Trajectories of Blood Pressure in Midlife Women: Does Menopause Matter?

Background: Whether changes in blood pressure (BP) over women's midlife are more driven by chronological aging or the menopause transition (MT) has been debated. We sought to determine whether women can be classified into distinct trajectory groups based on pattern and level of systolic (SBP), diastolic blood pressure, pulse pressure (PP), and mean arterial pressure (MAP) over the MT, and to assess whether menopause-related factors predict the group and/or level of BP measures. Methods: Participants were from the Study of Women's Health Across the Nation (SWAN). Group-based trajectory modeling was used to identify women who shared distinct BP trajectories over time relative to menopause onset and to assess associations of menopause-related factors with trajectory group and/or level of BP measures. An accelerated rise relative to menopause onset suggests a menopause contribution. Results: The study included 3,302 multi-racial/ethnic women with BP measures over 17 follow-up visits (baseline age[SD]: 46.3[2.7]). Women were classified into either low, medium, or high trajectory group in each BP measure. The low SBP, PP, and MAP trajectories (in 35%, 53%, and 28% of the cohort, respectively) were rising slowly before menopause but showed a significant accelerated rise 1 year after menopause, indicating a menopause contribution. The remaining BP trajectories were rising up until menopause and either continued with the same rise or declined after menopause. A younger menopause age predicted the low SBP, PP, and MAP trajectories. A greater follicle-stimulating hormone level predicted lower SBP and PP levels, while vasomotor symptoms occurrence predicted higher SBP, PP, and MAP levels over time. Estradiol did not predict trajectory or level of any BP measure. Conclusions: Distinct BP trajectories over the MT exist that revealed a group of women whose SBP, PP, and MAP trajectories are consistent with a menopause contribution. Our findings support frequent monitoring of BP during the MT.

Download Full-text

Cystatin C Trajectories Among Middle-Aged and Older Americans

Innovation in Aging ◽

10.1093/geroni/igaa057.1661 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 514-515

Author(s):

Erfei Zhao ◽

Eileen Crimmins ◽

Jennifer Ailshire ◽

Jung Ki Kim ◽

Qiao Wu

Keyword(s):

Cystatin C ◽

College Graduates ◽

Ethnic Difference ◽

Socioeconomic Differences ◽

Older Americans ◽

Growth Curve Models ◽

Racial Ethnic ◽

Retirement Study ◽

Over Time

Abstract Deterioration in kidney functioning is associated with aging and is a major risk factor for mortality and other poor health outcomes. Medicare expenses for poor kidney functioning are about 100 billion dollars every year. High Cystatin-C is an indicator of poor kidney functioning. We do not know if cystatin-C increases gradually as an individual ages. We use the Health and Retirement Study 2006/2008 Biomarker sample with follow-up for 8 years to examine this. Demographic and socioeconomic differences in trajectories of Cystatin-C trajectories were examined for 22,984 participants aged 50 and older. Growth curve models reveal that, although Cystatin-C increases with age (beta=0.025, p<0.001), the annual increase varies by age (60-69 = 0.005, 70-79 = 0.013, 80+ = 0.017, p<0.001), controlling for other socioeconomic variables. Cystatin-C increases faster for males than females. Cystatin-C of non-Hispanic Whites is lower than non-Hispanic Blacks but higher than Hispanics; there is no racial/ethnic difference in change over time. People who spent fewer years in school have higher Cystatin-C, and college graduates have slower growth in Cystatin-C compared to people who did not graduate from high school. These novel findings highlight the disparities in the process of kidney aging among older Americans.

Download Full-text

The Worsening of Positional Mild Obstructive Sleep Apnea over Time Is Associated with an Increase in Body Weight: Impact on Blood Pressure and Autonomic Nervous System

Respiration ◽

10.1159/000517031 ◽

2021 ◽

pp. 1-10

Author(s):

Wei-Hsiu Chang ◽

Hsien-Chang Wu ◽

Chou-Chin Lan ◽

Yao-Kuang Wu ◽

Mei-Chen Yang

Keyword(s):

