Blood pressure,smoking, and the incidence of lung cancer in hypertensive men in North Karelia,Finland

Few studies have suggested that elevated blood pressure might be associated with increased risk of lung cancer and that this association might vary according to smoking status. The aim of this study was to assess the effect of blood pressure and its possible interaction with smoking on lung cancer incidence in hypertensive patients. Lung cancer incidence was determined for 7,908 men enrolled in the hypertension register of the North Karelia Project between 1972 and 1988 by record linkage to the nationwide Finnish Cancer Registry. In a Cox regression model, both systolic and diastolic blood pressures were significant predictors of lung cancer, with a 10% increase in risk per 10-mmHg increment in blood pressure. In smokers, the age-adjusted hazard ratio associated with a 10-mmHg increment in diastolic blood pressure was 1.17 (95% confidence interval: 1.05, 1.29), and in nonsmokers it was 0.98 (95% confidence interval: 0.80, 1.16). For systolic blood pressure, these hazard ratios were 1.11 (95% confidence interval: 1.05, 1.17) for smokers and 1.04 (95% confidence interval: 0.95, 1.14) for nonsmokers. These findings suggest that high blood pressure levels are associated with increased risk of lung cancer in smoking, hypertensive men.     

Increases in hypertension and blood pressure during pregnancy with increased bone lead levels

Prior studies have revealed associations of current lead exposure (blood lead) and past lead exposure (bone lead) with risks of hypertension and elevated blood pressure. The authors examined the effects of blood and bone lead on hypertension and elevated blood pressure in the third trimester and postpartum among 1,006 women enrolled in Los Angeles prenatal care clinics between 1995 and 2001. The authors measured bone lead concentration by K-shell x-ray fluorescence in the tibia (mean = 8.0 micro g/g (standard deviation (SD) 11.4)) and calcaneus (heel) (mean = 10.7 micro g/g (SD 11.9)). Geometric mean prenatal and postnatal blood lead levels were 1.9 micro g/dl (geometric SD +3.6/-1.0) and 2.3 micro g/dl (geometric SD +4.3/-1.2), respectively. For each 10- micro g/g increase in calcaneus bone lead level, the odds ratio for third-trimester hypertension (systolic blood pressure > or =140 mmHg or diastolic blood pressure > or =90 mmHg) was 1.86 (95% confidence interval (CI): 1.04, 3.32). In normotensive subjects, each 10- micro g/g increase in calcaneus bone lead level was associated with a 0.70-mmHg (95% CI: 0.04, 1.36) increase in third-trimester systolic blood pressure and a 0.54-mmHg (95% CI: 0.01, 1.08) increase in diastolic blood pressure. Tibia bone lead concentration was not related to hypertension or elevated blood pressure either in the third trimester or postpartum, nor was calcaneus bone lead related to postpartum hypertension or elevated blood pressure. Past lead exposure influences hypertension and elevated blood pressure during pregnancy. Controlling blood pressure may require reduction of lead exposure long before pregnancy.     

Nurse-led adherence support in hypertension: a randomized controlled trial

BACKGROUND: Lack of medication adherence is a common reason for poor control of blood pressure in the community, increasing the risk of heart attacks and strokes. OBJECTIVE: To evaluate the effect of nurse-led adherence support for people with uncontrolled high blood pressure compared with usual care. METHODS: We recruited 245 women and men with uncontrolled hypertension (> or = 150/90 mmHg) from 21 general practices in Bristol, UK. Participants were randomized to receive nurse-led adherence support or usual care alone. Main outcome measures were adherence to medication ('timing compliance') and blood pressure. RESULTS: Mean baseline timing compliance (+/- SD) was high in both the intervention (90.8 +/- 15.6%) and the control group (94.5 +/- 7.6%). There was no evidence of an effect of the intervention on timing compliance at follow-up (adjusted difference in means -1.0%; 95% confidence interval (CI) -5.1 to 3.1). There was also no difference at follow-up between the groups with regard to systolic blood pressure (-2.7 mmHg; 95% CI -7.2 to 1.8) or diastolic blood pressure (0.2 mmHg; 95% CI -1.9 to 2.3). Projected costs for the primary care sector per consultation were 6.60 pound sterling for the intervention compared with 5.08 pound sterling for usual care. CONCLUSION: In this study, adherence to blood pressure medication was much higher than previously reported. There was no evidence of an effect of nurse-led adherence support on medication adherence or blood pressure compared with usual care. Nurse-led adherence support was also more expensive from a primary care perspective.     

