Prevalence, awareness, treatment, and risk factors associated with hypertension in the Iranian population: the national survey of risk factors for noncommunicable diseases of Iran

BACKGROUND: The prevalence of hypertension in the Middle East is not well defined. We examined the prevalence, awareness, treatment, and control of hypertension in Iran. METHODS: The Survey of Risk Factors of Noncommunicable Diseases was conducted in 2005 and contains a representative sample of the Iranian adult population. Of 70,981 participants, the data of 68,250 adults aged 25-64 years who had two valid blood pressure (BP) readings were analyzed to estimate the total prevalence of hypertension (systolic BP >or= 140 mm Hg, diastolic BP >or= 90 mm Hg, or the concurrent use of antihypertensive agents) in the Iranian adult population. RESULTS: Approximately 25% or 6.6 million Iranians aged 25-64 years had hypertension; additionally 46% or 12 million Iranians aged 25-64 years had prehypertension. Among hypertensive patients, 34% were aware of their elevated BP; 25% were taking antihypertensive medications; and of these treated subjects, only 24% had BP values <140/90 mm Hg. Hypertension and prehypertension were associated with age, male gender, obesity, central obesity, hypercholesterolemia, and diabetes. CONCLUSIONS: The prevalence of hypertension and prehypertension is high, and the rates of awareness, treatment, and control are unacceptably low. These results underscore the urgent need to develop national strategies to improve prevention, detection, and treatment of hypertension in Iran.     

Control of hypertension 5 years after stroke in the North East Melbourne Stroke Incidence Study

Control of blood pressure after stroke is important for reducing the risk of recurrent stroke. We examined the control of hypertension in a community-based population of 5-year stroke survivors. Cases of first-ever stroke from the North East Melbourne Stroke Incidence Study were interviewed at 5 years poststroke. Blood pressure, history of hypertension, and antihypertensive medications were recorded. Individuals were classified as normotensive (blood pressure < 140/90 mm Hg, no history of hypertension, and no antihypertensive medications), controlled hypertensive (blood pressure < 140/90 mm Hg, history of hypertension, and/or taking antihypertensive medications), uncontrolled hypertensive (blood pressure > or = 140/90 mm Hg, history of hypertension, and/or taking antihypertensive medications), or uninformed hypertensive (blood pressure > or = 140/90 mm Hg, no known history of hypertension, and no antihypertensive medications). At 5 years poststroke, 441 (45%) of 978 first-ever stroke cases were alive. Of these, 305 (69%) had complete data on blood pressure, antihypertensive medication use, and history of hypertension. No statistical differences existed between those with or without these data. Eight-two percent were hypertensive; 63% had controlled hypertension, 30% had uncontrolled hypertension, and 7% were unaware that they were hypertensive. Overall, 67% of individuals classified as uncontrolled or uninformed hypertensive subjects were receiving treatment that was insufficient to achieve target blood pressure levels. Uncontrolled hypertensive subjects were more likely to recall receiving advice to manage their hypertension with medication (P < 0.02) and diet (P < 0.09). Although the majority of hypertensive individuals had controlled hypertension at 5 years poststroke, considerable improvement can be made in the control of hypertension after stroke.     

Prevalence of isolated systolic and isolated diastolic hypertension subtypes in China

BACKGROUND: Isolated systolic hypertension (ISH), more so than any other hypertension subtype, increases the risk for stroke and coronary heart disease. The prevalence of ISH versus other hypertension subtypes in the general Chinese adult population is not known. METHODS: The prevalence of isolated systolic and isolated diastolic hypertension (IDH) was examined in a representative national sample of 15,540 Chinese adults aged 35 to 74 years. Three seated blood pressure (BP) measurements taken after 5 min of rest were averaged and hypertension subtypes were defined among individuals not receiving antihypertensive therapy as follows: ISH as systolic BP >/=140 mm Hg and diastolic BP <90 mm Hg; IDH as systolic BP <140 mm Hg and diastolic BP >/=90 mm Hg; and combined systolic/diastolic hypertension (SDH) as a systolic BP >/=140 mm Hg and diastolic BP >/=90 mm Hg. RESULTS: Overall, 7.6% of the Chinese adult population had ISH, 7.4% had SDH, and 4.4% had IDH. The prevalence of ISH increased with age and was more common in older women than in older men. Stage 1 hypertension was much more prevalent than stage 2 hypertension among all hypertension subtypes. The prevalence of SDH, IDH, and ISH (women, only) were higher in northern China than southern. The prevalence of ISH and SDH (women, only) were higher among rural residents versus urban residents. CONCLUSIONS: These data document high rates of ISH in China. Given the risk of cardiovascular disease associated with ISH, our findings underscore the critical need for enhanced hypertension screening and treatment programs in China.     

