Impact of body mass index on blood pressure levels in patients with polycystic ovary syndrome

As there is controversy about the prevalence of hypertension in patients with polycystic ovary syndrome (PCOS) and, up to the present moment, no studies have evaluated the impact of body mass index (BMI) on blood pressure levels (BP) in these patients, we studied retrospectively sixty-nine patients with PCOS, with BMI of 29.0 +/- 6.7 kg/m(2) and aged 25.6 +/-5.6 yr, subdivided into three groups according to BMI (normal, overweight and obese) and evaluated regarding BP (mercury sphygmomanometer), basal hormonal profile, fasting glucose, and insulin sensitivity (HOMA-IR). Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were normal (118.1 +/- 17.0 and 74.7+/- 11.5 mmHg, respectively), with a hypertension prevalence of 20.3%. Of these patients, 78.6% were obese and 21.4% were overweight. When the groups were compared according to BMI, a significant increase in SBP and DBP was observed (higher in overweight and obese patients for SBP and higher in obese for DBP), as well as a significant progressive increase in glucose, insulin, homeostatic model assessment, and a significant progressive decline in LH levels. When the patients were subdivided as normotensive or hypertensive, a significant difference was observed only for BMI (28.2 +/- 6.1 and 34.7 +/- 8.6 kg/m(2), respectively; p = 0.007). In conclusion, we observed a significant and progressive impact of BMI on blood pressure levels in our patients with polycystic ovary syndrome.     

Long-term changes in clinic blood pressure in patients with white-coat hypertension

BACKGROUND: White-coat hypertension, defined as hypertensive blood pressure values in a clinical setting but normal self-measured blood pressures, is relatively common among young patients but long-term spontaneous changes in clinic blood pressure in these patients with white-coat hypertension have not been assessed. DESIGN: A prospective study, with two clinical examinations (with a 5-year interval between the examinations).METHODS: We examined 188 male patients (mean age 16 years) with clinic blood pressures > 140/90 mmHg at baseline by determining clinic and home blood pressures, heart rates, heights and weights. These parameters were re-examined 5 years later. White-coat hypertension (n = 139) was defined as an average home blood pressure < 130/90 mmHg.RESULTS: A decrease in clinic systolic blood pressure to < 140 mmHg during the 5-yea follow-up was observed in 101 of the 139 patients with white-coat hypertension (73%) and 26 of the 49 patients with sustained hypertension (53%, P < 0.02). There was no difference between clinic heart rates and body mass indices at baseline of the patients who remained hypertensive in the clinic and those who became normotensive. Both the white-coat and the sustained hypertensive patients who remained hypertensive had higher baseline home blood pressures and an increase in body mass index during the 5-year period and maintained the baseline clinic heart rate, whereas those who became normotensive exhibited a reduction in clinic heart rate and maintained the baseline body mass indexd. The clinic systolic blood pressure at 5-year follow-up was correlated significantly to the clinic and home systolic blood pressures at baseline, the heart rate and body mass indexd at 5-year follow-up and the changes in bodyh mass index during the 5-year period. CONCLUSION: The prevalence of clinic systolic blood pressures < 140 mmHg during the 5-year period among patients with white-coat hypertension was higher than that among those with sustained hypertension. The clinic and home blood pressures at baseline and body mass indices and clinic heart rates at 5-year follow-up were related to the clinic systolic blood pressures at 5-year follow-up. These results suggest that control of body weight is important in the management both of young patients with white-coat hypertension and of those with sustained hypertension.     

Nocturnal continuous measurement of blood pressure in sleep apnea syndromes. Comparison between normotensive and hypertensive patients

