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High Blood Pressure: Obesity, Salt, Low Exercise, Low Potassium, and Low Magnesium Causes: In a review of risk factors on blood pressure by meta-regression analysis of randomized trials, published between 1966 and March 2001 in nationwide surveys in the five countries, being overweight made the largest contribution to hypertension, between 11% (Italy) and 25% (USA), 5-13% for physical inactivity, 9-17% for high sodium intake, 4-17% for low potassium intake and 4-8% for low magnesium intake. The impact of alcohol was small (2-3%), for inadequate intake of calcium (2-8%), coffee (0-9%) and fish fatty acids (3-16%). Impact of dietary and lifestyle factors on the prevalence of hypertension in Western populations. Geleijnse JM, Kok FJ, Grobbee DE. Wageningen University, The Netherlands. Eur J Public Health. 2004 Sep;14(3):235-9. Etiology & Risk Factors Acetaminophen, Aspirin, NSAIDs Increase Risk: In a prospective cohort analysis of 16,031 male health professionals without a history of hypertension at baseline, during 4 years of follow-up, 1968 developed hypertension. After adjusting for multiple potential confounders, men who used acetaminophen 6 to 7 days per week compared with nonusers had a 34% increased risk of hypertension (P=.01). For NSAIDs (ibuprofen, etc.), the increased risk was 38% (P=.002) and 26% for aspirin (P<.001). Frequency of analgesic use and risk of hypertension among men. Forman JP, et al. Harvard. Arch Int Med 2007 Feb 26;167(4):394-9. Adiponectin Low in HBP: 426 Japanese men, 9/25/03 57th Annual Fall Conference and Scientific Sessions of the Council for High Blood Pressure Research of the American Heart Association. Yoshio Iwashima, 56yo aver and BMI 23.4. Two hundred and sixty-seven not insulin resistant or diabetic, all HBP. 159 controls. Adiponectin levels in hypertensive men averaged 5.0 g/mL controls averaged 6.2 g/mL, Both systolic and diastolic blood pressure were inversely associated with plasma adiponectin concentration. Earlier studies linked both hypoadiponectinemia and type 2 diabetes to two adiponectin gene polymorphisms: I164T and G276T. Increased risk for hypertension only among men carrying the I164T genotype. Angiotensin receptor blockers can increases circulating adiponectin. Adiponectin is a protein produced exclusively in adipose tissue, occurs in serum in relatively high concentration. It is decreased in obese and in type 2 diabetes. It enhances insulin sensitivity and glucose tolerance, and increases free fatty acid oxidation in muscle. Adiponectin is involved in the regulation of energy homeostasis. ADHD Medications Increase DB in Adults: In a DB PC study of 125 ADHD adults, average age 39, all five ADHD medications used increased blood pressure. Statistically significant changes in systolic blood pressure (bupropion: +5.9 mm Hg, p < .05; amphetamine: +5.4 mm Hg, p < .05), diastolic blood pressure (desipramine: +7.1 mm Hg, p < .05), and heart rate (bupropion: +6.9 mm Hg, p < .05; amphetamine: +7.3 mm Hg, p < .05; methylphenidate: +4.5 mm Hg, p < .05). Blood pressure changes associated with medication treatment of adults with attention-deficit/hyperactivity disorder. Wilens TE, Hammerness PG, et al. Massachusetts General Hospital. J Clin Psychiatry. 2005 Feb;66(2):253-9. Advanced Glycation End-Products Associated with Arterial Stiffness: The formation of advanced glycation end-products is associated with arterial stiffness in experimental models. Alagebrium (formerly known as ALT-711), an advanced glycation end-product cross-link breaker, has been shown to reduce arterial stiffness in elderly subjects. In a study of 30 untreated hypertensive and 16 normotensive subjects, plasma AGEs were significantly higher in hypertensive than in normotensive subjects (7.8 v 3 mug/ml; P < .0001). There was a significant relationship between plasma AGEs and aortic stiffness (r = 0.49, P < .01). In a stepwise regression model age, plasma AGE levels, smoking status, and total cholesterol explained 67% of the variability. Plasma AGEs may play a blood pressure-independent role in large but not small vessel remodeling in essential hypertension. Advanced glycation end-products and arterial stiffness in hypertension. McNulty M, et al. Trinity College, Dublin, Ireland. Am J Hypertension 2007 Mar;20(3):242-7. Atrial Natriuretic Peptide and Corin: Atrial natriuretic peptide (ANP) is a cardiac hormone that regulates blood pressure. In cardiomyocytes, the hormone is synthesized as a precursor, proatrial natriuretic peptide (pro-ANP), which is proteolytically converted to active ANP. Corin is a cardiac transmembrane serine protease