Pub Date : 2024-04-16DOI: 10.1038/s41371-024-00911-8
Katerina Massengale, Yanyan Xu, Harold Snieder, Shaoyong Su, Xiaoling Wang
Altered blood pressure (BP) circadian rhythmicity has been increasingly linked with cardiovascular risk. However, little is known about BP circadian rhythm change with age and its possible sociodemographic, anthropometric, and genetic moderators. Twenty-four-hour ambulatory BP was measured up to 16 times over a 23-year period in 339 European Americans (EAs) and 293 African Americans (AAs), with an average age of 15 years at the initial visit. BP circadian rhythms were indexed by amplitude and percent rhythm (a measure of rhythm integrity) and calculated using Fourier analysis. BP amplitude and percent rhythm increased with age and average BP (BP mesor). AAs were more likely to have lower BP amplitude and percent rhythm than their EA counterparts. BP amplitude and percent rhythm also decreased with adiposity (BMI and waist circumference). The summer season was associated with lower BP amplitude in AAs and lower percent rhythm in both AAs and EAs. Sex, height, socioeconomic status, physical activity, and family history of essential hypertension did not have an independent impact on BP amplitude or percent rhythm. The results of the present study suggest that BP circadian rhythm increases with age and BP mesor from childhood to young adulthood, decreases with adiposity, and that AAs are more likely to have lower circadian rhythm than EAs. Furthermore, we demonstrated that the summer season is associated with lower BP rhythmicity.
血压昼夜节律的改变与心血管风险的关系越来越密切。然而，人们对血压昼夜节律随年龄的变化及其可能的社会人口、人体测量和遗传调节因素知之甚少。在 23 年的时间里，对 339 名欧洲裔美国人（EAs）和 293 名非洲裔美国人（AAs）进行了多达 16 次的 24 小时动态血压测量，首次测量时的平均年龄为 15 岁。血压昼夜节律以振幅和节律百分比（节律完整性的衡量标准）为指标，并使用傅立叶分析法进行计算。血压振幅和节律百分比随年龄和平均血压（BP mesor）的增加而增加。与 EA 患者相比，AA 患者的血压振幅和节律百分比更低。血压振幅和节律百分比也随脂肪含量（体重指数和腰围）的增加而降低。在夏季，AA 族人的血压振幅较低，而 AA 族人和 EA 族人的血压节律百分比较低。性别、身高、社会经济地位、体力活动和家族性高血压病史对血压振幅或节律率没有独立影响。本研究的结果表明，血压昼夜节律随年龄和儿童至青年期血压中位数的增加而增加，随脂肪含量的增加而减少，而 AAs 比 EAs 更有可能具有较低的昼夜节律。此外，我们还证明夏季与较低的血压昼夜节律性有关。
{"title":"A longitudinal study of blood pressure circadian rhythm from childhood to early adulthood","authors":"Katerina Massengale, Yanyan Xu, Harold Snieder, Shaoyong Su, Xiaoling Wang","doi":"10.1038/s41371-024-00911-8","DOIUrl":"10.1038/s41371-024-00911-8","url":null,"abstract":"Altered blood pressure (BP) circadian rhythmicity has been increasingly linked with cardiovascular risk. However, little is known about BP circadian rhythm change with age and its possible sociodemographic, anthropometric, and genetic moderators. Twenty-four-hour ambulatory BP was measured up to 16 times over a 23-year period in 339 European Americans (EAs) and 293 African Americans (AAs), with an average age of 15 years at the initial visit. BP circadian rhythms were indexed by amplitude and percent rhythm (a measure of rhythm integrity) and calculated using Fourier analysis. BP amplitude and percent rhythm increased with age and average BP (BP mesor). AAs were more likely to have lower BP amplitude and percent rhythm than their EA counterparts. BP amplitude and percent rhythm also decreased with adiposity (BMI and waist circumference). The summer season was associated with lower BP amplitude in AAs and lower percent rhythm in both AAs and EAs. Sex, height, socioeconomic status, physical activity, and family history of essential hypertension did not have an independent impact on BP amplitude or percent rhythm. The results of the present study suggest that BP circadian rhythm increases with age and BP mesor from childhood to young adulthood, decreases with adiposity, and that AAs are more likely to have lower circadian rhythm than EAs. Furthermore, we demonstrated that the summer season is associated with lower BP rhythmicity.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 5","pages":"437-443"},"PeriodicalIF":2.7,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140572459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-10DOI: 10.1038/s41371-024-00910-9
Yang Zhao, Xueru Fu, Yamin Ke, Yuying Wu, Pei Qin, Fulan Hu, Ming Zhang, Dongsheng Hu
Our aim was to examine the independent and joint associations of estimated cardiorespiratory fitness (CRF) and its changes and obesity with risk of hypertension in a rural Chinese population. A prospective cohort including 9848 adults without hypertension at baseline was enrolled. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated by logistic regression models. Restricted cubic splines were used to model the dose–response relationship. During 6 years follow-up, 2,019 individuals developed hypertension. A negative association between estimated CRF and hypertension incidence was observed, with the risk being 0.87 (0.84–0.90) per MET increment. For estimated CRF change, the risks of hypertension were 1.50 (1.27–1.77) and 0.75 (0.59–0.97) for decreasers and increasers, respectively, compared to maintainers. Joint analyses showed individuals in the overweight/obesity-fourth quartile of estimated CRF had a 2.08 times higher risk of hypertension than those in the normal weight-first quartile (Pinteraction < 0.05). Those overweight/obesity-decreasers had the highest risk (OR: 2.19, 95%CI: 1.71–2.81; Pinteraction < 0.05) compared to the normal-maintainers. Similar results for abdominal obesity were also observed. Estimated CRF and its dynamic changes showed a negative association with hypertension incidence in the rural Chinese population.
