Imputing Observed Blood Pressure for Antihypertensive Treatment: Impact on Population and Genetic Analyses

Rana, Brinda K.; Dhamija, Anish; Panizzon, Matthew S.; Spoon, Kelly M.; Vasilopoulos, Terrie; Franz, Carol E.; Grant, Michael D.; Jacobson, Kristen C.; Kim, Kathleen; Lyons, Michael J.; McCaffery, Jeanne M.; Stein, Phyllis K.; Xian, Hong; O’Connor, Daniel T.; Kremen, William S.

doi:10.1093/ajh/hpt271

Cited by 10 publications

(15 citation statements)

References 45 publications

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“…To account for use of antihypertensive medications, 10mm Hg was added to systolic and diastolic BP measurements. 10–12 Mid arterial BP, a combined measure of systolic and diastolic BP, was calculated as ½ systolic BP+ ½ diastolic BP. 13 …”

Section: Methodsmentioning

confidence: 99%

Longitudinal Patterns of Change in Systolic Blood Pressure and Incidence of Cardiovascular Disease

et al. 2016

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Elevated blood pressure in mid-life contributes significantly to the risk of cardiovascular disease. However, patterns of blood pressure increase may differ among individuals and may result in differential risk. Our goal was to examine the contribution of longitudinal patterns of blood pressure change to incidence of heart failure, coronary heart disease, stroke and cardiovascular disease mortality. Latent class growth models were used to identify patterns of change in blood pressure across 4 clinical examinations (1987–1998) among 9,845 ARIC cohort participants (mean age: 53.7 (SD 5.7) years). Patterns of change in systolic blood pressure included slowly and steeply increasing, a decreasing and a sustained elevated blood pressure. Changes in diastolic and mid blood pressure (½ systolic + ½ diastolic) were less pronounced. The association of blood pressure pattern group membership with incidence of clinical outcomes was examined in follow-up from the fourth clinical examination (1996–1998) through Dec 31, 2011 using Poisson regression models adjusted for demographic and metabolic characteristics, and hypertension medication use. A gradient of rates of all events was observed across the identified patterns. Associations were attenuated after adjustment for covariates. Cumulative systolic blood pressure load rather than the temporal pattern of change in systolic blood pressure itself, plays a role in determining the risk of cardiovascular disease, in particular of heart failure and cardiovascular disease mortality, independent of blood pressure level measured at one point in time.

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Section: Methodsmentioning

confidence: 99%

Longitudinal Patterns of Change in Systolic Blood Pressure and Incidence of Cardiovascular Disease

et al. 2016

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“…Continuous BP measures, rather than categorical hypertension status, were used to increase our power for detecting a genetic covariance. We used medication-corrected ( Rana et al, 2014 ) BP estimates because medication may mask associations of hypertension with genetic status. These were calculated by leveraging data from the larger VETSA sample ( n = 1237) ( Rana et al, 2014 ).…”

Section: Methodsmentioning

confidence: 99%

“…We used medication-corrected ( Rana et al, 2014 ) BP estimates because medication may mask associations of hypertension with genetic status. These were calculated by leveraging data from the larger VETSA sample ( n = 1237) ( Rana et al, 2014 ). Twin analyses were performed using the maximum-likelihood based structural equation modeling software OpenMx ( Boker et al, 2011 , Neale et al, 2016 ).…”

Section: Methodsmentioning

confidence: 99%

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White matter disease in midlife is heritable, related to hypertension, and shares some genetic influence with systolic blood pressure

