Dietary calcium supplementation as a treatment for mild hypertension

The blood pressure responses of 19 mildly hypertensive (diastolic blood pressure 90-104 mmHg) individuals to treatment with either 1200 mg of elemental calcium supplementation or placebo were assessed weekly in a 6-month randomized, double-blind, placebo-controlled crossover study. Both groups showed a decrease in blood pressure (calcium treated: 6 +/- 12 mmHg systolic, 7 +/- 7 mmHg diastolic; and placebo controlled: 9 +/- 14 mmHg systolic, 9 +/- 8 mmHg diastolic). Differences between the two groups were not significant (P greater than 0.1). There were no adverse effects to either treatment. This study does not support the hypothesis that dietary calcium supplementation is more effective than placebo in reducing blood pressure in mildly hypertensive individuals.     

大气细颗粒物对妊娠期血压的急性效应研究

目的 研究大气细颗粒物对妊娠期血压的影响,为进一步探讨妊娠高血压疾病的发病机制提供依据.方法 利用上海市孕产期保健队列研究数据及大气细颗粒物监测数据,采用广义相加混合效应模型等方法分析大气细颗粒物对妊娠期血压的急性和滞后效应.结果 研究于2010年共纳入7 402例孕晚期妇女,结果表明在仅考虑气温、湿度、季节和长期趋势及周末效应的情况下,PM1每增加一个四分位数间距(滞后0天、1天、3天和5天),妊娠期妇女收缩压可分别增加0.509mmHg (95％ CI:0.045 ～0.974)、0.504mmHg(95％ CI:0.047～0.961)、0.456mmHg (95％ CI:0.011 ～0.901)、0.466mmHg(95％ CI:0.028 ～0.904),差异均有统计学意义(均P＜0.05);调整气象条件、周末效应、季节因素、产妇年龄、孕产史、高血压家族史、孕前BMI的情况下,妊娠期妇女收缩压可分别增加0.503mmHg(95％CI:0.066 ～0.940)、0.486mmHg(95％CI:0.055 ～0.916)、0.443mmHg(95％ CI:0.022 ～0.865)、0.480mmHg (95％ CI:0.064 ～0.895),差异均有统计学意义(均P＜0.05),但PM2.5浓度对妊娠期收缩压的影响差异无统计学意义(均P＞ 0.05).在仅考虑气温、湿度、季节、长期趋势及周末效应的情况下,PMI每增加一个四分位数间距,滞后3天妊娠期妇女舒张压可增加0.402mmHg(95％CI:0.027 ～0.777),差异有统计学意义(P＜0.05),然而在调整上述因素后,PM2.5水平变化对妊娠期舒张压的影响无统计学意义(P＞0.05).结论 PM1是妊娠期血压增高的独立危险因素,是较有价值的附加空气质量指标,孕期妇女应根据雾霾预警进行及时有效的防护.     

Isolated systolic hypertension in Dutch middle aged and all-cause mortality: a 25-year prospective study

In the early 1950s, the blood pressure of 3901 Dutch civil servants and their spouses aged 40-65 years was measured in a general health survey. Isolated systolic hypertension (systolic pressure greater than 160 mmHg, diastolic pressure less than 90 mmHg) was observed in 6.3% of the women and 3.0% of the men. The prevalence increased with age and it was more common in women in all age groups. Using logistic regression, with adjustment for potential confounders (age, smoking, serum cholesterol, Quetelet index, alcohol consumption, haemoglobin level, pulse rate and diastolic blood pressure) the association of 15- and 25-year total mortality with isolated systolic hypertension was determined. Compared to normotensive people (systolic pressure less than or equal to 135 mmHg, diastolic pressure less than 90 mmHg), the risk of death from all causes was significantly higher for men with isolated systolic hypertension after 15 and 25 years of follow-up (odds ratio OR = 2.4, 95% confidence interval (CI) 1.2-4.8 and OR = 3.2, 95% CI 1.3-8.0). For women 15-years mortality risk was strongly associated with isolated systolic hypertension (OR = 3.7, 95% CI 1.4-9.7). The increased risk was less pronounced after 25 years of follow-up (OR = 1.7, 95% CI 0.96-3.0). Our results support those of other studies and indicate that isolated systolic hypertension is an important independent risk factor for all-cause mortality. Since isolated systolic hypertension may be an indicator for the early onset of ageing, it is important to study its determinants and to pay more attention to its diagnosis and treatment in middle-aged populations.     

