Overtime work and blood pressure in normotensive Japanese male workers

BackgroundEpidemiological studies have observed conflicting patterns as to whether overtime work increases blood pressure (BP), probably as a consequence of methodological issues.MethodsWe conducted a prospective cohort study to investigate the relationship between overtime work hours and 1-year changes in BP in 1,235 normotensive Japanese male workers who carried out a variety of jobs in a manufacturing factory. Casual BP measurements were repeated at annual health examinations in 2004-2005, using an automatic manometer. An analysis of covariance that incorporated potential confounding factors including baseline age, body mass index (BMI), and lifestyle factors was used to calculate and compare the means of the 1-year change in systolic (SBP) and diastolic BP (DBP). The participants were grouped according to their average monthly overtime work hours obtained from timecard data between April and September 2004.ResultsThe multivariate-adjusted mean for 1-year change in DBP in 611 male assembly-line workers was 1.5 mm Hg (95% confidence interval (CI) 0.8-2.2) for <40.0 h/month, 2.3 mm Hg (95% CI 1.3-3.2) for 40.0-79.9 h/month, and 5.3 mm Hg (95% CI 2.7-7.9) for ≥80.0 h/month (P for heterogeneity = 0.02). A broadly similar pattern was observed for SBP. In contrast, there was no significant difference in means 1-year change for both SBP and DBP in 315 clerks and 309 engineers/special technicians, grouped according to overtime work hours.ConclusionsExtensive overtime work was associated with increased BP in normotensive male assembly-line workers, but not in clerks and engineers/special technicians.American Journal of Hypertension 2012; doi:10.1038/ajh.2012.37.     

Prohypertensive Effect of Gestational Personal Exposure to Fine Particulate Matter. Prospective Cohort Study in Non-smoking and Non-obese Pregnant Women

Exposure to fine particulate matter (PM) is a recognized risk factor for elevated blood pressure (BP) and cardiovascular disease in adults, and this prospective cohort study was undertaken to evaluate whether gestational exposure to PM(2.5) has a prohypertensive effect. We measured personal exposure to fine particulate matter (PM(2.5)) by personal air monitoring in the second trimester of pregnancy among 431 women, and BP values in the third trimester were obtained from medical records of prenatal care clinics. In the general estimating equation model, the effect of PM(2.5) on BP was adjusted for relevant covariates such as maternal age, education, parity, gestational weight gain (GWG), prepregnancy BMI, environmental tobacco smoke (ETS), and blood lead level. Systolic blood pressure (SBP) increased in a linear fashion across a dosage of PM(2.5) and on average augmented by 6.1?mm Hg (95% CI, 0.6-11.6) with log unit of PM(2.5) concentration. Effects of age, maternal education, prepregnancy BMI, blood lead level, and ETS were insignificant. Women with excessive gestational weight gain (>18?kg) had higher mean SBP parameters by 5.5?mmHg (95% CI, 2.7-8.3). In contrast, multiparous women had significantly lower SBP values (coeff.?=?-4.2?mm Hg; 95% CI, -6.8 to -1.6). Similar analysis performed for diastolic blood pressure (DBP) has demonstrated that PM(2.5) also affected DBP parameters (coeff.?=?4.1; 95% CI, -0.02 to 8.2), but at the border significance level. DBP values were positively associated with the excessive GWG (coeff.?=?2.3; 95% CI, 0.3-4.4) but were inversely related to parity (coeff.?=?-2.7; 95% CI, -4.6 to -0.73). In the observed cohort, the exposure to fine particulate matter during pregnancy was associated with increased maternal blood pressure.     

Blood pressure is associated with body mass index in both normal and obese children

