Assessing Cardiovascular Reactivity in Working Women with the Social Competence Interview

ABSTRACT

The Social Competence Interview (SCI), an interview to induce cardiovascular reactivity through recounting a stressful life experience, was used with a sample of 120 working women employed as childcare providers. Women recounted their most stressful work factor while cardiovascular reactions were monitored at 2-minute intervals (data points included 4 baseline, 6 SCI, and 3 recovery). Increases were found when comparing mean baseline and SCI measures: systolic blood pressure (SBP) increased 10.00 mm Hg; diastolic blood pressure (DBP) increased 10.63 mm Hg; and heart rate increased 4.57 beats per minute. Consistent with the literature SBP and DBP were higher for some subgroups of women (those who were 50 years or older, were obese, or had 4 or more risk factors) across all data points. There were no time by individual difference interactions, indicating that the patterns of change over time were the same across groups. In a logistic regression, comparing women who reached SBP ≥ 140 mm Hg and/or DBP ≥ 90 mm Hg during the SCI versus those who did not, higher BP was associated with being older and obese, having a higher level of acceptance coping, and a lower level of suppression of competing activities coping.     

Trimester-specific blood pressure levels in relation to maternal pre-pregnancy body mass index

We evaluated the influence of maternal pre-pregnancy body mass index (BMI), based on reported pre-pregnancy weight and height, on blood pressure (BP) levels during pregnancy by using information from a prospective cohort of 1733 women recruited before 20 weeks' gestation. Maternal antenatal BP values were abstracted from medical records, and we evaluated the mean BP differences according to BMI group in regression models, using generalised estimating equations to account for repeated BP records within each pregnancy. In each trimester, mean systolic BP (SBP) and diastolic BP (DBP) values were positively associated with maternal pre-gestational BMI. This association persisted after adjustment for maternal age, parity, smoking, education, marital status and physical activity. Overweight women (25-29 kg/m(2)) had first-, second- and third-trimester mean SBPs that were 8.1, 7.7 and 8.2 mmHg, respectively, higher than values observed in lean women (<20 kg/m(2)). Mean DBP values were 4.5, 5.4 and 5.6 mmHg higher for each successive trimester in overweight vs. lean women. Obese (>30 kg/m(2)) women consistently had the highest mean SBP and DBP values. Trimester-specific mean SBP values were 10.7-12.0 mmHg higher among obese women vs. lean women. Corresponding trimester-specific mean DBP values were 6.9-7.4 mmHg higher in obese vs. lean women. Similar patterns were observed when trimester-specific average mean arterial pressures were evaluated. Elevated pregnancy BPs associated with maternal pre-gestational BMI are consistent with a large body of literature that documents increased pre-eclampsia risk among overweight and obese women.     

Noise-induced hearing loss and blood pressure

Summary A sample of 188 male and 92 female engineering industry workers was investigated. Pure-tone audiometric measurements were used as an estimator of prolonged noise exposure. Using the air conductance thresholds at frequencies of 3,4 and 6 kHz, subjects were classified into three hearing classes. Their systolic (SBP) and diastolic blood pressure (DBP) was measured.In the older age group (41–64 years), the mean SBP of subjects with moderate hearing loss was 12 mmHg higher among men (n=35) and 18 mmHg higher among women (n=7) than among subjects with normal hearing (n=27). The mean DBP levels of subjects with moderate hearing loss were 5 mmHg and 4 mmHg higher, respectively. However, in the class of severe hearing loss (n=38; only male workers) the mean SBP was only 2 mmHg and the mean DBP only 1 mmHg higher than among subjects with normal hearing. In the younger age group (26–40 years) no differences in either SBP or DBP between the hearing classes were found.     

