Identifying Pre-hypertensives in the Community: At Risk Approach for Prevention of Hypertension

Introduction: Pre-hypertension is a borderline health state of increased blood pressure (BP) that falls short of the measurable parameters at which surveillance and/or therapy would be required. The approach of identifying people “At Risk” of developing hypertension can be more cost-effective and feasible for applying lifestyle interventions. Objectives: The objective of the present study is to find the prevalence of pre-hypertensives and associated bio-socio-demographic factors Materials and Methods: A cross-sectional study was conducted among 1946 participants aged 19 years and more in the Doiwala block of Dehradun, Uttarakhand. Multistage sampling was used to arrive at desired sample size. A pre-validated, structured questionnaire was used for data collection. The questionnaire included information on the socio-demographic profile (age, sex, education etc.), awareness about hypertension and its associated risk factors. Statistical Analysis: The chi-square test was used to compare proportions and draw inferences. Results: 958 (49.2%) study participants out of a total 1946 were found to be pre-hypertensives. A statistically significant association was found between pre-hypertension and factors such as male gender, age, education, occupation and waist-hip ratio. (p<0.05) Conclusion: It is recommended that identification on the pre-hypertensive group and subjecting them to lifestyle modification could be a fruitful strategy for preventing them from becoming hypertensive.

Effect of exercise on prehypertension and hypertension in middle-aged and elderly people in Asian populations: a meta-analysis / 中华行为医学与脑科学杂志

Objective:To systematically evaluate the effect of exercise on blood pressure of middle-aged and elderly Asian populations with prehypertension and hypertension, and to provide theoretical basis for formulating accurate exercise prescriptions.Methods:Randomized controlled trials on the effect of exercise on blood pressure in middle-aged and elderly patients with prehypertension and hypertension were collected by PubMed, EMBASE, the Cochrane Library, Web of Science, CNKI and Wanfang Database.The quality of the included studies was evaluated by the Cochrane risk bias assessment tool, and the meta-analysis was performed with Stata 15.0 software.Results:A total of 23 articles and 2 095 subjects were included.Meta analysis showed that compared with the control group, aerobic exercise(WMD=-9.94, 95% CI=-12.59--7.29, P<0.001), resistance exercise(WMD=-11.15, 95% CI=-18.36--3.95, P=0.002) and aerobic combined resistance exercise(WMD=-6.09, 95% CI=-8.87--3.31, P=0.005) could reduce the systolic blood pressure level.Aerobic exercise(WMD=-6.46, 95% CI=-8.20--4.72, P<0.001) and resistance exercise(WMD=-4.38, 95% CI=-8.07--0.69, P=0.02) could reduce the level of diastolic blood pressure, while aerobic combined resistance exercise(WMD=-4.88, 95% CI=-12.87-3.11, P=0.232)had no significant effect on diastolic blood pressure.The results of subgroup analysis indicated that the differences of age, baseline blood pressure, exercise intensity, exercise time, exercise frequency, and motion cycle were the main sources of heterogeneity.The funnel plot and Egger's test indicated that there was no publication bias in this Meta-analysis. Conclusion:Aerobic exercise and resistance exercise both have positive effects on reducing blood pressure of middle-aged and elderly Asian populations with prehypertension and hypertension.

Mechanism of Banxia Baizhu Tianma decoction to prevent the development of prehypertension and excessive phlegm-dampness syndrome in rats based on metabonomics technology / 药学学报

The alterations of serum biological endogenous chemicals in rats with phlegm dampness accumulation syndrome of prehypertension (PHT) were interfered by Banxia Baizhu Tianma decoction (BBT), and the metabolic regulatory pathway of BBT was clarified using serum metabonomics analysis. To replicate the rat model of prehypertension phlegm dampness syndrome, blood pressure, behavioral markers, and serum biochemical markers of rats were collected. BBT's effectiveness in controlling blood pressure and blood lipids was assessed, and changes in endogenous small molecules in rat serum were determined using UPLC-Q-Orbitrap MS metabolic analysis. The results showed that BBT could regulate 9 metabolites, including arachidonic acid, cholic acid, glycodeoxycholic acid, N-adenosyltyrosine, arginine, lysophosphatidylethanolamine (20:0/0:00), lysophospholipid (P-18:0), lysophospholipid (18:0), lysophospholipid (22:5(7Z,10Z,13Z,16Z,19Z)). MetaboAnalyst was used to analyze the metabolic pathway. There were 7 metabolic pathways closely related to the change of blood pressure in rats, among which arachidonic acid metabolic pathway was the most critical. The metabolism difference foreign body in the model rats tends to return to the normal level, which provides a research basis for the mechanism of BBT from the perspective of metabonomics. This study was approved by the Experimental Animal Welfare Ethics Review Committee of Shandong University of Traditional Chinese Medicine (approval number: SDUTCM20211103001).