Blood Pressure ◽

Obstructive Sleep Apnea ◽

Nervous System ◽

Autonomic Nervous System ◽

Sleep Apnea ◽

Obstructive Sleep ◽

Mild Obstructive Sleep Apnea ◽

Positional Dependency ◽

Over Time

Background: Most patients with mild obstructive sleep apnea (OSA) are positional dependent. Although mild OSA worsens over time, no study has assessed the natural course of positional mild OSA. Objectives: The aim of this study was to evaluate the natural course of positional mild OSA, its most valuable progression predictor, and its impact on blood pressure (BP) and the autonomic nervous system (ANS). Methods: This retrospective observational cohort study enrolled 86 patients with positional mild OSA and 26 patients with nonpositional mild OSA, with a follow-up duration of 32.0 ± 27.6 months and 37.6 ± 27.8 months, respectively. Polysomnographic variables, BP, and ANS functions were compared between groups at baseline and after follow-up. Results: In patients with positional mild OSA after follow-up, the apnea/hypopnea index (AHI) increased (9.1 ± 3.3/h vs. 22.0 ± 13.2/h, p = 0.000), as did the morning systolic BP (126.4 ± 13.3 mm Hg vs. 130.4 ± 15.9 mm Hg, p = 0.011), and the sympathetic activity (49.4 ± 12.3% vs. 55.3 ± 13.1%, p = 0.000), while the parasympathetic activity decreased (50.6 ± 12.3% vs. 44.7 ± 13.1%, p = 0.000). The body mass index changes were the most important factor associated with AHI changes among patients with positional mild OSA (Beta = 0.259, adjust R2 = 0.056, p = 0.016, 95% confidence interval 0.425 and 3.990). The positional dependency disappeared over time in 66.3% of patients with positional mild OSA while 69.2% of patients with nonpositional mild OSA retained nonpositional. Conclusions: In patients with positional mild OSA, disease severity, BP, and ANS regulation worse over time. Increased weight was the best predictor for its progression and the loss of positional dependency. Better treatments addressing weight control and consistent follow-up are needed for positional mild OSA.

Download Full-text

Screening and management of hypertension in a General Practice Outpatient Department of a tertiary level teaching hospital in eastern region of Nepal

Health Renaissance ◽

10.3126/hren.v13i1.17949 ◽

2017 ◽

Vol 13 (1) ◽

pp. 58-67

Author(s):

Ashok Kumar Yadav ◽

OD Lewis ◽

SK Sharma ◽

IP Mahato ◽

R Bhandari ◽

...

Keyword(s):

Blood Pressure ◽

Life Style ◽

Blood Pressure Level ◽

Outpatient Department ◽

Systemic Hypertension ◽

Common Disease ◽

Eastern Region ◽

Lifestyle Education ◽

Over Time

Background: Hypertension is a common disease affecting about 20% of the adult population, both in developed and developing world (WHO 2002). It is one of the serious public health problems. Timely detection, compliance with lifestyle modification and use of drugs are important for effective management of this condition. Objective: To find out the prevalence of systemic hypertension in the general outpatient department and to study the effect of drugs and lifestyle education on the blood pressure over time. Methods: This was an interventional series of cases involving diagnosis and management of patients with BP higher than 140/90 or with known hypertension. All the subjects included were given life style education to see the effect of change of life style on blood pressure over time. Results: A total of 258 subjects were screened and 145 (56%) were diagnosed as hypertensive. Of the total, 75 (29%) had a blood pressure level in pre- hypertensive range. Whereas, 42 (16.3%) had hypertension of stage 1, and 28 (11%) had hypertension of stage 2. Forty- nine patients came for first follow up, 40 patients for second and 10 patients for the third follow up. Blood pressure started to decrease with second follow up. Conclusion: This study demonstrated that the prevalence of hypertension is 56% in the general outpatient department. The lifestyle education can have positive impact on blood pressure control.Health Renaissance 2015;13 (1): 58-67

Download Full-text

Trends in Blood Pressure and High-Sensitivity Cardiac Troponin-T With Cardiovascular Disease: The Cardiovascular Health Study

American Journal of Hypertension ◽

10.1093/ajh/hpz102 ◽

2019 ◽

Vol 32 (10) ◽

pp. 1013-1020 ◽

Cited By ~ 1

Author(s):

David M Tehrani ◽

Wenjun Fan ◽

Vijay Nambi ◽

Julius Gardin ◽

Calvin H Hirsch ◽

...

