Knowledge of an urban population about arterial hypertension: prospective study carried out in Ouagadougou, Burkina Faso

The objective of this prospective survey was to estimate the prevalence of hypertension in the city of Ouagadougou and to evaluate the information level as well as the knowledge of the population regarding hypertension. We carried out a urban community based cross sectional study. Subjects were black African, and aged of 18 years at least. They were considered hypertensive when they were under a treatment for hypertension, or when they had high blood pressure (> or = 140/90 mm Hg) according to the WHO classification in 1999. The study selected 3441 subjects, among them 60.4% of women and 39.6% of men. The average age in the sample was 33.1 +/- 13.3 years; 64.4% of the subjects were 20 to 40 years old. The average systolic blood pressure in the population was of 124 +/- 21 mm Hg, and of 78 +/- 12 mm Hg for the diastolic one. The prevalence of hypertension in our sample was 23%, with 20.4% of unknown hypertensive subjects. Hypertension is highly frequent in urban area in Burkina Faso. As it could be expected, the knowledge of the population regarding hypertension proved inversely proportional to the educational level. Information programs and consciousness-raising campaign as well as detection program should be implemented urgently.     

Alcohol consumption and prehypertension: an investigation of university youth

Prehypertension and heavy alcohol consumption increase the risk for primary hypertension (PH), a major predictor of cardiovascular-related morbidity and mortality. Although undergraduate college students have exhibited prehypertensive blood pressure (BP) levels and more than 40% of undergraduates drink heavily, few researchers have examined both risk factors in the university context. In this study, the authors collected BP and self-reported quantity and frequency of alcohol consumption data from 211 undergraduates (95 women). Logistic regression analyses showed that prehypertensive undergraduates (ie, those with systolic BP > or = 120 mm Hg or diastolic BP > or = 85 mm Hg) were nearly 4 times more likely to consume alcohol levels associated with increased risk for developing PH. Additional research on alcohol and PH among adolescents and undergraduates is needed, with particular reference to mechanisms and reducing the risk for morbidity and mortality emanating from cardiovascular disease.     

Left heart hypertrophy in arterial hypertension in relation to hemodynamic and humoral factors

In patients with arterial hypertension hemodynamic as well as humoral factors may influence the development of left ventricular hypertrophy. We therefore investigated in 23 patients with long standing hypertension (11 females, 12 males, age 50 +/- 13 years) wether left ventricular mass as determined by echocardiography interrelates with hemodynamic or humoral parameters. Left ventricular mass measured 161 +/- 51 g/m2 and correlated significantly with patients' age (r = 0.55, p less than 0.05) and systolic blood pressure (159 +/- 21 mm Hg, r = 0.51, p less than 0.05) but not with diastolic blood pressure (99 +/- 15 mm Hg, r = 0.23, not significant). Plasma renin activity was 0.6 +/- 0.6 ng/ml/h and plasma norepinephrine levels measured 371 +/- 168 ng/l. Neither of these humoral parameters correlated significantly with left ventricular mass. It is concluded that in long standing hypertension left ventricular hypertrophy is determined predominantly by the elevation of systolic blood pressure and the patients' age.     

Role of the renin-angiotensin system in post-transplantation hypertension in patients with multiple kidneys.

To define the role of the renin-angiotensin system in post-transplantation hypertension we studied 12 hypertensive recipients of renal transplants. The patients received saralasin acetate, an angiotensin II antagonist, while on a normal sodium diet and again after seven days of sodium restriction. In six patients with only one kidney, saralasin did not lower blood pressure on either diet; salt depletion did not lower systolic or diastolic blood pressures. In six patients with more than one kidney, salt depletion also did not lower blood pressure; however, salt depletion plus saralasin lowered their systolic pressures from a mean (+/- S.E.M.) of 146 +/- 9 to 128 +/- 8 mm Hg, and mean diastolic pressures fell from 103 +/- 5 to 89 +/- 5 (P less than 0.001). In four of five patients renal-vein renin activity was greater in one or more host kidneys than in the transplant kidney (or kidneys). Although pre-transplant blood pressure was the same in both groups, post-transplantation hypertension is more likely to be angiotensin II-dependent in patients with more than one kidney.     

Elevated arterial blood pressure in cardiac tamponade.