Obesity is associated with elevated blood pressure (BP) both in adults and children. Childhood obesity has become a severe health problem, especially during the last few decades. So far there has not been any large-scale study specifically focusing on the association between obesity and BP in early life. The aim of this study is to examine systematically the association between obesity and BP in preschool Chinese children in mainland China. In 1996, measurements of weight, height, and BP values were collected in a nationwide, case-control study of 748 boys and 574 girls who ranged in age from 0.1 to 6.9 years in 8 cities in mainland China. One obese child and 1 nonobese child were matched for gender and age. The BP differences of the mean-matched pair were approximately 5 mm Hg for systolic blood pressure (SBP) and approximately 4 mm Hg for diastolic blood pressure (DBP) (P<0.05); a higher value was noted in obese children. The BP value of 19.4% children in the obese group and 7.0% children in the nonobese group was higher than the 95th percentile value (P<0.0001), which is defined as high BP by the Task Force on Blood Pressure Control in Children. Both SBP and DBP were significantly (P<0.05) positively related to body mass index (BMI) values (P<0.05) for children in obese and nonobese groups after adjustment for age, gender, and height. To be specific, an increase of 1 BMI unit was associated with, on average, an increase of 0.56 mm Hg and 0.54 mm Hg in SBP and DBP, respectively, for obese children. In nonobese children, the increase in SBP and DBP was 1.22 mm Hg and 1.20 mm Hg, respectively. An increase in the BMI is conclusively associated with elevated SBP and DBP in nonobese children. Furthermore, an increase in the adjusted BMI was associated with an increase in SBP and DBP in obese and nonobese children.     

Association between body composition and blood pressure in a contemporary cohort of 9-year-old children

Elevated blood pressure (BP) in children is an early risk factor for cardiovascular disease and is positively associated with body mass index (BMI). However, BMI does not distinguish between fat and lean masses, and the relationship of BP in children to different elements of body composition is not well established. BP, BMI and body composition were measured in 6863 children enrolled in the Avon Longitudinal Study of Parents and Children. Fat mass, lean mass and trunk fat were assessed using dual-energy X-ray absorptiometry. After full adjustment for confounders, total body fat and BMI were positively associated with systolic blood pressure (SBP) (beta=3.29, 95% confidence interval CI 3.02, 3.57 mm Hg/standard deviation (s.d.) and beta=3.97, 95% CI 3.73, 4.21 mm Hg/s.d., respectively) and diastolic blood pressure (DBP) (beta=1.26, 95% CI 1.05, 1.46 mm Hg/s.d. and beta=1.37, 95% CI 1.19, 1.54 mm Hg/s.d., respectively). SBP was also positively associated with lean mass (beta=3.38, 95% CI 2.95, 3.81 mm Hg/s.d.), and weakly associated with trunk fat (beta=1.42, 95% CI -0.06, 2.90 mm Hg/s.d., independent of total fat mass), which was robust in girls only. The association between lean mass and SBP remained even after accounting for fat mass. SBP in 9-year-old children is independently associated with fat mass and lean mass and, to a lesser extent, trunk fat in girls. In this analysis, because both fat and lean masses are associated with BP, BMI predicts BP at least as well as these components of body composition.     

Associations between weight gain and incident hypertension in a bi-ethnic cohort: the Atherosclerosis Risk in Communities Study.

OBJECTIVE: To examine associations between weight gain and changes in blood pressure and the incidence of hypertension in four ethnicity-gender groups. DESIGN: Longitudinal closed cohort studied over an average of 6 y. SUBJECTS: Total of 9309 white and African-American men and women 45-64 y of age who participated in the Atherosclerosis Risk in Communities (ARIC) Study. METHODS: Weight and blood pressure were measured at baseline and after an average of 3 and 6 y of follow-up. Proportional hazard models with weight gain as a time-dependent variable were used to examine the association between weight gain and changes in blood pressure and hypertension. Multivariate models were used with baseline SBP, DBP, age, BMI, height, WHR, smoking, physical activity, education, caloric intake, fat intake and study center as covariates. RESULTS: Weight gain was associated with increases in SBP and DBP in all groups. Hazard ratios for hypertension associated with 1 kg annual weight gain were 1.36 (95% CI, 1.29, 1.45) in white women, 1.12 (95% CI, 1.03, 1.21) in African-American women, 1.35 (95% CI, 1.27, 1.43) in white men and 1.43 (95% CI, 1.27,1.61) in African-American men. CONCLUSION: Weight gain was associated with increased blood pressure and increased incidence of hypertension. The association was weaker among African-American women compared to other ethnicity-gender groups.     

