ABSTRACT
OBJECTIVE: Previous studies focusing on primary aldosteronism (PA) and thyroid diseases were controversial. Hence, this study aimed to examine associations between thyroid function, thyroid diseases, and PA and its subtypes. DESIGN AND METHODS: This was a cross-sectional study, which enrolled 1023 patients with PA and 6138 patients with essential hypertension (EH) admitted to Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region from August 2011 to June 2022. All patients with PA were accurately classified into aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA) by adrenal vein sampling (AVS). Multivariate logistic regression analysis was used to assess the relationship of thyroid function, thyroid nodules, and PA and its subtypes. RESULTS: A total of 7161 patients (327 APA and 696 IHA, and 6138 EH) were included with a mean age of 48.20 ± 8.83 years. PA patients and PA subtypes showed lower FT4, FT3, TT4, TT3, and prevalence of positive TPOAb, meanwhile higher prevalence of thyroid nodules than EH patients (PA: 56.10%, IHA: 56.90%, APA: 54.80%, and EH: 48.90%, respectively). PA (adjusted OR: 1.290, 95% CI: 1.035-1.607, P = .02) and its subtype (IHA) (adjusted OR: 1.316, 95% CI: 1.005-1.724, P = .04) were significantly associated with thyroid nodules. Compared to patients with lower plasma aldosterone concentration (PAC) levels (<12â ng/dL), patients with PAC levels ≥ 12â ng/dL presented a higher prevalence of thyroid nodules. CONCLUSIONS: PA patients had lower thyroid function and higher prevalence of thyroid nodules compared to EH patients. Therefore, the screening of thyroid function and thyroid nodules may be indispensable for PA patients.
Subject(s)
Hyperaldosteronism , Thyroid Diseases , Thyroid Function Tests , Thyroid Gland , Humans , Hyperaldosteronism/blood , Hyperaldosteronism/epidemiology , Hyperaldosteronism/diagnosis , Middle Aged , Male , Female , Cross-Sectional Studies , Adult , Thyroid Gland/physiopathology , Thyroid Diseases/epidemiology , Thyroid Diseases/blood , Thyroid Nodule/epidemiology , Thyroid Nodule/blood , China/epidemiology , Prevalence , Aldosterone/blood , Essential Hypertension/blood , Essential Hypertension/epidemiology , Essential Hypertension/physiopathologyABSTRACT
BACKGROUND AND AIMS: H-type hypertension is essential hypertension combined with high homocysteine, and both synergistically increase the risk of cardiovascular and cerebrovascular events. The aim of this study was to investigate the risk factors of H-type hypertension in Tibetan plateau population and correlation with MTHFR C677T gene. METHODS AND RESULTS: A multi-stage cluster random sampling method was used to select the research subjects in Tibet Autonomous Region from June 2020 to November 2021. Among Tibetans, the incidence of H-type hypertension accounted for 84.31% of hypertensive patients. The logistic regression analysis demonstrated that age, uric acid (UA), triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C) were risk factors for the prevalence of H-type hypertension, the OR (95% CI) was 1.083(1.073-1.094), 1.002(1.001-1.004), 1.240(1.050-1.464) and 2.274(1.432-3.611), respectively. MTHFR C677T TT genotype patients with H-type hypertension OR (95% CI) was 1.629(1.004-2.643). Based on this, a nomogram model was established, and the reliability of the model was proved by area under ROC curve, Brier score and average absolute error. The model's results indicate that for every five years of age, the score increases by 6 points; for a 2mmol/L increase in TG, the score increases by 5.5 points; for a 1mmol/L increase in LDL-C, the score increases by 10 points; and individuals with the TT genotype receive 8 points. The higher the score, the greater the risk of disease. CONCLUSION: The MTHFR C677T TT genotype is a risk locus for Tibetan patients with H-type hypertension, with age, TG, and LDL-C were identified as risk factors for the disease.
Subject(s)
Genetic Predisposition to Disease , Methylenetetrahydrofolate Reductase (NADPH2) , Humans , Methylenetetrahydrofolate Reductase (NADPH2)/genetics , Tibet/epidemiology , Female , Male , Middle Aged , Risk Factors , Risk Assessment , Adult , Prevalence , Phenotype , Essential Hypertension/genetics , Essential Hypertension/diagnosis , Essential Hypertension/epidemiology , Essential Hypertension/physiopathology , Blood Pressure/genetics , Aged , Incidence , Polymorphism, Single Nucleotide , Homocysteine/blood , Hyperhomocysteinemia/genetics , Hyperhomocysteinemia/diagnosis , Hyperhomocysteinemia/epidemiology , Hyperhomocysteinemia/blood , Hypertension/genetics , Hypertension/diagnosis , Hypertension/epidemiology , Hypertension/physiopathologyABSTRACT
It remained debates on metabolic-related disorders in patients with primary aldosteronism (PA) and essential hypertension (EH). A systematic review and meta-analysis was conducted to explore the prevalence of metabolic syndrome (MS) and the related indicators in PA and EH. PubMed, Embase, Web of Science and the Cochrane Central Register of Controlled Trials from their commencement to December 2023 were searched for eligible studies. The meta-analysis was performed by Review Manager 5.3 and STATA 15.1 software. A total of 12 studies were included, revealing that there was no significant difference between PA and EH in the prevalence of MS (1.27[0.92, 1.76], p = 0.14) with higher heterogeneity (I2 = 68%, p = 0.0002), while it became significant different (1.45[1.17, 1.81], p = 0.0008) and lower heterogeneity (I2 = 26%, p = 0.19) in patients who were overweight or obese by subgroup analysis. Higher systolic blood pressure (2.99[0.67, 5.31], p = 0.01; I2 = 43%, p = 0.06) and diastolic blood pressure (2.10[0.82, 3.38], p = 0.001; I2 = 36%, p = 0.11) with lower heterogeneity, and lower triglyceride in PA group with higher heterogeneity (-0.23[-0.37, -0.09], p = 0.001; I2 = 76%, p < 0.0001) were observed. No significant difference was found in other indicators. This study showed a higher prevalence of MS in patients who were overweight or obese with PA. However, it was not the same in these patients who were in normal weight. More researches were needed to explore the relationship between PA and metabolism of glucose and lipid.
