Hypertension Subtypes, Mortality Risk, and Differential Effects Between Two Hypertension Guidelines

Prevalence and Mortality Trends of Hypertension Subtypes Among US Adults: An Analysis of the National Health and Nutrition Examination Survey

BACKGROUND

Hypertension (HTN) has been demonstrated as one of the leading risk factors for development of cardiovascular disease (CVD) and CVD mortality.

METHODS

This study examines the prevalence and distribution of HTN subtypes (isolated diastolic hypertension [IDH], isolated systolic hypertension [ISH], and systolic-diastolic hypertension [SDH]) across age, sex, and race/ethnicity per the nationally representative National Health and Nutrition Examination Survey (NHANES) from 1999 to 2020 based on the updated 2017 ACC/AHA HTN definition. We further examined for associations of each subtype with CVD and all-cause mortality using Cox regression analysis.

RESULTS

Among US adults, the overall prevalence of HTN is 47.4%. Across increasing age, the prevalence of IDH decreased, ISH increased, and SDH increased and peaked in the 6th decade of life after which SDH prevalence decreased. By age 80, over 80% of persons with HTN demonstrated ISH. A subcohort from NHANES 1999-2008 with follow-up until 2018 showed that ISH and SDH were most strongly associated with increased risk for CVD (HR = 1.18, 95% CI, 1.01-1.38; HR = 1.31, 95% CI, 1.07-1.60, respectively) and all-cause mortality (HR = 1.17, 95% CI, 1.06-1.28; HR = 1.21, 95% CI, 1.08-1.37, respectively).

CONCLUSIONS

Our data demonstrate the continuing importance of HTN subtype transitions across age and their differences in predicting future CVD and total mortality.

Correlation between weight-adjusted-waist index and hypertension in the US population: based on data from NHANES 2005-2018

Objectives

This study aimed to investigate the association between the weight-adjusted waist index (WWI) and the prevalence of hypertension in U.S. adults.

Methods

Data were sourced from the National Health and Nutrition Examination Survey (NHANES) spanning 2005-2018. In our cross-sectional study, we focused on the non-institutional U.S. population over the age of 18 from various communities in the United States. WWI is derived by dividing waist circumference by the square root of body weight. The definition of hypertension was based on self-reported history of hypertension, antihypertensive drug use, and blood pressure measurements. Participants without complete information on WWI and hypertension were excluded. The independent relationship and consistency between WWI and hypertension were assessed through weighted multivariate regression. The Pearson correlation test was used to detect the association between WWI and BMI. Subgroup analyses were used to verify the stability of the relationship between WWI and the prevalence of hypertension, and interaction tests were also conducted by gender, age, smoking, and triglycerides.

Results

Among the 37,299 participants included, the hypertension prevalence was 33.9%. After adjusting for confounding variables, WWI demonstrated a significant association with hypertension. Individuals in the top quarter of WWI had a 2.27fold higher chance of hypertension prevalence compared with the bottom quarter (OR = 2.27, 95% CI 1.97-2.61; P < 0.0001). Subgroup analysis highlighted that this association was particularly pronounced in males aged ≤60 years.

Conclusion

The findings underscore a robust correlation between elevated WWI and a heightened risk of hypertension, especially in males aged ≤60 years.

Risk analysis of blood pressure changes on cardiovascular disease in Chinese population

