International Journal of Cardiology: Hypertension最新文献

Background

Though some data from in-hospital or selected populations are available, there are no studies reporting community-level prevalence of Severe Hypertension (SH) in sub-Saharan Africa.

Methods

Study participants were recruited within the framework of The Heart Fund's global health initiative. Data were collected in August 2016 from 6 randomly selected sites, ensuring representativeness of both urban and rural areas. Blood pressure (BP) was measured twice, 10 ​min apart, after optimal resting time. SH was defined as systolic blood pressure ≥180 and/or diastolic blood pressure ≥110 ​mmHg ​at both readings. Demographics and data on cardiovascular history/risk factors were collected in the field.

Results

Among 1785 subjects examined, 1182 aged between 18 and 75 years were included in this analysis. The prevalence of SH was 14.1% (12.5% females vs 17.0% males; P ​= ​.03) (Fig. 1). Among participants with severe hypertension, 28.9% were either undiagnosed or untreated. Alarmingly, subjects at high cardiovascular risk (age ​≥ ​60 years and/or obese) had even higher prevalence of overall SH (29.6% and 24.9%, respectively) as well as undiagnosed/untreated SH (29.4% and 24.6%). SH prevalence was almost double in urban compared to rural areas (17.0% vs. 9.2%, P ​= ​.02); however, conversely, undiagnosed/untreated SH was significantly higher in rural areas (50.4% vs 21.9%).

Conclusion

(s): Our community-based study revealed very high prevalence of SH among adults in Abidjan area, with almost one out of every seven having SH. This underscores SH as a growing public health problem in sub-Saharan Africa.

Aldosterone affects myocardial fibrosis and remodeling. The aim was to investigate the relationship between plasma aldosterone concentration (PAC) and left atrial (LA) function in hypertension. 148 hypertensive patients were studied. LA phasic function was evaluated by strain and strain rate imaging. Patients were divided into two groups based on PAC. LA early diastolic strain and strain rate (LA_S-E and LA_SR-E) were lower in group II compared with group I (P ​< ​0.05). Multivariate regression analysis showed that LA_S-E was independently related to PAC (β ​= ​−0.581, P ​< ​0.001). In conclusion, PAC is associated with LA conduit function in hypertension.

Inconsistencies in studies of chronic psychosocial stress and hypertension may be explained by the use of stress markers greatly influenced by circadian rhythm and transient stressors. We assessed whether hair cortisol, a marker that captures systemic cortisol over months, was independently associated with hypertension. We measured hair cortisol and blood pressure in 75 consecutive participants in the Survey of the Health of Wisconsin, using an ELISA test. Individuals with values ​≥ ​median (78.1 ​pg/mg) were considered exposed. We used approximate Bayesian logistic regression, with a prior odds ratio of 1.0–4.0, to quantify the multivariate-adjusted hair cortisol-hypertension association. Participants' average age was 46.9 years; 37.3% were male; and 25.3% were hypertensive. Hypertension prevalence was 2.23 times higher in exposed (95% CI: 1.69–3.03). This finding was unlikely explained by differential measurement errors, since we conducted blinded measurements of exposure and outcome. Sensitivity analyses showed the association was unlikely explained by an unmeasured confounder, survival bias, or reverse causality bias. Findings suggest elevated hair cortisol is a risk factor for hypertension. Although feasible, the clinical value of hair cortisol as a tool for hypertension risk stratification or for monitoring the effect of chronic psychosocial stress management interventions is still uncertain.

The aim of the present study is to evaluate the association of serum uric acid (UA) levels with the risk of incident hypertension among different age groups in men and women using a single large Japanese general cohort. The present study is based on annual health check-up program in Gunma, Japan. We studied 12,029 participants (mean age, 48 ​± ​9 years old; 31% women) free of prevalent cardiovascular disease and hypertension at baseline (2009). Hypertension was defined by self-report, hypertensive medication use, or measured BP ​> ​140/90 ​mmHg ​at each visit. Discrete proportional hazards regression model was used to evaluate the association of UA level at baseline with incident hypertension through 2012 adjusted for age, gender, baseline blood pressure, and other CVD risk factors among different age decade groups in men and women. During follow-up of 3 years, 12% of the cohort (n ​= ​1457) developed hypertension. UA was strongly associated with incident hypertension in the multivariable model in all participants. In age-stratified analysis, participants below 50 years of age in men had the significant association of UA with incident hypertension, whereas participants above 50 years did not. In women, participants above 40 years had the significant association, whereas participants below 40 years did not. The present data suggest that UA level is an independent predictor for incident hypertension among middle aged men below 50 years old and middle aged and the elderly women above 40 years.