Subject(s)
Essential Hypertension , Hyperaldosteronism , Metabolic Syndrome , Metabolic Syndrome/epidemiology , Hyperaldosteronism/epidemiology , Hyperaldosteronism/complications , Humans , Prevalence , Essential Hypertension/epidemiology , Essential Hypertension/physiopathology , Blood Pressure/physiology , Female , Middle Aged , Male , Obesity/epidemiology , Obesity/complications , Adult , Overweight/epidemiology , Overweight/complicationsABSTRACT
Left ventricular hypertrophy (LVH) is a hypertensive heart disease that significantly escalates the risk of clinical cardiovascular events. Its etiology potentially incorporates various clinical attributes such as gender, age, and renal function. From mechanistic perspective, the remodeling process of LVH can trigger increment in certain biomarkers, notably sST2 and NT-proBNP. This multicenter, retrospective study aimed to construct an LVH risk assessment model and identify the risk factors. A total of 417 patients with essential hypertension (EH), including 214 males and 203 females aged 31-80 years, were enrolled in this study; of these, 161 (38.6%) were diagnosed with LVH. Based on variables demonstrating significant disparities between the LVH and Non-LVH groups, three multivariate stepwise logistic regression models were constructed for risk assessment: the "Clinical characteristics" model, the "Biomarkers" model (each based on their respective variables), and the "Clinical characteristics + Biomarkers" model, which amalgamated both sets of variables. The results revealed that the "Clinical characteristics + Biomarkers" model surpassed the baseline models in performance (AUC values of the "Clinical characteristics + Biomarkers" model, the "Biomarkers" model, and the "Clinical characteristics" model were .83, .75, and .74, respectively; P < .0001 for both comparisons). The optimized model suggested that being female (OR: 4.26, P <.001), being overweight (OR: 1.88, p = .02) or obese (OR: 2.36, p = .02), duration of hypertension (OR: 1.04, P = .04), grade III hypertension (OR: 2.12, P < .001), and sST2 (log-transformed, OR: 1.14, P < .001) were risk factors, while eGFR acted as a protective factor (OR: .98, P = .01). These findings suggest that the integration of clinical characteristics and biomarkers can enhance the performance of LVH risk assessment.
Subject(s)
Hypertension , Hypertrophy, Left Ventricular , Female , Humans , Male , Biomarkers , Essential Hypertension/complications , Essential Hypertension/epidemiology , Hypertension/complications , Hypertension/diagnosis , Hypertension/epidemiology , Hypertrophy, Left Ventricular/diagnosis , Hypertrophy, Left Ventricular/epidemiology , Hypertrophy, Left Ventricular/etiology , Nomograms , Retrospective Studies , Risk Assessment , Adult , Middle Aged , Aged , Aged, 80 and overABSTRACT
Homocysteine (Hcy) is a sulphur-containing nonessential amino acid derived from the intermediate metabolites of methionine. Methionine is obtained from dietary proteins, such as poultry, meat, eggs, seafood, and dairy products. Abnormalities in Hcy metabolic pathways, deficiencies in dietary methionine, folate, and vitamins B12, B6, and B2 and genetic defects, polymorphisms, or mutations in Hcy metabolism-related enzymes may lead to an increase in plasma Hcy levels. Generally, a plasma Hcy level higher than 10 or 15â µmol/L has been defined as hyperhomocysteinemia (HHcy). An individual with essential hypertension complicated with HHcy is considered to have H-type hypertension (HTH). Currently, HHcy is considered a novel independent risk factor for various cardiovascular diseases. To provide a useful reference for clinicians, the research progress on Hcy, HHcy, and HTH in recent years was systematically reviewed here, with a focus on the source and metabolic pathways of Hcy, plasma Hcy levels and influencing factors, detection methods for plasma Hcy levels, relationship between Hcy concentration and hypertension, pathogenesis of HTH, cardiovascular complications of HTH, and treatment of HTH.
