Prevalence of hypertension, and related factors among adults in Wolaita, southern Ethiopia: A community-based cross-sectional study.

INTRODUCTION: Hypertension is a global public health challenge. There is a lack of evidence on the prevalence of hypertension, prehypertension, and related factors among adult populations of Wolaita, southern Ethiopia. AIM: To assess the prevalence of hypertension, prehypertension, and related factors among adult populations of Wolaita, southern Ethiopia. METHODS: A community-based cross-sectional study was conducted on 2483 adult residents, selected using a two-stage random sampling technique. The quantitative data collected from structured questionnaires; anthropometric and biochemical measurements were entered into EpiData version 3.1 using double-entry systems. We determined the weighted prevalence of hypertension and pre-hypertension for the two-stage survey. The multivariate logistic regression analysis was used to assess factors associated with hypertension and carried out after declaring the data set as survey data to account for the effect of clustering. An adjusted coefficient with 95% CI was used to ascertain the significance of the association. RESULTS: The weighted prevalence of hypertension and prehypertension in the Wolaita area was 31.3% (27.7%-35.1%) and 46.4% (42.9%-50.0%) respectively. The weighted prevalence of hypertension of those who were not aware of their hypertension until the time of the survey was 29.8%% (26.5%-33.3%). Where the weighted prevalence of self-reported cases of hypertension was 2.2% (1.2%-3.8%). Obesity, sugar-sweetened food consumption, male sex, elevated total cholesterol, raised fasting blood sugar, and advancing age were positively associated with hypertension. CONCLUSION: The prevalence of hypertension among adults in Wolaita was high. A small proportion of the affected people are aware of their high blood pressure. This study reported a high prevalence of pre-hypertension; which indicates a high percentage of people at risk of hypertension. It is essential to develop periodic screening programs, and primary intervention strategies such as the prevention of obesity, and reduction of sugar-sweetened food consumption.

Prognostic Model of Prehypertension Risk Based on Molecular Markers.

The prognostic models assessing the risk of prehypertension in coming 1-2-year period for 30-60-year-old subjects were developed with the help of computer recognition technology using 6 recognition methods. These models are based on the content of molecular markers in blood serum and the risk factors for the development of prehypertension in men and women who had "optimal" BP for last 3 years and in patients with newly diagnosed prehypertension. The models were compared for their prediction power. The most effective model was obtained with gradient boosting method based on the content of molecular markers. It is characterized with a high predictive power (ROC AUC=0.76), specificity (96.4%), and overall accuracy (86.6%) accompanied with close relationship between prognosis and actual symptoms of prehypertension (p=0.001).

Different exercise training modalities produce similar endothelial function improvements in individuals with prehypertension or hypertension: a randomized clinical trial Exercise, endothelium and blood pressure.

Endothelial dysfunction is a characteristic of systemic arterial hypertension (SAH) and an early marker of atherosclerosis. Aerobic exercise training (AT) improves endothelial function. However, the effects of resistance training (RT) and combined training (CT) on endothelial function remain controversial in individuals with SAH. We determined the effects of AT, RT, and CT on endothelial function and systolic (SBP)/diastolic blood pressure (DBP) in individuals with prehypertension or hypertension. Forty-two participants (54 ± 11 y, resting SBP/DBP 137 ± 9/86 ± 6 mmHg) were randomly allocated into AT (n = 14, 40 min of cycling, 50-75% heart rate reserve), RT (n = 14, 6 resistance exercises, 4 × 12 repetitions, 60% maximum strength) and CT (n = 14, 2 × 12 repetitions of RT + 20 min of AT). All participants performed a 40-minute exercise session twice a week for 8 weeks. Endothelial function was evaluated by brachial artery flow-mediated dilation (FMD). Blood pressure was evaluated through ambulatory monitoring for 24 hours. After 8 weeks of exercise training, blood pressure was reduced in all 3 groups: -5.1 mmHg in SBP (95%CI -10.1, 0.0; p = 0.003) in AT; -4.0 mmHg in SBP (95%CI -7.8, -0.5; p = 0.027) in RT; and -3.2 mmHg in DBP (95%CI -7.9, 1.5; p = 0.001) in CT. All 3 exercise training modalities produced similar improvements in FMD: + 3.2% (95%CI 1.7, 4.6) (p < 0.001) in AT; + 4.0% (95%CI 2.1, 5.7) (p < 0.001) in RT; and +6.8% (95%CI 2.6, 11.1) (p = 0.006) in CT. In conclusion, different exercise training modalities were similarly effective in improving endothelial function but impacts on ambulatory blood pressure appear to be variable in individuals with prehypertension or hypertension.

