Blood pressure levels and hypertension prevalence in a high selenium environment: results from a cross-sectional study

Background and aims

Recent human and laboratory studies have suggested the possibility that selenium overexposure may increase blood pressure. We sought to ascertain whether adults living in a seleniferous area exhibit an association between selenium exposure and both blood pressure levels as well as prevalence of hypertension.

Blood pressure goals: A moving target

Clinical guidelines on hypertension have evolved over the past several decades. Each recommends varying blood pressure (BP) cut-offs which define hypertension, determine the thresholds to initiate pharmacotherapy, and guide treatment targets. In addition, different techniques of measuring BP in clinical trials may further contribute to the discrepancies in the achieved BP targets. Physicians find it difficult to navigate through different recommendations for hypertension management based on studies among different age groups and patients with a variety of co-morbidities and target organ involvement. In 2003, JNC 7 recommended a BP goal of < 140/90 mmHg in the general population and < 130/80 mmHg in those with diabetes mellitus or renal disease. JNC 8 re-set the BP target at < 140/90 mmHg for all adults under the age of 60 regardless of co-morbidities, and an even higher target of < 150/90 mmHg for those 60 years or older without diabetes or chronic kidney disease. The more recent results of the Systolic BP Intervention Trial (SPRINT) have a significant influence on the 2017 American College of Cardiology (ACC) and American Heart Association (AHA) guideline which redefines hypertension as BP ≥ 130/80 mmHg. It emphasizes individualized cardiovascular risk assessment and recommends a more aggressive BP target of < 130/80 mmHg and a treatment threshold based on the age, co-morbidities, and cardiovascular risk. The 2017 ACC/AHA guideline also advocates proper BP measurement and provides the estimates of corresponding BP values for clinic, home, and ambulatory BP monitoring measurements. A higher prevalence of hypertension is expected based on the ACC/AHA 2017 guideline. Its implementation may potentially lead to better BP control through enhanced awareness, improved adherence, and more timely initiation and intensification of pharmacologic therapy. Although there is no one-size-fits-all BP target, the ACC/AHA 2017 guideline is simple, inclusive and practical. Nonetheless, more studies are warranted to help further individualize BP goals for elderly patients and those with certain co-morbidities or multiple cardiovascular risk factors.     

Metabolomics study of blood pressure salt-sensitivity and hypertension

Background and aimsIdentify novel metabolite associations with blood pressure (BP) salt-sensitivity and hypertension.Methods and resultsThe Genetic Epidemiology Network of Salt Sensitivity (GenSalt) Replication study includes 698 Chinese participants who underwent a 3-day baseline examination followed by a 7-day low-sodium feeding and 7-day high-sodium feeding. Latent mixture models identified three trajectories of blood pressure (BP) responses to the sodium interventions. We selected 50 most highly salt-sensitive and 50 most salt-resistant participants for untargeted metabolomics profiling. Multivariable adjusted mixed logistic regression models tested the associations of baseline metabolites with BP salt-sensitivity. Multivariable adjusted mixed linear regression models tested the associations of BP salt-sensitivity with metabolite changes during the sodium interventions. Identified metabolites were tested for associations with hypertension among 1249 Bogalusa Heart Study (BHS) participants using multiple logistic regression. Fifteen salt-sensitivity metabolites were associated with hypertension in the BHS. Baseline values of serine, 2-methylbutyrylcarnitine and isoleucine directly associated with high salt-sensitivity. Among them, serine indirectly associated with hypertension while 2-methylbutyrylcarnitine and isoleucine directly associated with hypertension. Baseline salt-sensitivity status predicted changes in 14 metabolites when switching to low-sodium or high-sodium interventions. Among them, glutamate, 1-carboxyethylvaline, 2-methylbutyrylcarnitine, 3-methoxytyramine sulfate, glucose, alpha-ketoglutarate, hexanoylcarnitine, gamma-glutamylisoleucine, gamma-glutamylleucine, and gamma-glutamylphenylalanine directly associated with hypertension. Conversely, serine, histidine, threonate and 5-methyluridine indirectly associated with hypertension. Together, these metabolites explained an additional 7% of hypertension susceptibility when added to a model including traditional risk factors.ConclusionsOur findings contribute to the molecular characterization of BP response to sodium and provide novel biological insights into salt-sensitive hypertension.     