The epidemiology of elevated blood pressure as an estimate for hypertension in Aydin, Turkey.

BACKGROUND: Hypertension is an important public health problem, with some variability of its epidemiological properties in different populations. OBJECTIVES: The purpose of this study was to estimate the prevalence of hypertension and to determine the hypertension awareness, treatment and control rates in Aydin, a Turkish province. METHODS: Of 1600 coincidentally selected people aged over 18 years in Aydin, 1480 (92.5%) had their blood pressure (BP) measured and answered a standard questionnaire in 1995. RESULTS: Estimates of the prevalence of hypertension and its control were computed using two different criteria to define hypertension: BP > or =140/90 mm Hg or on treatment and BP > or =160/95 mm Hg or on treatment. Overall, the estimated prevalence of hypertension was 29.6% (for BP > or =140/90 mm Hg or on treatment). Hypertension prevalence increased progressively with age, from 9% in 18- to 29-year-olds to 70.6% in those 70-79 years of age. Women had a significantly higher prevalence than men (34.1% vs 26.0% respectively). Overall, 57.9% of hypertensive individuals were aware that they had high BP, and 82.1% of aware hypertensives were being treated with antihypertensive medications, but only 19.8% of treated hypertensives were under control (systolic pressure <140 mm Hg and diastolic pressure <90 mm Hg). In addition, housewives, unemployed, and the less educated individuals had greater mean systolic and diastolic BP. CONCLUSIONS: Our results indicate that hypertension is highly prevalent in Aydin, Turkey, and the detection and control of hypertension is unsatisfactory.     

Prevalence,awareness, treatment,and control of hypertension in china

The objective of this study was to estimate the prevalence and distribution of hypertension and to determine the status of hypertension awareness, treatment, and control in the general adult population in China. The International Collaborative Study of Cardiovascular Disease in ASIA (InterASIA), conducted in 2000-2001, used a multistage cluster sampling method to select a nationally representative sample. A total of 15 540 adults, age 35 to 74 years, were examined. Three blood pressure measurements were obtained by trained observers by use of a standardized mercury sphygmomanometer after a 5-minute sitting rest. Information on history of hypertension and use of antihypertensive medications was obtained by use of a standard questionnaire. Hypertension was defined as a mean systolic blood pressure > or =140 mm Hg, diastolic blood pressure > or =90 mm Hg, and/or use of antihypertensive medications. Overall, 27.2% of the Chinese adult population age 35 to 74 years, representing 129 824 000 persons, had hypertension. The age-specific prevalence of hypertension was 17.4%, 28.2%, 40.7%, and 47.3% in men and 10.7%, 26.8%, 38.9%, and 50.2% in women age 35 to 44 years, 45 to 54 years, 55 to 64 years, and 65 to 74 years, respectively. Among hypertensive patients, only 44.7% were aware of their high blood pressure, 28.2% were taking antihypertensive medication, and 8.1% achieved blood pressure control (<140/90 mm Hg). Our results indicate that hypertension is highly prevalent in China. The percentages of those with hypertension who are aware, treated, and controlled are unacceptably low. These results underscore the urgent need to develop national strategies to improve prevention, detection, and treatment of hypertension in China.     

Twenty-four hour ambulatory blood pressure for the management of antihypertensive treatment: a randomized controlled trial