Postural changes in blood pressure and pulse rate among black adolescents and white adolescents: the Minneapolis Children's Blood Pressure Study

Because studies have suggested a possible relation between vascular responsiveness to postural changes and risk of subsequent myocardial infarction, the reactivity of blood pressure and pulse rate to change from supine to standing positions was examined in 158 black males, 144 black females, 342 white males, and 272 white females aged 14-16 years. The study was part of the Minneapolis Children's Blood Pressure Study and was conducted during October to December 1985. Two blood pressure readings and one pulse reading were taken after five minutes of supine rest, immediately upon standing, and five minutes after standing. After adjustment for body mass index, mean systolic blood pressure decreased, and fourth- and fifth-phase diastolic blood pressures and pulse rate increased from supine to standing positions in all race and sex groups. Black males had significantly larger changes in systolic pressure than did white males (-5.9 vs. -4.1 mmHg), and males had significantly larger changes in fourth- and fifth-phase diastolic pressures compared with females of the same race (fourth-phase diastolic pressure, 8.0 vs. 4.1 mmHg for blacks and 10.0 vs. 4.8 mmHg for whites). Fifth-phase diastolic pressure increased more than did fourth-phase diastolic pressure in all groups. No race or sex differences were seen for pulse changes. For all race-sex groups, decreases in systolic pressure were positively correlated with initial levels of supine systolic pressure, whereas increases in fourth- and fifth-phase diastolic pressures were negatively correlated with corresponding initial levels. Measurement of postural changes may provide a clinically simple and reproducible way of testing for abnormalities in blood pressure and may better discriminate those at high risk of hypertension and its cardiovascular complications than would the commonly used single-seated blood pressure measurement.     

Predictors of stroke - associated mortality in Africans

BACKGROUND: The objective of the study was to examine the association of the stroke-related mortality with gender, age, ethnicity, social class, blood pressure, fibrinogen, selected clinical data and meteorologic parameters in hospitalized Africans. METHODS: A series of 1032 consecutively hospitalized incident cases of acute stroke between 1987 and 1991 was studied. Univariate and multivariate analyses were used to estimate the risk (odds ratio=OR) of stroke mortality for meteorologic parameters on the month before the accident onset and selected sociodemophysiological variables on the day of admission. RESULTS: The variables significantly associated with stroke mortality in multivariate analysis were male sex (OR= 2.3 [1.3 - 4.1]), low social class (OR= 2.0 [1.2 - 4.0]), migrant tribes (OR= 1.7 [1.5 - 1.8]), ischemic stroke (OR= 1.4 [1.2 - 1.6]), heart rate >=100 bpm (OR= 1.1 [1.0 - 1.2]), age > or =60 years (OR= 1.03 [1.01 - 1.06]), systolic blood pressure> 160 mmHg (OR= 1. 02 [1.01 - 1.03]), and fibrinogen > or =400 mg/dl (OR= 1.01 [1.002 - 1. 02]). However, diastolic blood pressure > 90 mmHg and global radiation< 340 Cal/cm(2)/day were significantly (p< 0.05) and inversely associated with stroke mortality. CONCLUSION: Our results indicate that male sex, older age, low social class, migration, ischemic stroke and higher baseline levels of heart rate, systolic blood pressure and fibrinogen are significant predictors of stroke mortality, but lower global radiation and higher diastolic blood pressure are inversely linked.     

