[Show abstract][Hide abstract] ABSTRACT: Heart rate (HR) has been found to be associated with target organ damage in hypertension but the predictive capacity of resting HR vs ambulatory HR in longitudinal studies is not well known. We did a prospective study to investigate whether clinic HR and ambulatory HR assessed at baseline were independent predictors of albumin excretion rate (AER) and microalbuminuria (MA) in the early stage of hypertension.
The study was conducted in a cohort of 621 white stage 1 hypertensive subjects from the HARVEST never treated for hypertension (mean age 33.8 ± 8.4 years, 449 men). Clinic HR was the average of 6 readings. Clinic HR, daytime HR and night-time HR were included separately in linear (for AER) and logistic (for MA) regressions and were adjusted for baseline logAER, age, gender, body mass index, blood pressure, physical activity, smoking, alcohol consumption, and follow-up time.
During a median follow-up of 8.5 years AER increased from a median value of 5.7 mg/24 h to 7.2 mg/24 h (p < 0.001 for log-transformed data), and 42 subjects developed MA (AER > = 30 mg/24 h). In both linear and logistic regressions average night-time HR was an independent predictor of final AER (p = 0.014) and MA (p = 0.007), whereas clinic HR and daytime HR were not associated with these outcomes (p = NS for both). Night-time HR was 62.6 ± 8.3 bpm in the 579 subjects who did not develop MA and was 66.6 ± 7.7 bpm in the 42 subjects who developed MA (p = 0.002). Baseline BMI was another independent predictor of final AER (p = 0.007) and final MA (p = 0.001) and its inclusion into the models slightly attenuated the association of night-time HR with AER (p = 0.029) and MA (p = 0.016).
HR is an independent predictor of microalbuminuria in young persons screened for stage 1 hypertension suggesting that the chronic hemodynamic stress related to tachycardia may play a role in the development of renal damage in hypertension. In agreement with previous results, HR measured during sleep seems to be more representative of the overall hemodynamic load on the arteries than HR measured during waking hours or in the doctor's office.
No preview · Article · Jun 2015 · Journal of Hypertension
[Show abstract][Hide abstract] ABSTRACT: Controversy still exists about the long-term cardiovascular and metabolic effects of coffee consumption in hypertension. Aim of the study was to assess the predictive capacity of coffee use for cardiovascular events (CVE) and to ascertain whether the coffee-CVE association was mediated by the long-term effects of coffee on blood pressure (BP) and glucose metabolism.
The analysis was made in 1201 participants from the HARVEST, a prospective cohort study of non-diabetic subjects aged 18-45 years, screened for stage 1 hypertension. BP was measured with ambulatory monitoring in all.
Among the participants, 26.3% were abstainers, 62.7% were moderate coffee drinkers (1-3 cups/day) and 10.0% were heavy coffee drinkers (>3 cups/day). During a 12.5 year follow-up there were 60 CVE. In multivariable Cox analyses, coffee consumption was a significant predictor of development of hypertension needing treatment with hazard ratios (HR) of 1.5 (CI,1.1-1.9) for heavy drinkers and 1.1 (0.9-1.3) for moderate drinkers compared to abstainers. Also, coffee was a predictor of future prediabetes with HRs of 2.0 (1-3-3.1) and 1.3 (0.9-1.7), in the heavy and moderate drinkers, respectively. In multivariable Cox analyses, including other lifestyle factors, age, sex, parental CVE, BMI, total cholesterol, 24 h ambulatory BP, 24 h ambulatory heart rate and follow-up changes in body weight, both coffee categories were independent predictors of CVE with HRs of 4.3 (1.3-13.9) for heavy coffee drinkers and 2.9 (1.04-8.2) for moderate drinkers. Inclusion of hypertension development in the regression attenuated the strength of the coffee-CVE association with HRs of 3.9 (1.2-12.5) for heavy and of 2.8 (0.99-7.8) for moderate drinkers. When future prediabetes was also incorporated, the relationship was of boderline significance for heavy coffee drinkers (HR, 3.2, 0.94-10.9) and was no longer significant for moderate drinkers (HR, 2.3, 0.8-6.5).
Coffee use is linearly associated with increased risk of CVE in stage 1 hypertension. The effect of coffee on CVE seems to be at least partially mediated by its long-term effects on BP and glucose metabolism. Coffee consumption should be reduced in young-to-middle-age patients with hypertension.
