scholarly journals Blood pressure screening in midlife aids in prediction of dementia later in life

2022 ◽  
Vol 127 ◽  
Author(s):  
Linn Moberg ◽  
Jerzy Leppert ◽  
Simon Liljeström ◽  
Mattias Rehn ◽  
Lena Kilander ◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Blood Pressure ◽  
Cox Regression ◽  
Fasting Blood Glucose ◽  
Activity Level ◽  
Health Examination ◽  
Community Based ◽  
Increased Risk ◽  
Study Population

Background: There is substantial evidence that midlife hypertension is a risk factor for late life dementia. Our aim was to investigate if even high blood pressure at a single timepoint in midlife can predict an increased risk for all-cause dementia, Alzheimer’s disease (AD), or vascular dementia (VaD) later in life. Methods: The community-based study population comprised 30,102 dementia-free individuals from the Westmannia Cardiovascular Risk Factors Study. The participants were aged 40 or 50 years when the health examination took place in 1990–2000. Diagnose registers from both hospitals and primary healthcare centers were used to identify individuals who after inclusion to the study developed dementia. The association between midlife high blood pressure (defined as systolic blood pressure >140 and/or diastolic blood pressure >90 mmHg) at a single timepoint and dementia was adjusted for age, gender, body mass index (BMI), fasting blood glucose, education, smoking, and physical activity level. Multivariate binary cox regression analyses were used. Results: After a mean follow-up time of 24 years resulting in 662,244 person/years, 761 (2.5%) individuals had been diagnosed with dementia. Midlife high blood pressure at a single timepoint predicted all-cause dementia (hazard ratio [HR]: 1.22, 95% confidence interval [CI]: 1.02–1.45) and VaD (HR: 2.10, 95% CI: 1.47–3.00) but not AD (HR: 1.06, 95% CI: 0.81–1.38). Conclusion: This study suggests that even midlife high blood pressure at a single timepoint predicts all-cause dementia and more than doubles the risk for VaD later in life independently of established confounders. Even though there was no such association with AD, this strengthens the importance of midlife health examinations in order to identify individuals with hypertension and initiate treatment.

scholarly journals Awaking Blood Pressure Surge and Progression to Microalbuminuria in Type 2 Normotensive Diabetic Patients

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Michelangela Barbieri ◽  
Maria Rosaria Rizzo ◽  
Ilaria Fava ◽  
Celestino Sardu ◽  
Nicola Angelico ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Cox Regression ◽  
Blood Pressure Monitoring ◽  
Adult Patients ◽  
Diabetic Patients ◽  
Increased Risk ◽  
Pressure Surge

Background. We investigated the predictive value of morning blood pressure surge (MBPS) on the development of microalbuminuria in normotensive adults with a recent diagnosis of type 2 diabetes.Methods. Prospective assessments of 24-hour ambulatory blood pressure monitoring and urinary albumin excretion were performed in 377 adult patients. Multivariate-adjusted Cox regression models were used to assess hazard ratios (HRs) between baseline and changes over follow-up in MBPS and the risk of microalbuminuria. The MBPS was calculated as follows: mean systolic BP during the 2 hours after awakening minus mean systolic BP during the 1 hour that included the lowest sleep BP.Results. After a mean follow-up of 6.5 years, microalbuminuria developed in 102 patients. An increase in MBPB during follow-up was associated with an increased risk of microalbuminuria. Compared to individuals in the lowest tertile (−0.67±1.10 mmHg), the HR and 95% CI for microalbuminuria in those in the highest tertile of change (24.86±6.92 mmHg) during follow-up were 17.41 (95% CI 6.26–48.42);pfor trend <0.001. Mean SD MBPS significantly increased in those who developed microalbuminuria from a mean [SD] of 10.6[1.4]to 36.8[7.1],p<0.001.Conclusion. An increase in MBPS is associated with the risk of microalbuminuria in normotensive adult patients with type 2 diabetes.

scholarly journals Diabetic Retinopathy and Risk of Stroke

Stroke ◽  
2020 ◽  
Vol 51 (12) ◽  
pp. 3733-3736
Author(s):  
Ka-Ho Wong ◽  
Katherine Hu ◽  
Cecilia Peterson ◽  
Nazanin Sheibani ◽  
Georgios Tsivgoulis ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Diabetic Retinopathy ◽  
Primary Outcome ◽  
Vision Loss ◽  
Proportional Hazards ◽  
Cox Regression ◽  
Secondary Analysis ◽  
Cox Proportional Hazards ◽  
Increased Risk

