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Objectives: Masked hypertension, which is characterized by out-of-office hypertension but normal office blood pressure, is a risk factor for cardiovascular disease. However, the factors that contribute to masked hypertension are unclear. We aimed to determine the involvement of sleep-related characteristics in masked hypertension., Methods: The study included 3844 normotensive (systolic/diastolic blood pressure < 140/90 mmHg) community residents with no antihypertensive drug use at baseline (mean age 54.3 years). Home morning and evening blood pressure, oxygen desaturation during sleep (pulse oximetry), and sleep efficiency (actigraphy) were measured for 1 week. The number of nocturnal urinations during this period was obtained using a sleep diary., Results: Masked hypertension (mean morning and evening blood pressure ≥135/85 mmHg) was detected in 11.7% of study participants, and 79.0% of the participants with masked hypertension had sleep hypertension (≥120/70 mmHg). Multinominal logistic regression analysis identified different factors involved in masked hypertension with and without sleep hypertension; factors for masked hypertension with sleep hypertension included the frequency of at least 3% oxygen desaturation (coefficient = 0.038, P  = 0.001), nocturia (coefficient = 0.607, P  < 0.001), and carotid intima-media thickness (coefficient = 3.592, P  < 0.001). Only carotid intima-media thickness and measurement season were associated with masked hypertension without sleep hypertension. Low sleep efficiency was associated with isolated sleep hypertension but not masked hypertension., Conclusion: Sleep-related factors associated with masked hypertension differed depending on the presence of sleep hypertension. Sleep-disordered breathing and nocturnal urination frequency may help identify individuals who need home blood pressure monitoring., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: An association between the Moyamoya disease susceptible gene ring finger protein 213 (RNF213) variant and ischemic stroke and coronary artery disease has been suggested in case-control studies. We aimed to investigate the possible association between the RNF213 variant and the incidence of cardiovascular disease in a general population., Methods: The study participants consisted of 9153 Japanese community residents without history of cardiovascular disease. The clinical parameters employed in this analysis were observed at baseline between 2008 and 2010. The RNF213 p.R4859K variant was determined by TaqMan probe assay and then confirmed by Sanger sequencing., Results: During 8.52 years follow-up period, we observed 214 incident cases of cardiovascular diseases (99 total stroke cases, 119 major adverse cardiac event cases, including 4 cases of both). The incidence rate was higher for the variant allele carriers (120 cases; incidence rate, 71.0 per 10 000 person-years) than for the homozygotes of the wild-type allele (26.9), and the group differences achieved statistical significance (P = 0.009). Although the RNF213 variant was also associated with systolic blood pressure (dominant model: coefficient of 8.19 mmHg; P < 0.001), the Cox regression analysis adjusted for major covariates including systolic blood pressure identified the RNF213 variant as an independent determinant for cardiovascular disease (hazard ratio of 3.41, P = 0.002) and major adverse cardiac event (hazard ratio of 3.80, P = 0.010) but not with total stroke (P = 0.102)., Conclusion: The Moyamoya disease susceptible RNF213 variant was associated with blood pressure and the incidence of cardiovascular disease in a Japanese general population., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: High sleep blood pressure (BP) has been suggested to be an independent risk factor for cardiovascular outcomes. To assess the applicability of sleep BP measured using a timer-equipped home device, we investigated the association between home device-measured sleep BP and large artery stiffness., Methods: We performed a cross-sectional analysis of a dataset from the Nagahama study (N = 5916), a general population-based cohort study. Home morning BP and sleep BP were measured using a timer-equipped cuff-oscillometric device (HEM-7080IC). Office BP, carotid intima--media thickness (IMT), and brachial--ankle pulse wave velocity (baPWV) were measured at the follow-up investigation of the Nagahama study., Results: Sleep hypertension (SBP ≥120 mmHg and/or DBP ≥70 mmHg) was associated with the arterial parameters (IMT: β = 0.051, baPWV: β = 0.141, both P < 0.001) independently of morning hypertension (IMT: β = 0.093, baPWV: β = 0.216, both P < 0.001) irrespective of antihypertensive medication status. Individuals exhibiting isolated sleep hypertension (N = 801) had thicker IMT (0.69 ± 0.14 vs. 0.64 ± 0.13 mm, P = 0.017) and faster baPWV (1,299 ± 197 vs. 1,183 ± 178 cm/s, P < 0.001) than normotensives. A sleep SBP at least 110 mmHg and a sleep DBP at least 65 mmHg were identified as the lower threshold BP values for the association with arterial parameters., Conclusion: Sleep BP measurement using a home device may be a simple way to assess cardiovascular risks overlooked by office and home morning BP measurements.

