DBP, were inversely correlated with 1-year mortality, independently of age, coronary heart disease, left ventricular ejection fraction, brain natriuretic peptide, serum albumin, institutionalized status and antihypertensive drugs. Association between SBP, MBP and PP with 1-year mortality had a quite linear reverse pattern. CONCLUSION Among patients undergoing revascularization for CLI, there is an inverse correlation between admission SBP, MBP and PP with 1-year mortality. BP may represent a modifiable therapeutic target to prevent poor outcome in CLI patients.
Collapse
|
30
|
Vaura F, Kauko A, Suvila K, Havulinna AS, Mars N, Salomaa V, FinnGen, Cheng S, Niiranen T. Polygenic Risk Scores Predict Hypertension Onset and Cardiovascular Risk. Hypertension 2021; 77:1119-1127. [PMID: 33611940 PMCID: PMC8025831 DOI: 10.1161/hypertensionaha.120.16471] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Felix Vaura
- From the Department of Internal Medicine, University of Turku, Finland (F.V., A.K., K.S., T.N.)
| | - Anni Kauko
- From the Department of Internal Medicine, University of Turku, Finland (F.V., A.K., K.S., T.N.)
| | - Karri Suvila
- From the Department of Internal Medicine, University of Turku, Finland (F.V., A.K., K.S., T.N.).,Division of Medicine, Turku University Hospital, Finland (K.S., T.N.)
| | - Aki S Havulinna
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland (A.S.H., V.S., T.N.).,Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki (A.S.H., N.M.)
| | - Nina Mars
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki (A.S.H., N.M.)
| | - Veikko Salomaa
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland (A.S.H., V.S., T.N.)
| | | | - Susan Cheng
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (S.C.).,Division of Cardiology, Brigham and Women's Hospital, Boston, MA (S.C.)
| | - Teemu Niiranen
- From the Department of Internal Medicine, University of Turku, Finland (F.V., A.K., K.S., T.N.).,Division of Medicine, Turku University Hospital, Finland (K.S., T.N.).,Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland (A.S.H., V.S., T.N.)
| |
Collapse
|
31
|
Association of Age of Onset of Hypertension With Cardiovascular Diseases and Mortality. J Am Coll Cardiol 2021; 75:2921-2930. [PMID: 32527401 DOI: 10.1016/j.jacc.2020.04.038] [Citation(s) in RCA: 187] [Impact Index Per Article: 62.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/14/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND The relations of hypertension onset age with cardiovascular diseases (CVD) and all-cause mortality remain inconclusive. OBJECTIVES This study sought to examine the associations of hypertension onset age with CVD and all-cause mortality. METHODS This prospective study included 71,245 participants free of hypertension and CVD in the first survey (July 2006 to October 2007) of the Kailuan study, a prospective cohort study in Tangshan, China. All participants were followed biennially until December 31, 2017. A total of 20,221 new-onset hypertension cases were identified during follow-up. We randomly selected 1 control participant for each new-onset hypertensive participant, matching for age (±1 year) and sex, and included 19,887 case-control pairs. We used weighted Cox regression models to calculate the average hazard ratios of incident CVD and all-cause mortality across the age groups. RESULTS During an average follow-up of 6.5 years, we identified 1,672 incident CVD cases and 2,008 deaths. After multivariate adjustment, with the increase in hypertension onset age, the hazards of outcomes were gradually attenuated. The average hazard ratio (95% confidence interval) of CVD and all-cause mortality were 2.26 (1.19 to 4.30) and 2.59 (1.32 to 5.07) for the hypertension onset age <45 years old group, 1.62 (1.24 to 2.12) and 2.12 (1.55 to 2.90) for the 45- to 54-year age group, 1.42 (1.12 to 1.79) and 1.30 (1.03 to 1.62) for the 55- to 64-year age group, and 1.33 (1.04 to 1.69) and 1.29 (1.11 to 1.51) for the ≥65-year age group, respectively (p for interaction = 0.38 for CVD and <0.01 for death). CONCLUSIONS Hypertension was associated with a higher risk for CVD and all-cause mortality, and the associations were stronger with a younger age of onset.
