Prognostic Implication of Pulmonary Arterial Pressure in Surgical Repair of Predominantly Congenital Mitral Valve Regurgitation-Based Intracardiac Abnormalities.

INTRODUCTION: Knowledge is limited regarding the significance of pulmonary arterial pressure (PAP) in predominantly congenital mitral valve regurgitation (MR)-based intracardiac abnormalities. METHODS: From a prospective cohort, we included 200 patients with congenital MR regardless of other associated intracardiac abnormalities (mean age 60.4 months, 67% female, systolic PAP (sPAP) 54.2 mm Hg) surgically repaired in 2012-2019 and followed up to 2020 (median 30.0 months). Significant pulmonary hypertension (PH) was defined as sPAP >50 mm Hg at rest or mean PAP >25 mm Hg on right heart catheterization. By perioperative sPAP changes, patients were stratified as group I (pre-normotension to post-normotension), group II (pre-hypertension to post-normotension), or group III (pre-hypertension to post-hypertension). Primary outcomes were the recurrence of MR (defined as the regurgitation grade of moderate or greater) and the progression of MR (defined as any increase in the magnitude of regurgitation grade after surgery). Cox proportional hazard and Kaplan-Meier curve were performed. RESULTS: There was no association between preoperative PH and the recurrent MR (adjusted hazard ratios [aHR]: 1.146 [95% CI: 0.453-2.899]) and progressive MR (aHR: 1.753 [95% CI: 0.807-3.804]), respectively. There were no significant differences among group I, group II, and group III in the recurrent MR but in the progressive MR. A dose dependency was identified for preoperative sPAP with recurrent MR (aHR: 1.050 [95% CI: 1.029-1.071]) and progressive MR risks (aHR: 1.037 [95% CI: 1.019-1.055]), respectively. CONCLUSIONS: Preoperative higher sPAP is associated with worse outcomes, warranting heightened attention to the identification of perioperative sPAP.

The relationship of interleukin-6 and C-reactive protein with left ventricular geometry and function in patients with obstructive sleep apnea syndrome and pre-hypertension.

OBJECTIVE: To assess the relationship of interleukin-6 (IL-6) and C-reactive protein (CRP) levels with left ventricular geometry (LVG) and function in patients with obstructive sleep apnea syndrome (OSAS) and pre-hypertension. METHODS: A total of 458 patients were assigned into four groups: normal geometry (NG), concentric remodeling (CR), eccentric hypertrophy (EH), and concentric hypertrophy (CH). Pearson correlation and multivariate logistic regression analyses were used to determine the correlation between IL-6, CRP, and clinical, polysomnographic, and biochemical parameters with LVG and function. RESULTS: IL-6 and CRP levels were higher in the EH and CH groups than those in the NG and CR groups. The results of the Pearson correlation analysis showed that IL-6 level was positively correlated with the E/e' ratio and peak systolic pulmonary venous reverse velocity (PVa) duration time (PVaD), while negatively correlated with the E/A ratio, s', and left ventricular ejection fraction (LVEF). CRP level was positively correlated with A-wave duration time (AD), peak systolic pulmonary venous flow velocity (PVs), PVa and PVaD, while negatively correlated with the E/A ratio. The results of the multivariate logistic regression analysis revealed that IL-6 and CRP levels were correlated with EH (ß = 1.213, odds ratio [OR] = 3.363, p < 0.001; ß = 1.258, OR = 3.518, p < 0.001) and CH (ß = .938, OR = 2.555, p = 0.008; ß = 1.239, OR = 3.454, p < 0.001). CONCLUSION: IL-6 and CRP levels are associated with LVG and function, suggesting that IL-6 and CRP levels are involved in OSAS and pre-hypertension, leading to abnormal left ventricular structure and function.

Differences in hypertension and prehypertension among people living with and without HIV in China: role of HIV infection and antiretroviral therapy.