The aim of this study was to assess whether the use of 24-h blood pressure (BP) measurement in the management of antihypertensive therapy improves BP in patients with sustained hypertension. Patients with sustained hypertension (office BP > or =140/90 mm Hg, and 24-h systolic BP > or =130/80 mm Hg) were randomly assigned to a strategy using 24-h BP to manage antihypertensive treatment (target <130/80 mm Hg) or to a standard strategy using office BP (target <140/90 mm Hg). The primary end point was change in 24-h systolic BP at 1 year of follow-up. We included 136 patients in the primary analysis. After 1 year of follow-up, the change in 24-h systolic BP was significantly greater in the ambulatory BP group compared with the office BP group (mean difference (95% confidence interval) -3.6 (-7.0, -0.3), P=0.03). Intention-to-treat analysis revealed essentially unchanged results. The mean number of antihypertensive drugs per participant at 1 year of follow-up was 1.76+/-1.1 and 1.95+/-0.9 in the ambulatory and office BP group, respectively (P=0.049). The benefit of ambulatory BP monitoring was mainly seen in patients with previously known hypertension (mean difference -7.2 (-11.6, -2.8), P=0.002), but not in those with newly detected hypertension (mean difference 0.2 (-4.9, 5.4), P=0.93). In conclusion, using 24-h BP for the management of antihypertensive therapy in patients with sustained hypertension leads to a greater BP reduction compared with a standard treatment strategy using office BP, although fewer antihypertensive drugs were used in the ambulatory BP group.     

Prognosis of "masked" hypertension and "white-coat" hypertension detected by 24-h ambulatory blood pressure monitoring 10-year follow-up from the Ohasama study

OBJECTIVES: We sought to investigate the prognosis in subjects with "white-coat" hypertension (WCHT) and "masked" hypertension (MHT), in which blood pressure (BP) is lower in clinical measurements than during ambulatory monitoring. BACKGROUND: The prognostic significance of WCHT remains controversial, and little is known about MHT. METHODS: We obtained 24-h ambulatory BP and "casual" BP (i.e., obtained in clinical scenarios) values from 1,332 subjects (872 women, 460 men) > or =40 years old in a representative sample of the general population of a Japanese community. Survival and stroke morbidity were then followed up for a mean duration of 10 years. RESULTS: Composite risk of cardiovascular mortality and stroke morbidity examined using a Cox proportional hazards regression model for subjects with WCHT (casual BP > or =140/90 mm Hg, daytime BP <135/85 mm Hg; relative hazards [RH])1.28; 95% confidence interval [CI] 0.76 to 2.14) was no different from risk for subjects with sustained normal BP (casual BP <140/90 mm Hg, daytime BP <135/85 mm Hg). However, risk was significantly higher for subjects with MHT (casual BP <140/90 mm Hg, daytime BP > or =135/85 mm Hg; RH 2.13; 95% CI 1.38 to 3.29) or sustained hypertension (casual BP > or =140/90 mm Hg, daytime BP > or =135/85 mm Hg; RH 2.26; 95% CI 1.49 to 3.41) than for subjects with sustained normal BP. Similar findings were observed for cardiovascular mortality and stroke morbidity among subgroups by gender, use of antihypertensive medication, and risk factor level (all p for heterogeneity >0.2). CONCLUSIONS: Conventional BP measurements may not identify some individuals at high or low risk, but these people may be identifiable by the use of ambulatory BP.     

High systolic blood pressure is associated with Val/Val genotype in the catechol-o-methyltransferase gene. The Nord-Trøndelag Health Study (HUNT)

BACKGROUND: The catechol-O-methyltransferase (COMT) gene contains a functional polymorphism, Val158Met. A few studies on animals have shown a relationship between the COMT gene and BP, but whether this exists in human beings is unclear. The aim of this study was to evaluate the relationship between codon 158 COMT gene polymorphism and BP in a population-based cohort. METHODS: In the 1995-97 Nord-Tr?ndelag Health Study (HUNT), the association between Val/Met polymorphism at the COMT gene and BP was evaluated in a group of 2966 nondiabetic individuals. RESULTS: Among the 2591 individuals without current use of antihypertensive drugs, systolic BP > or =140 mm Hg was more likely among persons with Val/Val genotype compared with the other genotypes (44.8% v 39.1%, P = .02). In the multivariate analysis the prevalence odds ratio for having the Val/Val genotype was 1.63 (95% CI = 1.18 to 2.24) among individuals with systolic BP > or =160 mm Hg compared with those with systolic BP <140 mm Hg. Val/Val genotype was also more likely (OR = 1.30, 95% CI = 1.04 to 1.63) among individuals with hypertension (as defined by use of antihypertensive medication, systolic BP > or =140 mm Hg, or diastolic BP > or =90 mm Hg) than among those with normal BP. CONCLUSIONS: Based on the study findings, the Val/Val genotype appears to be associated with a higher prevalence of increased systolic BP compared with the Met/Met or Met/Val genotypes at the COMTgene.     