Hemodynamic Patterns and Target Organ Damage in Adolescents With Ambulatory Prehypertension.

Although the importance of office prehypertension/high normal blood pressure (BP) has been well documented, the significance of ambulatory prehypertension (AmbPreHT) has not been determined. We analyzed markers of target organ damage and hemodynamics in adolescents with AmbPreHT in comparison with hypertensive and normotensive subjects. Out of 304 white patients aged 15.0±2.5 years with office hypertension, 30 children had AmbPreHT and were compared with 66 normotensive healthy children and 92 children with true hypertension (elevated office, ambulatory, and central BP), 22 had ambulatory hypertension (AmbHT), and 70 had severe AmbHT (SevAmbHT). Stroke volume and cardiac output were greater in AmbPreHT compared with patients with normotension but did not differ between AmbPreHT, AmbHT, and SevAmbHT. Similarly, AmbPreHT, AmbHT, and SevAmbHT had similar total peripheral resistance, lower than patients with normotension (P<0.05). Central systolic BP was higher in patients with AmbPreHT, AmbHT, and SevAmbHT compared with normotensives (P<0.01). In all 3 groups, the carotid intima-media thickness Z scores were significantly higher than in normotensive (P<0.001). AmbPreHT and AmbHT patients had higher left ventricular mass index and prevalence of left ventricular hypertrophy compared with normotensive but lower compared with SevAmbHT (P<0.001). Pulse wave velocity Z scores were increased in patients with AmbPreHT, AmbHT, and SevAmbHT compared with patients with normotension (P<0.01). Multiple regression analysis showed that body mass index Z score, central systolic BP, and uric acid levels were significant independent predictors of left ventricular mass index. In conclusion, patients with AmbPreHT presented similar cardiovascular adaptations to those observed in patients with hypertensive and may be at risk of developing cardiovascular events.

Neck circumference as an indicator of elevated blood pressure independent from body composition: implications from the China nation health survey (CNHS).

BACKGROUND: The independent association of neck circumference (NC) on elevated blood pressure is still uncertain in adults of China. The aim of this study is to explore such association and investigate the predictive value of NC on hypertension. METHODS: A total of 4279 adults aged 20-80 years participated in the cross-sectional study in 2014. Anthropometric information, NC, body composition indexes such as waist circumference, hip circumference and body fat percentage, and blood pressure were measured. General linear regression model was used to explore the association between NC and blood pressure; Logistic regression models were fitted to calculate the multi-variable adjusted prevalence, and the association of NC with hypertension. RESULTS: The overall prevalence of hypertension and pre-hypertension were 11.05 and 23.63%, respectively. NC was positively associated with both SBP and DBP (p < 0.001). The adjusted prevalence of hypertension increased with elevated NC quartiles in both sexes (p for trend < 0.001), from 17.81 to 42.93% in male and 9.72 to 21.31% in female. For male, NC was only associated with hypertension (OR: 1.15, 95% CI: 1.05-1.25) but not with pre-hypertension (OR: 0.97, 95% CI: 0.88-1.06). However, in female, NC was associated with both pre-hypertension and hypertension, the BMI adjusted ORs were 1.15 (1.03-1.28) and 1.24 (1.14-1.34). The sex-specific AUCs for NC predicting hypertension were 0.633 in male and 0.663 in female, similar with AUCs of other body fat indexes. CONCLUSIONS: NC was associated with both pre-HTN and HTN independent from other body composition indexes. NC is a simple and useful anthropometric index to identify elevated blood pressure in Chinese adults.

