Browsing by Subject "Blood Pressure"
Now showing 1 - 9 of 9
- Results Per Page
- Sort Options
Item An Apple from the Tree? A Look at Cardiometabolic Risk Factors in Parents and Offspring(2015-06) Halvorsen, TanyaObjectives: To relate parental cardiometabolic risk factors with corresponding values in their children and assess the influence of adiposity on these associations. Study Design: Associations of adiposity, blood pressure, lipids, fasting insulin and glucose, and a risk factor cluster score were evaluated in a cross sectional study of 179 parents and their children (6-18 years, N=255). Insulin resistance was assessed by euglycemic clamp in parents and children aged 10 or older. Metabolic syndrome in parents was defined by ATPIII criteria. Cluster scores of the risk factors were created based on age-specific z-scores. Analyses included Pearson correlation and linear regression, adjusted for parent and child age, sex, race, and body mass index (BMI), accounting for within-family correlation. Results: We found positive parent-child correlations for measures of adiposity (BMI, BMI percentile, waist, subcutaneous fat, and visceral fat; r=0.22-0.34, all p≤0.003), systolic blood pressure (SBP) (r=0.20, p=0.002), total cholesterol (r=0.39, p<0.001), low-density lipoprotein cholesterol (r=0.34, p<0.001), high density lipoprotein cholesterol (r=0.26, p<0.001) triglycerides (r=0.19, p=0.01) and insulin sensitivity (r=0.22, p=0.02) as well as cluster scores (r=0.15, p=0.02). After adjustment for BMI all parent-child correlations, except systolic blood pressure, remained significant. Conclusions: Although adiposity is strongly correlated between parents and children, many cardiometabolic risk factors correlate independent of parent and child BMI. Adverse parental cardiometabolic profiles may identify at-risk children independent of the child’s adiposity status.Item Approaches to reducing cardiovascular disease risk and stress effects in underserved populations(2014-06) Witt, Dawn ReneeBackground: While the past decade has shown a decrease in mortality and morbidity due to cardiovascular disease (CVD), it remains the leading cause of death for both men and women in the US. The burden of CVD has been demonstrated to disproportionately affect underserved populations. The course and development of CVD has been shown to be affected by modifiable risk factors such as physical inactivity, poor nutrition, smoking, and the psychosocial risk factors of depression, anxiety and stress. Objective: This study sought to explore approaches to reducing cardiovascular disease risk and stress effects in underserved populations; Latina and African American women, and individuals living in a rural population in New Ulm, MN. Method: The first purpose of this dissertation was to describe the results from a secondary data analysis utilizing 2009 and 2011 screening data from the Heart of New Ulm Project (HONU) project. Secondly, we present the results of our recently published literature review that explored the use of motivational interviewing as a technique to reduce CVD risk among African American and Latina women. Results: Women reported higher levels of stress and had higher levels of C-reactive protein (CRP) compared to men at baseline. Men had a significantly higher diastolic blood pressure (DBP) and systolic blood pressure (SBP) and reported more physical activity (PA) and a greater history of heart disease compared to women at baseline. No significant difference was found between change in stress level and changes in SBP, PA or CRP for men; however change in stress level was associated with a change in SBP for women. The covariates of body mass index (BMI) and age demonstrated significant associations with the outcome variables for women; among men, smoking, BMI and education had significant association on the outcome measures.None of the community health promotion events were shown to have a direct effect on any of the outcome variables of interest. The female-specific, SBP model demonstrated a borderline significant indirect effect of stress in 2009 via PA and stress in 2011 on SBP in 2011. The female specific, less than moderate PA (< mod PA) and the greater than moderate PA (> mod PA) models both demonstrated significant indirect effects of stress in 2009 via PA and stress in 2011 on < mod PA and > mod PA, respectively. Additionally, stress for females in 2011 was associated with increased CRP in 2011. The male-specific models demonstrated a significant indirect effect of stress in 2009 on > mod PA and < mod PA in 2011 via PA and stress in 2011, respectively. We found that the use of MI in populations of African American and Latina women demonstrated that MI can be an effective technique to reduce CV risk (Witt et al., 2012). It was shown that positive effects were attained in increasing fruit and vegetable consumption, decreasing