Risk of progression to hypertension in a low-income Mexican population with prehypertension and normal blood pressure

BACKGROUND: Blood pressure (BP) levels below the prehypertensive category may be associated with the risk of developing hypertension. We estimated the incidence rates of hypertension in a low-income Mexican population according to several subcategories of baseline BP within normal and prehypertensive categories. METHODS: In total, 1572 nonhypertensive men (n = 632) and nonpregnant women (n = 940), aged 35 to 64 years at baseline, were followed for a median of 5.8 years. Hypertension was defined as systolic blood pressure (SBP) >or=140 mm Hg, diastolic blood pressure (DBP) >or=90 mm Hg, or a self-reported physician's diagnosis with antihypertensive medications. RESULTS: During follow-up, 267 subjects developed hypertension, of whom 83 were men and 184 were women. The age-adjusted incidence rate was higher in women (37.1 per 1000 person-years) than in men (23.7 per 1000 person-years). There was a significant association between BP levels at baseline and incidence of hypertension, even within the normal category. For the upper levels of normal SBP (110 to 119 mm Hg), the hazards ratio (HR) was 2.43 (95% confidence interval [CI], 1.50 to 3.93) in women and 2.44 (95% CI, 1.05 to 5.69) in men, compared with SBP <110 mm Hg. For the upper levels of normal DBP (70 to 79 mm Hg), the HR was 2.33 (95% CI, 1.65 to 3.31) in women and 1.80 (95% CI, 0.92 to 3.52) in men, compared with DBP <70 mm Hg, after adjustment for recognized predictors. CONCLUSIONS: A high risk for the incidence of hypertension was associated with levels of BP, even within the normal category. This information could help define a population at high risk of progression to hypertension, to establish preventive measures.     

Prognostic value of systolic and diastolic blood pressure in treated hypertensive men

BACKGROUND: The aim of this study was to assess the cardiovascular risk in hypertensive subjects according to systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels. METHODS: The study sample consisted of 4714 hypertensive men, treated by their physician, who had a standard health checkup at the d'Investigations Préventives et Cliniques Center, Paris, France, between 1972 and 1988. Cardiovascular disease (CVD) and coronary heart disease (CHD) mortality were assessed for a mean period of 14 years. RESULTS: Among treated subjects, 85.5% presented uncontrolled values for SBP (> or = 40 mm Hg) and/or DBP (> or = 90 mm Hg). After adjustment for age and associated risk factors, these subjects presented an increased risk for CVD mortality (risk ratio [RR], 1.66; 95% confidence interval [CI], 1.04-2.64) and for CHD mortality (RR, 2.35; 95% CI, 1.03-5.35) compared with controlled subjects. After adjustment for age, associated risk factors, and DBP, and compared with subjects with SBP under 140 mm Hg, the RR for CVD mortality was 1.81 (95% CI, 1.04-3.13) in subjects with SBP between 140 and 160 mm Hg and 1.94 (95% CI, 1.10-3.43) in subjects with SBP over 160 mm Hg. By contrast, after adjustment for SBP levels, CVD risk was not associated with DBP. Compared with subjects with DBP under 90 mm Hg, RR for CVD mortality was 1.17 (95% CI, 0.80-1.70) in subjects with DBP between 90 and 99 mm Hg and 1.03 (95% CI, 0.67-1.56) in subjects with DBP over 100 mm Hg. Similar results were observed for CHD mortality. CONCLUSIONS: In hypertensive men treated in clinical practice, SBP is a good predictor of CVD and CHD risk. Diastolic blood pressure, which remains the main criterion used by most physicians to determine drug efficacy, appears to be of little value in determining cardiovascular risk. Evaluation of risk in treated individuals should take SBP rather than DBP values into account.     

Impact of highly active antiretroviral therapy on blood pressure in HIV-infected patients. A prospective study in a cohort of naive patients