Collapse
|
32
|
Kim MJ. Millennial Blood Pressure Alert: Suboptimal Hypertension Management in Children, Adolescents, and Young Adults. Korean Circ J 2021; 51:607-609. [PMID: 34227273 PMCID: PMC8263296 DOI: 10.4070/kcj.2021.0180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 05/26/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Mi Jeong Kim
- Department of Cardiology, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Cardiovascular Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
| |
Collapse
|
33
|
Humphrey JD. Mechanisms of Vascular Remodeling in Hypertension. Am J Hypertens 2020; 34:432-441. [PMID: 33245319 PMCID: PMC8140657 DOI: 10.1093/ajh/hpaa195] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/09/2020] [Accepted: 11/19/2020] [Indexed: 12/19/2022] Open
Abstract
Hypertension is both a cause and a consequence of central artery stiffening, which in turn is an initiator and indicator of myriad disease conditions and thus all-cause mortality. Such stiffening results from a remodeling of the arterial wall that is driven by mechanical stimuli and mediated by inflammatory signals, which together lead to differential gene expression and concomitant changes in extracellular matrix composition and organization. This review focuses on biomechanical mechanisms by which central arteries remodel in hypertension within the context of homeostasis-what promotes it, what prevents it. It is suggested that the vasoactive capacity of the wall and inflammatory burden strongly influence the ability of homeostatic mechanisms to adapt the arterial wall to high blood pressure or not. Maladaptation, often reflected by inflammation-driven adventitial fibrosis, not just excessive intimal-medial thickening, significantly diminishes central artery function and disturbs hemodynamics, ultimately compromising end organ perfusion and thus driving the associated morbidity and mortality. It is thus suggested that there is a need for increased attention to controlling both smooth muscle phenotype and inflammation in hypertensive remodeling of central arteries, with future studies of the often adaptive response of medium-sized muscular arteries promising to provide additional guidance.
Collapse
Affiliation(s)
- Jay D Humphrey
- Department of Biomedical Engineering, Vascular Biology and Therapeutics Program, Yale University, New Haven, Connecticut, USA,Correspondence: Jay D. Humphrey ()
| |
Collapse
|
34
|
Association between self-reported hypertension onset age and electrocardiographic left ventricular hypertrophy. J Hum Hypertens 2020; 35:479-482. [PMID: 33077804 DOI: 10.1038/s41371-020-00428-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 10/01/2020] [Accepted: 10/01/2020] [Indexed: 11/08/2022]
Abstract
Objectively defined early-onset hypertension, based on repeated blood pressure measurements, is associated with greater odds of organ damage and cardiovascular mortality than late-onset hypertension. In this study we examined the association between two factors that are easily available in primary care, self-reported hypertension onset age and electrocardiographic left ventricular hypertrophy (ECG-LVH), in a nationwide population sample of 2864 Finns aged ≥50 years. We observed that, in contrast to prior findings, the odds of ECG-LVH were similar between self-reported hypertension onset age groups, and thus self-reported early-onset hypertension does not seem to associate with ECG-LVH more strongly than simple presence of hypertension.
Collapse
|
35
|
Wang C, Yuan Y, Wu S, Xue H. Reply. J Am Coll Cardiol 2020; 76:1813-1814. [DOI: 10.1016/j.jacc.2020.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 08/11/2020] [Indexed: 11/26/2022]
|
36
|
Abstract
PURPOSE OF REVIEW The purpose of this review is to describe the long-term or lifetime relationship between blood pressure and target organ damage. The use of the term "blood pressure" as opposed to hypertension is purposeful. The risk of cardiovascular disease from blood pressure begins below the levels of blood pressure defined as hypertension by contemporary definitions. RECENT FINDINGS An important recent publication that bears on this topic was the 2017 ACC/AHA Blood Pressure Management Guidelines. The redefinition of hypertension and blood pressure treatment goal to 130/80 mmHg and the decision to rely almost exclusively on data from event-based randomized controlled clinical trials, which led to a recommendation for lifestyle therapy only for most with stage 1 hypertension, were important. A report from the CARDIA study demonstrated significant risk for cardiovascular disease at 20 years for stage 1 hypertension. Based on all evidence, clinicians should consider the use of medication for stage 1 hypertension in those uncontrolled on lifestyle therapy.
