Serial changes in blood pressure from childhood into young adulthood for females in relation to body mass index and maturational age

This study determines: (1) patterns of change from childhood to young adulthood in body mass index (BMI), systolic blood pressure (SBP), and diastolic blood pressure (DBP), (2) effects of elevated BMI values on changes in blood pressures (BP), (3) extent of tracking for SBP, DBP, and BMI, and (4) prediction of future risk for elevated BP from earlier values. Annual serial BP and BMI data were available for 198 white females, ages 8–22 years, enrolled in the Fels Longitudinal Study. Patterns of change in BMI were described by a random effects model with a time series model for the correlated residuals. Serial BMI measures were differentiated from age-specific means to measure relative individual BMI levels. Serial BP were analyzed using a similar model to the BMI where relative individual BMI levels were included as an explanatory variable. There was a general increasing trend for SBP, DBP, and BMI from 8–22 years, but the rates of increase declined with age. At the same chronological age, early menarche females had a significantly greater BMI mean value than late menarche females. An average increase of 1 kg/m² in deviation from BMI population means resulted in an average increase of 1.2 mmHg in SBP and 0.6 mmHg in DBP. Having SBP and DBP levels 1 standard deviation above mean levels, relative to females at mean levels, as early as age 9 represents an odds ratio of 2 for exceeding national 75th percentile levels of SBP and DBP at age 21. Am. J. Hum. Biol. 10: 589–598, 1998. © 1998 Wiley-Liss, Inc.     

How Many Self-Measured Blood Pressure Readings Are Needed to Estimate Hypertensive Patients' “True” Blood Pressure?

The present research was aimed at determining the number of self-measured blood pressure (BP) readings needed to attain reliable estimates of true BP in hypertensive patients. Correlation coefficients and standard deviation of differences between pairs of measurements as well as generalizability theory were applied to data from a controlled study on stress management training for essential hypertension (García-Vera et al., 1997). Forty-three hypertensive patients self-recorded 48 readings of BP (at home and at work) at both the pretreatment and the posttreatment (separated by a period of 2 months) and 24 readings of BP at follow-up (6 months after the pretreatment). The results showed that it is enough to take two readings, one at work and the other at home, from each of 3 consecutive days to get reliable estimates of SBP and DBP across settings, over 1 week and over 2 months. This same criterion would be valid to get reliable estimates of DBP over 6 months, but two readings, one at work and the other at home, from 8 or more consecutive days may need to be taken to achieve similarly reliable results for SBP.     

Long-term reproducibility of ambulatory blood pressure in unselected elderly subjects.

The aim of this study was to evaluate the long-term reproducibility and validity of 24-h ambulatory blood pressure measurements (ABPM) in an unselected elderly population. In a rural Finnish community 503 randomly chosen invited persons over 65 years of age participated and went through 24-h ABPM. As part of the validation of the methodology, the reproducibility study was conducted in 26 persons (age 65-76 years). Two identical sets of measurement were performed at 4-12 (median 8) month intervals. The agreement between measurements was assessed by correlation coefficients and standard deviation (SD) of the differences. There were no significant differences in 24-h, daytime and night-time average diastolic blood pressure (DBP) and daytime average systolic blood pressure (SBP) between the two measurements. During the second measurement, 24-h SBP and night-time average SBP were slightly higher than those obtained by the first monitoring. Average 24-h SBP and DBP were 18 and 7 mmHg lower, respectively, than office blood pressure averages. The correlation coefficients were significantly higher for 24-h ambulatory blood pressure than for office blood pressure. The SD of the mean difference between visits was significantly lower for 24-h ambulatory blood pressure than for office blood pressure measurements. These findings show that the long-term reproducibility of ambulatory blood pressure is good in an elderly unselected population and better than the office blood pressure reproducibility.     