Fennema-Notestine

McEvoy

Notestine

et al. 2016

NeuroImage: Clinical

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White matter disease in the brain increases with age and cardiovascular disease, emerging in midlife, and these associations may be influenced by both genetic and environmental factors. We examined the frequency, distribution, and heritability of abnormal white matter and its association with hypertension in 395 middle-aged male twins (61.9 ± 2.6 years) from the Vietnam Era Twin Study of Aging, 67% of whom were hypertensive. A multi-channel segmentation approach estimated abnormal regions within the white matter. Using multivariable regression models, we characterized the frequency distribution of abnormal white matter in midlife and investigated associations with hypertension and Apolipoprotein E-ε4 status and the impact of duration and control of hypertension. Then, using the classical twin design, we estimated abnormal white matter heritability and the extent of shared genetic overlap with blood pressure. Abnormal white matter was predominantly located in periventricular and deep parietal and frontal regions; associated with age (t = 1.9, p = 0.05) and hypertension (t = 2.9, p = 0.004), but not Apolipoprotein ε4 status; and was greater in those with uncontrolled hypertension relative to controlled (t = 3.0, p = 0.003) and normotensive (t = 4.0, p = 0.0001) groups, suggesting that abnormal white matter may reflect currently active cerebrovascular effects. Abnormal white matter was highly heritable (a2 = 0.81) and shared some genetic influences with systolic blood pressure (rA = 0.26), although there was evidence for distinct genetic contributions and unique environmental influences. Future longitudinal research will shed light on factors impacting white matter disease presentation, progression, and potential recovery.

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“…Medications were categorized and organized by RLH, KK , MS, and CEF according to mechanism of action and indication. Medication adjustments for BP were based on previous work showing that taking into account drug class, number of antihypertensive drugs, and ethnicity was optimal; depending on these characteristics, values added to SBP/DBP measures ranged from 14‐38/9‐27mmHg, respectively . Based on Wu et al , HDL and triglycerides were adjusted by drug class, ethnicity, and number of statin or fibrate drugs taken.…”

Section: Methodsmentioning

confidence: 99%

A new look at the genetic and environmental coherence of metabolic syndrome components

Panizzon

Hauger

Sailors

et al. 2015

Obesity

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Objective Metabolic syndrome, a clustering of risk factors including insulin resistance, dyslipidemia, central obesity and hypertension, increases risk for cardiovascular disease and cognitive decline. The etiology of the risk factors’ cohesion remains unclear. We examined how genetic and environmental influences explained co-occurrence of metabolic syndrome components. Methods Continuous measures of body mass index (BMI), waist circumference, blood pressure (BP), fasting insulin and glucose, high-density-lipoprotein cholesterol (HDL) and triglycerides from 1193 middle-aged twin men participating in the Vietnam Era Twin Study of Aging at average age 62 (range 56-67) were analyzed using multivariate biometrical modeling. Results We found four heritable factors: adiposity (BMI, waist circumference), insulin resistance (glucose, insulin), lipids (HDL, triglycerides), and BP (systolic, diastolic). Heritabilities were .42-.68. In the best-fitting model, insulin resistance, lipids, and adiposity comprised a higher-order latent genetic factor. Adiposity and BP shared genetic influences independent of the latent genetic factor. All factors aggregated on a latent unique environmental factor. Conclusions Metabolic syndrome components form the equivalent of two genetic factors. BP was genetically unrelated to insulin resistance and lipids. Adiposity was the only characteristic genetically and environmentally related to all other factors. These results inform strategies for gene discovery and prediction of health outcomes.

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Imputing Observed Blood Pressure for Antihypertensive Treatment: Impact on Population and Genetic Analyses

Abstract: This study highlights the potential usefulness of applying a representative adjustment for medication use, such as by considering drug class, ethnicity, and the combination of drugs when assessing the relationship between BP and risk factors.

Cited by 10 publications

References 45 publications

Longitudinal Patterns of Change in Systolic Blood Pressure and Incidence of Cardiovascular Disease

Longitudinal Patterns of Change in Systolic Blood Pressure and Incidence of Cardiovascular Disease

White matter disease in midlife is heritable, related to hypertension, and shares some genetic influence with systolic blood pressure

A new look at the genetic and environmental coherence of metabolic syndrome components

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