Sleep apnea syndrome and systemic hypertension are frequently associated but their causal relationship is unclear. We compared the oscillations of systemic blood pressure and heart rate during polysomnography in 8 normotensive subjects (2 females) and 5 hypertensive (supine awake blood pressure: 165 +/- 7/96 +/- 5 mmHg) without treatment. Their ages (normotensive: 52.1 +/- 11.0 yrs, hypertensive: 51.2 +/- 6.4 yrs) and body mass indices (32.6 +/- 9.6 kg/m2 vs 33.2 +/- 5.2 kg/m2 respectively) were not statistically different. Systemic blood pressure was continuously monitored by a non invasive digital plethysmography (Finapres). Both groups had similar respiratory events indices (normotensive: 45.2 +/- 18.1/hr, hypertensive: 48.4 +/- 20.5/hr) and minimal oxygen saturations (79.4 +/- 9.1% vs 82.4 +/- 7.0% respectively). During apneas in slow-wave sleep were observed the minimal values for systolic and diastolic pressures which were significantly higher in hypertensive than in normotensive (138.2 +/- 9.6/83.2 +/- 16.1 mmHg vs 105.9 +/- 11.1/60.5 +/- 10.9 mmHg respectively). During resumption of ventilation maximal blood values were recorded which were also higher in hypertensive than in normotensive (185.0 +/- 13.8/113.2 +/- 21.5 mmHg vs 155.9 +/- 19.8/88.7 +/- 17.1 mmHg respectively) (p less than 0.05). Although absolute variations of blood pressure were similar, relative changes in systolic pressure were significantly higher in normotensive (p less than 0.05). Maximal heart rate was 76.8 +/- 6.2 bpm in normotensive and 76.6 +/- 3.9 bpm in hypertensive during resumption of ventilation.(ABSTRACT TRUNCATED AT 250 WORDS)     

Decreased exercise capacity in mild essential hypertension: non-invasive indicators of limiting factors.

Available data suggest that exercise capacity is limited in hypertension. The mechanism of this reduced maximal exercise capacity has not been fully elucidated. In this study 22 patients with mild essential hypertension (162 +/- 22 mmHg systolic and 95 +/- 8 mmHg diastolic) and 36 normotensive control subjects (128 +/- 13 mmHg systolic and 80 +/- 7 mmHg diastolic) (P less than 0.01) performed an ergometer test till exhaustion. Body mass index in the two groups did not differ. The maximal oxygen consumption VO2 was lower in the hypertensive group (18 +/- 7 versus 23 +/- 8 ml/kg/min; P less than 0.02) as was the maximal workload (141 +/- 52 vs. 185 +/- 70 Watt; P less than 0.01). Rate pressure product rose only 2.7 fold in hypertensive patients versus 3.5 fold in the control group (P less than 0.001). In hypertensive patients maximal workload decreased with increasing resting systolic blood pressure (P less than 0.05) while in the normotensive subjects maximal workload rose with increasing resting systolic blood pressure (P less than 0.05). In conclusion both high and low blood pressure was associated with a decreased maximal voluntary exercise capacity. Even mild hypertension was accompanied by lower maximal exercise capacity. Hypertensive patients also had a lower maximal VO2 and lower maximal rate pressure product than did normotensive subjects.     

Blood pressure response to treadmill testing among medical graduates: the right time to intervene

BACKGROUND: Longitudinal studies have revealed significant correlation between exaggerated blood pressure response to exercise and higher incidence of developing resting hypertension in future. Normotensive persons at high risk of developing systemic hypertension have greater cardiovascular reactivity to exercise. METHODS AND RESULTS: Our study compared the blood pressure response to treadmill exercise in normotensive offspring of the hypertensive parents (age 22 +/- 1.7 years, n = 50; study group) with those of the normotensive parents (age 22 +/- 1.4 years, n = 50; control group). The morphometric characteristics, resting, exercise (treadmill exercise with Bruce protocol) and recovery blood pressure values of all the subjects were recorded. The analysis showed that the difference in mean peak systolic blood pressure during exercise was the only statistically significant parameter in the study and control groups (188.52 +/- 25.16 mmHg and 178.56 +/- 14.96 mmHg, respectively, p < 0.05). The number of hyperreactors (defined as peak systolic blood pressure > 200 mmHg during exercise) was significantly more in study group compared to control group (10 and 3 respectively). The mean resting systolic blood pressure of hyperreactors (126.46 + 8.49 mmHg) falls in the pre-hypertension category as designated by JNC VII. Also, their resting diastolic blood pressure, recovery blood pressure and body mass index were significantly higher as compared to normoreactors. Conclusions: Our study showed that this response pattern could represent impairment in cardiovascular adjustment to exercise indicating a greater risk for development of resting hypertension in the future. Therefore there is a need for early lifestyle modifications to postpone/prevent development of hypertension.     

Status of home blood pressure measured in morning and evening: evaluation in normotensives and hypertensives in Japanese urban population.