Body mass index and cardiovascular mortality at different levels of blood pressure: a prospective study of Norwegian men and women.

STUDY OBJECTIVE--The study investigated the joint effect of body mass index and systolic blood pressure on cardiovascular and total mortality. DESIGN--This was a prospective cohort study. The main outcome measures were age adjusted mortality and relative risks estimated from survival models. SETTING--The population of the city of Bergen, Norway. PARTICIPANTS--Subjects were 21,145 men and 30,330 women aged 30-79 years at the time of examination in 1963. MAIN RESULTS--Both cause specific and all cause mortality increased with systolic blood pressure within each category of body mass index. Stroke mortality was not significantly associated with body mass index when adjusted for systolic blood pressure in either age group of men or women. Coronary heart disease mortality increased on average 30% per 5 kg/m2 increase in body mass index in men and women aged 30-59 years at baseline. Adjusted for systolic blood pressure, the relative risks were reduced to 1.20 (95% confidence interval (CI) 1.12, 1.29) in men and 1.10 (95% CI 1.03, 1.18) in women. They were similar at each level of systolic blood pressure. For coronary heart disease mortality in men and women aged 60-79 years at measurement a negative interaction between body mass index and systolic blood pressure was suggested in the first five years. Excluding the first five years, adjusted relative risks per 5 kg/m2, were 1.05 (95% CI 0.96, 1.15) in men and 1.11 (95% CI 1.04, 1.17) in women in the older age group. There was an upturn in cardiovascular mortality at low levels of body mass index in both age groups of women, but not in men. CONCLUSIONS--Hypertension is an important risk factor for cardiovascular and all cause mortality even in the obese. Body mass index is generally a weak predictor of cardiovascular mortality in this population. It is a stronger risk factor of coronary death in men when measured at a younger age. Thin people with hypertension are not at particularly high risk of death from coronary heart disease compared with their obese counterparts, except possibly in the first few years after measurement in the elderly. Being underweight is associated with increased risk of death from all cardiovascular causes in women, but not in men.     

中老年人群生活方式与血压水平和高血压发生风险的关联

  目的  探讨中老年人群生活方式及其变化与血压水平和高血压发生风险的关联。  方法  纳入东风-同济队列2008―2010年7 671名研究对象进行分析。分别采用线性回归和Logistic回归分析模型评估生活方式与血压水平和高血压发生风险的关联。  结果  校正混杂因素后,生活方式评分增加与血压水平和高血压风险的降低均有剂量反应关系。与基线生活方式评分0~1分组相比,＞4分组的SBP、DBP和平均动脉压分别降低4.03、2.25和2.84 mm Hg,新发高血压的OR值为0.68(95% CI: 0.52~0.88)。且每增加1分,高血压发生风险降低9%(OR=0.91, 95% CI: 0.87~0.95)。而从基线至2013年随访5年间生活方式评分维持在＞3的个体,其新发高血压风险的OR值为0.61(OR=0.61, 95% CI: 0.47~0.80),但是从基线0~2分提高至随访＞3分并不能降低高血压风险(OR=0.87, 95% CI: 0.54~1.40)。  结论  中老年人群尽早并长期坚持健康生活方式对于高血压防控效益最大。     

低剂量口服避孕药与妇女高血压关系的研究

对连续服用国产低剂量复方炔诺酮(1号片)和低剂量复方18-甲基炔诺酮(复方18甲)5～25年及同期使用宫内节育器(IUD)的健康妇女457例进行动脉压测定,对血压均值、高血压患病的危险性及其影响因素进行分析。结果表明:与同期IUD对照比较,长期服用低剂量复方避孕片(COC)有升高血压的作用,且1号片大于复方18甲(P<0.01)。分层分析表明连续使用低剂量口服避孕药(OC)15年以上增加患高血压的危险性,1号片组的相对危险度(RR)为3.36(95％CI1.62,6.97 P<0.01),复方18甲组的RR值为2.27(95％CI 1.05,4.88 P<0.05)。Logistic回归分析提示:从事农业生产劳动、有心脑疾患家族史、体质指数、使用COC及长期摄入COC的总剂量为高血压有显著意义的影响因素。研究结果还表明该人群中确诊高血压者已知血压高的比例较低,仅15％～30％。建议在服OC妇女中定期监测血压,在血压达正常高限的妇女中开展高血压一级预防,降低高血压患病危险性。     

Linking community-based blood pressure measurement to clinical care: a randomized controlled trial of outreach and tracking by community health workers.