Control parameters of the blood-pressure regulatory system

The open-loop gainG ₀ reference pressureP ₀ and basal heartrateR ₀ of the blood-pressure regulatory system have been estimated under four different experimental conditions by employing an aortic balloon and assuming a theoretical approach based on a 1st-order linear model. Mean values of 1·7–3·7, 75–130 mmHg, and 95–130 beats/min were obtained forG ₀,P ₀ andR ₀, respectively. Significant variations in these parameters were observed when the anaesthetic conditions were changed. It is suggested thatG ₀,P ₀ andR ₀ may have useful clinical applications both in characterising hypotensive and hypertensive syndromes and also in assessing the effect of anaesthetic agents.     

Studies of blood-pressure regulation in the unanaesthetized dog

Summary The effects of sinus-nerve stimulation on the blood pressure and heart rate were studied in unanaesthetized normotensive dogs. Care was taken that the dogs should be as unaffected as possible by the experimental measures. Stimulation frequencies of 10–100 Hz were employed, with the dogs running on a treadmill and at rest.At work no further blood-pressure reduction in the steady state was obtained when the stimulation frequencies were increased above 30–50 Hz, while the initial blood-pressure reduction at the onset of the CSNS (carotid-sinus-nerve-stimulation) increased up to stimulation frequencies of 70–80 Hz. A greater initial heart-rate reduction was obtained in the range 60–100 Hz than at lower stimulation frequencies. The initial and steady-state blood pressures were in complete agreement with the reported observations of sympathetic outflow during CSNS. No changes in the effects of CSNS were observed during 9 months of repeated stimulation.     

Pulse Transit Time and Blood Pressure: An Intensive Analysis

Relationships between pulse transit time (PTT) and intra-arterial systolic (SBP), diastolic (DBP), and mean arterial blood pressure (MAP) were examined in 4 subjects under three conditions: rest, paced respiration, and mental arithmetic. PTT was measured from the EKG R-wave to two peripheral pulses (brachial and radial) and from one pulse to the other. Three points on each pulse wave were used (peak, foot, slope) in the measurements, yielding nine different measures of PTT. The nine PTT measures were not consistently intercorrelated. PTTs initiated by the R-wave were moderately correlated with SBP, but not with DBP or MAP. Brachial to radial PTTs were not correlated with any measures of BP. Relationships between PTT and BP also varied from subject to subject. The limited magnitude of the correlations and their inconsistency suggest caution in the simple substitution of PTT for beat-to-beat measures of BP.     

老年高血压的动态血压监测

对60例老年高血压病患者(Ⅰ期24例,Ⅱ期21例、Ⅲ期15例)、30例健康老年人、30例健康中青年分别进行动态血压监测和比较。结果老年对照组动态血压监测各参数值均明显高于中青年对照组;高血压Ⅰ、Ⅱ、Ⅲ期各组与老年对照组比较各参数值也明显增高。如以老年对照组各项参数的(?)±2s为正常高限,则高血压Ⅰ、Ⅱ、Ⅲ期各组分别有9、13、15项数值超过正常。其中以24小时平均收缩压和舒张压日间平均收缩压和舒张压、夜间平均收缩压和舒张压及血压负荷值等为诊断动态高血压的重要指标。     

Blood pressure effects of long-term stimulant use in disorders of hypersomnolence

Untoward cardiovascular effects have been implicated as a deterrent to long-term central nervous system (CNS) stimulant use in disorders of hypersomnolence. In this study, we reviewed the relationship between blood pressure and long-term stimulant use. Medical records of 54 patients with narcolepsy and idiopathic CNS hyper- somnolence (ICH) were reviewed. The overall mean number of months of follow-up for the entire group was 45.6 (95% CI: 42–49). Both simple linear regression and multiple regression utilizing generalized estimating equations were used to show relationships between blood pressure (BP), time and other covariates. In the simple linear regression model, the average slope of the line of systolic BP (SBP) on time for the entire group was 0.06 (95% CI: -0.09, 0.13) and the line of diastolic BP (DBP) on time was 0.01 (95% CI: -0.05, 0.07). Two multiple regression equations were fitted for the continuous response variables SBP and DBP. Covariates in the model included: time, hypertension, weight at baseline, weight, SBP baseline (SBPBL), DBP baseline (DBPBL), high vs. low dose stimulant therapy and age at starting treatment. For SBP, the covariates weight at baseline, weight and SBPBL were significant (P< 0.05) predictors. For DBP, covariates reaching statistical significance (P< 0.05) included weight and DBPBL. There was no significant change in SBP or DBP over time in either model. Two different statistical models support the conclusion that there was no significant change in SBP or DBP over time in this population.     

