Abstract P355: Predicting the 20-year Risk of First Coronary or Ischemic Stroke Event in Northern Italy: The CAMUNI Absolute Risk Equation

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Giovanni Veronesi ◽  
Lloyd E Chambless ◽  
Francesco Gianfagna ◽  
Giuseppe Mancia ◽  
Giancarlo Cesana ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Family History ◽  
Diastolic Blood Pressure ◽  
Cardiovascular Events ◽  
Absolute Risk ◽  
Northern Italy ◽  
Men And Women ◽  
Basic Model ◽  
History Of

Aims. Recent US guidelines advocate the introduction of lifetime or long-term absolute risk prediction for primary prevention of cardiovascular events, especially for young people and women. Therefore, long-term prediction models might be specially beneficial in population considered at low incidence. We aim to develop a 20-year absolute risk prediction equation in a Northern Italy population. Methods. Four independent population-based cohorts were enrolled between 1986 and 1994 from the Brianza population (Northern Italy), adopting standardized MONICA procedures. The study sample comprises n=2574 men and 2673 women, aged 35 to 69 years and free of CVD at baseline. Participants were followed-up for incidence of first coronary and ischemic stroke events (fatal and non-fatal; all MONICA validated) for a median time of 15 years (IQ range: 12-20) and up to the end of 2008. We compared several gender-specific Cox Proportional Hazards models: the basic one includes age, total cholesterol, HDL-cholesterol, systolic blood pressure, anti-hypertensive treatment, cigarette smoking and diabetes. Candidates to model addition were diastolic blood pressure, triglycerides, BMI, family history of CHD, and education. Model calibration was tested using the Grønnesby-Bogan goodness-of-fit statistic. The Area Under the ROC-Curve (AUC) was a measure of discrimination, corrected for over-optimism via bootstrapping. Changes in discrimination (Δ-AUC) and reclassification (Net Reclassification Improvement, NRI) defined the improvement from the basic model due to an additional risk factor. Intermediate risk was defined as 20-year risk between 10% and 40%. Results. We observed n=286 events in men (incidence rate 7.7 per 1000 person-years) and n=108 in women (2.6 per 1000 person-years). All risk factors included in the basic model were predictive of first cardiovascular event in both genders; discrimination was 0.725 and 0.802 in men and women, respectively. Average specificity in the top risk quintile (cut-off value: 23% in men and 8.5% in women) was similar in men and women (85% vs. 83%), while sensitivity was higher in women (63% vs. 46%). All the models were well-calibrated (p-values >0.05). The addition of a positive family history of CHD in men (Hazard Ratio: 1.6; 95%CI 1.2-2.1) and of diastolic blood pressure in women (HR: 1.4 for 11 mmHg increase; 1.1-1.8) significantly improved discrimination (Δ-AUC=0.01; 95%CI 0.002-0.02 [men] and Δ-AUC=0.005; 95%CI 0.0001-0.01 [women]) and reclassification of subjects at intermediate risk (NRI=8.4%;1.7%-19.1% [men]; and NRI=11.7%; -3.2%-33.5% [women]). Conclusions. Traditional risk factors are predictive of cardiovascular events after 20 years, with good discrimination. The addition of family history of CHD may contribute to model improvement, at least among men; the role of diastolic blood pressure in women should be carefully evaluated.

scholarly journals A pilot study investigating the relationship between heart rate variability and blood pressure in young adults at risk for cardiovascular disease

2022 ◽  
Vol 28 (1) ◽  
Author(s):  
Linda P. Bolin ◽  
Amelia D. Saul ◽  
Lauren L. Bethune Scroggs ◽  
Carolyn Horne
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Pilot Study ◽  
Family History ◽  
Diastolic Blood Pressure ◽  
Biofeedback Training ◽  
Paced Breathing ◽  
History Of