Prehypertension in early versus late pregnancy.

INTRODUCTION: Hypertensive disorders play a significant role in maternal morbidity and mortality. Limited data on prehypertension (preHTN) in pregnancy exist. We examine the risk of adverse outcomes in patients with preHTN in early (<20 weeks) versus late pregnancy (>20 weeks). MATERIALS AND METHODS: Retrospective cohort study of singleton gestations between August 2013 and June 2014. Patients were divided based on when they had the highest blood pressure in pregnancy, as defined per the Joint National Committee 7 (JNC-7). Groups were compared using χ2, Fisher's exact, Student's t-test, and Mann-Whitney U test with p < .05 used as significance. RESULTS: There were 125 control, 95 early preHTN, 136 late preHTN, and 21 chronic hypertension (CHTN). Early preHTN had an increased risk of pregnancy-related hypertension (PRH) (OR 12.26, p < .01) and composite adverse outcomes (OR 2.32, p < .01). Late preHTN had an increased risk for PRH (OR 4.39, p = .02) compared with normotensive and decreased risk for PRH (OR 0.26, p = .02), and composite adverse outcomes (OR 0.379, p = .04) compared with CHTN. Compared with late preHTN, early preHTN had more PRH (OR 2.85, p < .01), and composite adverse outcomes (OR 1.68, p = .04). CONCLUSIONS: Early prehypertension increases the risk of adverse obstetrical outcomes. Other than an increased risk of PRH, patients with late prehypertension have outcomes similar to normotensive women.

Berberine-Promoted CXCR4 Expression Accelerates Endothelial Repair Capacity of Early Endothelial Progenitor Cells in Persons with Prehypertension.

OBJECTIVE: To evaluate whether the berberine treatment can improve endothelial repair capacity of early endothelial progenitor cells (EPCs) from prehypertensive subjects through increasing CXC chemokine receptor 4 (CXCR4) signaling. METHODS: EPCs were isolated from prehypertensive and healthy subjects and cultured. In vivo reendothelialization capacity of EPCs from prehypertensive patients with or without in vitro berberine treatment was examined in a nude mouse model of carotid artery injury. The protein expressions of CXCR4/Janus kinase-2 (JAK-2) signaling of in vitro EPCs were detected by Western blot analysis. RESULTS: CXCR4 signaling and alteration in migration and adhesion functions of EPCs were evaluated. Basal CXCR4 expression was significantly reduced in EPCs from prehypertensive patients compared with normal subjects (P<0.01). Also, the phosphorylation of JAK-2 of EPCs, a CXCR4 downstream signaling, was significantly decreased (P<0.01). Berberine promoted CXCR4/JAK-2 signaling expression of in vitro EPCs (P<0.01). Transplantation of EPCs pretreated with berberine markedly accelerated in vivo reendothelialization (P<0.01). The increased in vitro function and in vivo reendothelialization capacity of EPCs were inhibited by CXCR4 neutralizing antibody or pretreatment with JAK-2 inhibitor AG490, respectively (P<0.01). CONCLUSION: Berberinemodified EPCs via up-regulation of CXCR4 signaling contributes to enhanced endothelial repair capacity in prehypertension, indicating that berberine may be used as a novel potential primary prevention means against prehypertension-related atherosclerotic cardiovascular disease.

The Relationship between Serum Total Bilirubin and Carotid Intima-Media Thickness in Patients with Prehypertension.