Keyword(s):

Blood Pressure ◽

Cardiac Troponin ◽

Cardiovascular Health ◽

Troponin T ◽

High Sensitivity ◽

Health Study ◽

Cardiovascular Health Study ◽

Cvd Risk ◽

Over Time

AbstractBackgroundHigh-sensitivity cardiac troponin T (hs-cTnT) is individually associated with incident hypertension (HTN) and cardiovascular disease (CVD) events. We hypothesize that the increases in hs-cTnT with increases in blood pressure will be related to higher incidence of CVD.METHODSThe Cardiovascular Health Study is a longitudinal cohort of older adults. Those with hs-cTnT data and CVD risk factors at baseline and follow-up (2–3 years later) were stratified based on systolic blood pressure (SBP; optimal: <120 mm Hg, intermediate: 120–139 mm Hg, elevated: ≥140 mm Hg) and hs-cTnT (undetectable: <5 ng/l, detectable: 5–13 ng/l, elevated: ≥14 ng/l) categories. SBP and hs-cTnT were classified as increased or decreased if they changed categories between exams, and stable if they did not. Cox regression evaluated incident CVD events over an average 9-year follow-up.RESULTSAmong 2,219 adults, 510 (23.0 %) had decreased hs-cTnT, 1,279 (57.6 %) had stable hs-cTnT, and 430 (19.4 %) had increased hs-cTnT. Those with increased hs-cTnT had a higher CVD risk with stable SBP (hazard ratio [HR]: 1.28 [1.04–1.57], P = 0.02) or decreased SBP (HR: 1.57 [1.08–2.28], P = 0.02) compared to those within the same SBP group but a stable hs-cTnT. In those with lower SBP at follow-up, there was an inverse relation between diastolic blood pressure (DBP) and risk of CVD events in those with increased hs-cTnT (HR: 0.44 per 10 mm Hg increase, P < 0.01).CONCLUSIONAn increase in hs-cTnT over time is associated with a higher risk of CVD even when the blood pressure is stable or decreases over time.

Download Full-text

Association between cognitive phenotype in unaffected siblings and prospective 3- and 6-year clinical outcome in their proband affected by psychosis

Psychological Medicine ◽

10.1017/s0033291720000719 ◽

2020 ◽

pp. 1-11

Author(s):

Thijs J. Burger ◽

Frederike Schirmbeck ◽

Jentien M. Vermeulen ◽

Piotr J. Quee ◽

Mariken B. de Koning ◽

...

Keyword(s):

Repeated Measures ◽

Psychotic Disorders ◽

Cognitive Vulnerability ◽

Familial Risk ◽

Related Factors ◽

Cross Sectional ◽

The Impact ◽

Cognitive Alterations ◽

Over Time

Abstract Background Cognitive alterations are a central and heterogeneous trait in psychotic disorders, driven by environmental, familial and illness-related factors. In this study, we aimed to prospectively investigate the impact of high familial risk for cognitive alterations, unconfounded by illness-related factors, on symptomatic outcomes in patients. Methods In total, 629 probands with non-affective psychosis and their sibling not affected by psychosis were assessed at baseline, 3- and 6-year follow-up. Familial cognitive risk was modeled by three cognitive subtypes (‘normal’, ‘mixed’ and ‘impaired’) in the unaffected siblings. Generalized linear mixed models assessed multi-cross-sectional associations between the sibling cognitive subtype and repeated measures of proband symptoms across all assessments. Between-group differences over time were assessed by adding an interaction effect of time and sibling cognitive subtype. Results Probands affected by psychosis with a sibling of the impaired cognitive subtype were less likely to be in symptomatic remission and showed more disorganization across all time points. When assessing differences over time, probands of siblings with the impaired cognitive subtype showed less remission and less improvement of disorganization after 3 and 6 years relative to the other subtypes. They also showed less reduction of positive, negative and excitement symptoms at 6-year follow-up compared to probands with a sibling of the normal cognitive subtype. Conclusions Cross-sibling pathways from higher levels of familial cognitive vulnerability to worse long-term outcomes may be informative in identifying cognition-related environmental and genetic risks that impact psychotic illness heterogeneity over time.

Download Full-text

A Three-Month Follow-Up Study Evaluating Changes in Clinical Profile and Attitudes Towards Involuntary Admission

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1746 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S477-S478 ◽

Cited By ~ 1

Author(s):

E. Bainbridge ◽

B. Hallahan ◽

D. McGuinness ◽

A. Higgins ◽

K. Murphy ◽

...