Dietary zinc intake is inversely associated with systolic blood pressure in young obese women

Zinc may participate in blood pressure regulation and in the pathogenesis of hypertension. The study examined the relationship between zinc status and blood pressure in obese Korean women. Forty obese women (body mass index (BMI) ≥ 25 kg/m²) aged 19-28 years participated in this study. Zinc intake was estimated from one 24 hour recall and 2-day diet records. Serum and urinary zinc concentrations were determined by atomic absorbance spectrophotometry. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured using an automatic sphygmometer. Metabolic variables, such as waist circumference, triglyceride, high density lipoprotein (HDL) cholesterol, fasting glucose, and fasting insulin, were also measured. Dietary zinc intake of obese women was averagely 7.5 mg/day. Serum zinc and urinary zinc concentrations were 13.4 µmol/L and 378.7 µg/day, respectively. Averages of SBP and DBP were 119 mmHg and 78 mmHg. Dietary zinc intake was negatively correlated with SBP after adjusting for energy intake (P < 0.05), but serum and urinary zinc concentrations were not found to be correlated with SBP or DBP. Multivariate linear regression analysis showed that dietary zinc intake was inversely associated with SBP in obese women after adjusting for body weight, energy intake and sodium intake (P = 0.0145). The results show that dietary zinc intake may be an independent risk factor of elevated SBP in obese Korean women.     

Increasing blood pressure and its associated factors in Canadian children and adolescents from Canadian Health Measures Survey

ABSTRACT: BACKGROUND: Canada is facing a childhood obesity epidemic. Elevated blood pressure (BP) is a major complication of obesity. Reports on the impact of excess adiposity on BP in children and adolescents have varied significantly across studies. We evaluated the independent effects of obesity, physical activity, family history of hypertension, and socioeconomic status on BP in a nationally representative sample of children and adolescents. METHODS: We analysed cross-sectional data for 1850 children aged 6 to 17 years who participated in the Canadian Health Measures Survey, Cycle 1, 2007-2009. Systolic BP (SBP) and diastolic BP (DBP) were age-, sex-, and height-adjusted to z-scores (SBPZ and DBPZ). Body mass index (BMI) z-scores were calculated based on World Health Organization growth standards. Multivariate linear regression was used to evaluate the independent effects of relevant variables on SBPZ and DBPZ. RESULTS: For most age/sex groups, obesity was positively associated with SBP. Being obese was associated with higher DBP in adolescent boys only. The BP effect of obesity showed earlier in young girls than boys. Obese adolescents were estimated to have an average 7.6 mmHg higher SBP than normal weight adolescents. BMI had the strongest effect on BP among obese children and adolescents. Moderately active adolescent boys had higher SBP (3.9 mmHg) and DBP (4.9 mmHg) than physically active boys. Family history of hypertension showed effects on SBP and DBP in younger girls and adolescent boys. Both family income and parent education demonstrated independent associations with BP in young children. CONCLUSIONS: Our findings demonstrate the early impact of excess adiposity, insufficient physical activity, family history of hypertension, and socioeconomic inequalities on BP. Early interventions to reduce childhood obesity can, among other things, reduce exposure to prolonged BP elevation and the future risk of cardiovascular disease.     

Oral contraceptives: a risk factor for uncontrolled blood pressure among hypertensive women

The objective of the study was to assess the association between systolic and diastolic blood pressure (SBP and DBP) and the use of oral contraceptives (OC) in hypertensive women. In a prospective cross-sectional study, we evaluated 171 women who were referred to the Hypertension Outpatient Clinic of Hospital de Clínicas de Porto Alegre; 66 current users of OC, 26 users of other contraceptive methods and 79 women who were not using contraception. The average of six blood pressure readings was used to establish the usual blood pressure of the participants. Current OC users were compared with users of other methods and with patients not using contraception. Main outcome measures were SBP and DBP among the different groups, and prevalence of uncontrolled hypertension (SBP >or= 140 mmHg and DBP >or= 90 mmHg). DBP was higher in OC users (100.2 +/- 15.9 mmHg) than in patients using other contraceptive methods (93.4 +/- 14.7 mmHg) and not using contraceptives (93.3 +/- 14.4 mmHg, p = 0.016). Women using OC for more than 8 years presented higher age-adjusted blood pressure levels than women using OC for shorter periods. Patients using OC had poor blood pressure control (p for trend = 0.046) and a higher proportion of them presented moderate-severe hypertension. These results were independent of antihypertensive drug use. In a logistic regression model, we found that current OC use was independently and significantly associated with prevalence of uncontrolled hypertension. It is concluded that hypertensive women using OC present a significant increase in DBP and poor blood pressure control, independent of age, weight and antihypertensive drug treatment.     