that has been shown to process pro-ANP. A lack of corin may cause hypertension. CPAP May Help Hypertension: In patients who tolerated CPAP, the decrease in SBP was greater (-7.3 mmHg; p:0.009). CPAP treatment moreover significantly increased the percentage of patients who recovered the dipper pattern (9.1% vs 12 36.4%; p: 0.004).CPAP treatment significantly reduces SBP, particularly at night, and normalizes the nocturnal pressure pattern in patients with DC-BP and sleep apnea. Eur Respir J 2007 Feb 14. CRP a Hypertention Risk Factor: In a JAMA study by Howard Sesso of Harvard (12/10/03), 21,000 women were followed for eight years. Those with high C-reactive protein (CRP) blood level were 50% more likely to develop high blood pressure even after adjusting for other risk factors like excess weight. High CRP indicates inflammation somewhere in the body. High CRP can make blood vessel walls less flexible. Dipping Blood Pressure at Night Good; 24-Hour Monitoring Helped: Using 24-hour ambulatory blood pressure monitoring on a cohort of 3957 patients, average age 55 with 303 deaths during 27 750 person-years of follow-up, correcting for age, sex, hypertension, and diabetes treatment there was a 32% increased risk of death for awake hypertension (>/=135/85 mm Hg), and 67% for sleep hypertension (>/=120/70 mm Hg). By quintile analysis, the upper fifths of systolic and diastolic dipping during sleep were associated with an adjusted 42% decreased risk (HRs of 0.58) and on 32% decreased risk (HR 0.68). Ambulatory blood pressure predicted mortality significantly better than clinic blood pressure. The availability of blood pressure measures during sleep and, in particular, the pattern of dipping add clinically predictive information and provide further justification for the use of ambulatory monitoring in patient management. Predictors of All-Cause Mortality in Clinical Ambulatory Monitoring. Unique Aspects of Blood Pressure During Sleep. Ben-Dov IZ, et al. Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Hypertension 2007 Mar 26. Hostility, Impatience Linked to HBP; Not Depression, Anxiety, or Achievement Striving: Coronary Artery Risk Development in Young Adults (CARDIA) study, 3,308 18-30yo adults from Birmingham, AL, Chicago, IL, Minneapolis, MN, and Oakland, CA were followed for 15 years. Time urgency/impatience was rated on a scale from 0 to 3-4. After 15 years, participants with the highest score of 3-4 had an 84 percent greater risk of developing high blood pressure and those with the second highest score of 2 had a 47 percent greater risk, compared with those with the lowest score of 0. Hostility was rated on a score of 0 to 50 and then categorized into quartiles. After 15 years, those in the highest quartile had an 84 percent higher risk of hypertension and those in the second highest quartile had a 38 percent higher risk, compared with those in the lowest quartile. JAMA 10/22/03 Narrowed Retinal Arterioles Predict Hypertention: In the Beaver Dam eye study of 2451 normotensive people ages 43 to 84, 721 participants developed hypertension over a 10 year period. Those with lower arteriole:venule ratio in the retinas had a higher cumulative incidence of hypertension (incidences of 17.4%, 24.1%, 31.0%, and 45.1%, respectively, for decreasing quarters of distribution of arteriole:venule ratio). After adjustment for age and sex, participants with arteriole:venule ratios in the lowest quarter had a threefold higher risk of hypertension (odds ratio 2.95) than those with ratios in the highest quarter. This association remained significant after further adjustment for baseline systolic and diastolic blood pressure and other risk factors (1.82). Prospective cohort study of retinal vessel diameters and risk of hypertension. Tien Yin Wong, Anoop Shankar, Ronald Klein, Barbara E K Klein, Larry D Hubbard. University of Melbourne, University of Wisconsin. BMJ 2004;329:79 (10 July) NSAID Pain Pills: Ibuprofen, Acetaminophen Increase HBP: 80,000 female nurses ages 31-50 in a two year follow-up study. The 75% taking ibuprofen or acetaminophen (Tylenol) had 16% greater rate HBP and those taking these medicines over 22 days per month had 100% greater rate. Aspirin no effect. Arch Int Med 10/28/02. NSAID Pain Pills Increase Blood Pressure: In a review of 19 DB studies before May, 2004, with 45,451 participants, COX-2 inhibitors caused an increase in systolic and diastolic BP compared with placebo (3.85/1.06 mm Hg) while nonselective NSAIDs caused an increase as well (2.83/1.34 mm Hg). COX-2 inhibitors caused a 61% increase in hypertension vs a 25% increase with other NSAIDs. Meta-analysis of Cyclooxygenase-2 