Risk Factors for Arterial Hypertension in Adults With Initial Optimal Blood Pressure: The Strong Heart Study

Background— Stroke prediction models are valuable to physicians in evaluating the risk of their patients so that preventive interventions can be promoted. The Framingham Risk Profile is a widely used stroke prediction equation. However, the contributions of some common risk factors for stroke vary across populations and some risk factors are specific to certain populations. For example, albuminuria is an important risk factor in American Indians (AIs), which is not included in the Framingham equation. The objective of the current study is to develop stroke prediction equations using routinely collected variables in AIs, a population with high rates of diabetes and stroke. Methods— The data used in the analysis are from 4507 stroke free participants at enrollment in the Strong Heart Study (SHS), the largest population-based longitudinal study of cardiovascular disease (CVD) and its risk factors in AIs in Arizona, Oklahoma, and South/North Dakota. As of December 2008, 379/4507 (8.4%) participants suffered a first stroke during an average follow-up of 17 years. Baseline potential risk factors were included in the Cox proportional-hazard models to develop gender-specific prediction equations. Backward selection was used to choose the predictors. Model performance was assessed using Harrell’s C statistics based on bootstrapping methods. Results— Baseline age, untreated systolic blood pressure, treated diastolic blood pressure, HDL-C, current smoking, diabetes, macro-albuminuria, and history of CVD are significant predictors for incident stroke among women. Most of these predictors except HDL-C were also in the prediction equation for men. The equations provided good discrimination ability, as indicated by a C statistic of 0.72 for men and 0.73 for women. Conclusions— Predicted risk of stroke in 10 years can be provided for physicians and their patients. Then appropriate intervention can be implemented. The stroke prediction equations from SHS can be applied to other AIs as well as other ethnic groups with high rates of diabetes and albuminuria.

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Left ventricular mass and incident hypertension in individuals with initial optimal blood pressure: the Strong Heart Study

Journal of Hypertension ◽

10.1097/hjh.0b013e3283050899 ◽

2008 ◽

Vol 26 (9) ◽

pp. 1868-1874 ◽

Cited By ~ 19

Author(s):

Giovanni de Simone ◽

Richard B Devereux ◽

Marcello Chinali ◽

Mary J Roman ◽

Thomas K Welty ◽

...

Keyword(s):

Blood Pressure ◽

Left Ventricular Mass ◽

Left Ventricular ◽

Strong Heart Study ◽

Incident Hypertension ◽

Ventricular Mass ◽

Heart Study ◽

Optimal Blood Pressure

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Risk Factors for Arterial Hypertension in Adults With Initial Optimal Blood Pressure

Hypertension ◽

10.1161/01.hyp.0000199103.40105.b5 ◽

2006 ◽

Vol 47 (2) ◽

pp. 162-167 ◽

Cited By ~ 91

Author(s):

Giovanni de Simone ◽

Richard B. Devereux ◽

Marcello Chinali ◽

Mary J. Roman ◽

Lyle G. Best ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Arterial Hypertension ◽

Optimal Blood Pressure

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Abstract 3668: Predictors of Four-Year Incident Arterial Hypertension From Initial Prehypertension: The Strong Heart Study.

Circulation ◽

10.1161/circ.116.suppl_16.ii_833 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Marina De Marco ◽

Marcello Chinali ◽

Mary J. Roman ◽

Elisa T. Lee ◽

Marie Russell ◽

...

Keyword(s):

