Pulse Pressure, Prehypertension, and Mortality: The San Antonio Heart Study

Lorenzo, Carlos; Aung, KoKo; Stern, Michael P.; Haffner, Steven M.

doi:10.1038/ajh.2009.151

Cited by 30 publications

(29 citation statements)

References 37 publications

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“…Pulse pressure (PP=SBP-DBP) is an emerging independent risk factor for cardiovascular morbidity (7), and widening of pulse pressure has in the past been attributed to either increased cardiac contractility or diminished vascular compliance (38). Our data indicate that pulse pressure is already increased in prehypertension, and that the change can be attributed to both elevated contractility and diminished vascular compliance, even at this early stage.…”

Section: Discussionmentioning

confidence: 99%

“…The emerging cardiovascular risk factor (7) PP (=SBP-DBP) was already elevated (by ~17.5%) even in prehypertension. Why did this occur?…”

Section: Discussionmentioning

confidence: 99%

“…In the United States alone, up to ~41.9 million men and ~27.8 million women may exhibit prehypertension (2). Prehypertension tends to progress to hypertension over a relatively short time course, and is a risk factor for development of microalbuminuria and cardiovascular disease, with consequently increased mortality (3–7). However, the origins and pathogenesis of the syndrome are not yet well understood.…”

Section: Introductionmentioning

confidence: 99%

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Autonomic and Hemodynamic Origins of Pre-Hypertension

Davis

Rao

Naqshbandi

et al. 2012

Journal of the American College of Cardiology

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Objective To better understand the origins and progression of prehypertension. Background Prehypertension is a risk factor for progression to hypertension, cardiovascular disease and increased mortality. We used a cross-sectional twin study design to probe the role of heredity in likely pathophysiological events (autonomic or hemodynamic) in prehypertension. Methods 812 individuals (337 normotensive, 340 prehypertensive, 135 hypertensive) were evaluated in a sample of twin pairs, their siblings and other family members. They underwent non-invasive hemodynamic, autonomic and biochemical testing, as well as estimates of trait heritability (h2: % of trait variance accounted for by heredity) and pleiotropy (rG: genetic covariance or shared genetic determination of traits) by variance components. Results In the hemodynamic realm, an elevation of cardiac contractility (LV dP/dT max) prompted increased stroke volume, in turn increasing CO, which elevated blood pressure into the prehypertension range. Autonomic monitoring detected an elevation of norepinephrine secretion plus a decline in cardiac parasympathetic tone. Twin pair variance components documented substantial heritability as well as joint genetic determination for blood pressure and the contributory autonomic and hemodynamic traits. Genetic variation at a pathway locus also indicated pleiotropic effects on contractility and blood pressure. Conclusions Elevated blood pressure in prehypertension results from increased CO, driven by contractility as well as heart rate, which may reflect both diminished parasympathetic and increased sympathetic tone. In the face of increased CO, SVR fails to decline homeostatically. Such traits display substantial heritability and shared genetic determination, though by loci not yet elucidated. These findings clarify the role of heredity in the origin of prehypertension and its autonomic and hemodynamic pathogenesis. The results also establish pathways that suggest new therapeutic targets for prehypertension, or approaches to its prevention.

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Section: Discussionmentioning

confidence: 99%

“…The emerging cardiovascular risk factor (7) PP (=SBP-DBP) was already elevated (by ~17.5%) even in prehypertension. Why did this occur?…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Autonomic and Hemodynamic Origins of Pre-Hypertension

Davis

Rao

Naqshbandi

et al. 2012

Journal of the American College of Cardiology

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“…15,16 The prevalence of prehypertension in this Hungarian sample is also considerably higher compared to previously reported prevalence data in non-European countries such as the US and Jamaica, i.e., ~30% of the adult population (both countries). [17][18][19][20] While the association of hypertension with premature CVD morbidity and mortality has been well established, 21 it is now also widely accepted that any increase in BP values represents increased CVD risk, even at BP levels below the ones that are currently used to define hypertension, i.e., SBP ≥140 mm Hg and DBP ≥90 mm Hg. [21][22][23] Regarding the risk of stroke in particular, no lower cut-point of BP levels has been described; the risk is increasing continuously beginning with SBP as low as 115 mm Hg and DBP of 70 mm Hg.…”

Section: Predictors Of Hypertensionmentioning

confidence: 99%

High Prevalence of Prehypertension and Hypertension in a Working Population in Hungary

Sonkodi¹,

Sonkodi²,

Steiner

et al. 2012

American Journal of Hypertension

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A high proportion of relatively young and apparently healthy Hungarian employees were diagnosed with prehypertension and hypertension. Only a small proportion of HTN had their BP controlled. BMI and HR were significantly higher among individuals with prehypertension compared to NT. Whether the high rates of hypertension, prehypertension, and low levels of control explain the high stroke mortality and unfavorable cardiovascular disease (CVD) profile of Hungary needs further study.

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“…In the United States alone, up to ~41.9 million men and ~27.8 million women may exhibit prehypertension (2). Prehypertension tends to progress to hypertension over a relatively short time course, and is a risk factor for development of microalbuminuria and cardiovascular disease, with consequently increased mortality (3)(4)(5)(6)(7). However, the origins and pathogenesis of the syndrome are not yet well understood.…”

Section: Introductionmentioning

confidence: 99%

Autonomic and Hemodynamic Origins of Prehypertension: Central Role of Heredity

2012

American Journal of Kidney Diseases

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Pulse Pressure, Prehypertension, and Mortality: The San Antonio Heart Study

Cited by 30 publications

References 37 publications

Autonomic and Hemodynamic Origins of Pre-Hypertension

Autonomic and Hemodynamic Origins of Pre-Hypertension

High Prevalence of Prehypertension and Hypertension in a Working Population in Hungary

Autonomic and Hemodynamic Origins of Prehypertension: Central Role of Heredity

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