BACKGROUND. In cardiac tamponade cardiac output falls, but peripheral vascular resistance increases, so that systemic blood pressure may be maintained at normal or near-normal levels. We recently observed a patient with cardiac tamponade whose blood pressure was markedly elevated. METHODS. To determine the frequency of elevated blood pressure in patients with cardiac tamponade and their hemodynamic characteristics, we studied 18 consecutive patients with cardiac tamponade from a variety of causes using right heart catheterization. RESULTS. Six of the 18 patients had systolic arterial blood pressures ranging from 150 to 210 mm Hg (mean [+/- SD], 176 +/- 26) and diastolic pressures ranging from 100 to 130 mm Hg (mean, 113 +/- 14). All six had previously been hypertensive. After pericardiocentesis there was a significant decrease in blood pressure (to 139 +/- 13 mm Hg systolic, P less than 0.05; and 83 +/- 6 mm Hg diastolic, P less than 0.01) and peripheral vascular resistance (from 2150 +/- 588 to 1207 +/- 345 dyn.sec.cm-5, P less than 0.01). Cardiac output increased in all six. The other 12 patients, 3 of whom had a history of hypertension, had significant increases in cardiac output and systolic blood pressure (from 119 +/- 13 to 127 +/- 7 mm Hg, P less than 0.05) after pericardiocentesis, whereas peripheral vascular resistance decreased. Both groups had similar degrees of cardiac tamponade, as indicated by measurements of cardiac output and intrapericardial, right atrial, and pulmonary-artery wedge pressures. CONCLUSIONS. Elevated blood pressure may occur in some patients with cardiac tamponade who have preexisting hypertension. Moreover, blood pressure may fall after pericardiocentesis in patients who have elevated blood pressure associated with tamponade.     

Hormone replacement therapy reduces mean 24-hour blood pressure and its variability in postmenopausal women with treated hypertension

BACKGROUND: The rate and severity of hypertension increase dramatically after menopause. Complications seem to be more frequent and marked in hypertensive patients with greater blood pressure (BP) variability, and antihypertensive treatment does not easily reduce this variability. The effect of hormone replacement therapy (HRT) on BP and its variability is not well understood in moderate to severe hypertension, but estrogen may have calcium channel-blocking properties. Cardiovascular events occur more frequently in the morning, likely in part because of a rise in BP. DESIGN: We prospectively studied 34 postmenopausal women with treated hypertension (mean age = 53 years) and receiving a cyclic combination of estradiol and norgestrel for 19 weeks with 24-h ambulatory BP monitoring. RESULTS: Mean daily BP and its variability decreased significantly with HRT (149.3 +/- 6.1 mm Hg vs. 140.3 +/- 8.5 mm Hg [p < 0.001]; diastolic: 95.4 +/- 4.7 mm Hg vs. 92.4 +/- 7.2 mm Hg [p < 0.05]). There was also a significant decrease in the early morning BP values after HRT (154.0 +/- 6.9 mm Hg vs. 145.6 +/- 11.0 mm Hg [p < 0.001]; diastolic: 98.0 +/- 4.8 mm Hg vs. 95.1 +/- 10.0 mm Hg [p < 0.05]). Subjects who were taking calcium channel blockers (n = 11) had only half the reduction in 24-h systolic BP compared with those who were not taking calcium channel blockers (5.3 mm Hg vs. 10.5 mm Hg), and the reduction in those who were taking calcium channel blockers failed to reach statistical significance. CONCLUSIONS: Our results demonstrate that HRT may have a role in decreasing the severity of hypertension, and the mechanism of its action might be through calcium channels.     

The effect of balloon angioplasty on hypertension in atherosclerotic renal-artery stenosis. Dutch Renal Artery Stenosis Intervention Cooperative Study Group

BACKGROUND: Patients with hypertension and renal-artery stenosis are often treated with percutaneous transluminal renal angioplasty. However, the long-term effects of this procedure on blood pressure are not well understood. METHODS: We randomly assigned 106 patients with hypertension who had atherosclerotic renal-artery stenosis (defined as a decrease in luminal diameter of 50 percent or more) and a serum creatinine concentration of 2.3 mg per deciliter (200 micromol per liter) or less to undergo percutaneous transluminal renal angioplasty or to receive drug therapy. To be included, patients also had to have a diastolic blood pressure of 95 mm Hg or higher despite treatment with two antihypertensive drugs or an increase of at least 0.2 mg per deciliter (20 micromol per liter) in the serum creatinine concentration during treatment with an angiotensin-converting-enzyme inhibitor. Blood pressure, doses of antihypertensive drugs, and renal function were assessed at 3 and 12 months, and patency of the renal artery was assessed at 12 months. RESULTS: At base line, the mean (+/-SD) systolic and diastolic blood pressures were 179+/-25 and 104+/-10 mm Hg, respectively, in the angioplasty group and 180+/-23 and 103+/-8 mm Hg, respectively, in the drug-therapy group. At three months, the blood pressures were similar in the two groups (169+/-28 and 99+/-12 mm Hg, respectively, in the 56 patients in the angioplasty group and 176+/-31 and 101+/-14 mm Hg, respectively, in the 50 patients in the drug-therapy group; P=0.25 for the comparison of systolic pressure and P=0.36 for the comparison of diastolic pressure between the two groups); at the time, patients in the angioplasty group were taking 2.1+/-1.3 defined daily doses of medication and those in the drug-therapy group were taking 3.2+/-1.5 daily doses (P<0.001). In the drug-therapy group, 22 patients underwent balloon angioplasty after three months because of persistent hypertension despite treatment with three or more drugs or because of a deterioration in renal function. According to intention-to-treat analysis, at 12 months, there were no significant differences between the angioplasty and drug-therapy groups in systolic and diastolic blood pressures, daily drug doses, or renal function. CONCLUSIONS: In the treatment of patients with hypertension and renal-artery stenosis, angioplasty has little advantage over antihypertensive-drug therapy.     

Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. Systolic Hypertension in Europe Trial Investigators

BACKGROUND: Recent reports suggest that calcium-channel blockers may be harmful in patients with diabetes and hypertension. We previously reported that antihypertensive treatment with the calcium-channel blocker nitrendipine reduced the risk of cardiovascular events. In this post hoc analysis, we compared the outcome of treatment with nitrendipine in diabetic and nondiabetic patients. METHODS: After stratification according to center, sex, and presence or absence of previous cardiovascular complications, 4695 patients (age, > or =60 years) with systolic blood pressure of 160 to 219 mm Hg and diastolic pressure below 95 mm Hg were randomly assigned to receive active treatment or placebo. Active treatment consisted of nitrendipine (10 to 40 mg per day) with the possible addition or substitution of enalapril (5 to 20 mg per day) or hydrochlorothiazide (12.5 to 25 mg per day) or both, titrated to reduce the systolic blood pressure by at least 20 mm Hg and to less than 150 mm Hg. In the control group, matching placebo tablets were administered similarly. RESULTS: At randomization, 492 patients (10.5 percent) had diabetes. After a median follow-up of two years, the systolic and diastolic blood pressures in the placebo and active-treatment groups differed by 8.6 and 3.9 mm Hg, respectively, among the diabetic patients. Among the 4203 patients without diabetes, systolic and diastolic pressures differed by 10.3 and 4.5 mm Hg, respectively, in the two groups. After adjustment for possible confounders, active treatment was found to have reduced overall mortality by 55 percent (from 45.1 deaths per 1000 patients to 26.4 deaths per 1000 patients), mortality from cardiovascular disease by 76 percent, all cardiovascular events combined by 69 percent, fatal and nonfatal strokes by 73 percent, and all cardiac events combined by 63 percent in the group of patients with diabetes. Among the nondiabetic patients, active treatment decreased all cardiovascular events combined by 26 percent and fatal and nonfatal strokes by 38 percent. In the group of patients receiving active treatment, reductions in overall mortality, mortality from cardiovascular disease, and all cardiovascular events were significantly larger among the diabetic patients than among the nondiabetic patients (P=0.04, P=0.02, and P=0.01, respectively). CONCLUSIONS: Nitrendipine-based antihypertensive therapy is particularly beneficial in older patients with diabetes and isolated systolic hypertension. Thus, our findings do not support the hypothesis that the use of long-acting calcium-channel blockers may be harmful in diabetic patients.     

Twelve-year blood pressure dynamics in adults in Ljubljana area, Slovenia: contribution of WHO Countrywide Integrated Noncommunicable Diseases Intervention Program

Aim

To determine 12-year dynamics of the average value of arterial blood pressure and arterial hypertension prevalence among adult residents of Ljubljana area in Slovenia, and to assess the probable contribution of World Health Organization’s Countrywide Integrated Noncommunicable Diseases Intervention Program (CINDI) to observed dynamics.

Methods

A total of 4409 adults aged 25-64 participated in three successive cross-sectional surveys performed in Ljubljana area from late autumn to early spring 1990/1991, 1996/1997, and 2002/2003 (n_1990/91 = 1692, n_1996/97 = 1342, n_1990/91 = 1375). Standardized measurements of systolic and diastolic blood pressure were performed. The subjects were considered to have hypertension if systolic/diastolic blood pressure was ≥140/90 mm Hg. The dynamics of average values of systolic and diastolic blood pressures and arterial hypertension was statistically assessed with multiple linear or logistic regression.