老年高血压患者血压晨峰现象与颈动脉内膜中层厚度的关系

目的 了解血压控制良好的老年高血压人群血压晨峰值与颈动脉内膜中层厚度（IMT）之间是否存在相关性。方法入选经药物控制良好的老年高血压患者151例。进行ABPM检查,计算血压晨峰值,按照血压晨峰值进行分组。血压晨峰值≤30mmHg者分为非血压晨峰组（NMS组）,血压晨峰值〉30mmHg者分为血压晨峰组（MS组）。对入选对象进行颈动脉IMT测定。分析两组患者高血压相关因素对血压晨峰现象及IMT的影响,并对其血压晨峰值与IMT进行相关分析。结果两组151例高血压控制良好者,其中76例有血压晨峰现象,占50．3％。两组患者年龄、性别、体重指数、血脂、血糖、最高收缩压、平均收缩压、最低收缩压、最高舒张压、平均舒张压及最低舒张压比较,差异均无统计学意义（P〉0．05）。但MS组患者血压晨峰值[（42．34±7．10）mmHg]及IMT[（0．89±0．13）mm]高于NMS组[（21．16±5．23）mmHg,（0．84±0．14）mm,P〈0．01或P〈0．05],颈动脉IMT与血压晨峰值呈正相关（r=0．56,P〈0．01）。结论血压控制良好的老年高血压人群仍存在血压晨峰现象,其血压晨峰值可能促进颈动脉粥样硬化。     

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.     

A comparison of the effect of oral captopril and nicardipine in hypertensive crisis

BACKGROUND: Hypertensive crisis is defined as a severe elevation in blood pressure (BP) without target organ injury. There are few data about the efficacy and safety of comparative oral antihypertensive drugs. AIM: To compare the efficacy and safety of oral captopril (25 mg) and nicardipine (20 mg) in hypertensive crisis. METHODS: This prospective, randomized study included 50 patients attended at the emergency department with a hypertensive crisis (arterial blood pressure of at least 180/110 mmHg without target organ damage confirmed after 15 min of rest. Systolic (SBP) and diastolic blood pressure (DBP) and heart rate (HR) were assessed at several intervals during 4 h after the drug administration. Therapeutic success was defined by a SBP< or =160 and DBP< or =90 mmHg two hours after drug administration. The initial clinical characteristics as age, sex, initial systolic and diastolic BP and HR were no different in the two groups. RESULTS: BP levels started to significantly decrease within 15 minutes. At 2 hours, SBP and DBP dropped were similar in captopril group and nicardipine group,respectively to 162/94 vs 161/89 mmHg; p=ns. The therapeutic success at the second hour has been obtained in 68% of cases in the two groups. Age >70 years was a predictor's factor of therapeutic failure in the captopril group. Heart rate significantly dropped after 30 min in the captopril group (82.3 +/- 11.8 vs 77.6 +/- 12.7 c/min; p=0.037). This effect was maintained over four hours. There were no side effects in this study. CONCLUSION: Oral captopril or nicardipine are efficacy and safe in the treatment of hypertensive crisis.     

Comparison of blood pressure measurements on the bare arm, below a rolled-up sleeve, or over a sleeve

BACKGROUND: This study examined the effect of measuring blood pressure below subjects' rolled-up sleeves, over the sleeve, or on the bare arm. This is an important day-to-day issue for the busy GP. METHODS: The sample consisted of 201 subjects in family practice clinics and residents of a senior citizens' home. A digital device was used in all cases. Each participant underwent three blood pressure measurements in each of the following conditions in random order: cuff on bare arm; cuff over the sleeve; and cuff below the rolled-up sleeve. Differences between measurements were plotted against the mean blood pressure. Confounding factors controlled for were age, sex, clothing pressure and skin-fold thickness. RESULTS: Differences in mean blood pressure readings between the clothed and bare arm were 0.5 mmHg (SD 7.5) for systolic pressure and 1 mmHg (SD 5) for diastolic pressure; neither difference was significant. However, in hypertensive subjects (>140 mmHg systolic), although the mean difference remained small (systolic pressure, 2 mmHg, SD 10), the range of difference for individual subjects was -32 mmHg to +22 mmHg. CONCLUSION: The degree of clothing under the sphygmomanometer cuff does not have a clinically important effect on the blood pressure measurement. In patients known or found to be hypertensive, measurement on the bare arm is recommended.     

