A Longitudinal Study of Hypertension Risk Factors and Their Relation to Cardiovascular Disease: The Strong Heart Study
Abstract
This study estimated hypertension incidence and explored hypertension risk factors and their association with cardiovascular disease. Data collected from 4549 American Indian participants in the 3 exams of the Strong Heart Study were used. Hypertension was defined as systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or current use of antihypertensive medication. Generalized linear models were used to identify the risk factors for hypertension and the correlates of blood pressures. Cox proportional models with time-dependent covariates and the mixed models were used to explore the association of hypertension with cardiovascular disease. There was no sex difference in hypertension. After adjustment for other risk factors, the risks of developing hypertension among subgroups in each characterized group were as follows: prehypertensive versus normotensive, 3.21 times; macroalbuminuria and microalbuminuria versus normal, 3.47 and 1.72; diabetic versus nondiabetic, 1.56; overweight and obese versus normal weight, 1.30 and 1.51; and current alcohol drinking versus not, 1.22. Moreover, systolic blood pressure was significantly and positively associated with age, obesity, and albuminuria and negatively with smoking. After adjusting all other risk factors, those pretreated, untreated, controlled, and uncontrolled hypertensive participants had &1.74, 1.81, 2.19, and 2.77 times higher risks of developing cardiovascular disease compared with normotensive participants, respectively. In 45- to 74-year-old American Indians, the risk of developing hypertension was rising. Prehypertensive participants had 3.2/1.74 times higher risk of developing hypertension/cardiovascular disease than normotensive participants. Age, diabetes, and macro/microalbuminuria were independently significant risk factors of both hypertension and cardiovascular disease.
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In most studies examined, peak reduction in BP compared with baseline occurred at 2-3 h after consumption of dietary nitrate, which is the same time at which peak plasma nitrite concentrations have been observed.
“In most of the studies examined, peak reduction in BP compared with baseline occurred at 2-3 h after the consumption of dietary nitrate, which is the same time at which peak plasma nitrite concentrations have been observed (81,82,86,87,89,92) ,”
From The effects of dietary nitrate on blood pressure and endothelial function: a review of human intervention studies (2013) · cites this paper as [86]
Lower doses of dietary nitrate (100 g, 2 mmol) reduce diastolic BP.
“In addition, lower doses of dietary nitrate (100 g, 2 mmol) were shown to reduce DBP (86) , suggesting that even relatively small doses, that are easily achievable in the diet, have BP-lowering effects.”
From The effects of dietary nitrate on blood pressure and endothelial function: a review of human intervention studies (2013) · cites this paper as [86]
Dietary nitrate present in beetroot was responsible for the BP-lowering effects, whereas betalains had minimal effect.
“suggesting that dietary nitrate present in the beetroot was responsible for the BP-lowering effects, whereas betalains had minimal effect.”
From The effects of dietary nitrate on blood pressure and endothelial function: a review of human intervention studies (2013) · cites this paper as [86]
There were no significant differences in BP reduction between bread enriched with 100 g red or white beetroot (both 2 mmol nitrate).
“The results of the study showed that there were no significant differences in BP reduction between bread enriched with 100 g red or white beetroot (both 2 mmol nitrate) (86) ,”
From The effects of dietary nitrate on blood pressure and endothelial function: a review of human intervention studies (2013) · cites this paper as [86]
Ingestion of three doses of beetroot juice (100, 250 and 500 g containing 2, 6 and 11 mmol nitrate) dose-dependently reduced systolic BP over 24 h, with dose-dependent effects less apparent for diastolic BP.
“The study by Hobbs et al. (86) demonstrated that the ingestion of three doses of beetroot juice (100, 250 and 500 g containing 2, 6 and 11 mmol nitrate, respectively) dosedependently reduced SBP over a period of 24 h, with dose-dependent effects being less apparent for DBP.”
From The effects of dietary nitrate on blood pressure and endothelial function: a review of human intervention studies (2013) · cites this paper as [86]
In healthy normotensive subjects, acute dietary nitrate from beetroot juice and inorganic salts has a dose-dependent effect on peak change in systolic blood pressure (R2=0.45, P=0.033).
“For systolic BP, R 2 0•45 (P¼0•033); for diastolic BP, R 2 0•27 (P¼ 0•233).”
From The effects of dietary nitrate on blood pressure and endothelial function: a review of human intervention studies (2013) · cites this paper as [86]
In healthy normotensive subjects, acute dietary nitrate from beetroot juice and inorganic salts does not have a significant dose-dependent effect on peak change in diastolic blood pressure (R2=0.27, P=0.233).
“For systolic BP, R 2 0•45 (P¼0•033); for diastolic BP, R 2 0•27 (P¼ 0•233).”
From The effects of dietary nitrate on blood pressure and endothelial function: a review of human intervention studies (2013) · cites this paper as [86]
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Decreasing Association Between Body Mass Index and Blood Pressure Over Time
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Effects of Physical Exercise on Endothelial Function and DNA Methylation
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“smoking and development of hypertension [12,13],”
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“Following ribo fl avin intervention (1 · 6mg/d for 16 weeks), systolic BP decreased signi fi cantly, a fi nding which con fi rmed that the BP-lowering effects of ribo fl avin in individuals with the MTHFR 677TT genotype were not con fi ned to high-risk CVD patients but also applied to hypertensive individuals generally (51)…”
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BackgroundInfluentialNo association between perfluoroalkyl chemicals and hypertension in children
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“Urban populations have greater access to fast foods [32,33] and tend to lead a sedentary lifestyle [34] that contribute to the rising prevalence of obesity, an important risk factor of hypertension [35,36].”