AIM: It has been found that serum total bilirubin has a vital role in anti-inflammatory and antioxidant progress. Prehypertension, the intermediate stage between normal blood pressure and hypertension, is linked with subclinical atherosclerosis and target-organ damage. METHODS: This study was designed to evaluate the relationship between total bilirubin and carotid intima-media thickness (cIMT), a marker of subclinical atherosclerosis, in patients with prehypertension. RESULTS: We consecutively enrolled 219 patients with prehypertension. All the participants were divided into two groups according to cIMT values (<0.9 vs. ≥0.9 mm). We found that the increased cIMT group has higher systolic blood pressure, triglyceride and C- reactive protein, but lower total bilirubin compared to the normal cIMT group. The cIMT was negatively correlated with total bilirubin. Multivariate regression analyses revealed total bilirubin was an independent factor for subclinical atherosclerosis. CONCLUSION: This study demonstrated that serum total bilirubin was inversely related with cIMT, and was an independent predictor of subclinical atherosclerosis in patients with prehypertension.

Prehypertension and high serum uric acid increase risk of arterial stiffness.

Prehypertension and serum uric acid are emerging as independent risk factors for arterial stiffness and may also predict cardiovascular diseases. Previous studies have demonstrated the association between serum uric acid and arterial stiffness in hypertensive adults, but there are limited studies in prehypertensive adults. We compared the serum uric acid (SUA) and cardio-ankle vascular index (CAVI) between normotensive and prehypertensive participants. The association between SUA, prehypertension and CAVI were investigated. One hundred and eighteen participants were recruited and divided into two groups according to their blood pressure (normotensive, 53 and prehypertensive, 65). Blood pressure, resting heart rate, pulsatile stress, height, waist circumference and body composition were measured. After an overnight fast, blood samples were collected to measure lipid profile and SUA levels. Arterial stiffness was assessed according to the CAVI. The results showed that the SUA and CAVI of the prehypertensive group were significantly higher than those of the normotensive group. Multiple regression analysis demonstrated that CAVI was significantly correlated with age, systolic blood pressure and SUA. Furthermore, prehypertension and high SUA were significantly associated with increased risk of abnormal CAVI (relative risk, 2.696; 95% CI, 1.552-4.683; p < .001). The study demonstrated that prehypertension and high SUA significantly increased the risk of arterial stiffness as assessed by CAVI.

Subclinical target organ damage in normotensive and prehypertensive patients.

BACKGROUND: Prehypertension is a risk factor for the development of hypertension and other cardiovascular diseases. The objective of this study was to evaluate for the evidence of subclinical target organ damage in two groups of subjects without hypertension. METHODS: This was a prospective cross-sectional study. Subjects seeking care for various clinical conditions in the hospital were invited for the survey. The subjects' were divided in to two groups according to their blood pressure: prehypertension (systolic blood pressure 120 to 139 mm Hg or diastolic blood pressure, 80 to 89 mm Hg) and normotension (systolic blood pressure, <120 mm Hg and diastolic blood pressure, <80 mm Hg). Urine albumin excretion and other biochemical analyses were performed using standard methods. RESULTS: We recruited a total of 3300 subjects, the prehypertension group included 1100 individuals and the normotension group was composed of 2200 persons. The prevalence of microalbuminuria in subjects in the prehypertension group was 6.8% and in those who are the in the optimal BP group was 3.6% (P<0.001). Subjects in the prehypertension group had a mean B-type natriuretic peptide (BNP) level of 98 (72) pg/mL compared with 43.6 (20) pg/mL found among subjects in the normotension group (<0.001). In the logistic regression model, tobacco smoking aOR 2.7 (95% CI.; 1.7-5.8), higher uric acid level aOR 2.2 (1.7-3.2), microalbuminuria 7.6 (4.9-14.7) and a higher BNP level aOR 2.5 (1.8-7.6) were significantly associated with the occurrence of prehypertension. CONCLUSIONS: Microalbuminuria, BNP level and hyperuricemia were significantly associated with prehypertension.

Nicotine Mediates CD161a+ Renal Macrophage Infiltration and Premature Hypertension in the Spontaneously Hypertensive Rat.