OBJECTIVES: To assess the impact of highly active antiretroviral therapy (HAART) on the blood pressure (BP) of naive patients after 1 year of treatment. METHODS: A prospective, observational study of 95 HIV-positive patients in our Unit starting HAART between January 2001 and October 2002 and maintaining the same regimen for 48 weeks of follow-up was carried out. Data on blood pressure (BP) and demographic, epidemiological, clinical, immunovirological and therapeutic characteristics related to HIV infection were collected prior to HAART and at week 48. High blood pressure (HBP) [systolic BP (SBP) > or =140 mm Hg and/or diastolic BP (DBP) > or =90 mm Hg] was defined according to international criteria. RESULTS: Of the 95 patients, 78 were men, 44% had AIDS and 68% were smokers, and their mean age was 40 years. At week 48 the prevalence of HBP was 26% and SBP, DBP and pulse pressure (PP) increased (121.8 versus 116.6 mm Hg, P=0.0001; 76.3 versus 69.7 mm Hg, P=0.004; 46.9 versus 43.8 mm Hg, P=0.001, respectively). Univariate analysis showed that HBP was associated with older age, higher body mass index (BMI), higher baseline lipids, and higher baseline BP. A linear regression model adjusting for age and sex suggested a significant impact of older age, higher baseline SBP, higher baseline hypercholesterolaemia and lower baseline CD4-cell count on SBP increase. CONCLUSIONS: Blood pressure increased after 48 weeks of HAART, leading to an important prevalence of hypertension. The increase in SBP depended on age and baseline lipid profile and immunological status. BP should be periodically measured and treated when necessary in HIV-infected patients on HAART.     

Effect of weight loss on blood pressure changes in overweight patients: A systematic review and meta-analysis

To determine quantitative differences between weight loss and changes in clinic blood pressure (BP) and ambulatory BP in patients with obesity or overweight, the authors performed a meta-analysis. PubMed, Embase, and Scopus databases were searched up to June 2022. Studies that compared clinic or ambulatory BP with weight loss were included. A random effect model was applied to pool the differences between clinic BP and ambulatory BP. Thirty-five studies, for a total of 3219 patients were included in this meta-analysis. The clinic systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly reduced by 5.79 mmHg (95% CI, 3.54–8.05) and 3.36 mmHg (95% CI, 1.93–4.75) after a mean body mass index (BMI) reduction of 2.27 kg/m², and the SBP and DBP were significantly reduced by 6.65 mmHg (95% CI, 5.16–8.14) and 3.63 mmHg (95% CI, 2.03–5.24) after a mean BMI reduction of 4.12 kg/m². The BP reductions were much larger in patients with a BMI decrease ≥3 kg/m² than in patients with less BMI decrease, both for clinic SBP [8.54 mmHg (95% CI, 4.62–12.47)] versus [3.83 mmHg (95% CI, 1.22–6.45)] and clinic DBP [3.45 mmHg (95% CI, 1.59–5.30)] versus [3.15 mmHg (95% CI, 1.21–5.10)]. The significant reduction of the clinic and ambulatory BP followed the weight loss, and this phenomenon could be more notable after medical intervention and a larger weight loss.     

Does hypertensive disorder of pregnancy predict offspring blood pressure at 21 years? Evidence from a birth cohort study

Although few studies found that the offspring of women who experienced preeclampsia have higher blood pressure (BP) at childhood and adolescence, no study has observed whether this association exists for adult offspring. To examine whether maternal hypertensive disorder of pregnancy (HDP) predicts adult offspring BP. We followed a sub-sample of 2608 mother-offspring pairs for 21 years from an original cohort of 7223 singleton infants whose mothers gave birth in Brisbane, Australia between 1981 and 1983. HDP was defined as diastolic BP (DBP) over 90?mm?Hg on at least two occasions beyond 20 weeks gestation associated with proteinuria and/or excessive fluid retention. Adult offspring's systolic BP (SBP) and DBP were measured at 21 years. Multivariable regressions were used to examine the independent associations of HDP with offspring BP. Unadjusted regression analysis showed that offspring of women who experienced HDP have 3.46?mm?Hg greater SBP and 3.02?mm?Hg greater DBP at 21 years. This association remained consistent after adjusting for potential confounding and mediating factors including offspring gender, age, percentile birth weight for gestation, placenta weight and body mass index (BMI) at 21 year, maternal age, education, racial origin, and smoking during pregnancy and their pre-pregnancy BMI. Findings of this study suggest that maternal HDP predicts adult offspring BP.     