To assess home blood pressure status in a Japanese urban population, we analyzed home blood pressure values in normotensive subjects determined by casual blood pressure (< 140/90 mmHg), hypertensive subjects without medication (> or = 140/90 mmHg) and treated hypertensive patients. The subjects (468 male, 232 female; mean age 41 years old) were recruited from a company located in Tokyo. Home blood pressure was measured with a semi-automatic device (Omron HEM-759P). Subjects were instructed to perform triplicate morning and evening measurements on 7 consecutive days. In the treated hypertensive group (n = 70), there was a significant difference between morning (139 +/- 12/88 +/- 9 mmHg) and evening (130 +/- 12/79 +/- 8 mmHg) home blood pressure. In the normotensive group (n = 558), however, only the diastolic blood pressure (DBP) component of the home blood pressure was significantly different between morning (115 +/- 13/72 +/- 9 mmHg) and evening (114 +/- 12/68 +/- 8 mmHg). In the nontreated hypertensive group (n = 72), casual blood pressure (145 +/- 14/92 +/- 9 mmHg) was higher than morning (138 +/- 16/89 +/- 11 mmHg) and evening (134 +/- 16/83 +/- 11 mmHg) home blood pressure, but no difference was seen between morning and evening systolic blood pressure (SBP). According to the reference value of the Japanese Society of Hypertension 2004 (SBP > or = 135 mmHg and/or DBP > or = 85 mmHg), 7.2% (systolic) and 8.7% (diastolic) of subjects in the normotensive group were classified as hypertensive by home blood pressure. Casual blood pressure in the treated hypertensive group was normal in 64.3% for SBP and 70.0% for DBP. However, their morning SBP (32.9%), morning DBP (40.0%), evening SBP (10.0%), and evening DBP (17.1%) were classified as hypertensive by home blood pressure. Furthermore, patients who were taking antihypertensive drug(s) only in the morning (n = 52) showed higher morning SBP (6 mmHg, p = 0.086) and morning DBP (6 mmHg, p = 0.005) than patients taking drug(s) by other administration schedules (n = 18), but no difference in evening home blood pressure was observed. In conclusion, a proportion of the subjects defined as normotensive by casual blood pressure were classified as hypertensive by home blood pressure in the present urban population. Furthermore, morning home blood pressure control in the treated hypertensive group classified as under control by casual blood pressure was insufficient, especially in patients who were taking medication only in the morning.     

Gender differences in left ventricular chamber and midwall systolic function in normotensive and hypertensive adults

OBJECTIVE: Whether left ventricular (LV) systolic function differs between healthy men and women independent of afterload, LV geometry, age, heart rate and body size is disputed. METHODS: We studied 517 clinically healthy adults without history of cardiovascular or endocrinal disease (age range 20-70, 274 with essential arterial hypertension). Echocardiography was used to assess LV geometry and systolic function both at endocardial and midwall levels. RESULTS: Normotensive and hypertensive women had higher LV systolic function at endocardial and midwall levels independent of afterload. After adjustment for age, body surface area, heart rate and LV geometry, LV systolic function remained higher in women than in men in hypertensive and normotensive subjects. In a second set of multivariate analyses adjusting for age, body mass index, LV geometry and heart rate, women had significantly higher LV systolic function than men, both among normotensive and hypertensive subjects. In a reference group of 95 subjects with optimal blood pressure and normal body mass index (mean age 34 +/- 10; 32 men) extracted from the study sample, lower limits (5th percentile) of parameters of LV systolic function were higher in women than in men. Use of gender-specific partition values revealed that subnormal LV chamber function was uncommon in overweight, normotensive subjects as well as in hypertensive subjects; vice versa, stress-corrected midwall dysfunction was frequently subnormal in both normotensive, overweight (14%, mostly women) and in hypertensive subjects (18%, mostly men). At the opposite end of the spectrum, gender-specific supranormal, stress-corrected LV systolic chamber function (> 95th percentile of the distribution in the reference group) was relatively frequent in both overweight, normotensive (14%) and in hypertensive subjects (27%). CONCLUSIONS: Clinically healthy hypertensive and normotensive women have higher LV chamber and midwall systolic function than men, independent of left ventricular geometry, body size, age and heart rate. Use of gender-specific partition values to define subnormal and supranormal LV systolic function revealed that, both in hypertensive and overweight normotensive subjects, subnormal LV chamber function was uncommon, whereas stress-corrected LV chamber systolic function was frequently supranormal. Vice versa, myocardial contractility was subnormal in approximately one-sixth of asymptomatic, normotensive overweight and of hypertensive subjects, with potentially unfavorable prognostic impact.     