Relationship of blood pressure to cardiovascular death: the effects of pulse pressure in the elderly

PURPOSE: To investigate the relationship of systolic and diastolic blood pressure to fatal myocardial infarction, fatal stroke and other death related to cardiovascular diseases (CVD). METHODS: The study was based on a prospective longitudinal study conducted by the Veterans Administration at the Boston Outpatient Clinic. Participants are male volunteers from the greater Boston area. Main outcome measures are fatal myocardial infarction, fatal stroke and other deaths related to cardiovascular diseases. The method of pooled logistic regression was used for statistical analysis. RESULTS: For younger men (age 21-59), after adjusting for effects of other risk factors, when systolic and diastolic blood pressure were considered separately, SBP was predictive of cardiovascular death (SBP: RR = 1.23; 95% CI = (1.05, 1.45) per 10 mmHg of increase), and DBP showed a nonsignificant positive trend in relation to cardiovascular death (DBP: RR = 1.27; 95% CI = (0.95, 1.69) per 10 mmHg of increase). For older men (age 60-85), when SBP and DBP were considered separately, SBP (RR = 1.26; 95% CI = (1.02, 1.55) per 15 mmHg of increase) was directly related, but DBP (RR = 1.05; 95% CI = (0.83, 1.32) per 8 mmHg of increase) was not related to cardiovascular death. However, for the elderly group, when SBP and DBP were considered jointly in the regression model, then the regression coefficient of DBP (beta = -0.018, p = 0.30) was of approximately the same absolute magnitude as that of SBP (beta = 0.021, p = 0.02) but opposite in sign. For younger men, when SBP and DBP were considered jointly, SBP (beta = 0.021, p = 0.049) but not DBP (beta = -0.001, p = 0.953) was positively related to cardiovascular death. CONCLUSIONS: We found that, for the elderly, pulse pressure (SBP-DBP) may be a more accurate predictor of cardiovascular death than either SBP or DBP alone. The relative risk per 35 mmHg of increase of pulse pressure, which equals the approximate interval from the 10th to the 90th percentile in the elderly group, is 2.1 with 95% CI = (1.1, 3.8). In younger subjects, SBP, but not DBP, is an independent predictor of fatal CVD.     

Hypophosphataemia in the metabolic syndrome. Gender differences in body weight and blood glucose.

OBJECTIVE: We examined gender differences in the clustering of risk factors, especially regarding the possible role of serum phosphate (S-P) in obese patients who participated in a 4 week education programme to reduce their excess risk of cardiovascular disease (CVD). RESULTS: Significantly higher body mass index (BMI) and concentrations of S-P and high density lipids (S-HDL) in serum were found in women (n=1272) than in men (n=993). In women, BMI was inversely correlated with S-P at the time of admission. Also in women (but not in men), changes in BMI and S-P over 1 or 1-1/2 y were inversely correlated. In men (but not in women), S-P level was inversely correlated with age, systolic blood pressure (SBP), diastolic blood pressure (DBP) and blood glucose at the time of admission. In women, S-P increased and DBP decreased, in addition to weight decrease over both 6 months and 1(1/2) y or 1 y. In women (but not in men), significantly higher age, S-P, S-chol, S-TG, S-urate, SBP and DBP values were found with the highest vs the lowest decile of S-Ca. CONCLUSION: We conclude that higher S-P and S-Ca levels may contribute to the difference in metabolic disturbances occurring in obesity, seen in women vs men.     