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“H ypertension (HTN) is the main risk factor leading to cardiovascular events.(1) In addition, type 2 diabetes mellitus (T2DM) and different phenotypes of glucose intolerance are rising globally, resulting in a higher incidence and burden of their complications.”
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Postgraduate Symposium The MTHFR C677T polymorphism, B-vitamins and blood pressure
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“High blood pressure or hypertension, defined as a blood pressure (BP) of >140/90mmHg((1)), is a major risk factor for CVD, with subjects with uncontrolled hypertension being at approximately three times greater risk of developing CVD compared with subjects who are normotensive((2)).”
BackgroundPredictors of Significant Short-Term Increases in Blood Pressure in a Community-Based Population
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“a blood pressure of 140/90mmHg or greater) is estimated to carry an almost threefold greater risk of developing CVD((26)), while treating hypertension substantially reduces cardiovascular events, and stroke in particular((27)).”
BackgroundAssociations of cardiovascular risk factors in Al Ain- United Arab Emirates
AlKetbi, L. B., Revel, A. D., Nagelkerke, N. J. D., Jaber, T. M., Omar, A. O., Ahmed, N. M., Nazirudeen, M. K., Sayed, M. F. A., Nour, F. A., & Abdouni, S. (2009) · Cardiovascular Diabetology · doi:10.1186/1475-2840-8-21 · Cited by 27 · see citing works
“the risk associated with obesity may differ between smokers and non-smokers) between these risk factors have been reported in different studies [2-5].”
ResultEffects of cigarette smoking on blood pressure stratified by BMI in Mongolian population, China
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“There were also some prospective studies (8,26,27) showing that there is no signifi cant positive association or there is a negative association between smoking and BP.”
BackgroundResultTatsumi, Y., Morimoto, A., Asayama, K., Sonoda, N., Miyamatsu, N., Ohno, Y., Miyamoto, Y., Izawa, S., & Ohkubo, T. (2019) · American Journal of Hypertension · doi:10.1093/ajh/hpz123 · Cited by 26 · see citing works
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“Evidence from a number of studies [2224] suggest that uric acid be added to the list of conventional risk factors of hypertension like obesity [25,26], age [27,28] renal disease [10,29], diabetes mellitus [30,31].”
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The Relationship Between Fasting Blood Glucose and Hypertension
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BackgroundPharmacokinetics of Nitrate and Nitrite Following Beetroot Juice Drink Consumption
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“A major risk factor for the development of CVD is increased blood pressure (BP) or hypertension [2,3] which is often the target for CVD-based interventions.”
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Undiagnosed hypertension in Croatia
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Screening For Hypertension Annually Compared With Current Practice
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“18,19 Notably, HTP aerosols contain comparable levels of nicotine, 7 and HTP use has been found to induce endothelial dysfunction, 20 raising concerns about the potential adverse effects of HTPs on hypertension.”
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The association between risk factors and hypertension in perak, malaysia.
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Hypertension in patients with chronic kidney disease
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ResultAlcohol Consumption and Prehypertension: An Investigation of University Youth
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“Identified risk factors were in line with Wang et al. (2006) and Omorogiwa et al. (2009) in their studies.”
ResultThe well-being valuation model: a method for monetizing the nonmarket good of individual well-being
Sidney, J. A., Jones, A., Coberley, C. R., Pope, J. E., & Wells, A. R. (2016) · Health Services and Outcomes Research Methodology · doi:10.1007/s10742-016-0161-9 · Cited by 13 · see citing works
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- Authors
- Wang, W., Lee, E. T., Fabsitz, R. R., Devereux, R., Best, L., Welty, T. K., & Howard, B. V.
- Affiliations
- Cornell University (US)
- Venue
- Hypertension
- Published
- 2006-03
- Volume
- 47
- Issue
- 3
- Pages
- 403-409
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2057641540
- Cited by
- 228
- References
- 52
- Citations by year
- 2026: 4 · 2025: 10 · 2024: 12 · 2023: 14 · 2022: 11 · 2021: 8 · 2020: 16 · 2019: 14 · 2018: 6 · 2017: 15 · 2016: 5 · 2015: 9 · 2014: 18 · 2013: 17 · 2012: 14
- FWCI
- 7.38
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (U01HL041652, U01HL041654, U01 HL-41642, U01HL 41652, UL01HL41654, U01HL041642)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- cardiovascular disease, hypertension risk factors, Native Americans, Strong Heart Study, prehypertension, albuminuria, microalbuminuria, diabetes mellitus, obesity, alcohol consumption, smoking, systolic blood pressure, antihypertensive drugs, hypertension incidence
- MeSH terms
- Aged, Aging, Albuminuria, Alcohol Drinking, Cardiovascular Diseases, Female, Humans, Hypertension, Indians, North American, Longitudinal Studies, Male, Middle Aged, Obesity, Risk Factors, Smoking, Cohort Studies, Diabetes Complications, Overweight
About these checks
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