Abstract 5020: The Association between Different Measures of Blood Pressure and Coronary Artery Calcium in Postmenopausal Women

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Matthew A Allison ◽  
JoAnn Manson ◽  
Robert Langer ◽  
Aaron Aragaki ◽  
Sylvia Smoller ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Coronary Artery ◽  
Diastolic Blood Pressure ◽  
Postmenopausal Women ◽  
Coronary Artery Calcium ◽  
Systolic Hypertension ◽  
Blood Pressure Medication ◽  
Isolated Systolic Hypertension ◽  
Medication Status

Background: The aim of this study was to determine the magnitude and significance of the associations between coronary artery calcium (CAC) and different measures of blood pressure among postmenopausal women. Methods: Subjects were a subset of women aged 50 to 59 at baseline in the Women’s Health Initiative (WHI) clinical trial of conjugated equine estrogen (CEE) who underwent a one-time computed tomography (CT) scan of the chest following the end of the trial to determine CAC. At the baseline WHI clinic visit, CEE trial participants provided data on a wide range of factors to include blood pressure measurements which were measured twice with the participant in the seated position using a conventional mercury sphygmomanometer and appropriately sized cuffs. Results: The sample consisted of 1,064 women with a mean age of 55.1 (2.8) years at WHI randomization and 64.8 (2.9) years at CAC ascertainment. The prevalence of a CAC score > 0 was 47%, while the prevalence of a CAC score >= 10 and > 100 was 39 and 19%, respectively. There was a linear association between the log-odds of any CAC and SBP while there was a curvilinear and inverse association with DBP that was independent of CVD risk factors and blood pressure medication status. For any value of diastolic blood pressure, the probability of CAC increased with higher levels of SBP. Conversely, for any given value of SBP, the probability of any CAC decreased with higher levels of DBP. Those with a PP >= 55 mmHg had nearly a two-fold higher odds for having any CAC (Odds Ratio: 1.95, 95% CI: 1.24 – 3.06) while individuals with isolated systolic hypertension (SBP >= 140 and DBP < 90) had a 73% higher odds for CAC (95% CI: 1.03 – 2.90, p = 0.04) independent of other risk factors and blood pressure medication status. There was no significant associations between mean arterial pressure and CAC. Conclusions: In postmenopausal women over the age of 50 years, both SBP and DBP are relevant for determining the risk for coronary artery calcium. Notably, higher levels of pulse pressure and systolic blood pressure were strong determinants of CAC, while diastolic blood pressure was inversely related. Consequently, isolated systolic hypertension may be relevant in women. These results may be of clinical relevance for the prevention of coronary artery disease. This research has received full or partial funding support from the American Heart Association, AHA National Center.

Abstract 031: Diastolic Blood Pressure, Coronary Artery Calcium, and Cardiac Outcomes in the Multi-ethnic Study of Atherosclerosis

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
John W McEvoy ◽  
Faisal Rahman ◽  
Mahmoud Al Rifai ◽  
Michael Blaha ◽  
Khurram Nasir ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Confidence Interval ◽  
Diastolic Blood Pressure ◽  
Coronary Artery Calcium ◽  
J Curve ◽  
Increased Risk ◽  
All Cause Mortality

Diastolic blood pressure (BP) has a J-curve relationship with coronary heart disease and death. Because this association is thought to reflect reduced coronary perfusion at low diastolic BP, our objective was to test whether the J-curve is most pronounced among persons with coronary artery calcium. Among 6,811 participants from the Multi-Ethnic Study of Atherosclerosis, we used Cox models to examine if diastolic BP category is associated with coronary heart disease events, stroke, and mortality. Analyses were conducted in the sample overall and after stratification by coronary artery calcium score. In multivariable-adjusted analyses, compared with diastolic BP of 80 to 89 mmHg (reference), persons with diastolic BP <60 mmHg had increased risk of coronary heart disease events (HR 1.69 [95% confidence interval 1.02-2.79]) and all-cause mortality (HR 1.48 [95% confidence interval 1.10-2.00]), but not stroke. After stratification, associations of diastolic BP <60 mmHg with events were present only among participants with coronary artery calcium >0. Diastolic BP <60 mmHg was not associated with events when coronary artery calcium was zero. We also found no interaction in the association between low diastolic BP and events based on race. In conclusion, diastolic blood pressure <60 mmHg was associated with increased risk of coronary heart disease events and all-cause mortality in the sample overall, but this association appeared strongest among individuals with elevated CAC; suggesting that added caution may be needed when pursuing intensive BP treatment targets among persons with subclinical atherosclerosis.

scholarly journals 430 Relation of blood pressure to coronary artery calcium and mortality

