Blood Pressure and Left Ventricular Geometric Changes: A Directionality Analysis

Hypertension ◽  
2021 ◽  
Author(s):  
Miaoying Yun ◽  
Shengxu Li ◽  
Yinkun Yan ◽  
Dianjianyi Sun ◽  
Yajun Guo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Temporal Relationship ◽  
Black People ◽  
Left Ventricular ◽  
Study Cohort ◽  
Path Coefficients ◽  
Normotensive Subjects ◽  
Geometric Changes ◽  
Relationship Of

This study assessed the temporal relationship of elevated blood pressure (BP) with left ventricular hypertrophy (LVH) and geometric changes in a longitudinal cohort of adults. Left ventricular mass index (LVMI), relative wall thickness (RWT), and BP were measured at 2 time points 4.1 to 14.9 years apart between 2000 and 2016 among 984 adults (677 White and 307 Black people; 41.1% men; age range, 24.2–56.7 years) in the Bogalusa Heart Study cohort. Cross-lagged path analysis models were used to examine the temporal relationship of BP with LVMI and RWT in subjects who did not take antihypertensive medications (n=693). The cross-lagged path coefficients did not differ significantly between race and sex groups. In the combined sample, the path coefficients from baseline systolic BP to follow-up LVMI/RWT were significantly greater than the path coefficients from baseline LVMI/RWT to follow-up systolic BP (0.111 versus −0.005 for LVMI, P =0.010 for difference; 0.146 versus 0.004 for RWT, P =0.002 for difference). Hypertensive subjects at baseline had a significantly higher incidence rate of concentric LVH at follow-up compared with normotensive subjects (19.4% versus 9.7%, P <0.001 for difference), but incident eccentric LVH did not show such a difference between hypertensive and normotensive subjects (5.4% versus 4.4%, P =0.503 for difference). Diastolic BP showed similar results to those of systolic BP. In conclusion, the findings on these one-directional paths provide strong and fresh evidence that elevated BP precedes the development of LVH, especially concentric LVH, during the young-to-midlife adult age period.

scholarly journals Temporal relationship between body mass index and uric acid and their joint impact on blood pressure in children and adults: the Bogalusa Heart Study

2021 ◽  
Author(s):  
Miaoying Yun ◽  
Tao Zhang ◽  
Shengxu Li ◽  
Xuan Wang ◽  
Lijun Fan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
Uric Acid ◽  
Body Mass ◽  
Temporal Relationship ◽  
Mediation Effect ◽  
Mediation Analyses ◽  
Path Coefficients ◽  
Analysis Models

Abstract Objective This study aimed to examine the temporal relationship between body mass index (BMI) and uric acid (UA), and their joint effect on blood pressure (BP) in children and adults. Methods The longitudinal cohorts for temporal relationship analyses consisted of 564 and 911 subjects examined twice 5–14 years apart from childhood to adulthood. The cross-sectional cohorts for mediation analyses consisted of 3102 children and 3402 nondiabetic adults. Cross-lagged panel analysis models were used to examine the temporal relationship between BMI and UA, and mediation analysis models the mediation effect of UA on the BMI–BP association. Results After adjusting for age, race, sex and follow-up years in children, and additionally smoking and alcohol drinking in adults, the path coefficients (standardized regression coefficients) from baseline BMI to follow-up UA (0.145 in children and 0.068 in adults) were significant, but the path coefficients from baseline UA to follow-up BMI (0.011 in children and 0.016 in adults) were not. In mediation analyses, indirect effects through UA on the BMI-systolic BP association were estimated at 0.028 (mediation effect = 8.8%) in children and 0.033 (mediation effect = 13.5%) in adults (P < 0.001 for both). Direct effects of BMI on systolic BP (0.289 in children and 0.212 in adults) were significant. The mediation effect parameters did not differ significantly between Blacks and Whites. Conclusions Changes in BMI precede alterations in UA, and the BMI–BP association is in part mediated through BMI-related increase in UA both in children and in adults. These findings have implications for addressing mechanisms of obesity hypertension beginning in early life.