Subject(s)
Biomarkers , Homocysteine , Hyperhomocysteinemia , Animals , Humans , Biomarkers/blood , Blood Pressure , Essential Hypertension/diagnosis , Essential Hypertension/blood , Essential Hypertension/physiopathology , Essential Hypertension/epidemiology , Homocysteine/blood , Hyperhomocysteinemia/blood , Hyperhomocysteinemia/diagnosis , Hyperhomocysteinemia/complications , Hypertension , Risk FactorsABSTRACT
BACKGROUND: We aimed to analyze hypertension in neurofibromatosis type 1 (NF1) in a Finnish population-based cohort in 1996-2014. METHODS: A cohort of 1365 individuals with confirmed NF1 was compared with a control cohort of 13,923 individuals matched for age, sex, and area of residence. Diagnoses of hypertension were retrieved from the Finnish Care Register for Health Care. These registered data were separately analyzed for secondary and essential hypertension. Purchases of antihypertensive drugs were queried from the Finnish Register of Reimbursed Drug Purchases. RESULTS: We identified 115 NF1 patients with hospital diagnosis of hypertension. Our findings revealed a hazard ratio (HR) of 1.64 (95% CI 1.34-2.00, p < 0.001) in NF1 versus controls. NF1 patients presented with a significantly increased hazard for both secondary hypertension (n = 9, HR 3.76, 95% CI 1.77-7.95, p < 0.001) and essential hypertension (n = 98, HR 1.73, 95% CI 1.39-2.14, p < 0.001). No difference in the HR of hypertension was observed between men and women, while NF1 patients with essential hypertension were, on average, younger than the controls. The proportions of individuals with antihypertensive medication did not differ between NF1 patients and controls (OR 0.85). CONCLUSION: NF1 is a risk factor for hypertension. Despite the recognized risk for secondary hypertension, essential hypertension is the predominant type in NF1.
Subject(s)
Hypertension , Neurofibromatosis 1 , Male , Humans , Female , Neurofibromatosis 1/diagnosis , Hypertension/epidemiology , Essential Hypertension/epidemiology , Essential Hypertension/complications , Risk Factors , Finland/epidemiologyABSTRACT
BACKGROUND: Although hypertension is a critical risk factor for dementia, the association between primary aldosteronism (PA) and dementia has been scarcely reported. We aimed to investigate whether the risk of dementia in patients with PA was elevated compared with patients with essential hypertension (EH). METHODS: From the National Health Insurance Claim database in Korea (2003-2017), 3,687 patients with PA (adrenalectomy [ADX], n = 1,339, mineralocorticoid receptor antagonist [MRA] n = 2,348) with no prior dementia were age- and sex-matched at a 1:4 ratio to patients with EH (n = 14,741). The primary outcomes were all-cause dementia events, including Alzheimer's disease, vascular dementia, or other dementia combined with a prescription of one or more medications for dementia (donepezil, galantamine, memantine, or rivastigmine). Multivariable Cox regression models were used to evaluate the hazard ratios (HRs) and 95% confidence intervals for the outcome incidence rates between patients with PA and their EH matches. RESULTS: During a median follow-up of 5.2 years, there were 156 cases of all-cause dementia (4.2%), 140 cases of Alzheimer's disease (3.8%), and 65 cases of vascular dementia (1.8%). Compared with EH, the risk of all-cause dementia was increased in treated PA (unadjusted hazard ratio [HR] 1.26; p < 0.011). Among PA, MRA group had higher risks of all-cause dementia, especially vascular dementia, adjusted for age, sex, income, comorbidities, and concurrent medication (adjusted HR 1.31; p = 0.027 and adjusted HR 1.62; p = 0.020, respectively) compared to EH. ADX group seemed to have a lower dementia risk than the EH group, but there was no statistical significance after full adjustment. This trend became more prominent when the dementia risks were evaluated from the time of hypertension diagnosis rather than treatment initiation for PA. CONCLUSION: The findings of this cohort study suggest that PA, especially the MRA group, is associated with an increased risk of dementia. Monitoring cognitive function in PA patients even after treatment initiation might be warranted to prevent dementia.
Subject(s)
Alzheimer Disease , Dementia, Vascular , Hyperaldosteronism , Hypertension , Humans , Cohort Studies , Alzheimer Disease/complications , Dementia, Vascular/complications , Hyperaldosteronism/complications , Hyperaldosteronism/epidemiology , Hyperaldosteronism/diagnosis , Essential Hypertension/drug therapy , Essential Hypertension/epidemiology , Essential Hypertension/chemically induced , Hypertension/epidemiology , Mineralocorticoid Receptor Antagonists/adverse effectsABSTRACT
ABSTRACT: Chronic forms of morbidity, including mental disorders and hypertension, play a dominant role in determining a disease load in the developing world. This article investigates the associations between the diagnoses of primary hypertension and generalized anxiety disorder (GAD) and the severity of GAD in individuals with primary hypertension. The association of GAD and age, sex, marriage, education level, income, chronic medical conditions, family history of mental disorders, adverse life events, and hypertension was assessed in 470 patients with the diagnosis of primary hypertension. Data analysis was performed with IBM SPSS Statistics software version 16. A significant relationship was found between the prevalence of GAD and the following variables: history of mental disorders ( p < 0.0001), chronic medical conditions ( p < 0.0001), and adverse life events ( p < 0.0001). The mean anxiety score was higher among patients with uncontrolled blood pressure, and a significant relationship was observed between the prevalence of GAD and blood pressure ( p < 0.0001). Because of the significant association between GAD and primary hypertension, it is recommended that anxiety disorders be considered in patients in whom primary hypertension is not controlled easily. This may lead to more proper control of hypertension while taking fewer antihypertensive medications.