Socio-demographic factors, overweight/obesity and nutrients associated with hypertension among rural adults (≥18 years): Findings from National Nutrition Monitoring Bureau survey

Background: Hypertension is the leading cause of death throughout the world. The study was conducted to assess the prevalence, determinants and knowledge & practices about hypertension among rural adults in India. Methods: A community-based cross-sectional study was carried out in 10 major states of India. Information on socio-economic & demographic particulars was collected and anthropometric measurements like height, weight, waist & hip circumference and blood pressure were measured. Foods and nutrient intakes were assessed by 24-h recall method. Analysis was done using SPSS window 22. Results: The prevalence of pre-hypertension was 45.3% (95% CI: 44.6e46.0) and hypertension was 22% (95% CI: 21.5e22.3) (age standardized prevalence; 20.2%) while, overweight/obesity was 22.6% (95% CI: 22.2e23.0) as per Asian cut offs (BMI_x0001_23). The prevalence of hypertension was higher in West Bengal (29.5%) and Kerala (28.9%) and low in Madhya Pradesh and Uttar Pradesh (16e19%). The odds of hypertension was 1.2 times higher among forward communities, businessmen, tobacco users and those consuming alcohol, 2e3 times higher among overweight (CI: 1.87e2.25) and obese (2.65e3.27). The odds of hypertension was 1.2 times higher among those consuming lower tertile of carbohydrates (CI ¼ 1.02e1.41) and zinc (CI ¼ 1.11e1.42). About 76% were aware of hypertension, 21% were old hypertensive & 19% were on treatment. Conclusions: Age standardized prevalence of hypertension was 20% among adults and was associated with age, occupation, overweight/obesity, tobacco and alcohol use, low intake of carbohydrates and zinc. Therefore, increasing awareness and consumption of healthy diet through behavior change communication will help to control hypertension among adults.

To assess the prevalence of clinical and subclinical cardiac autonomic dysfunction in adolescent with family history of hypertension and adolescent with prehypertension; correlating with adolescent anthropometric parameters

Objectives: Hypertension (HTN) is an inherited disorder and these patients manifest with cardiac autonomic dysfunction (CAD). The present study intends to assess the presence of pre HTN, clinical and subclinical CAD in adolescents with a family history of HTN, and to obtain its correlation with anthropometric values. Materials and Methods: After obtaining ethical clearance and informed consent, three groups containing 50 subjects each, of age 17–19 years were included in the study. (Group-I: Normotensives without a family history of HTN; Group-II: Normotensives with a family history of HTN and Group-III: prehypertensives). CAD was done by performing (1) resting tachycardia, (2) loss of sinus arrhythmia, and (3) heart rate response to the Valsalva manoeuvre. If any two of them are positive then the presence of CAD was confirmed. Results: Height, weight, BMI, SBP and DBP was significantly higher in group 3 (prehypertensives). Confirmed CAD findings was seen in 36% of group 2 and 46% of group 3 participants. Of the anthropometric parameters, a significant positive correlation was seen between weight and SBP, DBP and CAD parameters, and height with SBP and DBP. Conclusion: Clinical and subclinical CAD exists in adolescents with risk factors for HTN including heredity, obesity, and pre-HTN values. These risk factors show multiplicative effects for disease genesis and indicate high sympathetic and low parasympathetic drives. Extra care should be taken to curb the onset of clinical HTN and CAD in these young adults. Additional work needs to be done on pathophysiological mechanisms for the same.

Correlation between TyG and TyG combined obesity index and prehypertension in middle-aged and elderly population / 公共卫生与预防医学

Objective To explore the correlation between Triglyceride Glucose Index (TyG) and its combined obesity Index and prehypertension in middle-aged and elderly population in China, and to provide a monitoring tool for better hierarchical management of prehypertension population. Methods A total of 5 099 people with non-hypertension were enrolled through the database of the China Health and Retirement Longitudinal Study (CHARLS). Body mass index (BMI), waist circumference (WC) and waist to height ratio (WTHR) were obtained, and TyG-BMI, TyG-WC and TyG-WTHR indexes were calculated by multiplying the TyG index with the three indexes respectively. Logistic regression analysis was used to explore the relationship between TyG index and obesity index and prehypertension. The DeLong method was used to compare the values of Area Under the Curve (AUC) of each index to distinguish their value in identifying prehypertension. Results Compared with the normal blood pressure group, the prehypertension group was older, and the blood pressure was higher. Logistic regression analysis showed that higher levels of TyG-BMI and TyG-WC index were significantly associated with prehypertension. Compared with the lowest quartile array Q1, the OR values of TyG-BMI Q2-Q4 were 1.24 (95%CI :1.03-1.49), 1.40 (95%CI :1.10-1.76) and 1.91 (95%CI :1.43-2.56), while the OR values of TyG-WC index Q2-Q4 group were 1.45 (95%CI :1.19-1.75), 1.49 (95%CI :1.13-1.95), and 2.12 (95%CI: 1.47-3.07), respectively. There was no statistically significant difference in the AUC value between TyG-WC and TyG-BMI (P =0.0998). Conclusion Among the four novel indexes, higher levels of TyG-WC and TyG-BMI are positively correlated with prehypertension. Compared with TyG and TyG-WTHR, TyG-WC and TyG-BMI have the potential to become an effective auxiliary means in the individual hierarchical management of prehypertension in the middle-aged and elderly.

Effects of an internet-based blood pressure monitoring and management platform on blood pressure control in a prehypertensive population: an intervention study / 中华健康管理学杂志

Objective:To explore the intervention effects of an Internet-based blood pressure monitoring and management platform in a prehypertensive population.Methods:One hundred and fifty-eight prehypertensive patients who were examined at the Third Xiangya Hospital in Changsha, China, from August to December 2019 were randomly divided into either the experimental or control groups using the random number table method. The experimental group utilized an Internet-based blood pressure monitoring and management platform, whereas the control group utilized regular telephone and SMS health management routines. The intervention duration was 12 months for both groups. Data were analyzed using descriptive analysis, t-tests, chi-square tests, χ 2 tests, and rank-sum tests. Results:Post intervention systolic blood pressure (124.79±9.71 mmHg) (1 mmHg=0.133 kPa) and diastolic blood pressure measurements (77.41±8.21 mmHg) of the participants in the experimental group were significantly lower than those before the intervention (128.29±5.10 mmHg and 79.99±6.01 mmHg, respectively), and significantly lower than those of the control group′s measurements after the intervention (130.00±7.78 mmHg and 80.33±7.90 mmHg, respectively) (all P<0.05). The blood pressure goal attainment rate was significantly higher in the experimental group (23.08%) than that of the control group (8.75%), with statistically significant differences within the experimental group before and after intervention, as well as between the groups post intervention ( P<0.05). Positive lifestyle changes, such as prehypertension knowledge score, active restriction and control of salt and oil intake, reduction of smoking, and exercising weekly, were significantly higher than those in the control group before the intervention (all P<0.05). Conclusion:The use of an Internet-based blood pressure monitoring and management platform can effectively help patients with prehypertension control their blood pressure levels, improve their knowledge about the condition, and improve their lifestyle choices.

