Age-related anthropometric remodelling resulting in increased and redistributed adiposity is associated with increases in the prevalence of cardiovascular risk factors in Chinese subjects

BACKGROUND: Ageing promotes increases in the prevalence of components of the metabolic syndrome, which obesity often underlies. METHODS: We report the relationship between ageing, obesity and other cardiovascular risk factors in 694 community-based Chinese subjects in gender-specific groups of three age ranges: 20.0-39.9 (young), 40.0-59.9 (middle-aged) and 60.0-79.9 (old-aged) years. RESULTS: Body mass index (BMI) values were similar in males in each age group, but waist and percentage body fat increased (6.6, and 39.5%, both p < 0.001, respectively), from young to old-age groups, as did blood pressure and glycated haemoglobin levels (all p < 0.001). In the females, increases (all p < 0.001) in percentage body fat (29.3%) were accompanied by greater increases in BMI (10.3%) and waist (19.2%) than the males. Blood pressure, glycated haemoglobin, total and LDL-cholesterol and triglyceride levels increased linearly with age (all p < 0.001). CONCLUSION: Age-related increases in central adiposity and percentage body fat were associated with increasingly adverse cardiovascular risk factor profiles.     

Abdominal Obesity and Risk

The relationship between insulin and hypertension. The statistical association between hypertension and hyperinsulinemia has been observed repeatedly. There is also considerable evidence of a causal relationship either via effects on the sympathetic nervous system or via reabsorption of sodium or both (for recent reviews see 1–3). Regarded in this way hypertension becomes one of the abnormalities in a cluster of metabolic derangements which are frequently associated, including hyperinsulinemia, glucose intolerance, elevated plasma lipids and hypertension.

It is clear from previous and recent studies that abdominal obesity is closely associated to this cluster of abnormalities. This has been found repeatedly in both cross-sectional and longitudinal studies in both sexes with or without obesity (for review, see 4).     

Central hypertension is a non‐negligible cardiovascular risk factor

High blood pressure (BP) confers cardiovascular risk. However, the clinical value of central BP remains debatable. In this article, we aim to briefly review the prognosis, diagnosis, and treatment of central hypertension. Central and brachial BPs are closely correlated. In most prospective investigations, elevated central and peripheral BPs were similarly associated with adverse outcomes. Outcome‐driven thresholds of the central systolic BP estimated by the type I device were on average 10 mmHg lower than their brachial counterparts. Cross‐classification based on the central and brachial BPs identified that nearly 10% of patients had discrepancy in their status of central and brachial hypertension. Irrespective of the brachial BP status, central hypertension was associated with increased cardiovascular risk, highlighting the importance of central BP assessment in the management of hypertensive patients. Newer antihypertensive agents, such as renin–angiotensin–aldosterone system inhibitors and calcium channel blockers, were more efficacious than older agents in central BP reduction. Clinical trials are warranted to demonstrate whether controlling central hypertension with an optimized antihypertensive drug treatment will be beneficial beyond the control of brachial hypertension.     

Relationship Between Visceral Fat Accumulation and Hypertension in Obese Men

Purpose.?Visceral‐fat (VF) accumulation is suggested to be a major contributor to such cardiovascular‐disease risk factors as hypertension (H), glucose intolerance (G), and hyperlipidemia (L). We have devised a simple way of estimating VF accumulation, and investigated the relationship between VF and hypertension in obese men. Methods.?First, CT scan was used to measure VF area in the umbilical region in 108 obese men. Then the umbilical‐region circumference (C) was measured with a tape measure and abdominal skinfold thickness (S) with a skinfold caliper. The data obtained with a model formula (VF_e = αC² ? βCS + γ) and actual VF area were compared, and three coefficients, α, β, and γ, were calculated by means of multivariate analysis. Next, in 354 male company employees, VF_e was estimated using this model formula, and cardiovascular risk factors were investigated. Results.?The formula for estimating VF (cm²) was VF_e = 0.03C² ? 0.36CS ? 47 (correlation coefficient; r = 0.72). Discriminant analysis between the merely obese group (O) and the group complicated by multiple cardiovascular risk factors (O, H, G, and L) determined a VF_e‐cutoff value of 120 cm². Its discriminant sensitivity/specificity values were significantly higher than those based on body mass index (BMI) (cutoff value of 27 kg/m²) (p < 0.05). Hypertensive obese (HO) men with high VF_e value (>120 cm²) had a higher frequency of other risk factors (G or L: 86%). Conclusion. VF_e is considered useful in estimating VF accumulation, and seems more effective than BMI for predicting multiple cardiovascular risk factors (VF syndrome) in obese hypertensive men.     

