Subject(s)
Hyperaldosteronism/drug therapy , Hypertension/drug therapy , Mineralocorticoid Receptor Antagonists/therapeutic use , Spironolactone/analogs & derivatives , Spironolactone/therapeutic use , Aldosterone/metabolism , Eplerenone , Gynecomastia/etiology , Humans , Hypokalemia/prevention & control , Meta-Analysis as Topic , Mineralocorticoid Receptor Antagonists/adverse effects , Spironolactone/adverse effectsABSTRACT
OBJECTIVE: Noninvasive blood pressure (BP) measurement often triggers a transient rise in BP, known as an alerting reaction. However, the prevalence and prognostic significance of the alerting reaction has never been assessed in the general population. METHODS: We evaluated the association between the alerting reaction and left ventricular mass by MRI and urinary albumin-to-creatinine ratio in the Dallas Heart Study, a large population sample of 3069 individuals. Participants were categorized into four groups based on levels of consecutive BP: first, normal first BP and average third to fifth (avg3-5) BP of less than 140/90âmmHg (control group); second, high first BP of at least 140/90âmmHg and normal (avg3-5) BP (alerting reaction group); third, normal first BP and high (avg3-5) BP; and fourth, high first to fifth BP. Then, associations between BP categories with incident cardiovascular outcomes (coronary heart disease, stroke, atrial fibrillation, heart failure, and cardiovascular death) over a median follow-up period of 9.4 years were assessed. RESULTS: The sample-weighted prevalence of isolated hypertension during the first BP measurement was 9.6%. Presence of an alerting reaction was independently associated with increased left ventricular mass, urinary albumin-to-creatinine ratio, cardiovascular events after adjustment for traditional cardiovascular risk factors, and baseline BP (adjusted hazard ratio 1.24, 95% confidence interval 1.07-1.43). CONCLUSION: Our study indicated that the alerting reaction is independently associated with increased cardiovascular and renal complications.
Subject(s)
Blood Pressure Determination , Cardiovascular Diseases/epidemiology , Heart Ventricles/pathology , Hypertension/physiopathology , Adult , Albuminuria/epidemiology , Atrial Fibrillation/epidemiology , Blood Pressure/physiology , Cardiovascular Diseases/mortality , Coronary Disease/epidemiology , Creatinine/urine , Female , Heart Failure/epidemiology , Humans , Hypertension/epidemiology , Hypertrophy, Left Ventricular/epidemiology , Hypertrophy, Left Ventricular/pathology , Incidence , Magnetic Resonance Imaging , Male , Middle Aged , Prevalence , Prognosis , Proportional Hazards Models , Renal Insufficiency/epidemiology , Renal Insufficiency/urine , Risk Factors , Stroke/epidemiologyABSTRACT
BACKGROUND: Multiple epidemiological studies from Europe and Asia have demonstrated increased cardiovascular risks associated with isolated elevation of home blood pressure (BP) or masked hypertension (MH). Previous studies have not addressed cardiovascular outcomes associated with MH and white-coat hypertension (WCH) in the general population in the United States. OBJECTIVES: The goal of this study was to determine hypertensive target organ damage and adverse cardiovascular outcomes associated with WCH (high clinic BP, ≥140/90 mm Hg; normal home BP, <135/85 mm Hg), MH (high home BP, ≥135/85 mm Hg; normal clinic BP, <140/90 mm Hg), and sustained hypertension (high home and clinic BP) in the DHS (Dallas Heart Study), a large, multiethnic, probability-based population cohort. METHODS: Associations among WCH, MH, sustained hypertension, and aortic pulsed wave velocity by magnetic resonance imaging; urinary albumin-to-creatinine ratio; and cystatin C were evaluated at study baseline. Then, associations between WCH and MH with incident cardiovascular outcomes (coronary heart disease, stroke, atrial fibrillation, heart failure, and cardiovascular death) over a median follow-up period of 9 years were assessed. RESULTS: The study cohort comprised 3,027 subjects (50% African Americans). The sample-weighted prevalence rates of WCH and MH were 3.3% and 17.8%, respectively. Both WCH and MH were independently associated with increased aortic pulsed wave velocity, cystatin C, and urinary albumin-to-creatinine ratio. Both WCH (adjusted hazard ratio: 2.09; 95% confidence interval: 1.05 to 4.15) and MH (adjusted hazard ratio: 2.03; 95% confidence interval: 1.36 to 3.03) were independently associated with higher cardiovascular events compared with the normotensive group, even after adjustment for traditional cardiovascular risk factors. CONCLUSIONS: In a multiethnic U.S. population, both WCH and MH were independently associated with increased aortic stiffness, renal injury, and incident cardiovascular events. Because MH is common and associated with an adverse cardiovascular profile, home BP monitoring should be routinely performed among U.S. adults.