Abstract Background Cardiovascular disease is one of the leading causes of death globally with hypertension being a primary cause of premature death from this disease process. Individuals with a family history of cardiovascular disease and hypertension are at a greater risk for developing the same sequela. Autonomic cardiac control is important in the level of cardiac function. One intervention that is effective in improving cardiovascular function is heart rate variability biofeedback training. The purpose of our study was to determine the effectiveness of heart rate biofeedback training on HRV and blood pressure in individuals with a family history of cardiovascular disease. Methods Thirty-four participants (76.5% female, 22.7 ± 4.3 years) completed a baseline assessment and training using an established short-term HRV protocol followed by two weeks of at-home paced breathing employing a smartphone application. The participants were then reassessed in a biofeedback clinic. Results The participants physiological measures showed a significant increase in means between pre and post intervention of SDNN (t (32) = 2.177, p =.037) and TP, (t (32) = 2.327 p = .026). Correlation noted a medium effect on diastolic blood pressure and high frequency heart rate variability, F, r = .41, n =33, p < .05. A multiple regression with all predictor variables in the model found no significance with diastolic and systolic blood pressure. Conclusions The findings from this pilot study demonstrated that a two-week paced breathing intervention may assist in reducing heart rate and diastolic blood pressure while improving heart rate variability.

scholarly journals Evaluation of blood pressure in school children aged 12-16 years

2017 ◽  
Vol 4 (4) ◽  
pp. 1218
Author(s):  
Balakrishnan Nadesan ◽  
Mani Madhavan Sachithananthamoorthi ◽  
Sivaraman Thirumalaikumarasamy ◽  
Ezhilarasu Ramalingam
Keyword(s):  
Blood Pressure ◽  
Family History ◽  
Diastolic Blood Pressure ◽  
School Children ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
Cross Sectional ◽  
Significant Difference ◽  
History Of ◽  
Family History Of Hypertension

Background: Hypertension is considered as a major health issue in developed as well as developing countries and its possible origin during childhood prompts pediatricians to routinely include measurement of blood pressure (BP) as an integral part of pediatric physical examination. The objectives of the study were to evaluate the normal range of blood pressure in adolescent school going students of 12-16 years, prevalence of hypertension and relationship of BP with variables like age, body mass index (BMI), socioeconomic status and family history of hypertension.Methods: A cross sectional study was undertaken for a period of one year in adolescent school children in age groups between 12-16 years. Detailed clinical examination was done in 1060 adolescent school children and BP was recorded in right upper limb and correlation of BP with BMI, family history of hypertension and diabetes were studied.Results: Mean systolic and diastolic pressure showed linear relationship with age. There was a highly statistically significant difference between mean systolic and diastolic blood pressure between lower and middle socio-economic class. Prevalence of obesity in our study was 1.13%, overweight was 7.83%. Prevalence of hypertension in obese children was 33.33% and in overweight children 18.07%. Family history of hypertension and diabetes carry a significant correlation with elevated systolic and diastolic blood pressure in adolescents.Conclusions: This study revealed that socio economic factors play a significant role in determining the blood pressure of the individual. Children of middle class have significantly elevated mean systolic pressure and mean diastolic pressure than low socio-economic groups. 

scholarly journals Blood Pressure and Its Association with Gender, Body Mass Index, Smoking, and Family History among University Students

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Hussein H. Alhawari ◽  
Sameeha Al-Shelleh ◽  
Hussam H. Alhawari ◽  
Aseel Al-Saudi ◽  
Dina Aljbour Al-Majali ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
Family History ◽  
Cardiovascular Diseases ◽  
University Students ◽  
Diastolic Blood Pressure ◽  
Body Mass ◽  
Mean Difference ◽  
Significant Difference ◽  
History Of

