Antikainen R, Jousilahti P, Tuomilehto J. Systolic blood pressure, isolated systolic hypertension and risk of coronary heart disease, strokes, cardiovascular disease and all-cause mortality in the middle-aged population
To determine the risk of death from coronary heart disease, stroke, all cardiovascular disease and all-cause mortality associated with systolic blood pressure and in particular with isolated systolic hypertension among the middle-aged population.
A prospective 15-year cohort study of two independent cross-sectional random samples of subjects participating in baseline surveys in 1972 and 1977. Each survey included a self-administered questionnaire, measurements of height, weight and blood pressure and the determination of the serum cholesterol concentration.
North Karelia and Kuopio provinces in eastern Finland. Mortality follow-up complete with the personal identification number.
Participants were 10,333 men and 11,160 women aged 25-64 years without histories of myocardial infarction and stroke incidence at the time of the baseline survey. Isolated systolic hypertension in these analyses was defined as systolic blood pressure > or = 160 mmHg and diastolic blood pressure < 95 mmHg. Subjects with blood pressure < 160/90 mmHg were considered normotensive.
Coronary heart disease, stroke, cardiovascular disease and all-cause mortality among men and women aged 45-64 years increased with the increasing systolic blood pressure. Among women aged 45-64 years, isolated systolic hypertension increased the relative risk of these fatal events. Among men aged 45-64 years, only coronary heart disease mortality was significantly associated with isolated systolic hypertension.
Isolated systolic hypertension is an important predictor of death from coronary heart disease, stroke, cardiovascular disease and all causes for women. For men aged 45-64 years, the risk of death from coronary heart disease was associated with isolated systolic hypertension, but the risk of stroke, cardiovascular disease and all-cause mortality associated with increasing systolic blood pressure was evident already at the systolic blood pressure levels < 160 mmHg, independently of the level of diastolic blood pressure.
"What is more, Meyer et al.  reported significantly higher IMT in children, which may validate congenital character of vascular changes in CoAo. It is important, that the pathological values of peripheral vascular parameters in the study are established risk factors for serious cardiovascular events (stroke, coronary artery disease, general cardiac mortality) [35, 36]. Similar prognostic value was determined for both AP and AI—indicators of increased ASP, reflecting total vascular stiffness . "
[Show abstract][Hide abstract] ABSTRACT: Patients after successful repair of coarctation of aorta (CoAo) are at risk of hypertension at rest and associated end-organ damage. The aim of the study was to assess arterial stiffness and function in adults after coarctation repair in relation to descending aorta (AoD) residual coarctation and patient's age at operation.
85 patients after CoAo repair (53 males) aged 34.6 ± 10.3 years; median age at operation 0.9 ± 8.2 years. The control group-30 individuals (18 males) at mean age 33.6 ± 8.2 years. The following central parameters: augmentation pressure (AP) and augmentation index (AI) as well as peripheral vascular parameters: flow-mediated dilatation (FMD), nitroglycerin-mediated vasodilatation (NMD), intima-media thickness (IMT) and pulse wave velocity (PWV) were measured.
47 CoAo-repaired patients were normotensive, and compared to control, they presented higher values of central parameters AP (7.3 ± 4.6 vs. 4.4 ± 3.6 mmHg; p = 0.002) and AI (18.6 ± 10.4 vs. 13.5 ± 4.3%; p = 0.03); as well as the increased PWV (6.8 ± 1.2 vs. 5.4 ± 0.9 m/s; p = 0.003), while IMT was comparable (0.53 ± 0.01 vs. 0.51 ± 0.01 mm; p = 0.06). The vasodilatation was impaired in the normotensive patients: FMD (4.8 ± 2.8 vs. 8.5 ± 2.3%; p = 0.00003) and NMD (11.3 ± 4.6 vs. 19.8 ± 7.2%; p = 0.00001). The comparison of recoarctation (46, 54%) to non-recoarctation (39, 46%) patients did not reveal any significant differences in resting systolic and diastolic pressures, as well as the values of AI and the peripheral vascular parameters; the value of AP was higher in the recoarctation patients (10.5 ± 6.9 vs. 7.5 ± 4.1; p = 0.02) and correlated positively with the gradient across AoD (r = 0.295, p = 0.01). There was no significant linear correlation between age at the time of surgery and any of peripheral arterial parameters.
Residual stenosis in AoD does not affect the arterial vasodilatation nor stiffness in patients after CoAo repair. Early operation has no impact on peripheral vascular remodeling or central pressure which supports the claim that coarctation of the aorta is a systemic vascular disorder which leads to progressive vascular and end-organ damage despite early correction.
Clinical Research in Cardiology 12/2010; 100(5):447-55. DOI:10.1007/s00392-010-0263-2 · 4.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study was carried out to compare the fasting plasma glucose (FPG) and 2-h plasma glucose (2-h PG) criteria for diabetes with regard to their relation to stroke mortality and the incidence of ischemic and hemorrhagic stroke. In addition, the age-and gender difference in the incidence of coronary heart disease (CHD) and stroke and their relation with known cardiovascular disease risk factors and diabetes mellitus was examined. The study was a sub-data analysis of the Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in Europe (DECODE) study including 25 181 individuals, 11 844 (47%) men and 13 345 (53%) women aged 25 to 90 years, from 14 European cohorts. In individuals without a history of diabetes elevated 2-h post-challenge glucose was a better predictor of stroke mortality than elevated fasting glucose in men, whereas the latter was better than the former in women. Elevated FPG and 2-h PG levels were associated with an increased risk of ischemic stroke incidence. 2-h PG contributed to the risk more strongly than FPG. No relationship between hyperglycemia and the risk of hemorrhagic stroke was found. The risk of CHD and ischemic stroke incidence increased with age in both genders, but was higher in all age groups in men than in women. The gender difference was, however, more marked for CHD than for ischemic stroke. Age, smoking and diabetes contributed to the development of both CHD and ischemic stroke. Elevated cholesterol levels predicted CHD only, whereas elevated blood pressure was a risk predictor for the incidence of ischemic stroke. The CHD and ischemic stroke risk was higher in men than in women with and without diabetes, however, the gender difference diminished for CHD but enlarged for ischemic stroke in diabetic individuals. The known risk factors including diabetes contributed differently to the risk of CHD and ischemic stroke in women and in men. Hyperglycemia defined by FPG or 2-h PG increases the risk of ischemic stroke in individuals without diabetes. FPG better predicts stroke mortality in women and 2-h PG in men. The risk of acute CHD and ischemic stroke is higher in men than in women in all ages, but such gender difference is more marked for CHD than for ischemic stroke. CHD risk is higher in men than in women, but the difference is reduced in diabetic population. Diabetes, however, increases stroke risk more in men than in women in all ages. Ei saatavilla
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