scholarly journals Racial Differences in Blood Pressure Control Following Stroke: The REGARDS Study

Stroke ◽  
2021 ◽  
Author(s):  
Oluwasegun P. Akinyelure ◽  
Byron C. Jaeger ◽  
Tony L. Moore ◽  
Demetria Hubbard ◽  
Suzanne Oparil ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Racial Differences ◽  
Disease Risk ◽  
Atherosclerotic Cardiovascular Disease ◽  
Study Visit ◽  
History Of ◽  
Regards Study ◽  
White Adults ◽  
Multivariable Adjustment

Background and Purpose: In the general population, Black adults are less likely than White adults to have controlled blood pressure (BP), and when not controlled, they are at greater risk for stroke compared with White adults. High BP is a major modifiable risk factor for recurrent stroke, but few studies have examined racial differences in BP control among stroke survivors. Methods: We used data from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) to examine disparities in BP control between Black and White adults, with and without a history of stroke. We studied participants taking antihypertensive medication who did and did not experience an adjudicated stroke (n=306 and 7693 participants, respectively) between baseline (2003–2007) and a second study visit (2013–2016). BP control at the second study visit was defined as systolic BP <130 mm Hg and diastolic BP <80 mm Hg except for low-risk adults ≥65 years of age (ie, those without diabetes, chronic kidney disease, history of cardiovascular disease, and with a 10-year predicted atherosclerotic cardiovascular disease risk <10%) for whom BP control was defined as systolic BP <130 mm Hg. Results: Among participants with a history of stroke, 50.3% of White compared with 39.3% of Black participants had controlled BP. Among participants without a history of stroke, 56.0% of White compared with 50.2% of Black participants had controlled BP. After multivariable adjustment, there was a tendency for Black participants to be less likely than White participants to have controlled BP (prevalence ratio, 0.77 [95% CI, 0.59–1.02] for those with a history of stroke and 0.92 [95% CI, 0.88–0.97] for those without a history of stroke). Conclusions: There was a lower proportion of controlled BP among Black compared with White adults with or without stroke, with no statistically significant differences after multivariable adjustment.

scholarly journals Sympathetic responsiveness is not increased in women with a history of hypertensive pregnancy

2017 ◽  
Vol 312 (1) ◽  
pp. R49-R54 ◽  
Author(s):  
Sushant M. Ranadive ◽  
Ronee E. Harvey ◽  
Brian D. Lahr ◽  
Virginia M. Miller ◽  
Michael J. Joyner ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Postmenopausal Women ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Cardiovascular Responses ◽  
Physical Stress ◽  
Mean Blood Pressure ◽  
Hypertensive Pregnancy ◽  
History Of

Hypertensive pregnancy (HTNP) is a risk factor for future cardiovascular disease. Exaggerated cardiovascular responses to physical stress are also considered an independent marker of cardiovascular disease risk. However, there are limited data regarding the blood pressure (BP) responses to acute stress in women, who have a history of HTNP. Hence, the aim of the study is to compare BP responses to a physical stress in postmenopausal women with a history of HTNP to age- and parity-matched women with a history of normotensive pregnancy (NP). Beat-to-beat BP and heart rate was recorded in 64 postmenopausal women with [age = 58.5 (55.2, 62.2) yr, where values are the median, 25th percentile, and 75th percentile] and without [age = 59.4 (55.9, 62.4) yr] a history of HTNP before and during isometric handgrip (IHG) exercise (30% of maximal voluntary contraction) to fatigue. Muscle metaboreflex was measured during postexercise ischemia following IHG exercise. BP variables increased similarly in response to IHG exercise [systolic: NP = 11.5 (8.9, 17.6) %, HTNP = 11.3 (9.5, 15.9) %; diastolic NP = 11.2 (7.9, 13.3) %, HTNP = 9.5 (7.1, 14.3) %; mean blood pressure: NP = 9.8 (5.0, 13.6) %, and HTNP = 7.2 (4.4, 10.4) %] and postexercise ischemia [systolic: NP = 14.1 (10.3, 23.0) %, HTNP = 15.8 (10.6, 21.4) %; diastolic NP = 12.2 (4.8, 17.0) %, HTNP = 10.4 (5.3, 17.1) %; and mean blood pressure: NP = 11.1 (6.1, 17.9) %, HTNP = 9.4 (2.9, 14.8) %] in both groups. Although having a history of HTNP is associated with future cardiovascular disease risk, results from this study suggest that the risk may not be manifested through altered cardiovascular metaboreflex response to physical stressors.

scholarly journals Nighttime Blood Pressure Phenotype and Cardiovascular Prognosis