Results

After the adjustment for the effects of sex, age, and education, the average value of systolic blood pressure remained almost the same between 1990/1991 and 1996/1997 (130.6 ± 20.3 and 130.6 ± 19.6 mm Hg, respectively; P = 0.728), whereas it significantly decreased to 127.6 ± 17.8 mm Hg in 2002/2003 (P<0.001). The average value of diastolic blood pressure was not significantly different in 1990/1991, 1996/1997, and 2002/2003 (83.4 ± 11.6 mm Hg, 84.1 ± 11.4 mm Hg, and 83.5 ± 11.2 mm Hg, respectively; P = 0.059). The odds ratio for arterial hypertension increased significantly between 1990/1991 and 1996/1997 (P = 0.001), but decreased between 1996/1997 and 2002/2003 (P = 0.135).

Conclusions

The values of blood pressure remained unchanged or increased during the first half of 12-year period, but decreased during the second half. The favorable decrease in average blood pressure could be attributed to systematic intervention promoted by CINDI program activities in Slovenia, which started in the late 1990s.Arterial hypertension is one of the most important modifiable risk factors for cardiovascular diseases and one of the major contributors to adult mortality or disability in many countries (1). Changing the lifestyle, screening for arterial hypertension, and implementing early antihypertensive drug treatment are among the cornerstones of the successful prevention of cardiovascular diseases (1-3).Many different international programs were designed and implemented in the last three decades to combat chronic noncommunicable diseases. One of such programs is Countrywide Integrated Noncommunicable Diseases Intervention program (CINDI) of the World Health Organization (WHO), Regional Office for Europe (4), which started in the 1980s (5). Intervention measures target the population in general and high-risk groups and are implemented according to the common protocol (6), preferably on a country level. The CINDI strategy aims to reduce the burden of noncommunicable diseases primarily by discouraging an unhealthy lifestyle. The measures are supposed to be implemented through national or regional noncommunicable diseases prevention policies with a clear link to general national health policies, and lead to the improvement of individual risk by decreasing biological risk factors (obesity, increased arterial blood pressure, and abnormalities in lipid and carbohydrate metabolism) (7). An important element of the program is arterial hypertension control to reduce the risk of cardiovascular diseases. CINDI-WHO Working Group on Hypertension has developed international recommendations, where the most frequently used nonpharmacological interventions for arterial hypertension control are stress management; smoking cessation; salt, calories and saturated fats intake reduction; vegetable and fruit consumption; physical activity increase; and alcohol intake reduction (8). Given the experiences of Finland (North Karelia) and Lithuania, the CINDI program could be extremely successful (9).Combating noncommunicable diseases in Slovenia has become one of the most important preventive issues since mortality in the country is still mainly attributable to noncommunicable diseases, with cardiovascular diseases being the leading group of death causes (10). Among the physiological risk factors for noncommunicable diseases in Slovenia, especially in Ljubljana area, there was a 19% high prevalence of severe arterial hypertension (systolic/diastolic blood pressure ≥160/95 mm Hg) registered at the beginning of the 1990s (11,12). Thus, in comparison with Hungary (5%), Israel (7%), Romania (5-10%), and Italy (24-27%), Slovenia belongs among the countries with the highest prevalence of severe arterial hypertension (11). Consecutively, it was realized that a program like CINDI was strongly needed. A group of general practitioners from the city of Ljubljana introduced this program for the first time at the end of the 1980s, but Slovenia as a state officially joined CINDI program at the beginning of the 1990s, when its activities were limited to Ljubljana area (13). The CINDI program in Slovenia was introduced between 1990 and 1994. From the late fall to early spring 1990/1991, the basic cross-sectional CINDI survey (CINDI Risk Factor/Process Evaluation Survey) according to CINDI program protocol (6) was carried out. In 1994, a CINDI Slovenia Preventive Unit was established as an autonomous unit within the Ljubljana Community Health Centre. At that time, no specific major interventions were performed except for the survey on cardiovascular disease risk factors and dissemination of the concerning results on their prevalence among physicians and general population. The need for immediate action in the field of arterial hypertension became more obvious when the second CINDI survey, carried out in late 1996 and early 1997, revealed an increase in arterial hypertension prevalence (14). After that, a more systematic promotional and prevention activities through group health education and individual counseling were put into action and developed into the Nationwide Program on Primary Prevention of Cardiovascular Diseases, which was launched and carried out under the auspices of the Ministry of Health of the Republic of Slovenia (15,16).We performed a detailed retrospective analysis of dynamics of the average values of blood pressure and arterial hypertension prevalence detected in three CINDI surveys during the 12-year period in Ljubljana area. We also aimed at assessing the probable contribution of CINDI program activities to this dynamics. The main post-hoc hypothesis was that there were differences in average values of systolic and diastolic blood pressure and arterial hypertension prevalence within the observation period. The beneficial contribution of CINDI program was expected in the second half of the period, after the systematic interventional activities of this program had started.     

Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group

BACKGROUND: The effect of dietary composition on blood pressure is a subject of public health importance. We studied the effect of different levels of dietary sodium, in conjunction with the Dietary Approaches to Stop Hypertension (DASH) diet, which is rich in vegetables, fruits, and low-fat dairy products, in persons with and in those without hypertension. METHODS: A total of 412 participants were randomly assigned to eat either a control diet typical of intake in the United States or the DASH diet. Within the assigned diet, participants ate foods with high, intermediate, and low levels of sodium for 30 consecutive days each, in random order. RESULTS: Reducing the sodium intake from the high to the intermediate level reduced the systolic blood pressure by 2.1 mm Hg (P<0.001) during the control diet and by 1.3 mm Hg (P=0.03) during the DASH diet. Reducing the sodium intake from the intermediate to the low level caused additional reductions of 4.6 mm Hg during the control diet (P<0.001) and 1.7 mm Hg during the DASH diet (P<0.01). The effects of sodium were observed in participants with and in those without hypertension, blacks and those of other races, and women and men. The DASH diet was associated with a significantly lower systolic blood pressure at each sodium level; and the difference was greater with high sodium levels than with low ones. As compared with the control diet with a high sodium level, the DASH diet with a low sodium level led to a mean systolic blood pressure that was 7.1 mm Hg lower in participants without hypertension, and 11.5 mm Hg lower in participants with hypertension. CONCLUSIONS: The reduction of sodium intake to levels below the current recommendation of 100 mmol per day and the DASH diet both lower blood pressure substantially, with greater effects in combination than singly. Long-term health benefits will depend on the ability of people to make long-lasting dietary changes and the increased availability of lower-sodium foods.     

Talking Effect and White Coat Phenomenon in Hypertensive Patients

Both white coat effect (the tendency of blood pressure to rise during a medical visit) and talking effect were analyzed in 42 patients with essential hypertension. Blood pressure was measured during the clinic visit and over the subsequent 24-hour ambulatory period, with the physician performing 49 ± 4 measurements for each patient. Three silent periods and two talking periods (stress and relaxation) were randomly allocated in a crossover design and studied, using analysis of variance. During the initial 11-minute silent period, systolic/diastolic blood pressures increased by 6 mm Hg/5 mm Hg. During the subsequent talking periods, these variations were significantly greater: +22 mm Hg/+17 mm Hg. Measures of systolic/diastolic blood pressure were higher during stressful talking than during relaxed talking. The talking and its emotional contents seemed to explain 70% of the white coat phenomenon. To minimize the white coat phenomenon in the clinic, physicians, nurses, and clinicians are advised to measure blood pressure during an initial period of silence.     

Long-term follow-up of blood pressure in family members of soldiers killed during the war in Bosnia and Herzegovina

Aim

To asses prevalence of essential arterial hypertension in family members of soldiers killed in 1992-1995 war in Bosnia and Herzegovina.

Methods

The study enrolled 1144 subjects who lost a family member in the war and 582 of their close neighbors who experienced no such loss. Data on their medical history and habits were collected, and their blood pressure was recorded in 1996 and 2003. Arterial hypertension was defined as systolic blood pressure ≥140 mm Hg (≥130 mm Hg in patients with diabetes mellitus), or diastolic blood pressure ≥90 mm Hg (≥80 mm Hg in patients with diabetes mellitus), or taking antihypertensive therapy. Additional laboratory and clinical tests were performed in subjects with hypertension.

Results

The prevalence of hypertension at both time points was higher in the group with a killed family member than in the group without the loss (55.1% vs 42.1%, P<0.001 in 1996, and 50.7% vs 39.0%, P<0.001 in 2003, respectively). However, there was also a significant decrease in the prevalence of hypertension in the group with the loss in 2003 (P<0.001), but not in group without the loss. Posttraumatic stress disorder (PTSD), smoking, and alcohol consumption were more prevalent in the group with a killed family member, but not cholesterol and triglyceride blood concentrations. In both groups, hypertension was more prevalent in subjects with PTSD and smoking or drinking habit. Proportion of subjects with hypertension who smoked and used alcohol was similar in both groups. Proportion of subjects with hypertension who did not smoke or drink was higher in the group with the loss (51.1% vs 36.7%, P<0.001; 46.2% vs 35.0%, P = 0.006; respectively).