RATIONALE: Renal inflammation contributes to the pathophysiology of hypertension. CD161a+ immune cells are dominant in the (SHR) spontaneously hypertensive rat and expand in response to nicotinic cholinergic activation. OBJECTIVE: We aimed to phenotype CD161a+ immune cells in prehypertensive SHR after cholinergic activation with nicotine and determine if these cells are involved in renal inflammation and the development of hypertension. METHODS AND RESULTS: Studies used young SHR and WKY (Wistar-Kyoto) rats. Splenocytes and bone marrow cells were exposed to nicotine ex vivo, and nicotine was infused in vivo. Blood pressures, kidney, serum, and urine were obtained. Flow cytometry, Luminex/ELISA, immunohistochemistry, confocal microscopy, and Western blot were used. Nicotinic cholinergic activation induced proliferation of CD161a+/CD68+ macrophages in SHR-derived splenocytes, their renal infiltration, and premature hypertension in SHR. These changes were associated with increased renal expression of MCP-1 (monocyte chemoattractant protein-1) and VLA-4 (very-late antigen-4). LLT1 (lectin-like transcript 1), the ligand for CD161a, was overexpressed in SHR kidney, whereas vascular cellular and intracellular adhesion molecules were similar to those in WKY. Inflammatory cytokines were elevated in SHR kidney and urine after nicotine infusion. Nicotine-mediated renal macrophage infiltration/inflammation was enhanced in denervated kidneys, not explained by angiotensin II levels or expression of angiotensin type-1/2 receptors. Moreover, expression of the anti-inflammatory α7-nAChR (α7-nicotinic acetylcholine receptor) was similar in young SHR and WKY rats. CONCLUSIONS: A novel, inherited nicotinic cholinergic inflammatory effect exists in young SHR, measured by expansion of CD161a+/CD68+ macrophages. This leads to renal inflammation and premature hypertension, which may be partially explained by increased renal expression of LLT-1, MCP-1, and VLA-4.

Matrix metalloproteinase (MMP)-2 decreases calponin-1 levels and contributes to arterial remodeling in early hypertension.

Increased matrix metalloproteinase (MMP)-2 is implicated in the vascular remodeling of hypertension. Calponin-1 is a contractile protein, and its absence is associated with vascular smooth muscle cell (VSMC) phenotype switch, which leads to migration and remodeling. We evaluated whether increased MMP-2 activity precedes chronic vascular remodeling by decreasing calponin-1 and inducing VSMC proliferation. Sham or two kidney-one clip (2K1C) rats were treated with doxycycline at 30mg/kg/day. Systolic blood pressure was increased in the 2K1C rats after 1 and 2weeks post-surgery, and doxycycline was effective to reduce it only at 2weeks of hypertension (p<0.05). Increased activity of MMP-2 was observed in aortas from 2K1C at 1 and 2weeks of hypertension, followed by increased VSMC proliferation, and those effects were abolished by treating 2K1C rats with doxycycline (p<0.05). Increased aortic media to lumen ratio started to emerge in 2K1C rats at 1week of hypertension, and it was established by 2weeks. MMP-2 and calponin-1 co-localized in the cytosol of VSMC. Aortas from 2K1C rats showed a significant reduction in calponin-1 levels at 1week of hypertension, and doxycycline prevented its loss (p<0.05). However, at 2weeks of hypertension, calponin-1 was upregulated in 2K1C (p<0.05 vs. Sham groups). The mRNA levels of calponin-1 were not altered in the aortas of 2K1C at 1week of hypertension. MMP-2 may contribute to the post-translational decrease in calponin-1, thus culminating in hypertension-induced maladaptive arterial remodeling.

Clinical Characteristics and Renal Histology in Pediatric Patients with Hypertension and Prehypertension Secondary to IgA Nephropathy.