Keyword(s):

Psychiatric Inpatient ◽

Traumatic Experience ◽

Involuntary Admission ◽

Clinical Predictors ◽

Related Factors ◽

Explanatory Variables ◽

Positive Attitudes ◽

Competing Interest ◽

Over Time

IntroductionInvoluntary admission and treatment is often a traumatic experience for patients and there is a wide variation in attitudes towards care even when patients are recovered.Objectives/aimsThe purpose of this large prospective study was to identify clinical predictors of attitudes towards care during involuntary admission.MethodsThree hundred and ninety-one consecutively admitted involuntarily patients to three psychiatric inpatient units over a 30-month period were invited to participate in the study. Comprehensive assessments at admission and 3 months after discharge were attained including measures of symptoms, insight, functioning, attitudes towards involuntary admission and coercive experiences. Multiple linear regression modelling was used to determine the optimal explanatory variables for attitudes towards care.ResultsTwo hundred and sixty-three individuals participated at baseline and 156 (59%) successfully completed follow-up assessments. Individuals improved significantly over time clinically and in their attitudes towards their care. At baseline greater insight (P < 0.001) and less symptoms (P = 0.02) were associated with more positive attitudes towards care as was older age (P = 0.001). At follow-up, greater insight (P < 0.001), less symptoms (P = 0.02) and being older (P = 0.04) were associated with more positive attitudes towards care. More positive attitudes towards care at follow-up were associated with greater improvements in insight over time (P < 0.001) and having a diagnosis of an affective psychosis (P = 0.0009).ConclusionsThe best predictors of positive attitudes towards care during and after involuntary admission are illness related factors, such as levels of insight and improvement in insight, rather than service or legislation related factors, such as the use of coercive measures, seclusion and restraint.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

FC08-04 - Trajectories of depressive episodes and hypertension over 24 years: the whitehall II prospective cohort study

European Psychiatry ◽

10.1016/s0924-9338(11)73559-3 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1855-1855

Author(s):

H. Nabi ◽

J.-F. Chanstang ◽

T. Lefèvre ◽

A. Dugravot ◽

M. Melchior ◽

...

Keyword(s):

Blood Pressure ◽

General Health Questionnaire ◽

Antidepressant Medication ◽

Estimating Equation ◽

Depression Subscale ◽

Medical Examinations ◽

Depressive Episodes ◽

The Impact ◽

Over Time

IntroductionProspective data on depressive symptoms and blood pressure (BP) are scarce, and the impact of age on this association is poorly understood.ObjectivesThe present study examines longitudinal trajectories of depressive episodes and the probability of hypertension associated with these trajectories over time.MethodsParticipants were 6,889 men and 3,413 women London based civil servants followed for 24 years between 1985 and 2009. The age of participants over the follow-up ranged from 35 to 80 years. Depressive episode (defined as scoring 4 or more on the General Health Questionnaire-Depression subscale or using prescribed antidepressant medication) and hypertension (systolic/diastolic blood pressure ≥ 140/90 mm Hg or use of antihypertensive medication) were assessed concurrently at five medical examinations.ResultsIn longitudinal logistic regression analyses based on Generalized-Estimating-Equation using age as the time scale, participants with depression trajectory characterised by increasing depressive episodes overtime had a greater increase in the likelihood for hypertension with advancing age; an adjusted-excess increase of 7% (95% CI 3-12, p < 0.001) for each five-year increase in age compared to those with a low/stable depression trajectory. In a model adjusted for relevant confounders, a higher risk of hypertension in the first group of participants did not become evident before age 55. A similar pattern of association was observed in men and women although the association was stronger in men.ConclusionsThis study suggests that the risk of hypertension increases with repeated experience of depressive episodes over time and materializes in later adulthood.

Download Full-text

Blood pressure variability is related to faster cognitive decline in ischemic stroke patients: PICASSO subanalysis

Scientific Reports ◽

10.1038/s41598-021-83945-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yerim Kim ◽

Jae-Sung Lim ◽

Mi Sun Oh ◽

Kyung-Ho Yu ◽

Ji Sung Lee ◽

...