Determinants of sustained uncontrolled blood pressure in a national cohort of persons with diabetes

BACKGROUND: Randomized clinical trials have demonstrated that strict blood pressure (BP) control in diabetes reduces cardiovascular morbidity and mortality. Previous observational studies have confirmed that hypertension is inadequately controlled in the general population of the United States. In this study we evaluated the prevalence and determinants of severe, sustained, uncontrolled hypertension in a national cohort of persons with diabetes. METHODS: We identified 64,105 veterans from the national Veterans Administration diabetes registry for whom BP, survey, laboratory, and medication data were available. Using mean BP from three visits in fiscal year 2000, we determined the prevalence of sustained BP readings > or = 160/100, > or = 140/90, or > or = 130/80 mm Hg. We determined predictors of the three thresholds using demographic variables, self-reported medical comorbidities, estimated glomerular filtration rate, and number of BP-lowering medications. RESULTS: Over a mean interval of 131.0 days (+/-81.4), we found that 6,347 (9.9%) of the 64,105 veterans with diabetes had mean BP > or = 160/100 mm Hg. Similarly 25,924 (40.4%) had a mean BP > or = 140/90 mm Hg, and 38,296 (59.7%) had a mean BP > or = 130/80 mm Hg. Independent predictors of mean BP > or = 160/100 mm Hg included age, ethnicity, education level, cardiovascular comorbidities, alcohol use, and number of BP-lowering medications. CONCLUSIONS: Administrative databases can be used to identify patients with sustained uncontrolled hypertension within health care systems. Our findings suggest important patient-level factors that can be targeted for quality improvement programs in diabetes.     

Retinal arteriolar narrowing is associated with 5-year incident severe hypertension: the Blue Mountains Eye Study

We assessed whether retinal arteriolar narrowing and structural abnormalities independently predicted 5-year incident severe (grade 2 or 3) hypertension in an older population-based cohort. The Blue Mountains Eye Study baseline (1992 to 1994) examined 3654 residents aged 49 and older in 2 postal code areas, west of Sydney. Of the 2335 participants (75.1% of survivors) who returned at the 5-year examinations, 1319 were normotensive or had mild (grade 1) hypertension at baseline. Baseline retinal photographs were graded for focal retinal vessel wall signs and vessel diameters were measured. Participants were classified as having normal, high-normal blood pressure [BP] (systolic BP 121 to 139 mm Hg and/or diastolic BP 81 to 89 mm Hg), mild hypertension (systolic BP 140 to 159 mm Hg and/or diastolic BP 90 to 99 mm Hg), or severe hypertension if they had a previous diagnosis of hypertension and were receiving antihypertensive medications or had systolic BP > or =160 mm Hg and/or diastolic BP > or =100 mm Hg at examination. Incident severe hypertension was defined in persons who were free of severe hypertension at baseline but classified as having severe hypertension at the 5-year examinations. Of the 1319 baseline subjects at risk, 390 (29.6%) developed severe hypertension. After adjusting for age, sex, body mass index, smoking, glucose, and total cholesterol, generalized retinal arteriolar narrowing at baseline was associated with increased risk of incident severe hypertension (odds ratio 2.6; 95% confidence interval, 1.7 to 3.9) when comparing the narrowest versus widest quintile. This association remained significant after further adjustment for baseline mean arterial BP or BP status. Our findings support the hypothesis that small vessel structural changes may precede the development of severe hypertension.     