Background and Purpose: Diabetic retinopathy (DR) is a common microvascular complication of diabetes, which causes damage to the retina and may lead to rapid vision loss. Previous research has shown that the macrovascular complications of diabetes, including stroke, are often comorbid with DR. We sought to explore the association between DR and subsequent stroke events. Methods: This is a secondary analysis of patients enrolled in the ACCORD Eye study (Action to Control Cardiovascular Risk in Diabetes). The primary outcome was stroke during follow-up. The exposure was presence of DR at study baseline. We fit adjusted Cox proportional hazards models to provide hazard ratios for stroke and included interaction terms with the ACCORD randomization arms. Results: We included 2828 patients, in whom the primary outcome of stroke was met by 117 (4.1%) patients during a mean (SD) of 5.4 (1.8) years of follow-up. DR was present in 874 of 2828 (30.9%) patients at baseline and was more common in patients with than without incident stroke (41.0% versus 30.5%; P =0.016). In an adjusted Cox regression model, DR was independently associated with incident stroke (hazard ratio, 1.52 [95% CI, 1.05–2.20]; P =0.026). This association was not affected by randomization arm in the ACCORD glucose ( P =0.300), lipid ( P =0.660), or blood pressure interventions ( P =0.469). Conclusions: DR is associated with an increased risk of stroke, which suggests that the microvascular pathology inherent to DR has larger cerebrovascular implications. This association appears not to be mediated by serum glucose, lipid, and blood pressure interventions.

scholarly journals Trimethyllysine Predicts All-Cause and Cardiovascular Mortality in Community-Dwelling Adults and Patients With Coronary Heart Disease

2021 ◽  
Author(s):  
Espen Ø Bjørnestad ◽  
Indu Dhar ◽  
Gard F T Svingen ◽  
Eva R Pedersen ◽  
Mads M Svenningsson ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiovascular Mortality ◽  
Cox Regression ◽  
Community Dwelling ◽  
Health Study ◽  
Community Based ◽  
Increased Risk ◽  
Established Coronary Heart Disease

Abstract Aims Trimethyllysine (TML) is involved in carnitine synthesis, serves as a precursor of trimethylamine N-oxide (TMAO) and is associated with cardiovascular events in patients with established coronary heart disease (CHD). We prospectively examined circulating TML as a predictor of all-cause and cardiovascular mortality in community-dwelling adults and patients with CHD. Methods and Results By Cox regression modelling, risk associations were examined in 6393 subjects in the community-based Hordaland Health Study (HUSK). A replication study was conducted among 4117 patients with suspected stable angina pectoris in the Western Norway Coronary Angiography Cohort (WECAC). During a mean follow-up of 10.5 years in the HUSK-cohort, 884 (13.8%) subjects died, of whom 287 from cardiovascular causes. After multivariable adjustments for traditional cardiovascular risk factors, the hazard ratio (HR) (95% CI) for all-cause mortality comparing the 4th vs. 1st TML-quartile was 1.66 (1.31-2.10, p &lt; 0.001). Particularly strong associations were observed for cardiovascular mortality (HR [95% CI] 2.04 [1.32-3.15, p = 0.001]). Corresponding risk-estimates in the WECAC (mean follow-up of 9.8 years) were 1.35 [1.10-1.66, p = 0.004] for all-cause and 1.45 [1.06-1.98, p = 0.02] for cardiovascular mortality. Significant correlations between plasma TML and TMAO were observed in both cohorts (rs≥0.42, p &lt; 0.001); however, additional adjustments for TMAO did not materially influence the risk associations, and no effect modification by TMAO was found. Conclusion Elevated TML-levels were associated with increased risk of all-cause and cardiovascular mortality both in subjects with and without established CHD.