Subject(s)
Anxiety Disorders , Hypertension , Humans , Comorbidity , Anxiety Disorders/epidemiology , Anxiety Disorders/diagnosis , Anxiety , Hypertension/epidemiology , Prevalence , Chronic Disease , Essential Hypertension/epidemiologyABSTRACT
BACKGROUND: Left Ventricular Diastolic Dysfunction is considered a critical link between hypertension and heart failure, particularly in individuals with heart failure and preserved ejection fraction. The aim of this study is to assess the prevalence and factors associated with clinical parameters of left ventricular diastolic dysfunction in patients with essential hypertension. METHODS: A hospital-based cross-sectional study was done among 68 newly diagnosed and known hypertensive patients visiting out patientdepartmentat Bir hospital. Patients who meet the inclusion criteria were chosen alternatively by referring OPD register. Patients with hypertension had undergone echocardiography to see whether left ventricular diastolic dysfunction was present and was compared to other clinical parameters like age, sex, body mass index, and dyslipidemia using the student t-test/chi-square test. RESULTS: The prevalence of left ventricular diastolic dysfunction in essential hypertensive patients was 33.8%. About 25% patients had grade 1; 7.4% and 1.5% of patients had grade 2 and grade 3 diastolic dysfunction respectively. Patients who had a duration of hypertension of more than five years were more than nine times (OR 9.14; 2.89-28.87) more likely to have Left ventricular diastolic dysfunction. Age and Body Mass Index were found statistically significant with diastolic dysfunction (P<0.05). CONCLUSIONS: Left ventricular diastolic dysfunction was found prevalent in hypertensive patients. Age, Body mass index, Dyslipidemia and Duration of hypertension were found to be statistically significant with diastolic dysfunction Keywords: Diastolic dysfunction; hypertension; Nepal; prevalence.
Subject(s)
Heart Failure , Hypertension , Ventricular Dysfunction, Left , Humans , Prevalence , Cross-Sectional Studies , Nepal/epidemiology , Ventricular Dysfunction, Left/epidemiology , Ventricular Dysfunction, Left/diagnosis , Essential Hypertension/complications , Essential Hypertension/epidemiology , Hypertension/epidemiology , Heart Failure/epidemiologyABSTRACT
Objective. The hallmarks of type 2 diabetes mellitus (T2DM) are insulin resistance (IR) and insulin receptor substrate (IRS) proteins essential for the insulin signaling. IRS-1 gene has not only been shown to be associated with T2DM, but also has indicated that it may significantly correlate with diabetic complications, such as coronary heart disease and obesity. The aim of this study was to evaluate changes of the lipid panel data in T2DM patients with comorbid obesity and/or essential hypertension in connection with the IRS-1 (rs2943640) polymorphism. Methods. The study involved 33 T2DM patients and 10 healthy individuals. The IRS-1 (rs2943640) polymorphism was genotyped using a TaqMan real-time polymerase chain reaction method. Blood serum lipid panel data were determined with commercially available kits using a Cobas 6000 analyzer. Results. Analysis of the serum lipid panel data depending on the presence of the C/A alleles of IRS-1 (rs2943640) polymorphism in T2DM patients, regardless of the presence/absence of comorbidities, showed significantly lower level of high-density lipoprotein cholesterol (HDL-C) and significantly higher level of non-HDL-C in the carriers of C allele vs. carriers of A allele. In T2DM patients with comorbid obesity and essential hypertension, proatherogenic lipid changes were found in both C and A alleles carriers. Analysis of the effect of IRS-1 (rs2943640) genotypes on serum lipid panel data in T2DM patients, regardless of the presence/absence of comorbidities, showed that the CC genotype carriers had more pronounced pro-atherogenic changes vs. carriers of СРand ÐÐ genotypes. In the comorbid course of T2DM (both in combination with obesity and obesity and essential hypertension), pro-atherogenic changes were found in the carriers of the CA genotype of IRS-1 (rs2943640) polymorphism. Conclusions. The presence of the C allele of IRS-1 (rs2943640) polymorphism in both homo-zygous and heterozygous states indicates increased risk of pro-atherogenic changes in T2DM patients with comorbid obesity and/or essential hypertension.