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
I J Cho ◽  
J H Lee ◽  
S Y Choi ◽  
E J Chun ◽  
S H Park ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Coronary Artery ◽  
Diastolic Blood Pressure ◽  
Coronary Artery Calcium ◽  
Multicenter Observational Study ◽  
J Curve ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Study Population ◽  
Artery Disease

Abstract Background Diastolic blood pressure has a J-curve relation with coronary heart disease and death, but it is debating whether a J-curve association exists in general population. We aimed to assess the relation of blood pressure to mortality, and whether their association is interacted with presence of high coronary artery calcium (CAC). Methods The KOICA registry is a retrospective, multicenter observational study designed to investigate the effectiveness and prognostic value of CAC score for primary prevention of cardiovascular disease in asymptomatic Korean adults. The association between CAC score and blood pressure was assessed. Patients were divided into 2 groups according to the baseline CACS (&gt; 300 and ≤ 300), and all-cause mortality was assessed. Results The study population composed 48903 subjects with a mean age of 54 ± 9. There were 425 (0.9%) deaths during follow-up. At baseline, SBP (systolic blood pressure) more than 110 mmHg and DBP (diastolic blood pressure) more than 80 mmHg was associated with increased risk for CACS &gt; 300. In patients with baseline CACS ≤ 300, all-cause mortality was increased in patients with SBP of 110-119 mmHg (HR 1.47, p = 0.023), 130-139 mmHg (HR 1.72, p = 0.002) and ≥ 140 mmHg (HR 1.47, p = 0.042) compared to SBP of 120-129 mmHg, whereas DBP did not predict all-cause mortality. In contrast, SBP was not associated to all-cause mortality in patients with CACS &gt; 300, whereas DBP &lt; 60 mmHg (HR 3.53, p =0.018) and 70-79 mmHg (HR 2.21, p = 0.042) was associated with increased risk for all-cause mortality compared to DBP of 80-89 mmHg. Conclusion Low DBP was associated with increased risk for all-cause mortality in subjects with high CAC score, suggesting high-risk for coronary artery disease. However, this J-curve relation was not shown in the population with low CAC score.

scholarly journals The Role of Diastolic Blood Pressure When Treating Isolated Systolic Hypertension

1999 ◽  
Vol 159 (17) ◽  
pp. 2004 ◽  
Author(s):  
Grant W. Somes ◽  
Marco Pahor ◽  
Ronald I. Shorr ◽  
William C. Cushman ◽  
William B. Applegate
Keyword(s):  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Systolic Hypertension ◽  
Isolated Systolic Hypertension

scholarly journals The Prevalence and Risk Factors of Isolated Systolic Hypertension Among Elderly Chinese Population

2020 ◽  
Author(s):  
QingKun Zheng ◽  
Pengshun Rong ◽  
Xiaobo Huang ◽  
Yang Zhang ◽  
Jianxiong Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Physical Exercise ◽  
Chinese Population ◽  
Systolic Hypertension ◽  
Multivariate Logistic Regression Analysis ◽  
The Elderly ◽  
Cluster Sampling ◽  
Isolated Systolic Hypertension ◽  
Elderly Chinese

Abstract Objective To investigate the prevalence status of the isolated systolic hypertension (ISH) among the elderly Chinese population and analyze risk factors of ISH. Methods The survey was conducted from September 2015 to September 2016 enrolling 1269 people aging above 80 in the urban community in Chengdu, China. The participants were recruited by using a stratified cluster sampling method. The average blood pressure of an individual was obtained by using a standardized mercury sphygmomanometer to measure the blood pressure twice after a 10-minute seated rest. Results The prevalence of ISH was 53.0% among the elderly population; the ISH was accounted for 82.2% of all hypertension cases. The prevalence of ISH of males and females was 54.7% and 51.5%, respectively, without significant differences (P = 0.25). The prevalence of ISH in the 80–84 group, 85–89 group, and > 90 group were 52.5%, 53.0%, and 60.0%, respectively without significant differences (P for trend = 0.36). Multivariate logistic regression analysis showed that drinking alcoholic, obesity, and heart rate (HR) > 75 beats/min were all positively correlated to the incident of ISH; however, physical exercise was negatively correlated to the occurrence of ISH. Conclusion 53.0% of the elderly Chinese population aged above 80 has ISH. The gender and physical exercise are not the independent risk factor of ISH. But drinking alcoholic, obesity and HR > 75 are significantly related to the occurrence of ISH.

scholarly journals The different risk factors for isolated diastolic hypertension and isolated systolic hypertension: a national survey

2021 ◽  
Author(s):  
Kun Xie ◽  
Xiufang Gao ◽  
Liwen Bao ◽  
Ying Shan ◽  
Haiming Shi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Systolic Hypertension ◽  
Young Patients ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Isolated Systolic Hypertension ◽  
Logistic Analysis ◽  
Diastolic Hypertension ◽  
Convenience Sampling