Determinants of left atrial size in patients with newly diagnosed untreated hypertension

The present study determined the relationships between ambulatory blood pressure, left ventricular mass, body mass index, and other clinical and demographic variables to left atrial size in previously untreated hypertensive and normotensive subjects. Left atrial size was measured uni-dimensionally using M-mode echocardiography in 58 newly diagnosed never-treated hypertensive patients (office blood pressure 149/96 +/- 15/7 mmHg) and 28 normotensive control subjects (office blood pressure, 122/78 +/- 8/8 mmHg). Left ventricular mass, septal and posterior wall thickness were significantly increased in hypertensive compared to normotensive subjects (230 +/- 63 g versus 181 +/- 45 g, 1.1 +/- 0.2 cm versus 0.94 +/- 0.2 cm, and 1.04 +/- 0.2 cm versus 0.92 +/- 0.2 cm respectively; all p < 0.001). Left ventricular internal diameter (4.9 +/- 0.6 versus 4.8 +/- 0.4 cm, = 0.54) and left atrial size (3.74 +/- 0.48 versus 3.70 +/- 0.34 cm, p = 0.86) were not different between the two groups respectively. Body mass index, weight, left ventricular mass, wall thickness, and 24-h pulse pressure were significant correlates of left atrial size in the entire group and in the hypertensive subgroup. In the normotensive subgroup, body weight, body mass index, 24-h systolic and pulse pressure, and left ventricular mass were significant correlates. Multiple regression analyses in the entire group and the hypertensive subgroup alone showed that body mass index and left ventricular mass were the two best predictors of left atrial dimension. These data demonstrate that body mass index and left ventricular mass were the main correlates of left atrial size in patients with previously untreated stage I-II hypertension.     

Echocardiographic left ventricular mass and electrolyte intake predict arterial hypertension

OBJECTIVE: To identify predictors of arterial hypertension. PATIENTS: One hundred thirty-two normotensive adults from a large employed population. METHODS: Echocardiography, standard blood tests, and 24-hour urine collection, at baseline and after an interval of 3 to 6 years (mean, 4.7 +/- 0.8 years). RESULTS: At follow-up, 15 subjects (11%; 7 men, 8 women) had a systolic blood pressure greater than 140 mm Hg or a diastolic blood pressure greater than 90 mm Hg or both (mean, 143 +/- 7 and 87 +/- 6 mm Hg, respectively). At baseline, subjects who developed hypertension had a greater left ventricular mass index than those who did not (92 +/- 25 compared with 77 +/- 19 g/m2 body surface area; P less than 0.005) and higher 24-hour urinary sodium/potassium excretion ratio (3.6 +/- 1.7 compared with 2.6 +/- 1.4; P less than 0.04); there were no differences in race, initial age, systolic or diastolic blood pressure, coronary risk factors, or plasma renin activity. The likelihood of developing hypertension rose from 3% in the lowest quartile of sex-adjusted left ventricular mass index to 24% in the highest quartile (P less than 0.005); a parallel trend was less regular for quartiles of the sodium/potassium excretion ratio (P less than 0.04). In multivariate analyses, follow-up systolic pressures in all subjects and in the 117 who remained normotensive were predicted by initial age, systolic blood pressure, black race, and sex-adjusted left ventricular mass index; final diastolic blood pressure was predicted by its initial value, plasma triglyceride levels, urinary sodium/potassium ratio, low renin activity, black race, and plasma glucose level. CONCLUSIONS: Echocardiographic left ventricular mass in normotensive adults is directly related to the risk for developing subsequent hypertension. Left ventricular mass improves prediction of future systolic pressure, whereas diastolic pressure is more related to initial metabolic status. Black race is also an independent determinant of higher subsequent blood pressure.     

The international database of self-recorded blood pressures in normotensive and untreated hypertensive subjects.