OBJECTIVES: Hypertension is a growing health concern in people living with HIV (PLWH). However, association between HIV infection and hypertension is equivocal. METHODS: In all, 1472 PLWH and 2944 HIV-negative individuals frequency-matched by age and sex were derived from the baseline survey of Comparative HIV and Aging Research in Taizhou (CHART), China. Prehypertension was defined as systolic blood pressure (BP) of 120-139 mmHg and/or diastolic blood pressure of 80-89 mmHg. RESULTS: Despite the fact that prevalence of hypertension was overall lower among PLWH than among HIV-negative people (21.1% vs. 29.1%, P < 0.001), it was similar at ages 18-29 (7.6% vs. 8.5%) and 30-44 years (17.1% vs. 18.5%) but significantly lower in PLWH at ages 45-59 (26.1% vs. 40.7%) and 60-75 years (37.1% vs. 57.3%). Prehypertension prevalence was consistently higher in PLWH across all age groups. In the model adjusting for traditional risk factors, HIV infection was associated with hypertension (adjusted odds ratio [aOR] = 1.27, 95% confidence interval: 1.04-1.55) and prehypertension (aOR = 1.77, 95% CI: 1.51-2.08), and attenuated after additional adjustment for abdominal obesity. Age-stratified analysis showed that these associations of HIV with hypertension were observed at ages 18-29 and 30-44 years and associations with prehypertension were observed at ages 18-29, 30-44 and 45-59 years only. Years since HIV diagnosis and stavudine use were the HIV-specific factors independently associated with hypertension or/and prehypertension. CONCLUSIONS: HIV infection is independently associated with prehypertension and hypertension especially at younger ages, and this risk may increase as treatment becomes prolonged. Our findings reinforce the urgent necessity for active BP screening and control strategies be adopted for PLWH in China.

Serum total bilirubin concentration is associated with carotid atherosclerosis in patients with prehypertension.

Objectives: Bilirubin has been demonstrated to be linked with anti-inflammatory and antioxidant progress. We aimed to evaluate the association between serum total bilirubin level and carotid intima-media thick-ness (cIMT) in patients with prehypertension. METHODS: We consecutively enrolled pre-hypertensive patients from a community in Guangzhou between January 2017 and January 2018. All patients underwent carotid artery ultrasonography measurement. The correlation between serum total bilirubin and cIMT was assessed by using the Pearson's correlation coefficient. Multiple logistic regression analysis was performed to assess the independent association between clinical parameters and carotid atherosclerosis. RESULTS: A total of 691 subjects with prehypertension were included in this study. There were 101 patients with increased cIMT (mean age 52.69 ± 11.58 years; 50 male) and 590 subjects with normal cIMT (mean age50.28 ± 10.33 years; 332 male). We found that cIMT was significantly related with systolic blood pressure(r = 0.257, P < 0.001), C-reactive protein (r = 0.327, P < 0.001), total cholesterol (r = 0.218, P = 0.002) and total bilirubin (r =-0.489, P < 0.001). A multiple logistic regression analysis revealed that total bilirubin was an independent factor for atherosclerosis (OR = 0.476; 95%CI: 0.253, 0.764; P < 0.001). CONCLUSION: Our results suggested that serum total bilirubin was inversely related with cIMT, and might be an early clinical marker for predicting the occurrence of subclinical carotid atherosclerosis in patients with prehypertension.

Comparison of Home and Ambulatory Blood Pressure Measurements in Association With Preclinical Hypertensive Cardiovascular Damage.

OBJECTIVE: To evaluate whether home or ambulatory blood pressure (BP) monitoring was associated with preclinical hypertensive cardiovascular target organ damage (TOD). METHODS: We enrolled participants with prehypertension and stage 1 hypertension from 11 medical centers within the Taiwan hypertension-associated cardiac disease consortium. Recordings of clinical BP measurement, ambulatory BP monitoring for 24 hours, and home BP monitoring during morning and evening were made. The measured parameters of target organ damage included left ventricular mass index (LVMI), left atrial volume index (LAVI), and carotid-femoral pulse wave velocity (PWV). RESULTS: Data were collected from 561 study participants (mean age, 65.0 ± 10.8 years; men, 61.3%). Morning and evening home BP values were slightly higher than the daytime and nighttime ABP values (difference for systolic morning-daytime/evening-nighttime, 7.3 ± 14.2/11.3 ± 18.5 mm Hg, P < .001; for diastolic, 5.4 ± 9.4/7.3 ± 12.1, P < .001). Daytime ambulatory (r = 0.114), nighttime ambulatory (r = 0.130), morning home (r = 0.310), and evening home (r = 0.220) systolic BPs (SBPs) were all associated with LVMI (all P < .05). The correlation coefficient was significantly greater for the relationship between daytime home SBP and LVMI than for the relationship between ambulatory SBP and LVMI (P < .01). The goodness of fit of the association between SBP and LVMI improved by adding home daytime SBP to the other SBPs (P < .001). Similar findings were observed for LAVI, but not for PWV. CONCLUSION: These findings indicate that morning SBP assessed by home monitoring appears to be a better predictor than other BP measures to determine preclinical hypertensive cardiovascular damage in patients with early-stage hypertension.