OBJECTIVES: This study assessed the effectiveness of enhanced tracking and follow-up services provided by community health workers in promoting medical follow-up of persons whose elevated blood pressures were detected during blood pressure measurement at urban community sites. METHODS: In a randomized controlled trial, 421 participants received either enhanced or usual referrals to care. Participants were 18 years or older, were either Black or White, and had blood pressure greater than or equal to 140/90 mm Hg and income equal to or less than 200% of poverty. The primary outcome measure was completion of a medical follow-up visit within 90 days of referral. RESULTS: The enhanced intervention increased follow-up by 39.4% (95% confidence interval [CI] = 14%, 71%; P = .001) relative to usual care. Follow-up visits were completed by 65.1% of participants in the intervention group, compared with 46.7% of those in the usual-care group. The number needed to treat was 5 clients (95% CI = 3, 13) per additional follow-up visit realized. CONCLUSIONS: Enhanced tracking and outreach increased the proportion of persons with elevated blood pressure detected during community measurement who followed up with medical care.     

Association of Preconception Blood Pressure with the Risk of Anemia in Children under Five Years of Age: A Large Longitudinal Chinese Birth Cohort

Hypertension during pregnancy may increase the risk of anemia in the offspring. However, few studies have investigated the effects of elevated blood pressure during the preconception period on childhood anemia. This large population-based birth cohort study was performed to determine whether abnormal preconception blood pressure has long-term consequences for childhood health. Data were obtained from the China–US Collaborative Project for Neural Tube Defect Prevention. The study consisted of 40,638 women with singleton live births who were registered in a monitoring system before pregnancy in southern China during the period 1993–1996. Children were assessed by hemoglobin measurement at approximately 53 months of age. The incidences of childhood anemia were 19.80% in the hypertension group and 16.07% in the non-hypertension group. Compared with the non-hypertension group, the hypertension group had an increased risk of childhood anemia (adjusted risk ratio (RR): 1.25; 95% confidence interval (CI): 1.11–1.41). After categorization according to blood pressure, combined systolic and diastolic hypertension was associated with a significantly increased risk of childhood anemia, compared with normotension (adjusted RR: 1.37; 95% CI: 1.16–1.63). Compared with women who had normal blood pressure, the adjusted RRs for childhood anemia were 1.20 (95% CI: 1.13–1.28), 1.26 (95% CI: 1.08–1.47), and 1.38 (95% CI: 1.14–1.67) among women with prehypertension, stage-1 hypertension, and stage-2 hypertension, respectively. Our results suggest a linear association between prepregnancy hypertension and the risk of childhood anemia in the Chinese population. Interventions targeting preconception blood pressure may have a positive effect on childhood health.     

Screening For Hypertension Annually Compared With Current Practice

PURPOSE

Hypertension is the most common diagnosis in ambulatory care, yet little evidence exists regarding recommended screening intervals or the sensitivity and specificity of a routine office-based blood pressure measurement, the most common screening test. Screening for hypertension is usually performed by measuring blood pressure at every outpatient visit, which often results in transiently elevated findings among adults who do not have a diagnosis of hypertension. We hypothesize that a more limited annual screening strategy may increase specificity while maintaining sensitivity.

METHODS

A retrospective case-control study of 372 adults without hypertension and 68 patients with newly diagnosed hypertension was conducted to compare the usual screening practice of checking blood pressure at every visit with a second strategy that considered only annual blood pressure measurements.

RESULTS

Specificity improved from 70.4% (95% CI, 65.5%-75.0%) for the usual practice to 82.0% (95% CI, 77.7%-85.8%) for the annual screening strategy. No statistically significant difference in sensitivity existed between the 2 methods.