Collapse
Affiliation(s)
- Daniel W Jones
- Department of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
| | - Donald C Clark
- Department of Medicine, Division of Cardiology, University of Mississippi Medical Center, Jackson, MS, USA
| |
Collapse
|
37
|
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.
Collapse
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
| |
Collapse
|
38
|
Suvila K, McCabe EL, Lima JAC, Aittokallio J, Yano Y, Cheng S, Niiranen TJ. Self-reported Age of Hypertension Onset and Hypertension-Mediated Organ Damage in Middle-Aged Individuals. Am J Hypertens 2020; 33:644-651. [PMID: 32227078 PMCID: PMC7368170 DOI: 10.1093/ajh/hpaa055] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/26/2020] [Accepted: 03/26/2020] [Indexed: 01/19/2023] Open
Abstract
Background Objectively defined early onset hypertension, based on repeated blood pressure measurements, is a strong risk factor for cardiovascular disease (CVD). We aimed to assess if also self-reported hypertension onset age is associated with hypertension-mediated organ damage (HMOD). Additionally, we evaluated the agreement between self-reported and objectively defined hypertension onset age. Methods We studied 2,649 participants (50 ± 4 years at the time of outcome assessment, 57% women) of the Coronary Artery Risk Development in Young Adults (CARDIA) study who underwent measurements for echocardiographic left ventricular hypertrophy (LVH), left ventricular diastolic dysfunction (LVDD), coronary calcification, and albuminuria. We divided the participants into groups according to self-reported hypertension onset age (<35 years, 35–44 years, ≥45 years, and no hypertension). We used multivariable-adjusted logistic regression models to assess the relation between self-reported hypertension onset age with the presence of HMOD, with those who did not report hypertension as the referent group. Results Compared with individuals without self-reported hypertension, self-reported hypertension onset at <35 years was associated with LVH (odds ratio (OR), 2.38; 95% confidence interval (CI), 1.51–3.76), LVDD (OR, 2.32; 95% CI, 1.28–4.18, coronary calcification (OR, 2.87; 95% CI, 1.50–5.47), and albuminuria (OR, 1.62; 95% CI, 0.81–3.26). Self-reported hypertension onset at ≥45 years was only associated with LVDD (OR, 1.81; 95% CI, 1.06–3.08). The agreement between self-reported and objectively defined hypertension onset age groups was 78–79%. Conclusions Our findings suggest that self-reported hypertension onset age, a pragmatically feasible assessment in clinical practice, is a reasonable method for assessing risk of HMOD and CVD.
Collapse
Affiliation(s)
- Karri Suvila
- Division of Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Elizabeth L McCabe
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jenni Aittokallio
- Division of Perioperative Services, Turku University Hospital and University of Turku, Turku, Finland
| | - Yuichiro Yano
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
| | - Susan Cheng
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Teemu J Niiranen
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Turku, Finland
| |
Collapse
|
39
|
Niiranen TJ, Suvila K, Cheng S. Early-Onset Hypertension: Under-Recognized, Under-Treated, and Under-Estimated in Risk. J Am Coll Cardiol 2020; 75:2931-2933. [PMID: 32527402 DOI: 10.1016/j.jacc.2020.04.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Teemu J Niiranen
- Department of Medicine, Turku University Hospital and University of Turku, Turku, Finland; Department of Public Health Solutions, Finnish Institute for Health and Welfare, Turku, Finland.
| | - Karri Suvila
- Department of Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Susan Cheng
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| |
Collapse
|
40
|
Falkner B, Jones D. What About Stage 1 Hypertension in Young Adults? Hypertension 2020; 76:38-39. [PMID: 32520627 DOI: 10.1161/hypertensionaha.120.14527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bonita Falkner
- From the Thomas Jefferson University, Philadelphia, PA (B.F.)