BACKGROUND/AIM: It has been shown that hypertension (HT) and prehypertension (Pre-HT) are associated with increased cardiovascular risk. However, the significance of secondary HT/Pre-HT in children with IgA nephropathy (IgAN) is uncertain. This study aimed to examine the clinical and histopathological features of pediatric patients with HT/Pre-HT. METHODS: Data on children with IgAN from a single Chinese nephrology center were retrospectively reviewed. Morphological changes were evaluated using the Oxford classification, parameters including crescents, glomerular activity index, glomerular chronicity index (GCI), arterial lesions and Lee's grading. The clinical and pathological features were compared according to the occurrence of HT/Pre-HT. RESULTS: One hundred and eight previously untreated children with IgAN were included. HT/Pre-HT was present in 19.44% of children. Children with HT/Pre-HT were older (14.67 ± 2.37 vs. 12.07 ± 2.94 years, p < 0.01) and had higher uric acid (380.62 vs. 301.68 µmol/l, p < 0.01) and lower estimated glomerular filtration rate (eGFR; 89.95 vs. 111.84 ml/min/1.73 m2, p < 0.01). These children also had a higher proportion of segmental glomerulosclerosis or adhesion, GCI, tubular atrophy/interstitial fibrosis and arteriole wall thickening (all p < 0.05). Blood pressure (BP) values were significantly correlated with eGFR, uric acid, segmental glomerulosclerosis or adhesion, tubular atrophy/interstitial fibrosis and arteriole wall thickening (all p < 0.05). In particular, serum uric acid levels had a stronger association with systolic BP (r = 0.434, p < 0.01). CONCLUSION: Our results show that elevated serum uric acid level might be a marker of HT/Pre-HT. In renal histology, chronic lesions were more severe and prevalent in patients with HT/Pre-HT than in those without HT/Pre-HT.

Precursors of Hypertensive Heart Phenotype Develop in Healthy Adults: A High-Resolution 3D MRI Study.

OBJECTIVES: This study used high-resolution 3-dimensional cardiac magnetic resonance to define the anatomical and functional left ventricular (LV) properties associated with increasing systolic blood pressure (SBP) in a drug-naïve cohort. BACKGROUND: LV hypertrophy and remodeling occur in response to hemodynamic stress but little is known about how these phenotypic changes are initiated in the general population. METHODS: In this study, 1,258 volunteers (54% women, mean age 40.6 ± 12.8 years) without self-reported cardiovascular disease underwent 3-dimensional cardiac magnetic resonance combined with computational modeling. The relationship between SBP and wall thickness (WT), relative WT, end-systolic wall stress (WS), and fractional wall thickening were analyzed using 3-dimensional regression models adjusted for body surface area, sex, race, age, and multiple testing. Significantly associated points in the LV model (p < 0.05) were identified and the relationship with SBP reported as mean ß coefficients. RESULTS: There was a continuous relationship between SBP and asymmetric concentric hypertrophic adaptation of the septum and anterior wall that was associated with normalization of wall stress. In the lateral wall an increase in wall stress with rising SBP was not balanced by a commensurate hypertrophic relationship. In normotensives, SBP was positively associated with WT (ß = 0.09) and relative WT (ß = 0.07) in the septal and anterior walls, and this regional hypertrophic relationship was progressively stronger among pre-hypertensives (ß = 0.10) and hypertensives (ß = 0.30). CONCLUSIONS: These findings show that the precursors of the hypertensive heart phenotype can be traced to healthy normotensive adults and that an independent and continuous relationship exists between adverse LV remodeling and SBP in a low-risk population. These adaptations show distinct regional variations with concentric hypertrophy of the septum and eccentric hypertrophy of the lateral wall, which challenge conventional classifications of LV remodeling.

Maternal protein restriction increases respiratory and sympathetic activities and sensitizes peripheral chemoreflex in male rat offspring.