Baseline Characteristics and Early Blood Pressure Control in the CONVINCE Trial

-Blood pressure (BP) control rates around the world are suboptimal. Part 2 of the National Health and Nutrition Educational Survey (NHANES) III indicates that only 27.4% of hypertensive Americans aged 18 to 74 years have a BP of <140/90 mm Hg. We wanted to assess BP control during the first 2 years and to describe the baseline characteristics of patients enrolled in the Controlled ONset Verapamil INvestigation of Cardiovascular Endpoints (CONVINCE) Study, an international clinical trial that compares outcomes in hypertensive patients randomized to initial treatment with either controlled-onset extended-release verapamil or the investigator's choice of atenolol or hydrochlorothiazide. At randomization, BP was <140/90 mm Hg in only 20.3% of the 16 602 subjects (average+/-SD age 65.6+/-7.4 years; 56% women, 84% white/7% black/7% Hispanic). The average BP at enrollment was 148/85 mm Hg for patients taking BP medications (n=13 879) and 161/94 mm Hg for previously untreated patients (n=2723). After medication titration, with a transtelephonic computer that recommended an increase in the dose or number of antihypertensive agents whenever the BP was 140/90 mm Hg, 84.8% of the subjects attained the goal BP. During 2 years of treatment, BP control was maintained in 67% to 69% of the subjects (69% to 71% for systolic BP of <140 mm Hg and 90% for diastolic BP of <90 mm Hg). These data suggest that the control of systolic BP is more difficult than the control of diastolic BP. The US national goal of having 50% of hypertensives with a BP of <140/90 mm Hg may be achievable if a forced titration strategy is used. Interested investigators, free care and medications, and well-educated subjects may make the attainment of such a goal easier in the CONVINCE study than in the general population.     

Clinical and genetic correlates of aldosterone-to-renin ratio and relations to blood pressure in a community sample

Aldosterone:renin ratio (ARR) is used to screen for hyperaldosteronism. Data regarding correlates of ambulatory ARR in the community and its relation to hypertension incidence are limited. We defined clinical correlates of ARR, determined its heritability, tested for association and linkage, and related ARR to blood pressure (BP) progression in nonhypertensive individuals among 3326 individuals from the Framingham Heart Study (53% women; mean age: 59 years). Ambulatory morning ARR (serum aldosterone and plasma renin concentrations) were related to clinical covariates, genetic variation across the REN locus, a 10-cM linkage map, and among nonhypertensive participants (n=1773) to progression of >or=1 Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure BP category (optimal: <120/80 mm Hg, normal: 120 to 129/80 to 84 mm Hg, high normal: 130 to 139/85 to 89 mm Hg, hypertension: >or=140/90 mm Hg), or incident hypertension (systolic BP: >or=140 mm Hg, diastolic BP: >or=90 mm Hg, or use of antihypertensive treatment). ARR was positively associated with age, female sex, untreated hypertension, total/high-density lipoprotein cholesterol ratio, hormone replacement therapy, and beta-blocker use, but negatively associated with angiotensin-converting enzyme inhibitor and diuretic use. ARR was heritable (h(2)=0.40), had modest linkage to chromosome 11p (logarithm of the odds: 1.89), but was not associated with 17 common variants in REN (n=1729). On follow-up (mean: 3 years), 607 nonhypertensive individuals (34.2%) developed BP progression, and 283 (16.0%) developed hypertension. Higher baseline logARR was associated with increased risk of BP progression (odds ratio per SD increment: 1.23; 95% CI: 1.11 to 1.37) and hypertension incidence (odds ratio per SD increment: 1.16; 95% CI: 1.00 to 1.33). ARR is a heritable trait influenced by clinical and genetic factors. There is a continuous gradient of increasing risk of BP progression across ARR levels in nonhypertensive individuals.     

White-coat hypertension as a risk factor for the development of home hypertension: the Ohasama study

BACKGROUND: White-coat hypertension is a condition characterized by elevated blood pressure (BP) in medical settings combined with normal ambulatory-recorded BP or self-measured BP at home (home BP). However, it is unknown whether this condition represents a transient state in the development of hypertension outside medical settings. METHODS: We followed up 128 subjects with white-coat hypertension (home BP <135/85 mm Hg and office BP > or = 140/90 mm Hg) for 8 years and compared the risk of progression with home hypertension (home BP > or = 135/85 mm Hg or start of treatment with antihypertensive medication) with 649 sustained normotensive subjects (home BP <135/85 mm Hg and office BP <140/90 mm Hg) using data from population-based home BP measurement projects in Japan. RESULTS: During the 8-year follow-up period, 60 subjects (46.9%) with white-coat hypertension and 144 (22.2%) with sustained normotension progressed to home hypertension. The odds ratio of subjects with white-coat hypertension for progression to home hypertension (adjusted for possible confounding factors) was significantly higher than for subjects with sustained normotension (odds ratio, 2.86; P<.001). This association was observed independent of baseline home BP levels. CONCLUSION: The results from the present 8-year follow-up study demonstrate that white-coat hypertension is a transitional condition to hypertension outside medical settings, suggesting that white-coat hypertension may carry a poor cardiovascular prognosis.     