No preview · Article · Jun 2015 · Journal of Hypertension
[Show abstract][Hide abstract] ABSTRACT: Whether and how coffee use influences glucose metabolism is still a matter for debate. We investigated whether baseline coffee consumption is longitudinally associated with risk of impaired fasting glucose in a cohort of 18-to-45 year old subjects screened for stage 1 hypertension and whether CYP1A2 polymorphism modulates this association. A total of 1,180 nondiabetic patients attending 17 hospital centers were included. Seventy-four percent of our subjects drank coffee. Among the coffee drinkers, 87 % drank 1-3 cups/day (moderate drinkers), and 13 % drank over 3 cups/day (heavy drinkers). Genotyping of CYP1A2 SNP was performed by real time PCR in 639 subjects. At the end of a median follow-up of 6.1 years, impaired fasting glucose was found in 24.0 % of the subjects. In a multivariable Cox regression coffee use was a predictor of impaired fasting glucose at study end, with a hazard ratio (HR) of 1.3 (95 % CI 0.97-1.8) in moderate coffee drinkers and of 2.3 (1.5-3.5) in heavy drinkers compared to abstainers. Among the subjects stratified by CYP1A2 genotype, heavy coffee drinkers carriers of the slow *1F allele (59 %) had a higher adjusted risk of impaired fasting glucose (HR 2.8, 95 % CI 1.3-5.9) compared to abstainers whereas this association was of borderline statistical significance among the homozygous for the A allele (HR 1.7, 95 % CI 0.8-3.8). These data show that coffee consumption increases the risk of impaired fasting glucose in hypertension particularly among carriers of the slow CYP1A2 *1F allele.
No preview · Article · Jan 2015 · European Journal of Epidemiology
[Show abstract][Hide abstract] ABSTRACT: Purpose: Aim of this study was to investigate and compare several parameters of arterial distensibility between a group of hypertensives premenopausal women and a group of hypertensive male peers.
Methods: We studied 385 stage 1 hypertensives subjects (280 men and 105 women), from the HARVEST study (mean age 38±10 years). Arterial distensibility was evaluated by applanation tonometry. Between-gender differences were adjusted for several confounders, patient were divided into 3 age classes and differences in arterial distensibility parameters were examined with a 2-way ANCOVA using sex and age-class as factors.
Results: Despite better metabolic profile and lower systolic blood pressure (BP), women showed lower large (C1) and small artery (C2) compliance, higher augmentation index (AIx) and total peripheral resistance (TPR) than men (all age-adjusted p<0.0001); pulse wave velocity (PWV) did not differ between the two genders. When data were adjusted for BP and heart rate (HR), lifestyle habits and metabolic parameters, differences remained highly significant (p<0.0001). However, when height was included in the models, only the differences in C2 and AIx remained significant (p=0.033 and p=0.001, respectively). Other significant determinants of distensibility were: systolic BP and HR for C1 and C2, BMI and age for C2 and AIx, and sedentariness for Aix. The gender-related differences in distensibility parameters did not vary across the age classes, with no significant interaction between age and sex. In both genders C2 and AIx were closely correlated with TPR (all p<0.001).
Conclusions: These data show that height accounts for most of the difference in arterial distensibility parameters between hypertensive men and women. However, after adjustment for height, impairment of C2 and AIx persist in premenopausal hypertensives women, indicating an higher TPR condition.
Preview · Article · Aug 2013 · European Heart Journal
[Show abstract][Hide abstract] ABSTRACT: Glomerular hyperfiltration predicts development of nephropathy in hypertension but the factors responsible for increased glomerular filtration rate (GFR) are not well known. Aim of this study was to examine which clinical variables influence GFR in the early stage of hypertension.
Participants were 1,106 young-to-middle-age hypertensive adults with creatinine clearance >60 ml/min/1.73 m(2). Clinic and ambulatory blood pressures (BPs) were measured and the difference between clinic and 24-h systolic BP was defined as the white-coat effect (WCE). In 606 participants, 24-h urinary epinephrine and norepinephrine were also measured. Glomerular hyperfiltration, defined as a GFR ≥150 ml/min/1.73 m(2), was present in 201 subjects.