BACKGROUND: Maternal protein restriction in rats increases the risk of adult offspring arterial hypertension through unknown mechanisms. OBJECTIVES: The aims of the study were to evaluate the effects of a low-protein (LP) diet during pregnancy and lactation on baseline sympathetic and respiratory activities and peripheral chemoreflex sensitivity in the rat offspring. METHODS: Wistar rat dams were fed a control [normal-protein (NP); 17% protein] or an LP (8% protein) diet during pregnancy and lactation, and their male offspring were studied at 30 d of age. Direct measurements of baseline arterial blood pressure (ABP), heart rate (HR), and respiratory frequency (Rf) as well as peripheral chemoreflex activation (potassium cyanide: 0.04%) were recorded in pups while they were awake. In addition, recordings of the phrenic nerve (PN) and thoracic sympathetic nerve (tSN) activities were obtained from the in situ preparations. Hypoxia-inducible factor 1α (HIF-1α) expression was also evaluated in carotid bifurcation through a Western blotting assay. RESULTS: At 30 d of age, unanesthetized LP rats exhibited enhanced resting Rf (P = 0.001) and similar ABP and HR compared with the NP rats. Despite their similar baseline ABP values, LP rats exhibited augmented low-frequency variability (∼91%; P = 0.01). In addition, the unanesthetized LP rats showed enhanced pressor (P = 0.01) and tachypnoeic (P = 0.03) responses to peripheral chemoreflex activation. The LP rats displayed elevated baseline tSN activity (∼86%; P = 0.02) and PN burst frequency (45%; P = 0.01) and amplitude (53%; P = 0.001) as well as augmented sympathetic (P = 0.01) and phrenic (P = 0.04) excitatory responses to peripheral chemoreflex activation compared with the NP group. Furthermore, LP rats showed an increase of ∼100% in HIF-1α protein density in carotid bifurcation compared with NP rats. CONCLUSION: Sympathetic-respiratory overactivity and amplified peripheral chemoreceptor responses, potentially through HIF-1α-dependent mechanisms, precede the onset of hypertension in juvenile rats exposed to protein undernutrition during gestation and lactation.

Significantly increased visceral adiposity index in prehypertension.

BACKGROUND: The prevalence of prehypertension has increased in China, and prehypertension frequently progress to hypertension over a short time period; both have become public health problems. Therefore, this study was conducted to determine the relationship between the Visceral Adiposity Index (VAI) and blood pressure (BP) in China. METHODS: A cross-sectional epidemiological survey was conducted in China using a stratified random cluster sampling method. Sex-specific VAI quartile cut-off points were used as follows: 0.88, 1.41, 2.45 in males and 0.85, 1.33, 2.22 in females. Prehypertension and hypertension were each defined according to The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines. A multivariate logistic analysis was conducted to analyze the relationship among VAI, prehypertension and hypertension. RESULTS: The ORs for prehypertension and hypertension in the upper quartiles of the VAI were 1.514 (1.074-2.133), P=0.018 and 1.660 (1.084-2.542), P=0.020, in males, after adjusting for age, education, smoking habits, alcohol consumption, physical activity, serum creatinine, fasting glucose, and plasma insulin. Following further adjustments for the above confounders, chronic kidney disease, and diabetes, the ORs for prehypertension and hypertension in the upper quartile of the VAI were 1.660 1.533 (1.086-2.165), P=0.015, and 1.743 (1.133-2.680), P=0.011, in males. The ORs for prehypertension and hypertension in the upper quartile of the VAI were 1.691 (1.223-2.338), P=0.001, and 1.682 (1.162-2.435), P=0.006, in females, after adjusting for age, education, smoking habits, alcohol consumption, physical activity, serum creatinine, fasting glucose, and plasma insulin. Following further adjustments for the above confounders, chronic kidney disease, and diabetes, the ORs for prehypertension and hypertension in the upper quartile of the VAI were 1.688 (1.220-2.334), P=0.002, and 1.657 (1.141-2.406), P=0.008, in females. CONCLUSIONS: A higher VAI was positively associated with both prehypertension and hypertension in both males and females. It is both essential and urgent that clinicians take steps to control and prevent visceral adiposity.

Prehypertension-associated elevation in circulating lysophosphatidlycholines, Lp-PLA2 activity, and oxidative stress.