Inhibitors and Their Effects on Blood Pressure. Aw TJ, Haas SJ, et al. Monash University, Melbourne, Australia. Arch Intern Med. 2005 Feb 14. Ed: While these increases are small, physician refusal to recommend non-prescription alternatives such as glucosamine with chondroitin for arthritis is difficult to understand. Increased Weight Strongly Linked to Increased Hypertension Risk: In the 14.5 year prospective Physicians' Health Study of 13,563 initially healthy, nonhypertensive men , 4920 participants developed hypertension. Higher baseline BMI, even within the "normal" range, was consistently associated with increased risk of hypertension. Compared to participants in the lowest BMI quintile (<22.4 kg/m(2)), the relative risks of developing hypertension for men with a BMI of 22.4 to 23.6, 23.7 to 24.7, 24.8 to 26.4, and >26.4 kg/m(2) were 1.20, 1.31, 1.56, and 1.85, respectively (P <.0001). Further adjustment for diabetes, high cholesterol, and baseline BP did not substantially alter these results. This is a strong gradient between higher BMI and increased risk of hypertension, even among men within the "normal" and mildly "overweight" BMI range. A Prospective Study of Body Mass Index and the Risk of Developing Hypertension in Men. Gelber RP, et al. Harvard. Am J Hypertension 2007 Apr;20(4):370-377. Uric Acid Elevation Predicts Hypertension: Several epidemiological studies have shown a positive association between serum uric acid levels and the risk of hypertension. In a prospective study with 23 years of follow-up of 4,489 adults who did not have hypertension, 289 developed hyptertension. Multivariate analysis found a 48% increased risk in men with hyperuricemia and 90% in women (OR = 1.48 and 1.90(p <0.05, respectively). Hyperuricemia as a predictor of hypertension in a screened cohort in Okinawa, Japan. Nagahama K, et al. University of the Ryukyus, Okinawa, Japan. . Hypertens Res. 2004 Nov;27(11):835-41. Folic Acid Supplements Lower Hypertension Risk: In two 8-year prospective studies of 93,803 younger women ages 27-44 in the Nurses' Health Study II (1991-1999) and 62,260 older women ages 43-70 in the Nurses' Health Study I (1990-1998) without hypertension, 7373 younger women and 12,347 older women developed hypertension. After adjusting for multiple potential confounders, younger women who consumed at least 1000 microg/d of total folate (dietary plus supplemental) had a decreased risk of hypertension (relative risk [RR], 0.54; P <.001) compared with those who consumed less than 200 microg/d. The multivariable RR for the same comparison in older women was 0.82 (P = .05). Among women who did not take folic acid supplements, dietary folate intake of 400 microg/d or more was not significantly associated with risk of hypertension. Folate intake and the risk of incident hypertension among US women. Forman JP, Rimm EB, et al. Harvard. JAMA. 2005 Jan 19;293(3):320-9 Genetics Genetics Determine Which Med to Use: Study of 1162 HBP patients in the Family Blood Pressure Program in Rochester, Minn. Adducin 2 (ADD2) and solute-carrier 9A (SLC9A2) genes may affect BP and measured in all patients. Patients with one particular SNP in their ADD2 gene did better with a beta blocker whereas beta blockers in general did no better than diuretics. Someone whose kidneys are resorbing lots of sodium will do better on a diuretic. Patients with another particular SNP in theirSLC9A2 gene did better on a beta blocker than a RAS inhibitor. Sharon Kardia, Univ Mich. AHA press release 9/25/03 Adducin Polymorphisms: Genetic variability in the ADD1 (Gly460Trp) and ADD2 (C1797T) subunits of the cytoskeleton protein adducin plays a role in the pathogenesis of hypertension, possibly via changes in intracellular cation concentrations. ADD2 1797CC homozygous men have decreased erythrocyte count and hematocrit. J Hum Hypert 2007 Feb 15 Aldosterone plays a major role in the development of both hypertension and heart failure. It is a substrate of the ABCB1 (P-glycoprotein) efflux transporter, whose expression and activity has been shown to be linked to the ABCB1 3435C-->T polymorphism. The ABCB1 3435 genotype affects angiotensin II-stimulated serum aldosterone levels and salt-stimulated urinary sodium excretion. Pharmacogenetic Genomics 2007 Feb;17(2):137-44. Genetic Defects Support Salt’s Harmful Effect: Mendelian forms of hypertension have demonstrated that mutations that increase renal salt balance lead to higher blood pressure. New Amish study of Gitelman's Syndrome shows that mutations that decrease the net salt balance might have the converse effect. Cruz, Yale, Hypertension 2001 Jun;37(6):1458-64 Thomas E. Radecki, M.D., J.D. |