Underlying Mechanisms of Bile Acids in Progression of Hypertension Based on Metabolomics and Network Analysis / 中国实验方剂学杂志

ObjectiveTo explore the underlying mechanism of bile acids and metabolites as well as the key metabolic pathways and important endogenous targets in prehypertension. MethodThe metabolic mechanism of prehypertension was explored with non-targeted metabolomics combined with network analysis. The serum metabolomics of patients with prehypertension was analyzed by ultra-high performance liquid chromatography quadrupole time-of-flight tandem mass spectrometry. The relevant biological functions and signal targets were predicted and generated by network analysis. Finally，the predicted targets of this important pathway were verified by in vitro experiments，and the relevant information was verified by enzyme-linked immunosorbent assay （ELISA） and Western blot. ResultAs revealed by non-targeted metabolomics，there were 64 potential biomarkers and 13 metabolic pathways in the normal group，the prehypertension group， and the hypertension group. The results of network analysis and biological verification showed that the occurrence of prehypertension was related to vascular inflammation caused by the abnormal metabolism of bile acids and aromatic amino acids. Bile acid metabolism plays an important role in the occurrence and development of prehypertension by regulating the vascular inflammatory response. Amino acid N-acyltransferase，myeloperoxidase， and bile acid downstream receptor TGR5 are critical in the changes of the metabolic network. ConclusionIn prehypertension，bile acids are presumedly involved in regulating vascular inflammation， resulting in damage to blood vessels in prehypertension.

Fatores associados à pré-hipertensão e hipertensão arterial em trabalhadores de saúde que atuam em serviços de alta complexidade / Factors associated with prehypertension and hypertension among healthcare workers working in high-complexity services

Resumo Objetivou-se estimar a prevalência e fatores associados à pré-hipertensão e hipertensão arterial entre trabalhadores de saúde que atuam em setores de alta complexidade para pacientes críticos e crônicos. Foi realizado um estudo epidemiológico, transversal com 490 trabalhadores de saúde da macrorregional do norte de Minas Gerais, Brasil. A variável dependente pressão arterial foi categorizada em normal, pré-hipertensão e hipertensão. Para análise múltipla, foi utilizada a Regressão Logística Multinomial. A prevalência da hipertensão arterial foi de 21,8% e da pré-hipertensão foi de 25,9%. As chances de se desenvolver a hipertensão arterial e a pré hipertensão foram maiores nos profissionais do sexo masculino, com idade ≥40 anos, em trabalhadores com vínculo empregatício concursado e naqueles obesos ou com sobrepeso. O uso de medicamento contínuo e o trabalho no turno noturno estiveram associados à hipertensão e pré-hipertensão, respectivamente. A prevalência de hipertensão arterial no grupo de trabalhadores foi menor do que a da população brasileira. São necessários estudos com trabalhadores desse grupo e investimentos em medidas preventivas e que incentivem a mudança para um estilo de vida saudável.

Abstract The objective was to estimate the prevalence and factors associated with prehypertension and hypertension among health workers who work in high-complexity services for critically-ill and chronic patients. An epidemiological, cross-sectional study was carried out with 490 health workers in the macroregional region of Northern Minas Gerais, Brazil. The dependent variable blood pressure (BP) was categorized as normal BP, prehypertension and hypertension. Multinomial Logistic Regression was used for the multiple analysis. The prevalence of arterial hypertension was 21.8% and that of prehypertension was 25.9%. The chances of developing arterial hypertension and prehypertension were higher in male professionals, aged ≥40 years, in civil servant workers and those who were obese or overweight. The use of continuous medication and night shift work were associated with hypertension and prehypertension, respectively. The prevalence of arterial hypertension in the group of workers was lower than that of the Brazilian population. It is necessary to carry out studies with workers from this group and investments are required in preventive measures that encourage a change to a healthy lifestyle.

Modulação Autonômica Cardíaca é Fator Chave para Pressão Alta em Adolescentes / Cardiac Autonomic Modulation is a Key Factor for High Blood Pressure in Adolescentes

Resumo Fundamento O interesse pela hipertensão em crianças e adolescentes aumentou desde a atualização do sistema de classificação da pressão arterial para comparar com o sistema de classificação dos adultos, alterando a terminologia de "normal alta" para "pré-hipertensão". Objetivo O objetivo deste estudo foi analisar a associação da modulação autonômica cardíaca com os níveis pressóricos dos adolescentes. Métodos 203 adolescentes foram agrupados de acordo com a pressão arterial sistólica (PAS) e a pressão arterial diastólica (PAD). Um grupo foi caracterizado como pré-hipertensão, e o outro como normotenso. Foram coletadas características antropométricas, cardiovasculares e de qualidade do sono. Inicialmente, os dados foram submetidos ao teste de normalidade Kolmogorov-Smirnov . As variáveis quantitativas contínuas foram analisadas por meio do teste T de Student não pareado. Para análise das variáveis categóricas, foi utilizado o teste qui-quadrado. Um modelo de regressão logística foi realizado. O nível de significância estabelecido foi p<0,05. Os dados foram expressos como média ± desvio padrão e intervalo de confiança. O software R foi utilizado para análise dos dados. O tamanho do efeito foi calculado com a fórmula de Cohen. Resultados O grupo pré-hipertensão apresentou aumento da entropia de Shannon e diminuição da variância total. Além disso, no modelo de regressão logística, os adolescentes deste grupo tiveram 1,03 mais chances de ter a entropia de Shannon afetada quando a PAS foi ajustada ao gênero, maturação sexual, tempo escolar, idade, circunferência da cintura e qualidade do sono. Conclusão Nossos dados mostram que a modulação autonômica pode desempenhar um papel importante no desenvolvimento da pressão arterial elevada em adolescentes ao controlar fatores como tempo escolar e qualidade do sono.