{"title":"Independent and joint associations of estimated cardiorespiratory fitness and its dynamic changes and obesity with the risk of hypertension: A prospective cohort","authors":"Yang Zhao, Xueru Fu, Yamin Ke, Yuying Wu, Pei Qin, Fulan Hu, Ming Zhang, Dongsheng Hu","doi":"10.1038/s41371-024-00910-9","DOIUrl":"10.1038/s41371-024-00910-9","url":null,"abstract":"Our aim was to examine the independent and joint associations of estimated cardiorespiratory fitness (CRF) and its changes and obesity with risk of hypertension in a rural Chinese population. A prospective cohort including 9848 adults without hypertension at baseline was enrolled. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated by logistic regression models. Restricted cubic splines were used to model the dose–response relationship. During 6 years follow-up, 2,019 individuals developed hypertension. A negative association between estimated CRF and hypertension incidence was observed, with the risk being 0.87 (0.84–0.90) per MET increment. For estimated CRF change, the risks of hypertension were 1.50 (1.27–1.77) and 0.75 (0.59–0.97) for decreasers and increasers, respectively, compared to maintainers. Joint analyses showed individuals in the overweight/obesity-fourth quartile of estimated CRF had a 2.08 times higher risk of hypertension than those in the normal weight-first quartile (Pinteraction < 0.05). Those overweight/obesity-decreasers had the highest risk (OR: 2.19, 95%CI: 1.71–2.81; Pinteraction < 0.05) compared to the normal-maintainers. Similar results for abdominal obesity were also observed. Estimated CRF and its dynamic changes showed a negative association with hypertension incidence in the rural Chinese population.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 5","pages":"413-419"},"PeriodicalIF":2.7,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140572293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-03DOI: 10.1038/s41371-024-00909-2
Päivi A. Lempiäinen, Antti Ylitalo, Heikki Huikuri, Y. Antero Kesäniemi, Olavi H. Ukkola
Non-dipping blood pressure (BP) pattern is a predictor for cardiovascular (CV) events and mortality. We evaluated dipping status change and its association with incidence of non-fatal CV events in middle-aged subjects. The OPERA study was carried out during the years 1991–1993, with a follow-up study 21.7 years later. In this study, we included 452 participants with 24-h ambulatory BP measurements (ABPM) available in both surveys. The study population was divided into four groups according to the dipping pattern change: dipping–dipping (n = 152/33.6%), dipping–non-dipping (n = 198/43.8%), non-dipping–dipping (n = 20/4.4%), and non-dipping–non-dipping (n = 82/18.1%). Sixty-five participants experienced a CV event (14.4%) during the 21.7 (SD 0.8) years of follow-up. The incidence of events was highest (28%) in the non-dipping–non-dipping group, and lowest (6.6%) in the dipping–dipping group (p < 0.001). In Cox regression analyses the covariates were age, sex, total cholesterol, hypertension and use of antihypertensive medication, systolic office BP and ambulatory mean or nighttime systolic BP, as well as the change in the variables during the follow-up period. After adjustments, the association of the non-dipping–non-dipping pattern with CV events compared with the dipping–dipping pattern remained significant (HR 4.01; 95% CI 1.89–8.67, p < 0.001). In summary, non-dipping–non-dipping pattern was associated with non-fatal CV events in the long term, and the effect was independent of the conventional risk factors including office and ambulatory BP levels.