Blood pressure levels and hypertension status among ethnic groups in England

The prevalence of cardiovascular disease and hypertension show wide variability among different ethnic groups in the UK. We combined data collected annually between 1991-1996 in the Health Surveys for England--nationwide surveys that provide information on the health status in a representative sample of the population living in England, to compare blood pressure (BP) levels, hypertension rates (systolic BP > or = 160 mm Hg or diastolic BP > or = 95 mm Hg, or those on antihypertensive medication), hypertension treatment and control rates in people of white, black (combining black-Caribbean, black-African and black-other), and South Asian origin (combining Indians, Pakistanis and Bangladeshis). Analyses were stratified into two age groups, 16-39 (younger) and > or = 40 years (older), but were focused on older adults (30,619 whites, 295 blacks and 529 South Asians). Age-adjusted mean BP levels and hypertension rates of older adults were highest among blacks, while South Asian men showed BP levels and hypertension rates similar to black men and South Asian women had mean BP levels and hypertension rates similar to white women. After controlling for age, BMI, smoking, alcohol consumption, and social class the odds ratio (OR) of being hypertensive among older adults was higher in black men (OR 2.0; 95% CI 1.4, 2.9; P < 0.001); black women (OR 1.7; 95% CI 1.2, 2.5; P < 0.01); and South Asian men (1.9; CI 1.4, 2.4; P < 0.001), than in their white counterparts. Among those studied with hypertension, treatment rates were highest among black men and women. Among those on antihypertensive medication, the odds of having BP controlled (SBP < 160 mm Hg and DBP < 95 mm Hg) did not differ among the three groups of older men but was reduced in older South Asian women, compared with white women.     

老老年人群动态血压参数与动脉僵硬度的相关性

目的探讨老老年人群动态血压参数与动脉僵硬度的相关性。方法筛选年龄≥80岁的老老年人238例,以血压≥160/95 mm Hg(1 mm Hg=0.133 kPa)为标准,分为高血压组(134例)和对照组(104例),并进行臂-踝脉搏传导速度(baPWV)和24 h动态血压监测。用Pearson分析动态血压各参数与动脉僵硬度的相关性。结果高血压组baPWV高于对照组(P<0.05)。高血压组偶测收缩压,24 h、昼间和夜间收缩压、舒张压、脉压,收缩压负荷及舒张压负荷均高于对照组.夜间收缩压下降率、舒张压下降率低于对照组,差异有统计学意义(P<0.05,P<0.01)。baPWV与偶测血压;24 h收缩压、舒张压、脉压;昼间收缩压、舒张压、脉压、心率;夜间收缩压、舒张压、脉压;收缩压负荷、舒张压负荷呈正相关(P<0.05,P<0.01),而与夜间收缩压下降率呈负相关(P<0.01)。结论高血压是老老年人群动脉僵硬度增加的一个重要因素,动脉僵硬度与动态血压、脉压、心率及血压负荷相关。     

Development of hypertension over 6 years in a birth cohort of young middle-aged men: the Cardiovascular Risk Factor Study in southern Sweden (CRISS)

OBJECTIVES: To explore the development of hypertension (HT) in a cohort of young middle-aged men. DESIGN: Prospective birth-cohort study of men surveyed over 6 years. SETTING: Helsingborg County Hospital, Sweden, 1990-97. SUBJECTS: A total of 628 men born in 1953-54, all surveyed at 37, 40 and 43 years of age. MAIN OUTCOME MEASURES: Systolic blood pressure (SBP), diastolic blood pressure (DBP), S-cholesterol, body mass index (BMI), alcohol consumption, ethnicity. HT was defined as SBP > or = 140 mmHg and/or DBP > or = 90 mmHg, or ongoing treatment. Using SBP < 130 mmHg and DBP < 85 mmHg as reference, the odds of conversion to HT in men with high normal blood pressure (BP) (SBP 130-139 mmHg and DBP 85-89 mmHg) was investigated. RESULTS: At age 37, 243 men (39%) had reference BP, 167 (26%) had high normal BP and 218 (35%) were hypertensive. Corresponding numbers at age 40 were 265 (42%), 166 (27%) and 197 (31%); and at age 43, 180 (29%), 142 (22%) and 306 (49%), respectively. High normal BP at baseline was associated with the development of HT both at age 40 (odds ratio (OR)=2.45 confidence interval (CI): 1.42-4.22) and at age 43 (OR=2.46, CI: 1.59-3.80), independent of other cardiovascular disease risk factors and ethnicity. The progression to HT was predicted also by S-cholesterol, alcohol consumption, BMI and weight gain. CONCLUSIONS: Over a short-term period, a substantial proportion of young middle-aged men with high normal BP develop HT with overweight and alcohol consumption as important determinants. These findings have implications for the prevention, screening and medical care of HT in this target population.     