Hypertension is one of the major risk factors associated with cardiovascular diseases. In this study, we will assess the frequency of hypertension among healthy university students and its association with gender, body mass index, smoking, and family history of both hypertension and cardiovascular diseases. We screened healthy university students ranging from 18 to 26 years of age. For each participant, we performed blood pressure measurements using a previously validated device and obtained demographic data, body mass index (BMI), smoking status, and family history of both hypertension and cardiovascular diseases. Out of the total number of 505 participants included in this study, 35.2% have blood pressure between 130/80 and 139/89, and 13.5% have blood pressure of more than 140/90. We found significant gender differences in both systolic pressure (p = 0.003) with mean difference = 18.08 mmHg (CI: 16.13 to 19.9) and diastolic pressure (p = 0.011) with mean difference = 3.6 mmHg (CI: 2.06 to 5.14), higher in males than in females. Upon comparing the mean difference in both systolic and diastolic blood pressure with BMI, we found significant differences in both systolic (p < 0.001) and diastolic (p = 0.002) blood pressure. We also found that smokers have significantly (p = 0.025) higher systolic blood pressure (mean difference = 4.2 mmHg, CI: 3.2 mmHg to 8.8 mmHg), but no significant difference for diastolic blood pressure (p = 0.386), compared to nonsmokers. First-degree family history of both hypertension and cardiovascular diseases affected systolic but not diastolic blood pressure. Taking into account the adverse short- and long-term effect of hypertension, we recommend adopting an awareness program highlighting the importance of screening blood pressure in young adolescent populations, keeping in mind that both high BMI and smoking are important modifiable factors.

scholarly journals Risk Occurred Probability and Influencing Factors of Stroke in Followed-Up Hypertension Patients

2021 ◽  
Author(s):  
An-le Li ◽  
Ying Qi ◽  
Shuai Zhu ◽  
Zhi-hao Hu ◽  
Xue-jin Xu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Family History ◽  
Influencing Factors ◽  
Cumulative Risk ◽  
Occurrence Rate ◽  
Risk Probability ◽  
History Of ◽  
Second Peak ◽  
Peak Value

Abstract Objective To explore the risk occurred probability and influencing factors of stroke in followed-up hypertension (HP) patients through the analysis of long-term followed-up cohort data. Methods The method of followed-up observation cohort was used to collect the information of 168417 followed-up hypertension patients from 2002 to 2020 in Jiading district in Shanghai. Kaplan-Meier method was used to analyze the risk occurred probability of stroke complications in long-term followed-up HP patients, and the influencing factors were analyzed by Cox proportional risk model. Results Among 168417 followed-up hypertension patients, 11143 cases had occurred stroke, and the cumulative occurrence rate of stroke was 6.62% (male was 6.87%, female was 6.37%). With the extension of the years of hypertension, the cumulative risk occurred probability of stroke in HP patients would continue to increasing, and the interval was not equidistant. The total cumulative risk probability of stroke in HP patients was 78.9% (male was 91.0%, female was 70.7%). During the period of hypertension, the risk occurred probability of stroke was not fixed, but fluctuates. There were 4 onset peaks, which were in 8 years (peak value 4.2%), 15 years (peak value 14.0%), 22 years (peak value 6.0%) and 26 years (peak value 13.9%). The highest risk probability of male patients was in 26 years (peak value 23.1%), and the second peak was in 15 years (peak value 15.6%). The highest risk probability of female patients was in 15 years (peak value 12.9%), and the second peak was in 26 years (peak value 8.7%). The risk probability of different sex, BP grad and BMI was different, male was higher than female, grade 3 HP higher than grade 1 and grad 2 HP, thin higher than normal weight. The major influencing factors of stroke complications were age (RR = 2.917, p < 0.001), body mass index (RR = 1.450, p < 0.001), family history of stroke (RR = 1.386, p < 0.001), blood pressure grad (RR = 1.148, p < 0.001), registry age (RR = 1.071, P < 0.001 and family history of hypertension (RR = 1.051, P < 0.001). Conclusion The risk occurred probability of stroke among hypertension would continue to increase disproportionately during period of hypertension, and the total cumulative risk probability could finally reach 78.9%. Male was higher than female. Age, BMI, family history (stroke and HP), blood pressure grad and duration of HP were related to the occurrence of stroke complications.