{"title":"Non-dipping blood pressure pattern is associated with cardiovascular events in a 21-year follow-up study","authors":"Päivi A. Lempiäinen, Antti Ylitalo, Heikki Huikuri, Y. Antero Kesäniemi, Olavi H. Ukkola","doi":"10.1038/s41371-024-00909-2","DOIUrl":"10.1038/s41371-024-00909-2","url":null,"abstract":"Non-dipping blood pressure (BP) pattern is a predictor for cardiovascular (CV) events and mortality. We evaluated dipping status change and its association with incidence of non-fatal CV events in middle-aged subjects. The OPERA study was carried out during the years 1991–1993, with a follow-up study 21.7 years later. In this study, we included 452 participants with 24-h ambulatory BP measurements (ABPM) available in both surveys. The study population was divided into four groups according to the dipping pattern change: dipping–dipping (n = 152/33.6%), dipping–non-dipping (n = 198/43.8%), non-dipping–dipping (n = 20/4.4%), and non-dipping–non-dipping (n = 82/18.1%). Sixty-five participants experienced a CV event (14.4%) during the 21.7 (SD 0.8) years of follow-up. The incidence of events was highest (28%) in the non-dipping–non-dipping group, and lowest (6.6%) in the dipping–dipping group (p < 0.001). In Cox regression analyses the covariates were age, sex, total cholesterol, hypertension and use of antihypertensive medication, systolic office BP and ambulatory mean or nighttime systolic BP, as well as the change in the variables during the follow-up period. After adjustments, the association of the non-dipping–non-dipping pattern with CV events compared with the dipping–dipping pattern remained significant (HR 4.01; 95% CI 1.89–8.67, p < 0.001). In summary, non-dipping–non-dipping pattern was associated with non-fatal CV events in the long term, and the effect was independent of the conventional risk factors including office and ambulatory BP levels.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 5","pages":"444-451"},"PeriodicalIF":2.7,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00909-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140572192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-21DOI: 10.1038/s41371-024-00907-4
Nicolás Roberto Robles, Francesco Fici, Guido Grassi
New European Hypertension Society Guidelines for the Management of Hypertension recommend unattended blood pressure measurement use for hypertensive urgencies in the Emergency Wards. Available evidence shows that, in the specific situation of hypertensive urgencies, BP is reduced to less than 160/100 mmHg or even lower values in 30 min in 30% of the patients when unattended BP measurement is used. The implementation of unattended blood pressure measurement could avoid a significant number of antihypertensive treatments.
{"title":"Management of hypertensive urgencies: a new opportunity for unattended blood pressure measurement","authors":"Nicolás Roberto Robles, Francesco Fici, Guido Grassi","doi":"10.1038/s41371-024-00907-4","DOIUrl":"10.1038/s41371-024-00907-4","url":null,"abstract":"New European Hypertension Society Guidelines for the Management of Hypertension recommend unattended blood pressure measurement use for hypertensive urgencies in the Emergency Wards. Available evidence shows that, in the specific situation of hypertensive urgencies, BP is reduced to less than 160/100 mmHg or even lower values in 30 min in 30% of the patients when unattended BP measurement is used. The implementation of unattended blood pressure measurement could avoid a significant number of antihypertensive treatments.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 4","pages":"295-297"},"PeriodicalIF":2.7,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140184624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-06DOI: 10.1038/s41371-024-00904-7
Stephen D. Persell, Lauren Anthony, Yaw A. Peprah, Ji Young Lee, Jim Li, Hironori Sato, Lucia C. Petito
This pragmatic matched cohort study using EHR data extended the follow up to 18 months for BP outcomes comparing individuals prescribed remote patient monitoring (n = 288) and temporally-matched controls (n = 1152) from six primary care practices. After 18 months, the RPM-prescribed cohort had greater BP control < 140/90 mm Hg (RPM cohort: 71.5%, control cohort: 51.9%, p < 0.001) and lower systolic BP (131.6 versus 136.0 mm Hg, p = 0.004) using office and home measurements. BP control at 18 months assessed by office measurements only was also higher in the RPM group (62.2% versus 51.9%, p = 0.004).