Cardiovascular reactivity and positive/negative affect during conversations

Systolic and diastolic blood pressures (SBP, DBP) were measured for 70 college students before, during and after informal dyadic conversations. Participants rated the positive and negative affect they experienced during conversation. SBP and DBP increased significantly from baseline to conversation. Increases in SBP and DBP were associated with more positive affect and unrelated to negative affect. Blood pressure measures taken one week later provided a more useful assessment of resting levels than measures taken before the conversation. Relationships between BP reactivity and positive affect remained significant after controlling for resting levels of BP, amount of talk during conversation, and sex of speaker in hierarchical regression. Blood pressure elevation during social interaction may be associated with involvement or enthusiasm, rather than emotional distress; this association is not simply an artifact of talkativeness. We suggest that cardiovascular reactivity in healthy young adults engaged in nonthreatening conversations may be a widespread phenomenon and not necessarily pathological.     

Arterial blood-pressure change and endogenous circulating substance P in man

Substance P (SP) is a powerful vasodilator and this peptide is today considered to be a chemical messenger. The potential effects on circulating SP of acute changes in arterial blood-pressure was investigated in nine subjects. An increase in arterial mean blood-pressure (+33%, P less than 0.001, n = 9) was obtained by infusion of angiotensin II and a decrease in pressure (-10%, P less than 0.005, n = 6) was obtained by ganglionic blockade. The concentration of SP in plasma, from supine subjects in the normotensive condition, ranged from 3 to 13 pmol/l (with a mean of 5.6 pmol/l). SP was thus within the reference interval: 3-16 pmol/l (n.s.). Plasma SP remained very constant in each subject during the changes in blood-pressure (mean variation in plasma concentration of SP was 0.97 (SD) pmol/l). The results show that acute changes in arterial blood-pressure do not result in any detectable change in plasma SP, this seems to indicate that endogenous circulating SP has no significant role in the vascular tonus controlled by the arterial baroreflex.     

Intercrural differences of arterial blood-pressure and blood-flow in new-born infants

Intercrural systolic blood-pressure differences did not exceed 10 mmHg in 22 healthy infants who were term, pre-term or small for their gestational age (three); as measured simultaneously in both legs with 3-cm wide thigh cuffs and mercury-in-silastic strain gauges around the calves. In 13 infants with indwelling umbilical artery catheter and normal angiographic findings in both legs, blood-pressure differences were similarly low in a majority of the infants, but in three of these intercrural differences of 15-20 mmHg were found. Resting and submaximal arterial leg blood-flow, measured with venous occlusion plethysmography, showed larger intercrural differences than blood-pressure, and did not add further information. The results indicate that simultaneous systolic blood-pressure measurements in the legs, with strain gauge plethysmography, is a simple and risk-free noninvasive method, suitable, for example, for diagnosing thromboembolism in infants. An indwelling umbilical artery catheter seems to interfere very little with the arterial circulation in the catheterized leg.     

Blood-pressure responses during social interaction in high- and low-cynically hostile males

The Cook and Medley Hostility (Ho) Scale has been found to predict the development of coronary heart disease, coronary death, and death from other causes. Enhanced physiological responsiveness among high-Ho subjects may represent a link between hostility and health. The present study examined the systolic and diastolic blood-pressure (SBP, DBP) and heart-rate (HR) responses of high- and low-Ho undergraduate males while they presented their position and listened to their partner's opposing position in a current events discussion task. Compared to low-Ho subjects, the high-Ho group displayed larger SBP and DBP responses. These results and others suggest that cynical hostility is associated with greater physiological responses to interpersonal stressors.     