Patients' mean age was 33.1 ± 8.5 years and office BP was 146 ± 10.5/94 ± 5.0 mm Hg. In multivariable linear regression, significant predictors of GFR were younger age (P < 0.0001), male gender (P < 0.0001), 24-h systolic BP (P = 0.0001), body mass (P < 0.0001), WCE (P = 0.02), log-epinephrine (P = 0.01), and coffee use (P < 0.01). In a logistic model, independent predictors of glomerular hyperfiltration were obesity (odds ratio, 95% confidence interval = 6.1, 3.8-9.8), male gender (2.9, 1.8-4.9), age <33 years (2.1, 1.5-3.1), ambulatory hypertension (2.0, 1.4-3.0), WCE >15 mm Hg (1.6, 1.1-2.3), heavy coffee use (2.0, 1.1-3.8), and epinephrine >25 mcg/24 h (1.9, 1.2-3.1).
The novel finding of this study is that hyper-reactivity to stress, as determined by urinary epinephrine level and WCE, and coffee use contribute to determining glomerular hyperfiltration in the early stage of hypertension. Our data may help to identify a subset of patients with glomerular hyperfiltration, who may be at increased risk of chronic kidney disease and may benefit from antihypertensive treatment.
No preview · Article · Jun 2012 · American Journal of Hypertension
[Show abstract][Hide abstract] ABSTRACT: We did a prospective study to investigate whether clinic heart rate (HR) and 24-h ambulatory HR were independent predictors of subsequent increase in body weight (BW) in young subjects screened for stage 1 hypertension. The study was conducted in 1,008 subjects from the Hypertension and Ambulatory Recording Venetia Study (HARVEST) followed for an average of 7 years. Ambulatory HR was obtained in 701 subjects. Data were adjusted for lifestyle factors and several confounders. During the follow-up BW increased by 2.1 ± 7.2 kg in the whole cohort. Both baseline clinic HR (P = 0.007) and 24-h HR (P = 0.013) were independent predictors of BMI at study end. In addition, changes in HR during the follow-up either measured in the clinic (P = 0.036) or with 24-h recording (P = 0.009) were independent associates of final BMI. In a multivariable Cox regression, baseline BMI (P < 0.001), male gender (P < 0.001), systolic blood pressure (BP) (P = 0.01), baseline clinic HR (P = 0.02), and follow-up changes in clinic HR (P < 0.001) were independent predictors of overweight (Ov) or obesity (Ob) at the end of the follow-up. Follow-up changes in ambulatory HR (P = 0.01) were also independent predictors of Ov or Ob. However, when both clinic and ambulatory HRs were included in the same Cox model, only baseline clinic HR and its change during the follow-up were independent predictors of outcome. In conclusion, baseline clinic HR and HR changes during the follow-up are independent predictors of BW gain in young persons screened for stage 1 hypertension suggesting that sympathetic nervous system activity may play a role in the development of Ob in hypertension.
[Show abstract][Hide abstract] ABSTRACT: Objective: To examine the effect of dynamic resistance exercise training on blood pressure (BP) and other cardiovascular risk factors in healthy sedentary adults. Design and Methods: Meta-analysis of studies retrieved from four electronic databases as well as cross-referencing from identified articles. Inclusion criteria were as follows: randomized controlled trials; dynamic resistance training of at least 4 weeks was the sole intervention; participants were sedentary normotensive and/or hypertensive adults (≥18 years) with no other concomitant disease; resting systolic and/or diastolic BP were available; and finally the article was published in a peer-reviewed journal up to July 2009. Random effects models weighting for the number of trained participants were used for analysis with data reported as means and 95% confidence limits (CL). Results: 25 randomized controlled trials were included, involving 29 study groups (sg) and 845 men and women (368 controls, 477 exercisers). According to baseline BP, 11 study groups were classified as normotensives, 14 and 4 as prehypertensives and hypertensives, respectively. Resistance training induced a significant net BP reduction of −2.2 (95%CL,−4.3;−0.23)/−3.0;(−4.2;−1.7) mmHg; the BP responses were not significantly different between the three subgroups (P > 0.25). In addition, resistance training significantly increased peak VO2 (+3.2 (+1.5;+4.8) mL.min-1.kg-1 (n = 8 sg), reduced body fat by 0.46 (−0.86;0.053) % (n = 11 sg) and reduced triglycerides by 0.10 (−0.17;−0.043) mmol.L-1 whereas body mass index, total cholesterol, HDL-cholesterol, LDL-cholesterol and fasting glucose remained statistically unaltered (P > 0.05). Conclusions: The meta-analysis suggests that dynamic resistance training may reduce BP and favourably affect some other CV risk factors. However, additional studies are needed especially in the hypertensive populations.
