Cardiovascular Phenotype of Elevated Blood Pressure Differs Markedly Between Young Males and Females

Nardin, Chiara; Mäki-Petäjä, Kaisa; Miles, K.; Yasmin, Yasmin; McDonnell, Barry J.; Cockcroft, John R.; Wilkinson, Ian B.; McEniery, Carmel M.; Benedict, Samantha; Dhakam, Zahid; Day, Lisa; Hickson, Stacey S.; Middlemiss, Jessica; Munnery, Margaret; Pusalkar, Pawan; Retallick, Christopher; Sabit, Ramsey; Sharman, James E.; Smith, Jane; Woodcock-Smith, J.; Thomas, Edna; Wallace, Sheila J.

doi:10.1161/hypertensionaha.118.11975

Cited by 42 publications

(30 citation statements)

References 28 publications

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“…Although ongoing studies for young adults are currently being investigated, most are still at the initial stages and the long term impact on cardiovascular end points remains to be determined. 56 57 58 Therefore, the insights provided in our study could help to refine strategies for primary prevention and might have important implications for future research.…”

Section: Discussionmentioning

confidence: 89%

“…Without a defined association between high blood pressure and cardiovascular risks, developing and implementing standardised treatment advice and guidelines that include young adults is challenging. Although ongoing studies for young adults are currently being investigated, most are still at the initial stages and the long term impact on cardiovascular end points remains to be determined 565758. Therefore, the insights provided in our study could help to refine strategies for primary prevention and might have important implications for future research.…”

Section: Discussionmentioning

confidence: 90%

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Association between high blood pressure and long term cardiovascular events in young adults: systematic review and meta-analysis

Luo

Cheng

Zhang

et al. 2020

BMJ

128

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ObjectiveTo evaluate and quantify the future risk of cardiovascular events in young adults with high blood pressure.DesignSystematic review and meta-analysis.Data sourcesMedline, Embase, and Web of Science were searched from inception to 6 March 2020. Relative risks were pooled using a random effects model and expressed with 95% confidence intervals. Absolute risk difference was calculated. Dose-response relations between blood pressure and individual outcomes were assessed by a restricted cubic spline model.Eligibility criteria for selecting studiesStudies were selected that investigated the adverse outcomes of adults aged 18-45 with raised blood pressure. The primary study outcome was a composite of total cardiovascular events. Coronary heart disease, stroke, and all cause mortality were examined as secondary outcomes.ResultsSeventeen observational cohorts consisting of approximately 4.5 million young adults were included in the analysis. The average follow-up was 14.7 years. Young adults with normal blood pressure had increased risk of cardiovascular events compared with those with optimal blood pressure (relative risk 1.19, 95% confidence interval 1.08 to 1.31; risk difference 0.37, 95% confidence interval 0.16 to 0.61 per 1000 person years). A graded, progressive association was found between blood pressure categories and increased risk of cardiovascular events (high normal blood pressure: relative risk 1.35, 95% confidence interval 1.22 to 1.49; risk difference 0.69, 95% confidence interval 0.43 to 0.97 per 1000 person years; grade 1 hypertension: 1.92, 1.68 to 2.19; 1.81, 1.34 to 2.34; grade 2 hypertension: 3.15, 2.31 to 4.29; 4.24, 2.58 to 6.48). Similar results were observed for coronary heart disease and stroke. Generally, the population attributable fraction for cardiovascular events associated with raised blood pressure was 23.8% (95% confidence interval 17.9% to 28.8%). The number needed to treat for one year to prevent one cardiovascular event was estimated at 2672 (95% confidence interval 1639 to 6250) for participants with normal blood pressure, 1450 (1031 to 2326) for those with high normal blood pressure, 552 (427 to 746) for those with grade 1 hypertension, and 236 (154 to 388) for those with grade 2 hypertension.ConclusionsYoung adults with raised blood pressure might have a slightly increased risk of cardiovascular events in later life. Because the evidence for blood pressure lowering is limited, active interventions should be cautious and warrant further investigation.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 90%

Association between high blood pressure and long term cardiovascular events in young adults: systematic review and meta-analysis

Luo

Cheng

Zhang

et al. 2020

BMJ

128

View full text Add to dashboard Cite

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“…In most studies increased CO has been positively associated with elevated BP [ 16 , 24 , 28 ]. There are also some data supporting gender differences in the contribution of increased cardiac output to hypertension; an analysis from the ENIGMA cohort in young adults showed that males with hypertension tended towards a ‘cardiac’ phenotype, with elevated HR, SV and CO [ 29 ]. Females on the other hand tended towards increased SVR and pulse wave velocity (PWV, a measure of arterial stiffness) described as a ‘vascular’ phenotype.…”

Section: Determinants Of the Static Component Of Bpmentioning

confidence: 99%

Haemodynamics of Hypertension in Children

Haseler

Chowienczyk

et al. 2020

Curr Hypertens Rep

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Purpose of Review To review the haemodynamic characteristics of paediatric hypertension. Recent Findings Pulsatile components of blood pressure are determined by left ventricular dynamics, aortic stiffness, systemic vascular resistance and wave propagation phenomena. Recent studies delineating these factors have identified haemodynamic mechanisms contributing to primary hypertension in children. Summary Studies to date suggest a role of cardiac over activity, characterized by increased heart rate and left ventricular ejection, and increased aortic stiffness as the main haemodynamic determinants of primary hypertension in children.

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“…Определение уровня жесткости сосудистой стенки по величине Alp% для оценки прогноза больных АГ проводилось в работах как отечественных [7,13], так и зарубежных авторов [15][16][17]. В настоящем исследовании были выявлены прямые корреляции Alp% со степенью атеросклеротического поражения сосудов: количеством АСБ, толщиной КИМ.…”

Section: Discussionunclassified