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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 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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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 the citing paper
“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 the citing paper
“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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“anti-hypertensive or lipid-lowering therapy), but not for risk factors per se; such statistical adjustment may not have taken into account patients who are undiagnosed or untreated and thus at a higher risk for CVD [ 24 ].”
Background
Metadata
- 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
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