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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.)
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2
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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.)
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3
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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.
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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
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4
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Routila J, Suvila K, Grénman R, Leivo I, Westermarck J, Ventelä S. Cancer cell line microarray as a novel screening method for identification of radioresistance biomarkers in head and neck squamous cell carcinoma. BMC Cancer 2021; 21:868. [PMID: 34320941 PMCID: PMC8320194 DOI: 10.1186/s12885-021-08618-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 07/15/2021] [Indexed: 11/23/2022] Open
Abstract
Background Currently, no clinically useful biomarkers for radioresistance are available in head and neck squamous cell carcinoma (HNSCC). This study assesses the usefulness of Cell Line Microarray (CMA) method to enhance immunohistochemical screening of potential immunohistochemical biomarkers for radioresistance in HNSCC cell lines. Methods Twenty-nine HNSCC cell lines were cultured, cell pellets formalin-fixed, paraffin-embedded, and arrayed. Radioresistance features of the cell lines were combined to immunohistochemical stains for p53, NDFIP1, EGFR, stem cell marker Oct4, and PP2A inhibitor CIP2A. Results Expression of p53, EGFR or CIP2A did not indicate intrinsic radioresistance in vitro. Stem cell marker Oct4 nuclear positivity and NDFIP1 nuclear positivity was correlated with increased intrinsic radioresistance. Conclusion The usefulness of CMA in analysis of HNSCC cell lines and discovery of biomarkers is demonstrated. CMA is very well adapted to both testing of antibodies in a large panel of cell lines as well as correlating staining results with other cell line characteristics. In addition, CMA-based antibody screening proved an efficient and relatively simple method to identify potential radioresistance biomarkers in HNSCC. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08618-6.
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Affiliation(s)
- Johannes Routila
- Turku Bioscience Centre, University of Turku and Åbo Akademi university, Turku, Finland.,Department for Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20521, Turku, Finland.,Department for Otorhinolaryngology, Satakunta Central Hospital, Pori, Finland
| | - Karri Suvila
- Turku Bioscience Centre, University of Turku and Åbo Akademi university, Turku, Finland
| | - Reidar Grénman
- Department for Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20521, Turku, Finland
| | - Ilmo Leivo
- Institute of Biomedicine, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland
| | - Jukka Westermarck
- Turku Bioscience Centre, University of Turku and Åbo Akademi university, Turku, Finland.,Institute of Biomedicine, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland
| | - Sami Ventelä
- Turku Bioscience Centre, University of Turku and Åbo Akademi university, Turku, Finland. .,Department for Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20521, Turku, Finland. .,Institute of Biomedicine, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland.
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5
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Abstract
Hypertension is related to increased risk of cognitive decline in a highly age-dependent manner. However, conflicting evidence exists on the relation between age of hypertension onset and cognition. Our goal was to investigate the association between early- versus late-onset hypertension and midlife cognitive performance in 2946 CARDIA study (Coronary Artery Risk Development in Young Adults) participants (mean age 55±4, 57% women). The participants underwent 9 repeat examinations, including blood pressure measurements, between 1985 to 1986 and 2015 to 2016. The participants underwent brain magnetic resonance imaging and completed Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, Stroop interference test, and the Montreal Cognitive Assessment to evaluate cognitive function at the year 30 exam. We assessed the relation between age of hypertension onset and cognitive function using linear regression models adjusted for cognitive decline risk factors, including systolic blood pressure. We observed that individuals with early-onset hypertension (onset at <35 years) had 0.24±0.09, 0.22±0.10, 0.27±0.09, and 0.19±0.07 lower standardized Z-scores in Digit Symbol Substitution Test, Stroop test, Montreal Cognitive Assessment, and a composite cognitive score than participants without hypertension (P<0.05 for all). In contrast, hypertension onset at ≥35 years was not associated with cognitive function (P >0.05 for all). In a subgroup of 559 participants, neither early- nor late-onset hypertension was related to macrostructural brain alterations (P >0.05 for all). Our results indicate that early-onset hypertension is a potent risk factor for midlife cognitive impairment. Thus, age of hypertension onset assessment in clinical practice could improve risk stratification of cognitive decline in patients with hypertension.