Subject(s)
Diabetes Mellitus, Type 2 , Insulin Resistance , Humans , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/genetics , Insulin Receptor Substrate Proteins/genetics , Polymorphism, Genetic , Obesity/epidemiology , Obesity/genetics , Insulin Resistance/genetics , Essential Hypertension/epidemiology , Essential Hypertension/genetics , LipidsABSTRACT
OBJECTIVES: Primary aldosteronism (PA), the most common endocrine cause of hypertension, is associated with a higher risk of cardiovascular disease (CVD) than blood pressure (BP)-matched essential hypertension (EH). We aimed to compare the calculated risks of CVD in patients who had hypertension with PA or EH using CVD risk calculators, hypothesising that they will fail to recognise the increased CVD risk in PA. DESIGN: Cross-sectional analysis. SETTING: An endocrine hypertension service in Victoria, Australia. PARTICIPANTS: Patients who had hypertension without CVD referred for the investigation of hypertension. OUTCOME MEASURES: Calculated 5-year or 10-year CVD risk as predicted by the National Vascular Disease Prevention Alliance (NVDPA) algorithm, Framingham Risk Score, Pooled Cohort Equations and QRISK3. RESULTS: Those with PA (n=128) and EH (n=133), did not differ significantly in their calculated CVD risks with the NVDPA algorithm (moderate-to-high 5-year risk 36/100 vs 45/99, p=0.17); the Framingham Risk Score (median 10-year risk 7.72% (4.43%-12.95%) vs 6.84% (3.85%-10.50%), p=0.14); the Pooled Cohort Equations (median 10-year risk 9.45% (4.36%-15.37%) vs 7.90% (2.09%-14.73%), p=0.07); and QRISK3 (median 10-year risk 11.31% (7.22%-20.29%) vs 12.47% (5.10%-19.93%), p=0.51). Similarities persisted on regression analyses accounting for systolic BP. CONCLUSIONS: CVD risk algorithms do not reflect the increased risk of CVD in patients with PA, and likely underestimate the true risk of CVD among those with PA. Screening for PA, in addition to using the CVD risk algorithm in patients who had hypertension, may facilitate the targeted treatment of PA and minimisation of cardiovascular risk in affected individuals.
Subject(s)
Cardiovascular Diseases , Hyperaldosteronism , Hypertension , Humans , Essential Hypertension/complications , Essential Hypertension/epidemiology , Hyperaldosteronism/complications , Hyperaldosteronism/epidemiology , Cardiovascular Diseases/etiology , Cardiovascular Diseases/complications , Cross-Sectional Studies , Risk Factors , Hypertension/complications , Hypertension/epidemiology , Heart Disease Risk Factors , VictoriaABSTRACT
BACKGROUND: The present study investigated the prevalence of osteoporosis (OP) among patients with essential hypertension (EH) in the Changchun community and analysed the correlation between EH and OP. METHODS: The study included 425 subjects with EH and 425 age- and sex-matched healthy controls. Bone mineral density (BMD) and serum creatinine (CR) levels were measured, and the subjects' current EH and OP statuses were surveyed to analyse the correlation between EH and OP. RESULTS: The EH group exhibited lower BMD and a higher rate of having OP than the control group, and this difference was statistically significant (p < 0.05). A significant sex difference in the BMD T-score was observed among the subjects (male: - 1.19 ± 1.55, female: - 1.70 ± 1.34). In both the EH group and the control group, the rate of having OP in females was greater than that in males. However, the OP prevalence among subjects with EH varied significantly by age, body weight, fracture history, nocturnal urination frequency, depression and anxiety status, duration of hypertension, and antihypertensive medication use (p < 0.05). Two-way analysis of variance suggested an effect of the interaction between different EH statuses and bone mass conditions on the serum CR values (F = 3.584, p = 0.028, bias η2 = 0.008). CONCLUSIONS: The prevalence of OP and low BMD were significantly higher among subjects with EH than among healthy controls. Additionally, the findings indicate that age, weight, fracture history, nocturnal urination frequency, depression and anxiety, duration of hypertension and antihypertensive drug use may be correlated to having OP in EH subjects, requiring further studies. Moreover, serum CR levels in subjects with different bone mass profiles were strongly influenced by the presence or absence of EH, and the serum CR levels differed significantly with the interaction of these two factors.
Subject(s)
Fractures, Bone , Hypertension , Osteoporosis , Bone Density , Essential Hypertension/complications , Essential Hypertension/epidemiology , Female , Humans , Hypertension/epidemiology , Male , Osteoporosis/drug therapy , Osteoporosis/epidemiology , Osteoporosis/etiology , Prevalence , Risk FactorsABSTRACT
Background: The relationship of glycemic abnormalities between primary aldosteronism (PA) patients and essential hypertension (EH) patients is still debatable. This meta-analysis aimed to explore differences in the prevalence of glycemic abnormalities and levels of abnormal glucose metabolism in PA and EH patients. Methods: A search was performed using PubMed, Scopus, Cochrane and Web of Science databases from their inception through January 2022. Inclusion criteria for this study were 1) observational studies which contained specific data of interest, 2) studies including data which compared adult PA and EH patients and 3) studies which used appropriate methods to diagnose PA. Risk ratio (RR) or standardized mean difference (SMD) with a 95% confidence interval (95% CI) was calculated. Results: Twenty-six studies involving 53,186 patients were included in the meta-analysis. Patients with PA demonstrated significantly higher overall incidence of glycemic abnormalities than patients with EH [RR 1.54; 95% CI (1.20,1.98)]. Risk of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in PA patients were higher than in EH patients [RR 1.27; 95%CI (1.08, 1.49) and RR 2.99; 95%CI (1.74, 5.16), respectively]. There was no statistically significant difference of risk between these groups for impaired fasting glucose (IFG) [RR 1.70; 95%CI (0.55, 5.26)]. Moderate heterogeneity was observed in overall glycemic abnormalities outcomes. A high level of heterogeneity was observed for IFG, while the level was low for DM and IGT. Conclusions: PA patients have a higher risk of glycemic abnormalities than in EH patients. Further study should be conducted to investigate underlying mechanisms of glycemic abnormalities in PA. Systematic Review Registration: www.inplasy.com, INPLASY, identifier 202220004.