广西地区打鼾人群血压状况分析

目的了解广西地区打鼾的发生率、打鼾人群血压状况及打鼾与高血压的相关性。方法2003年1月至2005年3月对广西桂南、桂中、桂北14岁及以上人群进行打鼾的流行病学调查。采用集中填写问卷辅以入户问卷调查的方法收集资料，同时检测受调查者血压、身高、体重等身体参数。结果共抽样调查2862户，11163人，年龄14—99岁，平均年龄（39．6±17．5）岁。其中2940人打鼾，打鼾发生率为27．3％（2940／10758）。非打鼾人群平均收缩压为（122．7±21．7）mmHg（1mmHg=0．133kPa），舒张压为（75．7±13．2）mmHg，高血压患病率为19．9％（1566／7860）。打鼾人群平均收缩压为（128．2±30．9）mmHg，舒张压为（79．3±12．4）mmHg，高血压患病率为31．5％（931／2940）。随着年龄的增加，打鼾的发生率逐渐升高（趋势X^2=592．613，P=0．000），高血压的患病率也逐渐升高（趋势X^2=1868．277，P=0．000）。非习惯性打鼾者高血压患病率为27．6％，习惯性打鼾者高血压患病率37．4％。轻度打鼾者高血压患病率为27．5％，中度为31．1％，重度为37．4％，同时合并（被发现）有睡眠呼吸暂停者为44．1％。可能影响高血压的诸多因素的单因素分析及logistic回归分析结果显示，年龄、民族、打鼾、体重指数、饮酒是高血压的危险因素。控制年龄、民族、体重指数、饮酒等因素后的偏相关分析结果显示，打鼾人群的打鼾程度与收缩压和舒张压均呈正相关。结论广西地区14岁及以上人群打鼾发生率为27．3％。打鼾人群收缩压与舒张压及高血压患病率明显高于非打鼾人群。高血压的患病率随打鼾程度的增加而增加。打鼾程度与收缩压和舒张压均呈正相关。打鼾是除年龄、体重指数、饮酒以外与高血压发生相关的危险因素。     

Blood pressure variability: clinical relevance and application

Blood pressure variability is an entity that characterizes the continuous and dynamic fluctuations that occur in blood pressure levels throughout a lifetime. This phenomenon has a complex and yet not fully understood physiological background and can be evaluated over time spans ranging from seconds to years. The present paper provides a short overview of methodological aspects, clinical relevance, and potential therapeutic interventions related to the management of blood pressure variability.     

I. Factors associated with the initial blood pressure level and with the subsequent blood pressure increase in a longitudinal population study: The study of men born in 1913

In a longitudinal population study of Swedish men aged 50 atentry the relationships between a number of variables on theone hand and the systolic blood pressure at the start of thestudy and the subsequent systolic blood pressure change on theother were analyzed. Weight, skinfold, mother's death from cardiovasculardisease, systolic blood pressure at work and scrum protein wereall significantly correlated with both the initial pressurelevel and the subsequent pressure change, implying that theyare either causal factors for blood pressure increase or havethe same cause as the blood pressure increase. Blood glucose,serum lipids, haematocrit, pulse rate, eyeground features, heartvolume, smoking habits, serum transaminase and a number of otherfactors were correlated with the initial pressure level only,implying that they are probably not causing the pressure change.Alcohol consumption, stress, coffee consumption, occupationand other variables were neither related to the initial bloodpressure level nor to the blood pressure change     

Epidemiology of elevated blood pressure in youth and its utility for predicting adulthood outcomes: A review

Elevated blood pressure has been demonstrated to track from youth to adulthood and some have demonstrated an association between early-life blood pressure and subsequent atherosclerosis and cardiovascular disease. In addition, reports regarding the strength of tracking are inconsistent and the modifiable risk factors that affect the trajectory of blood pressure from youth to adulthood remain unclear. This paper comprehensively evaluated the existing classifications of youth hypertension and the current trends of youth hypertension. Further, evidence for the consequences of hypertension in youth has been comprehensively evaluated. Importantly, a review of the studies examining tracking from youth to adulthood has been performed and a number of studies investigating the factors affecting tracking has also been investigated. The overall consideration of this body of literature highlights the vital importance of identifying hypertension in youth to prevent complications in adulthood. Adiposity is regarded to be a factor affecting the progression of hypertension from youth to adulthood yet there is little evidence available for other modifiable factors. It is apparent that further research is necessary within this field in order to create effective preventative strategies to target youth hypertension.     