Abstract Background The interest regarding hypertension among children and adolescents has increased since the blood pressure rating system was updated to be compared with the adult rating system, changing the terminology from "normal high" to "prehypertension". Objective This study aimed to analyze the association between cardiac autonomic modulation and pressure levels of adolescents. Methods 203 adolescents were grouped according to systolic blood pressure (SBP) and diastolic blood pressure (DBP). One group was characterized as prehypertension, and the other as normotensive. Anthropometric, cardiovascular and sleep quality characteristics were collected. Initially, the data were submitted to the Kolmogorov-Smirnov normality test. Continuous quantitative variables were analyzed using the unpaired Student t-test. For the analysis of categorical variables, a chi-square test was used. A logistic regression model was performed. The level of significance was set at p<0.05. The data were expressed as mean ± standard deviation and confidence interval. The R software was used for data analysis. The effect size was calculated using the Cohen's formula. Results The prehypertension group showed an increase in Shannon entropy and a decrease in total variance. Also, in the logistic regression model, adolescents in this group were 1.03 times more likely to have Shannon entropy's affected when SBP was adjusted for gender, sexual maturation, school time, age, waist circumference, and sleep quality. Conclusion Our data show that autonomic modulation may play an important role in the development of elevated blood pressure in adolescents, when controlling for other factors, such as school time and sleep quality.

Índice tobillo-brazo obtenido mediante fotopletismografía como marcador de insuficiencia arterial periférica asintomática en pacientes prehipertensos

RESUMEN Introducción: La enfermedad arterial periférica (EAP) puede presentarse de forma asintomática, de ahí la necesidad de su diagnóstico para evitar complicaciones. Objetivo: Determinar la presencia de enfermedad arterial periférica mediante el índice tobillo-brazo obtenido por fotopletismografía en pacientes prehipertensos. Método: Se realizó un estudio descriptivo de corte transversal, en un universo constituido por los 35 pacientes mayores de 18 años, con diagnóstico presuntivo de prehipertensión arterial, del Consultorio 2 perteneciente al Policlínico Universitario Josué País García de Santiago de Cuba. Para medir el índice tobillo-brazo se empleó el pletismógrafo digital ANGIODIN® PD 3000. Resultados: El 100% de los pacientes carecía de síntomas de EAP, pero al realizar la medición del índice tobillo-brazo se encontró que el 51,43% de ellos tenía signos de esta enfermedad. La EAP fue más frecuente en hombres (52,94 vs. 50,0%), sin que se encontraran diferencias estadísticas significativas (p>0,05). Conclusiones: El índice tobillo-brazo obtenido mediante fotopletismografía resultó útil para determinar la presencia de enfermedad arterial periférica asintomática en pacientes prehipertensos. Se identificó una alta incidencia de la enfermedad, con mayor frecuencia en el sexo masculino.

ABSTRACT Introduction: Peripheral artery disease (PAD) may present with no symptoms at all, hence the need for diagnosis to avoid complications. Objective: To determine the presence of peripheral artery disease by means of the ankle-brachial index obtained by photoplethysmography in prehypertensive patients. Method: A descriptive cross-sectional study was carried out in a population of 35 patients over 18 years of age, with a presumptive diagnosis of prehypertension, belonging to the Family Doctor's Office 2 from the Policlínico Universitario Josué País García in Santiago de Cuba. The ANGIODIN® PD 3000 digital plethysmograph was used to measure the ankle-brachial index. Results: None of the patients had symptoms of PAD, but after measuring the ankle-brachial index, 51.43% of them were found to have signs of this disease. Peripheral artery disease was more frequent in men (52.94 vs. 50.0%), with no significant statistical differences (p>0.05). Conclusions: The ankle-brachial index obtained by photoplethysmography was useful in determining the presence of asymptomatic peripheral artery disease in prehypertensive patients. A high incidence of the disease was identified, with a higher frequency in the male sex.

The association of abnormal thyroid stimulating hormone levels with elevated blood pressure among females of child-bearing potential / 中华内分泌代谢杂志