hypertension/lowering SBP, achieving weight loss goals, and improving knowledge of CVD risk modification among those receiving motivational interviewing. Conclusion: The results from this study provide compelling evidence that future work exploring the effects of stress on modifiable risk factors for CVD in underserved populations, particularly physical activity and blood pressure is warranted. The work presented here demonstrate that while the effects of stress on the outcomes of interest were small, more intensive, targeted interventions with individuals experiencing elevated stress may produce more substantive effects in mediating the relationship between stress and physical activity and blood pressure. The small effect sizes found in this study may be due to in part, to the lack of intensity of the interventions delivered via HONU programming and may also be attributed to the fact that the HONU interventions did not specifically have a stress reduction component. Use of behavioral interventions such as motivational interviewing have demonstrated efficacy in supporting positive behavior change and could be used as an adjunct component in CVD risk reduction interventions at the population level, particularly among underserved populations. The key is to deliver the intervention consistently and in a culturally appropriate manner.Recommendations for Future Research:Behavior change programs delivered at the population level and future CVD prevention programming in settings such as New Ulm should continue to build upon the lessons learned from community based projects like HONU, the Minnesota Heart Health Program (MHHP), Pawtucket, and the North Karelia Project. Additionally, more work is needed to determine how to support long-lasting behavior change using techniques such as motivational interviewing and ensure that the modifiable risk factors for CVD are addressed. Targeted interventions that address stress among those experiencing the highest levels of stress may prove to have the most impact in mitigating the effect of stress on other modifiable behaviors. As the results from behavior change interventions have demonstrated, uptake of healthy lifestyle and health promoting behaviors and adhering and maintaining those behaviors are a universal problem, regardless of race and sex. Use of behavioral interventions such as motivational interviewing have demonstrated efficacy in supporting and sustaining positive behavior change and could be used as an adjunct component in CVD risk reduction interventions at the population level, particularly among underserved populations. Developing and implementing targeted interventions that clearly address stress reduction among those at risk for CVD is warranted.Item Central Blood Pressure Regulation in Relation to Obesity in Youth(2017-08) Hultgren, NeilAbstract Introduction Measures of central blood pressure (BP) are hypothesized to be positively associated with obesity status in youth. However, few studies have addressed this topic with a large sample size and wide range of BMI values. Methods A total of 310 participants (males/females =151/159) aged of 8 to 18 years old (mean±SD: 12.8±2.7 years) were recruited. Height (cm) and weight (kg) were measured using a wall-mounted stadiometer and an electric scale. Body mass index (BMI) was calculated (kg/m2) and obesity status was determined using age – and sex- derived BMI percentile (BMI%) with the following categories: normal weight (NW) represented as <85th BMI percentile; overweight/obesity (OW/OB) represented as between 85th to < 1.2 times the 95th BMI percentile); severe obesity (SO) represented as ≥ 1.2 times the 95th BMI percentile. Dual energy X-ray absorptiometry (DXA) was used to measure body composition. Brachial systolic (SBP) and diastolic (DBP) blood pressure was measured with an automated cuff. Central BP was obtained from SphygmoCor MM3 systems, which utilizes applanation tonometry to derive radial-aorta SBP (r-a SBP), radial-aorta DBP (r-a DBP), carotid-aorta SBP (c-a SBP), and carotid-aorta DBP (c-a DBP). Central BP measures were compared across obesity groups using ANCOVA with post-hoc Tukey HSD, adjusted for age, Tanner stage, sex, and race, with further adjustment of height for brachial BP. Unadjusted Pearson correlations examined the relationship between central BP measures with obesity (BMI, BMI%, body fat (%), visceral fat mass (kg)). Linear regression analyses examined the association between body fat (%) and visceral fat mass (kg) with brachial and central SBP and DBP after adjusting for age, Tanner stage, sex, and race, with height included for brachial BP. Results There were 120 NW, 89 OW/OB, and 99 SO participants. Body fat (%) was significantly different (p<0.001) among all obesity groups: NW (25.1±6.1 %), OW/OB (39.5±7.2 %), SO (48.0±4.9 %). Brachial SBP (bSBP), r-a SBP, and c-a SBP