江苏无锡地区机关人员血压与心电图异常的关系

目的:探讨机关人员的血压水平及其与临床心电图异常的关系。方法:通过对江苏无锡地区部分机关的8 540名工作人员的系统查体,计算不同性别的血压分类及高血压患病率,分析不同血压水平的心电图异常检出率。结果:(1)男性正常高限血压占12.12%,高血压占37.15%;女性正常高限血压占7.37%,高血压占21.08%,男性正常高限及高血压患病率显著高于女性(P<0.01);(2)高血压患病率随年龄增高而增高,除70~79岁组外,均为男性显著高于女性(P<0.01);(3)随着血压升高,临床心电图异常分类如ST-T改变、左室高电压、左室肥厚、束支传导阻滞、室性早搏、陈旧性心梗等检出率显著升高。结论:随着血压升高,临床心电图异常特别是室性异常心电图的发生率显著升高。血压达到正常高限时,临床心电图异常率已开始升高。     

中国35～64岁人群血压水平与10年心血管病发病危险的前瞻性研究

目的探讨我国35～64岁人群血压水平与心血管病发病危险的关系,为《中国高血压防治指南》的修订工作提供流行病学数据。方法采用前瞻性队列研究的方法,对1992年建立的11省市35～64岁队列人群共31728人的基线血压水平和1992～2002年发生的心血管病(包括冠心病和脑卒中)事件的关系进行分析。结果(1)以血压110～119／75～79mmHg(1mmHg=0．133kPa)为对照,血压在120～129／80～84mmHg时,心血管病发病危险增加了1倍(RR=2．09);血压在140～149／90～94mmHg时,心血管病发病危险增加了2倍以上(RR=3．23);当血压≥180／110mmHg时,心血管病发病危险增加了10倍以上(RR=11．81)。(2)与理想血压相比,2级高血压时,急性冠心病事件发病的危险是理想血压组的2．3倍,急性缺血性脑卒中和急性出血性脑卒中发病的危险分别是理想血压组的4．9倍和11．7倍。(3)在总的心血管病事件中,36．1％可归因于高血压;其中44．0％的急性脑卒中事件和23．7％的急性冠心病事件可归因于高血压。(4)不同血压水平时,随着合并其他心血管病危险因素个数的增加,10年心血管病发病的综合危险增加。结论血压水平从110／75mm Hg开始,随着血压水平的增加,心血管病发病危险持续上升,所以将某个血压水平作为高血压的诊断标准是人为制订的。应该加强多重危险因素的综合干预,以减少总的心血管病的发病危险。     

肾血管性与原发性高血压患者24h动态血压的比较

目的 比较肾血管性高血压(RVH)与原发性高血压(EH)患者24 h动态血压的差别.方法 应用动态血压监测仪观察51例RVH患者的24 h动态血压,并与年龄、性别与之相匹配的51例EH患者的24 h动态血压进行比较.结果 RVH组24 h、白天及夜间动态收缩压、舒张压及脉压均值都比EH组有不同程度的升高(P<0.05),尤以夜间收缩压升高明显;血压负荷增加明显,24 h收缩压、舒张压负荷分别达到58.96%和35.98%,而EH组血压负荷均在20.00%左右,两组比较差异有统计学意义(P<0.05).EH组夜间血压下降率为10.36%,血压曲线呈勺型(60.8%的患者夜间血压下降率>10%);而RVH组夜间血压下降率为5.39%,血压曲线呈非勺型(仅有27.50%的患者夜间血压下降率>10%).结论 RVH患者动态血压均值、脉压和血压负荷明显增加,昼夜节律减弱.

