Abdominal aortic aneurysms (AAA) are fatal in 80% of the cases when ruptured. Hypertension has been considered a potential risk factor for AAA; but the findings from prospective cohort studies have not been entirely consistent, nor have they been summarised in a comprehensive meta-analysis. Our aim was to conduct a systematic review and meta-analysis of cohort studies of the association between blood pressure, hypertension and AAA to clarify the strength and shape of these associations. We searched PubMed and Embase databases for relevant cohort studies up to April 30th, 2018. Random-effects models were used to calculate summary relative risks (RRs) and 95% confidence intervals (CIs). The meta-analysis included 21 cohort studies (20 publications) with data on 28,162 cases and 5,440,588 participants. The findings indicate that the RR of AAA in hypertensive patients is 1.66 times (95% CI: 1.49–1.85, I 2 = 79.3%, n = 13) that of non-hypertensive patients. In addition, there was a 14% (95% CI: 6–23%, I 2 = 30.5%, n = 6) and a 28% (95% CI: 12–46%, I 2 = 80.1%, n = 6) increase in the RR of AAA for every 20 mmHg and 10 mmHg increase in systolic blood pressure (SBP) and diastolic blood pressure (DBP), respectively. The analysis of DBP showed evidence of a strong and highly significant nonlinear dose–response relationship ( p < 0.001) with a steeper association from 80 mmHg and above. This meta-analysis suggests that hypertension increases the risk of developing AAA by 66%. Further studies are needed to clarify the underlying mechanism explaining the much stronger association between DBP and AAA than for SBP. Electronic supplementary material The online version of this article (10.1007/s10654-019-00510-9) contains supplementary material, which is available to authorized users.

Cardiovascular disease is the leading cause of death worldwide, while sudden cardiac death (SCD) accounts for over 60% of all cardiovascular deaths. Elevated blood pressure and hypertension have been associated with increased risk of SCD, but the findings have not been consistent. To clarify whether blood pressure or hypertension is associated with increased risk of SCD and to quantify the size and the shape of any association observed. PubMed and Embase databases were searched for published prospective studies on blood pressure or hypertension and SCD up to 30 April 2018. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using a random effects model. The meta-analysis included 2939 SCDs among 418,235 participants from 18 studies. The summary RRs were 2.10 (95% CI 1.71-2.58, I 2 = 56.7%, p heterogeneity = 0.018, n = 10) for prevalent hypertension, 1.28 (95% CI 1.19-1.38, I 2 = 45.5%, p heterogeneity = 0.07, n = 10) per 20 mmHg increment in systolic blood pressure (SBP) and 1.09 (95% CI 0.83-1.44, I 2 = 83.4%, p heterogeneity = 0.002, n = 3) per 10 mmHg increment in diastolic blood pressure (DBP). A nonlinear relationship was suggested between SBP and SCD. The results persisted in most subgroup and sensitivity analyses. There was no evidence of publication bias. This meta-analysis found an increased risk of SCD with hypertension diagnosis and increasing SBP. Future studies should clarify the association for DBP and the shape of the dose-response relationship between blood pressure and SCD.

Background: Hypertension or elevated blood pressure (BP) is an important risk factor for aortic dissection (AD); however, few prospective studies concerning this topic have been published. We investigated the association between hypertension/elevated BP and AD in two cohorts and conducted a meta-analysis of published prospective studies, including these two studies. Methods: We analyzed data from the Japan Specific Health Checkups (J-SHC) Study and UK Biobank, which prospectively followed 534,378 and 502,424 participants, respectively. Multivariable Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the association of hypertension/elevated BP with AD incidence in the UK Biobank and AD mortality in the J-SHC Study. In the meta-analysis, summary relative risks (RRs) were calculated using random effects models. A potential nonlinear dose-response relationship between BP and AD was tested using fractional polynomial models, and the best-fitting second-order fractional polynomial regression model was determined. Results: In the J-SHC Study and UK Biobank, there were 84 and 182 ADs during 4- and 9-year follow-up, and the adjusted HRs of AD were 3.57 (95% CI, 2.17-6.11) and 2.68 (95% CI: 1.78-4.04) in hypertensive individuals, 1.33 (95% CI: 1.05-1.68) and 1.27 (95% CI: 1.11-1.48) per 20-mmHg increase in systolic BP (SBP), and 1.67 (95% CI: 1.40-2.00) and 1.66 (95% CI: 1.46-1.89) per 10-mmHg increase in diastolic BP (DBP), respectively. In the meta-analysis, the summary RRs were 3.07 (95% CI 2.15-4.38, I2=76.7%, n=7 studies, 2,818 ADs, 4,563,501 participants) for hypertension and 1.39 (95% CI: 1.16-1.66, I2=47.7%, n=3) and 1.79 (95% CI: 1.51-2.12, I2=57.0%, n=3) per 20-mmHg increase in SBP and per 10-mmHg in DBP, respectively. The AD risk showed a strong, positive dose-response relationship with SBP and even more so with DBP. The risk of AD in the nonlinear dose-response analysis was significant at SBP >132 mmHg and DBP >75 mmHg. Conclusions: Hypertension and elevated SBP and DBP are associated with a high risk of AD. The risk of AD was positively dose-dependent, even within the normal BP range. These findings provide further evidence for the optimization of BP to prevent AD.

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Background: The nutritional status of lactating mothers (LMs) is related to their own health and significantly impacts the secretion of breast-milk, and subsequently the growth and development of infants. Due to the influence of regional economy, traditional habits, and lack of nutrition knowledge, the problem of poor dietary nutrition among Chinese LMs is prominent. We aimed to evaluate and compare the dietary and nutrient intakes in LMs from urban and rural areas in China to provide baseline data for the implementation of relevant health guidance and strategies. Methods: A multi-stage sampling method was used to recruit urban and rural LMs from 13 provinces and municipalities in China. An online dietary record using food photographs was employed to keep track of what the LMs had eaten in 2 days in the form of face-to-face interview. A total of 954 participants were included in the final analysis. Data expressed as quartiles P50 (P25; P75) were compared using the Mann-Whitney U-test (level of significance: p < 0.05). Results: The consumption of staple food was higher in the rural (283.37 g/d) than in the urban areas (263.21 g/d). The consumption of vegetables, fruits, fish, shrimp, and shellfish, milk and dairy products was lower than the recommended amounts in both areas, and the insufficient intake of these food types was more serious in rural areas. While the energy intake of 83.8% of all LMs was lower than the estimated energy reference, it was comparable in the urban and rural areas. The intake of macronutrients (carbohydrates, protein, and fats) in rural areas was lower than in urban areas. The intake of some vitamins (VA, VB 1 , VB 2 , VB 9 and VC) and minerals (calcium, magnesium, iodine and copper) was not ideal for LMs in both rural and urban areas. Conclusions: Overall, the dietary intake in LMs was lower than the recommended levels. Many essential nutrients failed to meet the recommended doses, both in the urban and rural areas. The deficiencies in micronutrients were more prevalent in rural compared to urban areas. Educating LMs about women's health and appropriate dietary intake is, therefore, essential.