scholarly journals Long Term Clinical Outcomes of Patients with Ischemic Stroke in Primary care – A 9-year Retrospective Study

2020 ◽  
Author(s):  
Jinghao Han ◽  
Yue Kwan Choi ◽  
Wing Kit Leung ◽  
Eric Ming Tung Hui ◽  
Maria Kwan Wa Leung
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Ischemic Stroke ◽  
Diastolic Blood Pressure ◽  
Cardiovascular Events ◽  
Recurrent Stroke ◽  
Stroke Patients ◽  
All Cause Mortality

Abstract Background: We aim to document the long-term outcomes of ischemic stroke patients and explore the potential risk factors for recurrent cardiovascular events and all-cause mortality in primary care.Methods: A retrospective cohort study performed at two general out-patient clinics (GOPCs) under Hospital Authority (HA) in Hong Kong (HK). Ischemic stroke patients with at least two consecutive follow-up visits during the recruitment period (1/1-30/6/2010) were enrolled. Patients were followed up regularly till the date of recurrent stroke, cardiovascular event, death or 31/12/2018. Risks of recurrent cardiovascular events and death were estimated by Cox proportional hazards model. The primary outcome was the occurrence of recurrent cerebrovascular event including transient ischemic stroke (TIA), ischemic stroke or hemorrhagic stroke. The secondary outcomes were all-cause mortality and coronary heart disease (CHD).Results: A total of 466 patients (mean age, 71.5 years) were enrolled. During a median follow-up period of 8.7 years, 158 patients (33.9%) died. Eighty patients (17.2%) had recurrent stroke and 57 (12.2%) patients developed CHD. Age was an independent risk factor for recurrent stroke, CHD and death. Statin therapy at baseline had a protective effect for recurrent stroke (hazard ratio [HR] =0.454, 95% confidence interval [CI] 0.269-0.766, P=0.003) and all-cause mortality (HR= 0.693, 95% CI 0.486-0.968, P=0.043). In addition, female sex, antiplatelet and a higher diastolic blood pressure (DBP) at baseline were also independent predictors for survival.Conclusions: Long term prognosis of ischemic stroke patients in primary care is favorable. Use of statin was associated with a significant decrease in stroke recurrence and mortality. Patients who died had a significant lower DBP at baseline, highlighted the need to consider both systolic and diastolic blood pressure in our daily practice.

scholarly journals Effect of Acute Aerobic Exercise on Diastolic blood Pressure in Preclinical Medical Students of Services Institute of Medical Sciences, Lahore

Esculapio ◽  
2021 ◽  
Vol 17 (2) ◽  
pp. 170-174
Author(s):  
Muhammad Shafiq ◽  
◽  
Miraa Qutab ◽  
Saqib Javaid ◽  
Rida Fatima ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Medical Students ◽  
Family History ◽  
Aerobic Exercise ◽  
Diastolic Blood Pressure ◽  
Medical Sciences ◽  
Post Exercise ◽  
Waist Hip Ratio ◽  
History Of ◽  
Preclinical Medical Students

