The 10-year incidence of hypertension across blood pressure categories in a population-based cohort in southwestern Sweden

Background To explore the determinants of incident hypertension, and especially the impact of baseline blood pressure categories, in a representative Swedish population. Methods A 10-year longitudinal study of residents aged 30–74. Blood pressures were measured and categorized according to ESH guidelines with optimal blood pressure < 120/80 mmHg, normal 120–129/80–84 mmHg, and high normal 130–139/85–89 mmHg. Incident hypertension was defined as ongoing treatment or three consecutive blood pressure readings ≥ 140/ ≥ 90 mmHg (one or both) at follow-up, while those with ≥ 140 and/or ≥ 90 mmHg at only one or two visits were labelled as unstable. After excluding subjects with hypertension, ongoing blood pressure lowering medication or a previous CVD event at baseline, 1099 remained for further analyses. Results Sixteen (2.6%) subjects with optimal baseline blood pressure had hypertension at follow up. Corresponding numbers for subjects with normal, high normal and unstable blood pressure were 55 (19.4%), 50 (39.1%) and 46 (74.2%), respectively. Compared with subjects in optimal group those in normal, high normal and unstable blood pressure categories had significantly higher risk to develop manifest hypertension with odds ratios OR and (95% CI) of 7.04 (3.89–12.7), 17.1 (8.88–33.0) and 84.2 (37.4–190), respectively, with adjustment for age, BMI and family history for hypertension. The progression to hypertension was also independently predicted by BMI (p < 0.001), however, not by age. Conclusions Subjects with high normal or unstable blood pressure should be identified in clinical practice, evaluated for global hypertension risk and offered personalized advice on lifestyle modification for early prevention of manifest hypertension and cardiovascular disease.

Baseline and Cumulative Blood Pressure in Predicting the Occurrence of Cardiovascular Events

Background: Both baseline blood pressure (BP) and cumulative BP have been used to estimate cardiovascular event (CVE) risk of higher BP, but which one is more reliable for recommendation to routine clinical practice is unclear.Methods: In this prospective study, conducted in the Kailuan community of Tanshan City, China, a total of 95,702 participants free of CVEs at baseline (2006–2007) were included and followed up until 2017. Time-weighted cumulative BP that expresses the extent of cumulative BP exposure is defined as the sum of the mean of two consecutive systolic or diastolic BP times the interval between the two determinations, then normalized by the total follow-up duration. Incident CVEs during 2006–2017 were confirmed by review of medical records. We performed a competing risk regression analysis to assess CVE risk of the different durations of higher BP exposure. ROC analysis was performed to assess the predictive value of higher BP on CVE occurrence.Results: We found that when the risk of higher BP on CVE occurrence was estimated based on time-weighted cumulative BP, the hazard ratios (HRs) increased with the increase in duration of higher BP exposure in each of the four BP groups: &lt;120/&lt;80, 120–129/&lt;80, 130–139/80–89, and ≥140/≥90 mmHg; this time trend also occurred across the four different BP groups, with the higher BP group exhibiting CVE risk earlier during the follow-up. These results were confirmed by the same analysis performed on participants without baseline hypertension. However, such reasonable time trends did not occur when a single baseline BP was used as the primary estimation. We also demonstrated that the predictive values of baseline systolic and diastolic BP that predict CVE occurrence were only 0.6–3.2 and 0.2–3.1% lower, respectively, than those of cumulative BP combined with baseline BP during follow-up.Conclusions: Baseline BP remains a useful indicator for predicting future occurrence of CVEs. Nevertheless, time-weighted cumulative BP could more reliably estimate the CVE risk of higher BP exposure than baseline BP.