Subject(s)
Diabetes Mellitus , Glucose Intolerance , Hyperaldosteronism , Prediabetic State , Adult , Blood Glucose/metabolism , Essential Hypertension/complications , Essential Hypertension/epidemiology , Glucose Intolerance/epidemiology , Humans , Hyperaldosteronism/complications , Hyperaldosteronism/epidemiology , Observational Studies as Topic , Prediabetic State/complications , Prediabetic State/epidemiologyABSTRACT
Whether arteriosclerosis can influence the hypertension control remains incompletely understood. We hypothesized that higher arteriosclerosis may be associated with uncontrolled hypertension. Arteriosclerosis was assessed by carotid femoral artery pulse wave velocity (CF-PWV) and uncontrolled hypertension (systolic blood pressure [BP] ≥130 mm Hg or diastolic BP ≥80 mm Hg). The multivariable-adjusted logistic regression was used for analysis. A total of 1,428 patients with essential hypertension (mean age 68 years, 49.6% male) were enrolled into the study from 2010 to 2017. The BP was uncontrolled in 50.7% of the participants and the mean level of CF-PWV was 12.3 m/s. All the cardiovascular risk factors were worse and CF-PWV was higher in patients with uncontrolled hypertension (all p < 0.05). Multivariable-adjusted logistic regression analysis showed that CF-PWV as a continuous variable (odd ratio [OR] 1.093, 95% confidence interval [CI] 1.046-1.142) was independently associated with uncontrolled hypertension, after male (OR 1.511) and total cholesterol (OR 1.167), followed by body mass index (OR 1.092), fasting plasma glucose (OR 1.075), and creatinine (OR 1.010) (all p < 0.05). As a binary variable, CF-PWV >12 m/s was also independently associated with uncontrolled hypertension (OR 1.690, 95% CI 1.320-2.164, p < 0.05). Arteriosclerosis is independently associated with uncontrolled BP in patients with hypertension.
Subject(s)
Arteriosclerosis , Hypertension , Vascular Stiffness , Aged , Arteriosclerosis/complications , Arteriosclerosis/diagnosis , Arteriosclerosis/epidemiology , Blood Pressure , Essential Hypertension/complications , Essential Hypertension/diagnosis , Essential Hypertension/epidemiology , Female , Humans , Hypertension/diagnosis , Hypertension/epidemiology , Male , Pulse Wave Analysis , Risk FactorsABSTRACT
Background: Essential hypertension (EH) is a common and multifactorial disorder that is likely to be influenced by multiple genes. The methylenetetrahydrofolate reductase (MTHFR) gene rs1801133 and rs1801131 polymorphisms influence MTHFR enzyme activity and plasma homocysteine concentration. In addition, variations in MTHFR functions likely play roles in the etiology of EH. Thus far, a large number of studies investigating the associations between the MTHFR polymorphisms and EH have provided controversial or inconclusive results. To better assess the purported relationship, we performed a comprehensive analysis of 52 published studies. Objective and Methods. Eligible studies were identified by searching the PubMed, Wanfang, and China National Knowledge Infrastructure (CNKI) databases. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated to assess the potential association between the MTHFR rs1801133 polymorphism and EH. Results: Overall, 10712 patients and 11916 controls were involved; we observed significantly increased association between the MTHFR rs1801133 polymorphism and EH risk (such as T vs. C: OR = 1.38, 95% CI = 1.25 - 1.54, P ≤ 0.001), with similar results evident within race subgroups (such as Asian: T vs. C: OR = 1.47, 95% CI = 1.30 - 1.67, P ≤ 0.001; compared to Chinese: T vs. C: OR = 1.54, 95% CI = 1.33 - 1.79, P ≤ 0.001). Similar associations were also found in subgroups defined by the source of controls and genotype methods. To our regret, based on the limited studies, no association was detected for rs1801131 polymorphism. Conclusions: Our study provides evidence that the MTHFR rs1801133 null genotype may increase EH risk. Future studies with larger sample sizes are warranted to evaluate this association in more detail.