Limited reproducibility of 24-h ambulatory blood pressure monitoring

Abstract

Results of 24-h ambulatory blood pressure monitoring (ABPM) including average blood pressure, variability, and nocturnal dipping are considered the gold standard for diagnosis and the best predictor of the future end organ damage in chronic hypertension. Here we report on the reproducibility of ABPM results for these three measures over a period of months. A total of 35 hypertensive patients (43% female, mean age 64 years), underwent two separate ABPM recordings within 14 weeks, with unchanged medical treatment and lifestyle in the interim. The day and night average blood pressure, dipping status of systolic pressure, and the standard deviation of systolic and diastolic blood pressure as a measure of variability were compared between the two recordings. Individual values for average systolic and diastolic pressures showed only a modest correlation between the two measurements (r?=?0.56, r?=?0.81, p?<?0.01). Standard deviations of 24-h pressure were also positively but weakly correlated (r?=?0.4, p?<?0.001). The occurrence of dipping was reproducible in 71% of the patients. Average blood pressure, pressure variability, and dipping as assessed by ABPM are only moderately reproducible. Clinical decision-making based on single ABPM datasets should be made with caution, and repetition of ABPM seems justified in some cases.     

Determinants of masked hypertension in hypertensive patients treated in a primary care setting

Background: Recent data suggest that masked hypertension (MH) carries a cardiovascular risk similar to that of uncontrolled hypertension. Aims: The objective of this study was to determine the prevalence and determinants of MH in patients treated for hypertension in a Canadian primary care setting. Methods: Office blood pressure (OBP) was measured at baseline and after 3 months of valsartan‐based therapy in 5636 hypertensive patients who had recorded their home blood pressure monitoring (HBPM) for seven consecutive days at month 3 using an Omron HEM‐711 apparatus. MH was defined in nondiabetic patients as an OBP <140/90 mmHg and an HBPM ≥135/85 mmHg, and in those with diabetes as an OBP <130/80 mmHg and an HBPM ≥125/75 mmHg. Results: Of the 5636 patients, 1025 had diabetes. OBP was controlled at 3 months in 268 (26.1%) of them, but 167 (62.3%) had MH. OBP was controlled in 2728 (59.1%) of the 4611 patients without diabetes, and 935 (34.3%) of them had MH. Overall, 1102 patients had MH, representing 36.8% of patients with controlled OBP and 19.6% of the entire hypertensive study population. Stepwise multiple logistic regression analysis in nondiabetic patients with controlled OBP at 3 months revealed that older age, male sex, higher body mass index and higher office systolic blood pressure were determinants of MH. Conclusion: Our results indicate that one of five hypertensive patients and more than one of three with controlled OBP will have MH. MH is associated with other cardiovascular risk factors, such as diabetes, and in nondiabetics, with male sex, older age and obesity.     

Microalbuminuria,cardiovascular disease and risk factors in a nondiabetic/nonhypertensive population. The Nord-Trøndelag Health Study (HUNT, 1995-97), Norway