Comparison of serum levels of Cystatin-C and traditional renal biomarkers for the early detection of pre-hypertensive nephropathy.

OBJECTIVE: To compare serum Cystatin-C and serum creatinine levels along with estimated glomerular filtration rate of apparently healthy people of South Asian descent with pre-hypertension to determine which is better in detecting reversible renal dysfunction. METHODS: :The comparative cross-sectional study was conducted at the Army Medical College, Rawalpindi, Pakistan, in 2013-14, and comprised apparently normal healthy male and female volunteers. The subjects were divided into normotensive group 1 and pre-hypertensive group 2. Serum Cystatin-C levels were measured by sandwhich enzyme-linked immunosorbent assay technique whereas serum creatinine levels were measured by Jaffe's procedure. Glomerular filtration rate estimation was done by using standard equations. SPSS 20 was used for data analysis. RESULTS: Of the 78 subjects, 39(50%) were in normotensive group 1 and 39(50%) in the pre-hypertensive group 2. The mean age was 38.74 } 5.71 years in group 1 and 38.07 } 3.84 years in group 2. Serum Cystatin-C levels were higher in group 2 than in group 1(p= 0.0001), whereas serum creatinine levels manifested no statistical difference between the groups (p=0.106). Estimated glomerular filtration rate based on Cystatin-C significantly decreased in group 2 than in group 1 (p=0.0001). Serum Cystatin-C displayed a significant positive correlation and estimated glomerular filtration rate based on Cystatin-C negative correlation with the rising blood pressure values (p=0.0001).Serum Cystatin-C reflected a very high sensitivity and specificity at a cutoff value of 0.77 mg/l compared to serum creatinine. CONCLUSIONS: Serum Cystatin-C and Estimated glomerular filtration based on rate Cystatin-C appeared to be better renal biomarkers in the detection of pre-hypertensive nephropathy.

Cardiovascular Risk in Patients with Prehypertension and the Metabolic Syndrome.

Prehypertension (pHTN) and metabolic syndrome (MetS) are both lifestyle diseases that are potentiated by increased adiposity, as both disease processes are closely related to weight. In the case of pHTN, increased adiposity causes dysregulation of the renin-angiotensin-aldosterone-system (RAAS) as well as adipokine- and leptin-associated increases in adrenergic tone. In MetS, excess weight potentiates hyperglycemia and insulin resistance which causes positive feedback into the RAAS system, activates an inflammatory cascade that potentiates atherosclerosis, and causes lipid dysregulation which together contribute to cardiovascular disease, especially coronary heart disease (CHD) and heart failure (HF). The relationship with all-cause mortality is not as clear-cut in part because of some protective effects associated with the obesity paradox in chronic diseases such as CHD and HF. However, in healthy populations, the absence of excess weight and its associated effects on prehypertension and MetS are associated with a longer absolute and disease-free lifespan.

NIRCa: An artificial neural network-based insulin resistance calculator.