Conclusion

This study showed higher prevalence of hypertension in family members of killed soldiers, regardless of the presence of other cardiovascular risk factors. Only the stress of mourning was associated with higher prevalence of hypertension. Over time, proportion of hypertensive subjects with the loss decreased in the group with a killed family member, further suggesting that at least a part of their hypertension might have been of psychological origin.Many studies investigated the effect of stress on various aspects of health status, but few found the association between stress and a particular disease (1-3). At the same time, the belief that stress causes and aggravates arterial hypertension is a widespread opinion among lay public, despite the lack of strong evidence. Arterial hypertension is currently defined as systolic blood pressure ≥140 mm Hg, or diastolic blood pressure ≥90 mm Hg, or taking antihypertensive therapy (4). In patients with diabetes mellitus, it is defined as systolic blood pressure ≥130 mm Hg, or diastolic blood pressure ≥80 mm Hg, or taking antihypertensive therapy (4). The exact etiology of essential arterial hypertension remains an enigma, primarily due to the high number of systems involved in the regulation of arterial pressure (5). Several factors are suggested as contributing to the hypertension – genetic factors, salt sensitivity, changes in ion homeostasis (sodium, potassium, and calcium), changes in renin-angiotensin-aldosteron system, insulin resistance, stimulation of sympathetic nervous system, and deficiency of vasodilator substances (5,6). Also, a number of environmental factors may have a role in the development of high blood pressure, such as salt intake, obesity, occupation, and alcohol intake (5). However, stress itself is not among them (5). This could be the consequence of the fact that it is very hard to design an objective study on the effect of stress on the arterial hypertension, due to substantial difficulties in defining, perception, and measurement of stress (7,8). A large study among employees of Australian government tax office showed no direct effect of job stress on blood pressure, but suggested a significant relationship of increased blood pressure and unhealthy habits, such as smoking, alcohol consumption, physical inactivity, and obesity, especially in men (9).One of the most convincing, although unwanted, models of chronic stress is war. There are many studies on psychiatric health status of the soldiers and war veterans, dealing mainly with the evaluation of posttraumatic stress disorder (PTSD) (10-14), and a considerable number of studies investigating physical health of the soldiers (15-19). At the same time, somatic status of civilians affected by war was evaluated less frequently. A study on Afghan, Iranian, and Somali asylum seekers, and refugees living in the Netherlands showed that they suffered mainly from PTSD, depression, and anxiety (20), whereas the Israeli civilians had significantly higher levels of anxiety, despite the normal levels of cortisol and growth hormone (21). Several studies investigated the effect of the 1991-1995 war in Croatia. A study of prevalence of risk factors for cerebrovascular disease after the war in Croatia found significantly higher rate of arterial hypertension, hyperlipidemia, and obesity in people suffering from PTSD (22). A retrospective study on the prevalence of acute coronary syndrome before and during the 1992-1995 war in Bosnia and Herzegovina revealed increased number of acute myocardial infarctions and unstable angina pectoris cases during the war (23).All of these studies evaluated the effects of general war stress on health, but none of them investigated the effect of the family member loss during the war, which is a frequent situation during military operations, and at the same time, an experience considered to cause great immediate stress reaction, as well as long-lasting psychological consequences (24) even in peace time. In this study, our aim was to investigate the prevalence of essential arterial hypertension in the family members of soldiers killed during the 1992-1995 war in Bosnia and Herzegovina, with the hypothesis that mourning may represent a stress that could affect arterial blood pressure.     

The relation between blood pressure and mortality due to coronary heart disease among men in different parts of the world. Seven Countries Study Research Group

BACKGROUND: Elevated blood pressure is known to be a risk factor for death from coronary heart disease (CHD). However, it is unclear whether the risk of death from CHD in relation to blood pressure varies among populations. METHODS: In six populations in different parts of the world, we examined systolic and diastolic blood pressures and hypertension in relation to long-term mortality from CHD, both with and without adjustment for variability in blood pressure within individual subjects. Blood pressure was measured at base-line in 12,031 men (age range, 40 to 59 years) who were free of CHD. During 25 years of follow-up, 1291 men died from CHD. RESULTS: At systolic and diastolic blood pressures of about 140 and 85 mm Hg, respectively, 25-year rates of mortality from CHD (standardized for age) varied by a factor of more than three among the populations. Rates in the United States and northern Europe were high (approximately 70 deaths per 10,000 person-years), but rates in Japan and Mediterranean southern Europe were low (approximately 20 deaths per 10,000 person-years). However, the relative increase in 25-year mortality from CHD for a given increase in blood pressure was similar among the populations. The overall unadjusted relative risk of death due to CHD was 1.17 (95 percent confidence interval, 1.14 to 1.20) per 10 mm Hg increase in systolic pressure and 1.13 (95 percent confidence interval, 1.10 to 1.15) per 5 mm Hg increase in diastolic pressure, and it was 1.28 for each of these increments after adjustment for within-subject variability in blood pressure. CONCLUSIONS: Among the six populations we studied, the relative increase in long-term mortality due to CHD for a given increase in blood pressure is similar, whereas the absolute risk at the same level of blood pressure varies substantially. If the absolute risk of CHD is used as an indication for antihypertensive therapy, these findings will have major implications for treatment in different parts of the world.     

