Importance of obesity, race and age to the cardiac structural and functional effects of hypertension

AbstractObjectives. The purpose of this study was to determine the effects of obesity and its interaction with age, race and the magnitude of blood pressure elevation in a large cohort of patients with mild to moderate hypertension and a high prevalence of left ventricular hypertrophy.Background. Obesity, race and age each have important effects on the incidence and severity of hypertension and may contribute to the effects of blood pressure elevation on the cardiac manifestations of hypertension.Methods. Left ventricular structure and function were assessed with two-dimensional targeted M-mode echocardiography in 692 men with mild to moderate hypertension (average blood pressure 153/100 mm Hg), and the data were compared in relation to obesity (determined from body mass index), age, race, blood pressure, physical activity, plasma renin activity, urinary sodium excretion, hematocrit, heart rate and serum lipids.Results. Left ventricular hypertrophy was common (630% with increased left ventricular mass, 22% with left ventricular hypertrophy on the electrocardiogram [ECG]). On multivariable regression analysis, body mass index was the strongest predictor of left ventricular mass and magnified the slope relation of blood pressure to left ventricular mass. Despite a greater prevalence of ECG left ventricular hypertrophy in blacks (31%) than in whites (10%), left ventricular mass and echocardiographic prevalence of left ventricular hypertrophy did not differ by race. However, septal, posterior left ventricular and relative wall thickness were greater in black than in white men.Conclusions. Obesity is the strongest clinical predictor of left ventricular mass and left ventricular hypertrophy la men, even in those with mild to moderate hypertension of sufficient severity to be associated with a high prevalence of left ventricular hypertrophy. Moreover, independent effects of systolic blood pressure on left ventricular mass an amplified by obesity. Although race does not affect left ventricular mass or the prevalence of left ventricular hypertrophy, black race is associated with greater relative wall thickness, itself a predictor of unfavorable cardiovascular outcome

Renal insufficiency as a predictor of cardiovascular outcomes and mortality in elderly individuals

AbstractObjectivesThis study was designed to evaluate the relationship between elevated creatinine levels and cardiovascular events.BackgroundEnd-stage renal disease is associated with high cardiovascular morbidity and mortality. The association of mild to moderate renal insufficiency with cardiovascular outcomes remains unclear.MethodsWe analyzed data from the Cardiovascular Health Study, a prospective population-based study of subjects, aged >65 years, who had a serum creatinine measured at baseline (n = 5,808) and were followed for a median of 7.3 years. Proportional hazards models were used to examine the association of creatinine to all-cause mortality and incident cardiovascular mortality and morbidity. Renal insufficiency was defined as a creatinine level ≥1.5 mg/dl in men or ≥1.3 mg/dl in women.ResultsAn elevated creatinine level was present in 648 (11.2%) participants. Subjects with elevated creatinine had higher overall (76.7 vs. 29.5/1,000 years, p < 0.001) and cardiovascular (35.8 vs. 13.0/1,000 years, p < 0.001) mortality than those with normal creatinine levels. They were more likely to develop cardiovascular disease (54.0 vs. 31.8/1,000 years, p < 0.001), stroke (21.1 vs. 11.9/1,000 years, p < 0.001), congestive heart failure (38.7 vs. 17/1,000 years, p < 0.001), and symptomatic peripheral vascular disease (10.6 vs. 3.5/1,000 years, p < 0.001). After adjusting for cardiovascular risk factors and subclinical disease measures, elevated creatinine remained a significant predictor of all-cause and cardiovascular mortality, total cardiovascular disease (CVD), claudication, and congestive heart failure (CHF). A linear increase in risk was observed with increasing creatinine.ConclusionsElevated creatinine levels are common in older adults and are associated with increased risk of mortality, CVD, and CHF. The increased risk is apparent early in renal disease

High concordance between mental stress-induced and adenosine-induced myocardial ischemia assessed using SPECT in heart failure patients:Hemodynamic and biomarker correlates

Mental stress can trigger myocardial ischemia, but the prevalence of mental stress–induced ischemia in congestive heart failure (CHF) patients is unknown. We characterized mental stress–induced and adenosine-induced changes in myocardial perfusion and neurohormonal activation in CHF patients with reduced left-ventricular function using SPECT to precisely quantify segment-level myocardial perfusion. Methods: Thirty-four coronary artery disease patients (mean age ± SD, 62 ± 10 y) with CHF longer than 3 mo and ejection fraction less than 40% underwent both adenosine and mental stress myocardial perfusion SPECT on consecutive days. Mental stress consisted of anger recall (anger-provoking speech) followed by subtraction of serial sevens. The presence and extent of myocardial ischemia was quantified using the conventional 17-segment model. Results: Sixty-eight percent of patients had 1 ischemic segment or more during mental stress and 81% during adenosine. On segment-by-segment analysis, perfusion with mental stress and adenosine were highly correlated. No significant differences were found between any 2 time points for B-type natriuretic peptide, tumor necrosis factor-α, IL-1b, troponin, vascular endothelin growth factor, IL-17a, matrix metallopeptidase-9, or C-reactive protein. However, endothelin-1 and IL-6 increased, and IL-10 decreased, between the stressor and 30 min after stress. Left-ventricular end diastolic dimension was 179 ± 65 mL at rest and increased to 217 ± 71 after mental stress and 229 ± 86 after adenosine (P < 0.01 for both). Resting end systolic volume was 129 ± 60 mL at rest and increased to 158 ± 66 after mental stress (P < 0.05) and 171 ± 87 after adenosine (P < 0.07), with no significant differences between adenosine and mental stress. Ejection fraction was 30 ± 12 at baseline, 29 ± 11 with mental stress, and 28 ± 10 with adenosine (P = not significant). Conclusion: There was high concordance between ischemic perfusion defects induced by adenosine and mental stress, suggesting that mental stress is equivalent to pharmacologic stress in eliciting clinically significant myocardial perfusion defects in CHF patients. Cardiac dilatation suggests clinically important changes with both conditions. Psychosocial stressors during daily life may contribute to the ischemic burden of CHF patients with coronary artery disease. Keywords: heart failure, mental stress, ischemia, myocardial perfusion, adenosine, single-photon emission computed tomograph