Body composition influences blood pressure during submaximal graded test in women

This study aimed to determine whether body composition affected cardiovascular responses of normal, overweight and obese women by comparing heart rate (HR) and blood pressure (BP) during a graded submaximal treadmill exercise. Thirty five healthy non-smoking, premenopausal women (age 30.8 ± 9.5 yr; height 1.66 ± 0.05 m; weight 73.8 ± 18.9 kg; body fat 36.2 ± 9.5%; maximum oxygen uptake 33.5 ± 8.1 mL·min·kg⁻¹) volunteered for this study, and were classified into three groups based on BMI: normal weight (NOR; ≤24.9 kg·m²), overweight (OVW; 25−29.9 kg·m²) and obese (OBE; ≥30 kg·m²). Participants performed a submaximal graded test at 30%, 40%, 50% and 60% of maximal oxygen uptake, during which HR, systolic BP (SBP), diastolic BP (DBP) and mean arterial pressure (MAP) were measured. At rest, participants of OBE group had higher BP than NOR and OVW. During the submaximal graded test, HR, SBP and MAP increased as a function of intensity. There were no group differences in HR, but greater SBP, DBP and MAP in OBE compared to NOR and OBW at all intensities except 60%. Overall, our study further contributes to underscore the importance of stress testing specifically to evaluate the increased risks apparently healthy obese women are placed at to developing diseases from the chronic exposure to raised BP, despite normal resting BP and HR responses during exercise.     

Comparison of cardiovascular risk factors in obese blacks and whites

Blacks are known to have higher blood pressure levels, a higher prevalence of hypertension, and higher body weights than whites. However, the interrelationships of these and other cardiac risk factors have not been analyzed in an obese population. We compared blood pressure (BP) and lipid levels in 174 obese blacks and 939 obese white patients who were entering a weight loss program; we also assessed the effects of weight loss on these factors. Prevalence of treated hypertension was similar in blacks and whites (28% vs. 25%, respectively). In patients not taking BP medication, black women weighed more (108 kg) than white women (102 kg) and black and white males' weights were similar (135 kg vs. 131 kg). Systolic and diastolic BP were similar in black and white women; black males had similar SBP but a significantly lower DBP than white males (83 mmHg vs. 89 mmHg, respectively). Lipid levels were similar in black and white women except black women had lower triglycerides (1.30 mmol/L) than white women (1.58 mmol/L, p < 0.05); and black males compared to white males had significantly lower total cholesterol (4.76 mmol/L vs. 5.56 mmol/L), LDL-cholesterol (3.15 mmol/L vs. 3.52 mmol/L) and triglycerides (1.31 mmol/L vs. 2.17 mmol/L, p < 0.05). Adult-onset obesity adversely affected a number of cardiovascular risk factors in whites, but not in blacks. Blacks lost significantly less weight (-13 kg) than whites (-19 kg). However, controlling for the difference in weight loss, blacks sustained comparable improvement in lipids and blood pressure, except for TC/HDL-C (whites improved significantly more, -0.36 kg/m2, than blacks, 0.03 kg/m2). Thus, the impact of obesity on cardiovascular risk factors seems ameliorated in blacks compared to whites.     

Effect of a moderately hypoenergetic Mediterranean diet and exercise program on body cell mass and cardiovascular risk factors in obese women