BACKGROUND: Direct measurement of insulin sensitivity in children with type 1 diabetes is cumbersome and time consuming. OBJECTIVE: The aim of our study was to develop novel, accurate machine learning-based methods of insulin resistance estimation in children with type 1 diabetes. METHODS: A hyperinsulinemic hyperglycemic clamp study was performed to evaluate the glucose disposal rate (GDR) in a study group consisting of 315 patients aged 7.6 to 19.7 years. The group was randomly divided into a training and independent testing set for model performance assessment. GDR was estimated on the basis of simple clinical variables using 2 non-linear methods: artificial neural networks (ANN) and multivariate adaptive regression splines (MARSplines). The results were compared against the most frequently used predictive model, based on waist circumference, triglyceride (TG), and HbA1c levels. RESULTS: The reference model showed moderate performance ( R 2 = 0.26) with a median absolute percentage error of 49.1%, and with the worst fit observed in young (7-12 years) children ( R 2 = 0.17). Predictions of the MARSplines model were significantly more accurate than those of the reference model (median error 3.6%, R 2 = 0.44 P < .0001). The predictions of the ANN, however, showed significantly lower error than those of the reference model (P < .0001) and MARSplines (P < .0001) and better fit regardless of patient age. ANN-estimated GDRs were within a ±20% error range in 75% of cases with a median error of 0.6% and an R 2 = 0.66. The predictive tool is available at http://link.konsta.com.pl/gdr. CONCLUSIONS: The developed GDR estimation model reliant on ANN allows for an optimized prediction of GDR for research and clinical purposes.

L-Arginine and B vitamins improve endothelial function in subjects with mild to moderate blood pressure elevation.

PURPOSE: The aim of this trial was to investigate the influence of a dietetic product consisting of a unique combination of L-arginine with the vitamins B6, folic acid and B12 (Telcor® Arginin plus) on endothelial dysfunction. METHODS: Subjects aged 40-65 years with mild to moderate blood pressure (BP) elevation not treated with anti-hypertensive drugs were randomly assigned to either the dietetic product (n = 40) or a matching placebo (n = 41) for 3 months with open follow-up for a further 3 months. Postprandial change in endothelial function was assessed using the validated reactive hyperaemia index (RHI) at 3 months compared to the study onset (RHI post-pre, visit 3-visit 1; ΔΔRHI). Secondary parameters included BP and plasma homocysteine concentration. RESULTS: The primary efficacy analysis revealed superiority of the nutritional intervention over placebo (p = 0.0349) in reducing the deterioration of endothelial function. While in the active group ΔΔRHI increased (0.371 ± 0.122), almost no change could be detected in the placebo group (0.031 ± 0.100), thus demonstrating a significant improvement in vascular function in the intervention group. Moreover, the intervention reduced BP and homocysteine levels. Non-serious adverse events were equally distributed in both groups, and none of the events were assessed as possibly intervention-related by the investigators. CONCLUSIONS: This trial confirmed the effective and safe use of dietary management with L-arginine in combination with B vitamins. The primary efficacy analysis demonstrated a statistically significant superiority of the combination of L-arginine with B vitamins over placebo in improving and restoring impaired endothelial function and lowering BP in patients with mild to moderate blood pressure elevation.

Clinical implication of an impaired fasting glucose and prehypertension related to new onset atrial fibrillation in a healthy Asian population without underlying disease: a nationwide cohort study in Korea.

AIMS: For healthy populations without comorbidities, whether prehypertension and impaired fasting glucose (IFG) are associated with new onset atrial fibrillation (AF) is not well known. METHODS AND RESULTS: We included 366 507 subjects (age ≥20 years) not diagnosed with non-valvular AF from the Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC) from 2003 to 2008. In total, 139 306 subjects diagnosed with AF-related comorbidities were excluded, and a 227 102 healthy population was followed up until 2013. The body mass index (BMI), blood pressure (BP), and fasting blood glucose (BG) level were acquired during National health check-ups. Subjects with IFG [hazard ratio (HR) 1.16, P = 0.017] had a higher AF risk and the diastolic BP (HR 1.11, P = 0.045) was a stronger indicator for an AF incidence than the systolic BP. After dividing the subjects into two mutually exclusive groups, AF incidence was increased dramatically by the combination effect of both prehypertension and an IFG in BMI <25 kg/m2 group, but, in BMI ≧25 kg/m2 group, did not show this tendency. An IFG related to AF risk was more prominent in the BMI <25 kg/m2 population (HR 1.18, P = 0.025) than those with a BMI ≥25 kg/m2, and subjects with both an IFG and prehypertension had a greater AF risk (HR 1.27, P = 0.016) than those without. CONCLUSION: Even in a healthy Asian populations without comorbidities, prehypertension and IFG were important risk factors of AF. Specifically, when prehypertension, including systolic and diastolic BPs, was finally combined with the IFG, the risk of new onset AF was increased especially in the BMI <25 kg/m2 group.

