Predictors of New-Onset Diastolic and Systolic Hypertension

Franklin, Stanley S.; Pio, Jose R.; Wong, Nathan D.; Larson, Martin G.; Leip, Eric; Vasan, Ramachandran S.; Levy, Daniel

doi:10.1161/01.cir.0000157159.39889.ec

Cited by 261 publications

(203 citation statements)

References 26 publications

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“…19 Different factors were important for hypertension control in men and women and four gender interactions were found, adding to the bulk of evidence of sex differences in hypertension. 7,9,20,21 Gender differences are common in cardiovascular medicine, which has, for example, led to separate Framingham 10-year risk equations in men and women. 22 A part of the differences may be explained by the different sex hormones.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with uncontrolled hypertension and cardiovascular risk in hypertensive 60-year-old men and women—a population-based study

et al. 2009

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The objective of this study was to describe cardiovascular risk profiles of 60-year-olds with uncontrolled diagnosed hypertension (X140/90 mm Hg) in comparison with individuals with controlled diagnosed hypertension. To study how medical, lifestyle and socioeconomic factors are associated with uncontrolled diagnosed hypertension in men and women separately, a populationbased, cross-sectional study of 4228 60-year-olds in Sweden, of whom 503 men and 445 women had previously diagnosed hypertension, was conducted. Physical examination including measuring blood pressure was carried out, and a medical/lifestyle/ socioeconomic questionnaire was completed. Only 22% of the men and 33% of the women with diagnosed hypertension had a blood pressure below 140/90 mm Hg. Both men and women had multiple cardiovascular risk factors in addition to hypertension. Antihypertensive monotherapy was more common in men and women with controlled hypertension. None of the participants without pharmacological treatment had a controlled blood pressure. Four factors were independently associated with uncontrolled hypertension in men: waist circumference above 97 cm (odds ratio (OR)¼1.85, confidence interval (CI)¼1.17-2.92), coronary heart disease (CHD) (OR¼0.28, CI¼0.17-0.46), no health care for financial reasons (OR¼2.71, CI¼1.09-6.78) and daily intake of fruit (OR¼0.59, CI¼0.37-0.93). In women, three factors remained independently associated: waist circumference above 78 cm (OR¼1.93, CI¼1.09-3.43), CHD (OR¼0.36, CI¼0.18-0.72) and living in an apartment (OR¼0.55, CI¼0.35-0.85). More efforts are warranted to reduce blood pressure and to modulate associated risk factors to be able to reduce the high morbidity and mortality observed in individuals with hypertension. INTRODUCTIONHypertension is a major risk factor for cardiovascular diseases. 1 Antihypertensive treatment has been shown to reduce the occurrence of total major cardiovascular events, and the larger the reduction of blood pressure that is achieved, the larger is the reduction in mortality and cardiovascular events is observed. 2 Despite this established knowledge and benefits of blood pressure reductions, many hypertensive patients do not reach the goal for blood pressure reduction (below 140/90 mm Hg). [3][4][5][6] A recent study reported different factors associated with newly diagnosed high blood pressure in men and women. 7 Risk profiles, lifestyles and metabolic characteristics differed in men and women with normal and newly diagnosed high blood pressure. Cardiovascular risk profile in men and women with hypertension is highly important, as the risk of serious cardiovascular events is higher when additional cardiovascular risk factors are present. 1 A study of hypertensive Americans showed that women have more cardiovascular risk factors

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Section: Discussionmentioning

confidence: 99%

Factors associated with uncontrolled hypertension and cardiovascular risk in hypertensive 60-year-old men and women—a population-based study

et al. 2009

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“…Isolated systolic hypertension is a very special form of hypertension, which is in many respects not comparable with other hypertension forms in younger and middle-aged patients. 19 Symptoms reported by the patients while undergoing antihypertensive treatment could be explained by the adverse events related to the medication, inadequate blood pressure control and the consequent emergence of symptoms of hypertension, or due to interactions with concomitant treatment. 18 The nature of the symptoms and their increasing incidence with the severity of hypertension in this study suggest that these symptoms were the result of inadequate blood pressure control rather than side effects of the medication.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of hypertension-attributed symptoms in routine clinical practice: a general practitioners-based study

