Journal of The American Society of Hypertension最新文献

We investigated determinants of hypertension in Bangladesh using both Joint National Committee 7 (JNC7) and 2017 American College of Cardiology/American Hypertension Association (2017 ACC/AHA) guidelines. After reporting background characteristics, odds ratios (ORs) were obtained by multilevel logistic regression. Among 7839 respondents aged ≥35 years, 25.7% (n = 2016) and 48.0% (n = 3767) respondents had hypertension as per the JNC7 and 2017 ACC/AHA guidelines, respectively. The following factors were significant according to the 2017 ACC/AHA guideline: ≥65 years (adjusted OR [AOR]: 2.4, 95% confidence interval [CI]: 2.2–3.0), 55–64 years (AOR: 1.6, 95% CI: 1.4–1.9), and 45–54 years (AOR: 1.4, 95% CI: 1.3–1.6) age groups, females (AOR: 2.0, 95% CI: 1.7–2.2), overweight/obesity (AOR: 2.4, 95% CI: 2.0–2.8), diabetes (AOR: 1.4, 95% CI: 1.2–1.6), secondary (AOR: 1.2, 95% CI: 1.1–1.4), or college education level (AOR: 1.8, 95% CI: 1.4–2.3), middle (AOR: 1.3, 95% CI: 1.1–1.6), richer (AOR: 1.5, 95% CI: 1.2–1.8) or richest (AOR: 2.0, 95% CI: 1.6–2.4) wealth quintiles, residence in Khulna (AOR: 1.5, 95% CI: 1.2–1.9), and Rangpur (AOR: 1.7, 95% CI: 1.3–2.2) divisions. All factors were significant as per the JNC7 guideline too. Both guidelines found similar determinants. Prevention and control programs should prioritize increasing awareness among people with higher likelihood of hypertension.

Intradialytic systolic blood pressure (SBP) changes are related to the volume status; however, whether SBP change impacts on adverse outcomes depends on the volume status remains uncertain. We retrospectively investigated the relationship among intradialytic changes in SBP, cardiovascular outcomes, and volume status in maintenance hemodialysis patients. We determined SBP changes (ΔSBP) as postdialysis SBP minus predialysis SBP and volume status as the ratio of extracellular water to total body water (ECW/TBW) using bioelectrical impedance analysis. There were 82 (60.3%) with ΔSBP −20 to 10 mm Hg, 21 (15.4%) with ΔSBP ≤ −20 mm Hg, and 33 (24.3%) with ΔSBP ≥ 10 mm Hg, and they were followed up for a median of 34 months. Cardiovascular events more frequently occurred in the patients with ΔSBP ≤ −20 mm Hg and ≥ 10 mm Hg (hazard ratio: 2.3 and 3.0; P = .062 and .006); these associations persisted even after adjusting for postdialysis ECW/TBW (P = .056 and .028). Moreover, ΔSBP ≥ 10 mm Hg was associated with increased cardiovascular mortalities independent of postdialysis ECW/TBW (P = .043). There was an independent association of volume status between considerable SBP decrease or increase during hemodialysis and adverse cardiovascular outcomes. Besides appropriate volume control, other factors related to BP changes during hemodialysis must be investigated.

A recent publication reported that Systolic Blood Pressure Intervention Trial participants with 10-year cardiovascular disease risk less than 11.5% derived more harm than benefit from intensive treatment. The authors consider that serious adverse events (SAEs) are of equal importance to that of either all-cause death or the primary composite outcome (myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes). Under this premise, one death would correspond to 2.7 SAEs and a primary outcome to 1.8 SAEs overall, and to be between 6 and 18 times as important as an SAE in the intensive treatment group. In our opinion, patient utility should be considered when clinical decisions are made for the treatment of hypertension.

The objective of this study was to determine the effect of laparoscopic sleeve gastrectomy (LSG) on blood pressure in private practice settings. This study involved a retrospective review of 870 consecutive adult patients >18 y of age who underwent LSG over a period of 12 mo in a private bariatric surgery center. Data were collected from the preoperative and postoperative follow-up visits at 1, 3, 6, and 12 mo. The study population consists of 694 hypertensive and 176 normotensive patients. From the baseline to 12 mo after LSG, (1) mean body weight/body mass index decreased from 123 kg/44 kg/m² to 94 kg/34 kg/m² (P < .001); (2) mean systolic/diastolic blood pressure in hypertensive patients decreased from 131.9/79.9 to 127.6/77.1 mm Hg (P < .001); 3) only mean systolic blood pressure decreased in normotensive patients from 117.5 to 114.0 mm Hg (P < .001). One month after LSG, mean systolic blood pressure had decreased from 131.9 to 126.2 mm Hg (P < 0. 001) and the average number of antihypertensive medications per patient declined from 1.5 at the baseline to 0.6 (P < .001). Over the following 11 mo, blood pressure remained stable despite reduced antihypertensive therapy. Patients requiring more than two antihypertensive agents fell from 49% at the baseline to 22% at 12 mo. Hypertension resolved in 34% of patients. Linear regression analysis showed no association between change in body weight and change in systolic blood pressure. Within 1 mo of LSG, hypertensive patients experienced a significant decline in systolic blood pressure and antihypertensive therapy that remains unchanged at 12 mo in the face of major reductions in antihypertensive medications. Weight loss and blood pressure reduction may not be directly related.