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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
| | - Yuichiro Yano
- Department of Family Medicine and Community Health, Duke University, Durham, USA
| | - Zaldy S. Tan
- Department of Neurology, Jona Goldrich Center for Alzheimer’s and Memory Disorders, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Susan Cheng
- Division of Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, USA
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, USA
- Framingham Heart Study, Framingham, 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
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
[Figure: see text].
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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.)
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7
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Abstract
PURPOSE OF REVIEW To review the current evidence on research related to age of hypertension onset-its definition, correlates, heritability, and association with adverse outcomes. We also propose a framework for implementing assessment of hypertension onset age into clinical practice. RECENT FINDINGS Prior studies have used both objective measurements and self-report to determine age of hypertension onset or early-onset hypertension. Yet, no criterion for standard definition currently exists for either. Data from epidemiological and clinical studies demonstrate that early-onset hypertension is a highly heritable trait that confers an increased risk for cardiovascular death and end-organ damage compared with late-onset hypertension. Literature to date suggests that (parental) age of hypertension onset can be feasibly assessed for estimating (1) risk of future hypertension in non-hypertensive persons; and (2) the propensity for cardiovascular disease in individuals with established hypertension.
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Affiliation(s)
- Karri Suvila
- Division of Medicine, Turku University Hospital, Turku, Finland.
- Department of Internal Medicine, University of Turku, Turku, Finland.
| | - Ville Langén
- Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Geriatrics, University of Turku, Turku, Finland
| | - Susan Cheng
- The Framingham Heart Study, Framingham, MA, USA
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Teemu J Niiranen
- Department of Internal Medicine, University of Turku, Turku, Finland
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Turku, Finland
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8
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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9
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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] [What about the content of this article? (0)] [Affiliation(s)] [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
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10
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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.
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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
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11
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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] [What about the content of this article? (0)] [Affiliation(s)] [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
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Suvila K, McCabe EL, Lehtonen A, Ebinger JE, Lima JA, Cheng S, Niiranen TJ. Early Onset Hypertension Is Associated With Hypertensive End-Organ Damage Already by MidLife. Hypertension 2019; 74:305-312. [PMID: 31256722 PMCID: PMC6938569 DOI: 10.1161/hypertensionaha.119.13069] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Early onset hypertension confers increased risk for cardiovascular mortality in the community. Whether early onset hypertension also promotes the development of target end-organ damage (TOD), even by midlife, has remained unknown. We studied 2680 middle-aged CARDIA study (Coronary Artery Risk Development in Young Adults) Study participants (mean age 50±4 years, 57% women) who underwent up to 8 serial blood pressure measurements between 1985 and 2011 (age range at baseline 18-30 years) in addition to assessments of echocardiographic left ventricular hypertrophy, coronary calcification, albuminuria, and diastolic dysfunction in 2010 to 2011. Age of hypertension onset was defined as the age at first of 2 consecutively attended examinations with blood pressure ≥140/90 mm Hg or use of antihypertensive medication. Participants were divided in groups by hypertension onset age (<35 years, 35-44 years, ≥45 years, or no hypertension). While adjusting for TOD risk factors, including systolic blood pressure, we used logistic regression to calculate odds ratios for cases (participants with TOD) versus controls (participants without TOD) to examine the relation of hypertension onset age and hypertensive TOD. Compared with normotensive individuals, hypertension onset at age <35 years was related to odds ratios of 2.29 (95% CI, 1.36-3.86), 2.94 (95% CI, 1.57-5.49), 1.12 (95% CI, 0.55-2.29), and 2.06 (95% CI, 1.04-4.05) for left ventricular hypertrophy, coronary calcification, albuminuria, and diastolic dysfunction, respectively. In contrast, hypertension onset at age ≥45 years was not related to increased odds of TOD. Our findings emphasize the importance of assessing age of hypertension onset in hypertensive patients to identify high-risk individuals for preventing hypertensive complications.
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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, USA
| | - Arttu Lehtonen
- Department of Geriatrics, University of Turku, Turku, Finland
| | - Joseph E. Ebinger
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Joao A.C. Lima
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Susan Cheng
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, USA,Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA,Framingham Heart Study, Framingham, MA, USA
| | - Teemu J. Niiranen
- Division of Medicine, Turku University Hospital and University of Turku, Turku, Finland,Department of Public Health Solutions, National Institute for Health and Welfare, Turku, Finland
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