No preview · Article · Jun 2010 · Journal of Hypertension
[Show abstract][Hide abstract] ABSTRACT: The evolution of hypertension (HT) subtypes in young-to-middle-age subjects is unclear.
We did a prospective study in 1,141 participants aged 18-45 years from the HARVEST study screened for stage 1 HT, and 101 nonhypertensive subjects of control during a median follow-up of 72.9 months.
At baseline, 13.8% of the subjects were classified as having isolated systolic HT (ISH), 24.8% as having isolated diastolic HT (IDH), and 61.4% as having systolic-diastolic HT (SDH). All hypertensive groups developed sustained HT (clinic blood pressure > or =140/90 mm Hg from two consecutive visits occurring at least after > or =6 months of observation) more frequently than nonhypertensive subjects (P < 0.001 for all) with adjusted odds ratio of 5.2 (95%CI 2.9-9.2) among the SDH subjects, 2.6 (95%CI 1.5-4.5) among the IDH subjects, and 2.2 (95%CI 1.2-4.5) among the ISH subjects. When the definition of HT was based on ambulatory blood pressure (mean daytime blood pressure > or =135/85 mm Hg, n = 798), odds ratios were 5.1 (95%CI 3.1-8.2), 5.6 (95%CI 3.2-9.8), and 3.3 (95%CI 1.7-6.3), respectively. In the fully adjusted logistic model, the risk of ambulatory HT was smaller for the ISH than the IDH (P = 0.049) or SDH (P = 0.053) individuals.
The present results indicate that young-to-middle-age subjects with ISH have a smaller risk of developing ambulatory HT than either subjects with SDH or IDH. Whether antihypertensive treatment can be postponed for long periods of time in young subjects with mild elevations of clinic systolic BP and low global cardiovascular risk should be examined in further studies.
No preview · Article · Mar 2009 · American Journal of Hypertension
[Show abstract][Hide abstract] ABSTRACT: The longitudinal relationship between coffee use and hypertension is not well known. Aim. We did a prospective study to investigate if there is a temporal relationship between coffee consumption and development of sustained hypertension.
We assessed 1107 white subjects with elevated blood pressure who were followed up for 6.4 years. Coffee intake and other life-style factors were ascertained from regularly administered questionnaires. Incident physician-diagnosed hypertension was the outcome measure.
During the follow-up, 561 subjects developed sustained hypertension, whereas 546 subjects did not meet the criteria for treatment. Coffee drinkers developed sustained hypertension more frequently than abstainers (53.1% versus 43.9%, P = 0.007). The incidence of hypertension did not differ between moderate and heavy coffee drinkers. Kaplan-Meier analysis confirmed that sustained hypertension was developed more frequently by coffee drinkers compared with nondrinkers (P<0.001). The adjusted relative risk of hypertension was greater in both categories of coffee drinking than in abstainers (hazard ratio, 95% confidence limit (CL) = 1.24, 1.06-1.44). The risk of hypertension associated with coffee drinking increased gradually with increasing level of alcohol use (adjusted P for interaction = 0.005).
In subjects screened for stage 1 hypertension a nonlinear association was found between coffee consumption and development of sustained hypertension.
No preview · Article · Jan 2007 · Annals of Medicine
[Show abstract][Hide abstract] ABSTRACT: Factors related to the development of microalbuminuria in hypertension are not well known. We did a prospective study to investigate whether glomerular hyperfiltration precedes the development of microalbuminuria in hypertension. We assessed 502 never-treated subjects screened for stage 1 hypertension without microalbuminuria at baseline and followed up for 7.8 years. Creatinine clearance was measured at entry. Urinary albumin and ambulatory blood pressure were measured at entry and during the follow-up until subjects developed sustained hypertension needing antihypertensive treatment. Subjects with hyperfiltration (creatinine clearance >150 ml/min/1.73 m2, top quintile of the distribution) were younger and heavier than the rest of the group and had a greater follow-up increase in urinary albumin than subjects with normal filtration (P<0.001). In multivariable linear regression, creatinine clearance adjusted for confounders was a strong independent predictor of final urinary albumin (P<0.001). In multivariable Cox regression, patients with hyperfiltration had an adjusted hazard ratio for the development of microalbuminuria based on at least one positive measurement of 4.0 (95% confidence interval (CI), 2.1-7.4, P<0.001) and an adjusted hazard ratio for the development of microalbuminuria based on two consecutive positive measurements of 4.4 (95% CI, 2.1-9.2, P<0.001), as compared with patients with normal filtration. Age, female gender, and 24 h systolic blood pressure were other significant predictors of microalbuminuria. In conclusion, stage 1 hypertensive subjects with glomerular hyperfiltration are at increased risk of developing microalbuminuria. Early intervention with medical therapy may be beneficial in these subjects even if their blood pressure falls below normal limits during follow-up.
