Prehypertension and incidence of cardiovascular disease: a meta-analysis

Huang, Yuli; Wang, Sheng; Cai, Xiaoyan; Mai, Weiyi; Hu, Yunzhao; Tang, Hongfeng; Xu, Dingli

doi:10.1186/1741-7015-11-177

Cited by 196 publications

(140 citation statements)

References 41 publications

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“…9 Specifically, a recent large meta-analysis involving about 470,000 participants from 18 prospective cohort studies with SBP of > 120-139 or DBP > 80-89 mm Hg showed patients with these BP levels were at elevated risk of CVD after adjustment of cardiovascular risk factors. 19 The risk was consistent even in the low range of hypertension (SBP of 120-129/80-84 mm Hg). Even mildly elevated BP levels have been also associated with increased risk of carotid atherosclerosis and increased atheroma.…”

Section: Discussionmentioning

confidence: 83%

Association of Severe Obstructive Sleep Apnea and Elevated Blood Pressure Despite Antihypertensive Medication Use

Walia

Rueschman

et al. 2014

Journal of Clinical Sleep Medicine

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Rationale:We hypothesized that untreated severe obstructive sleep apnea (OSA) is associated with elevated ambulatory blood pressure (BP) in subjects with high cardiovascular disease (CVD) risk despite medical management. Methods: Data from the baseline examination of the Heart Biomarker Evaluation in Apnea Treatment (HeartBEAT) study, a 4-site randomized controlled trial were analyzed. Individuals with moderate-severe OSA (apnea hypopnea index, AHI = 15-50) and cardiovascular risk were recruited from cardiology practices. Those with hypertension were included. Intensive antihypertensive regimen (IAR) was defi ned as ≥ 3 antihypertensives including a diuretic. Defi nitions were: controlled BP (BP < 130/80), uncontrolled elevated BP (BP ≥ 130/80 not on IAR) and resistant elevated BP (BP ≥ 130/80 mm Hg despite IAR). Associations of untreated severe OSA (AHI ≥ 30) and uncontrolled and resistant elevated BP were evaluated using logistic regression analyses adjusted for age, sex, race, body mass index, smoking status, diabetes, and CVD. Results: Among the 284 participants (mean age 63.1 ± 7.2 years, 23.6% with severe OSA), 61.6% had controlled BP, 28.5% had uncontrolled elevated BP, and 9.9% had resistant elevated BP. Among participants prescribed IAR, resistant elevated BP was more prevalent in those with severe compared to moderate OSA (58.3% vs. 28.6%, p = 0.01). Participants with severe OSA had a 4-fold higher adjusted odds of resistant elevated BP (OR 4.1, 95% CI: 1.7-10.2), a fi nding not reproduced in the absence of IAR use. Conclusions: Among patients with increased cardiovascular risk and moderate to severe OSA, untreated severe compared to moderate OSA was associated with elevated BP despite IAR suggesting untreated severe OSA contributes to poor BP control despite aggressive medication use. S C I E N T I F I C I N V E S T I G A T I O N SO bstructive sleep apnea (OSA) is characterized by reduction in upper airway muscle tone resulting in repetitive complete (apnea) or partial (hypopnea) upper airway closure during sleep. OSA results in increased sympathetic nervous system activation, changes in baroreceptor function, increased oxidative stress, and endothelial dysfunction, which can increase blood pressure (BP).1-4 Respiratory events during sleep result in acute and transient BP perturbations,5,6 which persist during the daytime. These pathophysiological changes explain the association between OSA and hypertension (HTN) in several large-scale epidemiological studies. 7Elevations in BP including high normal BP often progress to HTN. 8 There are several large-scale epidemiological studies citing the importance of high normal BP and cardiovascular risk. In the Framingham Heart Study, high-normal BP (defi ned as systolic blood pressure of 130-139 or diastolic blood pressure of 85-89 mm Hg) was associated with an approximate 2-fold increased risk factor-adjusted cardiovascular disease (CVD) risk.9 These fi ndings are consistent in cross-ethnic groups. For example, another large prospective study of approximate...