OBJECTIVE: To assess the effects of a moderately hypoenergetic Mediterranean diet (MHMD) and exercise program on body cell mass (BCM) and cardiovascular disease risk factors in obese women. SUBJECTS/METHODS: Forty-seven obese women, 39.7+/-13.2 years of age, with a body mass index (BMI)=30.7+/-6.0 kg/m(2), completed the study. The following were measured at baseline, 2 and 4 months: BCM, BCM index (BCMI), body weight, BMI, fat-free mass (FFM), fat mass (FM), total body water (TBW), extracellular water (ECW) and intracellular water (ICW) using bioelectrical impedance analysis; fasting blood glucose (FBG), serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) concentrations; systolic (SBP) and diastolic (DBP) blood pressure. RESULTS: Body weight, BMI, FM, TC and TG significantly decreased (P<0.001; P<0.002 (TG)) at 2 and 4 months. FFM, TBW, ECW, FBG and DBP significantly decreased at 2 months (P<0.05 (FFM); P<0.001). LDL-C significantly decreased (P<0.001), while HDL-C significantly increased (P<0.002) at 4 months. BCM, BCMI, ICW and SBP remained stable over time. CONCLUSION: BCM was preserved and cardiovascular disease risk factors improved in obese women placed on a MHMD and exercise program for 4 months.     

延边地区朝鲜族与汉族青少年心血管病危险因素的分布比较

[目的]比较朝鲜族与汉族青少年心血管病危险因素的分布.[方法]1997年9月,采用横断面研究方法,对延边地区朝鲜族、汉族中学生1122名的心血管病危险因素进行了调查.[结果]男性高密度脂蛋白-胆固醇水平,朝鲜族和汉族分别为1.00、1.07、mmol/L,空腹血糖分别为4.64、3.36mmol/L,重度肥胖率分别为9.4%、3.1%.女性甘油三酯水平,朝鲜族和汉族分别为0.82、0.75mmol/L,空腹血糖分别为4.86、3.36mmol/L,舒张压分别为72.9、70.5mmHg,肥胖率分别为18.3%、10.8%.朝鲜族肥胖组,甘油三酯、收缩压及舒张压均值皆高于正常体重组.汉族总胆固醇、甘油三酯、低密度脂蛋白-胆固醇、收缩压与舒张压均值肥胖组皆高于正常体重组.血糖对朝鲜族的血压的影响较大,而低密度脂蛋白-胆固醇对汉族血压的影响较大.[结论]朝鲜族和汉族青少年心血管病危险因素分布有差异,应对青少年提早进行心血管病危险因素的监测.     

2型糖尿病患者体质指数变化与心血管病其他危险因素的关联研究

目的 分析2型糖尿病患者（T2DM）BMI变化与心血管病其他危险因素的关联。方法 基于农村社区T2DM队列,基线和随访时测量研究对象的身高、体重、血压、糖化血红蛋白（HbA1c）、TC、TG、LDL-C和HDL-C。分析中剔除随访期间死亡及失访或信息不全者,共纳入8 953例研究对象。使用多重线性回归和Cox比例风险回归模型分析BMI变化和心血管病其他危险因素的关联。结果 基线调查时,有40.97%的T2DM患者伴有超重肥胖。超重肥胖组的SBP、DBP、TG水平显著高于BMI正常组,HDL-C水平低于BMI正常组（P<0.01）。随访期间,患者血糖控制率上升了15%,不同BMI变化组的HbA1c水平均有不同程度下降;与BMI持续正常组相比,持续超重肥胖组的HbA1c水平下降幅度较小,SBP、DBP上升幅度较大;HbA1c、SBP、DBP、TG、HDL-C不达标比例分别比BMI持续正常组高1.142（1.057~1.233）倍、1.123（1.055~1.196）倍、1.220（1.128~1.320）倍、1.400（1.282~1.528）倍、1.164（1.069~1.267）倍;BMI转为异常组血压、血脂等相关指标变化与持续超重肥胖组相似;BMI转为正常组血糖、血压等变化值以及不达标比例与BMI持续正常组差异无统计学意义（P>0.05）。BMI变化值与SBP、DBP、TG和LDL-C的变化值呈正相关,与HDL-C呈负相关（P<0.05）。结论 BMI异常变化将伴随着血糖、血压、血脂等心血管疾病（CVD）危险因素的不利变化,BMI的正常化将有利于CVD不良因素的转归。     

Association Between Late-Life Blood Pressure and the Incidence of Cognitive Impairment: A Community-Based Prospective Cohort Study

Objectives

To investigate the association between late-life blood pressure and the incidence of cognitive impairment in older adults.