Soy milk lowers blood pressure in men and women with mild to moderate essential hypertension

Soy-based diets reduce blood pressure in spontaneously hypertensive rats, but apparently not in hypertensive humans. In the present study, the antihypertensive potential of soy milk (500 mL twice daily) compared with cow's milk was investigated in a 3-mo double-blind randomized study of 40 men and women with mild-to-moderate hypertension. Before initiation of the study, urinary isoflavonoids (measured by HPLC) were undetectable in most cases (for genistein, they were always <100 micromol/L). After 3 mo of soy milk consumption, systolic blood pressure decreased by 18.4 +/- 10.7 mmHg compared with 1.4 +/- 7.2 mmHg in the cow's milk group (P < 0.0001), diastolic blood pressure decreased by 15.9 +/- 9.8 mmHg vs. 3.7 +/- 5.0 mmHg in the cow's milk group (P < 0.0001) and mean blood pressure decreased by 16.7 +/- 9.0 mmHg compared with 3.0 +/- 4.6 mmHg in the cow's milk group (P < 0.0001). Urinary genistein was strongly (r = -0.588) and significantly (P = 0.002) correlated with the decrease in blood pressure, particularly for diastolic values. In conclusion, chronic soy milk consumption had modest, but significant hypotensive action in essential hypertensive subjects. This hypotensive action was correlated with the urinary excretion of the isoflavonoid genistein.     

Clinical validation of an automatic device measuring blood pressure in the fingers.

BACKGROUND: To assess the agreement between a new automatic device (FS-20D) using a cuff-oscillometric method to measure arterial blood pressure (BP) in the fingers and a standard mercury sphygmomanometer. METHODS: The blood pressure measurements were taken in a sequential order, in a sample of both normotensive subjects (n. 57) and slight to moderate hypertensive patients (n. 28) without vascular complications. RESULTS: The mean sphygmomanometer-monitor difference was 0.52 +/- 4.57 mmHg for systolic and 0.25 +/- 4.41 mmHg for diastolic values; the agreement limits were: SBP -8.6 divided by 9.6 mmHg, 95% CI: -0.5 divided by 1.5; DBP: -8.6 divided by 9.1 mmHg, 95% CI: -0.7 divided by 1.2. The grade of agreement between the monitor and the sphygmomanometer was "A" (British Hypertension Society) for both systolic and diastolic values (difference of readings < 5 mmHg: 82%; < 10 mmHg: 97% for systolic blood pressure, 98% of diastolic blood pressure). CONCLUSIONS: The monitor was proved to be reliable with a good level of precision and accuracy. The FS-20D monitor may be used in self-monitoring of blood pressure of patients with slight to moderate hypertension.     

Lack of effect on blood pressure by polyunsaturated and monounsaturated fat diets.

We carried out a blind highly controlled study to investigate the effects of a sunflower-oil-rich diet and a rapeseed-oil-rich diet on the blood pressure of normotensive subjects. Twenty-nine men and 30 women, average age 30 years (range 18-65) were first fed a baseline diet high in saturated fatty acids (19 E% (percentage of total energy), total fat 36 E%) for 2 weeks. According to the crossover design 30 subjects then received a sunflower oil diet high in polyunsaturated fatty acids (13 E%, total fat 38 E%) followed by a low erucic acid rapeseed oil diet high in monounsaturated fatty acids (16 E%, total fat 38 E%) for 3.5 weeks each. The other 29 subjects had the same diets in reverse order. At the end of the saturated fat period systolic blood pressure was 122.6 +/- 11.5(mean +/- SD) mmHg and diastolic blood pressure 75.4 +/- 7.5 mmHg; during the sunflower oil diet the figures were 119.6 +/- 10.3 and 73.9 +/- 7.4 mmHg, and during the rapeseed oil diet 120.1 +/- 11.2 and 72.6 +/- 6.4 mmHg, respectively. There was a significant difference in diastolic blood pressure only between the two oil diets (P less than 0.01). At the end of a 4 weeks' recovery period the systolic and diastolic blood pressures of the subjects were even lower (118.6 +/- 10.6 and 72.3 +/- 8.3 mmHg, respectively) than during the study. These results suggest that the dietary changes had only minor effects - if any at all - on blood pressure in healthy normotensive subjects.     