Circulation ◽  
2020 ◽  
Vol 142 (19) ◽  
pp. 1810-1820 ◽  
Author(s):  
Kazuomi Kario ◽  
Satoshi Hoshide ◽  
Hiroyuki Mizuno ◽  
Tomoyuki Kabutoya ◽  
Masafumi Nishizawa ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Cardiovascular Events ◽  
Disease Risk ◽  
Blood Pressure Monitoring ◽  
Cardiovascular Disease Risk ◽  
Atherosclerotic Cardiovascular Disease ◽  
Unique Identifier ◽  
Ambulatory Bp Monitoring ◽  
Nighttime Blood Pressure

Background: Ambulatory and home blood pressure (BP) monitoring parameters are better predictors of cardiovascular events than are office BP monitoring parameters, but there is a lack of robust data and little information on heart failure (HF) risk. The JAMP study (Japan Ambulatory Blood Pressure Monitoring Prospective) used the same ambulatory BP monitoring device, measurement schedule, and diary-based approach to data processing across all study centers and determined the association between both nocturnal hypertension and nighttime BP dipping patterns and the occurrence of cardiovascular events, including HF, in patients with hypertension. Methods: This practitioner-based, nationwide, multicenter, prospective, observational study included patients with at least 1 cardiovascular risk factor, mostly hypertension, and free of symptomatic cardiovascular disease at baseline. All patients underwent 24-hour ambulatory BP monitoring at baseline. Patients were followed annually to determine the occurrence of primary end point cardiovascular events (atherosclerotic cardiovascular disease and HF). Results: A total of 6,359 patients (68.6±11.7 years of age, 48% men) were included in the final analysis. During a mean±SD follow-up of 4.5±2.4 years, there were 306 cardiovascular events (119 stroke, 99 coronary artery disease, 88 HF). Nighttime systolic BP was significantly associated with the risk of atherosclerotic cardiovascular disease and HF (hazard ratio adjusted for demographic and clinical risk factors per 20-mm Hg increase: 1.21 [95% CI, 1.03–1.41], P =0.017; and 1.36 [95% CI, 1.08–1.71], P =0.009, respectively). Disrupted circadian BP rhythm (riser pattern, nighttime BP higher than daytime BP) was significantly associated with higher overall cardiovascular disease risk (1.48 [95% CI, 1.05–2.08]; P =0.024), and especially HF (2.45 [95% CI, 1.34–4.48]; P =0.004) compared with normal circadian rhythm. Conclusions: Nighttime BP levels and a riser pattern were independently associated with the total cardiovascular event rate, in particular for HF. These findings suggest the importance of antihypertensive strategies targeting nighttime systolic BP. Registration: URL: https://www.umin.ac.jp/ctr/ ; Unique identifier: UMIN000020377.

Abstract 17098: Liver Fibrosis and Associated Cardiovascular Disease Risk and Its Predictors Among US Adults With and Without Diabetes

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nathan D Wong ◽  
Matthew Bang ◽  
WENJUN FAN ◽  
Aprille Espinueva
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Liver Fibrosis ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Atherosclerotic Cardiovascular Disease ◽  
Advanced Fibrosis ◽  
Alcoholic Fatty Liver ◽  
Female Sex ◽  
Ascvd Risk

Background: Liver fibrosis is a complication of non-alcoholic fatty liver disease (NAFLD) and is associated with increased atherosclerotic cardiovascular disease (ASCVD) risk. Whether this risk may be enhanced in persons with pre-diabetes (pre-DM) or diabetes (DM), however, is not established. We examined the association of liver fibrosis with estimated ASCVD risk and its predictors according to DM status. Methods: We studied 30,895 adults (3,983 or 12.9% with DM) from the National Health and Nutrition Examination Surveys 1999-2014 with liver function measures to calculate FIB-4 scores; values of 1.3-2.67 and >2.67 indicated a moderate and high probability of advanced fibrosis, respectively. We studied the prevalence high FIB-4 scores in those with and without pre-DM and DM and the 10-year ASCVD risk based on the ACC/AHA Pooled Cohort Risk Calculator in persons without known ASCVD. In addition, multiple logistic regression examined predictors of high FIB-4 scores. Results: The prevalence of FIB-4 scores of 1.3-2.67 and >2.67 ranged from 17.8% and 1.5% in those without pre-DM/DM, 29.9% and 2.5% in those with pre-DM, and 35.3% and 3.5% in those with DM, respectively (p<0.0001). The figure shows the 10-year ASCVD risk by FIB-4 scores and presence of pre-DM and DM. Multivariable indicators of a FIB-4 score >2,67 were age (odds ratio [OR]=3.0 / 10 years), female sex (OR=0.53), non-Hispanic Black ethnicity (OR=2.0), waist circumference (OR=0.76/SD), alcohol use (OR=1.5), and NALFD (OR=3.3) in those without DM, and age (OR=2.2/10 years), female sex (OR=0.48), systolic blood pressure (1.4/SD), diastolic blood pressure (0.76/SD), and current smoking (OR=2.2) in those with DM (all p<0.05 to p<0.0001). Conclusions: Advanced fibrosis is more prevalent in those with vs. without DM. The presence of DM with higher FIB-4 scores is associated with especially high estimated ASCVD risks warranting increased efforts to address prevention and treatment of liver fibrosis.