Reversible hypertension in primary hyperparathyroidism — Pre-and posteroperative blood pressure in 75 cases

Summary In 75 operatively proved cases of primary hyperparathyroidism (PH) mean systolic and diastolic blood pressure (BP) values were significantly higher pre- than postoperatively. There were 27 patients (36%) who showed hypertension before operation (systolic BP150 mm Hg, mean 169±20 mm Hg). In 20 of these the hypertension was reversible after successful treatment of PH, in seven cases elevated values persisted. The mean age of patients with persisting hypertension was significantly higher than the group with normalization of BP after operation (P<0.01). As far as clinical presentation of PH was concerned it were those cases with hypercalcaemic syndrome and with accidentally discovered hypercalcaemia who most often showed hypertension. In cases with recurrent urolithiasis and with osteitis fibrosa as leading symptoms there was no significant increase of hypertension as compared to the whole group. Because of the relatively high incidence of hypertension in PH this possibility should be taken into consideration in each diagnostic clarification of hypertensive patients.     

Trends in the prevalence of hypertension, antihypertensive therapy, and left ventricular hypertrophy from 1950 to 1989

BACKGROUND: Men and women with hypertension are at increased risk for cardiovascular disease, especially when left ventricular hypertrophy is present. We examined temporal trends in the use of antihypertensive medications and studied the relation between their use, the prevalence of high blood pressure, and the presence of electrocardiographic evidence of left ventricular hypertrophy. METHODS: A total of 10,333 participants in the Framingham Heart Study who were 45 to 74 years of age underwent a total of 51,756 examinations from 1950 to 1989. Data were obtained on blood pressure and the use of antihypertensive medications, and electrocardiograms were assessed for left ventricular hypertrophy. The generalized-estimating-equation method was used to test for trends over time. RESULTS: From 1950 to 1989, the rate of use of antihypertensive medications increased from 2.3 percent to 24.6 percent among men and from 5.7 percent to 27.7 percent among women. The age-adjusted prevalence of systolic blood pressure of at least 160 mm Hg or diastolic blood pressure of at least 100 mm Hg declined from 18.5 percent to 9.2 percent among men and from 28.0 percent to 7.7 percent among women. This decline was accompanied by age-adjusted reductions in the prevalence of electrocardiographic evidence of left ventricular hypertrophy, from 4.5 percent to 2.5 percent among men and from 3.6 percent to 1.1 percent among women. CONCLUSIONS: Our findings support the notion that the increasing use of antihypertensive medication has resulted in a reduced prevalence of high blood pressure and a concomitant decline in left ventricular hypertrophy in the general population. Our observations may in part explain the considerable decline in mortality from cardiovascular disease observed since the late 1960s.     

Relationship of blood pressure and pump flow in an implantable centrifugal blood pump during hypertension

The purpose of this study was to evaluate the real time relationship between pump flow and pump differential pressure (D-P) during experimentally induced hypertension (HT). Two calves (80 and 68 kg) were implanted with the EVA-HEART centrifugal blood pump (SunMedical Technology Research Corp., Nagano, Japan) under general anesthesia. Blood pressure (BP) in diastole was increased to 100 mm Hg by norepinephrine to simulate HT. Pump flow, D-P, ECG, and BP were measured at pump speeds of 1,800, 2,100, and 2,300 rpm. All data were separated into systole and diastole, and pump flow during HT was compared with normotensive (NT) conditions at respective pump speeds. Diastolic BP was increased to 99.3+/-4.1 mm Hg from 66.5+/-4.4 mm Hg (p<0.01). D-P in systole was under 40 mm Hg (range of change was 10 to 40 mm Hg) even during HT. During NT, the average systolic pump flow volume was 60% of the total pump flow. However, during HT, the average systolic pump flow was 100% of total pump flow volume, although the pump flow volume in systole during HT decreased (33.1+/-5.7 vs. 25.9+/-4.0 ml/systole, p<0.01). In diastole, the average flow volume through the pump was 19.6+/-6.9 ml/diastole during NT and -2.2+/-11.1 ml/diastole during HT (p<0.01). The change in pump flow volume due to HT, in diastole, was greater than the change in pump flow in systole at each pump speed (p<0.001). This study suggests that the decrease of mean pump flow during HT is mainly due to the decrease of the diastolic pump flow and, to a much lesser degree, systolic pump flow.     