The Association of Body Mass Index and Waist Circumference with Blood Pressure Depends on Age and Gender: A Study of 10,928 Non-Smoking Adults in the Greek EPIC Cohort

Body mass index (BMI) and waist circumference are independently associated with blood pressure, but the dependence of these associations on gender and age has not been clarified. We investigated the associations of BMI and waist circumference with systolic (SBP) and diastolic (DBP) blood pressure and assessed possible interactions with gender and age. Data concerning blood pressure and anthropometric variables were collected at enrollment in a cohort study from 10,928 non-smoking adults, all over Greece, who have never received antihypertensive treatment. Multiple regression-derived standardized coefficients were estimated to compare effects among variables. Among men, waist circumference appears more important than BMI in the prediction of SBP (standardized coefficients 2.26 vs. 1.52 mmHg/SD), and to a lesser extent DBP. In contrast, among women, BMI is more important than waist circumference, in the prediction of SBP (standardized coefficients 3.97 vs. 1.56 mmHg/ SD) and to a lesser extent DBP. The different effects of BMI and waist circumference on blood pressure by gender are evident among older individuals (> 55 years); among younger individuals BMI and waist circumference have comparable effects in both genders. Among younger individuals, BMI and waist circumference are independent and equally important predictors of SBP and DBP in both genders, whereas among older individuals waist circumference is the dominant predictor of blood pressure among men and BMI is the dominant predictor of blood pressure among women. Associations are more evident with respect to SBP than DBP.     

石家庄市学龄儿童超重、肥胖与血压、血脂和血糖的关系

目的探讨城市学龄儿童超重、肥胖与血压、血脂和血糖等心血管疾病危险因素的聚集性。方法采用多阶段分层抽样，测定石家庄市区913名7～13岁儿童的身高、体重、收缩压（SBP）、舒张压（DBP）、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）和空腹血糖水平。结果儿童超重和肥胖总检出率为29．24％（男34．98％，女24．23％）。与正常儿童相比，超重和肥胖儿童的SBP、DBP、TC和TG水平明显升高，HDL-C明显降低。超重和肥胖儿童的高血压、高TG、高TC、高血糖和低HDL-C检出率也明显高于正常儿童。校正年龄和性别后，超重和肥胖儿童的SBP、DBP、TC、TG、血糖升高和HDL-C降低的危险性分别为正常儿童的6．77、3．22、2．55、6．42、3．85和2．94倍（95％CI分别是4．15～11．04、1．38～7．49、1．59～4．11、3．46～11．92、1．69～8．78和1．83～4．73）；超重与肥胖儿童有任意1、2、3个所选心血管疾病危险因素的危险性分别是正常儿童的2．74、13．15和15．33倍（95％CI分别是1．92～3．92、6．69～25．87和4．17～56．39）。结论儿童期超重与肥胖增加儿童心血管疾病危险因素的聚集性以及儿童获得多个心血管疾病的危险性。控制儿童超重和肥胖有助于心血管疾病的早期预防。     

Smoking habits and risk of fatal stroke: 18 years follow up of the Oslo Study.