Effect of oral pseudoephedrine on blood pressure and heart rate: a meta-analysis

Oral pseudoephedrine is commonly used to treat symptoms of rhinitis and rhinorrhea, but its effect on blood pressure (BP) and heart rate (HR) remains uncertain. We assessed whether pseudoephedrine causes clinically meaningful elevations in HR or BP. We searched MEDLINE, EMBASE, and the Cochrane Library for English-language, randomized placebo-controlled trials of oral pseudoephedrine treatment in adults. The primary data extracted were systolic BP (SBP), diastolic BP (DBP), and HR. Study quality was assessed using the methods of Jadad, and data were synthesized using a random-effects model and weighted mean differences. Twenty-four trials had extractable vital sign information (45 treatment arms; 1285 patients). Pseudoephedrine caused a small but significant increase in SBP (0.99, mm Hg; 95% CI, 0.08 to 1.90) and HR (2.83 beats/min; 95% CI, 2.0 to 3.6), with no effect on DBP (0.63 mm Hg, 95% CI, -0.10 to 1.35). The effect in patients with controlled hypertension demonstrated an SBP increase of similar magnitude (1.20 mm Hg; 95% CI, 0.56 to 1.84 mm Hg). Higher doses and immediate-release preparations were associated with greater BP increases. Studies with more women had less effect on BP or HR. Shorter duration of use was associated with greater increases in SBP and DBP.     

Reduction in blood pressure with statins: results from the UCSD Statin Study, a randomized trial.

BACKGROUND: Some studies have suggested reductions in blood pressure (BP)with statin treatment, particularly in persons with hypertension. Randomized trial evidence is limited. METHODS: We performed a randomized, double-blind, placebo-controlled trial with equal allocation to simvastatin, 20 mg; pravastatin sodium,40 mg; or placebo for 6 months. Nine hundred seventy-three men and women without known cardiovascular disease or diabetes mellitus, with low-density lipoprotein cholesterol screening levels of 115 to 190 mg/dL, had assessment of systolic and diastolic BP (SBP and DBP, respectively). Blood pressure values were compared for placebo vs statins by intention-to-treat (ITT) analysis. Additional analyses were performed that (1) were confined to subjects with neither high baseline BP (SBP>140 mm Hg or DBP>90 mm Hg) nor receiving BP medications, to exclude groups in whom BP medications or medication changes may have influenced results, and (2) separately evaluated simvastatin and pravastatin (vs placebo). The time course of BP changes after statin initiation and the effect of stopping statins on BP were examined. RESULTS: Statins modestly but significantly reduced BP relative to placebo,by 2.2 mm Hg for SBP (P=.02) and 2.4 mm Hg for DBP (P<.001) in ITT analysis. Blood pressure reductions ranged from 2.4 to 2.8 mm Hg for both SBP and DBP with both simvastatin and pravastatin, in those subjects with full follow-up, and without potential for influence by BP medications (ie, neither receiving nor meriting BP medications). CONCLUSIONS: Reductions in SBP and DBP occurred with hydrophilic and lipophilic statins and extended to normotensive subjects. These modest effects may contribute to the reduced risk of stroke and cardiovascular events reported on statins. Trial Registration clinicaltrials.gov Identifier: NCT00330980.     

Sibutramine is safe and effective for weight loss in obese patients whose hypertension is well controlled with angiotensin-converting enzyme inhibitors