Objective: Abnormalities in circadian blood pressure (BP) variation, particularly increase in nocturnal BP, have been reported to be risk factors for cardiovascular disease, although the factors associated with BP abnormalities are not fully understood. This study aimed to clarify possible associations of sleep characteristics, including sleep fragmentation, sleep disordered breathing, and nocturia, with sleep BP by simultaneous multiday measurements., Methods: A cross-sectional study evaluated 5959 community participants having home-measured data on nocturnal BP change (sleep BP - awaking BP), sleep characteristics, and sleep disordered breathing. Sleep characteristics including the fragmentation index were assessed using wrist-wearable actigraphy, whereas sleep disordered breathing was assessed by 3% oxygen desaturation index obtained using a finger-type monitor. The number of nocturnal urinations was recorded in a sleep diary., Results: Mean nocturnal SBP change was -8.5 ± 7.9%. A 3% oxygen desaturation index was associated with the BP change independently of the basic covariates (β = 0.051, P = 0.001), although the association became insignificant (P = 0.196) after adjusting the fragmentation index (β = 0.105, P < 0.001). The association of the fragmentation index was also insignificant (P = 0.153) after adjusting measurement season (middle season: β = 0.163, P < 0.001; summer season: β = 0.249, P < 0.001). In contrast, the frequency of urination showed strong and independent association (β = 0.140, P < 0.001), with smaller nocturnal BP drop in participants with frequent urination., Conclusion: Subjective sleep estimates and frequent nocturnal urination may represent a potential risk for circadian BP abnormalities.

Background: Cardio-ankle vascular index (CAVI) has been increasingly used as an index for arterial stiffness. However, the degree of longitudinal changes and factors affecting these changes in CAVI (ΔCAVI) are largely unknown. The aim of this study was to descriptively clarify factors associated with longitudinal ΔCAVI for the precise use of this index in the assessment of arterial stiffness., Methods: Study participants comprised 9501 community residents (53.1 ± 13.3 years), with 8004 patients included in the longitudinal analysis. CAVI was calculated by the transient time interval of arterial waveform measured at four extremities., Results: Factors showing a strong association with baseline CAVI (7.38 ± 1.10) included age (β = 0.586), SBP (β = 0.175), and male sex (β = 0.142), whereas BMI showed an inverse association (β = -0.208) (all P < 0.001). During the 1815 ± 135 days follow-up period, CAVI increased by 0.47 ± 0.68. Multivariate analysis identified age (β = 0.508), male sex (β = 0.089), Brinkman index (β = 0.074), and SBP (β = 0.037) as positive determinants, whereas BMI (β = -0.079) and baseline CAVI (β = -0.590) as inverse determinants for ΔCAVI (all P < 0.001). Further data accumulation is needed to determine a reference value of CAVI due to its large population differences., Conclusion: Several factors were commonly associated with baseline and longitudinal ΔCAVI. These factors should be carefully considered when CAVI is used for the assessment of arterial stiffness.

Objective: Morphological change in retinal vessel calibers has been reported as a marker of cardiovascular risk, but its association with arterial stiffening, a possible factor relating retinal vessel sings and cardiovascular outcomes, is not clear. The study aim was to clarify the relationship between retinal small vessel calibers and longitudinal change in large arterial stiffness in a sample of the general population., Methods: The study included 6720 Japanese participants (52.1 ± 12.8 years). Central retinal arteriolar equivalent (CRAE) and venular equivalent were measured by fundus photography. Arterial stiffness was evaluated by brachial-to-ankle pulse wave velocity (baPWV) at baseline and at 5 years., Results: The overall change in baPWV (ΔbaPWV) during a mean follow-up 1814 ± 136 days was 41 ± 131 cm/s (3.4 ± 9.9%), and was significantly increased in individuals with narrower CRAE (quartiles: Q1, 4.3 ± 10.6%; Q2, 3.3 ± 10.0%; Q3, 3.1 ± 9.3%; Q4, 3.1 ± 9.7%, P = 0.001). No significant association was observed with central retinal venular equivalent. Multivariate analysis identified CRAE as a significant inverse determinant of ΔbaPWV (β = -0.033, P = 0.006) independent of possible covariates including age, sex, blood pressure, and baseline baPWV. The association between CRAE and ΔbaPWV was prominent in a middle-aged (age Q2, β = -0.078, P = 0.002), but not younger (Q1, P = 0.232) or older (Q3, P = 0.427; Q4, P = 0.542) participants., Conclusion: Narrower CRAE in middle-age was associated with the long-term risk of arteriosclerosis in a general population sample.