Association between general and central adiposity and development of hypertension in early childhood

2019 ◽  
Vol 26 (12) ◽  
pp. 1326-1334 ◽  
Author(s):  
Maira A Ortiz-Pinto ◽  
Honorato Ortiz-Marrón ◽  
Isabel Ferriz-Vidal ◽  
María V Martínez-Rubio ◽  
María Esteban-Vasallo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
Body Mass ◽  
High Blood Pressure ◽  
Abdominal Obesity ◽  
Excess Weight ◽  
Weight Changes ◽  
Increased Risk ◽  
Incident Cases

Objectives To evaluate the association of general and abdominal obesity with high blood pressure in young children. Methods A longitudinal study including 1796 participants from the Madrid region (Spain) with baseline at age 4 years and a follow-up 2 years later. Blood pressure, body mass index and waist circumference were measured during a physical examination. We evaluated the association between obesity at baseline and weight changes between the ages of 4 and 6 years and high blood pressure. Data were analysed using linear and logistic regressions adjusted for covariates. Results Obese 4 year olds (general or abdominal obesity) experienced an average 4–5 mmHg increase in systolic blood pressure and a 2.5–3 mmHg increase in diastolic blood pressure by the age of 6 years. Compared to children maintaining a non-excess weight (based on body mass index) during follow-up incident and persistent cases of excess weight (overweight or obesity) had an odds ratio (OR) for high blood pressure of 2.49 (95% confidence interval (CI) 1.50–4.13) and OR 2.54 (95% CI 1.27–5.07), respectively. Regarding abdominal obesity we estimated OR 2.81 (95% CI 0.98–8.02) for incident cases and OR 3.42 (95% CI 1.38–8.49) for persistent cases. Similar estimates for the waist–height ratio were observed. Individuals who experienced remission to non-excess weight did not have an increased risk of high blood pressure. Conclusions We observed an increased risk for high blood pressure among 4-year-olds who presented with persistent or incident cases of excess weight (body mass index) or abdominal obesity after 2 years of follow-up. Children with excess weight or obesity at baseline who remitted to non-excess weight did not exhibit an increased risk of high blood pressure.

scholarly journals Women With Diabetes Are at Increased Relative Risk of Heart Failure Compared to Men: Insights From UK Biobank

2021 ◽  
Vol 8 ◽  
Author(s):  
Sucharitha Chadalavada ◽  
Magnus T. Jensen ◽  
Nay Aung ◽  
Jackie Cooper ◽  
Karim Lekadir ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cox Regression ◽  
Cardiac Risk ◽  
Uk Biobank ◽  
Contributing Factors ◽  
Increased Risk ◽  
Study Population ◽  
The Uk

Aims: To investigate the effect of diabetes on mortality and incident heart failure (HF) according to sex, in the low risk population of UK Biobank. To evaluate potential contributing factors for any differences seen in HF end-point.Methods: The entire UK Biobank study population were included. Participants that withdrew consent or were diagnosed with diabetes after enrolment were excluded from the study. Univariate and multivariate cox regression models were used to assess endpoints of mortality and incident HF, with median follow-up periods of 9 years and 8 years respectively.Results: A total of 493,167 participants were included, hereof 22,685 with diabetes (4.6%). Two thousand four hundred fifty four died and 1,223 were diagnosed or admitted with HF during the follow up periods of 9 and 8 years respectively. Overall, the mortality and HF risk were almost doubled in those with diabetes compared to those without diabetes (hazard ratio (HR) of 1.9 for both mortality and heart failure) in the UK Biobank population. Women with diabetes (both types) experience a 22% increased risk of HF compared to men (HR of 2.2 (95% CI: 1.9–2.5) vs. 1.8 (1.7–2.0) respectively). Women with type 1 diabetes (T1DM) were associated with 88% increased risk of HF compared to men (HR 4.7 (3.6–6.2) vs. 2.5 (2.0–3.0) respectively), while the risk of HF for type 2 diabetes (T2DM) was 17% higher in women compared to men (2.0 (1.7–2.3) vs. 1.7 (1.6–1.9) respectively). The increased risk of HF in women was independent of confounding factors. The findings were similar in a model with all-cause mortality as a competing risk. This interaction between sex, diabetes and outcome of HF is much more prominent for T1DM (p = 0.0001) than T2DM (p = 0.1).Conclusion: Women with diabetes, particularly those with T1DM, experience a greater increase in risk of heart failure compared to men with diabetes, which cannot be explained by the increased prevalence of cardiac risk factors in this cohort.

scholarly journals Blood pressure and 10-year all-cause mortality: Findings from the PERU MIGRANT Study

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 1134
Author(s):  
Aida Hidalgo-Benites ◽  
Valeria Senosain-Leon ◽  
Rodrigo M. Carrillo-Larco ◽  
Andrea Ruiz-Alejos ◽  
Robert H. Gilman ◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Blood Pressure ◽  
Cox Regression ◽  
Rank Test ◽  
National Committee ◽  
Hypertension Prevalence ◽  
Risk Of Death ◽  
Mortality Effect ◽  
Increased Risk ◽  
All Cause Mortality