Abstract 2154: Paroxysmal Atrial Tachyarrhythmia (AT) as a Trigger for Heart Failure Exacerbations: Assessment by Implanted Trans-pulmonary Impedance Sensor

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Rajat Jhanjee ◽  
Grant Templeton ◽  
John Nguyen ◽  
Scott Sakaguchi ◽  
Fei Lu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Temporal Relationship ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Pulse Generators ◽  
Sentinel Event ◽  
Impedance Sensor ◽  
Relationship Of

Introduction: From clinical experience, it is known that worsening of heart failure (HF) is often associated with a seemingly greater susceptibility to atrial tachyarrhythmias (AT), particularly atrial fibrillation. However, it is not clear whether it is the HF or the AT that is the sentinel event, and triggers the other. recently, certain contemporary implantable pulse generators (IPGs) are able to estimate intra-thoracic fluid status by means of detecting alterations of trans-pulmonary electrical impedance (OptiVol® [OV], Medtronic Inc). This capability permits long-term assessment of HF in pts. Employing this tool (i.e., OV) this study examined the temporal relationship between HF as assessed by OV method and AT events. Methods: Fourteen patients (pts: males, 71%, mean age 70±6.7 years) with OV-capable IPGs were enrolled. At each patient visit, OV index values since last follow-up, and AT duration (hours) were collected. OV Index >60 based on Medtronic Impedance Diagnostics in Heart Failure Trial (MID-HeFT) data was used as a cutoff to signify HF. Devices were interrogated to ascertain the temporal relationship of OV Index >60 and incidence of AT. Results are presented as mean ± SD. Results: Eighty-five pt visits were analyzed (mean=6.1 visits per pt, average follow-up, 21.7±5.7 months). Left-ventricular ejection fraction was 40±10%, with ischemic cardiomyopathy accounting for 57% pts. In 23 of 85 visits the OV index exceeded threshold and episodes of AT were detected by the device. Of these 23 instances in which there was AT-HF concordance, AT onset preceded the increase of OV index above threshold in 21/23 cases (91% of the time), comprising 9 of 14 pts (64%). Conclusions: In patients with both systolic HF and paroxysmal AT, our findings suggest that AT tends to precede worsening of heart failure and may act as the trigger event.

scholarly journals Associations of Serum Uromodulin and Its Genetic Variants With Blood Pressure and Hypertension in Chinese Adults

2021 ◽  
Vol 8 ◽  
Author(s):  
Yang Wang ◽  
Ming-Fei Du ◽  
Shi Yao ◽  
Ting Zou ◽  
Xiao-Yu Zhang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Genetic Variants ◽  
Lower Risk ◽  
Study Cohort ◽  
Chinese Adults ◽  
Sodium Homeostasis ◽  
Incidence Risk ◽  
Normotensive Subjects

Background: Uromodulin, also named Tamm Horsfall protein, has been associated with renal function and regulation of sodium homeostasis. We aimed to examine the associations of serum uromodulin levels and its genetic variants with longitudinal blood pressure (BP) changes and hypertension incidence/risk.Methods: A total of 514 participants from the original Baoji Salt-Sensitive Study cohort were genotyped to examine the associations of genetic variations in uromodulin gene with the longitudinal BP changes and the incidence of hypertension over 8 years of follow-up. In addition, 2,210 subjects from the cohort of Hanzhong Adolescent Hypertension Study were used to investigate the relationships between serum uromodulin levels and the risk of hypertension.Results: SNPs rs12917707 and rs12708631 in the uromodulin gene were significantly associated with the longitudinal BP changes over 8 years of follow-up. SNP rs12708631 was significantly associated with the incidence of hypertension over 8 years. In addition, gene-based analyses supported the associations of uromodulin gene with the longitudinal BP changes and hypertension incidence in Baoji Salt-Sensitive Study cohort. Furthermore, serum uromodulin levels in the hypertensive subjects were lower than in the normotensive subjects (25.5 ± 1.1 vs. 34.7 ± 0.7 ng/mL). Serum uromodulin levels decreased gradually as BP levels increased (34.6, 33.2, 27.8, and 25.0 ng/mL for subjects with normotension, high-normal, grade 1 hypertension, and grade 2 hypertension, respectively). Serum uromodulin was significantly associated with the lower risk of hypertension [0.978 (0.972–0.984)] in Hanzhong Adolescent Hypertension Study cohort.Conclusion: This study shows that uromodulin is associated with blood pressure progression and development of hypertension.

scholarly journals Metabolic Syndrome Features and Excess Weight Were Inversely Associated with Nut Consumption after 1-Year Follow-Up in the PREDIMED-Plus Study