Abstract Background Hypertension is highly prevalent and is one of the modifiable risk factors for cardiovascular outcomes. Isolated diastolic hypertension (IDH), however, tend to be ignored due to insufficient recognition. We sought to depict the clinical manifestation of IDH and isolated systolic hypertension (ISH) in order to find a more efficient way to improve the management. Methods Patients with primary hypertension aged over 18 years were investigated from all over the country using convenience sampling during 2017–2019. IDH was defined as systolic blood pressure (SBP) < 140 mmHg and diastolic blood pressure (DBP) ≥ 90 mmHg. ISH was defined as SBP ≥ 140 mmHg and DBP < 90 mmHg. Results Totally 8548 patients were screened and 8475 participants were included. The average age was 63.67 ± 12.78 years and male accounted for 54.4%. Among them, 361 (4.3%) had IDH and 2096 had ISH (24.7%). Patients with IDH (54.84 ± 13.21 years) was much younger. Aging turned out to be negatively associated with IDH but positively associated with ISH. Logistic analysis showed BMI was a significant risk factor for IDH (OR 1.30, 95%CI 1.05–1.61, p = 0.018), but not for ISH (OR 1.05, 95%CI 0.95–1.16, p = 0.358). Moreover, smoking was significantly associated with IDH (OR 1.36, 95%CI 1.04–1.78, p = 0.026) but not with ISH (OR 1.04, 95%CI 0.90–1.21, p = 0.653). Conclusions Patients with IDH were much younger and the prevalence decreased with aging. BMI and smoking were remarkably associated with IDH rather than ISH. Keeping fit and giving up smoking might be particularly efficient in the management of young patients with IDH. Trial registration: NCT03862183, retrospectively registered on March 5, 2019

scholarly journals The different risk factors for isolated diastolic hypertension and isolated systolic hypertension: a national survey

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kun Xie ◽  
Xiufang Gao ◽  
Liwen Bao ◽  
Ying Shan ◽  
Haiming Shi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Systolic Hypertension ◽  
Young Patients ◽  
Significant Risk ◽  
Multivariate Logistic Regression Analysis ◽  
Significant Risk Factor ◽  
Isolated Systolic Hypertension ◽  
Diastolic Hypertension ◽  
Convenience Sampling

Abstract Background Hypertension is highly prevalent and is one of the modifiable risk factors for cardiovascular outcomes. Isolated diastolic hypertension (IDH), however, tends to be ignored due to insufficient recognition. We sought to depict the clinical manifestation of IDH and isolated systolic hypertension (ISH) to find a more efficient way to improve the management. Methods Patients with primary hypertension aged over 18 years were investigated from all over the country using convenience sampling during 2017–2019. IDH was defined as systolic blood pressure (SBP) < 140 mmHg and diastolic blood pressure (DBP) ≥90 mmHg. ISH was defined as SBP ≥ 140 mmHg and DBP < 90 mmHg. Results A total of 8548 patients were screened, and 8475 participants were included. The average age was 63.67 ± 12.78 years, and males accounted for 54.4%. Among them, 361 (4.3%) had IDH, and 2096 had ISH (24.7%). Patients with IDH (54.84 ± 13.21 years) were much younger. Aging turned out to be negatively associated with IDH but positively associated with ISH. Multivariate logistic regression analysis showed BMI was a significant risk factor for IDH (OR 1.30, 95%CI 1.05–1.61, p = 0.018), but not for ISH (OR 1.05, 95%CI 0.95–1.16, p = 0.358). Moreover, smoking was significantly associated with IDH (OR 1.36, 95%CI 1.04–1.78, p = 0.026) but not with ISH (OR 1.04, 95%CI 0.90–1.21, p = 0.653). Conclusions Patients with IDH were much younger, and the prevalence decreased with aging. BMI and smoking were remarkably associated with IDH rather than ISH. Keeping fit and giving up smoking might be particularly efficient in the management of young patients with IDH. Trial registration NCT03862183, retrospectively registered on March 5, 2019.

scholarly journals Unsolved Problem: (Isolated) Systolic Hypertension with Diastolic Blood Pressure below the Safety Margin

2020 ◽  
Vol 29 (4) ◽  
pp. 301-309
Author(s):  
Goran Koracevic ◽  
Milovan Stojanovic ◽  
Tomislav Kostic ◽  
Dragan Lovic ◽  
Miloje Tomasevic ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Systolic Hypertension ◽  
Unsolved Problem ◽  
Safety Margin ◽  
Isolated Systolic Hypertension

scholarly journals Homocysteine Predicts Incident Isolated Systolic Hypertension in Older Adults