Should Pre-hypertension Be Treated?

Hypertension is an important preventable risk factor for disease and death worldwide. In light of the world's population growth and aging, hypertension is a global public health issue. Many studies have shown associations between pre-hypertension and a higher risk of the future development of hypertension and cardiovascular disease in general populations. However, pre-hypertension per se is not a disease with an immediate high risk, and the clinical value of the identification of pre-hypertension is the potential detection of the early stage of the risk of hypertension and/or cardiovascular disease over an individual's lifespan. We recently assessed the impacts of age-related differences in risk factors on new-onset hypertension among normotensive individuals. As risk factors of the new onset of hypertension, the impact of diastolic blood pressure compared with systolic blood pressure (SBP), men compared with women, and higher body mass index were greater in the younger adults, whereas in the older adults, the impact of SBP and female sex were greater. Proteinuria was a risk factor for hypertension in both younger and older adults. Non-pharmacological approaches such as body weight reduction, low-salt diet, physical exercise, and good sleep hygiene should be first-line treatments for pre-hypertension. In addition, careful observation to detect the new onset of hypertension and the identification of the appropriate timing of pharmacologic treatment should be conducted, especially in adults with pre-hypertension and the risk factors mentioned above.

Race or vitamin D: A determinant of intima media thickness in obese adolescents?

OBJECTIVE: Carotid intima media thickness (IMT), a predictor of cardiovascular events, is reported to be higher in African-American (AA) vs White (AW) individuals. We investigated whether racial differences in IMT in obese adolescents could be explained by differences in 25 hydroxy-vitamin D [25(OH)D]. RESEARCH DESIGN AND METHODS: A total of 63 obese adolescents had 25(OH)D levels, determination of IMT, body composition, insulin sensitivity (IS) by hyperinsulinemic-euglycemic clamp, lipids and blood pressure (BP). RESULTS: IMT was higher and 25(OH)D lower in AA vs AW. IMT correlated with 25(OH)D level (r = -0.38, P = .002) but not with IS. In multiple regression analysis, race, HbA1c, BP and age, and not 25(OH)D, BMI or IS, were the significant determinants of IMT (R2 = 0.44, P < .001). Without race in the model, 25(OH)D (ß = -0.36, P = .009) contributed to the variance in IMT (R2 = 0.32, P = .007). CONCLUSION: Obese AA adolescents vs AW, have higher IMT, explained by race, BP, and HbA1c. Although 25(OH)D levels contribute to the variance in IMT, the observed racial difference in IMT could be mediated through other unknown race-related factors besides 25(OH)D.

Moderately elevated blood pressure during pregnancy and odds of hypertension later in life: the POUCHmoms longitudinal study.

OBJECTIVE: Hypertensive disorders in pregnancy signal an increased risk of cardiovascular disease for women. However, future hypertension risk among pregnant women with moderately elevated blood pressure (BP) is unknown. We examined associations among moderately elevated BP or hypertensive disorders during pregnancy and later prehypertension or hypertension. DESIGN: Longitudinal cohort study. SETTING: Five communities in Michigan, USA. SAMPLE: Data are from pregnant women enrolled in the Pregnancy Outcomes and Community Health Study. We included 667 women with gestational BP measurements who participated in the POUCHmoms Study follow-up 7-15 years later. METHODS: Moderately elevated BP was defined as two measures of systolic BP ≥ 120 mmHg or diastolic BP ≥80 mmHg among women without a hypertensive disorder. Weighted multinomial logistic regression models estimated odds of prehypertension or hypertension at follow-up, adjusted for maternal confounders and time to follow-up. MAIN OUTCOME MEASURES: Prehypertension or hypertension. RESULTS: Women meeting the moderately elevated BP criteria (64%) had significantly higher odds of hypertension at follow-up (adjusted odds ratio 2.6; 95% confidence interval 1.2-5.5). These increased odds were observed for moderately elevated BP first identified before or after 20 weeks of gestation, and for elevated systolic BP alone or combined with elevated diastolic BP. CONCLUSIONS: Moderately elevated BP in pregnancy may be a risk factor for future hypertension. Pregnancy offers an opportunity to identify women at risk for hypertension who may not have been identified otherwise. TWEETABLE ABSTRACT: Moderately elevated blood pressure in pregnancy may be associated with hypertension later in life.

