Predictors of Significant Short-Term Increases in Blood Pressure in a Community-Based Population

doi:10.1016/j.amjmed.2007.06.021

The American Journal of Medicine

Volume 120, Issue 11, November 2007, Pages 960-967

https://doi.org/10.1016/j.amjmed.2007.06.021 Get rights and content

Abstract

Background

Blood pressure predicts the risk of cardiovascular disease events in a linear, graded manner. Factors associated with significant short-term increases in blood pressure are not well established. We aimed to identify predictors of a significant increase in blood pressure over a 1-year period among nonhypertensive, community-dwelling adults.

Methods

From the community-based Heart Strategies Concentrating on Risk Evaluation study, 509 nonhypertensive adults (mean age 58 years; 68% were female; 24% were black) had baseline and 1-year assessments of blood pressure. Demographics, medical history, anthropometrics, lipids/lipoproteins, physical activity, and psychologic status were measured at both intervals. A “significant” increase in blood pressure was defined as an increase in systolic blood pressure of greater than 20 mm Hg, diastolic blood pressure of greater than 10 mm Hg, or initiation of antihypertensive medication.

Results

At 1 year, 22% of participants had a significant increase in blood pressure. In multivariable analysis, baseline body mass index (BMI) and a greater than 5% increase in weight or waist circumference were associated with a significant increase in blood pressure (adjusted relative risk 2.09; 95% confidence interval, 1.35-3.21). The adverse effect of an increase in weight and waist circumference on blood pressure was evident in subgroup analyses by age, race, baseline BMI, and regular exercise.

Conclusions

Baseline BMI and a greater than 5% increase in weight or waist circumference over 1 year are associated with a significant increase in blood pressure. These data emphasize the need for weight maintenance. They also serve to stratify individuals who may benefit from close clinical observation and preventive intervention.

Section snippets

Source Population

The source population consists of 2000 participants enrolled in the Heart SCORE study. Heart SCORE is an ongoing single-center, prospective, community-based participatory research cohort study. Baseline enrollment began on June 16, 2003 and was completed on October 11, 2006. Eligibility criteria include age 45 to 75 years, residence in the greater Pittsburgh metropolitan area, ability to undergo baseline and annual follow-up visits, and absence of known comorbidities expected to limit life

Results

At baseline, 202 of the 509 study participants (39.7%) had normal blood pressure and the remaining 307 participants (60.3%) were prehypertensive. By using the primary outcome definition, 114 of the 509 participants (22.4%) experienced a clinically “significant” increase in blood pressure from the baseline to 1-year assessment. This included 18 participants (3.5%) with an increase in systolic blood pressure of greater than 20 mm Hg, 56 participants (11.0%) with an increase in diastolic blood

Discussion

Our results indicate that in a diverse community cohort of nonhypertensive individuals, baseline BMI and changes in weight and/or waist circumference over a 1-year period are independent predictors of a significant increase in blood pressure. These findings extend previous associations between weight and blood pressure5, 6 because they indicate that regardless of baseline BMI, increases in weight and/or waist circumference are independent predictors of increases in blood pressure over 1 year.

Conclusion

Our results demonstrate that baseline BMI and 1-year changes in weight and waist circumference are independent predictors of a clinically significant increase in blood pressure over 1 year among individuals without hypertension. Moreover, these variables remain predictive across race, gender, and all classes of BMI. These findings serve to stratify individuals who may benefit from close clinical observation and preventive intervention as published in previously conducted trials.21, 22