{"title":"Blood pressure outcomes at 18 months in primary care patients prescribed remote physiological monitoring for hypertension: a prospective cohort study","authors":"Stephen D. Persell, Lauren Anthony, Yaw A. Peprah, Ji Young Lee, Jim Li, Hironori Sato, Lucia C. Petito","doi":"10.1038/s41371-024-00904-7","DOIUrl":"10.1038/s41371-024-00904-7","url":null,"abstract":"This pragmatic matched cohort study using EHR data extended the follow up to 18 months for BP outcomes comparing individuals prescribed remote patient monitoring (n = 288) and temporally-matched controls (n = 1152) from six primary care practices. After 18 months, the RPM-prescribed cohort had greater BP control < 140/90 mm Hg (RPM cohort: 71.5%, control cohort: 51.9%, p < 0.001) and lower systolic BP (131.6 versus 136.0 mm Hg, p = 0.004) using office and home measurements. BP control at 18 months assessed by office measurements only was also higher in the RPM group (62.2% versus 51.9%, p = 0.004).","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 3","pages":"286-288"},"PeriodicalIF":2.7,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00904-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140049673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-04DOI: 10.1038/s41371-024-00906-5
Alexander S. MACDONALD, Alex MCCONNACHIE, David Alexander DICKIE, Philip M. BATH, Kirsten FORBES, Terence QUINN, Niall M. BROOMFIELD, Krishna DANI, Alex DONEY, Keith W. MUIR, Allan STRUTHERS, Matthew WALTERS, Mark BARBER, Ajay BHALLA, Alan CAMERON, Paul GUYLER, Ahamad HASSAN, Mark KEARNEY, Breffni KEEGAN, Sekaran LAKSHMANAN, Mary Joan MACLEOD, Marc RANDALL, Louise SHAW, Ganesh SUBRAMANIAN, David WERRING, Jesse DAWSON
Blood Pressure Variability (BPV) is associated with cardiovascular risk and serum uric acid level. We investigated whether BPV was lowered by allopurinol and whether it was related to neuroimaging markers of cerebral small vessel disease (CSVD) and cognition. We used data from a randomised, double-blind, placebo-controlled trial of two years allopurinol treatment after recent ischemic stroke or transient ischemic attack. Visit-to-visit BPV was assessed using brachial blood pressure (BP) recordings. Short-term BPV was assessed using ambulatory BP monitoring (ABPM) performed at 4 weeks and 2 years. Brain MRI was performed at baseline and 2 years. BPV measures were compared between the allopurinol and placebo groups, and with CSVD and cognition. 409 participants (205 allopurinol; 204 placebo) were included in the visit-to-visit BPV analyses. There were no significant differences found between placebo and allopurinol groups for any measure of visit-to-visit BPV. 196 participants were included in analyses of short-term BPV at week 4. Two measures were reduced by allopurinol: the standard deviation (SD) of systolic BP (by 1.30 mmHg (95% confidence interval (CI) 0.18–2.42, p = 0.023)); and the average real variability (ARV) of systolic BP (by 1.31 mmHg (95% CI 0.31–2.32, p = 0.011)). There were no differences in other measures at week 4 or in any measure at 2 years, and BPV was not associated with CSVD or cognition. Allopurinol treatment did not affect visit-to-visit BPV in people with recent ischemic stroke or TIA. Two BPV measures were reduced at week 4 by allopurinol but not at 2 years.