Advances in Genomics Research of Blood Pressure Responses to Dietary Sodium and Potassium Intakes

Hypertension ◽  
2021 ◽  
Author(s):  
Michael A. Razavi ◽  
Lydia A. Bazzano ◽  
Jovia Nierenberg ◽  
Zhijie Huang ◽  
Camilo Fernandez ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Salt Sensitivity ◽  
Dietary Sodium ◽  
Atherosclerotic Cardiovascular Disease ◽  
Atherosclerotic Cardiovascular Disease Risk ◽  
Blood Pressure Responses ◽  
Sodium And Potassium

More than half of US adults have hypertension by 40 years of age and a subsequent increase in atherosclerotic cardiovascular disease risk. Dietary sodium and potassium are intricately linked to the pathophysiology of hypertension. However, blood pressure responses to dietary sodium and potassium, phenomena known as salt and potassium sensitivity of blood pressure, respectively, are heterogenous and normally distributed in the general population. Like blood pressure, salt and potassium sensitivity are complex phenotypes, and previous research has shown that up to 75% of individuals experience a blood pressure change in response to such dietary minerals. Previous research has also implicated both high salt sensitivity and low salt sensitivity (or salt resistance) of blood pressure to an increased risk of hypertension and potentially atherosclerotic cardiovascular disease risk. Given the clinical challenges required to accurately measure the sodium and potassium response phenotypes, genomic characterization of these traits has become of interest for hypertension prevention initiatives on both the individual and population levels. Here, we review advances in human genomics research of blood pressure responses to dietary sodium and potassium by focusing on 3 main areas, including the phenotypic characterization of salt sensitivity and resistance, clinical challenges in diagnosing such phenotypes, and the genomic mechanisms that may help to explain salt and potassium sensitivity and resistance. Through this process, we hope to further underline the value of leveraging genomics and broader multiomics for characterizing the blood pressure response to sodium and potassium to improve precision in lifestyle approaches for primordial and primary atherosclerotic cardiovascular disease prevention.

scholarly journals Cardiovascular Disease Risk Management in Persons With HIV: Does Clinician Specialty Matter?

2020 ◽  
Vol 7 (9) ◽  
Author(s):  
Nwora Lance Okeke ◽  
Katherine R Schafer ◽  
Eric G Meissner ◽  
Jan Ostermann ◽  
Ansal D Shah ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Density Lipoprotein ◽  
National Commission ◽  
Cardiovascular Disease Risk Factor ◽  
Atherosclerotic Cardiovascular Disease ◽  
Southeastern Us ◽  
The Impact

Abstract Background The impact of clinician specialty on cardiovascular disease risk factor outcomes among persons with HIV (PWH) is unclear. Methods PWH receiving care at 3 Southeastern US academic HIV clinics between January 2014 and December 2016 were retrospectively stratified into 5 groups based on the specialty of the clinician managing their hypertension or hyperlipidemia. Patients were followed until first atherosclerotic cardiovascular disease event, death, or end of study. Outcomes of interest were meeting 8th Joint National Commission (JNC-8) blood pressure (BP) goals and National Lipid Association (NLA) non–high-density lipoprotein (HDL) goals for hypertension and hyperlipidemia, respectively. Point estimates for associated risk factors were generated using modified Poisson regression with robust error variance. Results Of 1667 PWH in the analysis, 965 had hypertension, 205 had hyperlipidemia, and 497 had both diagnoses. At study start, the median patient age was 52 years, 66% were Black, and 65% identified as male. Among persons with hypertension, 24% were managed by an infectious diseases (ID) clinician alone, and 5% were co-managed by an ID clinician and a primary care clinician (PCC). Persons managed by an ID clinician were less likely to meet JNC-8 hypertension targets at the end of observation than the rest of the cohort (relative risk [RR], 0.84; 95% CI, 0.75–0.95), but when mean study blood pressure was considered, there was no difference between persons managed by ID and the rest of the cohort (RR, 0.96; 95% CI, 0.88–1.05). There was no significant association between the ID clinician managing hyperlipidemia and meeting NLA non-HDL goals (RR, 0.89; 95% CI, 0.68–1.15). Conclusions Clinician specialty may play a role in suboptimal hypertension outcomes in persons with HIV.