No effects of quercetin from onion skin extract on serum leptin and adiponectin concentrations in overweight-to-obese patients with (pre-)hypertension: a randomized double-blinded, placebo-controlled crossover trial.

PURPOSE: Chronic low-level systemic and adipose tissue inflammation has been identified as a major etiologic factor in many chronic diseases, including hypertension and cardiovascular diseases. Evidence from experimental studies suggests anti-inflammatory effects of dietary flavonols such as quercetin. METHODS: We investigated the effects of regular intake of quercetin on leptin, adiponectin, biomarkers of inflammation, glucose and insulin in overweight-to-obese patients with pre- and stage 1 hypertension. Another objective was to assess the safety of daily quercetin supplementation measured by parameters of liver and kidney function and of hematology. Subjects (n = 70) were randomized to receive a supra-nutritional dose of 162 mg/d quercetin or placebo in a double-blinded, placebo-controlled crossover trial with 6-week treatment periods separated by a 6-week washout period. Two subjects dropped out for personal reasons. Only data from the remaining 68 subjects were included in the analysis. RESULTS: Compared to placebo, quercetin did not significantly affect serum concentrations of leptin and adiponectin, HOMA-AD or the ratios of leptin/adiponectin and adiponectin/leptin. Neither quercetin nor placebo significantly changed serum C-reactive protein and plasma tumor necrosis factor alpha. Compared to placebo, quercetin did not significantly affect glucose, insulin, HOMA-IR, blood biomarkers of liver and renal function, hematology and serum electrolytes. CONCLUSION: A supra-nutritional dose of 162 mg/d quercetin from onion skin extract for 6 weeks is safe but without significant effects on parameters of systemic and adipose tissue inflammation as well as glucose and insulin in overweight-to-obese subjects with (pre-)hypertension. This trial was registered at www.germanctr.de/ and http://apps.who.int/trialsearch/ as DRKS00000555.

Combined exercise training reduces blood pressure, arterial stiffness, and insulin resistance in obese prehypertensive adolescent girls.

Childhood obesity is strongly linked to pathological processes for cardiovascular diseases in later adulthood. Obese adolescent girls with high blood pressure (BP) are reported to have increased arterial stiffness, which is associated with the development of hypertension and atherosclerosis. The present study sought to examine the impact of combined resistance and aerobic exercise (CRAE) training on BP, brachial-ankle pulse wave velocity (baPWV), insulin resistance (IR), and body composition in obese prehypertensive girls. Forty girls (age, 15 ± 1 years; systolic BP, 132 ± 2 mmHg, diastolic BP, 80 ± 5 mmHg) were randomly assigned to either a combined exercise (EX, n = 20) or no exercise group (CON, n = 20). The EX group performed CRAE for 12 weeks, 3 times per week. BP, baPWV, blood nitrite/nitrate, endothelin-1 (ET-1), homeostasis model assessment for insulin resistance (HOMA-IR), and body composition were measured before and after the exercise intervention. BP (∆-7.3 ± 2.67 mmHg), baPWV (∆-1.23 ± 0.49 m/s), ET-1 (∆-14.35 ± 1.76 µmol/mL), nitrite/nitrate (∆0.5 ± 0.09 µM), HOMA-IR (∆-1.4 ± 0.07), percent body fat (∆-1.35 ± 0.9%), and waist circumference were significantly improved (P < 0.05) in the EX group after 12 weeks of training versus the CON group. These findings indicate that 12 weeks of CRAE improves BP, HOMA-IR, and arterial stiffness and reduces central adiposity in obese adolescent girls with prehypertension. Thus, this study provides evidence that CRAE can be a useful therapeutic treatment for high BP, IR, and central adiposity, thereby reducing the likelihood of pathological development for cardiovascular diseases in later adulthood.

