Blood pressure, blood pressure development and potential risk factors for hypertension with special reference to metabolic factors and kidney function

Abstract

Objectives: The overall aim of this thesis was to search for predictors of blood pressure development with special reference to anthropometric, metabolic and renal function variables.Study populations and methods: Two large long-term prospective population studies, The Population Study of Women in Gothenburg, Sweden carried out since 1968-69, with 1462 women between 38 and 60 years old at baseline and 24 year follow-up, and The Reykjavik Study, Iceland, which started in 1967 with an initial participation of 8285 men and 9183 women in various age groups. In this thesis the prospective part of the Reykjavik study included 2639 men and 2346 women, with a 3 to 8 year follow-up. Main outcome measures: Cardiovascular and renal morbidity and mortality data, systolic blood pressure, diastolic blood pressure, pulse pressure, body mass index (BMI), waist to hip ratio (WHR), glucose tolerance, serum insulin concentration, and microproteinuria. Results: · Blood pressure and pulse pressure increased with increasing age, while there seemed to be a secular trend with decreasing blood pressure during recent years.· Hypertensive women had an increased mortality and a higher incidence of myocardial infarction and stroke compared to non-hypertensive women, while renal failure was not a common reason for death either in hypertensive or in non-hypertensive women. Hypertensive women had a more than doubled risk of developing diabetes compared with non-hypertensive women.· There was a correlation between overweight and blood pressure, mainly to the measures indicating total amount of fat rather than its distribution.· oThere were correlations between glucose intolerance and blood pressure as observed in both sexes and irrespective of being obese or not.· There was also a correlation between fasting serum insulin and blood pressure, mainly seen in obese women and confined to women with the highest serum insulin concentrations.· Albuminuria and subclinical proteinuria were more common in hypertensive than in non-hypertensive women, but albuminuria and subclinical proteinuria were not found to be a predictor of increasing blood pressure.Conclusions: Age, BMI and increments in BMI, fasting and postload glucose and serum insulin seem to be predictors for hypertension and increased blood pressure in women. WHR plays an uncertain role in the development of hypertension. Microproteinuria in otherwise healthy normotensive or hypertensive women does not appear to impair the long-term prognosis.