Abstract：

Objective To compare 24 h ambulatory blood pressure changes between patients with renovascular hypertension and essential hypertension.Methods The 24 h ambulatory blood pressure of patients with age and gender matched renovascular hypertension (RVH, n=51) was compared with that of patients with essential hypertension (EH, n=51).Results The 24 h, daytime and nighttime systolic blood pressures(SBP),diastolic blood pressures(DBP) and pulse pressures (PP) in RVH were significantly higher than in EH (all P<0.05), especially the nocturnal SBP (P<0.05). The SBP and DBP loads in RVH were 58.96% and 35.98% respectively, while blood pressure loads were around 20.00% in EH (P<0.05). In patients with RVH, The nocturnal blood pressure fall was 5.39%, and only 27.50% patients were dippers, while the nocturnal blood pressure fall was 10.36% and 60.8% patients were dippers in EH.Conclusion RVH patients have higher dynamic BP, PP, BP loads and blunted diurnal rhythm compared to those with EH.     

北京地区2740人的血压水平10年（1992-2002）变化情况

目的探讨北京地区人群个体血压水平10年的变化情况。方法采用前瞻性队列研究的方法，于1992年对北京大学社区和首钢地区35～64岁人群，进行了基线心血管病危险因素调查，并持续10年对心血管病的发病情况进行了随访。在2002年对相同人群再次进行了危险因素调查，对两次调查结果中血压水平的变化情况进行了流行病学分析。结果(1)10年间平均收缩压水平随年龄的增长而持续增加；平均舒张压水平在55岁以前呈上升变化，在55～64岁组呈轻度下降；(2)1992年与2002年相同年龄组间比较(例如1992年45～54岁与2002年45～54岁)．平均收缩压水平、平均舒张压水平及高血压患病率均明显增加；(3)10年间总的高血压患病率由27．6％增加到48．8％，55～64岁组高血压患病率最高，35～44岁组高血压患病率增加的幅度最大；单纯收缩期高血压(ISH)在全部高血压患者中所占比例随年龄的增长明显增加，65～岁组的ISt{所占比例最高，达61．8％；(4)1992年血压在120／80mmHg以下、120～129／80～84mmHg、130～139／85～89mmHg3个亚组的人群到2002年成为高血压患者的比例分别为22．2％、44．7％和64．3％。结论收缩压和舒张压随年龄的增长呈现不同的变化；目前45～64岁年龄组人群的平均收缩压水平、平均舒张压水平及高血压患病率，均较10年前45～64岁年龄组人群高；随年龄的增长单纯收缩期高血压在全部高血压患者中所占比例增加；血压在120～139／80～89mmHg的亚组人群10年后的高血压发病率，与血压在120／80mmHg以下的亚组人群相比明显增加。     

高血压病患者动态血压与左心功能相关关系的研究

目的观察收缩压、舒张压分别对左室收缩及舒张功能的不同影响。方法应用诊所血压、２４小时动态血压监测及超声心动图，观察３８例Ⅰ、Ⅱ期高血压病患者血压与左室心肌质量、左室收缩及舒张功能的相关关系。结果２４小时及白天平均收缩压及诊所收缩压均与舒张早期充盈峰值流速（ＥＰＦＶ）呈负相关（Ｐ值均＜００５），２４小时、白天及夜间平均舒张压均与年龄呈负相关（Ｐ值均＜０．０５），与舒张功能各参数之间无相关关系，诊所收缩压与年龄、心房收缩期充盈峰值流速（ＡＰＦＶ）呈正相关（Ｐ＜０．００１及０．０５），夜间平均收缩压及诊所收缩压与左室心肌质量指数呈正相关（Ｐ＜０．０１及０．０５）。而２４小时平均收缩压、白天平均收缩压、２４小时平均舒张压、白天及夜间平均舒张压则均与左室心肌质量指数无明显相关关系。结论２４小时平均收缩压是影响左室舒张功能的重要因素之一，２４小时平均舒张压与左室舒张功能无相关关系。夜间平均收缩压增高是导致左心室肥厚的重要因素之一。随年龄增长，收缩压增高，舒张压下降     

The relationship between nut consumption and blood pressure in an Iranian adult population: Isfahan Healthy Heart Program