| | | |
Collapse
|
41
|
Nuotio J, Suvila K, Cheng S, Langén V, Niiranen T. Longitudinal blood pressure patterns and cardiovascular disease risk. Ann Med 2020; 52:43-54. [PMID: 32077328 PMCID: PMC7877994 DOI: 10.1080/07853890.2020.1733648] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Observational and interventional studies have unequivocally demonstrated that "present", i.e. single-occasion, blood pressure is one of the key determinants of cardiovascular disease risk. Over the past two decades, however, numerous publications have suggested that longitudinal blood pressure data and assessment of long-term blood pressure exposure provide incremental prognostic value over present blood pressure. These studies have used several different indices to quantify the overall exposure to blood pressure, such as time-averaged blood pressure, cumulative blood pressure, blood pressure trajectory patterns, and age of hypertension onset. This review summarises existing research on the association between these indices and hard cardiovascular outcomes, outlines the strengths and weaknesses of these indices, and provides an overview of how longitudinal blood pressure changes can be measured and used to improve cardiovascular disease risk prediction.KEY MESSAGESNumerous recent publications have examined the relation between cardiovascular disease and long-term blood pressure (BP) exposure, quantified using indices such as time-averaged BP, cumulative BP, BP trajectory patterns, and age of hypertension onset.This review summarises existing research on the association between these indices and hard cardiovascular outcomes, outlines the strengths and weaknesses of these indices, and provides an overview of how longitudinal BP changes can be measured and used to improve cardiovascular disease risk prediction.Although longitudinal BP indices seem to predict cardiovascular outcomes better than present BP, there are considerable differences in the clinical feasibility of these indices along with a limited number of prospective data.
Collapse
Affiliation(s)
- Joel Nuotio
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland.,Department of Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Karri Suvila
- Division of Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Susan Cheng
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,The Framingham Heart Study, Framingham, MA, USA
| | - Ville Langén
- Division of Medicine, Turku University Hospital and University of Turku, Turku, Finland.,Department of Geriatrics, University of Turku, Turku, Finland
| | - Teemu Niiranen
- Division of Medicine, Turku University Hospital and University of Turku, Turku, Finland.,Department of Health, The Finnish Institute for Health and Welfare, Helsinki, Finland
| |
Collapse
|
42
|
Pyun WB. Hypertension Control in Young Population: the Earlier, the Better. Korean Circ J 2020; 50:1092-1094. [PMID: 33258317 PMCID: PMC7707978 DOI: 10.4070/kcj.2020.0427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/03/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Wook Bum Pyun
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea.
| |
Collapse
|
43
|
Lechner K, Halle M, Scherr J, Drezner JA. Exercise recommendations in athletes with coronary artery calcification. Eur J Prev Cardiol 2019; 27:882-884. [PMID: 31604400 DOI: 10.1177/2047487319881700] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Katharina Lechner
- Technical University of Munich, School of Medicine, Department of Prevention, Rehabilitation and Sports Medicine, Germany
| | - Martin Halle
- Technical University of Munich, School of Medicine, Department of Prevention, Rehabilitation and Sports Medicine, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Germany
| | - Johannes Scherr
- University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Switzerland
| | - Jonathan A Drezner
- Department of Family Medicine and the Center for Sports Cardiology, University of Washington, Seattle, USA
| |
Collapse
|
44
|
Niiranen TJ, Suvila K, Suppogu N, Ebinger JE, Lima JAC, Bairey Merz CN, Cheng S. Sex Differences in the Cardiac Effects of Early-Onset Hypertension. Hypertension 2019; 74:e52-e53. [PMID: 31564163 DOI: 10.1161/hypertensionaha.119.13809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Teemu J Niiranen
- From the Department of Medicine, Turku University Hospital and University of Turku, Finland (T.J.N., K.S.).,National Institute for Health and Welfare, Helsinki, Finland (T.J.N.)
| | - Karri Suvila
- From the Department of Medicine, Turku University Hospital and University of Turku, Finland (T.J.N., K.S.)
| | - Nissi Suppogu
- Barbra Streisand Women's Heart Center (N.S., C.N.B.M., S.C.), Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Joseph E Ebinger
- Hypertension Center of Excellence (J.E.E.), Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Joao A C Lima
- Cardiology Division, Johns Hopkins Hospital, Baltimore, MD (J.A.C.L.)
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center (N.S., C.N.B.M., S.C.), Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Susan Cheng
- Barbra Streisand Women's Heart Center (N.S., C.N.B.M., S.C.), Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| |
Collapse
|