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To investigate the influence of fluorescein angiography (FA) on blood pressure (BP) in patients with retinal diseases, and analyze the predictive factors for acute elevation of systolic BP after FA.
and Methods: A prospective study was conducted with 636 patients undergoing FA between April 2021 and October 2021. BP and pulse were measured in each patient before and 20 min after FA. The baseline characteristics of patients who developed an acute elevation in systolic BP (>10 mmHg) were compared with those of the remaining patients to detect factors that may predict this acute elevation.
Overall, mean systolic BP changed from 142 ± 17 mmHg to 140 ± 20 mmHg after 20 min (p = 0.1). Mean diastolic BP changed from 79 ± 15 mmHg to 78 ± 13 mmHg after 20 min (p = 0.45). Mean pulse rate changed from 73 ± 14 bpm to 70 ± 12 bpm after 20 min (p = 0.001). 103 patients (16 %) had acute elevation of systolic BP (>10 mmHg). Mean systolic BP changed from 143 ± 17 mmHg to 162 ± 19 mmHg after 20 min in this group (p = 0.001). Patients in this group were significantly older compared to the rest (73 ± 12 vs 67 ± 15, p = 0.001). The rate of chronic renal failure was significantly higher in this group compared to the rest of the patients (42/7.8 % vs 15/14.6 %, p = 0.01).
This study demonstrated that fluorescein angiography is a relatively safe procedure with regards to blood pressure changes. However, chronic renal failure could be considered as predictive factor for acute elevation of systolic blood pressure after this procedure.
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Citation Excerpt :
All subjects provided written informed consent. The Heart Strategies Concentrating on Risk Evaluation study has been previously described.5,6 Briefly, this community-based participatory study began in 2003 in Allegheny County, PA with aims to improve risk stratification, identify racial disparities, and evaluate mechanisms for population differences in CVD.
To further reduce the burden of cardiovascular disease (CVD) and expand prevention efforts, the American Heart Association (AHA) introduced in 2010 the concept of Ideal Cardiovascular Health (ICH), which includes 7 metrics (smoking status, body mass index, physical activity, diet, total cholesterol, blood pressure, and fasting plasma glucose). Limited data exist on the relation between ICH and long-term CVD risk. The Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) study cohort was used to examine the relation between ICH and incident major adverse cardiovascular events (MACE: first occurrence of death, myocardial infarction, stroke, acute ischemic syndrome, or coronary revascularization). The 7 factors of the ICH were scored at study entry on a 0 to 2 scale, resulting in possible range of 0 to 14, with higher scores representing “better” health. Cox regression analyses were used to estimate hazard ratios (HR) of MACE, along with 95% confidence intervals. Over a median follow-up of 12 years, the study population (n = 1,863, 67% women, 42% Black race, mean age 59 years [range 45 to 75]) had 218 MACE. In unadjusted analysis, the ICH score (per 1 unit) was associated with an estimated 12% lower risk of MACE (HR [95% Confidence Interval]: 0.88 [0.82, 0.93]). Adjusting for demographics, education, and quality of life, ICH score was associated with a 10% lower risk of MACE (HR 0.90 [0.84, 0.96]). In a community-based sample of adults, the AHA ICH construct, which includes 7 modifiable CVD risk factors, appears to be a valid measure for predicting long-term risk of MACE.
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We used data from a Swedish population-based sample of 5857 women, aged 50–64 years. Data on VMS and potential confounders were collected by questionnaires.
Body mass index (BMI), waist hip ratio (WHR), glucose, blood pressure, lipid profile and estradiol levels were measured.
Symptoms of flushing/sweats were reported by 55% and sweats by 31% of all women. Estradiol concentrations were significantly lower in women with VMS. After multivariate adjustment, women with symptoms of sweats had a statistically significantly higher BMI, waist hip ratio, total cholesterol level, LDL level, triglycerides level, glucose level, systolic and diastolic blood pressure. These patterns did not change after correction for estradiol. The associations between flushing/sweats combined and cardiovascular risk factors were less pronounced.
Women with VMS have a less favorable cardiovascular risk profile. Although estradiol levels were significantly lower among women with VMS, the increased cardiovascular risk profile cannot be explained by circulating estradiol levels.
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The authors have no conflict of interests to report.

This project is funded in part by a grant with the Pennsylvania Department of Health (Contract ME-02-384). The department specifically disclaims responsibility for any analyses, interpretations, or conclusions.

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Clinical Research StudyPredictors of Significant Short-Term Increases in Blood Pressure in a Community-Based Population

Abstract

Background

Methods

Results

Conclusions

Section snippets

Source Population

Results

Discussion

Conclusion

Am Heart J

Lancet

Am J Hypertens

Am J Hypertens

Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

JAMA

Is the relation of systolic blood pressure to risk of cardiovascular disease continuous and graded, or are there critical values?

Hypertension

Associations of fat distribution and obesity with hypertension in a bi-ethnic population: The ARIC Study

Obes Res

Associations between weight gain and incident hypertension in a bi-ethnic cohort: the Atherosclerosis Risk in Communities Study

Int J Obes Relat Metab Disord

A longitudinal study of hypertension risk factors and their relation to cardiovascular disease: The Strong Heart Study

Hypertension

High-normal blood pressure progression to hypertension in the Framingham Heart Study

Hypertension

The sixth report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure

Arch Intern Med

Clinical Research Study
Predictors of Significant Short-Term Increases in Blood Pressure in a Community-Based Population