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Cognitive Function ◽

Cognitive Decline ◽

Repeated Measures ◽

Blood Pressure Variability ◽

Cognitive Test ◽

Multiple Variables ◽

Over Time

AbstractBlood pressure variability (BPV) is associated with higher cardiovascular morbidity risks; however, its association with cognitive decline remains unclear. We investigated whether higher BPV is associated with faster declines in cognitive function in ischemic stroke (IS) patients. Cognitive function was evaluated between April 2010 and August 2015 using the Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment in 1,240 Korean PICASSO participants. Patients for whom baseline and follow-up cognitive test results and at least five valid BP readings were available were included. A restricted maximum likelihood–based Mixed Model for Repeated Measures was used to compare changes in cognitive function over time. Among a total of 746 participants (64.6 ± 10.8 years; 35.9% female). Baseline mean-MMSE score was 24.9 ± 4.7. The median number of BP readings was 11. During a mean follow-up of 2.6 years, mean baseline and last follow-up MMSE scores were 25.4 ± 4.8 vs. 27.8 ± 4.4 (the lowest BPV group) and 23.9 ± 5.2 vs. 23.2 ± 5.9 (the highest BPV group). After adjusting for multiple variables, higher BPV was independently associated with faster cognitive decline over time. However, no significant intergroup difference in cognitive changes associated with mean systolic BP was observed. Further research is needed to elucidate how BPV might affect cognitive function.

Download Full-text

Impact of Model Choice When Studying the Relationship Between Blood Pressure Variability and Risk of Stroke Recurrence

Hypertension ◽

10.1161/hypertensionaha.120.16807 ◽

2021 ◽

Author(s):

Hugues de Courson ◽

Loïc Ferrer ◽

Antoine Barbieri ◽

Phillip J. Tully ◽

Mark Woodward ◽

...

Keyword(s):

Blood Pressure ◽

Blood Pressure Variability ◽

Proportional Hazards ◽

Cox Model ◽

Positive Association ◽

Vascular Risk Factor ◽

Stroke Recurrence ◽

The Impact ◽

Over Time

Long-term blood pressure variability (BPV), an increasingly recognized vascular risk factor, is challenging to analyze. The objective was to assess the impact of BPV modeling on its estimated effect on the risk of stroke. We used data from a secondary stroke prevention trial, PROGRESS (Perindopril Protection Against Stroke Study), which included 6105 subjects. The median number of blood pressure (BP) measurements was 12 per patient and 727 patients experienced a first stroke recurrence over a mean follow-up of 4.3 years. Hazard ratios (HRs) of BPV were estimated from 6 proportional hazards models using different BPV modeling for comparison purposes. The 3 commonly used methods first derived SD of BP measures observed over a given period of follow-up and then used it as a fixed covariate in a Cox model. The 3 more advanced modeling accounted for changes in BP or BPV over time in a single-stage analysis. While the 3 commonly used methods produced contradictory results (for a 5 mmHg increase in BPV, HR=0.75 [95% CI, 0.68–0.82], HR=0.99 [0.91–1.08], HR=1.19 [1.10–1.30]), the 3 more advanced modeling resulted in a similar moderate positive association (HR=1.08 [95% CI, 0.99–1.17]), whether adjusted for BP at randomization or mean BP over the follow-up. The method used to assess BPV strongly affects its estimated effect on the risk of stroke, and should be chosen with caution. Further methodological developments are needed to account for the dynamics of both BP and BPV over time, to clarify the specific role of BPV.

Download Full-text

Race Differences in COVID-19 Stress and Social Isolation: Implications for Depressive Symptoms

Innovation in Aging ◽

10.1093/geroni/igab046.1973 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 513-513

Author(s):

Akari Oya ◽

Angela Turkelson ◽

Courtney Polenick ◽

Karen Fingerman ◽

Kira Birditt

Keyword(s):

Depressive Symptoms ◽

Social Isolation ◽

Minority Groups ◽

Well Being ◽

Race Differences ◽

Nationally Representative ◽

Related Stress ◽

Racial Ethnic ◽

Over Time

Abstract The experience of the COVID-19 pandemic may vary widely by race. This study examined race differences in pandemic-related stress, social isolation and the implications for well-being. Participants included 1260 adults (45% women) ages 18 to 97 from the May and June 2020 nationally representative Survey of Consumers and 562 who completed a 6 month follow up in November/December. A total of 76% were White, 10% were Black, 3% were Asian, and 11% were Hispanic. Participants reported experiences of pandemic-related stress, social isolation and depressive symptoms in the last month. Analyses showed that minority groups reported greater pandemic related stress that had negative implications for depressive symptoms over time. The implication of social isolation for the stress-depressive symptoms link also varied by race. Overall this study showed racial inequities in the implications of COVID-19 pandemic and that reducing social isolation may only be beneficial for certain racial/ethnic groups.

Download Full-text