Subject(s)
Blood Pressure Determination/methods , Masked Hypertension/complications , White Coat Hypertension/complications , Adolescent , Adult , Aged , Antihypertensive Agents/therapeutic use , Blood Pressure , Cohort Studies , Ethnicity , Female , Follow-Up Studies , Humans , Male , Middle Aged , Outcome Assessment, Health Care , Prevalence , Prognosis , Risk Factors , Texas , Young AdultSubject(s)
Antihypertensive Agents/administration & dosage , Drug Resistance , Hypertension/drug therapy , Hypertension/prevention & control , Blood Pressure Determination/methods , Female , Humans , Hypertension/diagnosis , Male , Primary Prevention/methods , Prognosis , Reference Values , Risk Assessment , Treatment OutcomeSubject(s)
Body Mass Index , Global Health , Hypertension/epidemiology , Obesity/epidemiology , Adult , Age Distribution , Aged , Comorbidity , Female , Humans , Hypertension/diagnosis , Incidence , Male , Middle Aged , Obesity/diagnosis , Prognosis , Risk Assessment , Sex Distribution , Survival Analysis , United States/epidemiologySubject(s)
Antihypertensive Agents/administration & dosage , Erectile Dysfunction/epidemiology , Erectile Dysfunction/etiology , Hypertension/drug therapy , Sexual Behavior/physiology , Age Factors , Aged , Antihypertensive Agents/adverse effects , Erectile Dysfunction/psychology , Humans , Hypertension/diagnosis , Hypertension/epidemiology , Incidence , Male , Middle Aged , Prognosis , Psychology , Risk FactorsSubject(s)
Antihypertensive Agents/therapeutic use , Hypertension/drug therapy , Hypertension/epidemiology , Adult , Age Distribution , Aged , Aged, 80 and over , Blood Pressure Determination/methods , Female , Humans , Hypertension/diagnosis , Incidence , Male , Middle Aged , Prognosis , Risk Assessment , Severity of Illness Index , Sex Distribution , Treatment Outcome , United States/epidemiology , Young AdultABSTRACT
Primary aldosteronism is widely held to be the most common cause of identifiable (secondary) hypertension, reported to be present in 6-10% of all hypertensive patients. This belief reflects the widespread use of the aldosterone-to-renin ratio (ARR) as a screening test. Unfortunately, the ARR is often wrong, leading to even more expensive testing that is also often misleading but that may then lead to potentially harmful additional measures. This review provides evidence that referral bias has markedly inflated the estimates of this condition and recommends a much less aggressive approach to the diagnosis of this condition based on more limited testing and the use of mineralocorticoid receptor antagonists in the treatment of most hypertensive patients.
Subject(s)
Hyperaldosteronism/epidemiology , Hypertension/etiology , Humans , Hyperaldosteronism/complications , Hyperaldosteronism/diagnosis , PrevalenceABSTRACT
The occurrence of additional cardiovascular events when the diastolic blood pressure is lowered below a critical level is referred to as "the diastolic J curve." Although the critical level of diastolic blood pressure where the J curve begins is not certain, increasingly strong evidence from prospective, controlled studies has confirmed the existence of such a J curve. With the likely addition of more patients who will be treated more vigorously, in particular, elderly subjects with isolated systolic hypertension, the potential for an increase in the number of adverse cardiovascular events must be considered and caution used to avoid too low a diastolic blood pressure.
Subject(s)
Blood Pressure , Hemodynamics/physiology , Hypertension/diagnosis , Hypotension/prevention & control , Age Factors , Aged , Blood Pressure Determination , Female , Geriatric Assessment , Humans , Hypertension/drug therapy , Male , Prognosis , Risk Assessment , Safety Management , Severity of Illness IndexABSTRACT
The appearance of cardiovascular events when the diastolic blood pressure is lowered to some critical level is referred to as a "J-curve." Extensive data document the presence of a J-curve appearing when the diastolic blood pressure is lowered by antihypertensive medication to a level below 65 mm Hg, particularly in patients with underlying coronary heart disease even if such disease has not been clinically evident. Caution is needed in the more intensive and widespread treatment of hypertensive patients to avoid a J-curve.