Background The long-term impact of elevated blood pressure on mortality outcomes has been recently revisited due to proposed changes in cut-offs for hypertension. This study aimed at assessing the association between high blood pressure levels and 10-year mortality using the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) and the American College of Cardiology and the American Heart Association (ACC/AHA) 2017 blood pressure guidelines. Methods Data analysis of the PERU MIGRANT Study, a prospective ongoing cohort, was used. The outcome of interest was 10-year all-cause mortality, and exposures were blood pressure categories according to the JNC-7 and ACC/AHA 2017 guidelines. Log-rank test, Kaplan-Meier and Cox regression models were used to assess the associations of interest controlling for confounders. Hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated. Results A total of 976 records, mean age of 60.4 (SD: 11.4), 513 (52.6%) women, were analyzed. Hypertension prevalence at baseline almost doubled from 16.0% (95% CI 13.7%–18.4%) to 31.3% (95% CI 28.4%–34.3%), using the JNC-7 and ACC/AHA 2017 definitions, respectively. Sixty three (6.4%) participants died during the 10-year follow-up, equating to a mortality rate of 3.6 (95% CI 2.4–4.7) per 1000 person-years. Using JNC-7, and compared to those with normal blood pressure, those with pre-hypertension and hypertension had 2.1-fold and 5.1-fold increased risk of death, respectively. Similar mortality effect sizes were estimated using ACC/AHA 2017 for stage-1 and stage-2 hypertension. Conclusions Blood pressure levels under two different definitions increased the risk of 10-year all-cause mortality. Hypertension prevalence doubled using ACC/AHA 2017 compared to JNC-7. The choice of blood pressure cut-offs to classify hypertension categories need to be balanced against the patients benefit and the capacities of the health system to adequately handle a large proportion of new patients.

scholarly journals Blood Pressure Classification of 2017 Associated With Cardiovascular Disease and Mortality in Young Chinese Adults

Hypertension ◽  
2020 ◽  
Vol 76 (1) ◽  
pp. 251-258 ◽  
Author(s):  
Shouling Wu ◽  
Yongjian Song ◽  
Shuohua Chen ◽  
Mengyi Zheng ◽  
Yihan Ma ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Cox Regression ◽  
Chinese Adults ◽  
Cox Regression Analysis ◽  
Increased Risk ◽  
All Cause Mortality ◽  
New Guidelines ◽  
Stage 1

The American College of Cardiology/American Heart Association introduced new guidelines for blood pressure (BP) classification in 2017. We explored associations between the newly defined categories and eventual cardiovascular disease (CVD) events, stroke, and all-cause mortality in young Chinese adults. In the community-based Kailuan Study, 16 006 participants aged 18 to 40 years and examined at baseline in 2006/2007 underwent 2-yearly follow-up examinations up to 2016 to 2017. Taking the highest BP reading recorded by manual sphygmomanometry at baseline in 2006 to 2007, we categorized the BP according to the new guidelines. Outcome parameters were CVD events, stroke, and all-cause mortality. During follow-up (mean: 10.9±0.63 years), we observed 458 events (CVD, 167; stroke, 119; and all-cause death, 172). After multivariable adjustment, hazard ratios for CVD events were for elevated BP 0.80 (95% CI, 0.28–2.30), stage 1 hypertension 1.82 (95% CI, 1.12–2.94), and stage 2 hypertension 3.54 (95% CI, 2.18–5.77) versus normal BP. Similar results were obtained for stroke and all-cause death. In Cox regression analysis with BP category entered as time-dependent covariate, stage 1 hypertension was not associated with increased risk ( P >0.10). In the subgroup of individuals taking antihypertensive medication during follow-up, none of the BP categories was significantly associated with the incidence of CVD events. During a mean follow-up of 10.9 years, the newly defined category of stage 1 hypertension in young untreated Chinese adults aged <40 years at baseline was associated with an increased risk for CVD, stroke, and all-cause mortality. This increased risk occurred, however, after progression to stage 2 hypertension. The data may help validating the new BP classification system for young adult Chinese.

scholarly journals Increased Risk of Migraine in Patients with Temporomandibular Disorder: A Longitudinal Follow-Up Study Using a National Health Screening Cohort