Although accounting for a striking proportion of obesity effects on blood pressure (BP) in other populations, the extent to which obesity-associated increases in BP are explained by insulin resistance and metabolic changes in populations of African ancestry is uncertain. We determined the contribution of insulin resistance and associated metabolic abnormalities to variations in office or ambulatory BP in a black African community with prevalent obesity and hypertension. In 1225 randomly selected participants of black South African ancestry (age>16years, 43.1% obese, 47.4% abdominal obesity), we assessed adiposity indexes, the homeostasis model of insulin resistance (HOMA-IR) and associated metabolic abnormalities and office or ambulatory (n ​= ​798) BP. In separate models, waist circumference (p ​< ​0.0005-<0.0001) and HOMA-IR (p ​< ​0.51–0.005), were independently associated with office, 24 ​h, day or night systolic (SBP) or diastolic (DBP) BP. However, whilst a one standard deviation increase in waist circumference translated into a 1.47–3.08 ​mm Hg increased in office, 24-h SBP or DBP, in mediation analysis HOMA-IR accounted for only 0.12–0.30 ​mm Hg of the impact of a one standard deviation effect of waist circumference on office, and 24-h SBP and 0.003–0.17 ​mm Hg of the impact of a one standard deviation effect of waist circumference on office and 24-h DBP. In conclusion, in a black African community, insulin resistance accounts for a negligible proportion of the impact of obesity on office or ambulatory BP.

Purpose

The environmental conditions in space, particularly exposure to cosmic radiation, coupled with decreased mobility, altered glucose metabolism, and hemodynamic changes may promote cardiovascular disease Therefore, we assessed early vascular aging markers and hemodynamics using a novel oscillometric blood pressure device.

Methodology

In eight cosmonauts (46.5 ​± ​5.3 ​yrs, 77.6 ​± ​8.2 ​kg, 176 ​± ​6.2 ​cm, 7 men/1woman), we determined heart rate, peripheral blood pressure, central blood pressure, and pulse wave velocity in the supine position using an oscillometric brachial device coupled with transfer function analysis. We obtained measurements at baseline (65–90 days before flight) and four days (R+4) and eight days (R+8) after return from six months mission onboard the International Space Station.

Results

Compared to baseline, heart rate increased significantly on R+4 (58.6 ​± ​6.4 vs. 70.3 ​± ​5.2 bpm) but did not differ on R+8. Central systolic blood pressure increased from 112.5 ​± ​13.5 on baseline to 125.6 ​± ​18.5 on R+4 and 121.6 ​± ​9.5 ​mmHg, albeit showing no statistical significance compared to baseline (p ​= ​0.243/0.295). Peripheral diastolic and systolic as well as central diastolic blood pressure measurements followed this trend. Pulse wave velocity increased non-significantly from baseline (6.7 ​± ​0.8 ​m/s) to R+4 (7.2 ​± ​0.8 ​m/s, p ​= ​0.499) and stayed elevated on R+8 (7.1 ​± ​0.5 ​m/s, p ​= ​0.614).

Conclusion

The important finding of our study is that six months in a near-earth orbit do not lead to clinically significant changes in early vascular ageing biomarkers. However, these findings cannot be extrapolated to the conditions encountered in deep space. Non-invasive testing of vascular biomarkers may have utility in detecting vascular risks during space travel at an early stage.

Left ventricular (LV) hypertrophy at electrocardiography (ECG) predicts incident atrial fibrillation (AF). However, the diagnostic performance of ECG for diagnosis of LV hypertrophy in patients with AF is still not well characterized.

We analyzed 563 hypertensive patients enrolled in the Umbria-Atrial Fibrillation (Umbria-FA) registry, an ongoing prospective observational registry in patients with AF. All patients underwent ECG and standard echocardiography at their entry in the Register. Mean age was 74 years and 43% of patients were women. Prevalence of ECG-LV hypertrophy, defined by Perugia criterion corrected for body mass index, was 23%. Echocardiographic LV mass was the reference standard. Sensitivity, specificity and diagnostic accuracy of ECG-LV hypertrophy were 37.4% (95% confidence interval [CI]: 31.6–43.4), 90.0% (95% CI: 86.0–93.2) and 64.5% (95% CI: 60.4–68.3), respectively. Performance was comparable in patients with AF or sinus rhythm at ECG recording. The area under the receiver-operating characteristic (ROC) curve was 0.622 (95% CI: 0.580–0.664) in the group with AF and 0.662 (95% CI: 0.605–0.720) in that with sinus rhythm (p ​= ​0.266 for comparison). These data suggest that standard ECG is reliable for diagnosis of LV hypertrophy in patients with a history of AF, regardless of the presence of AF or sinus rhythm at the time of ECG recording.