Objective:To explore the association between abnormal thyroid stimulating hormone (TSH) and elevated blood pressure among females of child-bearing potential.Methods:A total of 294 674 females of child-bearing age who participated in pre-pregnancy health examination in Shenzhen from 2013 to 2019 were selected. Demographic characteristics, blood pressure, TSH, fasting blood glucose and other indexes were collected. Multivariate logistic regression model was used to analyze the association between abnormal TSH levels and elevated blood pressure (including prehypertension and hypertension).Results:This study showed that females of child-bearing potential with prehypertension and hypertension accounted for 21.77% and 2.41%, respectively. Compared with females of child-bearing potential with normal TSH, the risk of prehypertension and hypertension increased by 34.0% ( OR=1.340, 95% CI 1.248-1.438) and 59.6% ( OR=1.596, 95% CI 1.301-1.938) among those with decreased TSH, respectively, whereas the risk of prehypertension and hypertension increased by 13.6% ( OR=1.136, 95% CI 1.076-1.198) and 38.0% ( OR=1.380, 95% CI 1.198-1.581) among those with elevated TSH, respectively. Subgroup analysis showed that abnormal TSH levels in most subgroups, such as age, ethnicity, educational level, occupation, spouse smoking, alcohol drinking, body mass index, and fasting blood glucose, were associated with the risk of elevated blood pressure. Heterogeneity test showed that the association between decreased TSH and elevated blood pressure was higher in females with high school and below or alcohol drinking, and the association between elevated TSH and elevated blood pressure was higher in females with college/bachelor′s degree and above or non-smoking spouse. Conclusion:There is a significant association between abnormal TSH levels and the risk of prehypertension and hypertension in females of child-bearing potential, and the association should be explored with stratified educational level, alcohol drinking, and spouse smoking status.

Non-targeted metabolomics study and biomarker screening of prehypertensive liver-fire hyperactivity syndrome based on UPLC-Q-Exactive MS technology / 中国中药杂志

In this study, patients with prehypertensive liver-fire hyperactivity syndrome(LFHS) were selected as the research objects. The plasma samples of healthy volunteers and patients with prehypertensive LFHS were analyzed by non-targeted metabolomics based on UPLC-Q-Exactive MS. The differential biomarkers and metabolic pathways were screened out by multivariate statistics and metabolic pathway analysis, which revealed the characteristics of metabolic patterns of the syndrome. Thirty-three potential biomarkers such as androsterone and lysophosphatidylcholine and 16 related metabolic pathways such as steroid hormone metabolism and lipid metabolism were identified, and a partial least squares-discriminant analysis(PLS-DA) model of traditional Chinese medicine(TCM) syndromes was preliminarily constructed: Y =-0.070X_(13)-0.006X_8+ 0.040X_5-0.152X_1+0.131X_(10)+0.036X_(11)+0.043X_(23)+0.076X_(16)+0.132X_(20)+0.081X_(19)-0.101X_(31)+0.082X_(15)-0.038X_9+0.079X_(24). The predictive value of the model was 88.1%, and the explanatory power was 88.4%. In this study, the characteristic metabolic pattern of the prehypertensive LFHS was distinguished and revealed by metabolomics. The constructed PLS-DA model is expected to provide an objective basis for the identification of TCM syndromes in prehypertension, and inspiration for exploring the biological basis of TCM syndromes at small-molecular and overall levels.

High blood pressure levels and cardiovascular risk among Munduruku indigenous people / Níveis pressóricos elevados e risco cardiovascular entre indígenas Munduruku / Niveles altos de presión arterial y riesgo cardiovascular entre los indígenas Munduruku

Objective: to identify the risk factors associated with prehypertension and arterial hypertension among Munduruku indigenous people in the Brazilian Amazon. Method: a cross-sectional study carried out with 459 Munduruku indigenous people selected by means of stratified random sampling. Sociodemographic variables, habits and lifestyles, anthropometric data, fasting glucose and lipid profiles were evaluated. An automatic device calibrated and validated to measure blood pressure was used. The analyses of the data collected were carried out in the R software, version 3.5.1. For continuous variables, the Kruskall-Wallis test was used; for the categorical ones, Fischer's Exact. The significance level was set at 5% and p-value≤0.05. Results: the prevalence of altered blood pressure levels was 10.2% for values suggestive of hypertension and 4.1% for pre-hypertension. The risk of prehypertension among indigenous people was associated with being male (OR=1.65; 95% CI=0.65-4.21) and having a substantially increased waist circumference (OR=7.82; 95% CI=1.80-34.04). Regarding the risk for arterial hypertension, it was associated with age (OR=1.09; 95% CI=1.06-1.12), with increased waist circumference (OR=3.89; 95% CI=1.43-10, 54) and with substantially increased waist circumference (OR=5.46; 95% CI=1.78-16.75). Conclusion: among Munduruku indigenous people, men were more vulnerable to developing hypertension; age and increased waist circumference proved to be strong cardiovascular risk factors.

Objetivo: identificar os fatores de risco associados à préhipertensão e hipertensão arterial entre indígenas Munduruku da Amazônia brasileira. Método: estudo transversal realizado com 459 indígenas Munduruku selecionados por meio de amostragem aleatória estratificada. Foram avaliadas variáveis sociodemográficas, hábitos e estilos de vida, dados antropométricos, glicemia de jejum e perfis lipídicos. Utilizou-se aparelho automático calibrado e validado para medir a pressão arterial. As análises dos dados coletados foram realizadas pelo software R versão 3.5.1. Para as variáveis contínuas, utilizou-se o teste Kruskall-Wallis; para as categóricas, o Exato de Fischer. Considerou-se nível de significância de 5% e valor p≤0,05. Resultados: a prevalência de níveis pressóricos alterados foi de 10,2% para valores sugestivos de hipertensão e de 4,1% para pré-hipertensão. O risco de pré-hipertensão entre indígenas associou-se a ser do sexo masculino (OR=1,65; IC95% 0,65-4,21) e ter circunferência da cintura aumentada substancialmente (OR=7,82; IC95% 1,80-34,04). Quanto ao risco para hipertensão arterial, associou-se à idade (OR=1,09; IC95% 1,06-1,12), à circunferência da cintura aumentada (OR=3,89; IC95% 1,43-10,54) e à circunferência da cintura aumentada substancialmente (OR=5,46; IC95% 1,78-16,75). Conclusão: entre indígenas Munduruku, os homens estavam mais vulneráveis para desenvolver hipertensão; a idade e a circunferência da cintura aumentada mostraram-se como fortes fatores de risco cardiovascular.