Albuminuria is a prognostic factor for mortality and cardiovascular events, even at low levels. Changes in albumin excretion are associated with end-stage renal disease and hypertension (HTN) in cohorts including high-risk participants. We aimed to investigate the evolvement of albumin excretion in healthy individuals with normal kidney function and normoalbuminuria, and possible associations with HTN and metabolic outcomes. The study cohort consisted of 1967 healthy adults with normal kidney function (estimated glomerular filtration rate ≥ 90 mL/min/1.73 m²; urine albumin to creatinine ratio [ACR] < 30 mg/g). Delta ACR slope was calculated as ACR difference between two consecutive visits divided by the time interval. During a mean follow-up period of 93.8 months, mean delta ACR slope was 0.27 ± 3.29 mg/g/year and was higher in participants with age >40 years, obesity, a high waist circumference, higher baseline ACR, HTN, prediabetes, and metabolic syndrome. Delta ACR slopes in the upper quartile predicted diabetes (OR = 1.31, P = .027) and albuminuria (4.34, P < .001). Upper quartile of ACR slopes correlated with a higher risk for new-onset HTN (1.249, P = .031). Delta systolic and diastolic blood pressures were associated with ACR slopes in addition to age, body mass index, and baseline ACR. In conclusion, accelerated change in ACR correlates with HTN and diabetes in healthy individuals with normal kidney function and normoalbuminuria.

Angiogenesis inhibition with bevacizumab, a monoclonal antibody against vascular endothelial growth factor A (VEGF-A), is an anticancer treatment associated with hypertension and renal glomerular toxicity referred to as a preeclampsia-like syndrome. In preeclampsia, podocyturia predates proteinuria and clinical features of preeclampsia, and is regarded as a biomarker of ongoing glomerular injury. Using a quantitative polymerase chain reaction of the podocyte-specific molecules nephrin, podocin, and VEGF-A in the urine, we examined whether podocyturia is present in bevacizumab-treated cancer patients, and whether it relates to proteinuria and the cumulative dose of bevacizumab. Urine samples were cross-sectionally collected from 43 bevacizumab-treated patients, 21 chemotherapy-treated patients, and 7 healthy controls. Urinary protein-to-creatinine ratio (mean and range) was 32.0 mg/mmol (5.2–284.4) in the bevacizumab group, compared with 11.4 mg/mmol (1.1–21.0) in the chemotherapy group and 7.4 mg/mmol (3.9–16.5) (P < .05) in healthy controls, whereas urinary albumin-to-creatinine ratio values in the three groups were, respectively, 18.9 mg/mmol (0.1–227.7), 1.5 mg/mmol (0.2–3.5), and 0.2 mg/mmol (0.1–0.4) (P < .05). The cumulative dose of bevacizumab ranged from 550 to 93,628 mg. Urinary podocin mRNA expression was undetectable in 59% of participants, urinary nephrin mRNA expression per mmol creatinine ranged from 0.0 to 5.3 and urinary VEGF-A mRNA expression from 0.0 to 2.7. Urinary nephrin mRNA expression did not correlate to the albumin-to-creatinine ratio or the cumulative dose of bevacizumab, whereas the latter correlated with the albumin-to-creatinine ratio (r = 0.77; P < .001). Our results demonstrate that the cumulative dose of bevacizumab is closely correlated with albuminuria but not with podocyturia as measured with the quantitative polymerase chain reaction technique, challenging the feasibility of this measurement to monitor ongoing glomerular injury in patients chronically treated with bevacizumab.