Exploring an absent presence: Wayfinding as an embodied sociocultural experience

Wayfinding has often been seen as being about the quickest or shortest possible route between two points (Hölscher et al 2011; Tam 2011; Haque et al 2006). Moreover, this process has very often been seen as a cognitive one, with the experiential nature of wayfinding and with the embodied, emotional and sociocultural aspects of this experience conspicuously absent. We argue that wayfinding is rarely a purely cognitive process that involves an individual person, who is entirely instrumental in navigating a direct and precise route, but instead that this is a process almost always directed according to embodied and sociocultural needs. We propose a reassessment of present wayfinding definitions and suggest an alternative understanding that includes sociocultural elements, embodied individuals and experience through their embodied senses, as crucial elements of the concept. Seeing wayfinding from this different sociocultural ontological viewpoint, opens up new ways of understanding and planning wayfinding systems

Digital play and the actualisation of the consumer imagination

In this article, the authors consider emerging consumer practices in digital virtual spaces. Building on constructions of consumer behavior as both a sense-making activity and a resource for the construction of daydreams, as well as anthropological readings of performance, the authors speculate that many performances during digital play are products of consumer fantasy. The authors develop an interpretation of the relationship between the real and the virtual that is better equipped to understand the movement between consumer daydreams and those practices actualized in the material and now also in digital virtual reality. The authors argue that digital virtual performances present opportunities for liminoid transformations through inversions, speculations, and playfulness acted out in aesthetic dramas. To illustrate, the authors consider specific examples of the theatrical productions available to consumers in digital spaces, highlighting the consumer imagination that feeds them, the performances they produce, and the potential for transformation in consumer-players

Hemoglobin A1c and Arterial and Ventricular Stiffness in Older Adults

Objective: Arterial and ventricular stiffening are characteristics of diabetes and aging which confer significant morbidity and mortality; advanced glycation endproducts (AGE) are implicated in this stiffening pathophysiology. We examined the association between HbA1c, an AGE, with arterial and ventricular stiffness measures in older individuals without diabetes. Research Design & Methods: Baseline HbA1c was measured in 830 participants free of diabetes defined by fasting glucose or medication use in the Cardiovascular Health Study, a population-based cohort study of adults aged ≥65 years. We performed cross-sectional analyses using baseline exam data including echocardiography, ankle and brachial blood pressure measurement, and carotid ultrasonography. We examined the adjusted associations between HbA1c and multiple arterial and ventricular stiffness measures by linear regression models and compared these results to the association of fasting glucose (FG) with like measures. Results: HbA1c was correlated with fasting and 2-hour postload glucose levels (r = 0.21; p<0.001 for both) and positively associated with greater body-mass index and black race. In adjusted models, HbA1c was not associated with any measure of arterial or ventricular stiffness, including pulse pressure (PP), carotid intima-media thickness, ankle-brachial index, end-arterial elastance, or left ventricular mass (LVM). FG levels were positively associated with systolic, diastolic and PP and LVM. Conclusions: In this sample of older adults without diabetes, HbA1c was not associated with arterial or ventricular stiffness measures, whereas FG levels were. The role of AGE in arterial and ventricular stiffness in older adults may be better assessed using alternate AGE markers

Hotel Theming in China: A Qualitative Study of Practitioners’ Views

Facing increasing competition, many hotels have adopted “theming” as a marketing strategy. Although still in its fledgling stage, hotel theming has already gained popularity in the growing Chinese hotel market. This study conducted focus group discussions to understand the concepts behind hotel theming in China. Respondents were 41 practitioners from the Chinese hotel industry, who were enrolled in an executive graduate program. Data revealed that hotel theming has four analytical dimensions, namely, the current state, perceived facilitators, inhibitors, and future prospective for developing such strategy in China. Results showed that the specific traits of the Chinese hotel market are highly important for the success of hotel theming in the given context

Performing the high-school prom in the UK: Locating authenticity through practice

The purpose of this study was threefold: to develop an understanding of the appropriation of the US High School Prom in the UK and more importantly to generate an insight into the producers and consumers of such an event; to establish if the performance of the prom is hyper-real or if there is an awareness of the authentic or inauthentic elements of this ritual and finally to ascertain local interpretation of authenticity and glocal practice. The method used here was a qualitative approach employing 24 in-depth interviews with young adults (18-20 years) who had attended a prom in the UK in the last three years. The findings illustrated that the role and the social network of the individual was key to engagement with the High School Prom and also indicated a possible symbiosis of the strands of theory associated with authenticity. Diverse localised meanings of the prom performance were also identified. As the school prom is a growth market in the UK businesses should be aware of adolescents&rsquo; desire for ownership of this event and should tailor their marketing accordingly

Depression and HIV Infection are Risk Factors for Incident Heart Failure Among Veterans: Veterans Aging Cohort Study.

Background: Both HIV and depression are associated with increased heart failure (HF) risk. Depression, a common comorbidity, may further increase the risk of HF among HIV+ adults. We assessed the association between HIV, depression and incident HF. Methods and Results: Veterans Aging Cohort Study (VACS) participants free from cardiovascular disease at baseline (N = 81,427; 26,908 HIV+, 54,51