CONCLUSION

A limited annual screening strategy for hypertension can improve specificity without sacrificing sensitivity when compared with routine screening at every visit in previously normotensive adults.Key words: hypertension, blood pressure, blood pressure determination, preventive health services, sensitivity and specificity, mass screening     

Association between prenatal lead exposure and blood pressure in children

Background: Lead exposure in adults is associated with hypertension. Altered prenatal nutrition is associated with subsequent risks of adult hypertension, but little is known about whether prenatal exposure to toxicants, such as lead, may also confer such risks.Objectives: We investigated the relationship of prenatal lead exposure and blood pressure (BP) in 7- to 15-year-old boys and girls.Methods: We evaluated 457 mother–child pairs, originally recruited for an environmental birth cohort study between 1994 and 2003 in Mexico City, at a follow-up visit in 2008–2010. Prenatal lead exposure was assessed by measurement of maternal tibia and patella lead using in vivo K-shell X-ray fluorescence and cord blood lead using atomic absorption spectrometry. BP was measured by mercury sphygmomanometer with appropriate-size cuffs.Results: Adjusting for relevant covariates, maternal tibia lead was significantly associated with increases in systolic BP (SBP) and diastolic BP (DBP) in girls but not in boys (p-interaction with sex = 0.025 and 0.007 for SBP and DBP, respectively). Among girls, an interquartile range increase in tibia lead (13 μg/g) was associated with 2.11-mmHg [95% confidence interval (CI): 0.69, 3.52] and 1.60-mmHg (95% CI: 0.28, 2.91) increases in SBP and DBP, respectively. Neither patella nor cord lead was associated with child BP.Conclusions: Maternal tibia lead, which reflects cumulative environmental lead exposure and a source of exposure to the fetus, is a predisposing factor to higher BP in girls but not boys. Sex-specific adaptive responses to lead toxicity during early-life development may explain these differences.     

Acetylcholinesterase Activity,Cohabitation with Floricultural Workers,and Blood Pressure in Ecuadorian Children

Background: Acetylcholinesterase (AChE) inhibitors are commonly used pesticides that can effect hemodynamic changes through increased cholinergic stimulation. Children of agricultural workers are likely to have paraoccupational exposures to pesticides, but the potential physiological impact of such exposures is unclear.Objectives: We investigated whether secondary pesticide exposures were associated with blood pressure and heart rate among children living in agricultural Ecuadorian communities.Methods: This cross-sectional study included 271 children 4–9 years of age [51% cohabited with one or more flower plantation workers (mean duration, 5.2 years)]. Erythrocyte AChE activity was measured using the EQM Test-mate system. Linear regression models were used to estimate associations of systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate with AChE activity, living with flower workers, duration of cohabitation with a flower worker, number of flower workers in the child’s home, and number of practices that might increase children’s exposure to pesticides.Results: Mean (± SD) AChE activity was 3.14 ± 0.49 U/mL. A 1-U/mL decrease in AChE activity was associated with a 2.86-mmHg decrease in SBP (95% CI: –5.20, –0.53) and a 2.89-mmHg decrease in DBP (95% CI: –5.00, –0.78), after adjustment for potential confounders. Children living with flower workers had lower SBP (–1.72 mmHg; 95% CI: –3.53, 0.08) than other children, and practices that might increase exposure also were associated with lower SBP. No significant associations were found between exposures and heart rate.Conclusions: Our findings suggest that subclinical secondary exposures to pesticides may affect vascular reactivity in children. Additional research is needed to confirm these findings.     

广西壮族自治区40岁以上人群冠心病事件发病影响因素的队列研究

目的探讨影响广西壮族自治区40岁以上人群冠心病事件发病的影响因素。方法在1991年全国高血压调查的基础上，对广西壮族自治区〉40岁以上11818人进行了随访调查，取得其冠心病发病资料。结果冠心病事件的发生与收缩压（SBP）、舒张压（DBP）、脉压、吸烟、体重指数（BMI）和有无心肌梗死（心梗）史有关。Cox回归分析表明，有心梗史者较无心梗史者发生冠心病事件的相对危险度（RR）大21倍（95％CI：9．06～48．44）；脉压每增高10mmHg（1mmHg=0．133kPa），冠心病事件发生的RR为1．29倍（95％CI：1．11～1．49），大于DBP的118倍（95％CI：1．02～1．22）、SBP的1．13倍（95％CI：105～1．28）；吸烟者比不吸烟者的冠心病事件的RR增加1．23倍（95％CI：1．05～1．45）；每增加1的BMI，冠心病事件的RR增加1．03倍（95％CI：1．01～1．05）。结论有心梗史者、高血压、吸烟、高BMI是冠心病发病的危险因素。     