{"title":"Allopurinol and blood pressure variability following ischemic stroke and transient ischemic attack: a secondary analysis of XILO-FIST","authors":"Alexander S. MACDONALD, Alex MCCONNACHIE, David Alexander DICKIE, Philip M. BATH, Kirsten FORBES, Terence QUINN, Niall M. BROOMFIELD, Krishna DANI, Alex DONEY, Keith W. MUIR, Allan STRUTHERS, Matthew WALTERS, Mark BARBER, Ajay BHALLA, Alan CAMERON, Paul GUYLER, Ahamad HASSAN, Mark KEARNEY, Breffni KEEGAN, Sekaran LAKSHMANAN, Mary Joan MACLEOD, Marc RANDALL, Louise SHAW, Ganesh SUBRAMANIAN, David WERRING, Jesse DAWSON","doi":"10.1038/s41371-024-00906-5","DOIUrl":"10.1038/s41371-024-00906-5","url":null,"abstract":"Blood Pressure Variability (BPV) is associated with cardiovascular risk and serum uric acid level. We investigated whether BPV was lowered by allopurinol and whether it was related to neuroimaging markers of cerebral small vessel disease (CSVD) and cognition. We used data from a randomised, double-blind, placebo-controlled trial of two years allopurinol treatment after recent ischemic stroke or transient ischemic attack. Visit-to-visit BPV was assessed using brachial blood pressure (BP) recordings. Short-term BPV was assessed using ambulatory BP monitoring (ABPM) performed at 4 weeks and 2 years. Brain MRI was performed at baseline and 2 years. BPV measures were compared between the allopurinol and placebo groups, and with CSVD and cognition. 409 participants (205 allopurinol; 204 placebo) were included in the visit-to-visit BPV analyses. There were no significant differences found between placebo and allopurinol groups for any measure of visit-to-visit BPV. 196 participants were included in analyses of short-term BPV at week 4. Two measures were reduced by allopurinol: the standard deviation (SD) of systolic BP (by 1.30 mmHg (95% confidence interval (CI) 0.18–2.42, p = 0.023)); and the average real variability (ARV) of systolic BP (by 1.31 mmHg (95% CI 0.31–2.32, p = 0.011)). There were no differences in other measures at week 4 or in any measure at 2 years, and BPV was not associated with CSVD or cognition. Allopurinol treatment did not affect visit-to-visit BPV in people with recent ischemic stroke or TIA. Two BPV measures were reduced at week 4 by allopurinol but not at 2 years.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 4","pages":"307-313"},"PeriodicalIF":2.7,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00906-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140028222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-29DOI: 10.1038/s41371-024-00903-8
Paul Olowoyo, Anastase Dzudie, Akinkunmi Paul Okekunle, Reginald Obiako, Ana Mocumbi, Hind Beheiry, Gianfranco Parati, Daniel T. Lackland, Fred S. Sarfo, Augustine Odili, Abiodun M. Adeoye, Kolawole Wahab, Charles Agyemang, Norman Campbell, Andre Pascal Kengne, Paul K. Whelton, Pierpaolo Pellicori, Ad Adams Ebenezer, Oladimeji Adebayo, Oladotun Olalusi, Ayodele Jegede, Ezinne Uvere, Olayinka Adebajo, Baffour Awuah, Andrew Moran, Bryan Williams, Tomasz J. Guzik, Collins Kokuro, Fred Bukachi, Okechukwu S. Ogah, Christian Delles, Pasquale Maffia, Rufus Akinyemi, Prebo Barango, Dike Ojji, Mayowa Owolabi
The prevalence of hypertension, the commonest risk factor for preventable disability and premature deaths, is rapidly increasing in Africa. The African Control of Hypertension through Innovative Epidemiology, and a Vibrant Ecosystem [ACHIEVE] conference was convened to discuss and initiate the co-implementation of the strategic solutions to tame this burden toward achieving a target of 80% for awareness, treatment, and control by the year 2030. Experts, including the academia, policymakers, patients, the WHO, and representatives of various hypertension and cardiology societies generated a 12-item communique for implementation by the stakeholders of the ACHIEVE ecosystem at the continental, national, sub-national, and local (primary) healthcare levels.
{"title":"ACHIEVE conference proceedings: implementing action plans to reduce and control hypertension burden in Africa","authors":"Paul Olowoyo, Anastase Dzudie, Akinkunmi Paul Okekunle, Reginald Obiako, Ana Mocumbi, Hind Beheiry, Gianfranco Parati, Daniel T. Lackland, Fred S. Sarfo, Augustine Odili, Abiodun M. Adeoye, Kolawole Wahab, Charles Agyemang, Norman Campbell, Andre Pascal Kengne, Paul K. Whelton, Pierpaolo Pellicori, Ad Adams Ebenezer, Oladimeji Adebayo, Oladotun Olalusi, Ayodele Jegede, Ezinne Uvere, Olayinka Adebajo, Baffour Awuah, Andrew Moran, Bryan Williams, Tomasz J. Guzik, Collins Kokuro, Fred Bukachi, Okechukwu S. Ogah, Christian Delles, Pasquale Maffia, Rufus Akinyemi, Prebo Barango, Dike Ojji, Mayowa Owolabi","doi":"10.1038/s41371-024-00903-8","DOIUrl":"10.1038/s41371-024-00903-8","url":null,"abstract":"The