氨氯地平联合培哚普利对高血压患者血压变异性的影响

目的 观察氨氯地平联合培哚普利对高血压患者血压变异性的影响.方法 选择2012年9月至2013年10月就诊的原发性高血压患者,均给予氨氯地平5 mg/d（4周）,4周后血压仍不能控制的患者（78例）,按随机数字表法分为A、B两组,每组39例,A组患者服用氨氯地平剂量加倍（10 mg/d）;B组在服用氨氯地平的基础上加服培哚普利4 mg/d.A、B两组患者均在加服药前与加服药8周后采用无创便携式动态血压监测仪检测24 h动态血压,以测量值的标准差和变异系数作为血压变异性的指标.结果 A组加服药8周后,24 h收缩压变异度（24 h SSD）、白天收缩压变异度（dSSD）、夜间收缩压变异度（nSSD）、夜间收缩压变异系数（nSCV）、24 h舒张压变异度（24h DSD）、白天舒张压变异度（dDSD）、夜间舒张压变异度（nDSD）均较加服药前降低[（13.22±1.10） mmHg（1 mmHg=0.133 kPa）比（15.97±1.65） mmHg、（12.04±2.21） mmHg比（15.15±2.89） mmHg、（10.22±3.29） mmHg比（12.23±3.21） mmHg、0.093±0.021比0.104±0.017、（11.33±2.09） mmHg比（13.27±1.43） mmHg、（10.64±1.81） mmHg比（12.57±1.43） mmHg、（9.56±1.32） mmHg比（11.23±2.26） mmHg],差异有统计学意义（P＜0.05）,但24 h收缩压变异系数（24 h SCV）、白天收缩压变异系数（dSCV）、24h舒张压变异系数（24 h DCV）、白天舒张压变异系数（dDCV）、夜间舒张压变异系数（nDCV）变化差异无统计学意义（P＞0.05）;B组加服药8周后,与加服药前比较,24 h SSD、24 h SCV、dSSD、dSCV、24 h DSD、24 h DCV、dDSD、dDCV、nDSD均显著下降[（10.23±4.72） mmHg比（15.27±3.23） mmHg、0.083±0.032比0.106±0.019、（10.85±3.29）mmHg比（15.09±3.21）mmHg、0.080±0.028比0.096±0.025、（10.13±2.43）mmHg比（13.37 ±3.13） mmHg、0.111±0.035比0.136±0.032、（9.58±2.49） mmHg比（12.29±3.27） mmHg、0.112±0.036比0.123±0.041、（9.46±2.78） mmHg比（11.19±4.26） mmHg],差异有统计学意义（P＜0.05）,但nSSD、nSCV及nDCV变化差异无统计学意义（P＞0.05）;加服药8周后,B组24 h SSD、24 h SCV、24 h DSD、24h DCV、dSSD、dDSD、dSCV及dDCV均显著低于A组,差异有统计学意义（P＜0.05）;两组nSSD、nDSD、nSCV及nDCV比较差异无统计学意义（P＞0.05）.结论 氨氯地平单药加倍剂量和氨氯地平联合培哚普利均能有效降低24 h收缩压及舒张压变异性,且联合治疗的效果更好,值得进一步推广使用.     

老年高血压合并体位性低血压患者靶器官损害及最佳血压水平的研究

目的研究老年高血压合并体位性低血压患者靶器官损害情况及最佳的血压水平。方法选取2010年3月~7月进行体检的长期居住广州的军队离退休老干部中的原发性高血压患者849例,对其进行健康问卷调查,并测量卧位及立位后0、2 min血压和心率,对体位性低血压的发生率进行统计,同时分析体位性低血压组与非体位性低血压组患者靶器官损害情况。结果老年高血压患者体位性低血压的发生率随着高血压分级升高而增加;体位性低血压组的左室肥厚及微量白蛋白尿的发生率均高于非体位性低血压组;血压控制在130~139/70~79 mm Hg时体位性低血压的发生率最低。结论老年高血压合并体位性低血压发生靶器官损害的危险较高,130~139/70~79 mm Hg可能是老年高血压合并体位性低血压患者最佳的血压范围。     