Middeke¹,

Schaaf²,

Eckes

2007

J Hum Hypertens

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The objective of the present study was to determine the prevalence of symptoms generally attributed to hypertension and the relationship between symptoms and blood pressure categories. Routine office blood pressure measurement in the morning was obtained and morning symptoms were reported using a standardized questionnaire in a multicenter study from general practitioners in Germany. Dizziness and headaches were significantly (Po0.001) more prevalent in 2154 untreated hypertensives (19.6 and 17.0%) as compared with 1399 normotensives (13.6 and 7.4%), whereas tiredness was less in hypertensives (12.0 vs 17.0%, Po0.01). In untreated and in 52 469 treated hypertensives, the overall prevalence of symptoms increased constantly with blood pressure levels from 26.1% in untreated male patients with mild hypertension to 54.3% of female patients with severe treated hypertension, with a higher prevalence in women ( þ 7% vs men) and in patients with concomitant diseases ( þ 13% vs patients without concomitant diseases). The prevalence of symptoms in older patients with untreated isolated systolic hypertension was not different from younger normotensives. There was a tight positive correlation between systolic and diastolic blood pressure and dizziness (R ¼ 0.73 and 0.76) as well as headaches (R ¼ 0.83 and 0.90) for all blood pressure levels in all patient groups. Typical hypertension-attributed symptoms like dizziness and headaches are more prevalent in hypertensives and they are closely related to blood pressure levels in untreated and treated hypertensives. Morning symptoms in hypertensives may suggest that there is inadequate control of blood pressure. More attention should be paid to perceived symptoms in hypertensives.

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“…The educational subgroups with the highest risk of gestational hypertension had the highest blood pressure values at enrolment, and their increased risk of gestational hypertension was almost entirely explained by factors that are also associated with essential hypertension. 45 These findings suggest that the relatively high risk of gestational hypertension in women with relatively low levels of education may reflect pre-existing hypertensive tendencies that are disclosed by the physiological stress of pregnancy.…”

Section: Implications and Conclusionmentioning

confidence: 90%

Maternal educational level and risk of gestational hypertension: the Generation R Study

et al. 2008

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We examined whether maternal educational level as an indicator of socioeconomic status is associated with gestational hypertension. We also examined the extent to which the effect of education is mediated by maternal substance use (that is smoking, alcohol consumption and illegal drug use), pre-existing diabetes, anthropometrics (that is height and body mass index (BMI)) and blood pressure at enrolment. This was studied in 3262 Dutch pregnant women participating in the Generation R Study, a population-based cohort study. Level of maternal education was established by questionnaire at enrolment, and categorized into high, mid-high, mid-low and low. Diagnosis of gestational hypertension was retrieved from medical records using standard criteria. Odds ratios (OR) of gestational hypertension for educational levels were calculated, adjusted for potential confounders and additionally adjusted for potential mediators. Adjusted for age and gravidity, women with mid-low (OR: 1.52; 95% CI: 1.02, 2.27) and low education (OR: 1.30; 95% CI: 0.80, 2.12) had a higher risk of gestational hypertension than women with high education. Additional adjustment for substance use, pre-existing diabetes, anthropometrics and blood pressure at enrolment attenuated these ORs to 1.09 (95% CI: 0.70, 1.69) and 0.89 (95% CI: 0.50, 1.58), respectively. These attenuations were largely due to the effects of BMI and blood pressure at enrolment. Women with relatively low educational levels have a higher risk of gestational hypertension, which is largely due to higher BMI and blood pressure levels from early pregnancy. The higher risk of gestational hypertension in these women is probably caused by pre-existing hypertensive tendencies that manifested themselves during pregnancy.

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Predictors of New-Onset Diastolic and Systolic Hypertension

Cited by 261 publications

References 26 publications

Factors associated with uncontrolled hypertension and cardiovascular risk in hypertensive 60-year-old men and women—a population-based study

Factors associated with uncontrolled hypertension and cardiovascular risk in hypertensive 60-year-old men and women—a population-based study

Prevalence of hypertension-attributed symptoms in routine clinical practice: a general practitioners-based study

Maternal educational level and risk of gestational hypertension: the Generation R Study

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