OBJECTIVES: To pool data from individual subjects in an attempt to determine an operational threshold for making clinical decisions based on the self-recorded blood pressure (SRBP) and to examine how many hypertensive subjects, diagnosed by conventional blood pressure (CBP) measurement, would have a self-recorded blood pressure within the normotensive range if the proposed thresholds were applied. DATA SOURCES: Thirteen research groups studied 4668 untreated subjects. RESULTS: In total 2401 subjects were normotensive, 494 were borderline hypertensive and 1773 were definitely hypertensive. Hypertension had been diagnosed from the mean of 1-6 (median 3) CBP measurements obtained during 1-3 (median 1) visits. The reference values for SRBP measurements determined from the 95th percentiles of the distributions for normotensive subjects were 137 mmHg systolic and 85 mmHg diastolic. Of the subjects with systolic hypertension, 16% had systolic SRBP 相似文献   

Obesity markers and blood pressure in a sample of Portuguese children and adolescents.

BACKGROUND: Little information exists regarding the effect of several obesity markers on blood pressure (BP) levels in youth. DESIGN: Transverse study including 2494 boys and 2589 girls. METHODS: Height, weight and waist were measured according to the international criteria and body fat (BF) by bioimpedance. BP was measured by an automated device. Hypertension was defined using sex-specific, age-specific and height-specific observation-points. RESULTS: Body mass index (BMI) and waist were positively related with systolic blood pressure (SBP) and diastolic blood pressure (DBP) and heart rate in both sexes, whereas the relationships with BF were less consistent. Stepwise linear regression analysis showed that BMI was positively related with SBP and DBP in both sexes, whereas BF was negatively related with SBP in both sexes and with heart rate in boys only; finally, waist was positively related with SBP in boys and heart rate in girls. Age and heart rate-adjusted values of SBP and DBP increased with BMI: for SBP, 117+/-1, 123+/-1 and 124+/-1 mmHg in normal, overweight and obese boys, respectively; corresponding values for girls were 111+/-1, 114+/-1 and 116+/-2 mmHg (mean+/-SE, P<0.001). Overweight and obese boys had an odds ratio for being hypertensive of 2.26 (95% confidence interval: 1.79-2.86) and 3.36 (2.32-4.87), respectively; corresponding values for girls were 1.58 (confidence interval 1.25-1.99) and 2.31 (1.53-3.50). CONCLUSION: BMI, not BF or waist, is consistently and independently related to BP levels in children; overweight and obesity considerably increase the risk of hypertension.     

Circadian variation and blood pressure: response to rapid weight loss by hypocaloric hyponatraemic diet in obesity.

Ambulatory intra-arterial blood pressure was monitored in 15 obese hypertensive and 10 obese normotensive subjects weighing more than 30% of their ideal body weight. Measurements were taken before and after 1 month in hospital on a diet of 330kCal/day designed to ensure 34 g protein and 65 mmol sodium. Mean +/- s.d. body mass index in the whole group fell from 40.8 +/- 7.6 to 37.2 +/- 7.4 kg/m2 (P less than 0.0001). Daytime intra-arterial blood pressure fell from 176 +/- 19/102 +/- 14 to 162 +/- 16/95 +/- 14 mmHg (P less than 0.0005 and P less than 0.002) in the hypertensive group and from 141 +/- 15/82 +/- 5 to 131 +/- 13/79 +/- 4 mmHg (P less than 0.005 for systolic pressure) in the normotensive group. Circadian variation of systolic intra-arterial blood pressure comparing the mean daytime with the mean night-time blood pressure recordings showed a day-night difference of 27 +/- 10 mmHg in the normotensive group compared with 12 +/- 13 mmHg in the hypertensive group (P less than 0.01). This trend was reversed after weight loss, when the normotensive group showed a day-night difference of 20 +/- 13 mmHg compared with 18 +/- 17 mmHg in the hypertensive group. Thus, circadian variation of systolic intra-arterial blood pressure in the hypertensive group was significantly (P less than 0.01) reduced compared with the normotensive group prior to, but not after, weight loss. These data show that, in obese subjects, weight loss produced a significant reduction in ambulatory intra-arterial blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)     

Relation of blood pressure and body build to left ventricular mass in normotensive and hypertensive employed adults