2020 ◽  
Vol 150 (12) ◽  
pp. 3161-3170
Author(s):  
Alicia Julibert ◽  
Maria del Mar Bibiloni ◽  
Laura Gallardo-Alfaro ◽  
Manuela Abbate ◽  
Miguel Á Martínez-González ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Metabolic Syndrome ◽  
Energy Intake ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Virgin Olive Oil ◽  
Hdl Cholesterol ◽  
Excess Weight ◽  
Study Cohort

ABSTRACT Background High nut consumption has been previously associated with decreased prevalence of metabolic syndrome (MetS) regardless of race and dietary patterns. Objectives The aim of this study was to assess whether changes in nut consumption over a 1-y follow-up are associated with changes in features of MetS in a middle-aged and older Spanish population at high cardiovascular disease risk. Methods This prospective 1-y follow-up cohort study, conducted in the framework of the PREvención con DIeta MEDiterránea (PREDIMED)-Plus randomized trial, included 5800 men and women (55–75 y old) with overweight/obesity [BMI (in kg/m2) ≥27 and &lt;40] and MetS. Nut consumption (almonds, pistachios, walnuts, and other nuts) was assessed using data from a validated FFQ. The primary outcome was the change from baseline to 1 y in features of MetS [waist circumference (WC), glycemia, HDL cholesterol, triglyceride (TG), and systolic and diastolic blood pressure] and excess weight (body weight and BMI) according to tertiles of change in nut consumption. Secondary outcomes included changes in dietary and lifestyle characteristics. A generalized linear model was used to compare 1-y changes in features of MetS, weight, dietary intakes, and lifestyle characteristics across tertiles of change in nut consumption. Results As nut consumption increased, between each tertile there was a significant decrease in WC, TG, systolic blood pressure, weight, and BMI (P &lt; 0.05), and a significant increase in HDL cholesterol (only in women, P = 0.044). The interaction effect between time and group was significant for total energy intake (P &lt; 0.001), adherence to the Mediterranean diet (MedDiet) (P &lt; 0.001), and nut consumption (P &lt; 0.001). Across tertiles of increasing nut consumption there was a significant increase in extra virgin olive oil intake and adherence to the MedDiet; change in energy intake, on the other hand, was inversely related to consumption of nuts. Conclusions Features of MetS and excess weight were inversely associated with nut consumption after a 1-y follow-up in the PREDIMED-Plus study cohort. This trial was registered at isrctn.com as ISRCTN89898870.

Myocardial work analysis in screening of familial dilated cardiomyopathy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Triantafyllou ◽  
R Monteiro ◽  
A Protonotarios ◽  
T Gossios ◽  
P Elliott ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Dilated Cardiomyopathy ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Systemic Hypertension ◽  
Work Efficiency ◽  
Work Analysis ◽  
Significant Difference ◽  
Global Work

Abstract Introduction Early detection of affected family relatives of patients with dilated cardiomyopathy (DCM) is essential in order to guide follow up, outcomes and initiate early treatment. Myocardial work analysis is a novel method which integrated strain imaging and blood pressure and has the potential to identify patients with subclinical disease. Purpose We analysed myocardial work in family relatives of DCM patients with positive genotype but negative phenotype in order to identify whether myocardial work can identify early changes. Methods Seventy-four family relatives of DCM patients attending for screening were examined. All individuals were asymptomatic with either positive (45/74, G+) or negative (29/74, G-) genotype and no echocardiographic evidence of left ventricular dilatation or systolic impairment. Non-invasive myocardial work analysis using two-dimensional (2D) speckle tracking echocardiography was analysed. Global longitudinal strain (GLS) was measured by the same vendor specific software used for myocardial work analysis. Left ventricular (LV) ejection fraction (EF) was measured with the Simpson's biplane method. The peak systolic arm cuff blood pressure (BP) measurement at the time of echocardiography was used for the myocardial work study. Results In total we included 74 individuals (37±15 years old, 50.7% women) with mean systolic and diastolic BP of 121.3±14 and 73.2±10 mmHg respectively, mean EF was 58±5% and mean GLS at 18.4±2.5%. G+ individuals had pathogenic and very likely pathogenic mutations in 8 different genes (TTN, BAG3, DSP, FLNC, LMNA, DMD, RBM20, TPM1). There was no difference in age, systemic hypertension, diabetes or medical treatment between the 2 groups. No significant difference was found among G+ and G- individuals in mean systolic and diastolic BP (121.2±14.7 vs 121.2±15.2 mmHg), mean EF (57.3±5 vs 59.1±4%), GLS (−18.2±1.5 vs −18.6±2.9%), mean global work index (1818±403 vs 1928±295 mmHg%) and global constructive work (2192±464 vs 2260±318 mmHg%). However, we found significant reduction of the global work efficiency (GWE) with a GWE of 94.4±2.7% in the G+ versus 95.9±1.6% in the G- individuals (p 0.02). Moreover, the global wasted work (GWW) was increased in the G+ with a GWW of 111±58 mmHg% versus 82±41 mmHg% in the G- individuals (p 0.03). Conclusion DCM gene carriers show, early on, decreased myocardial work efficiency and increased wasted work compared to unaffected family members, which appears to be earlier than other parameters such as EF and GLS. Myocardial work analysis could potentially recognize individuals showing early cardiac involvement and guide closer follow up and early initiation of treatment. Funding Acknowledgement Type of funding source: None