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Section: Discussionmentioning

confidence: 83%

Association of Severe Obstructive Sleep Apnea and Elevated Blood Pressure Despite Antihypertensive Medication Use

Walia

Rueschman

et al. 2014

Journal of Clinical Sleep Medicine

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“…54 Plourde and Karelis 75 based this decision on the fact that prehypertension (also predicts CVD mortality. 147 We agree that pre-hypertension is a risk factor, perhaps also prehypercholesterolemia and other lower cut-points in the rest of MetS criteria, but modifications from the most consensused and accepted definition of MetS hampers future comparability of the data. Likewise, there is evidence supporting than other factors such as hepatic fat markers and low inflammation markers are also important characteristics of the MHO concept.…”

mentioning

confidence: 81%

Obesity and Cardiovascular Disease

Ortega

Lavie

Blair

2016

Circulation Research

829

537

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T here is overall agreement in the scientific and clinical community that obesity is one of the major public health problems of this century. The first documented reports on obesity date from the end of the 19th century and the beginning of the 20th century.1-3 From these days to date, >57 000 articles have been published in PubMed including the term obesity in the title, with these figures being 3× larger when searching by obesity also in the abstract. Figure 1 graphically Abstract: The prevalence of obesity has increased worldwide over the past few decades. In 2013, the prevalence of obesity exceeded the 50% of the adult population in some countries from Oceania, North Africa, and Middle East. Lower but still alarmingly high prevalence was observed in North America (≈30%) and in Western Europe (≈20%). These figures are of serious concern because of the strong link between obesity and disease. In the present review, we summarize the current evidence on the relationship of obesity with cardiovascular disease (CVD), discussing how both the degree and the duration of obesity affect CVD. Although in the general population, obesity and, especially, severe obesity are consistently and strongly related with higher risk of CVD incidence and mortality, the one-sizefits-all approach should not be used with obesity. There are relevant factors largely affecting the CVD prognosis of obese individuals. In this context, we thoroughly discuss important concepts such as the fat-but-fit paradigm, the metabolically healthy but obese (MHO) phenotype and the obesity paradox in patients with CVD. About the MHO phenotype and its CVD prognosis, available data have provided mixed findings, what could be partially because of the adjustment or not for key confounders such as cardiorespiratory fitness, and to the lack of consensus on the MHO definition. In the present review, we propose a scientifically based harmonized definition of MHO, which will hopefully contribute to more comparable data in the future and a better understanding on the MHO subgroup and its CVD prognosis. (Circ Res.

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“…Hypertension plays a leading role in the cause of premature death and disability [12]. Furthermore, it is directly linked to the risk of developing cardiovascular diseases, cerebrovascular diseases, and chronic kidney diseases [13][14][15][16]. Studies reveal that 33% urban and 25% of Indians are hypertensive and only 1-10 th of rural and 1-5 th of urban are on control [17].…”

Section: Discussionmentioning

confidence: 99%

The Relationship Between Blood Pressure and Pupil to Limbus Diameter Ratio in Hypertensive Women: A Pilot Study

Archana

Sailesh

Bashetti

et al. 2017

Asian J Pharm Clin Res

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Objective: This study was undertaken to observe the relationship between blood pressure (BP) and pupil to limbus diameter (PLD) ratio in hypertensive working women.Methods: A total of 30 hypertensive working women were part of the study after obtaining written, voluntary, informed consent, and ensuring confidentiality. PLD ratio was measured by two-box method as described in the literature. Results:Positive correlation was observed between PLD ratio of the right eye (r=0.951) and left eye (r=0.927) and systolic BP. This correlation is statistically significant at 0.01 levels (two tailed). Positive correlation was observed between PLD ratio of the right eye (r=0.844) and left eye (r=0.828) and diastolic BP. This correlation is statistically significant at 0.01 levels (two tailed). Positive correlation was observed between PLD ratio of the right eye (r=0.416) and left eye (r=0.396) and pulse pressure. This correlation is statistically significant at 0.05 levels (two tailed). Positive correlation was observed between PLD ratio of the right eye (r=0.883) and left eye (r=0.844) and mean arterial BP. This correlation is statistically significant at 0.05 levels (two tailed). Positive correlation was observed between PLD ratio of the right eye (r=0.841) and left eye (r=0.819) and pulse rate. This correlation is statistically significant at 0.05 levels (two tailed). Conclusion:Positive correlation was observed between PLD ratio and autonomic parameters. We recommend further detailed studies to utilize the measurement of PLD ratio as an autonomic function test.

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Prehypertension and incidence of cardiovascular disease: a meta-analysis

Cited by 196 publications

References 41 publications

Association of Severe Obstructive Sleep Apnea and Elevated Blood Pressure Despite Antihypertensive Medication Use

Association of Severe Obstructive Sleep Apnea and Elevated Blood Pressure Despite Antihypertensive Medication Use

Obesity and Cardiovascular Disease

The Relationship Between Blood Pressure and Pupil to Limbus Diameter Ratio in Hypertensive Women: A Pilot Study

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