Left ventricular muscle mass is increased in the presence of large body size, high blood pressure and obesity, but the relative contributions to ventricular mass of these and other factors have not been elucidated. Accordingly, echocardiographic left ventricular mass in unmedicated employed adults (162 normotensive, 145 borderline hypertension and 317 with established essential hypertension) was related to height, weight, lean body mass, body mass index, systolic and diastolic blood pressure, age, gender, race and 24 h urinary sodium and potassium excretion. In the total population, body mass index, systolic blood pressure and height were the most significant (p less than 0.0001) independent correlates of left ventricular mass, whereas gender and age made smaller contributions. In each normotensive and hypertensive subgroup, body mass index and height remained highly significant independent predictors of left ventricular mass, systolic blood pressure became a weaker predictor (0.001 less than p less than 0.02) and only among patients with established hypertension was diastolic blood pressure a weak independent determinant (p less than 0.05) of ventricular mass. The increase in left ventricular mass attributable to obesity was due to eccentric hypertrophy because end-diastolic relative wall thickness was similar in obese and nonobese subjects in each blood pressure group. Thus obesity, as measured by body mass index, is as important a potential determinant of left ventricular muscle mass as is systolic blood pressure and it is of greater statistical significant in an adult employed population than is diastolic blood pressure, height, gender, age or dietary sodium intake.     

Lack of effect of percutaneous transluminal renal angioplasty on nocturnal hypotension in renovascular hypertensive patients

OBJECTIVE: To investigate whether nocturnal blood pressure fall is blunted in renovascular hypertension and can therefore be used as a diagnostic criterion for this condition. METHODS: In 14 renovascular hypertensive patients (age 43.8+/-2.1 years, mean+/-SEM, clinic blood pressure 173.6+/-3.7 mmHg systolic and 109.0+/-2.0 mmHg diastolic) and in 14 age- and blood pressure-matched essential hypertensive controls 24 h ambulatory blood pressure was measured after washout from drug treatment, during angiotensin converting enzyme inhibitor treatment and, in renovascular hypertension, also after percutaneous transluminal renal angioplasty. RESULTS: The 24 h average systolic and diastolic blood pressures were 146.4+/-5.7 and 97.5+/-3.6 mmHg in renovascular and 144.3+/-1.2 and 98.0+/-2.2 mmHg in essential hypertensive patients. The angiotensin converting enzyme inhibitor treatment reduced 24 h average systolic and diastolic blood pressures by 8.5% and 9.7% in the renovascular and by 8.3% and 10.8% in the essential hypertensive group. Greater systolic and diastolic blood pressure reductions (-18.2% and -18.1%) were observed in renovascular hypertensive patients after percutaneous transluminal renal angioplasty. Blood pressure fell by about 10% during the night and the fall was similar in renovascular and in essential hypertensive patients. In the former group, nocturnal hypotension was similar after washout, during angiotensin converting enzyme inhibitor treatment and after percutaneous transluminal renal angioplasty. Similar results were obtained for nocturnal bradycardia. CONCLUSIONS: Nocturnal blood pressure fall is equally manifest in renovascular and essential hypertension. The removal of the renal artery stenosis and blood pressure normalization do not enhance this phenomenon. Nocturnal hypotension seems therefore to be unaffected by renovascular hypertension.     

Masked hypertension in obstructive sleep apnea syndrome

BACKGROUND: Ambulatory blood pressure (BP) monitoring (ABPM) detects subjects with normal clinic but high ambulatory 24-h BP, that is, masked hypertension. METHODS: One hundred and thirty newly diagnosed obstructive sleep apnea syndrome (OSAS) patients, free of recognized cardiovascular disease were included (111 men, age = 48 +/- 1 years, BMI = 27.6 +/- 0.4 kg/m, respiratory disturbance index (RDI = 42 +/- 2/h). Clinic BP, 24-h ABPM, baroreflex sensitivity (BRS), echocardiography and carotid intima-media thickness (IMT) were assessed. RESULTS: Forty-one patients (31.5%) were normotensive, 39 (30.0%) exhibited masked hypertension, four (3.1%) white-coat hypertension and 46 (35.4%) hypertension. Significant differences were found between normotensive, masked hypertensive and hypertensive patients in terms of BRS (10.5 +/- 0.8, 8.0 +/- 0.6 and 7.4 +/- 0.4 ms/mmHg, respectively, P < 0.001), carotid IMT (624 +/- 17, 650 +/- 20 and 705 +/- 23 microm, respectively, P = 0.04) and left ventricular mass index (37 +/- 1, 40 +/- 2 and 43 +/- 1 g/height2.7, respectively, P = 0.003). A clinic systolic BP more than 125 and a diastolic BP more than 83 mmHg led to a relative risk (RR) of 2.7 and a 90% positive predictive value for having masked hypertension. CONCLUSION: Masked hypertension is frequently underestimated in OSAS and is nearly always present when clinic BP is above 125/83 mmHg.     