prevalence of hypertension, the commonest risk factor for preventable disability and premature deaths, is rapidly increasing in Africa. The African Control of Hypertension through Innovative Epidemiology, and a Vibrant Ecosystem [ACHIEVE] conference was convened to discuss and initiate the co-implementation of the strategic solutions to tame this burden toward achieving a target of 80% for awareness, treatment, and control by the year 2030. Experts, including the academia, policymakers, patients, the WHO, and representatives of various hypertension and cardiology societies generated a 12-item communique for implementation by the stakeholders of the ACHIEVE ecosystem at the continental, national, sub-national, and local (primary) healthcare levels.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 3","pages":"193-199"},"PeriodicalIF":2.7,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00903-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139996509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-27DOI: 10.1038/s41371-024-00902-9
Yingting Zuo, Shuohua Chen, Xue Tian, Shouling Wu, Anxin Wang
It has not been fully investigated whether improved arterial stiffness (AS) can reduce the clinical outcomes risk in community population-based study. In this prospective study, a total of 5247 individuals with abnormal AS (at baseline) and repeated brachial-ankle pulse wave velocity (baPWV) measurement before 2018 years were enrolled from the Kailuan Study. According the second baPWV measurement, we divided the participants into two groups, improved AS (defined as transfer elevated AS status to normal) and persistent AS (defined as maintaining elevated AS status). The outcome was a composite event of stroke, myocardial infraction, and all-cause mortality. We used Cox proportional hazards regression to examine the association between AS status at the follow-up and the subsequent outcome. During a median of 5.2 years follow-up, we observed 413 end point events. After adjusted for potential confounders, comparing with the persistent AS group, individuals in the improved AS group had a 43% (hazard ratio [HR], 0.57; 95% confidence interval [CI] 0.35–0.94) decreased the risk of the primary composite events. We also found a baPWV decrease of 1 m/s was associated with a 3% decreased risk (HR, 0.97; 95% CI 0.94–0.99) for primary composite events. We further demonstrated that younger than 60 years, non-smoker, non-hypertension, and non-diabetes were associated with improved the AS status. In conclusion, improving AS status may reduce the risk of clinical events. In the future, more research should be performed to explore the target for improving the AS status.
在以社区为基础的人群研究中，改善动脉僵化（AS）是否能降低临床结果风险尚未得到充分研究。在这项前瞻性研究中，开滦研究共纳入了 5247 名 AS 异常（基线时）且在 2018 年前重复测量过肱-踝脉搏波速度（baPWV）的个体。根据第二次baPWV测量结果，我们将参与者分为两组，即强直性脊柱炎改善组（定义为强直性脊柱炎升高状态转为正常）和强直性脊柱炎持续组（定义为强直性脊柱炎升高状态维持不变）。结果是中风、心肌梗死和全因死亡的综合事件。我们使用 Cox 比例危险回归法来检验随访时的 AS 状态与后续结果之间的关联。在中位 5.2 年的随访期间，我们观察到 413 例终点事件。在对潜在的混杂因素进行调整后，与持续性强直性脊柱炎组相比，强直性脊柱炎好转组的患者发生主要复合事件的风险降低了 43%（危险比 [HR]，0.57；95% 置信区间 [CI]，0.35-0.94）。我们还发现，baPWV 下降 1 m/s 与主要复合事件风险降低 3% 相关（HR，0.97；95% 置信区间 [CI]，0.94-0.99）。我们进一步证实，年龄小于 60 岁、不吸烟、无高血压、无糖尿病与改善 AS 状态有关。总之，改善强直性脊柱炎状况可降低发生临床事件的风险。今后，应开展更多的研究来探索改善 AS 状态的目标。
{"title":"Changes in baPWV and the risk of clinical outcomes: a cohort study of Chinese community-based population","authors":"Yingting Zuo, Shuohua Chen, Xue Tian, Shouling Wu, Anxin Wang","doi":"10.1038/s41371-024-00902-9","DOIUrl":"10.1038/s41371-024-00902-9","url":null,"abstract":"It has not been fully investigated whether improved arterial stiffness (AS) can reduce the clinical outcomes risk in community population-based study. In this prospective study, a total of 5247 individuals with abnormal AS (at baseline) and repeated brachial-ankle pulse wave velocity (baPWV) measurement before 2018 years were enrolled from the Kailuan Study. According the second baPWV measurement, we divided the participants into two groups, improved AS (defined as transfer elevated AS status to normal) and persistent AS (defined as maintaining elevated AS status). The outcome was a composite event of stroke, myocardial infraction, and all-cause mortality. We used Cox proportional hazards regression to examine the association between AS status at the follow-up and the subsequent outcome. During a median of 5.2 years follow-up, we observed 413 end point events. After adjusted for potential confounders, comparing with the persistent AS group, individuals in the improved AS group had a 43% (hazard ratio [HR], 0.57; 95% confidence interval [CI] 0.35–0.94) decreased the risk of the primary composite events. We also found a baPWV decrease of 1 m/s was associated with a 3% decreased risk (HR, 0.97; 95% CI 0.94–0.99) for primary composite events. We further demonstrated that younger than 60 years, non-smoker, non-hypertension, and non-diabetes were associated with improved the AS status. In conclusion, improving AS status may reduce the risk of clinical events. In the future, more research should be performed to explore the target for improving the AS status.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 5","pages":"460-466"},"PeriodicalIF":2.7,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139981346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-26DOI: 10.1038/s41371-024-00905-6