Homocysteine and blood pressure in the Third National Health and Nutrition Examination Survey, 1988-1994

Studies suggest that homocysteine may elevate blood pressure and increase the risk of hypertension. The association of homocysteine with blood pressure and with the risk of hypertension was investigated using cross-sectional data from the Third National Health and Nutrition Examination Survey (1998-1994). Homocysteine had an independent positive association with blood pressure after adjusting for cardiovascular risk factors. A 1 standard deviation ( approximately 5 micro mol/liter) increase in homocysteine was associated with increases in diastolic and systolic blood pressure of 0.5 and 0.7 mmHg, respectively, in men and of 0.7 and 1.2 mmHg in women. Similarly, higher levels of homocysteine were associated with an increased risk of hypertension. In a comparison of the highest and lowest quintiles of homocysteine, women had a threefold increase in the risk of hypertension (95% confidence interval (CI): 1.7, 5.4), and men had a twofold increase (95% CI: 0.7, 5.1). In light of the homocysteine-blood pressure association, the association of homocysteine with prevalent cardiovascular disease was examined with and without adjusting for blood pressure. The results support a mediating role for blood pressure in women and suggest that the full effect of homocysteine on cardiovascular risk may be underestimated when blood pressure is adjusted.     

太极拳对中老年原发性高血压患者血压水平影响Meta分析

目的 探讨太极拳对中老年原发性高血压患者血压水平的影响,为临床治疗高血压的选择方案提供参考依据。方法 通过检索中国知网、万方数据、维普、Web of Science、Medline等数据库,共纳入19篇国内外文献。检索期限为建库至2017年10月。结果 Meta分析结果显示,太极拳对中老年原发性高血压患者收缩压（WMD = 11.14,95%CI[7.82,14.47],Z = 6.58,P＜0.01）和舒张压（WMD = 5.64,95%CI[3.34,7.94],Z = 4.80,P＜0.01）的影响均具有统计学意义。亚组分析结果显示,收缩压和舒张压指标在干预时间亚组的“＞60 min/次”分析结果中均无统计学意义,在干预时间亚组的“≤ 60 min/次”、干预频率和干预周期亚组分析结果中均具有统计学意义。结论 太极拳对中老年原发性高血压患者的收缩压和舒张压均有不同程度的降低,是高血压病非药物治疗的有效方法之一,可为临床治疗高血压的选择方案提供依据。     

The inter-arm blood pressure difference and peripheral vascular disease: cross-sectional study

BACKGROUND: A blood pressure (BP) difference between the upper limbs is often encountered in primary care. Knowledge of its prevalence and importance in the accurate measurement of BP is poor, representing a source of error. Current hypertension guidelines do not emphasize this. OBJECTIVES: To establish the prevalence of an inter-arm blood pressure difference (IAD) and explore its association with other indicators of peripheral vascular disease (PVD) in a hypertensive primary care population. METHODS: This was a cross-sectional study. Primary care, one rural general practice, was the setting of the study. The methods were controlled simultaneous measurement of brachial BPs, ankle-brachial pressure index (ABPI) and tiptoe stress testing in 94 subjects. RESULTS: In all, 18 of 94 [19%, 95% confidence interval (CI) 11-27%] subjects had mean systolic inter-arm difference (sIAD) > or =10 mmHg and seven of 94 (7%, 95% CI 2-12%) had mean diastolic inter-arm difference (dIAD) > or =10 mmHg. Nineteen of 91 (20%, 95% CI 12-28%) had a reduced ABPI <0.9. There was negative correlation between systolic (Pearson's correlation coefficient - 0.378; P = 0.01) and diastolic (Pearson's correlation coefficient - 0.225; P = 0.05) magnitudes of IAD with ABPI. On tiptoe testing, 9/90 subjects (10%, 95% CI 4-16%) had a pressure drop > or =20%. CONCLUSIONS: An IAD and asymptomatic PVD are common in a primary care hypertensive population. Magnitude of the IAD is inversely correlated with ABPI, supporting the hypotheses that IADs are causally linked to PVD, and that IAD is a useful marker for the presence of PVD. Consequently, detection of an IAD should prompt the clinician to screen subjects for other signs of vascular disease and target them for aggressive cardiovascular risk factor modification.     