Study objectives

Recent evidence suggests that compared to peripheral blood pressure (BP), central BP may be more strongly associated with target organ damage and cardiovascular morbidity and mortality. Technological advances now allow the ambulatory measurement of peripheral and central BP over 24 ​h. For the first time, we set out to characterise the diurnal profile of central BP and pulse pressure amplification (PPA) in patients with obstructive sleep apnoea (OSA).

Methods

In this observational study, patients with moderate to severe OSA underwent 24 ​h central and peripheral BP testing before and after at least 4 weeks of CPAP therapy. Concurrent actigraphy was performed to confirm sleep and wake times.

Results

36 patients were screened, 31 had successful testing (mean (SD) age 45 ​± ​10 years, AHI 58 ​± ​27 events/hr, Office BP 136/89 ​± ​10.7/9.5 ​mmHg, 32% on anti-hypertensives, 77% dippers), 21 completed testing post CPAP. Central systolic and diastolic BP followed the same nocturnal dipping profile as peripheral BP, however the peripheral pulse pressure (PP) narrowed in sleep (−3.2 ​mmHg, p ​< ​0.001), whereas the central PP remained unchanged (0.124 ​mmHg, NS), causing a significant reduction in PPA overnight (−10.7%, p ​< ​0.001). The magnitude of dip in central systolic pressure was less than peripheral systolic pressure (by 2.3 ​mmHg, p ​< ​0.001). After treatment with CPAP, the PPA reduction overnight was attenuated (by −3.3%, p ​= ​0.004).

Conclusions

In moderate to severe OSA, central BP and PPA reduce overnight during sleep. Further randomised controlled studies are needed to quantify the differential effects of CPAP and anti-hypertensives on central versus peripheral BP.

Hypertension is a worldwide disorder that contributes significantly to morbidity, mortality, and healthcare costs in both developed and developing communities. A retrospective cohort study of hypertensive patients attending the Internal Medicine continuity clinic at Nashville General Hospital (NGH) between January and December 2007 was conducted. Given the easy access to health care at NGH and affordable Blood pressure (BP) medications, we explored the ability to achieve optimal BP control <140/90 ​mmHg and evaluated which factors are associated. Of the 199 subjects, 59% achieved BP goal <140/90 ​mmHg. The mean BP was 139/80 ​mmHg. Health insurance status was associated with SBP and DBP (All P ​< ​0.046). Patients with health insurance had a 2.2 fold increased odds of achieving BP control compared to patients without health insurance (P ​= ​0.025). Furthermore, the number of BP medications used was significantly associated with SBP and DBP (All P ​< ​0.003). Patients taking more than three BP medications had a 58% reduced odds of achieving optimal BP control compared to patients taking one medication (P ​= ​0.039). Ethnicity was not associated with achieving BP control. Our study revealed the number of BP medications used and health insurance status, are factors associated with achieving BP control.

Objective

The objective of this study was to review the current evidence on the effects of Mg²⁺ deficiency on cardiovascular disease (CVD) and hypertension, since Mg²⁺ is a potent vasodilator and modulates vasomotor tone, blood pressure and peripheral blood flow. Several factors could contribute to its deficiency and when it occurs, is associated with an increased incidence of cardiovascular disease (CVD), hypertension, heart failure (HF), and cardiac arrhythmias.

Methods

In order to get a better to get an updated perspective of the current status of Mg²⁺ deficiency and its implications in CVD, hypertension, and cardiac arrhythmias, a focused Medline search of the English language literature was conducted between 2014 and 2018 and 30 pertinent papers were retrieved.

Results

The analysis of data showed that Mg²⁺ deficiency is difficult to occur, under normal circumstances, because it is plentiful in green leafy vegetables, cereals, nuts, and the drinking water. However, Mg²⁺ deficiency can occur under special circumstances such as hypertension and HF treated with large doses of diuretics, patients with chronic kidney disease (CKD) treated with hemodialysis, and patients with gastroesophageal reflux disease treated with proton pump inhibitors. When hypomagnesemia occurs, it is associated with serious cardiac arrhythmias and aggravation of hypertension.

Conclusion

The analysis of data suggests that Mg²⁺ deficiency does occur and it is associated with an increased incidence of CVD, HF, serious cardiac arrhythmias, and hypertension. Retaining normal Mg²⁺ levels will prevent the onset of these diseases.