Close correlation of intra-abdominal fat accumulation to hypertension in obese women

The relation between intra-abdominal visceral fat accumulation and blood pressure was investigated in 67 obese women (mean body mass index, 33.6 +/- 3.1; average age, 50 +/- 11 years). As an index of intra-abdominal fat accumulation, the ratio of the intra-abdominal visceral fat area to subcutaneous fat area was determined using a computed tomographic section at the level of the umbilicus. When the obese subjects were divided into a hypertensive group and a normotensive group, the ratio of the intra-abdominal visceral fat area to subcutaneous fat area in the hypertensive group was significantly higher (0.53 +/- 0.33 versus 0.29 +/- 0.12, p less than 0.01). Significant correlations between the ratio of intra-abdominal visceral fat area to subcutaneous fat area and systolic blood pressure (r = 0.62, p less than 0.001) and diastolic blood pressure (r = 0.53, p less than 0.001) also were found. However, no significant difference existed in either the body mass index or the waist-to-hip circumference ratio between the hypertensive and normotensive groups. Plasma renin activity, aldosterone, epinephrine, and norepinephrine levels were not significantly different between the two groups. Moreover, the correlation between the ratio of the intra-abdominal visceral fat area to subcutaneous fat area ratio and blood pressure was found independent of age and body mass index by multiple regression analyses. We conclude that intra-abdominal fat accumulation itself may play an important role in the pathogenesis of hypertension in obesity.     

The relationship between body weight and plasma viscosity in hypertensive diabetic Nigerians

Plasma viscosity and fibrinogen concentrations were measured in 70 diabetics (35 hypertensive and 35 normotensive) and compared with those of 35 age- and sex-matched normotensive healthy subjects in relation to body weight. The body weight, body mass index, blood pressure (systolic and diastolic), mean arterial pressure, plasma viscosity and fibrinogen level of the hypertensive diabetics were significantly higher than the values seen in the controls. Among the normotensive diabetics, only the fibrinogen concentration was elevated above that of the controls (P less than 0.01). Body weight, body mass index, blood pressure (systolic and diastolic), mean arterial pressure and plasma viscosity were all significantly higher in the hypertensive diabetics than in their normotensive counterparts. The difference in fibrinogen titre of both groups of diabetics was not significant. Body mass index, fibrinogen and plasma viscosity were correlated significantly with systolic and diastolic blood pressures (P less than 0.001). The order of relative contribution showed that fibrinogen contributed most to blood pressure, followed by plasma viscosity and then body mass index. The results suggest that high levels of body weight, fibrinogen concentration and plasma viscosity could contribute to the development of hypertension in diabetic Nigerians.     

Effect of body weight changes on 24-hour blood pressure and left ventricular mass in hypertension: a 4-year follow-up

BACKGROUND: Few data are available on the long-term effects of weight loss on 24-h blood pressure (BP) and left ventricular mass in overweight hypertensive patients. METHODS: A total of 181 never-treated overweight hypertensive subjects (body mass index, 25 to 39 kg/m(2), office BP 145/94 +/- 12/7 mm Hg) had 24-h BP monitoring and echocardiography twice, at baseline and after 3.8 +/- 2 years (minimum 1 year). None of the subjects received antihypertensive drugs during the follow-up. Main outcome measures were changes in 24-h BP and in left ventricular mass. RESULTS: Percent change in body weight had a direct relationship with 24-h BP changes (r = 0.35 and 0.31 for systolic and diastolic BP, respectively; both P <.001). The associations with office BP changes (r = 0.13, P =.10 for systolic BP; r = 0.15, P =.06 for diastolic BP) were significantly weaker (both P <.01, z test). The patients who lost weight during follow-up (n = 106) had a significantly lower increase in 24-h BP (+0.6 +/- 9/ +0.2 +/- 6 v +4.9 +/- 9/ +2.7 +/- 7 mm Hg for systolic/diastolic BP, both P <.01) and in left ventricular mass (-3 +/- 30 g v +9 +/- 32 g, P <.02) than the remaining subjects. In a multiple linear regression, a 10% weight loss independently predicted a 4.3/3.8 mm Hg decrease in 24-h systolic/diastolic BP. CONCLUSIONS: Long-term weight loss determines a sustained BP reduction during the 24 h and a decrease in left ventricular mass in overweight hypertensive subjects. The relation of weight loss with ambulatory BP changes is closer than that with office BP.     