Subject(s)
Genetic Predisposition to Disease , Methylenetetrahydrofolate Reductase (NADPH2) , Asian People/genetics , Essential Hypertension/diagnosis , Essential Hypertension/epidemiology , Essential Hypertension/genetics , Humans , Methylenetetrahydrofolate Reductase (NADPH2)/genetics , Polymorphism, Single NucleotideABSTRACT
BACKGROUND: The effect of comorbid hypertension and type 2 diabetes mellitus (T2DM) on coronary artery plaques examined by coronary computed tomography angiography (CCTA) is not fully understood. We aimed to comprehensively assess whether comorbid hypertension and T2DM influence coronary artery plaques using CCTA. MATERIALS AND METHODS: A total of 1100 T2DM patients, namely, 277 normotensive [T2DM(HTN-)] and 823 hypertensive [T2DM(HTN +)] individuals, and 1048 normotensive patients without T2DM (control group) who had coronary plaques detected on CCTA were retrospectively enrolled. Plaque type, coronary stenosis, diseased vessels, the segment involvement score (SIS) and the segment stenosis score (SSS) based on CCTA data were evaluated and compared among the groups. RESULTS: Compared with patients in the control group, the patients in the T2DM(HTN-) and T2DM(HTN +) groups had more partially calcified plaques, noncalcified plaques, segments with obstructive stenosis, and diseased vessels, and a higher SIS and SSS (all P values < 0.001). Compared with the control group, T2DM(HTN +) patients had increased odds of having any calcified and any noncalcified plaque [odds ratio (OR) = 1.669 and 1.278, respectively; both P values < 0.001]; both the T2DM(HTN-) and T2DM(HTN +) groups had increased odds of having any partially calcified plaque (OR = 1.514 and 2.323; P = 0.005 and P < 0.001, respectively), obstructive coronary artery disease (CAD) (OR = 1.629 and 1.992; P = 0.001 and P < 0.001, respectively), multivessel disease (OR = 1.892 and 3.372; both P-values < 0.001), an SIS > 3 (OR = 2.233 and 3.769; both P values < 0.001) and an SSS > 5 (OR = 2.057 and 3.580; both P values < 0.001). Compared to T2DM(HTN-) patients, T2DM(HTN +) patients had an increased risk of any partially calcified plaque (OR = 1.561; P = 0.005), multivessel disease (OR = 1.867; P < 0.001), an SIS > 3 (OR = 1.647; P = 0.001) and an SSS > 5 (OR = 1.625; P = 0.001). CONCLUSION: T2DM is related to the presence of partially calcified plaques, obstructive CAD, and more extensive coronary artery plaques. Comorbid hypertension and diabetes further increase the risk of partially calcified plaques, and more extensive coronary artery plaques.
Subject(s)
Computed Tomography Angiography , Coronary Angiography , Coronary Artery Disease/diagnostic imaging , Coronary Stenosis/diagnostic imaging , Coronary Vessels/diagnostic imaging , Diabetes Mellitus, Type 2/epidemiology , Essential Hypertension/epidemiology , Plaque, Atherosclerotic , Vascular Calcification/diagnostic imaging , Aged , Comorbidity , Coronary Artery Disease/epidemiology , Coronary Stenosis/epidemiology , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/diagnosis , Essential Hypertension/diagnosis , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Retrospective Studies , Risk Assessment , Risk Factors , Severity of Illness Index , Vascular Calcification/epidemiologyABSTRACT
BACKGROUND: Urine albumin/creatinine ratio (UACR) is an important marker of early renal damage (ERD) caused by hypertension. Recent studies showed that blood pressure was a significant inverse association with temperature and climate. The purposes of our study were sought to explore the association of common medical comorbidities with ERD, and find independent risk factors to ERD in Chinese tropics with essential hypertension. METHODS: From January 2018 to December 2019, we assessed UACR in a total of 599 hypertensive Chinese Hainan patients. We defined ERD as a UACR between 30 mg/g and 300 mg/g. We analysed differences between qualitative variables using the chi-squared (χ2) test. We calculated correlations between UACR and age, hypertension duration (HD), systolic blood pressure (SBP), and diastolic blood pressure (DBP) using the Spearman's rho test. To determine the odds ratio (OR), we evaluated binary logistic regression models. RESULTS: Among the 599 patients, 281 (46.9%) were found to have ERD. ERD and factors related to sex, body mass index (BMI), and SBP did not differ significantly (all, p>0.05). Our main findings showed that age, HD, and DBP were associated with ERD (p<0.01, respectively). Furthermore, age ≥ 65 years, HD ≥10 years, DBP ≥ 90 mmHg, SBP ≥ 160 mmHg, and diabetes differed significantly according to ERD status (p < 0.05, respectively). In multivariate analysis using stepwise regression, age (OR = 1.468), DBP (OR = 1.853), and diabetes (OR = 2.031) were significant independent predictors of ERD. The area under the receiver operating characteristic (ROC) curve was 0.677, and the sensitivity and specificity of the optimal cut-off value were 44.5 and 81.1%, respectively. CONCLUSIONS: Common medical comorbidities are associated with ERD; age, DBP, and diabetes are independent risk factors for ERD in patients with essential hypertension who live in the Chinese tropics. Early monitoring of the UACR, as well as control of blood glucose and DBP, can effectively delay ERD.