Effects of education and relaxation training with essential hypertension patients

Thirty subjects with essential hypertension were assigned randomly to either a no treatment control, education, or education with relaxation training group. Independent blood pressure recordings were collected by medical staff at pretest, posttest, and 8-week follow-up. Results suggest a significant interaction between treatment and time for the dependent physiological measure, systolic blood pressure. During the pretest to follow-up period, the control group averaged a 5.9 mm. Hg. increase, the education with relaxation group an 8.8 mm. Hg. decrease, and the education group a 14.9 mm. Hg. decrease in systolic blood pressure. There was no significant difference in group means for diastolic blood pressure within groups over time. As measured at follow-up, education appeared more effective in reducing systolic blood pressure than education with relaxation training. More than one-third of subjects associated unpleasant side effects with their antihypertensive medication. Almost all treatment subjects rated the education and relaxation as helpful for understanding and managing their hypertension.     

The pathogenesis of acute pulmonary edema associated with hypertension

BACKGROUND: Patients with acute pulmonary edema often have marked hypertension but, after reduction of the blood pressure, have a normal left ventricular ejection fraction (> or =0.50). However, the pulmonary edema may not have resulted from isolated diastolic dysfunction but, instead, may be due to transient systolic dysfunction, acute mitral regurgitation, or both. METHODS: We studied 38 patients (14 men and 24 women; mean [+/-SD] age, 67+/-13 years) with acute pulmonary edema and systolic blood pressure greater than 160 mm Hg. We evaluated the ejection fraction and regional function by two-dimensional Doppler echocardiography, both during the acute episode and one to three days after treatment. RESULTS: The mean systolic blood pressure was 200+/-26 mm Hg during the initial echocardiographic examination and was reduced to 139+/-17 mm Hg (P< 0.01) at the time of the follow-up examination. Despite the marked difference in blood pressure, the ejection fraction was similar during the acute episode (0.50+/-0.15) and after treatment (0.50+/-0.13). The left ventricular regional wall-motion index (the mean value for 16 segments) was also the same during the acute episode (1.6+/-0.6) and after treatment (1.6+/-0.6). No patient had severe mitral regurgitation during the acute episode. Eighteen patients had a normal ejection fraction (at least 0.50) after treatment. In 16 of these 18 patients, the ejection fraction was at least 0.50 during the acute episode. CONCLUSIONS: In patients with hypertensive pulmonary edema, a normal ejection fraction after treatment suggests that the edema was due to the exacerbation of diastolic dysfunction by hypertension--not to transient systolic dysfunction or mitral regurgitation.     

Comparison of blood pressure between Indiana AMA and NMA members

OBJECTIVE: 1) To determine whether African-American physicians, compared to caucasian physicians, were at increased risk to develop hypertension; and 2) to determine whether physicians' knowledge of cardiovascular risk factors influenced their pattern of exercise. DESIGN: A mailed survey of members of the American Medical Association (AMA) and the National Medical Association (NMA) was completed to assess health status and plans for retirement. RESULTS: High-normal blood pressure was defined as systolic blood pressure of 85-89 mmHg. Mild (stage-1) hypertension was defined as systolic blood pressure of 140-159 mmHg and diastolic blood pressure of 90-99 mmHg. Gender (male), age, and body mass index (BMI) were significantly correlated with elevated levels of selected blood pressure measures. Using regression analysis to control for gender, age, and BMI, ethnicity was identified as a fourth factor accounting for elevated blood pressure. NMA physicians had 3.25 times the risk of having systolic blood pressure in the mild (stage-1) hypertension range, 5.78 times the risk for blood pressure in the high-normal diastolic hypertension range, and 5.19 times the risk for blood pressure in the mild (stage-1) diastolic hypertension range. Medical specialty and type of psychological support were not significant predictors of elevated blood pressure. CONCLUSION: These data suggest that African-American physicians may be at an increased risk to develop abnormal blood pressure, compared to caucasian physicians, potentially affecting the number of physicians available to minority communities.