Background and aimsFew studies outside of Western countries have evaluated the relationship between consumption of nuts and blood pressure (BP). This study aimed to investigate the relationship between nut consumption and blood pressure in an Iranian adult population.Methods and resultsWe performed a cross-sectional investigation among 9660 randomly selected Iranian adults, sampled to represent three large Iranian regions, using data collected in the Isfahan Healthy Heart Program in 2007. The frequency of nut consumption was assessed by a food frequency questionnaire. Systolic and diastolic BPs (SBP and DBP) were measured in duplicate by trained personnel using a standard protocol. Multiple linear and logistic regressions were applied to assess the relationship between nut intake and BP levels and the presence of hypertension as SBP ≥ 140 mmHg, and/or a DBP ≥ 90 mmHg and/or current use of at least one type of anti-hypertensive medication. Those with nut consumption ≥4 times/week showed less mean of BPs and hypertension prevalence, compared to those who consumed nuts <1 times/week (p < 0.001). Compared to no consumption, consuming nuts ≥4 times/week was associated with a 34% lower prevalence of hypertension (multivariate odds ratio (OR) = 0.66; confidence interval (CI) = 0.51–0.87; p for trend = 0.009).ConclusionsMore frequent nut consumption is associated with lower BP and lower risk of hypertension among Iranian adults.     

高血压病患者运动血压与动态血压关系的研究

目的　探讨高血压病患者运动血压与动态血压的关系。方法　分别以活动平板运动试验中最大运动量时收缩压 (peakSBP)和舒张压 (peakDBP)过度升高和反应正常分组 ,以运动后收缩压(recSBP)和舒张压 (recDBP)恢复慢和恢复正常分组 ,对比分析 30 3例 1、2级高血压病患者的动态血压变化。结果　peakSBP、peakDBP过度升高组动态血压各检测值均显著高于反应正常组 (P <0 0 5或0 0 1) ;recSBP恢复慢组的夜间平均收缩压、舒张压显著高于恢复正常组 (P <0 0 1) ;recDBP恢复慢组白昼舒张压负荷显著高于恢复正常组 (P <0 0 1)。多元逐步回归分析显示 ,对peakSBP、peakDBP、recSBP最具影响的共同参数为夜间平均舒张压。结论　高血压病患者运动试验中 74 2 6 %～ 81 85 %存在运动中血压过度升高和运动后收缩压恢复慢并与动态血压检测值有显著统计意义。     

持续性、隐蔽性和白大衣3种高血压患者血压变异性分析

目的：探讨持续性,隐蔽性高血压患者与白大衣高血压患者的血压变异性（BPV）特点。方法：选择2010年12月～2012年12月在我院查体人群527例作为分析对象,并按照血压的特点全部病例被分成高血压组（SH 组,143例）、隐蔽性高血压组（MH 组,93例）、白大衣高血压组（86例）和正常对照组（NC 组,205例）。血压变异系数（CV）＝BPV/平均血压。结果：隐蔽性高血压组、持续高血压组血压 CV 较 NC 组显著增大[24h 收缩压 CV（27.73±5.36）％比（29.83±5.95）％比（17.93±4.85）％,24h 舒张压 CV（23.02±4.63）％比（22.69±4.63）％比（14.32±4.21）％,白昼收缩压 CV（25.12±4.79）％比（25.98±4.73）％比（14.97±4.29）％,白昼舒张压 CV（21.03±4.59）％比（20.92±4.53）％比（11.79±4.43）％,夜间收缩压 CV（21.52±4.93）％比（22.37±4.98）％比（11.57±4.19）％,夜间舒张压CV（18.79±4.83）％比（20.09±5.19）％比（6.98±3.69）％],P 均＜0.01;而白大衣高血压组与 NC 组之间,持续高血压组与隐蔽性高血压组之间血压 CV 差异均无统计学意义（P ＞0.05）。结论：持续性,隐蔽性高血压患者血压变异性较为显著,这可能是这类患者靶器官损害比较严重的主要原因之一。     

H型高血压患者的血压变异性研究

目的观察H型高血压患者血压变异性的特点。方法连续选择2011年2月~2013年2月于军事科学院门诊部就诊的80例原发性高血压患者,分别进行血浆同型半胱氨酸(Hcy)水平测定和动态血压监测,根据Hcy水平分为H型高血压组(n=44)和非H型高血压组(n=36),分析比较两组间的血压变异性。结果与非H型高血压患者相比,H型高血压组患者24h平均收缩压标准差(24hSSD)[(15.83±4.02)mmHg vs.(13.25±3.89)mmHg]、白昼收缩压标准差(dSSD)[(16.82±4.98)mmHg vs.(12.75±3.86)mmHg]、白昼舒张压标准差(dDSD)[(10.29±2.23)mmHg vs.(8.62±1.82)mmHg]和夜间收缩压标准差(nSSD)[(12.88±4.54)mmHg vs.(10.12±3.36)mmHg]明显增高,差异具有统计学意义(P均0.05)显著。结论与非H型高血压患者相比,H型高血压患者血压变异性增高。     