Diagnostics ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 724
Author(s):  
Soo-Hwan Byun ◽  
Chanyang Min ◽  
Dae-Myoung Yoo ◽  
Byoung-Eun Yang ◽  
Hyo-Geun Choi
Keyword(s):  
Blood Pressure ◽  
National Health ◽  
Temporomandibular Disorder ◽  
Fasting Blood Glucose ◽  
Health Screening ◽  
Control Group ◽  
Follow Up Study ◽  
Kaplan Meier ◽  
Increased Risk

Background: The aim of this study was to investigate the association between temporomandibular disorder (TMD) and migraine through a longitudinal follow-up study using population data from a national health screening cohort. Methods: This cohort study used data from the Korean National Health Insurance Service-Health Screening Cohort from 2002 to 2015. Of the 514,866 participants, 3884 TMD patients were matched at a 1:4 ratio with 15,536 control participants. Crude models and models adjusted for obesity, smoking, alcohol consumption, systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol, and Charlson Comorbidity Index (CCI) scores were calculated. Chi-squared test, Kaplan–Meier analysis, and two-tailed log-rank test were used for statistical analysis. Stratified Cox proportional hazard models were used to assess hazard ratios (HR) and 95% confidence intervals (CIs) for migraine in both control groups. Results: The adjusted HR for migraine was 2.10 (95% CI: 1.81–2.44) in the TMD group compared to the control group, which was consistent in subgroup analyses according to age, sex, and Kaplan–Meier analysis. Conclusions: This study demonstrated that TMD patients have a higher risk of migraine. These results suggest that dentists can decrease the risk of migraine in TMD patients by managing TMD properly.

Predictive value of 24-hour ambulatory blood pressure monitoring for cardiovascular events

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
V Intan-Goey ◽  
M Scherrenberg ◽  
M Falter ◽  
T Kaihara ◽  
P Dendale
Keyword(s):  
Blood Pressure ◽  
Ambulatory Blood Pressure ◽  
Predictive Value ◽  
Cardiovascular Events ◽  
Risk Model ◽  
Cox Regression ◽  
Blood Pressure Monitoring ◽  
Increased Risk ◽  
Time Periods

Abstract Funding Acknowledgements Type of funding sources: None. Background Hypertension is one of the most important cardiovascular risk factors. Twenty-four-hour ambulatory blood pressure (BP) monitoring remains the gold standard to diagnose hypertension. However, it is still unclear whether different time periods of measurement differ in their predictive value for cardiovascular events. Purpose To investigate whether different time periods of home BP monitoring can be used as a predictor of cardiovascular events and mortality. Methods In this retrospective study, we included patients who had a 24-hour BP measurement between May 2015 and March 2016. Follow-up data were collected up to a maximum of 67 months. BP measurements were taken every 15 minutes from 9 AM until 9 PM and subdivided into 4 time periods, each consisting of 3 hours of measurements. Correlation of BP with major adverse cardiovascular event (MACE) defined as cardiovascular hospitalization and all-cause mortality was examined using a Cox-regression model, which was adjusted for possible confounding factors. Results A total of 301 patients were included for analysis with mean follow-up of 1830,4 days ± 229. The mean age was 64.3 ± 15.2 and 52.8% of patients were female. Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) for the 4 time periods were respectively 135,3 ± 16/ 82,6 ± 13,2mmHg, 132,3 ± 15,5/ 79,7 ± 12,7mmHg, 135,3 ± 15,5/ 81,7 ± 12,3mmHg and 136,4 ± 16,4 mmHg/ 81,6 ± 12,1mmHg. MACE occurred in 66 (21.9%) patients. The multivariable Cox proportional hazard risk model revealed that SBP between 12 and 3PM (HR 0.966 95% CI (0.945-0.989)) and the DBP between 6 and 9PM (HR 0.935 95% CI (0.898-0.973)) were associated with a reduced risk for MACE. Furthermore, the SBP between 6 and 9PM (HR 1.044 95% CI (1.021-1.068)) and the DBP between 3 and 6PM (HR 1.05 95% CI (1.013-1.089)) were associated with an increased risk for MACE. Conclusions The risk of cardiovascular events is higher in patients with a high SBP between 6 and 9PM and high DBP between 3 and 6PM. Lower risk is seen when the SBP is high between 12 and 3PM and the DBP is high between 6 and 9PM. These results might be explained by the circadian rhythm of BP. Further study is needed to confirm this time dependent predictive value of BP measurements.

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