Sibutramine treatment in obesity results in significantly greater weight reduction compared with placebo, although weight loss with sibutramine may be accompanied by small but statistically significant mean increases in blood pressure (BP). This 52-week, placebo-controlled, double-blind, randomised study investigated the effects of sibutramine 20 mg once daily or placebo on body weight in 220 obese (body mass index (BMI) 27-40 kg/m2), hypertensive patients. At randomisation, hypertension was well controlled (< or = 95 mm Hg diastolic blood pressure (DBP)) with an angiotensin-converting enzyme (ACE) inhibitor, with or without concomitant thiazide diuretic therapy. Therapy for hypertension continued for the 52 weeks of the study. Sibutramine 20 mg produced significantly greater weight loss compared with placebo: 4.5 kg with sibutramine compared with 0.4 kg with placebo (last observation carried forward (LOCF); P < or = 0.05). A total of 62 patients (42.8%) treated with sibutramine lost < or = 5% of their body weight compared with six patients (8.3%) treated with placebo; 19 patients (13.1%) treated with sibutramine lost > or = 10% of their body weight compared with two patients (2.8%) treated with placebo (LOCF; P < or = 0.05 for both comparisons). Hypertension remained well controlled for the 52 weeks of the study with both sibutramine and placebo treatment. After 52 weeks, the differences between placebo treatment and sibutramine treatment for both mean supine systolic blood pressure (SBP) and DBP were approximately 3 mm Hg: mean DBP was 82.8 mm Hg with placebo treatment compared with 85.5 mm Hg with sibutramine treatment (LOCF; P = 0.004) and mean SBP was 130.4 mm Hg with placebo compared with 133.1 mm Hg with sibutramine (LOCF; P = 0.0497; both comparisons, sibutramine vs placebo). The mean increases in SBP and DBP did not appear to change the overall risk category for coronary heart disease end points. Changes in pulse rate at week 52 were a decrease of 0.3 beats per minute (bpm) for placebo treatment compared with an increase of 5.7 bpm for sibutramine treatment (P < 0.001). Mandated withdrawals from the study due to protocol-defined changes in BP were not statistically different between the two treatment groups. Greater favourable changes in lipid profile, serum glucose, and uric acid could be accounted for by greater weight losses occurring in the sibutramine treatment group. Sibutramine was well tolerated. This study indicates that in obese patients whose hypertension is well controlled at the outset with an ACE inhibitor, with or without concomitant thiazide diuretic therapy, sibutramine safely and effectively achieves weight loss without compromising good BP control.     

A cross-sectional study on association of calcium intake with blood pressure in Japanese population

To investigate the association of calcium intake independently of other nutrients already known as predictors of hypertension, a cross-sectional study was carried out on the same population in Japan as used for the INTERSALT study. Dietary calcium intake was estimated from a 1-day 24-h recall. Sodium and potassium intakes were evaluated by 24-h urinary excretion. Data from 476 subjects aged 20-59 years, 230 men and 246 women, were analysed. The mean dietary calcium intake ranged from 557 to 608 mg/day among men, and from 528 to 639 mg/day among women. Among men, the pooled estimate of the regression coefficients of blood pressure (mm Hg) per 100 mg increase of calcium intake, adjusted for age and body mass index (BMI), were -0.42 mm Hg for systolic blood pressure (SBP) and -0.35 mm Hg for diastolic blood pressure (DBP), but there was no statistical significance. Among women, the pooled estimates of regression coefficients adjusted for age and BMI were -0.92 mm Hg for SBP and -0.83 mm Hg for DBP with statistical significance. After adjustment for age, BMI, alcohol intake and urinary excretion of sodium and potassium, the pooled estimate of calcium intake was -0.66 mm Hg for DBP with statistical significance and -0.70 mm Hg for SBP. A significant negative association of calcium intake with blood pressure was observed among the subjects in Osaka. Our study suggests that increased calcium intake may provide a benefit of lowering blood pressure independently of other minerals such as sodium and potassium.     

Predictors of blood pressure in a cohort of school-aged children.