The process of arteriosclerosis begins early in life, and cardiovascular risk factors identified in childhood tend to persist into adulthood. Cardio-ankle vascular index (CAVI), a recent parameter of arterial stiffness, is considered an independent predictor of cardiovascular risk. However, there are no studies reporting sex- and age-specific physiological values of CAVI in childhood. We aimed to establish reference values for CAVI and its blood pressure–corrected variant (CAVI₀) in 500 healthy children and adolescents aged 7 to 19 years and to study potential relationships with anthropometric indices. Sex- and age-specific distributions of CAVI and CAVI₀ values in healthy children and adolescents are presented. Boys aged 15–19 years had lower CAVI than girls, which could result from CAVI's slight blood pressure dependence. CAVI₀ did not show such sex difference. Body roundness index—a novel parameter to quantify abdominal fat—was a strong anthropometric predictor of both CAVI and CAVI₀. This is the first study providing pediatric age- and sex-specific reference values for arterial stiffness parameters CAVI and CAVI₀. The presented data can contribute to the understanding of the evolution of these indices during childhood and adolescence. Under specific conditions, CAVI₀ may offer more robust information about arterial stiffness than standard CAVI.

Mirabegron is a β₃-adrenoreceptor agonist used for the treatment of overactive bladder syndrome. We evaluated the cardiovascular (CV) safety of mirabegron using pooled data from 13 studies. The analysis included 13,396 patients who received ≥1 dose of mirabegron (25 mg/50 mg) or comparator antimuscarinics (solifenacin 2.5 mg/5 mg/10 mg or tolterodine extended release 4 mg) as monotherapies, or placebo. We focused on changes in blood pressure and CV adverse events. Baseline CV risk factors had an imbalanced effect on subsequent CV adverse events. The frequency of these adverse events was comparable for overactive bladder treatments (0.4%–1.5%) and placebo (0.9%). Changes from baseline in blood pressure were similar for the overactive bladder treatments and placebo, and did not confer increased risk of CV adverse events. Multivariate analyses demonstrated that baseline CV risk factors (history of arrhythmia, history of coronary artery disease, and history of stroke/transient ischemic attack) were significantly associated with subsequent CV adverse events in the trials, whereas overactive bladder therapies were not. In conclusion, using an analytical approach to carefully control for CV characteristics of patients in these trials demonstrated no evidence of increased CV risk for mirabegron or antimuscarinics over placebo in the treatment of overactive bladder syndrome.

A cross-sectional study was conducted; information for 9247 women living in rural China was collected by questionnaire interview and anthropometric and laboratory measurements during July to August 2013 and July to October 2014. Multiple logistic regression analysis was used to examine the association between parity and hypertension, estimating odds ratios and 95% confidence intervals (CIs). The biological interaction between parity and body mass index was estimated by the relative excess risk due to interaction, attributable proportion due to the interaction, and synergy index. In our study, the prevalence of multiparity and hypertension was 93.10% and 22.90% in premenopausal women and 98.04% and 51.06% in postmenopausal women, respectively. For premenopausal women, parity hypertension was not associated with hypertension. And for postmenopausal women, as compared with para 0-1 status, para 2, 3, 4, and ≥ 5 were positively associated with hypertension: adjusted odds ratios (95% CI) was 2.04 (1.24–3.38), 2.25 (1.32–3.82), 2.41 (1.34–4.36), and 2.10 (1.04–4.22), respectively. The interaction effect between multiparity and overweight/obesity on hypertension was additive (relative excess risk due to interaction [95% CI]: 1.59, 0.19–3.00; attributable proportion due to the interaction [95% CI]: 0.34, 0.02–0.67) only in postmenopausal women. Parity was independently related to hypertension, and the interaction effect between multiparity and overweight/obesity on hypertension was additive in rural postmenopausal women.

Hypertension phenotypes may represent differential pathophysiologic mechanisms and clinical impact, yet they have been poorly investigated. The study aimed to examine the associations of physical activity and sedentary behavior with hypertension phenotypes in a large group of Greek children and to identify thresholds regarding risk of hypertension. This was a cross-sectional study with a regionally representative sample of 2473 schoolchildren aged 9–13 years, with full data on physical activity and sedentary behavior indices, as well as arterial blood pressure measurements, physical examination, and anthropometry. Hypertensive children of both sexes had lower levels of physical activity (steps/d). Hypertensive girls had lower moderate-to-vigorous physical activity (MVPA), whereas hypertensive boys with isolated systolic hypertension (ISH) had more screen time than their normotensive counterparts. Increased levels of physical activity was associated with 33%–54% lower risk of all hypertension phenotypes in both sexes, whereas increased MVPA was associated with 41%–65% lower risk of all phenotypes in girls and with ISH and systolic and diastolic hypertension (SDH) in boys. In boys, higher sedentary time was associated with 11%–13% higher risk for SDH and ISH. Cutoff points of 12,378 steps/d, 47.3 min/d of MVPA, and 2.9 h/d of sedentary behavior were determined for identifying children at increased risk of hypertension. Physical activity is inversely associated with all hypertension phenotypes, whereas sedentary behavior is positively associated with ISH and SDH in boys. More studies should confirm the hypertension-specific cutoff values identified to be used in future prevention programs for childhood hypertension.