scholarly journals The Relationship of Left Ventricular Trabeculation to Ventricular Function and Structure Over a 9.5-Year Follow-Up

2014 ◽  
Vol 64 (19) ◽  
pp. 1971-1980 ◽  
Author(s):  
Filip Zemrak ◽  
Mark A. Ahlman ◽  
Gabriella Captur ◽  
Saidi A. Mohiddin ◽  
Nadine Kawel-Boehm ◽  
...  
Keyword(s):  
Ventricular Function ◽  
Left Ventricular ◽  
Relationship Of ◽  
The Relationship

scholarly journals The relationship between diastolic blood pressure and the risk of cardiovascular events in patients with atrial fibrillation: the Fushimi AF registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Ikeda ◽  
M Iguchi ◽  
H Ogawa ◽  
Y Aono ◽  
K Doi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Cardiovascular Events ◽  
Left Ventricular ◽  
Cox Proportional Hazards ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
The Impact

Abstract Background Hypertension is one of the major risk factors of cardiovascular events in patients with atrial fibrillation (AF). However, relationship between diastolic blood pressure (DBP) and cardiovascular events in AF patients remains unclear. Methods The Fushimi AF Registry is a community-based prospective survey of AF patients in Japan. Follow-up data were available in 4,466 patients, and 4,429 patients with available data of DBP were examined. We divided the patients into three groups; G1 (DBP&lt;70 mmHg, n=1,946), G2 (70≤DBP&lt;80, n=1,321) and G3 (80≤DBP, n=1,162), and compared the clinical background and outcomes between groups. Results The proportion of female was grater in G1 group, and the patients in G1 group were older and had higher prevalence of heart failure (HF), diabetes mellitus (DM), chronic kidney disease (CKD). Prescription of beta blockers was higher in G1 group, but that of renin-angiotensin system-inhibitors and calcium channel blocker was comparable. During the median follow-up of 1,589 days, in Kaplan-Meier analysis, the incidence rates of cardiovascular events (composite of cardiac death, ischemic stroke and systemic embolism, major bleeding and HF hospitalization during follow up) were higher in G1 group and G3 group than G2 group (Figure 1). When we divided the patients based on the systolic blood pressure (SBP) at baseline (≥130 mmHg or &lt;130 mmHg), the incidence of rates of cardiovascular events were comparable among groups. Multivariate Cox proportional hazards regression analysis including female gender, age (≥75 years), higher SBP (≥130 mmHg), DM, pre-existing HF, CKD, low left ventricular ejection fraction (&lt;40%) and DBP (G1, G2, G3) revealed that DBP was an independent determinant of cardiovascular events (G1 group vs. G2 group; hazard ratio (HR): 1.40, 95% confidence intervals (CI): 1.19–1.64, G3 group vs. G2 group; HR: 1.23, 95% CI: 1.01–1.49). When we examined the impact of DBP according to 10 mmHg increment, patients with very low DBP (&lt;60 mmHg) (HR: 1.50,95% CI:1.24–1.80) and very high DBP (≥90 mmHg) (HR: 1.51,95% CI:1.15–1.98) had higher incidence of cardiovascular events than patients with DBP of 70–79 mmHg (Figure 2). However, when we examined the impact of SBP according to 20 mmHg increment, SBP at baseline was not associated with the incidence of cardiovascular events (Figure 3). Conclusion In Japanese patients with AF, DBP exhibited J curve association with higher incidence of cardiovascular events. Funding Acknowledgement Type of funding source: None