OBJECTIVES: To examine anthropometric measures and birthweight as predictors of blood pressure (BP) in a cohort of children. DESIGN: Cross-sectional and longitudinal study comprising baseline anthropometric and BP measurements conducted in 1994 (n=1230), with follow-up in 1997 (n=628). SETTING: Seventy-five inner-Sydney primary schools. PARTICIPANTS: School children aged 8-9 years at baseline and 11-12 years at follow-up. MAIN OUTCOME MEASURES: Systolic and diastolic BP (SBP and DBP). STUDY FACTORS: Current weight, body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHR), weight gain since birth and birth weight. Potential confounders: age, sex and socioeconomic status (on the basis of the area of residence). RESULTS: Current weight was significantly associated with both SBP and DBP in boys and girls at baseline and follow-up. BMI and WC were similar predictors of SBP and DBP in each survey, but longitudinal BMI change has a stronger association with SBP (r=0.43, P<0.001) and DBP (r=0.26, P<0.001) than changes in WC (r=0.18, P<0.001 for SBP and r=0.16, P<0.001 for DBP) and WHR in boys with the similar results for girls. The unadjusted associations between SBP and DBP and birthweight were nonsignificant. After adjustments for age, height and socioeconomic status, however, the association becomes negative and significant in boys (beta=-1.47, P=0.04 for SBP and beta=-1.33, P=0.03 for DBP). CONCLUSION: Longitudinal change in BMI is a better predictor of BP than change in WC or the WHR, although cross-sectional measurements of BMI and WC are very similar predictors of BP. In preventing subsequent adverse effects on BP, attending to body weight during childhood is important.     

Chronotherapy of Hypertension with Angiotensin Receptor Blockers–A Meta-Analysis of Blood Pressure Measured by Ambulatory Blood Pressure Monitoring in Randomized Trials

BackgroundWe performed this meta-analysis evaluating the efficacy of chronotherapy of hypertension with angiotensin receptor blockers (ARBs).MethodsWe searched Pubmed, Web of Science, and Cochrane for all published randomized trials that compare antihypertensive effects of ARBs between bedtime dosing and awakening dosing. Blood pressure (BP) was measured by ambulatory BP monitoring in patients with mild or moderate essential hypertension.ResultsThe effects of ARBs on BP were assessed in 805 essential hypertensive patients included in 8 trials with a follow-up of 12 ± 3 weeks. The sleep-time systolic and diastolic BP (SBP, DBP) with bedtime dosing greatly decreased as compared with awakening dosing (weighted mean differences [WMD] for SBP WMD ?5.23 [95% confidence intervals (CI), ?7.27, ?3.20] mm Hg, p < 0.001; WMD for DBP ?2.94 [95% CI, ?4.52, ?1.36] mm Hg, p < 0.001). The reduction of daytime SBP (WMD 0.98 [95% CI, ?0.20, 2.17] mm Hg, p = 0.10), DBP (WMD 0.11 [95% CI, ?0.68, 0.89] mm Hg, p = 0.79), 24 hour SBP (WMD ?0.75 [95% CI, ?1.93, 0.42] mm Hg, p = 0.21) and DBP (WMD ?0. 77 [95% CI, ?1.55 0.01] mm Hg, p = 0.05) with bedtime dosing was similar with awakening dosing.ConclusionsBedtime dosing with ARBs is more effective in lowering sleep-time BP than awakening dosing in patients with essential hypertension, suggesting a utilization of chronotherapy of hypertension with ARBs to reduce sleep-time high BP. Larger multi-ethnic studies are needed to investigate the efficacy of chronotherapy of hypertension.     

Effects of coffee on ambulatory blood pressure in older men and women: A randomized controlled trial

This study assessed the effects of regular coffee drinking on 24-hour ambulatory blood pressure (ABP) in normotensive and hypertensive older men and women. Twenty-two normotensive and 26 hypertensive, nonsmoking men and women, with a mean age of 72.1 years (range, 54 to 89 years), took part in the study. After 2 weeks of a caffeine-free diet, subjects were randomized to continue with the caffeine-free diet and abstain from caffeine-containing drinks or drink instant coffee (5 cups per day, equivalent to 300 mg caffeine per day) in addition to the caffeine-free diet for a further 2 weeks. Change in systolic and diastolic blood pressures (SBP, DBP) determined by 24-hour ambulatory BP monitoring showed significant interactions between coffee drinking and hypertension status. In the hypertensive group, rise in mean 24-hour SBP was greater by 4.8 (SEM, 1.3) mm Hg (P=0.031) and increase in mean 24-hour DBP was higher by 3.0 (1.0) mm Hg (P=0.010) in coffee drinkers than in abstainers. There were no significant differences between abstainers and coffee drinkers in the normotensive group for 24-hour, daytime, or nighttime SBP or DBP. In older men and women with treated or untreated hypertension, ABP increased in coffee drinkers and decreased in abstainers. Restriction of coffee intake may be beneficial in older hypertensive individuals.