Subject(s)
Climate , Essential Hypertension/complications , Essential Hypertension/epidemiology , Kidney Diseases/complications , Kidney Diseases/epidemiology , Aged , Albuminuria/urine , Blood Pressure , China/epidemiology , Comorbidity , Correlation of Data , Creatinine/urine , Essential Hypertension/physiopathology , Essential Hypertension/urine , Female , Humans , Kidney Diseases/physiopathology , Kidney Diseases/urine , Male , Middle Aged , Risk FactorsABSTRACT
BACKGROUND: Essential hypertension is a condition characterized by a rise in blood pressure of undetermined cause, includes 90% of all hypertensive cases and is a highly important public health challenge with major modifiable cause of morbidity and mortality. Uric acids disorders in particular hyperuricemia are significant problems in essential hypertensive patients and can cause substantial morbidity and mortality. Determination of uric acid disorders may play a major role in the management and early aversion of complications in hypertensive patient. Therefore, this study aimed to determine uric acid disorders and associated factors among essential hypertensive adults in the outpatient department at Wolkite University specialized Hospital, Southern Ethiopia from November 1 to February 30, 2021. METHODS AND MATERIALS: An institional based cross sectional study was conducted on 270 essential hypertensive adults on follow-up in outpatient department from November 1 to February 30, 2021. Structured questionnaires through face to face interviews and participants' medical records were used to collect information on determinants related with uric acid disorders. The blood specimen was collected and level of serum uric acid, blood sugar and lipid profile was measured using standard principles and procedures with an ABX Pentra 400 automated chemistry analyzer. Bivariate and multivariate logistic regression analyses were done to identify factors associated with hyperuricemia. The p-value was set at <0.05 with a 95% confidence interval of the adjusted odds ratio. RESULTS: A total of 270 adult essential hypertensive patients were participated in the study, among those 196(27.4%) of study participants were hyperuricemic with 95%CI (21.9, 33.3). Being alcoholic [(AOR: 15.68, 95% CI: (5.93, 21.41)], taking antihypertensive medication [(AOR: 11.56, 95% CI: (3.94, 23.80)], BMI > = 30 [(AOR: 4.89, 95% CI: (1.46, 25.5)] and being centrally obese [(AOR: 6.87, 95% CI: (2.53, 18.63)] were factors significantly associated with hyperuricemia. CONCLUSION: In this study, the high burden of hyperuricemia (27.4%) was observed in essential hypertensive patients with follow-up in outpatient department. Taking alcohol and antihypertensive medication, being overweight and centrally obese were identified factors of uric acid disorders. The finding of this study should be taken into consideration to implement preventive interventions on identified predictors in hypertensive patients. Taking fruit and vegetable, and promoting physical exercise and determinations of serum uric acid level in adult essential hypertensive patients was recommended to minimize the emergence of hyperuricemia.
Subject(s)
Essential Hypertension , Hyperuricemia , Uric Acid/blood , Adult , Cross-Sectional Studies , Essential Hypertension/blood , Essential Hypertension/epidemiology , Ethiopia , Female , Health Knowledge, Attitudes, Practice , Humans , Hyperuricemia/blood , Hyperuricemia/epidemiology , Male , Middle Aged , Risk Factors , Surveys and QuestionnairesABSTRACT
Hypertension is a complex disease which is mainly influenced by genetic factors. Recently, genome-wide association study (GWAS) found three novel endothelial dysfunction-related sites: Vascular endothelial growth factor A (VEGFA) rs9472135, Faciogenital dysplasia 5 (FGD5) rs11128722, Zinc Finger C3HC-type Containing 1 (ZC3HC1) rs11556924. Endothelial dysfunction is one of the early events in pathophysiology of essential hypertension. To investigate the association of endothelial dysfunction-related genes with essential hypertension, we conducted a case-control study of 431 patients with hypertension and 345 controls. The polymorphisms were detected using Taqman Probe. The alleles and genotypes of ZC3HC1 rs11556924 and VEGFA rs9472135 were not statistically different between the two groups, while the allele of FGD5 rs11128722 was different [P = 0.045, OR = 1.265, 95% CI = (1.009-1.586)], especially in the male [P = 0.035, OR = 1.496, 95% CI = (1.037-2.158)]. Analyzing the different of genotype distribution of 3 SNPs in the two groups under different genetic models, the genotypes of FGD5 rs11128722 showed difference in male under dominant model [P = 0.049, OR = 1.610, 95% CI = (1.018-2.544)]. The polymorphism of FGD5 rs11128722 had a significant difference in Body Mass Index (BMI) among different genotypes; In the additive genetic model, BMI of GA genotype was higher than that of GG (P = 0.038); GA + AA was higher than GG in the dominant genetic model (P = 0.011). In our study, we found that the polymorphisms of VEGFA rs9472135 and ZC3HC1 rs11556924 may not significantly associated with the risk of essential hypertension, and FGD5 rs11128722 may increase the risk of it, especially in elderly men.
Subject(s)
Hypertension , Vascular Endothelial Growth Factor A , Adaptor Proteins, Signal Transducing/genetics , Aged , Case-Control Studies , Cell Cycle Proteins/genetics , Essential Hypertension/diagnosis , Essential Hypertension/epidemiology , Essential Hypertension/genetics , Genetic Predisposition to Disease , Genome-Wide Association Study , Humans , Hypertension/diagnosis , Hypertension/epidemiology , Hypertension/genetics , Male , Nuclear Proteins/genetics , Polymorphism, Single Nucleotide , Vascular Endothelial Growth Factor A/geneticsABSTRACT
Hemos leído con gran atención el artículo de los autores González Rey y otros, titulado: Disfunción endotelial en una etapa precoz del diagnóstico de hipertensión arterial. Resulta muy interesante el tratamiento de un tema básico de gran interés en la clínica a través del uso de biomarcadores casi siempre a la disposición de nuestros profesionales de la salud en los diferentes niveles de atención como resulta ser el caso de la microalbuminuria.1 El endotelio resulta cada vez de mayor interés para investigadores y médicos de asistencia, pues es el punto de confluencia de las enfermedades vasculares, metabólicas y neurodegenerativas, y es el primer eslabón en el desarrollo de la aterosclerosis. Se conoce que los diferentes factores involucrados en la activación y daño endotelial como las altas concentraciones de ácido úrico,2 los niveles elevados de ácidos grasos,3 el envejecimiento4 y la hiperglicemia,5 son los mismos que contribuyen a posteriori con el desarrollo y las complicaciones de la placa de ateroma. Vale destacar el aporte...(AU)