STUDY OBJECTIVE: To examine the risk of fatal stroke in relation to smoking habits in men screened for the Oslo study. DESIGN: The Oslo study is a prospective, cohort study of the epidemiology and preventive aspects of cardiovascular diseases in middle aged men. Screening started in May 1972 and results after 18 years of follow up are reported. PARTICIPANTS: There were 16209 men aged 40-49 years, of whom 16173 had no stroke history. Eighty five men died from stroke, of whom 48 were daily cigarettes smokers, 7 were pipe and cigar smokers, 15 smoked cigarettes and pipe or cigars daily, 11 were previous cigarette smokers, and 4 had never smoked cigarettes. MAIN RESULTS: Results of proportional hazards regression analysis adjusted for age, diastolic blood pressure, and glucose concentration showed the following rate ratios (RR) (95% confidence interval) of smoking groups compared with those who had never smoked or had previously smoked: combined cigarette and cigar or pipe smokers, RR = 6.1 (3.0, 12.5); cigarettes only, RR = 4.1 (2.3,7.4); and pipe and/or cigars only RR = 2.2 (0.9,5.5). The overall, age adjusted risk of smoking cigarettes daily was 3.5 and was found to increase with increasing cigarette consumption. Regardless of their smoking group, stroke cases had increased diastolic (DBP) and systolic blood pressure (SBP) when compared with men who had not had a stroke. The absolute differences in DBP and SBP between stroke cases and others for never and previous cigarette smokers versus daily smokers were twice as large: DBP, 12.1 mmHg versus 6.5 mmHg respectively and SBP, 16.0 mmHg versus 7.1 mmHg respectively. A high BMI increased the risk of fatal stroke of never and previous cigarette smokers. Men being treated for hypertension at the time of screening had three times the crude risk of fatal stroke of men who were not taking hypertensive treatment. CONCLUSIONS: Daily cigarette smoking increased the risk of fatal stroke three and a half times. Combined cigarette and pipe or cigar smoking had a higher risk than smoking cigarettes only. An increased risk was found in relation to increased daily cigarette consumption.     

Influence of albuminuria and glomerular filtration rate on blood pressure response to antihypertensive drug therapy

Background

Albuminuria and glomerular filtration rate (GFR), two factors linked to kidney and vascular function, may influence longitudinal blood pressure (BP) responses to complex antihypertensive drug regimens.

Methods

We reviewed the clinic records of 459 patients with hypertension in an urban, academic practice.

Results

Mean patient age was 57-years, 89% of patients were African American, and 69% were women. Mean patient systolic/diastolic BP (SBP/DBP) at baseline was 171/98 mmHg while taking an average of 3.3 antihypertensive medications. At baseline, 27% of patients had estimated (e)GFR <60 ml/min/1.73², 28% had micro-albuminuria (30–300 mg/g) and 16% had macro-albuminuria (>300 mg/g). The average longitudinal BP decline over the observation period (mean 7.2 visits) was 25/12 mmHg. In adjusted regression models, macro-albuminuria predicted a 10.3 mmHg lesser longitudinal SBP reduction (p < 0.001) and a 7.9 mmHg lesser longitudinal DBP reduction (p < 0.001); similarly eGFR <60 ml/min/1.73² predicted an 8.4 mmHg lesser longitudinal SBP reduction (p < 0.001) and a 4.5 lesser longitudinal DBP reduction (p < 0.001). Presence of either micro- or macro-albuminuria, or lower eGFR, also significantly delayed the time to attainment of goal BP.

Conclusions

These data suggest that an attenuated decline in BP in drug-treated hypertensives, resulting in higher average BP levels over the long-term, may mediate a portion of the increased risk of cardiovascular-renal disease linked to elevated urinary albumin excretion and reduced eGFR.     

Weight-control intervention in overweight subjects at high risk of cardiovascular disease: a trial of a public health practical training program in a medical school