Prehypertension is a risk factor for atherosclerosis. We investigated alterations in plasma metabolites that are associated with prehypertension. A group of 53 individuals was identified who remained within the range of prehypertension during repeated measurements in a 3-year period. This group was compared with the control group of 53 normotensive subjects who were matched for age and gender. Metabolomic profiles were analyzed with UPLC-LTQ-Orbitrap mass spectrometry. The prehypertensive group showed higher levels of lysophosphatidylcholines (lysoPCs) containing C14:0, C16:1, C16:0, C18:2, C18:1, C18:0, C20:5, C20:4, C20:3, and C22:6, higher circulating Lp-PLA2 activity, oxidized LDL (ox-LDL), interleukin 6 (IL-6), urinary 8-epi-PGF2α, and higher brachial-ankle pulse wave velocity (ba-PWV), before and after adjusting for BMI, WHR, smoking, alcohol consumption, serum lipid profiles, glucose, and insulin. LysoPC (16:0) was the most important plasma metabolite for evaluating the difference between control and prehypertensive groups, with a variable important in the projection (VIP) value of 17.173, and it showed a positive and independent association with DBP and SBP. In the prehypertensive group, the levels of lysoPC (16:0) positively and significantly correlated with ox-LDL, Lp-PLA2 activity, 8-epi-PGF2α, ba-PWV, and IL-6 before and after adjusting for confounding variables. Prehypertension-associated elevations in lysoPCs, Lp-PLA2 activity, ox-LDL, urinary 8-epi-PGF2α, IL-6, and ba-PWV could indicate increased oxidative stress from Lp-PLA2-catalyzed PC hydrolysis during increased LDL oxidation, thereby enhancing proinflammation and arterial stiffness.

Arterial and retinal vascular changes in hypertensive and prehypertensive adolescents.

INTRODUCTION: Increasing evidence suggests that arterial hypertension (AHT) may begin in childhood and result in the premature development of cardiovascular disease. In view of this, we believed it would be important to investigate the early vascular changes related to early hypertension at the micro- and macrovascular levels both under normal circumstances and after cold-induced sympathetic stimulation. METHODS: In a cohort of 121 adolescent subjects, we measured peripheral and central blood pressure (pBP and cBP, respectively), pulse pressure (PP), and the augmentation index (AIx), as well as retinal vascular diameters, at baseline and during a cold pressor test (CPT). We measured the central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) and calculated the retinal arteriolar-to-venular ratio (AVR). We compared macro- and microvascular alterations among normotensive (NT), prehypertensive (PHT), and hypertensive (HT) adolescents. RESULTS: Of the adolescent subjects in the study, 54.5% were NT, 25.6% were PHT, and 19.8% were HT. With regard to BMI, central systolic BP (cSBP), aortic pulse pressure (AoPP), and CRAE, the PHT adolescents had values similar to those in the HT group but significantly different than those in the NT group. In the studied population, there was a positive and significant correlation of AIx with cSBP and a negative association of CRAE with both cSBP and peripheral SBP (pSBP). We describe the evolution of these parameters during and after sympathetic stimulation. CONCLUSION: As compared with the prevalence of hypertension and prehypertension in large studies, involving teenagers and children, an alarming percentage (45.5%) of the adolescents in our study were HT or PHT. Higher pSBP and cSBP were associated with narrower retinal arterioles but not with changes of arterial elasticity. With particular regard to CRAE, the PHT group was more closely related to the HT group than to the NT group. There were no differences among the NT, PHT, and HT groups in the results of the CPT.

Prehypertension in a Mexican population: influence of age, gender, and body fat.

We studied the association of age, gender, and distribution of body fat with prehypertension in a sample of Mexican adults. This study was performed in a sample of 900 adults (275 men and 625 women), with the median age of 42 years. Resting blood pressure was measured in duplicate, and prehypertension and hypertension were defined according to JNC 7 criteria. The prevalence of hypertension and prehypertension in our population was 11.56% and 26.5%, respectively. The prevalence of prehypertension was significantly higher in men than in women. Prehypertension was associated with middle and old age (odds ratio [OR] = 2.6 and 2.4, respectively, P < .001), abdominal obesity (OR = 1.3, P = .008), upper quintiles of body mass index (OR = 2.05, P = .005), waist (OR = 1.97, P = .01) and hip (OR = 2.04, P = .005) circumferences, and body fat (OR = 2.37, P = .001). The main factors associated with the development of prehypertension are age, central obesity, and body fat.