Objetivo: identificar los factores de riesgo asociados con la prehipertensión y la hipertensión arterial entre los indígenas Munduruku en la Amazonía brasileña. Método: estudio transversal realizado con 459 indígenas Munduruku seleccionados mediante muestreo aleatorio estratificado. Se evaluaron variables sociodemográficas, hábitos y estilos de vida, datos antropométricos, glucosa en ayunas y perfiles lipídicos. Se utilizó un dispositivo automático calibrado y validado para medir la presión arterial. Los análisis de los datos recopilados se llevaron a cabo mediante el software R versión 3.5.1. Para las variables continuas se utilizó la prueba de KruskalWallis; para las categóricas, Exacto de Fischer. El nivel de significancia se estableció en 5% y p≤0,05. Resultados: la prevalencia de niveles alterados de presión arterial fue del 10,2% para valores sugestivos de hipertensión y del 4,1% para prehipertensión. El riesgo de prehipertensión entre los indígenas se asoció al sexo masculino (OR=1,65; IC95% 0,65-4,21) y a un aumento sustancial de la circunferencia de cintura (OR=7,82; IC95% 1,80-34,04). En cuanto al riesgo de hipertensión arterial, se asoció con la edad (OR=1,09; IC95% 1,06-1,12), con un aumento de la circunferencia de la cintura (OR=3,89; IC95% 1,43-10,54) y con un aumento sustancial de la circunferencia de la cintura (OR=5,46; IC95% 1,78-16,75). Conclusión: entre los indios Munduruku, los hombres eran más vulnerables a desarrollar hipertensión, la edad y el aumento de la circunferencia de la cintura demostraron ser fuertes factores de riesgo cardiovascular.

Prevalence of Hypertension Among Resident Doctors of Clinical Departments in a Tertiary Care Hospital in North-Eastern Region of India

Introduction: Hypertension is a global pandemic andrising every year. Detection of hypertension among doctorsis of utmost importance as hypertension is one of the majorcauses for diseases like chronic kidney disease, stroke, heartfailure and there is paucity in the studies done on doctors forprevalence of hypertension in India. Objective: The studywas undertaken to estimate the occurrence of hypertension inresident doctors of the clinical departments of a tertiary carehospital of northeastern India.Material and methods: It is a hospital based cross-sectionalstudy, conducted in the Department of General Medicine,Paediatrics and General surgery of tertiary care hospital ofnortheastern India including 100 doctors participants. Datalike age, height, weight, family history, smoking history weretaken. Blood pressure was measured on two occasions, oneon an emergency day and another on a non- emergency day.Statistical analysis: Data entry was done and evaluated usingMicrosoft Excel 2010 and IBM SPSS statistics 20.Results: The prevalence of hypertension and prehypertensionamong the doctors was found in 36% and 13% respectively,on an emergency day. This huge number of hypertension wasreduced to 19% when BP was taken on a non- emergency day.There was also significant positive relation between smokingand mean systolic BP (p-value <0.05).Conclusion: The prevalence of hypertension among doctorsis no less than the general population. Stress like emergencyduties may be an important factor of higher prevalence ofhypertension in doctors. There is a need of changes in lifestylefor better future for doctors and hence for the population.

Prevalence of hypertension and its risk factors among high school children in Bangalore, India

Background: Hypertension is a prominent health disorder that leads to 12.8% of deaths worldwide. Although predominantly considered a disorder of the adults, the roots of hypertension start from childhood. In the past children usually suffered from secondary hypertension. However, now with increased incidence of obesity, reduced physical activity, unhealthy dietary habits, use of tobacco and alcohol among adolescents there is now an increased prevalence of primary hypertension in this age group. The present study was conducted with the objective of assessing the prevalence of hypertension and its modifiable risk factors in high school children.Methods: The study was conducted among high school students aged 13 to 16 years in urban Bangalore. A self-administered questionnaire was used to assess the lifestyle. Age, sex, height, weight and resting blood pressure were recorded. Odds ratio, Chi square test and logistic regression were used in the analysis.Results: There were 550 students who participated in the study, 300 (54.54%) were males and 250 (45.45%) were females. The prevalence of prehypertension was 21.6% and hypertension was 8.9%. Logistic regression revealed that overweight, obesity, high salt intake, tobacco use, and stress were significantly associated with elevated blood pressure.Conclusions: There is a rise in the prevalence of hypertension among high school students. Changes in lifestyle seem to influence the development of hypertension in this age group. Behaviour change communication should be used to reduce the modifiable risk factors and promote healthy lifestyle among adolescents.

Efeito da Redução do Sal de Adição sobre a Pressão Arterial Central e Periférica / Effects of added salt reduction on central and peripheral blood pressure

Resumo Fundamento Os efeitos da redução na ingestão do sal sobre a pressão arterial (PA) casual de hipertensos já foram amplamente estudados, entretanto essa análise ainda é escassa no contexto da redução exclusiva do sal de adição na rigidez arterial e em indivíduos normotensos e pré-hipertensos. Objetivo Avaliar os efeitos da redução progressiva na ingestão do sal de adição (de 6 para 4 g/dia) sobre os valores da pressão periférica e central, a rigidez arterial em normotensos, pré-hipertensos e hipertensos. Métodos Ensaio clínico, simples cego com 13 semanas de seguimento. Foram avaliados normotensos (≤130/85 mmHg), pré-hipertensos (≥130 e <139/≥85 e <90 mmHg) e hipertensos estágio 1 (≥140 e <160/≥90 e <100 mmHg). Utilizou-se medida casual e monitorização residencial da PA com aparelho automático OMRON 705CP, medida central da PA com Sphygmocor®, dosagem do sódio urinário de 24h (colhido no intervalo entre cada visita) e mensuração de sal de adição. Foi adotado nível de significância p<0,05 para todas as análises. Resultados Foram avaliados 55 participantes (18 normotensos; 15 pré-hipertensos; 22 hipertensos) com mediana 48 anos (IQ:39-54). Os grupos foram semelhantes em relação a idade e sexo. Não houve diferença entre medidas de PA e excreção de sódio antes e depois da intervenção. Os parâmetros de rigidez arterial também não sofreram alterações significativas. Conclusão A redução gradativa da ingestão de sal de adição num seguimento de 13 semanas não foi capaz de reduzir de maneira significativa os valores periféricos e centrais da PA. (Arq Bras Cardiol. 2020; 114(3):554-561)