Cardiovascular outcome in treated hypertensive patients with responder, masked, false resistant, and true resistant hypertension

BACKGROUND: The aim of this study was to evaluate the cardiovascular outcome in apparently responder hypertensive patients with responder and masked hypertension, and in apparently resistant hypertensive patients with false and true resistant hypertension. METHODS: The occurrence of fatal and nonfatal cardiovascular events was evaluated in 340 patients with responder hypertension (clinic blood pressure [BP] <140/90 mm Hg and daytime BP <135/85 mm Hg), 126 with masked hypertension (clinic BP <140/90 mm Hg and daytime BP >135 or 85 mm Hg), 146 with false resistant hypertension (clinic BP >or=140 or 90 mm Hg and daytime BP <135/85 mm Hg), and 130 with true resistant hypertension (clinic BP >or=140 or 90 mm Hg and daytime BP >135 or 85 mm Hg). RESULTS: During follow-up period (4.98 +/- 2.9 years), the event-rate per 100 patient-years was 0.87, 2.42, 1.2, and 4.1 in patients with responder, masked, false resistant, and true resistant hypertension, respectively. After adjustment for several covariates, including clinic BP (forced into the model), Cox regression analysis showed that cardiovascular risk was significantly higher in masked hypertension (masked versus responder hypertension, relative risk [RR] 2.28, 95% confidence interval [CI] 1.1-4.7, P < .05) and in true resistant hypertension (true resistant versus responder hypertension, RR 2.94, 95% CI 1.02-8.41, P < .05), whereas there was no significant difference between false resistant and responder hypertension. CONCLUSIONS: This study shows that patients with masked hypertension are at higher risk than those with responder hypertension, and that those with false resistant hypertension are at lower risk than those with true resistant hypertension. Ambulatory BP monitoring should be performed in treated hypertensive patients to obtain a better prognostic stratification.     

Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

The National High Blood Pressure Education Program presents the complete Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Like its predecessors, the purpose is to provide an evidence-based approach to the prevention and management of hypertension. The key messages of this report are these: in those older than age 50, systolic blood pressure (BP) of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP; beginning at 115/75 mm Hg, CVD risk doubles for each increment of 20/10 mm Hg; those who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension; prehypertensive individuals (systolic BP 120-139 mm Hg or diastolic BP 80-89 mm Hg) require health-promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD; for uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes; this report delineates specific high-risk conditions that are compelling indications for the use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); two or more antihypertensive medications will be required to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg) for patients with diabetes and chronic kidney disease; for patients whose BP is more than 20 mm Hg above the systolic BP goal or more than 10 mm Hg above the diastolic BP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered; regardless of therapy or care, hypertension will be controlled only if patients are motivated to stay on their treatment plan. Positive experiences, trust in the clinician, and empathy improve patient motivation and satisfaction. This report serves as a guide, and the committee continues to recognize that the responsible physician's judgment remains paramount.     

Use of statins and blood pressure

BACKGROUND: Markers of inflammation such as high-sensitivity C-reactive protein (CRP) were shown to be elevated in patients with hypertension. Small trials using statin therapy showed blood-pressure (BP) reductions, but it is unknown whether this association extends to larger populations. The objective of this study was to determine whether statin use was associated with better blood-pressure control in adults with hypertension and whether inflammation levels mediated this relationship. METHODS: This was a cross-sectional study of 2584 hypertensive adults aged >or=40 years with no known cardiovascular disease from the National Health and Nutrition Examination Survey 1999-2002. Logistic regression models were calculated to determine whether there was an association between statin use and blood-pressure control. C-reactive protein was added to the full model to determine its impact on the association. RESULTS: Compared with people not using statin medication, significantly more statin users had their blood pressure under control (52.2% v 38.0%). After adjustment for demographic factors, statin users were two times (95% confidence interval [CI], 1.46 to 2.72) more likely to have their blood pressure under control (<140/90 mm Hg) than nonusers. After further adjustment for body mass index, diabetes, smoking, exercise, low-salt diet, and antihypertensive medications, the likelihood of having blood pressure under control remained more likely among statin users (odds ratio, 1.46; 95% CI, 1.05 to 2.05). The association between statin use and lower BP was most evident among participants who used antihypertensive medication as well as statins and was unchanged with the addition of CRP to the model. CONCLUSIONS: Statin use was associated with a BP level <140/90 mm Hg in a representative sample of US adults with hypertension. Levels of CRP did not attenuate the association. Further studies are needed to explore the effects of statin use on blood pressure and to determine how best to apply this knowledge in clinical care.     