scholarly journals Association between Breakfast Frequency and Atherosclerotic Cardiovascular Disease Risk: A Cross-Sectional Study of KNHANES Data, 2014–2016

2019 ◽  
Vol 16 (10) ◽  
pp. 1853 ◽  
Author(s):  
Hyeon Ji Lee ◽  
Jieun Jang ◽  
Sang Ah Lee ◽  
Dong-Woo Choi ◽  
Eun-Cheol Park
Keyword(s):  
Cardiovascular Disease ◽  
High Risk ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
High Risk Group ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cross Sectional ◽  
Breakfast Consumption ◽  
History Of ◽  
Ascvd Risk

The burden of cardiovascular disease (CVD) is increasing worldwide and one related lifestyle choice is breakfast consumption. This study examined the association between breakfast frequency and the 10-year risk of atherosclerotic CVD (ASCVD). The 10-year risk of ASCVD was defined as the risk of the first event of nonfatal myocardial infarction, coronary heart disease death, and nonfatal or fatal stroke within 10 years. Data from the Korean National Health and Nutrition Examination Survey, 2014–2016 were analyzed, and 7212 participants aged 40–79 years with no history of CVD were included. ASCVD risk was calculated according to the pooled cohort ASCVD equation, and participants with a score >7.5% were considered at high risk of ASCVD. The association between breakfast frequency and high ASCVD risk was confirmed by logistic regression analysis. Participants who never ate breakfast were more likely to be in the high-risk group compared to participants who ate breakfast >5 times per week (OR (adjusted odds ratio) = 1.46; 95% CI (confidence interval) = 1.12–1.89), and the risk was especially higher in female participants and those with a family history of CVD. Our study confirms that breakfast consumption even once per week may prevent CVD.

scholarly journals Using Predicted Atherosclerotic Cardiovascular Disease Risk for Discrimination of Awake or Nocturnal Hypertension

2020 ◽  
Vol 33 (11) ◽  
pp. 1011-1020
Author(s):  
Swati Sakhuja ◽  
John N Booth ◽  
David E Anstey ◽  
Byron C Jaeger ◽  
Cora E Lewis ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Disease Risk ◽  
Blood Pressure Monitoring ◽  
Cardiovascular Disease Risk ◽  
Atherosclerotic Cardiovascular Disease ◽  
Nocturnal Hypertension ◽  
Ascvd Risk ◽  
Using Data ◽  
Atherosclerotic Cardiovascular Disease Risk

Abstract BACKGROUND Several atherosclerotic cardiovascular disease (ASCVD) risk factors are associated with awake and nocturnal hypertension. METHODS We assessed the association between a composite ASCVD risk score and awake or nocturnal hypertension using data from participants aged 40–79 years who completed ambulatory blood pressure monitoring at the Year 30 Coronary Artery Risk Development in Young Adults study exam in 2015–2016 (n = 716) and the baseline Jackson Heart Study exam in 2000–2004 (n = 770). Ten-year predicted ASCVD risk was calculated using the Pooled Cohort risk equations. Awake hypertension was defined as mean awake systolic blood pressure (SBP) ≥135 mm Hg or diastolic blood pressure (DBP) ≥85 mm Hg and nocturnal hypertension was defined as mean asleep SBP ≥120 mm Hg or DBP ≥70 mm Hg. RESULTS Among participants with a 10-year predicted ASCVD risk &lt;5%, 5% to &lt;7.5%, 7.5% to &lt;10%, and ≥10%, the prevalence of awake or nocturnal hypertension as a composite outcome was 29.5%, 47.8%, 62.2%, and 69.7%, respectively. After multivariable adjustment, higher ASCVD risk was associated with higher prevalence ratios for awake or nocturnal hypertension among participants with clinic-measured SBP/DBP &lt;130/85 mm Hg but not ≥130/85 mm Hg. The C-statistic for discriminating between participants with vs. without awake or nocturnal hypertension was 0.012 (95% confidence interval 0.003, 0.016) higher when comparing a model with ASCVD risk and clinic-measured blood pressure (BP) together vs. clinic-measured BP without ASCVD risk. CONCLUSIONS Using 10-year predicted ASCVD risk in conjunction with clinic BP improves discrimination between individuals with and without awake or nocturnal hypertension.

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