Abstract Background Although the effects of salt intake reduction on casual blood pressure have been extensively studied in hypertensive individuals, data on reductions of added salt on arterial stiffness in both normotensive and prehypertensive subjects are scarce. Objective To evaluate the effects of progressive reduction in added salt intake (from 6 grams to 4 grams per day) on peripheral and central blood pressure and arterial stiffness in normotensive, prehypertensive and hypertensive individuals. Methods This was a single-blinded clinical trial with 13 weeks of follow-up. Normotensive (≤ 130/85 mmHg), prehypertensive (≥ 130 e < 139/≥ 85 e < 90 mmHg) and stage 1 hypertensive individuals (< 139/≥ 85 and < 90 mmHg) were assessed. Casual blood pressure measurements and ambulatory blood pressure monitoring were performed using the automated OMRON 705CP device, and central blood pressure was measured using the Sphygmocor®. Twenty-four-hour urinary sodium excretion and the amounts of added salt consumed were measured. Statistically significance level was set at p < 0.05 for all analysis. Results A total of 55 participants (18 normotensive, 15 prehypertensive and 22 hypertensive), median age 48 years (IQR:39-54) were studied. The groups were not different in age or sex. No difference was observed in blood pressure or sodium excretion levels before and after the intervention. No significant changes in arterial stiffness parameters were observed. Conclusion The progressive reduction in added salt intake during a period of 13 weeks did not cause significant reductions in peripheral and central blood pressure. (Arq Bras Cardiol. 2020; 114(3):554-561)

Rigidez arterial, hipertensão arterial e idade: associação com declínio do desempenho cognitivo após 4 anos de seguimento em participantes do ELSA-Brasil / Arterial stiffness, arterial hypertension and age: association with decline in cognitive performance after 4 years of follow-up in ELSA-Brasil participants

Nas últimas décadas, um número crescente de evidências destacou a importante contribuição dos fatores de risco vasculares para o declínio cognitivo acelerado e demências, incluindo a doença de Alzheimer. Apesar dos grandes progressos nesse campo de estudo, as evidências sobre o papel da rigidez arterial e da hipertensão na cognição não é conclusivo. O objetivo desta tese foi verificar se a rigidez arterial, a idade e a hipertensão arterial sistêmica estão associadas à diminuição do desempenho em testes de função cognitiva em adultos de meia idade e idosos após cerca de quatro anos de seguimento. Foram utilizados dados da linha de base (onda 1: 2008-2010) e do primeiro acompanhamento (onda 2: 2012-2014) do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). No primeiro artigo, utilizando modelos lineares de efeitos mistos, foi investigado se a rigidez aórtica, medida pela velocidade da onda de pulso carotídeo-femoral (VOP-cf) e a idade na linha de base, estariam associados ao declínio no desempenho cognitivo avaliado por três testes cognitivos (Teste de Memória, Teste de Fluência Verbal Fonêmica e Semântica e Teste de Trilhas B), aplicados nas duas visitas da coorte. Encontramos que a rigidez aórtica foi associada de forma independente da pressão arterial sistólica e da idade ao declínio mais rápido em duas habilidades cognitivas, memória e fluência. Entretanto, o declínio no Teste de Memória foi restrito aos participantes com altos valores de VOP-cf na linha de base. A idade também foi associada ao declínio mais rápido no desempenho de todos os testes cognitivo avaliados entre as ondas. No entanto, apenas os participantes mais velhos apresentaram uma trajetória de desempenho descendente nos Testes de Memória e Trilha B. No segundo artigo, por meio de regressão linear de efeitos mistos, foi investigado se a exposição à hipertensão arterial sistêmica (HAS) e a pré-hipertensão estariam associados ao declínio no desempenho do escore cognitivo global (avaliado pelo fator g) e em Teste de Memória, Fluência Verbal Fonêmica e Semântica e Trilhas B, todos analisados como escores padronizados. Também foi investigado se a HAS diagnosticada na meia idade, o tempo de exposição a HAS e o status de tratamento e de controle da HAS na linha de base da coorte estariam associados ao declínio cognitivo mais acelerado entre visita. Encontramos que tanto a exposições à HAS quanto à Pré-HAS na linha de base foram associadas ao declínio no desempenho cognitivo, avaliado pelo escore cognitivo global (fator g). A HAS também foi associada à redução nos escores padronizados dos Testes de Memória e Fluência Verbal, enquanto a Pré-HAS permaneceu longitudinalmente associada apenas à redução no escore padronizado do Teste de Fluência Verbal. Não encontramos evidências de que a exposição à HAS na meia idade estivesse associada ao declínio cognitivo, somente a exposição à HAS na idade mais velha permaneceu associada a redução do escore cognitivo global e do Teste de Memória. Também não identificamos que maior tempo de exposição à HAS estivessem associadas ao declínio cognitivo relacionado à idade. O status de tratamento da HAS não foi associado a alterações nos escores padronizados dos testes cognitivos avaliado, mas a HAS não controlada quando comparada a controlada foi associada ao declínio mais acelerado no escore cognitivo global e no Teste de Memória. Nenhuma das variáveis de HAS analisadas foram associadas a alterações nos escores padronizados do Teste de trilhas B. O aumento da rigidez aórtica, a exposição à HAS, a pré-HAS e a HAS de início tardio foram associadas à uma pior trajetória longitudinal no desempenho cognitivo global e em diferentes habilidades cognitivas. Embora a magnitude dos efeitos seja pequena, é notável detectar o impacto direto desses fatores no declínio cognitivo relacionado à idade, uma vez que, avaliamos uma população altamente instruída e com idade relativamente jovem em um curto intervalo de tempo. Os resultados reforçam a importância de estudar a função cognitiva na meia-idade, com vistas a identificar precocemente indivíduos em maior risco de declínio, assim como, fatores de risco que podem potencialmente acelerar o processo de envelhecimento cognitivo e impactar negativamente na função cognitiva ao longo do tempo.