Edinburgh Artery Study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population

Intermittent claudication has been studied in cardiovascular surveys but limited information is available on asymptomatic peripheral arterial disease. The purpose of this paper is to describe the prevalence of both asymptomatic and symptomatic disease and relation to ischaemic heart disease in the Edinburgh Artery Study. A cross-sectional survey was conducted on an age-stratified sample of men and women aged 55 to 74 years selected from age-sex registers in ten general practices in the city. Arterial disease was assessed in 1592 participants by means of the WHO questionnaire on intermittent claudication and measurement of the ankle brachial systolic pressure index (ABPI) and change in ankle systolic pressure during reactive hyperaemia. The prevalence of intermittent claudication was 4.5% (95% confidence interval (CI): 3.5%-5.5%). Major asymptomatic disease causing a significant impairment of blood flow occurred in 8.0% (95% CI: 6.6%-9.4%). A further 16.6% (95% CI: 14.6%-18.5%) had criteria considered abnormal in clinical practice: 9.0% had ABPI less than 0.9 and 7.6% had reactive hyperaemia pressure reduction greater than 20%. Intermittent claudication was equally common in both sexes. The ABPI and reactive hyperaemia results suggested a slight preponderance of asymptomatic disease in males and were consistent with an increasing prevalence with age and lower social class. Mean ABPI was higher in normal men than women, and was lower in the left leg than the right suggesting a unilateral predisposition to disease. Subjects with major asymptomatic disease had more evidence of ischaemic heart disease than in the normal population (relative risk (RR) 1.6; 95% CI: 1.3-1.9).(ABSTRACT TRUNCATED AT 250 WORDS)     

Diabetes mellitus: an independent risk factor for stroke?

Raised blood pressure is the strongest single risk factor for stroke in the general population. Diabetics are at increased risk of both hypertension and stroke. It is not clear if diabetes mellitus confers an excess risk of stroke that is independent of blood pressure. The authors examined the relation of diabetic status (personal history of diabetes and/or fasting plasma glucose greater than 7.8 mmol per liter) to stroke risk in a population-based cohort of 3,778 adults aged 50-79 years in Rancho Bernardo, California who were followed from 1972 for an average of 12 years. There were 232 stroke cases, 139 of which were ascertained from death certificates. Diabetics had higher mean systolic blood pressures, significantly so in females, and diabetics of both sexes were significantly more obese. Diabetics had greater univariate age-adjusted stroke mortality and morbidity rates than nondiabetics. The increased stroke rates were still apparent in diabetics after stratifying for systolic blood pressure. In multivariate analyses, the relative risks (RRs) for stroke mortality and morbidity associated with diabetes were not significantly changed in men (RR = 1.8) and women (RR = 2.2), after adjusting for the effect of risk factors including age, systolic blood pressure, cholesterol level, obesity, and smoking habits, and excluding persons with personal history of heart attack, heart failure, or stroke. These findings support the hypothesis that diabetes may confer excess risk of stroke independent of blood pressure.     

Parental history of coronary heart disease, hypertension, diabetes, and stroke: Relationship to coronary heart disease risk factor variables in their adult children