significantly increased (p<0.001 all) with increasing obesity status. BMI was significantly correlated (p<0.001 all) with bSBP (r=0.64), r-a SBP (r=0.57), and c-a SBP (r=0.52). BMI%, body fat (%), and visceral fat mass (kg) were also all significantly correlated to all brachial and Central BP measures. In multiple regression models, higher values of body fat (%) were significantly associated (all p<0.001) with higher brachial (r=0.66) and central SBP (r-a r=0.59) (c-a r=0.55) as well as brachial (r=0.44) and central DBP (r-a r=0.42) (c-a r=0.46). Higher values of visceral fat mass (kg) were significantly associated (all p<0.001) with higher brachial (r=0.61) and central SBP (r-a r=0.60) (c-a r=0.55) as well as brachial (r=0.39) and central DBP (r-a r=0.42) (c-a r=0.44). Older age was significantly associated with higher r-a SBP (r=0.59. p<0.001) and c-a SBP (r=0.55, p<0.01). Conclusion Central BP, regardless of measurement site, is highly associated with Obesity status (BMI, BMI%, body fat (%), and visceral fat mass (kg)) and hypertension status among youth.Item Diabetes and Blood Pressure Control(2010-07-21) Lisberg, AaronLowering the systolic blood pressure of newly diagnosed type 2 diabetics can significantly decrease the incidence of diabetes related microvascular complications such as retinopathy, vitreous hemorrhage, and renal failure. A 10 mm Hg reduction in systolic blood pressure leads to a 13% (P < 0.0001) decrease in the incidence of microvascular complications.Item High Blood Pressure and Diabetes(2010-07-21) Aakre, ChrisMillions of people in our country have high blood pressure. High blood pressure has been shown to be a risk factor for the development of diabetes. Other risk factors for development of Diabetes are discussed. Blood pressure medications can also increase or decrease a patient's risk of developing diabetes. Beta-blockers (BB), such as atenolol, and thiazide diuretics appear to increase risk by as much as 31% compared to treatment with an Angiotensin Converting Enzyme Inhibitor (ACE-I) and dihydropyridine class Calcium Channel Blocker (CCB). Side effect profiles of common antihypertensive medications are discussed.Item Preventing High Blood Pressure in African American Populations(2009-09-18) Berry, BrentHypertension (or high blood pressure) is a problem for many Americans with higher prevalence among African Americans. There are simple steps before advising the use of medications to take to ensure this problem does not lead to long-term systemic effects such as stroke, heart failure, and/or kidney disease.Item Preventing High Blood Pressure in African American Populations(2010-07-21) Berry, BrentHypertension (or high blood pressure) is a problem for many Americans with higher prevalence among African Americans. There are simple steps before advising the use of medications to take to ensure this problem does not lead to long-term systemic effects such as stroke, heart failure, and/or kidney disease.Item Role of the median preoptic nucleus in chronic blood pressure regulation by angiotensin II(2008-12) Ployngam, TrasidaThe median preoptic nucleus (MnPO) receives dense reciprocal inputs from both the subfornical organ (SFO) and organum vasculosum of the lamina terminalis (OVLT), the circumventricular organs known to be important as central neural sensors of circulating angiotensin II (ANG II). This thesis proposes to establish the role of the MnPO in chronic regulation of blood pressure based on the central hypothesis that the MnPO is a crucial component of the central sympathoexcitatory circuitry necessary for chronic blood pressure control following ANG II activation of the SFO and OVLT. Throughout the studies, cardiovascular responses to either pharmacological or physiological changes of circulating ANG II activity were compared between MnPO lesioned rats and sham lesioned controls. The first specific aim was designed to test the hypothesis that the intact MnPO is necessary for the full hypertensive response to chronic intravenous ANG II administration. In this specific aim, rats with electrolytic lesion of the MnPO displayed significantly attenuated hypertensive responses by day 7 through day 10 of ANG II infusion compared to sham lesioned rats. Therefore, we concluded that the MnPO is a crucial component of the central neuronal circuitry mediating chronic ANG II-induced hypertension. Sub-aim 1A was designed to determine the specific role of the MnPO neurons versus fibers of passage in the attenuated hypertensive responses to ANG II observed in the MnPO lesioned rats. In line with the findings of specific aim 1, rats with ibotenic acid lesion of the MnPO demonstrated attenuated responses to the hypertensive effect of chronic ANG II administration. However, the attenuated responses were less extensive relative to those seen in the electrolytic lesioned rats. Therefore, it was