Abstract 51: Ambulatory Blood Pressure Phenotype And Cardiovascular Risk In Youth: The Ship-ahoy Study

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Joseph T Flynn ◽  
Philip Khoury ◽  
Joshua A Samuels ◽  
Marc B Lande ◽  
Kevin Meyers ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiac Function ◽  
Linear Models ◽  
Independent Predictor ◽  
Systolic Function ◽  
Left Ventricular ◽  
Cvd Risk ◽  
Oscillometric Device ◽  
Echocardiographic Parameters ◽  
Relationship Of

We investigated whether blood pressure (BP) phenotype based on clinic & 24-hour ambulatory BP (ABP) was associated with intermediate markers of cardiovascular disease (CVD) in 374 adolescents enrolled in a study of the relationship of BP to CV risk. Clinic BP was measured by auscultation and categorized using the 2017 AAP guideline. ABP was measured for 24 hours by an oscillometric device and analyzed using the adult ABP wake SBP cut-point (130 mmHg). This created 4 BP phenotype groups: normal BP (n=224), white coat hypertensive (n=48), ambulatory hypertensive (n=57) & masked hypertensive (n=45). Echocardiographic parameters & carotid-femoral pulse wave velocity (PWVcf) were measured to assess CVD risk. Left ventricular mass (LVM) was lowest in the normal BP group, whereas multiple measures of cardiac function and PWVcf were worse in the masked and ambulatory hypertensive groups: Generalized linear models adjusted for body mass index (BMI) were constructed to examine the associations between BP phenotype and the measured CVD variables. ABP phenotype was an independent predictor of LVM, diastolic and systolic function and PWVcf in the unadjusted model. ABP phenotype remained significantly associated with diastolic function (E/e’, e’/a’), systolic function (ejection fraction) and increased arterial stiffness (PWVcf) after adjustment for BMI percentile (all p<=0.05). We conclude that BP phenotype is an independent predictor of markers of increased CVD risk in adolescents, including impaired cardiac function and increased vascular stiffness. ABP monitoring has an important role in CVD risk assessment in youth.

scholarly journals Epidemiology of Heart Failure Stages in Middle‐Aged Black People in the Community: Prevalence and Prognosis in the Atherosclerosis Risk in Communities Study

2021 ◽  
Author(s):  
Ramachandran S. Vasan ◽  
Solomon K. Musani ◽  
Kunihiro Matsushita ◽  
Walter Beard ◽  
Olushola B. Obafemi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Cardiovascular Disease ◽  
Left Ventricular ◽  
Study Cohort ◽  
Atherosclerosis Risk In Communities ◽  
Cardiovascular Morbidity And Mortality ◽  
Atherosclerosis Risk

Background Black individuals have a higher burden of risk factors for heart failure (HF) and subclinical left ventricular remodeling. Methods and Results We evaluated 1871 Black participants in the Atherosclerosis Risk in Communities Study cohort who attended a routine examination (1993–1996, median age 58 years) when they underwent echocardiography. We estimated the prevalences of 4 HF stages: (1) Stage 0 : no risk factors; (2) Stage A : presence of HF risk factors (hypertension, diabetes mellitus, obesity, smoking, dyslipidemia, coronary artery disease without clinical myocardial infarction), no cardiac structural/functional abnormality; (3) Stage B : presence of prior myocardial infarction, systolic dysfunction, left ventricular hypertrophy, regional wall motion abnormality, or left ventricular enlargement; and (4) Stage C/D : prevalent HF. We assessed the incidence of clinical HF, atherosclerotic cardiovascular disease events, and all‐cause mortality on follow‐up according to HF stage. The prevalence of HF Stages 0, A, B, and C/D were 3.8%, 20.6%, 67.0%, and 8.6%, respectively, at baseline. On follow‐up (median 19.0 years), 309 participants developed overt HF, 390 incurred new‐onset cardiovascular disease events, and 651 individuals died. Incidence rates per 1000 person‐years for overt HF, cardiovascular disease events, and death, respectively, were Stage 0, 2.4, 0.8, and 7.6; Stage A, 7.4, 9.7, and 13.5; Stage B 13.6, 15.9, and 22.0. Stage B HF was associated with a 1.5‐ to 2‐fold increased adjusted risk of HF, cardiovascular disease events and death compared with Stages 0/A. Conclusions In our large community‐based sample of Black individuals, we observed a strikingly high prevalence of Stage B HF in middle age that was a marker of high cardiovascular morbidity and mortality.

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