Andrew O. Agbaje
This study examined the mediating effect of total body fat mass, lean mass, blood pressure (BP) and insulin resistance on the associations of sedentary time (ST), light physical activity (LPA) and moderate-to-vigorous PA (MVPA) with carotid-femoral pulse wave velocity (cfPWV), carotid intima-media thickness (cIMT) and carotid elasticity in 1574 adolescents from the Avon Longitudinal Study of Parents and Children birth cohort, UK. ST, LPA and MVPA were assessed with ActiGraph accelerometer. ST and LPA were sex-categorised in tertiles as low (reference), moderate and high, while MVPA was categorised as <40 min/day (reference), 40–<60 min/day and ≥60 min/day. cfPWV, cIMT and carotid elasticity were measured with Vicorder and ultrasound. Fat mass and lean mass were assessed with dual-energy X-ray absorptiometry and homeostatic model assessment of insulin resistance (HOMA-IR) was computed. Mediation analyses structural equation models and linear mixed-effect models adjusted for cardiometabolic and lifestyle factors were conducted. Among 1574 adolescents [56.2% female; mean (SD) age 15.4 (0.24) years], 41% males and 17% females accumulated ≥60 min/day of MVPA. Higher ST was associated with lower cIMT partly mediated by lean mass. Higher LPA (standardized β = −0.057; [95% CI −0.101 to −0.013; p = 0.014]) and the highest LPA tertile were associated with lower cfPWV. BP had no significant mediating effect movement behaviour relations with vascular indices. Lean mass partially mediated associations of higher MVPA with higher cIMT (0.012; [0.007–0.002; p = 0.001], 25.5% mediation) and higher carotid elasticity (0.025; [0.014–0.039; p = 0.001], 28.1% mediation). HOMA-IR mediated the associations of higher MVPA with higher carotid elasticity (7.7% mediation). Engaging in ≥60 min/day of MVPA was associated with higher carotid elasticity. In conclusion, higher LPA was associated with lower arterial stiffness, but higher MVPA was associated with thicker carotid wall explained by higher lean mass.
{"title":"Mediating effect of fat mass, lean mass, blood pressure and insulin resistance on the associations of accelerometer-based sedentary time and physical activity with arterial stiffness, carotid IMT and carotid elasticity in 1574 adolescents","authors":"Andrew O. Agbaje","doi":"10.1038/s41371-024-00905-6","DOIUrl":"10.1038/s41371-024-00905-6","url":null,"abstract":"This study examined the mediating effect of total body fat mass, lean mass, blood pressure (BP) and insulin resistance on the associations of sedentary time (ST), light physical activity (LPA) and moderate-to-vigorous PA (MVPA) with carotid-femoral pulse wave velocity (cfPWV), carotid intima-media thickness (cIMT) and carotid elasticity in 1574 adolescents from the Avon Longitudinal Study of Parents and Children birth cohort, UK. ST, LPA and MVPA were assessed with ActiGraph accelerometer. ST and LPA were sex-categorised in tertiles as low (reference), moderate and high, while MVPA was categorised as <40 min/day (reference), 40–<60 min/day and ≥60 min/day. cfPWV, cIMT and carotid elasticity were measured with Vicorder and ultrasound. Fat mass and lean mass were assessed with dual-energy X-ray absorptiometry and homeostatic model assessment of insulin resistance (HOMA-IR) was computed. Mediation analyses structural equation models and linear mixed-effect models adjusted for cardiometabolic and lifestyle factors were conducted. Among 1574 adolescents [56.2% female; mean (SD) age 15.4 (0.24) years], 41% males and 17% females accumulated ≥60 min/day of MVPA. Higher ST was associated with lower cIMT partly mediated by lean mass. Higher LPA (standardized β = −0.057; [95% CI −0.101 to −0.013; p = 0.014]) and the highest LPA tertile were associated with lower cfPWV. BP had no significant mediating effect movement behaviour relations with vascular indices. Lean mass partially mediated associations of higher MVPA with higher cIMT (0.012; [0.007–0.002; p = 0.001], 25.5% mediation) and higher carotid elasticity (0.025; [0.014–0.039; p = 0.001], 28.1% mediation). HOMA-IR mediated the associations of higher MVPA with higher carotid elasticity (7.7% mediation). Engaging in ≥60 min/day of MVPA was associated with higher carotid elasticity. In conclusion, higher LPA was associated with lower arterial stiffness, but higher MVPA was associated with thicker carotid wall explained by higher lean mass.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 5","pages":"393-403"},"PeriodicalIF":2.7,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00905-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139972155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-21DOI: 10.1038/s41371-024-00896-4