The Risk and Influencing Factors of Hypertension in Jinchang Cohort

Background To investigate the incidence and influencing factors of hypertension in Jinchang cohort. Methods A prospective cohort study was conducted to collect the baseline and follow-up information of 22,826 employees from 2011 to 2015 based on the Jinchang cohort platform. The incidence of hypertension in the cohort was calculated and the influencing factors were analyzed by Cox proportional risk model. Results The subjects were followed up for an average of 22 years, and the incidence density of hypertension was 56.31/1000 person-years. Multivariate Cox regression results showed that the main risk factors for hypertension in the population included age ≥40 years, alcohol consumption, high-salt diet, history of diabetes, family history of hypertension, overweight and obesity, baseline systolic blood pressure ≥110 mm Hg and diastolic blood pressure ≥75 mm Hg, and higher education levels (middle school, high school, and above) were a protective factor. The incidence of grade 1 hypertension was related to age, drinking, history of diabetes, family history of hypertension and baseline blood pressure levels, and the incidence of grades 2 and 3 hypertension was related to high-salt diet, family history of hypertension, overweight or obesity, and baseline blood pressure levels. Conclusions The Jinchang cohort has a higher risk of hypertension. Age, unhealthy lifestyle, history of diabetes, family history of hypertension, obesity, and baseline blood pressure are strongly associated with the onset of hypertension. There are differences in the risk factors for the occurrence of grades 1, 2, and 3 hypertension.

RISK OF DEVELOPMENT OF HYPERTENSION AFTER DONOR NEPHRECTOMY

Objective: To assess live donor nephrectomy for development of hypertension. Study Design: Retrospective observational study. Place and Duration of Study: The study was conducted at Armed Forces Institute of Urology (AFIU) Rawalpindi, from May 2016 to May 2020. Methodology: All consenting kidney donors for live renal transplant were introduced with the process. Baseline blood pressure at time of workup of donation and annually afterwards after transplant on follow up examinations using retrospective data analysis of donor’s workup and follow up was used. Comparison of 1,2,3 and 4-year occurrence of hypertension among (normotensive) donors with 1,2,3 and 4-year of donation using estimates from Framingham Hypertension Risk Score. Results: A total of 79 donors with a completed annual follow-up rate of up to100 % during a 4-year period. The average age at donation was 33.96 ± 10.23 SD years; 50 donors (63.4%) were women. Overall 27% (22 out of 79) of all live donors developed post donation hypertension who were normotensive at the time of donation. Almost 2/3rd of the patients developing hypertension were females. There was a significant increase in blood pressure measurements each year after donation. Increased BMI of the patient was a risk factor for post donation development of hypertension. The donors who continue being normotensive 1-year post donation yielded an analogous risk to that fit Framingham populace. Conclusion: Live organ kidney givers are at augmented risk of development of hypertension post kidney donation. The study ascertains the potential significance of following donors and handling risk factors aggressively................

Trajectories of Blood Pressure Control a Year after Randomization and Incident Cardiovascular Outcomes in SPRINT

Background While studies have assessed the association between blood pressure trajectories and cardiovascular disease (CVD) outcomes using observational data, few have assessed these associations using clinical trial data. We sought to identify systolic blood pressure (SBP) trajectories and to determine if these trajectory patterns carry inherent CVD risk, irrespective of baseline blood pressure. Methods SBP trajectories were identified using latent class group based modeling among a cohort of 8901Systolic Blood Pressure Intervention Trial (SPRINT) participants by incorporating SBP measures during the first 12 months of the trial post randomization. Cox models were used to evaluate the association between SBP trajectory with CVD and all-cause mortality. Results Four distinct SBP trajectories were identified: ‘low decline’ (41%), ‘high decline’ (6%), ‘low stable’ (48%), and ‘high stable’ (5%). Relative to the ‘low decline’ group, the ‘low stable’ group was associated with a 29% increased risk of CVD (HR: 1.29, 95%CI: 1.06-1.57) and the ‘high stable’ group was associated with a 76% increased risk of all-cause mortality (HR: 1.76, 95%CI: 1.15-2.68). Relative to the ‘low stable’ group, the ‘high stable’ group was associated with a 54% increased risk of all-cause mortality (HR: 1.54, 95%CI: 1.05-2.28). Conclusions Our results demonstrate that SBP trajectory patterns are associated with important cardiovascular outcomes, irrespective of baseline blood pressure, which may help better identify individuals at risk and assist with accurate adjudication of antihypertensive therapy to reduce future events.