OBJECTIVE: To evaluate the effectiveness of a weight-control intervention for overweight subjects at high risk of cardiovascular disease (CVD) at a worksite conducted by medical students as a public health practical training program. METHODS: A total of 45 men and women who were obese (BMI > or = 24.0 kg/m2) and found to be hypertensive (SBP > or = 140 mmHg or DBP > or = 90 mmHg) or suffering from hypercholesterolemia (total serum cholesterol > or = 220 mg/dl) in an annual health check up in November 2001 were invited to participate in a weight-control intervention program. Eight individuals agreed (intervention group) and other sixteen control subjects whose sex and age (+/- 3 years) were matched to the intervention subjects were selected. The duration of the program was three months (from July to October 2002) and a 2 kg weight reduction in that period was set as the goal. The baseline survey consisted of a dietary questionnaire and a health quiz. Subjects had two counseling sessions and received four personal letters in the three months. A semi-quantitative food frequent questionnaire, a photograph method (Diet Agent Service, Matsushita Electric Works, Ltd.) and three day food records were conducted for dietary surveys. Changes in bodyweight, BMI, blood pressure, and serum total cholesterol concentration from November 2001 to November 2002 were compared between the intervention and control groups. Food group intakes and nutrient intakes were compared between weight reduction achievers and non-achievers. RESULTS: Mean bodyweight changes from November 2001 to November 2002 were -2.3 kg (SD 3.3 kg) for the intervention group and +0.3 kg (SD 1.5 kg) for the control group, the difference being significant (p = 0.013). For the intervention group mean bodyweight change from July to October 2002 was -1.5 kg (SD 2.4 kg). For total serum cholesterol, the mean changes were -32.1 mg/dl vs. +0.5 mg/dl (p = 0.005), for SBP -9.5 mmHg vs. +4.7 mmHg (p = 0.083) and for DBP -2.8 mmHg vs. +1.4 mmHg (p = 0.438). These were thought to be consequences of weight-control intervention. From dietary surveys, weight reduction achievers increased fish intake and decreased fats, snacks and sweets. Those who answered the health quiz more correctly demonstrated more reduction of bodyweight. CONCLUSIONS: Effectiveness of a weight-control intervention for reduction of CVD risk factors was found in the present public health practical training program for medical students. Dietary advice based on various dietary surveys was indicated to be effective in the weight-control program. A population strategy to distribute health information appeared necessary for effective health education programs for high-risk subjects.     

Hypertension prevalence and age-related changes of blood-pressure in semi-nomadic and urban Oromos of Ethiopia

We evaluated the prevalence of hypertension and the age-related behaviour of systolic blood pressure (SBP) and diastolic blood pressure (DBP) in a wide sample of male and female Ethiopian Oromos living in rural or pre-industrial urbanized settings. Blood pressure (BP) was measured in the sitting position after 5 min rest in 5277 Oromos. In the group, 4928 were semi-nomadic shepherds, while 349 came from a town of 60,000 inhabitants where they were involved in low-technology jobs. The first subgroup was composed of 2482 men and 2446 women. All subjects were divided into 3 age groups: 15–44, 45–64, and 65 years. Body weight (BW) and the Quetelet index (QI) were matched to BP levels using Pearson's method. In semi-nomadic men, SBP was 121.4±8.4 mmHg versus 132.4±10.4 mmHg in urban men (p<0.001). In women, SBP was 120.5±7.9 mmHg versus 128.1±10.1 mmHg (p<0.001). The prevalence of hypertension was 0.40% in the semi-nomadic and 3.15% in the urban population. In the latter, significant increases in BW and QI were found, which were significantly correlated to both SBP and DBP. In semi-nomadic men, a 5.33% increase in SBP and a 5.22% in DBP was found between age groups 1 and 2 (p<0.001 in both). In urban men the increase was 4.77% and 3.41% respectively (p<0.001). In both male populations no difference in SBP and DBP was observed between age groups 2 and 3. In semi-nomadic women however, a progressive rise in SBP (4.84% between age groups 1 and 2,p<0.001; 1.86% between groups 2 and 3,p<0.001) and DBP (4.26% between age groups 1 and 2,p<0.001; 2.72% between groups 2 and 3,p<0.001) was present. Similar differences in SBP and DBP were evident between urban women of age groups 1 and 2. Due to social reasons, women for group 3 were not available in the urban setting. In conclusion, this study shows a very low prevalence of hypertension in a semi-nomadic group and about an 8-fold increase in the urban population. SBP and DBP are significantly higher in the urban setting and in both men and women the increase is related to BW. Moreover, SBP and DBP progressively increase with age in women but not in men.