Sex Differences in the Association of Childhood Socioeconomic Status With Adult Blood Pressure Change: The CARDIA Study

Objective To examine sex differences in the relation of childhood socioeconomic status (CSES) to systolic (SBP) and diastolic blood pressure (DBP) trajectories during 15 years, spanning young (mean [M] [standard deviation {SD}] = 30 [3] years) and middle (M [SD] = 45 [3] years) adulthood, independent of adult SES. Methods A total of 4077 adult participants reported father's and mother's educational attainments at study enrollment (Year 0) and own educational attainment at enrollment and at all follow-up examinations. Resting BP also was measured at all examinations. Data from examination Years 5 (when participant M [SD] age = 30 [3] years), 7, 10, 15, and 20 are examined here. Associations of own adult (Year 5), mother's, and father's educations with 15-year BP trajectories were examined in separate multilevel models. Fully controlled models included time-invariant covariates (age, sex, race, recruitment center) and time-varying covariates that were measured at each examination (marital status, body mass, cholesterol, oral contraceptives/hormones, and antihypertensive drugs). Analyses of parental education controlled for own education. Results When examined without covariates, higher education - own (SBP γ = -0.03, DBP γ = -0.03), mother's (SBP γ = -0.02, DBP γ = -0.02), and father's (SBP γ = -0.02, DBP γ = -0.01) - were associated with attenuated 15-year increases in BP (p < .001). Associations of own (but not either parent's) education with BP trajectories remained independent of standard controls. Sex moderated the apparent null effects of parental education, such that higher parental education-especially mother's, predicted attenuated BP trajectories independent of standard covariates among women (SBP γ = -0.02, p = .02; DBP γ = -0.01, p = .04) but not men (SBP γ = 0.02, p = .06; DBP γ = 0.005, p = .47; p interaction SBP < .001, p interaction DBP = .01). Conclusions Childhood socioeconomic status may influence women's health independent of their own adult status.     

Cardiovascular reactivity, emotional factors, and home blood pressures in black males with and without a parental history of hypertension

Differences in cardiovascular responses to mental stress, psychological factors, and self-determined home blood pressure between black individuals with and without a family history of essential hypertension (EH) may suggest mechanisms responsible for the high incidence of EH in blacks. In this study, 12 black male students with a parental history of EH and 12 without a parental history of EH participated in a laboratory session during which two mental challenge tasks (anagrams and mental arithmetic) were presented. Following the laboratory session all subjects made daily recordings of their morning and evening blood pressure for four weeks (28 days) after the laboratory session. The results showed that sons of hypertensive parents had higher systolic (SBP) and diastolic (DBP) than sons of normotensive parents at rest and during mental challenge; no reliable differences in heart rate were observed. Sons of hypertensive parents had higher self-determined home blood pressure (SBP and DBP) and scored significantly higher on psychological measures of Trait-Anger/Temperament, Anger-Out, and Submissiveness. Apparently there was no significant change in SBP or DBP over the four weeks prior to final examinations in either of the groups. Although the resting blood pressure level, weight, and family history predicted a large proportion of the variance in home SBP and DBP, the amount of explained variance, particularly for DBP, was significantly increased by the inclusion of psychological variables and the level of cardiovascular responses (and not the delta change) to mental challenge in the regression equation. These findings indicate that the degree to which self-determined home blood pressures can be predicted is enhanced significantly by considering both the level of cardiovascular responses to stress and psychological measures of the experience and expression of anger. The implications of these results are discussed in light of current research demonstrating that average home blood pressures are a better predictor of cardiac complications than casual (office) blood pressures.     