Objectives: To evaluate the response of acute bout of moderate exercise on DBP in preclinical medical students of Services Institute of Medical Sciences (SIMS), Lahore and to compare it with gender, family history, lifestyle and waist-hip-ratio of the study participants. Methods: This cross-sectional study was performed in the Department of Physiology, SIMS from May to December 2019. Ninety-three (93) healthy male and female MBBS students were recruited through nonprobability convenient sampling. Socio-demographic components were gathered using a ques-tionnaire. Anthropometric data (height, weight and waist-hip-ratio) and resting DBP was recorded before the exercise. All participants underwent exercise challenge on a treadmill. Post-exercise DBP was measured by taking serial recordings at zero minutes, 2 minutes and 5 minutes after exercise cessation. Data was analyzed using SPSSv20. Results: Within the 93 participants, 87(93.5%) were physically inactive, with only 6(6.5%) were physically active. In comparison with the baseline DBP, the DBP at zero and 2 minutes post exercise was statistically significant (p<0.001) in study participants. There was no significant correlation between DBP immediately after exercise and gender (p = 0.751); family history of hypertension and diabetes mellitus (p = 0.603); and lifestyle (p = 0.954). A non-significant (p = 0.636) yet positive correlation was observed between post exercise DBPand waist-hip-ratio among males. Conclusion: Our study revealed that an acute bout of exercise significantly raised the DBPimmediately after exercise. This rise in BP was not significantly related to gender, lifestyle and family history of diabetes mellitus and hypertension. Keywords: Diastolic blood pressure, aerobic exercise, waist-hip-ratio, medical students, treadmill How to cite: Shafiq M., Qutab M., Javaid S., Fatima R., Ijaz M., Shafiq A. Effect of acute aerobic exercise on diastolic blood pressure in preclinical medical students of Services Institute of Medical Sciences, Lahore. Esculapio 2021;17(02):170-174.

scholarly journals Risk Probability and Influencing Factors of Stroke in Followed-up Hypertension Patients

2021 ◽  
Author(s):  
An-le Li ◽  
Ying Qi ◽  
Shuai Zhu ◽  
Zhi-hao Hu ◽  
Xue-jin Xu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Family History ◽  
Influencing Factors ◽  
Risk Model ◽  
Cumulative Risk ◽  
Peak Period ◽  
Risk Probability ◽  
History Of ◽  
Second Peak

Abstract Objective To explore the risk probability and influencing factors of stroke in followed-up hypertension (HP) patients through the analysis of long-term followed-up cohort data. Methods The method of followed-up observation cohort was used to collect the information of 168417 hypertension patients from 2002 to 2020 in Jiading district in Shanghai. Kaplan-Meier method was used to analyze the risk probability of stroke complications in long-term followed-up HP patients, and the influencing factors were analyzed by Cox proportional risk model. Results Among 168417 hypertension patients, 11143 cases had stroke, and the cumulative incidence rate was 6.62%, the male was 6.87% and the female was 6.37%. With the extension of the observation of patients, the cumulative risk probability of stroke in HP patients would continue to increasing, and the interval was not equidistant. The total cumulative risk probability of stroke in HP patients was 78.9%, and male was 91.0%, female was 70.7%. During the whole observation, the risk probability of stroke was not fixed, but fluctuates. There were 4 peak onset periods, which were 8 years (peak period 4.2%), 15 years (peak period 14.0%), 22 years (peak period 6.0%) and 26 years (peak period 13.9%). The highest risk probability of male patients was in 26 years (peak period 23.1%), and the second peak was in 15 years (peak period 15.6%). The highest risk probability of female patients was in 15 years (peak period 12.9%), and the second peak was in 26 years (peak period 8.7%). The risk probability of different sex, BP grad and BMI was different, male was higher than female, grade 3 HP higher than grade 1 and grad 2 HP, thin higher than normal weight. The major influencing factors of stroke complications were age (RR = 2.917, p < 0.001), body mass index (RR = 1.450, p < 0.001), family history of stroke (RR = 1.386, p < 0.001), blood pressure grad (RR = 1.148, p < 0.001), registry age (RR = 1.071, P < 0.001 and family history of hypertension (RR = 1.051, P < 0.001). Conclusion The risk probability of stroke among hypertension patients would continue to disproportionately increase during observation, and the total cumulative risk probability could finally reach 78.9%. Male was higher than female. Age, BMI, family history (stroke and HP), blood pressure grad and duration of HP were related to the occurrence of stroke complications.

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