In recent decades, increasing evidence has highlighted the critical contribution of vascular risk factors to the risk of accelerated cognitive decline and dementia, including Alzheimer's disease. Despite significant progress in this field of study, how to reduce the role of arterial stiffness and hypertension in cognition is not conclusive. This thesis aimed to verify whether arterial stiffness, age, and systemic arterial hypertension are associated with decreased performance on cognitive function tests in middle-aged and elderly adults after approximately four years of follow-up. We used data from baseline (wave 1: 2008-2010), and the first follow - up (wave 2: 2012-2014) Study of Adult Health Longitudinal (ELSA-Brazil). In the first paper, using mixed effects linear models, we investigated whether aortic stiffness, measured by carotid-femoral pulse wave velocity (cf-PWV) and age at baseline, were associated with the decline in three cognitive tests (Memory Test, Phonemic and Semantic Verbal Fluency Test, and Trail B Test), applied at both cohort visits. We found that aortic stiffness was independently associated with systolic blood pressure and age with the fastest decline in two cognitive skills, memory and fluency. However, the decrease in the Memory Test was restricted to participants with high baseline cf-PWV values. Age was also associated with the faster decline in the performance of all cognitive tests evaluated between waves. Still, only older participants showed a downward performance trajectory on Memory and Trail B tests. In the second paper, using mixed effects linear regression was investigated whether exposure to hypertension and prehypertension would be associated with the decline in the performance global cognitive score (assessed by the g factor) and Memory, Verbal Fluency Phonemic and Semantics and Trail B Tests. It was also investigated whether hypertension diagnosed in middle age, the time of exposure to hypertension and the treatment and control status of hypertension at the baseline of the cohort were associated with more accelerated cognitive decline between visits. We found that exposure to hypertension and prehypertension at baseline were associated with a decrease in cognitive performance assessed by the global cognitive score (g factor). Hypertension was also associated with a reduction in the standardized Memory and Verbal Fluency tests scores, whereas prehypertension remained longitudinally associated only with a decrease in the standardized Verbal Fluency Test score. We found no evidence that exposure to hypertension in middle age was associated with cognitive decline; only exposure to hypertension in older age remained associated with a reduction in the global cognitive score and the Memory Test. We also did not identify that longer exposure to hypertension was associated with age-related cognitive decline. The treatment status of hypertension was not associated with changes in the standardized scores of the assessed cognitive tests, but uncontrolled hypertension when compared to controlled hypertension was associated with the more accelerated decline in the global cognitive score and the Memory Test. None of the hypertension variables analyzed were associated with changes in the standardized scores of the Trail B test. The increase in aortic stiffness, exposure to hypertension, prehypertension and late-onset hypertension were associated with a worse longitudinal trajectory in global cognitive performance at different cognitive abilities. Although the magnitude of the effects is small, it is noteworthy to detect the direct impact of these factors on age-related cognitive decline, since we evaluated a highly educated and relatively young age population over a short time. The results reinforce the importance of studying cognitive function in middle-aged, in order to identify early individuals at higher risk of decline, as well as risk factors that can potentially accelerate the cognitive aging process and negatively impact cognitive function over time.

The distribution of sleep duration in mid－pregnancy and its association with prehypertension / 中华疾病控制杂志

@#Objective To study the distribution of sleep duration in mid－pregnancy women and examine its association with prehypertension ( PHT) ． Methods In the baseline survey of a prospective cohort study，943 women in mid－pregnancy were recruited in Guangzhou，China in 2017－2018． A standardized questionnaire was used to assess demographic characteristics，sleep duration and other lifestyles． We obtained maternal blood pressure values，weights，heights，and medical histories from medical records． Multivariate logistic regression was conducted to examine the association between sleep duration and PHT． Ｒesults The average daily sleep duration of women in mid －pregnancy was ( 10. 41 ± 1. 67 ) hours，and it was negatively related to age and educational level． Overall，98. 33% of pregnant women had a daily sleep duration ≥ 7 h and the distribution was related to passive smoking． The average night time sleep duration was ( 9. 48±1. 21 ) hours，and it was negatively related to age and educational level． The daytime sleep duration was ( 0. 93 ± 0. 69 ) hours，and it was positively associated with physical activity． The average bedtime was( 22 ∶ 42 ± 1．24) ，and it was positively associated with passive smoking． The prevalence of PHT was 9. 61%． We did not observe any significant association between sleep duration and PHT． Conclusions The mid－pregnancy women in Guangzhou had relatively long sleep duration， and it differed by maternal age，educational level，physical activity，and passive smoking． There was no significant association between sleep duration and PHT．