Journal of The American Society of Hypertension最新文献

A single clinic measurement of blood pressure (BP) may be common in low- and middle-income countries because of limited medical resources. This study aimed to examine the potential misclassification error when only one BP measurement is used. Participants (n = 14,706, 53.5% females) aged 25–64 years were selected by multistage stratified cluster sampling from eight provinces, each representing one of the eight geographical regions of Vietnam. Measurements were made using the World Health Organization STEPS protocols. Data were analyzed using complex survey methods. For systolic BP, 62.7% had a higher first reading whereas 30.0% had a lower first reading, and 27.3% had a reduction of at least 5 mmHg whereas 9.6% had an increase of at least 5 mmHg. Irrespective of direction of change, increased variability in BP was associated with greater age, urban living, greater body size and fatness, reduced physical activity levels, elevated glucose, and raised total cholesterol. These measurement variations would lead to substantial misclassification in diagnosis of hypertension based on a single reading because almost 20% of subjects would receive a different diagnosis based on the mean of two readings.

The relation between nonalcoholic fatty liver disease (NAFLD) and hypertension is not fully understood. To examine the effect of the change in NAFLD status on the risk of incident hypertension, and vice versa, 6704 eligible hypertension-free subjects and 9328 NAFLD-free subjects from the Dongfeng-Tongji cohort study at baseline were enrolled in the study. Among the hypertension-free subjects, development and persistence of NAFLD were associated with an increased odds ratio (OR) for incident hypertension (OR: 1.49, 95% confidence interval [CI]: 1.26–1.76, P < .0001; OR: 1.50, 95% CI: 1.27–1.78, P < .0001). However, the resolution of NAFLD was not a risk factor for incident hypertension. Among the NAFLD-free subjects, the risk of new-emerging NAFLD was robust for hypertension status both in no-yes (OR: 1.45, CI: 1.23–1.71) and yes-yes (OR: 1.61, CI: 1.35–1.92). Moreover, stratified analysis by diabetes and overweight/obese for the risk of incident NAFLD showed that incident hypertension (no-yes) and persistent hypertension (yes-yes) were associated with risk of incident NAFLD in subjects without diabetes or overweight/obesity. In the overweight/obese participants, persistent hypertension (yes-yes) was a risk factor for incident NAFLD (OR: 1.29, 95% CI: 1.01–1.64, P = .0387). Conclusively, incidence and persistence of NAFLD are associated with increased risk of hypertension, and vice versa.

Effective dissemination of health information to a desired population can be a challenging and expensive process, particularly to Chinese-Americans. Print and radio advertisements are limited by geographic, language, cost, and demographic barriers. The expense and efforts necessary to overcome these challenges can delay the distribution of knowledge and make it more expensive than necessary. The advent of web-based advertisements through media platforms such as Facebook offers a new method of reaching target audiences who can be both cost-effective and specific. A Facebook advertisement was displayed for 48 hours and consisted of a 26-character Chinese text body. The advertisement linked to an external informational video on hypertension prevention. Demographic information including age and gender were recorded. Descriptive statistics were used to compare reach and number of ad clicks between age groups. The 48-hour campaign reached a total of 508 people. Of those reached, 289 participants (56.9%) were between the ages of 55–64 years, and 170 participants (33.5%) were 65 years or older. The campaign also generated 52 link clicks. The results show that Facebook is a promising method of engaging Chinese-Americans. It is particularly effective in reaching the older female population and is a cost-effective alternative to print-based advertisements.

Vascular calcification leads to increased large artery stiffness. Matrix gla-protein (MGP) is a vitamin K–dependent protein that inhibits arterial calcification. Aldosterone promotes vascular calcification and stiffness, but the relationships between aldosterone, MGP, and arterial stiffness are unknown. We studied 199 adults (predominantly older men) with hypertension. We assessed the relationship between levels of dephospho-uncarboxylated MGP (dp-ucMGP), aldosterone, and carotid-femoral pulse wave velocity (CF-PWV) using standard regression and mediation analyses. Plasma aldosterone was measured in a subgroup of subjects (n = 106). Aldosterone was strongly associated with dp-ucMGP (standardized β = 0.50, P < .001), which was independent of potential confounders (β = 0.37, P < .001). Levels of dp-ucMGP were significantly associated with CF-PWV (β = 0.30; P < .001), which persisted after adjustment for potential confounders (β = 0.25; P = .004). Plasma aldosterone was also significantly associated with CF-PWV (standardized β = 0.21; P = .035). However, in a model that included aldosterone and dp-ucMGP, only the latter was associated with CF-PWV. Mediation analyses demonstrated a significant dp-ucMGP–mediated effect of aldosterone on CF-PWV, without a significant direct (dp-ucMGP independent) effect. Our study demonstrates a novel independent association between high aldosterone levels and dp-ucMGP, suggesting that aldosterone may influence the MGP pathway. This relationship appears to underlie the previously documented relationship between aldosterone and increased arterial stiffness.