The study aimed to assess the impact of changes in blood pressure on cardiovascular events in the Chinese population. It enrolled 33 179 Chinese participants aged ≥35 years (57.1% women) without CVD at baseline. BP status was defined according to the 2017 ACC/AHA hypertension guidelines. The type of BP change was defined as change in BP status from baseline to the end of follow-up, included stable BP <130/80, <130/80 to ≥130/80, ≥130/80 to <130/80 mm Hg, persistent BP ≥130/80 mm Hg. The hazard ratio (HR) of incident CVD by change in BP category was estimated using Cox proportional hazards and Fine-Gray models. During median follow-up of 3.17 years, 2023 CVD events occurred. Compared with BP <120/80, 120-129/<80 mm Hg at baseline (HR = 1.66, 95% CI: 1.09-2.53), 130-139/80-89 mm Hg (HR = 1.35, 95% CI: 0.94-1.95), and ≥140/90 mm Hg (HR = 2.46, 95% CI: 1.78-3.40) were risk factors for CVD. Compared with the group with stable BP <130/80 mm Hg, the risk of CVD was 1.88 (95% CI: 1.40-2.53) in the group with persistent BP ≥130/80 mm Hg and 1.40 (95% CI: 1.01-1.94) in the group of BP decreased to <130/80 mm Hg. These results showed that BP 120-129/<80, 130-139/80-89, and ≥140/90 mm Hg were associated with a high risk of CVD. Over time, persistent BP ≥130/80 mm Hg increased the risk of CVD, but a return to <130/80 mm Hg from hypertension decreased the risk of CVD.

Hypertension subtypes at high altitude in Peru: Analysis of the Demographic and Family Health Survey 2016-2019

BACKGROUND

The prevalence of hypertension in Peru has increased over the years. Approximately one third of the Peruvian population lives at high altitudes. This population presents particular physiological, genetic and environmental characteristics that could be related to the prevalence of hypertension and its subtypes.

OBJECTIVE

To assess the association between altitude and hypertension in the Peruvian population through an analysis of a nationally representative survey.

METHODS

We conducted a cross-sectional analysis of the Demographic and Family Health Survey for the period 2016-2019. We included 122,336 individuals aged 18 years and older. Hypertension was defined according to the JNC-7 guidelines. High-altitude location was defined as a residential cluster located above 2,500 meters above sea level. We utilized generalized linear models from the Poisson family with a log-link function to assess the magnitude of the association between high altitude and hypertension. Additionally, we employed multinomial regression models to analyze the association between high altitude and subtypes of hypertension, including isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH).

RESULTS

In the adjusted Poisson regression model, we found that the prevalence of hypertension among participants living at high altitudes was lower compared to those living at low altitudes (aPR: 0.89; 95% CI: 0.86-0.93). In the adjusted multinomial regression model, we observed a lower prevalence rate of ISH among participants residing at high altitudes (aRPR: 0.68; 95% CI: 0.61-0.73) and a higher prevalence rate of IDH among participants residing at high altitudes (aRPR: 1.60; 95% CI: 1.32-1.94).

CONCLUSIONS

Residents at high altitudes in Peru have a lower prevalence rate of ISH and a higher prevalence rate of IDH compared to those living at low altitudes. Further studies are needed to determine the influence of other biological, environmental, and healthcare access factors on this relationship.

Association between lean body mass and hypertension: A cross-sectional study of 50 159 NHANES participants

Increasing attention has been paid to the association between lean body mass (LBM) and hypertension in recent years, but the previous findings have often been contradictory. Therefore, the authors investigated the association between LBM and hypertension through a cross-sectional study in the United States. To investigate the relationship between LBM and hypertension, the authors conducted weighted multivariable logistic regression models. The authors used the restricted cubic spline regression model to determine if there was a nonlinear correlation. In order to locate the inflection point, the authors built a two-part linear regression model using a recursive method. In the full adjustment model, LBM was positively associated with hypertension, with ORs (95% CI) of 1.19 (1.02, 1.38). In the further linear trend test, the ORs (95% CI) for Q2, Q3, and Q4 were 0.76 (0.60, 0.95), 0.62 (0.47, 0.80), and 0.66 (0.48, 0.91), respectively, compared to Q1, which suggested that the association between LBM and hypertension might be non-linear. The authors performed the restricted cubic spline curve to confirm this non-linear relationship and found the inflection point of 43.21 kg with an opposite relationship in which LBM and hypertension exhibited a negative correction of 0.66 (0.50, 0.86) before the inflection point and a positive correlation of 1.20 (1.03, 1.39) after the inflection point. Our study highlighted a non-linear association between LBM and hypertension in the general US population.