Blood Pressure ◽

Arterial Hypertension ◽

Systolic Blood Pressure ◽

Peripheral Resistance ◽

Hdl Cholesterol ◽

Strong Heart Study ◽

Heart Study ◽

Lv Mass ◽

Baseline Systolic Blood Pressure

Background: Pre-hypertension (defined by JNC-VII) frequently evolves to arterial hypertension (HTN) and is recently shown to increase cardiovascular risk, especially in diabetics. It is unclear which metabolic and cardiac characteristics predict development of HTN in pre-hypertensive subjects. Methods: 627 pre-hypertensive participants in the Strong Heart Study, free of anti-hypertensive treatment and without prevalent cardiovascular disease or significant valve disease, were studied (64% women; 41% diabetic; 58±7 yrs). All participants underwent complete echocardiographic, anthropometric and laboratory testing. We evaluated 4-year incidence of HTN using anthropometric and metabolic profile as first predictors, and echocardiographic indices thereafter. Results: Four-year incidence of HTN was 41%. Preliminary analysis identified diabetes (DM by ADA criteria) as a significant predictor of incident HTN (53% among participants with DM vs 33% in non DM; OR= 2.02, 95% CI=1.42–2.88; p<0.001). Accordingly, additional analysis was performed separately in participants with or without baseline DM. After adjusting for age, gender, and heart rate, strongest predictor of HTN in DM was baseline systolic blood pressure (OR= 1.07/mmHg, 95% CI=1.03–1.12; p=0.001) with weaker effect of echocardiographic relative wall thickness (p=0.03). In non-DM, independent predictors of HTN were systolic blood pressure (HR= 1.08/mmHg, 95% CI=1.04–1.12; p<0.001), non-HDL cholesterol (HR= 1.01/mg*dL-1, 95% CI=1.00–1.01; p=0.01) and high LV mass index (OR=1.04 g/m2.7, 95% CI=1.01–1.07; p= 0.007). Higher Doppler stroke volume and total peripheral resistance also entered alternative models without LV mass (each p<0.05). Conclusion: In a population of pre-hypertension adults we demonstrate high incidence of HTN (41%). Independent predictors of HTN at 4-year follow-up are presence of diabetes and higher baseline systolic blood pressure. In non-DM, LV mass index is an indipendent predictor of incident HTN in addition to baseline systolic blood pressure and non-HDL cholesterol.

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Risk factors for cardiovascular diseases and development of prehypertension

ZHurnal «Patologicheskaia fiziologiia i eksperimental`naia terapiia» ◽

10.25557/0031-2991.2018.03.37-43 ◽

2018 ◽

pp. 37-43

Author(s):

В.В. Шерстнев ◽

М.А. Грудень ◽

В.П. Карлина ◽

В.М. Рыжов ◽

А.В. Кузнецова ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Ldl Cholesterol ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Hdl Cholesterol ◽

Serum Levels ◽

Left Ventricular ◽

Optimal Blood Pressure

Цель - исследование взаимосвязи факторов риска сердечно-сосудистых заболеваний и развития предгипертонии. Методика. Проведен сравнительный и корреляционный анализы показателей модифицируемых и немодифицируемых факторов риска сердечно-сосудистых заболеваний у обследованных лиц в возрасте 30-60 лет с «оптимальным» артериальным давлением, (n = 63, АД <120/80 мм рт.ст.) и лиц с предгипертонией (n = 52, АД = 120-139/80-89 мм рт.ст.). Результаты. Показано, что лица с предгипертонией по сравнению с группой лиц, имеющих «оптимальное» артериальное давление характеризуются статистически значимо повышенным содержанием холестерина и холестерина липопротеидов низкой плотности, интеллектуальным характером трудовой деятельности, а также значимыми сочетаниями факторов риска: повышенный уровень холестерина липопротеидов низкой плотности с интеллектуальным характером трудовой деятельности; повышенное содержание креатинина с уровнем триглициридов; наследственная отягощенность по заболеваниям почек и интеллектуальным характером трудовой деятельности; наследственная отягощенность по сахарному диабету и гипертрофия левого желудочка сердца. У лиц с предгипертонией документированы перестройки структуры взаимосвязи (количество, направленность и сила корреляций) между показателями факторов риска в сравнении с лицами, имеющими «оптимальное» артериальное давление. Заключение. Выявленные особенности взаимосвязей факторов риска сердечно-сосудистых заболеваний при предгипертонии рассматриваются как проявление начальной стадии дизрегуляционной патологии и нарушения регуляции физиологических систем поддержания оптимального уровня артериального давления. The aim of the study was to investigate the relationship between risk factors for cardiovascular disease and development of prehypertension. Methods. Comparative and correlation analyses of modifiable and non-modifiable risk factors for cardiovascular disease were performed in subjects aged 30-60 with «optimal» blood pressure (n = 63, BP <120/80 mm Hg) and prehypertension (n = 52, BP = 120-139 / 80-89 mm Hg). Results. The group with prehypertension compared with the «optimal» blood pressure group had significantly increased serum levels of low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol, sedentary/intellectual type of occupation, and significant combinations of risk factors. The risk factor combinations included an increased level of LDL cholesterol and a sedentary/intellectual occupation; increased serum levels of creatinine and triglycerides; hereditary burden of kidney disease and a sedentary/intellectual occupation; hereditary burden of diabetes mellitus and cardiac left ventricular hypotrophy. In subjects with prehypertension compared to subjects with «optimal» blood pressure, changes in correlations (correlation number, direction, and strength) between parameters of risk factors were documented. Conclusion. The features of interrelationships between risk factors for cardiovascular disease observed in prehypertension are considered a manifestation of early dysregulation pathology and disordered regulation of physiological systems, which maintain optimal blood pressure.

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