concluded that neuronal cell bodies in the MnPO are necessary for the full hypertensive response to chronic ANG II administration; however, damage of the fibers of passage partly contributes to the attenuated hypertensive responses observed in the electrolytic lesioned rats. The second specific aim was to determine the role of the MnPO in mediating the chronic hypotensive effect of the AT1 receptor antagonist, losartan. In this specific aim, rats with ibotenic acid lesion of the MnPO showed exaggerated hypotensive responses to chronic losartan administration. These findings were accompanied with a greater decline in total peripheral resistance in the MnPO lesioned rats. Therefore, we concluded that MnPO neurons do not mediate the chronic hypotensive effect of losartan and that the MnPO is not necessary for basal blood pressure control by endogenous ANG II. However, the findings suggested that the MnPO neurons likely participate in baroreflex mechanisms buffering against losartan-induced hypotension. The last specific aim was to establish the role of the MnPO in normal blood pressure control during chronic high dietary salt intake. Although plasma sodium concentration and osmolality were raised significantly in rats with electrolytic lesion of the MnPO during high salt intake, their mean arterial pressure and heart rate were comparable with those of sham lesioned rats throughout the study. Therefore, we concluded that the MnPO is not necessary to maintain normal blood pressure during high dietary salt intake. However, MnPO lesioned rats displayed less renal sodium retention during high salt intake compared to sham lesioned rats suggesting the role of the MnPO in the central neurohumoral control of sympathetic outflow, in particular, renal sympathetic activity, during chronic high salt intake. In conclusion, overall, the findings in this dissertation provide important insights into the role of the MnPO in the chronic hypertension induced by ANG II. Furthermore, they provide additional evidence of the integrative role of the MnPO in chronic normal blood pressure control by circulating ANG II, plasma osmolality, and the baroreflex.Item Single Ethnicity Study Of High Blood Pressure And Local Neighborhood Environments In Parsi Population In Mumbai(2019-05) SEHGAL, HITAKSHIABSTRACT The environment is dynamic and a changeable interface affecting health and disease susceptibility in populations. Environmental factors are of significance in public health because they are modifiable and preventable causes of diseases. Contemporary studies look at the comprehensive impact of the environment on health and recognize that Global Environmental Changes have a potentially larger influence human health and development. Local neighborhoods form a significant component of the general external exposome. Although we live in a globalized world, local neighborhoods, with their natural and built resources, remain influential on human health. The local neighborhood encompasses critical influences on lifestyle by affecting safety, access, physical or social activities, and belonging. High blood pressure is a common complex disease and a metabolic risk factor for morbidity and mortality among adults globally. Common complex diseases affect a large number of the global population, are chronic, can be inherited, are polygenic and involve environmental factors affecting lifestyle. High blood pressure is the single most significant risk factor for cardiovascular mortality. Apart from genetic factors, ageing and physiological effects of gender, the environment is the largest determinant of factors affecting blood pressure. A combination or single effect of a small number of the many environmental risk factors affect high blood pressure. Low- and middle- income countries (LMICs) bear a larger burden of the disease. The relation between local neighborhoods environments and high blood pressure in LMICs have not been studied. This study was directed toward exploring the impact of local neighborhoods in India, a middle-income country (MIC), on susceptibility to high blood pressure. The study was conducted in the Parsi population in Mumbai. Parsis are a founder population and the genetic stability in this population reduces the confounding actions of diverse genetics. 774 females and 756 males participated in the study. For all neighborhoods, the study had a gender-balanced and representative sample of the Parsi community in the age-group 19-53 years; who live in four distinct neighborhoods. Information on neighborhoods, socio-demographics known risk factors for high blood pressure were collected; height and weight of the participants were taken to calculate the body mass index (BMI); and two readings of their blood pressure were taken. Data were analyzed using SPSS software. Local neighborhood environments had an impact on BMI and blood pressure.