Sodium intake should be restricted to 100 mEq, that is, about 2.3 grams per day. Strict diets, however, are often cumbersome and seldom matched by rigorous compliance. We studied 291 patients on antihypertensive treatment, 240 of whom were instructed to avoid salty foods, such as cheese and cured meats, and to switch from regular bread to salt-free bread. The remaining 51 matched patients constituted a control group and received only generic dietary advice. Na[U]/24h, K[U]/24h, and office BP (automated repeated measurements) were recorded before dieting started and after 9 ± 1 weeks of dieting. Our intervention group showed a significant decrease in body weight (71.75 ± 14.0 to 70.54 ± 13.33 kg, P < .0001), sodium excretion (153.1 ± 44.61 to 133.5 ± 37.1 mEq/24h, P < .05), systolic and diastolic BP (134.16 ± 16.0 to 126.5 ± 10.53 mm Hg, P = .014 and 80.59 ± 11.47 to 75.9 ± 8.72 mm Hg, P = .026, respectively), and drug consumption (1.71 ± 0.91 to 1.49 ± 0.84 DDD, P < .05). The rate of responders to antihypertensive therapy increased (51.4% to 79.5%). In the control group neither significant nor substantial changes were seen. Our data suggest that even a minimal reduction in the apparent sodium intake (∼0.5 grams per day) can improve both BP values and responder rates in treated hypertensive patients, while reducing the consumption of antihypertensive drugs.

Myocardial damage could develop asymptomatically through nonischemic mechanisms such as cardiac overload. This study investigated possible associations between electrocardiogram (ECG) findings relevant to the QRS wave and high-sensitivity cardiac troponin I (hs-cTnI) in the general population. Subjects undergoing their annual health checkup were enrolled in the study (n = 1258). ECG features relevant to the QRS wave that were investigated included PQ interval, QRS voltage (Sokolow–Lyon voltage), QRS duration, product of QRS duration and voltage (Cornell product), corrected QT interval, and QRS axis. Laboratory measurements included hs-cTnI and B-type natriuretic peptide. hs-cTnI was significantly higher in subjects with a long PQ interval, high Sokolow–Lyon voltage, wide QRS duration, increased Cornell product, long corrected QT interval, or left QRS axis deviation. Univariate and multivariate regression analysis showed that Sokolow–Lyon voltage, QRS duration, and Cornell product were significantly associated with hs-cTnI after adjustment for possible confounding factors, including B-type natriuretic peptide. Logistic regression analysis with the endpoint of higher hs-cTnI than the median value showed that Sokolow–Lyon voltage and Cornell product were independently associated with increased hs-cTnI concentrations. ECG findings relevant to the QRS wave, especially increased QRS voltage, are associated with hs-cTnI in the general population.

Hypertension is one of the chronic side effects of dexamethasone (DEX) treatment; however, almost nothing is known about its acute effects. Therefore, the aim of this study was to investigate the possible mechanisms involved in blood pressure control after acute or short-term DEX treatment in adult animals. Eighty Wistar rats were divided into four groups: C1 and C5, for rats treated with saline for 1 or 5 days, respectively; D1 and D5, for rats treated with DEX for 1 or 5 days, respectively (decadron, 1 mg/kg, i.p.). Heart rate was increased in DEX treatment, but arterial pressure and cardiac muscle mass were not altered. Only few and isolated changes on gene expression and protein level of renin-angiotensin system components were observed. Five days of DEX treatment, but not one day, determined an increase in sympathetic component of spectral analysis (+75.93%, P < .05) and a significant reduction of parasympathetic component (–18.02%, P < .05), which contributed to the autonomic imbalance to the heart (LF/HF, +863.69%). The results of this present study demonstrated, for the first time, that short-term exposure to DEX treatment impairs the autonomic balance to the heart before hypertension, which was independent of renin-angiotensin system.

Orthostatic hypotension (OH) is often reported as a significant potential adverse effect of antidepressant use but the association between phasic blood pressure (BP) and antidepressants has not yet been investigated. This cross-sectional study compares continuously measured phasic BP and prevalence of OH in a cohort of antidepressant users ≥50 years compared with an age- and sex-matched cohort not taking antidepressants. OH was defined as a drop in systolic BP ≥ 20 mm Hg or in diastolic BP ≥ 10 mm Hg at 30 seconds after standing, measured using continuous beat-to-beat finometry. Multilevel time × group interactions revealed significantly greater systolic and diastolic BP drop in antidepressant users than nonusers at 30 seconds after stand. The prevalence of OH among antidepressant users was 31% (63/206), compared with 17% in nonusers (X² = 9.7; P = .002). Unadjusted logistic regression models demonstrated that selective serotonin reuptake inhibitor use was associated with OH at an odds ratio of 2.11 (95% confidence interval: 1.25–3.57); P = .005, and this association was not attenuated when covariates including cardiac disease and depressive symptom burden were added. There was no statistically significant association between serotonin noradrenaline reuptake inhibitor or tricyclic antidepressant use and OH in unadjusted models although the study was not powered to detect changes within these subgroups. Older people taking antidepressants have a two-fold higher prevalence of OH than nonusers, highlighting the importance of screening the older antidepressant user for OH and dizziness and rationalizing medications to reduce the risk of falls within this vulnerable cohort.