Association of elevated preoperative blood pressure with preincision hypotension in pediatric surgical patients.

INTRODUCTION: High blood pressure (BP) in childhood is associated with left ventricular hypertrophy and abnormal vascular reactivity even in apparently healthy children. This study examined the prevalence of high BP in children undergoing elective noncardiac operations. We also determined the association of preoperative high BP with preincision hypotension (PIH). METHODS: This was a retrospective cohort study that used clinical and anthropometric data on children aged 3-17 years who underwent elective, noncardiac operations from January 2006 to January 2014. Preoperative blood pressure (BP) was used to stratify children into three categories: normal BP (systolic and diastolic BP below the 90th percentile), prehypertension (systolic and/or diastolic BP ≥90th percentile but <95th percentile or if the BP exceeds 120/80 mmHg even if it is below the 90th percentile), and hypertension (systolic and/or diastolic BP ≥95th percentile). Multivariable logistic regression analysis was used to calculate adjusted odds ratios for PIH using age, gender, body mass index (BMI), and BP categories as covariates. RESULTS: Among 35832 children, the overall prevalence of prehypertension, hypertension, and hypertension by adult standards were 16.4%, 6.8%, and 3.3%, respectively. Overweight and obese children had higher rates of elevated BP. Presence of elevated baseline BP, high BMI category, and presence of OSA diagnosis were independent predictors of multiple episodes of PIH in a logistic regression model. CONCLUSION: In children, preoperative high BP is an independent predictor of PIH. Although the longtime consequences of high BP are well known, this report provides the first intraoperative evidence of adverse event associated with preoperative high BP in children. Mechanisms underlying this hypotensive response are unclear.

Prehypertension in midlife is associated with worse cognition a decade later in middle-aged and older women.

BACKGROUND: previous studies raised the possibility that adverse health effects associated with elevated blood pressure (BP) begin at prehypertension levels (BP = 120-139/80-89 mmHg), yet few studies have examined the effects of prehypertension on cognitive functioning. OBJECTIVE: to examine the relationship between BP categories and cognitive functions in middle-aged and older women. SUBJECTS AND METHODS: two hundred and forty-seven women from the Women's Healthy Ageing Project had their BP measured twice, at mean ages 50 and 60 years. Tests of executive function, processing speed and verbal episodic memory were also administered at follow-up. Analyses of co-variance were performed to evaluate the associations between BP categories and cognitive performance. RESULTS: prehypertensive BP at age 50 years is a significant predictor of reduced processing speed and verbal episodic memory a decade later. Cross-sectional measurements at age 60 years showed that untreated hypertensive women performed significantly worse on verbal episodic memory compared with their prehypertensive peers. CONCLUSION: hypertension is a modifiable cardiovascular risk factor, and our results suggest that reducing midlife BP, even at prehypertensive levels, may be an effective prevention strategy to reduce risk for subsequent cognitive decline in middle-aged and older women.

Ideal cardiovascular health behaviors and factors prevent the development of hypertension in prehypertensive subjects.