Abstract. Romundstad S, Holmen J, Hallan H, Kvenild K, Krüger Ø, Midthjell K (HUNT Research Centre, Verdal, Norway; Levanger Hospital, Levanger, Norway; and Nærøy Health Centre, Nærøy, Norway). Microalbuminuria, cardiovascular disease and risk factors in a nondiabetic/nonhypertensive population. The Nord‐Trøndelag Health Study (HUNT, &1995–97), Norway. J Intern Med 2002; 252 : 164–172. Objective. Microalbuminuria (MA) as an independent marker of cardiovascular morbidity and mortality in nondiabetic/nonhypertensive individuals is under international debate. The aim of this study was to investigate the associations between MA and known cardiovascular risk factors/markers and disease in a randomly selected nondiabetic/nonhypertensive sample. Design. Cross‐sectional study. Setting. Participants in the population‐based Nord‐Trøndelag Health Study (HUNT), Norway (n = 65 258). Subjects. A total of 2113 individuals (≥20 years), randomly selected without diabetes and treated hypertension, delivered three morning urine samples for MA analysis. Main outcome measures. MA expressed as albumin‐to‐creatinine ratio (ACR), cardiovascular risk factors and disease. Results. Increasing age, pulse pressure, systolic (SBP) and diastolic blood pressure (DBP) and coronary heart disease (CHD) significantly predicted MA in men and increasing pulse pressure, SBP and DBP were associated with MA in women, adjusted for other cardiovascular risk factors/markers. After excluding individuals with known CHD and untreated hypertension (SBP ≥ 140 mmHg, DBP ≥ 90 mmHg) and hence a high total risk of cardiovascular disease (CVD), only increasing age was associated with ACR in men and increasing SBP and pulse pressure in women. Smoking, elevated lipid and glucose levels were strongly associated with MA in individuals with a high total risk of CVD than in individuals with a low total risk. Conclusion. MA was associated with increasing blood pressure in both genders, age and CHD in men. Other cardiovascular risk factors/markers might be more influential in predicting ACR variation in nondiabetic/nonhypertensive individuals with a high total risk of CVD than in individuals with a low total risk.     

Prediction of atrial fibrillation in patients with hypertension: A comprehensive comparison of office and ambulatory blood pressure measurements

Hypertension is associated with the development of atrial fibrillation (AF). Evidence has shown that reverse dipping pattern, an abnormal increase of night‐time blood pressure (BP) comparing to daytime BP, is associated with cardiovascular events. However, the relationship between diurnal changes in BP and AF has not been sufficiently explored. This paper aims to cross‐sectionally explore the relationship between AF and ambulatory BP parameters, especially reverse dippers to the others, and further longitudinally analyze how BP patterns are associated to the risk of developing new‐onset AF. Between February 2012 and March 2021, five out of 412 patients were identified of AF at baseline; four were reverse dippers (3.7%) and one was from the others (.3%). Cross‐sectionally, the multivariate logistic regression analysis showed that reverse dippers were significantly more likely to have AF (odds ratio: 12.39, p = .030). After excluding patients with baseline AF, during the mean follow‐up of 4.6 ± 3.0 years, seven patients developed AF. Longitudinally, the multivariate Cox regression analysis revealed that 24‐h systolic BP (hazard ratio per 10 mmHg: 2.12, p = .015), night‐time systolic BP (hazard ratio per 10 mmHg: 2.27, p = .002), and presentation of reverse dipping (hazard ratio: 5.25, p = .042) were independently associated with new‐onset AF. None of the office BP measurements were associated with new‐onset AF. While ambulatory BP measurements were better predictors for the incidence of AF, careful management is necessary for reverse dippers as they are at high risk of developing AF.     

Hypertensive Retinopathy: Incidence,Risk Factors,and Comorbidities

We aimed to determine the prevalence and risk factors of retinopathy in hypertensive outpatients. Demographic data, accompanying diseases, anthropometric measurements, and blood and urine biochemistry of 655 hypertensive patients were evaluated. Hypertensive retinopathy rate was 66.3% (grade 1, 33.6%; grade 2, 32.7%). Age, duration of hypertension, and systolic blood pressure levels were significant risk factors for retinopathy (P = .048, P = .035, and P = .012, respectively). Any correlations between retinopathy and gender, body mass index, biochemistry, and associated diseases were not found. This study shows that the degree and duration of hypertension increases the incidence of retinopathy. Low-grade retinopathy seems not to be associated with other cardiovascular risks.