Cardiovascular reaction to job stress in middle-aged train drivers

In this study, cardiovascular (CV) response to a standard laboratory challenge was compared to 24-hr noninvasive monitoring of heart rate (HR) and blood pressure (BP) in 30 healthy middle-aged train drivers. Laboratory stress test consisted of the orthostatic test, the cold pressor test, the Valsalva maneuver, the Stroop test, and the numerical square. In addition, the participants completed an extensive questionnaire on their health state and family health history, lifestyle, job stress, social and family support, personality characteristics, and health risk behaviors. In waking activities (leisure time, traveling to work, preparations for driving, and an uneventful driving) HR and systolic Wood pressure (SBP), but not diastolic Wood pressure (DBP), were normal (e.g., mean HR = 78.3, SBP = 128.6. and DBP= 92.3 during driving). In occasional stressful work situations, most participants reacted with a considerable rise in SBP and DBP (maximum values 201 for SBP and 126 for DBP). Interindividual differences in maximum BP reactions to emergency stress were predicted reliably by several psychological characteristics and by the CV reactions to the laboratory psychological challenge. The frequency, intensity, and persistence of psychological and physiological reactions to urgent situations appear to be more relevant measures of the health impact of psychological job stress than are the shift average values of physiological stress markers.     

The immediate and delayed cardiovascular benefits of forgiving

Background The putative health benefits of forgiveness may include long-term buffering against cardiovascular reactivity associated with rumination. Although studies show short-term benefits of adopting a forgiving perspective, it is uncertain whether this perspective protects against repeated future rumination on offenses, which may be necessary for long-term health benefits. Also unclear is whether forgiveness offers unique benefits beyond simple distraction. Methods Cardiovascular parameters (systolic blood pressure [SBP], diastolic blood pressure [DBP], and heart rate) were measured while 202 participants thought about a previous offense from an angry or forgiving perspective or were distracted. All participants were then distracted for 5 minutes, after which they freely ruminated on the offense. Results Angry rumination initially yielded the greatest increase in blood pressure from baseline (mean [M] [standard deviation {SD}]: SBP = 9.24 [11.16]; M [SD]: DBP = 4.69 [7.48]) compared with forgiveness (M [SD]: SBP = 3.30 [6.48]; M [SD]: DBP = 1.51 [4.94]) and distraction (M [SD]: SBP = 4.81 [6.28]; M [SD]: DBP = 1.75 [3.80]), which did not differ from each other (p > .30). During free rumination, however, those who had previously focused on forgiveness showed less reactivity (M [SD]: SBP = 7.33 [9.61]; M [SD]: DBP = 4.73 [7.33]) than those who had been distracted (M [SD]: SBP = 10.50 [7.77]; M [SD]: DBP = 7.71 [6.83]) and those who previously focused on angry rumination (M [SD]: SBP = 12.04 [11.74]; M [SD]: DBP = 8.64 [12.63]). There were no differences for heart rate. Conclusions Forgiveness seems to lower reactivity both during the initial cognitive process and, more importantly, during mental recreations of an offense soon thereafter, potentially offering sustained protection, whereas effects of distraction appear transient.     

Impact of Autologous Stem Cell Transplantation on Blood Pressure and Renal Function in Multiple Myeloma Patients

Background

Autologous stem cell transplantation (ASCT) reverses kidney failure in one-third of multiple myeloma (MM) patients, which may lead to blood pressure (BP) improvement. We evaluate the long term impact of ASCT on BP and renal function in MM patients.