Objectives: We undertook descriptive epidemiology of spot urine sodium-to-potassium ratio (Na/K) in a population sample to clarify the close relationship between Na/K and blood pressure level independently of potential confounding factors., Methods: Study participants consisted of 9144 apparently healthy citizens (aged 54 ± 13 years). All clinical parameters were obtained at baseline., Results: Na/K was significantly higher in hypertensive individuals irrespective of antihypertensive medication status (normotension, 3.12 ± 1.82; untreated hypertension 3.50 ± 1.96; treated hypertension, 3.72 ± 2.53). As urinary Na (β = 0.092, P < 0.001) and K (β = -0.050, P < 0.001) levels were inversely associated with BP, Na/K (β = 0.118, P < 0.001) was more closely associated with BP than Na or K alone, as well as daily salt intake estimated from urinary Na (β = 0.088, P < 0.001). Several factors were significantly associated with Na/K, namely age, sex, obesity, blood pressure, renal function, salt restriction status, serum phosphate and urinary creatinine level, and fasting period and season at urine sample collection. However, the association between Na/K and BP was independent of these factors (adjusted β = 0.112, P < 0.001). No direct association was observed between Na/K and large arterial remodeling assessed by pulse wave analysis (P = 0.496) or retinal arteriolar morphological change (P = 0.431). Further, a genome-wide association study failed to identify any particular genotype influencing urinary Na and K levels., Conclusions: Although we clarified several factors that might affect spot urine Na/K, these relationships were not substantial enough to confound the association between urinary Na/K and BP. A simple measure of Na/K might be more representative of salt loading obtained from spot urine samples than Na excretion alone.

Objectives: Although central blood pressure (BP) is considered to be more closely associated with large arterial remodeling and cardiovascular outcomes than brachial BP, few studies have investigated these associations with changes in small arteries. As morphological changes in retinal vessels might be associated with cardiovascular outcomes, we conducted a cross-sectional study to investigate the association of central BP with retinal vessel caliber., Methods: The study included 8054 Japanese participants. Central BP was estimated by the radial arterial waveform by calibrating brachial BP. Central retinal arteriolar equivalent (CRAE) was computationally measured using fundus photography., Results: CRAE was most strongly associated with central SBP (r = -0.324, P < 0.001), followed by DBP (r = -0.292, P < 0.001) and central pulse pressure (PP; r = -0.226, P < 0.001). The correlation coefficient between SBP and CRAE was significantly greater in central SBP than in brachial SBP (r = -0.300, P < 0.001). After adjustment for possible covariates, brachial SBP (β = -0.221, P < 0.001) and central SBP (β = -0.239, P < 0.001) were independently associated with CRAE. Further, higher brachial SBP (β = -0.226, P < 0.001) and smaller PP amplification (β = 0.092, P < 0.001) were identified as independent determinants of narrowing of CRAE in the same equation, which indicated the superiority of central BP. Central BP-determined hypertensive individuals had a significantly narrower CRAE independent of brachial BP (central/brachial: hypertension/hypertension 121.4 ± 11.5, hypertension/normotension 120.9 ± 11.2, normotension/hypertension 125.1 ± 11.9, normotension/normotension 128.1 ± 11.5 μm)., Conclusion: Central BP was more closely associated with the narrowing of CRAE than brachial BP. Slight increases in central BP might be involved in the morphological changes in small retinal arteries, even in individuals with optimal brachial BP.

Objective: The present study examined the association between uric acid levels and high blood pressure in a multiethnic study of Chinese children and adolescents., Methods: The participants were divided into four different groups according to the uric acid quartiles. Three logistic regression models were conducted to investigate the relationship between the high blood pressure and uric acid levels. Model 1 adjusted age, sex and ethnicity. Model 2 adjusted age, sex, ethnicity, total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, estimated glomerular filtration rate, fasting glucose and waist circumference. Model 3 adjusted all the confounding factors in model 2 except the waist circumference and BMI. The concentrations of uric acid in high blood pressure participants and normotensive participants were compared with or without adjustment for confounding factors., Results: A total of 3778 participants aged 10-15 years from the Xinjiang Congenital Heart Disease Survey were included in the present study. The percentages of the high blood pressure in the four different uric acid quartiles were 7.4, 8.6, 9.6 and 11.8%, respectively. In model 1, 2 and 3 of the logistic regression, the participants in the third and fourth uric acid quartiles had significantly higher chance of suffering the high blood pressure when compared with the participants in the first uric acid quartile [odds ratio 1.608, 1.587, 1.597, P = 0.005, 0.015, 0.015, respectively, between participants in the first quartile and the third quartile; odds ratio 1.981, 1.945, 1.810, P = 0.001, 0.002, 0.007, respectively, between participants in the first quartile and the fourth quartile). The concentrations of serum uric acid were 220.7 μmol/l in high blood pressure participants and 204.1 μmol/l in normotensive participants (P = 0.024). After adjustment for confounding factors, the concentrations of serum uric acid were 219.7 vs. 204.5 μmol/l in one model (P < 0.001) and 219.3 vs. 204.5 μmol/l in the other model (P < 0.001)., Conclusions: Among Chinese children and adolescents, increasing levels of serum uric acid are associated with high blood pressure.