Relationships of parental (familial) history of coronary heart disease, stroke, hypertension, and diabetes to major coronary heart disease (CHD) risk factors were examined in 738 adults (average age, 40 years) in the Cincinnati Lipid Research Clinics Princeton School study. Men reporting parental CHD had higher plasma triglyceride and higher systolic and diastolic blood pressure than comparison group men reporting no parental CHD, stroke, hypertension, or diabetes. Women reporting parental CHD had higher plasma triglycerides than comparison group women reporting no parental CHD, stroke, hypertension, or diabetes. Men reporting stroke in one parent had higher total plasma cholesterol and triglyceride levels than comparison men. Women reporting stroke in one parent had higher triglyceride levels than comparison group women. Women reporting hypertension in one parent had higher mean triglyceride and systolic blood pressure than comparison women. Men and women reporting diabetes in one parent had higher triglyceride than comparison adults. Matching men whose fathers had died of CHD with those whose fathers were free of CHD revealed significant increments in triglyceride levels, systolic, and diastolic blood pressure in the men with positive family history of CHD. Matching women whose fathers had died of CHD with those whose fathers were free of CHD revealed higher total plasma cholesterol, low-density lipoprotein cholesterol, and Quetelet index. In men, categorical assessment by CHD risk factor levels (low, intermediate, high), revealed that plasma triglycerides and systolic blood pressure were positively associated with a parental history of CHD, while high-density lipoprotein cholesterol was inversely related. In women, similar observations were made for triglycerides. Family history is a practical tool for identification of risk to CHD, hypertension, stroke, and diabetes. Serial risk factor measurements in offspring from CHD-, hypertension-, stroke-, and diabetes-positive families should have considerable utility in early recognition and documentation of CHD risk factor levels which, in turn, should facilitate primary intervention designed to ameliorate or prevent the development of CHD.     

Glucose, insulin, and incident hypertension in the multi-ethnic study of atherosclerosis

Diabetes mellitus and hypertension commonly coexist, but the nature of this link is not well understood. The authors tested whether diabetes and higher concentrations of fasting serum glucose and insulin are associated with increased risk of developing incident hypertension in the community-based Multi-Ethnic Study of Atherosclerosis. At baseline, 3,513 participants were free of hypertension, defined as systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or use of antihypertensive medications to treat high blood pressure. Of these, 965 participants (27%) developed incident hypertension over 4.7 years' median follow-up between 2002 and 2007. Compared with participants with normal baseline fasting glucose, those with impaired fasting glucose and diabetes had adjusted relative risks of hypertension of 1.16 (95% confidence interval (CI): 0.96, 1.40) and 1.41 (95% CI: 1.17, 1.71), respectively (P = 0.0015). The adjusted relative risk of incident hypertension was 1.08 (95% CI: 1.04, 1.13) for each mmol/L higher glucose (P < 0.0001) and 1.15 (95% CI: 1.05, 1.25) for each doubling of insulin (P = 0.0016). Further adjustment for serum cystatin C, urinary albumin/creatinine ratio, and arterial elasticity measured by tonometry substantially reduced the magnitudes of these associations. In conclusion, diabetes and higher concentrations of glucose and insulin may contribute to the development of hypertension, in part through kidney disease and arterial stiffness.     

Coffee intake and incidence of hypertension

BACKGROUND: The long-term longitudinal evidence for a relation between coffee intake and hypertension is relatively scarce. OBJECTIVE: The objective was to assess whether coffee intake is associated with the incidence of hypertension. DESIGN: This study was conducted on a cohort of 2985 men and 3383 women who had a baseline visit and follow-up visits after 6 and 11 y. Baseline coffee intake was ascertained with questionnaires and categorized into 0, >0-3, >3-6, and >6 cups/d. Hypertension was defined as a mean systolic blood pressure (SBP) >or=140 mm Hg over both follow-up measurements, a mean diastolic blood pressure (DBP) >or=90 mm Hg over both follow-up measurements, or the use of antihypertensive medication at any follow-up measurement. RESULTS: Coffee abstainers at baseline had a lower risk of hypertension than did those with a coffee intake of >0-3 cups/d [odds ratio (OR): 0.54; 95% CI: 0.31, 0.92]. Women who drank >6 cups/d had a lower risk than did women who drank >0-3 cups/d (OR: 0.67; 95% CI: 0.46, 0.98). Subjects aged >or=39 y at baseline had 0.35 mm Hg (95% CI: -0.59, -0.11 mm Hg) lower SBP per cup intake/d and 0.11 mm Hg lower DBP (95% CI: -0.26, 0.03 mm Hg) than did those aged <39 y at baseline, although the difference in DBP was not statistically significant. CONCLUSIONS: Coffee abstinence is associated with a lower hypertension risk than is low coffee consumption. An inverse U-shaped relation between coffee intake and risk of hypertension was observed in the women.