Evaluation of a New Ambulatory Blood Pressure Monitor (Accutracker 102): Laboratory Comparisons With Direct Arterial Pressure, Stethoscopic Auscultatory Pressure, and Readings From a Similar Monitor (Spacelabs Model 5200)

Systolic (SBP) and diastolic (DBP) blood pressure levels generated by a new noninvasive ambulatory monitor, the Accutracker 102, were compared in the laboratory with intra-arterial pressure levels in 12 normotensive men, and with stethoscopic auscultatory determinations in 27 normotensive and hypertensive men and women over a wide range of within-subject pressure variations. In 11 subjects, its performance was also compared with another ambulatory monitor, the Spacelabs Model 5200. Highly positive correlations with both the intra-arterial (median r=+.90 for SBP, +.92 for DBP) and the stethoscopic standards (median r=+.93 for SBP, +.88 for DBP) were obtained using Accutracker's automatic readings (digital readout), while slightly higher correlations were obtained with hand-scoring of recorded data. The Spacelabs BP monitor also yielded readings that were highly correlated with stethoscopic readings (median r=+.83 for SBP, +.77 for DBP), although in 3 of the 11 subjects the Accutracker correlations were substantially higher than the Spacelabs correlations. Despite their generally good tracking of changes in pressure, both ambulatory monitors yielded absolute values in many subjects that differed by 5 mmHg or more from stethoscopic levels. The Accutracker's SBP levels were consistently too high and its DBP levels were occasionally too low, while Spacelabs' SBP and DBP values were too high and too low with equal frequency. However, mean deviation scores for each patient calculated from 5 concurrent ambulatory monitor and stethoscopic readings were shown to yield relatively stable correction factors for use when comparison with clinical standards is desired.     

The reproducibility of ethnic differences in the proportional awake–sleep blood pressure decline among women

A growing body of evidence indicates that African Americans (AA), on average, have a smaller proportional decline in blood pressure (BP) from waking to sleep than European Americans (EA), but this difference is largely based on correlational data from a single assessment day. The persistence of this difference over repeated sampling is not well established. The purpose of this study was to evaluate whether ethnic differences in the awake–sleep BP decline between AA and EA persisted over three monthly assessments. The subjects were 47 AA (age = 39.7 ± 8.7) and 92 EA (age = 37.4 ± 9.2) normotensive women. Subjects had 24‐h ambulatory BP monitoring done on midweek workdays at 1‐month intervals for three consecutive months. The proportional decline in BP was calculated as follows: (average awake ? average sleep)/average sleep. The persistence of ethnic differences was evaluated using repeated‐measures ANCOVA and by examining Bland–Altman plots. The ANCOVA results revealed that overall, the proportional decline of AA women was less than that of EA women for both SBP (P < 0.038) and DBP (P < 0.083), consistent with previous research, and that there were also no significant ethnic differences by monthly assessment. Bland–Altman plots revealed that overall and by ethnicity, the proportional decline in BP among individual subjects over the 3 months was also reproducible. These results suggest that the ethnic difference in awake–sleep BP between AA and EA women persists over time and that the awake–sleep decline in BP among individuals, whether AA or EA, is also reproducible. Am. J. Hum. Biol., 2010. © 2009 Wiley‐Liss, Inc.     

Impact of total sleep duration on blood pressure in preschool children

The onset of some adult diseases, e.g., cardiovascular disease, is known to be associated with lifestyles in childhood. The objective of this study was to clarify the relationship between total sleep duration (TSD) and systolic and diastolic blood pressure (SBP and DBP) among 117 children at ages 5-6 years. Parents reported their children's typical bedtimes and wake times for weekdays, and questions about mandatory nap times were answered by the preschool teachers. In the children, the mean TSD, SBP, and DBP were 624 +/- 57 (standard deviation) min, 99 +/- 10 mmHg, and 62 +/- 9 mmHg, respectively. When the children were divided into quartile groups based on TSD, the SBP was significantly higher in the highest group (TSD > 660 min) than in the lowest group (TSD < or = 585 min). The TSD was significantly correlated with SBP (r = 0.265) but not with DBP (r = 0.105), these relationships were similar when TSD and possible confounders such as age and body mass index were set as independent variables of multiple regression analysis. These findings suggest that sleep duration in preschool children is associated with SBP, and extremely short or long sleep may invite subclinical health problems.