Blood pressure and mortality risk in the elderly

Blood pressure was assessed between 1981 and 1983 in all persons over age 65 years in three communities (East Boston, Massachusetts; New Haven, Connecticut; and Iowa and Washington countries, Iowa), and cause-specific mortality was monitored annually over the subsequent 5 years as part of the National Institute on Aging-sponsored Established Populations for Epidemiologic Studies of the Elderly. Each community had 80% or more participation: in East Boston, 3,809 persons with 903 deaths, in New Haven, 2,812 persons with 804 deaths, and in Iowa, 3,673 persons with 763 deaths. At 2 years, odds of death from all causes were higher in the low (less than 130 mmHg) than the middle (130-159 mmHg) systolic blood pressure group for persons aged 65-79 years in all three populations. By 5 years, cardiovascular death increased with increasing systolic pressure in all three communities and reached significance in Iowa. Cancer death was highest in the low systolic pressure stratum in all three centers. All-cause, cardiovascular death, and cancer mortality was highest in the low (less than 75 mmHg) diastolic blood pressure group in East Boston, even at 5 years. Blood pressures obtained 9 years earlier in 2,079 (68%) of the East Boston participants showed a significantly higher risk of cardiovascular death with increasing systolic pressure and no relation between diastolic pressure and mortality risk. In the elderly, excess mortality at lower levels of blood pressure during early follow-up may in part be due to the effects of illness and disability present at baseline. This may obscure the usual rise in mortality with increasing systolic pressure. There is no consistent relation between diastolic pressure and mortality.     

Blood pressure and risk of renal cell carcinoma in the European prospective investigation into cancer and nutrition

Elevated blood pressure has been implicated as a risk factor for renal cell carcinoma (RCC), but prospective studies were confined to men and did not consider the effect of antihypertensive medication. The authors examined the relation among blood pressure, antihypertensive medication, and RCC in the European Prospective Investigation into Cancer and Nutrition (EPIC). Blood pressure was measured in 296,638 women and men, recruited in eight European countries during 1992-1998, 254,935 of whom provided information on antihypertensive medication. During a mean follow-up of 6.2 years, 250 cases of RCC were identified. Blood pressure was independently associated with risk of RCC. The relative risks for the highest versus the lowest category of systolic (>/=160 mmHg vs. <120 mmHg) and diastolic (>/=100 mmHg vs. <80 mmHg) blood pressures were 2.48 (95% confidence interval: 1.53, 4.02) and 2.34 (95% confidence interval: 1.54, 3.55). Risk estimates did not significantly differ according to sex or use of antihypertensive medication. Individuals taking antihypertensive drugs were not at a significantly increased risk unless blood pressure was poorly controlled. These results support the hypothesis that hypertension, rather than its medications, increases the risk of RCC in both sexes, while effective blood pressure control may lower the risk.     

Agreement between the Takeda UA-731 automatic blood pressure measuring device and the manual mercury sphygmomanometer: an assessment under field conditions in Newcastle upon Tyne, UK.

STUDY OBJECTIVE: To assess agreement between two Takeda UA-731 automatic blood pressure measuring devices (referred to as machines A and B) and two manual mercury sphygmomanometers. DESIGN: A 'Y' connector attached each Takeda UA-731 to a manual mercury sphygmomanometer. Simultaneous measurements were made on adult subjects. SETTING: A population based cardiovascular disease survey in Newcastle upon Tyne, UK. PARTICIPANTS: Measurements on machine A were compared in 71 individuals (all women), and on machine B in 75 individuals (9 men, 66 women). The age range of subjects was 28 to 76 years and median ages were 59 years for machine A and 50 years for machine B. MAIN RESULTS: Blood pressure (mmHg) ranged from 72 to 212 systolic and 44 to 102 diastolic. Both Takedas gave significantly lower readings than the manual devices for systolic and diastolic pressures: differences were mean (SD: 95% CI) 3.7 mmHg (6.5: 2.2, 5.2) for machine A systolic, 2.3 mmHg (4.5: 1.3, 3.4) machine A diastolic; 1.8 mmHg (6.2: 0.4, 3.3) machine B systolic, and 1.8 (4.4: 0.8, 2.8) machine B diastolic. On the British Hypertension Society criteria, machine A was graded C on systolic measurements and B on diastolic; machine B was graded B on both systolic and diastolic measurements. CONCLUSIONS: The performance of these machines compares favourably with the Dinamap 8100, recently adopted for survey work by the Department of Health. The Takeda UA-731 looks promising for epidemiological survey work but before it can be fully recommended further evaluations are needed.     