BACKGROUND: Seven ideal health metrics were defined by AHA to monitor cardiovascular health. This study aimed to investigate the impact of ideal cardiovascular health behaviors and factors on the development of hypertension in prehypertensive subjects. METHODS: Thirty-two thousand eight-hundred and eighty-seven participants with prehypertension were included in the study after excluding for preexisting stroke, myocardial infarction or malignancy. Cox proportional hazards regression was used to calculate hazard ratios and 95% confidence intervals [CI] for the development of hypertension. RESULTS: During a follow-up of 52.2 months, 15,500 prehypertensive participants developed hypertension. The cumulative incidence of hypertension decreased with the number of ideal health metrics increased. It was 78.61%, 71.08%, 63.15%, 56.07% and 61.62% in prehypertensive individuals carrying ≤ 1, 2, 3, 4 and ≥ 5 ideal health behaviors or factors, respectively. After adjustment for age, gender, family history of hypertension, alcohol consumption, resting heart rate, plasma triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and high-sensitivity C-reactive protein, the risk ratios of incident hypertension in the subjects who carried 2, 3, 4, and ≥ 5 ideal health metrics were 0.833 (95%CI: 0.789-0.880), 0.710 (95%CI: 0.672-0.749), 0.604 (95%CI: 0.568-0.642), and 0.581 (95%CI: 0.524-0.643), respectively, in comparison to those with ≤ 1 ideal health metric. A similar trend was also observed in male and female populations. Poor health metrics, including body mass index, diet (salt intake), physical activity, total cholesterol, and smoking, were predictors for the development of hypertension in prehypertensive individuals. CONCLUSION: Ideal cardiovascular health behaviors and factors are protective factors to prevent the progression from prehypertension to hypertension.

High prevalence of metabolic syndrome in a middle-aged and elderly population with prehypertension in Tianjin.

BACKGROUND: Prehypertension has been reported as being correlated with future cardiovascular risk and end-organ damage in middle-aged and elderly persons, and also playing an important role in metabolic syndrome (MetS). The association between prehypertension and MetS has rarely been reported among urban adults in Tianjin, China. METHODS: In this cross-sectional study, a total of 1176 participants aged 40-70 years (524 males and 652 females) were enrolled after excluding participants with hypertension or treated hypertension. Participants were divided into two groups [optimal blood pressure (BP) and prehypertension] based on the classification of BP from the JNC-7. The definition of MetS was as per the International Diabetes Federation standard. An adjusted logistic regression model was used to assess relationships between prehypertension and MetS. RESULTS: The prehypertension group had a significantly higher odds ratio (OR) than the optimal BP group for abnormal waist circumference (WC), fasting plasma glucose (FPG) and triglycerides (TG). In addition, the prehypertension group had a higher OR (3.12; 95% confidence interval 2.34-4.18) for having MetS after adjusting for potential confounders. CONCLUSIONS: The risk of having MetS was significantly associated with prehypertension in middle-aged and elderly persons in Tianjin. Stricter control of BP in this age group is warranted.

Prehypertension, hypertension, and the risk of acute myocardial infarction in HIV-infected and -uninfected veterans.

BACKGROUND: Compared to uninfected people, human immunodeficiency virus (HIV)-infected individuals may have an increased risk of acute myocardial infarction (AMI). Currently, HIV-infected people are treated to the same blood pressure (BP) goals (<140/90 or <130/80 mm Hg) as their uninfected counterparts. Whether HIV-infected people with elevated BP have excess AMI risk compared to uninfected people is not known. This study examines whether the association between elevated BP and AMI risk differs by HIV status. METHODS: The Veterans Aging Cohort Study Virtual Cohort (VACS VC) consists of HIV-infected and -uninfected veterans matched 1:2 on age, sex, race/ethnicity, and clinical site. For this analysis, we analyzed 81 026 people with available BP data from VACS VC, who were free of cardiovascular disease at baseline. BP was the average of the 3 routine outpatient clinical measurements performed closest to baseline (first clinical visit after April 2003). BP categories used in the analyses were based on criteria of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Analyses were performed using Cox proportional hazards regression. RESULTS: Over 5.9 years (median), 860 incident AMIs occurred. Low/high prehypertensive and untreated/treated hypertensive HIV-infected individuals had increased AMI risk compared to uninfected, untreated normotensive individuals (hazard ratio [HR], 1.60 [95% confidence interval {CI}, 1.07-2.39]; HR, 1.81 [95% CI, 1.22-2.68]; HR, 2.57 [95% CI, 1.76-3.76]; and HR, 2.76 [95% CI, 1.90-4.02], respectively). CONCLUSIONS: HIV, prehypertensive BP, and hypertensive BP were associated with an increased risk of AMI in a cohort of HIV-infected and -uninfected veterans. Future studies should prospectively investigate whether HIV interacts with BP to further increase AMI risk.