Full-text · Article · Sep 2006 · Kidney International
[Show abstract][Hide abstract] ABSTRACT: Resting heart rate has been shown to predict the development of hypertension in general population studies. The purpose of this study was to investigate the relationship between heart rate and long-term changes in heart rate with changes in blood pressure in a cohort of young subjects with mild hypertension.The study was carried out in 1095 subjects who took part in the multicenter HARVEST study. Subjects 18 to 45 years old with diastolic blood pressure (BP) from 90 to 99 mm Hg and/or systolic BP between 140 and 159 mm Hg, who never took antihypertensive therapy, were enrolled. Ambulatory 24h BP was measured at baseline. Urinary epinephrine and nor-epinephrine were measured at entry from 24h urine collections (n=713) and were 25±38 mcg/24h and 91±80 mcg/24h, respectively. Subjects were seen every six months for clinic BP and heart rate assessment to determine which subjects reached the end-point (need for drug therapy according to current guidelines).Clinic BP at entry was 146±11/94±5 mmHg, and clinic heart rate was 75±10 bpm. During a mean follow-up of 78±32 months, BP declined by 2.3±13.9/0.6±9.3 mmHg, and heart rate decreased by 3.0±10.8 bpm. In the subjects divided into tertiles of changes in heart rate, BP decreased by 6.6±13.5/2.9±9.1 mmHg in the bottom heart rate tertile (-14.4 bpm) and increased by 2.3±13.9/1.0±9.6 mmHg in the top tertile (+8.5 bpm). In a multivariable Cox regression analysis, significant predictors of changes in systolic BP were age (p=0.000), baseline heart rate (p=0.000), changes of heart rate over time (p=0.000), clinic systolic BP (p=0.000, negative association), 24h systolic BP (p=0.000), BMI (p=0.003), and gender (p=0.04). A similar model was obtained for changes in diastolic BP. Urinary catecholamines did not predict changes in BP in any model.These findings indicate that besides the resting heart rate also the changes in heart rate over time are predictive of development of more severe hypertension in young subjects with mildly elevated BP levels.
No preview · Article · May 2005 · American Journal of Hypertension
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to evaluate the prevalence of home blood pressure (BP) measurement, the type of devices and accuracy in a large sample of hypertensive patients referred to hospital outpatient hypertension clinics.
Eight hundred and fifty-five consecutive treated hypertensive patients who attended six specialized centers during a period of 4 months were included. They underwent the following procedures: (i) detailed medical interview by a structured questionnaire; (ii) physical examination; (iii) standard 12-lead electrocardiogram; (iv) BP measurements taken by a validated mercury sphygmomanometer and patient's devices.
A total of 640 (74.7%) of 855 patients were regularly performing home BP measurement. These patients were on average younger than those not practising it (58 vs 60 years, p<0.01); men were more numerous than women (58 vs 44%, p=0.03) and had higher educational level. Electronic arm-cuff instruments were the most frequently used devices (58%) followed by wrist devices (19%) and mercury or aneroid sphygmomanometers (23%). Significant correlations were found between BPs measured by validated mercury sphygmomanometers and patients' devices [r=0.85, p<0.0001 for systolic BP (SBP) and r=0.78, p<0.0001 for diastolic BP (DBP)]. Differences 5 mmHg in SBP or DBP were found in 50 and 60% of patients, respectively.
Our findings indicate that: (i) home BP measurement is performed by a majority of treated hypertensives seen in specialized centers; (ii) male gender, age and educational level seem to influence the adoption of home BP monitoring; (iii) electronic arm-cuff devices are the most used instruments; (iv) a notable fraction of patient's devices do not meet the accuracy criteria recommended by US Association for the Advancement of Medical Instrumentation.