Randomised, controlled, cross-over trial of soy protein with isoflavones on blood pressure and arterial function in hypertensive subjects

OBJECTIVE: To examine the effects of dietary soy/isoflavones on 24 hr blood pressure profiles and arterial function [systemic arterial compliance (SAC), pulse wave velocity (PWV) and brachial arterial flow mediated vasodilation (FMD)] compared to non legume-based plant protein without isoflavones, in hypertensive subjects. DESIGN: In a 6 month double-blind, placebo controlled, cross-over trial, 41 hypertensive subjects (26 men, 15 postmenopausal women), 30-75 years, received soy cereal (40 g soy protein, 118 mg isoflavones) and gluten placebo cereal, each for 3 months. RESULTS: Thirty-eight subjects completed protocol with results expressed as mean or mean change (+/-SEM) with each intervention. Soy increased urinary isoflavones (daidzein: 8-fold; genistein: 8-fold; equol: 9-fold; ODMA: 18-fold) with no change during gluten placebo. There was no difference in the change in individual 24 hr ambulatory BP parameters (SBP: 2 +/- 2 vs -1 +/- 1 mmHg, p = 0.21; DBP: 1 +/- 1 vs -1 +/- 1 mmHg, p = 0.06) central BP (cSBP: -4 +/- 2 vs 0 +/- 2 mmHg, p = 0.2) or the change in arterial function (FMD: 0.3 +/- 0.5 vs -0.2 +/- 0.5%, p = NS; SAC: 0.02 +/- 0.02 vs -0.02 +/- 0.02 U/mmHg, p = NS; PWV central: -0.2 +/- 0.2 vs 0.0 +/- 0.2 m/sec, p = NS; PWV peripheral: 0.01 +/- 0.3 vs -0.4 +/- 0.4 m/sec, p = NS) noted between interventions. Analysis of the area under curve of 24 hr BP outputs demonstrated that soy protein compared to gluten protein resulted in higher 24 hr systolic BP by 2.3 mmHg (p = 0.003), a higher daytime systolic BP by 3.4 mmHg (p = 0.0002) and a higher daytime diastolic BP by 1.4 mmHg (p = 0.008). Overall 24 hr diastolic BP, night systolic BP and night diastolic BP were not significantly different between groups. Furthermore, soy protein compared to gluten protein resulted in higher 24 hr heart rates by 3.5 bpm (p < 0.0001). CONCLUSIONS: In hypertensive subjects, compared to gluten placebo, soy dietary supplementation containing isoflavones had no effect on arterial function, on average 24 hr ambulatory blood pressure parameters or central blood pressure in men and women with hypertension. Area under the curve of 24 hr profiles demonstrated that daytime BP was higher after soy compared to gluten.     

Geographical variations in blood pressure in British men and women

Geographical variations in blood pressure have been studied using an automatic sphygmomanometer in 2596 men and women aged 25-29, 40-44 and 55-59 living in nine British towns. In males aged 40-59, systolic blood pressure showed a range in age-adjusted town means of 9.0 mmHg (p less than 0.05); in females the difference of 8.6 mmHg was not significant (p = 0.14). Mean arterial pressure (MAP) and diastolic at age 40-59 were significantly different between towns for both sexes. Differences at age 25-29 were of a similar magnitude, and the mean town blood pressures at 25-29 correlated highly with those at 40-59 [systolic; males r = 0.74 (p less than 0.05), females r = 0.65 (p = 0.059)]. The ranking of town blood pressures in an earlier study was reflected in the present study, but stronger associations were observed with cardiovascular mortality. It is concluded that geographical blood pressure variations in Britain are established by age 25-29 years.