Factors affecting seasonal changes in blood pressure in North India: A population based four-seasons study

ObjectiveThere are no community based, longitudinal, intra individual epidemiological studies on effect of weather and season on blood pressure (BP). We evaluated the effect of season and temperature on prevalence and epidemiology of BP in tropical climate.Methods and resultsIt was a longitudinal cross sectional survey of rural and urban subjects in their native surroundings. BP was measured in four different seasons in same subjects. A total of 978 subjects (452 rural and 521 urban) were included in the current analysis. Demographic characteristics such as age, gender, education, occupational based physical activity and body mass index (BMI) were recorded. Mean BP, both systolic and diastolic were significantly higher in winter season as compared to summer season. Mean difference between winter and summer was 9.01 (95% CI: 7.74–10.28, p < 0.001) in systolic BP and 5.61 (95% CI: 4.75–6.47, p < 0.001) in diastolic BP. This increase in BP was more marked in rural areas and elderly subjects. Prevalence of hypertension was significantly higher during winter (23.72%) than in summer (10.12%).ConclusionBP increases significantly during winter season as compared to summer season. Increase is more marked in rural areas and elderly subjects. Seasonal variation in BP should be taken into account while looking at prevalence of hypertension in epidemiological studies.     

氯沙坦钾降压效果的动态血压分析

目的 :观察新型血管紧张素 受体拮抗剂氯沙坦钾的降压疗效。方法 :42例原发性高血压 (EH)患者每天服用氯沙坦钾 50 mg,疗程 4～ 8周 ,均以 2 4 h动态血压作为监测及评价方法。结果 :2 4 h收缩压和舒张压均明显下降 (P <0 .0 1 ) ,收缩压谷峰比 =70 % ,舒张压谷峰比 =52 % ,对夜间血压不产生过度降压作用 ,且对血糖、血脂、血尿酸无不良影响 ,副反应发生率低。结论 :每日服用 50 mg氯沙坦钾对 EH有 2 4 h平稳降压作用     

血压变异性的研究进展

高血压一直以来作为心血管疾病的传统危险因素,受到众多专家学者的关注。如何有效降低血压以减轻对靶器官的损伤成为研究的重点。近年来,很多学者进行了广泛的研究,他们不再局限于偶侧血压,开始更加注重动态血压的变化。通过血压的动态监测,     

我国高血压专病门诊患者血压控制及糖代谢调查现状分析

目的 探讨高血压专病门诊就诊的高血压患者血压控制率、血糖现状和危险因素分布.方法 在全国127家医院的高血压专病门诊采用横断面调查的方法,对门诊顺序入组的32 004例高血压患者开展病史询问、血压测量及生化血检查,并进行统计学检验分析.结果 (1)血压达标率(＜ 140/90 mm Hg)(1 mm Hg =0.133 kPa):全部人群达标率为26.8％.冠心病、糖尿病、肾病和卒中的达标率分别为27.7％、30.0％、25.4％和21.3％.(2)接受调查的全部受试者的血压均值为(151 ±13)/(92±10)mm Hg,未服用降压药物3424例(10.7％).药物治疗者28 580例(89.3％).单药治疗19 818例(69.3％),联合用药治疗8762例(30.7％),使用最多的药物是肾素血管紧张素系统抑制剂,其次为钙通道阻滞剂.(3)高血压患者中有70.3％存在糖代谢异常,仍有20.2％未服降糖药物,这组患者糖化血红蛋白为7.84％.(4)患者的危险分层:低、中危占16.0％,高危和极高危分别占48.0％和36.0％,其中有50.0％患者存在不同程度与靶器官损害,49.0％患者并存其他临床疾病.结论 高血压患者中联合治疗的比例较低并是血压控制不良的原因之一,血压控制率不足30％;高血压患者中糖代谢异常普遍存在,有更多靶器官损害及临床疾病,有效的血压管理势在必行.