Circulation ◽  
2001 ◽  
Vol 103 (suppl_1) ◽  
pp. 1347-1347
Author(s):  
Rachel P Wildman ◽  
Lewis H Kuller
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Older Adults ◽  
Systolic Hypertension ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Isolated Systolic Hypertension ◽  
Kaplan Meier ◽  
Blood Pressures ◽  
Amino Acid Methionine

0019 Untreated isolated systolic hypertension (ISH) indicates arterial stiffening and carries a risk for both stroke and cardiovascular disease. Elevated plasma homocysteine, a metabolite of the essential amino acid methionine, has been linked to vascular stiffness. 187 normotensive (defined as systolic blood pressure (SBP) < 160 mmHg and diastolic blood pressure < 90 mmHg) men and women (mean age 71.29 + 6.3 yrs) were followed for an average of 7 years for incident ISH. ISH was defined as a SBP ≥160 mmHg (while maintaining a DBP of < 90 mmHg) at least one time at 3 year follow-up visits, or the initiation of antihypertensive therapy. The mean baseline systolic and diastolic blood pressures (DBP) were 127 and 69 mmHg, respectively. Over the 7 year period, 59(31.5%) participants developed ISH, 76% qualified by antihypertensive use, and 24% by blood pressure values. The Kaplan Meier Estimate of 7 year survival free from ISH was 67% (95% CI: 61%, 74%). The relationship between incident ISH and the traditional cardiovascular risk factors, creatinine, homocysteine, and carotid artery intima-media wall thickness (IMT) was assessed by Cox proportional hazards regression. The strongest predictor of incident ISH was baseline SBP. For participants with baseline SBPs of < 130, 130-139, and 140+ mmHg, the corresponding 7 year survival free from ISH was 80% (95% CI: 73%, 88% ), 53% (95%CI: 38%, 67%), and 44% (95% CI: 26%, 62%). Factors independently associated with time to ISH were higher triglycerides (upper tertile,RR=2.0, p=0.012), homocysteine levels (> 12.0 μmol/l, RR=2.2, p=0.005), and baseline SBP (per 10 mmHg,RR=1.4, p=0.003). The results were similar when the analysis was restricted to the 157 participants with a baseline SBP of < 140 mmHg. Baseline IMT was found to be univariately related to time to ISH (RR per each 1.0 mm increment=3.0; p=0.016). In multivariate analysis, this association remained independent of triglycerides and homocysteine, but not baseline SBP (RR per each 1.0 mm increment=2.5; p=0.049). In conclusion, among normotensive older adults, 32% can be expected to develop ISH over a 7 year period, and higher triglyceride and homocysteine levels are risk factors.

Abstract P057: Adiposity Associated Inflammation and Hypertension

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Matthew A Allison ◽  
Cindy Morgan ◽  
Dena Rifkin ◽  
Michael H Criqui
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
Body Mass ◽  
Systolic Hypertension ◽  
The Other ◽  
Blood Pressure Medication ◽  
Isolated Systolic Hypertension ◽  
Physical Measurements ◽  
Wide Range ◽  
The Mean

Background: The aim of this study was to test whether selected markers of adiposity associated inflammation (adipokines) are associated with hypertension (HTN) and isolated systolic hypertension (ISH). Methods: Subjects were 1970 individuals who were enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA). Subjects provided a wide range of health history information and had several physical measurements performed. Blood pressure was measured three times using a standard protocol, with the last two measurements being averaged. HTN was defined as a systolic blood pressure (SBP) > 140 mmHg, diastolic blood pressure (DBP) > 90 or taking a blood pressure medication while ISH was SBP > 140 or taking a blood pressure medication and a DBP <= 90. Fasting venous blood collected at this visit was analyzed for the following adipokines: leptin, adiponectin, tumor necrosis factor - alpha and resistin. Results: The mean age was 64.7 years and 50% were female. The mean SBP, DBP, mean arterial pressure (MAP) and pulse pressure (PP) was 124, 70, 88 and 54 mmHg, respectively. Forty-four percent had HTN. The Table shows the results of multivariable logistic regression for the adipokines and both HTN and ISH. As shown, leptin was consistently associated with a significantly higher odds for the presence of either HTN and ISH. This applies to whether leptin was utilized as a continuous or categorical variable (in quartiles). Adding body mass index to model #3 modestly attenuated the associations, but remained statistically significant (p ≤ 0.01 for all). Associations for the other adipokines were inconsistent and not significant after full adjustment. Conclusion: Higher leptin, but not the other adipokines studied, is significantly associated with diagnoses of both hypertension and isolated systolic hypertension independent of relevant covariates including body mass index. This suggests that leptin may have an influence on blood pressure beyond the effects of adiposity.

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