Effects of childhood primary hypertension on carotid intima media thickness: a matched controlled study

To determine whether carotid intima media thickness is increased in children with primary hypertension, the current study compared carotid intima media thickness in hypertensive children with that of normotensive control subjects matched closely for body mass index and determined the relationship between carotid intima media thickness and hypertension severity determined by ambulatory blood pressure monitoring. Children with newly diagnosed office hypertension (n=28) had carotid intima media thickness, left ventricular mass index, and ambulatory blood pressure monitoring performed. Carotid intima media thickness was performed in normotensive control subjects (n=28) matched pairwise to hypertensive subjects for age (+/-1 year), gender, and body mass index (+/-10%). Eighty-two percent of subjects were overweight or obese (body mass index > or =85th percentile). The median carotid intima media thickness of hypertensive subjects was greater than that of matched controls (0.67 versus 0.63 mm; P=0.045). In the hypertensive subjects, carotid intima media thickness correlated strongly with several ambulatory blood pressure monitoring parameters, with the strongest correlation for daytime systolic blood pressure index (r=0.57; P=0.003). In the hypertensive group, the prevalence of left ventricular hypertrophy was 32%, but unlike carotid intima media thickness, left ventricular mass index did not correlate with ambulatory blood pressure monitoring. Together, the findings that hypertensive subjects had increased carotid intima media thickness compared with matched controls and that higher carotid intima media thickness correlated with more severe hypertension by ambulatory blood pressure monitoring provide strong evidence that carotid intima media thickness is increased in childhood primary hypertension, independent of the effects of obesity.     

Spurious systolic hypertension in young adults; prevalence of high brachial systolic blood pressure and low central pressure and its determinants

OBJECTIVE: To investigate the prevalence and determinants of spurious systolic hypertension (SSH) in a population-based sample of young adults and estimate their 20-year risk of coronary heart disease. POPULATION AND METHODS: Seven hundred and fifty young adults (352 men and 398 women), aged 26-31 years, from the Atherosclerosis Risk in Young Adults study were studied. Blood pressure levels were measured twice and central (aortic) pressures were derived by applanation tonometry on the radial artery using a generalized transfer function. SSH was defined as brachial systolic blood pressure (SBP) > or = 140 mmHg, brachial diastolic blood pressure (DBP) < 90 mmHg, and central SBP < 124 mmHg for men and < 120 mmHg for women. The Framingham risk score was calculated. Analysis of variance models were used to compare SSH individuals with normotensive and hypertensive males for cardiovascular risk factors. RESULTS: SSH was diagnosed in 57 men (16.1%; 95% confidence interval, 12.3-20.0) versus only three women (8%; 95% confidence interval, 0-1.6). The female population was excluded from further analysis. Compared with normotensive males, SSH individuals were heavier (88.7 versus 81.8 kg, P < 0.05) had a higher body mass index (25.8 versus 24.2 kg/m, P < 0.01) and significantly higher brachial and central SBP, DBP, pulse pressure, and mean arterial pressure. They had significantly higher pulse pressure amplification. Twenty-year Framingham risk scores based on DBP did not differ significantly between SSH subjects and normotensive individuals (2.72 versus 2.10%, respectively). CONCLUSION: SSH is predominantly found among young adult men. Apart from weight and body mass index, no other cardiovascular risk factors differed significantly between subjects with SSH and normotension or hypertension. When calculating the 20-year risk of coronary heart disease based on brachial DBP, SSH individuals were at intermediate risk between normotensive and hypertensive participants, but differences were not statistically significant.