Liping Huang, Qiang Li, Jason HY Wu, Maoyi Tian, Xuejun Yin, Jie Yu, Yishu Liu, Xinyi Zhang, Yangfeng Wu, Ellie Paige, Kathy Trieu, Matti Marklund, Anthony Rodgers, Bruce Neal
The Salt Substitute and Stroke Study (SSaSS) demonstrated significant reductions in systolic blood pressure (SBP), and the risk of stroke, major cardiovascular events and total mortality with the use of potassium-enriched salt. The contribution of sodium reduction versus potassium increase to these effects is unknown. We identified four different data sources describing the association between sodium reduction, potassium supplementation and change in SBP. We then fitted a series of models to estimate the SBP reductions expected for the differences in sodium and potassium intake in SSaSS, derived from 24-h urine collections. The proportions of the SBP reduction separately attributable to sodium reduction and potassium supplementation were calculated. The observed SBP reduction in SSaSS was −3.3 mmHg with a corresponding mean 15.2 mmol reduction in 24-h sodium excretion and a mean 20.6 mmol increase in 24-h potassium excretion. Assuming 90% of dietary sodium intake and 70% of dietary potassium intake were excreted through urine, the models projected falls in SBP of between −1.67 (95% confidence interval: −4.06 to +0.73) mmHg and −5.33 (95% confidence interval: −8.58 to −2.08) mmHg. The estimated proportional contribution of sodium reduction to the SBP fall ranged between 12 and 39% for the different models fitted. Sensitivity analyses assuming different proportional urinary excretion of dietary sodium and potassium intake showed similar results. In every model, the majority of the SBP lowering effect in SSaSS was estimated to be attributable to the increase in dietary potassium rather than the fall in dietary sodium.
{"title":"The contribution of sodium reduction and potassium increase to the blood pressure lowering observed in the Salt Substitute and Stroke Study","authors":"Liping Huang, Qiang Li, Jason HY Wu, Maoyi Tian, Xuejun Yin, Jie Yu, Yishu Liu, Xinyi Zhang, Yangfeng Wu, Ellie Paige, Kathy Trieu, Matti Marklund, Anthony Rodgers, Bruce Neal","doi":"10.1038/s41371-024-00896-4","DOIUrl":"10.1038/s41371-024-00896-4","url":null,"abstract":"The Salt Substitute and Stroke Study (SSaSS) demonstrated significant reductions in systolic blood pressure (SBP), and the risk of stroke, major cardiovascular events and total mortality with the use of potassium-enriched salt. The contribution of sodium reduction versus potassium increase to these effects is unknown. We identified four different data sources describing the association between sodium reduction, potassium supplementation and change in SBP. We then fitted a series of models to estimate the SBP reductions expected for the differences in sodium and potassium intake in SSaSS, derived from 24-h urine collections. The proportions of the SBP reduction separately attributable to sodium reduction and potassium supplementation were calculated. The observed SBP reduction in SSaSS was −3.3 mmHg with a corresponding mean 15.2 mmol reduction in 24-h sodium excretion and a mean 20.6 mmol increase in 24-h potassium excretion. Assuming 90% of dietary sodium intake and 70% of dietary potassium intake were excreted through urine, the models projected falls in SBP of between −1.67 (95% confidence interval: −4.06 to +0.73) mmHg and −5.33 (95% confidence interval: −8.58 to −2.08) mmHg. The estimated proportional contribution of sodium reduction to the SBP fall ranged between 12 and 39% for the different models fitted. Sensitivity analyses assuming different proportional urinary excretion of dietary sodium and potassium intake showed similar results. In every model, the majority of the SBP lowering effect in SSaSS was estimated to be attributable to the increase in dietary potassium rather than the fall in dietary sodium.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 4","pages":"298-306"},"PeriodicalIF":2.7,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00896-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139912769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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