The accelerating epidemic of hypertension among rural Chinese women: results from Liaoning Province

BACKGROUND: The objective of the study was to assess prevalence, awareness, treatment, and control of hypertension and its risk factors in rural women in Liaoning Province in northeast China. METHODS: We conducted a cross-sectional analysis of 23,178 women of minimum age 35 years, living in rural Liaoning province in northeast China. We measured their blood pressure (BP) and investigated associated factors. Hypertension was defined as an average systolic BP > or =140 mm Hg, and/or an average diastolic BP > or =90 mm Hg, and/or self-report of current treatment for hypertension with antihypertensive medication. RESULTS: The overall prevalence of hypertension in this study was 38.6%. Among those with hypertension, 32.8% were aware that they had high BP, 27.4% were being treated with antihypertensive medications, and in 1.4% of the women the hypertension was controlled. Multivariate analysis revealed that higher age, Mongolian ethnicity, higher body mass index (BMI), higher waist circumference (WC), excessive salt intake, smoking, alcohol consumption, lipid disorder, diabetes, and family history of hypertension were associated with the prevalence of hypertension; a higher level of education (high school or beyond) and a higher income level were inversely related to hypertension prevalence. CONCLUSIONS: Our results indicate that hypertension is highly prevalent in rural women in Liaoning province and it is associated with known risk factors. There are unacceptably low percentages of those with hypertension who are aware of their condition, are receiving treatment, and in whom hypertension is controlled. Our study suggests the urgent need for a public health program to improve the prevention, detection, and treatment of hypertension in rural Chinese women.     

Guidelines for management of hypertension: report of the third working party of the British Hypertension Society.

Use non-pharmacological measures in all hypertensive and borderline hypertensive people. Initiate antihypertensive drug therapy in people with sustained systolic blood pressures (BP) >/=160 mm Hg or sustained diastolic BP >/=100 mm Hg. Decide on treatment in people with sustained systolic BP between 140 and 159 mm Hg or sustained diastolic BP between 90 and 99 mm Hg according to the presence or absence of target organ damage, cardiovascular disease or a 10-year coronary heart disease (CHD) risk of >/=15% according to the Joint British Societies CHD risk assessment programme/risk chart. In people with diabetes mellitus, initiate antihypertensive drug therapy if systolic BP is sustained >/=140 mm Hg or diastolic BP is sustained >/=90 mm Hg. In non-diabetic hypertensive people, optimal BP treatment targets are: systolic BP <140 mm Hg and diastolic BP <85 mm Hg. The minimum acceptable level of control (Audit Standard) recommended is <150/<90 mm Hg. Despite best practice, these levels will be difficult to achieve in some hypertensive people. In diabetic hypertensive people, optimal BP targets are; systolic BP <140 mm Hg and diastolic BP <80 mm Hg. The minimum acceptable level of control (Audit Standard) recommended is <140/<90 mm Hg. Despite best practice, these levels will be difficult to achieve in some people with diabetes and hypertension. In the absence of contraindications or compelling indications for other antihypertensive agents, low dose thiazide diuretics or beta-blockers are preferred as first-line therapy for the majority of hypertensive people. In the absence of compelling indications for beta-blockade, diuretics or long acting dihydropyridine calcium antagonists are preferred to beta-blockers in older subjects. Compelling indications and contraindications for all antihypertensive drug classes are specified. For most hypertensives, a combination of antihypertensive drugs will be required to achieve the recommended targets for blood pressure control. Other drugs that reduce cardiovascular risk must also be considered. These include aspirin for secondary prevention of cardiovascular disease, and primary prevention in treated hypertensive subjects over the age of 50 years who have a 10-year CHD risk >/=15% and in whom blood pressure is controlled to the audit standard. In accordance with existing British recommendations, statin therapy is recommended for hypertensive people with a total cholesterol >/=5 mmol/L and established vascular disease, or 10-year CHD risk >/=30% estimated from the Joint British Societies CHD risk chart. Glycaemic control should also be optimised in diabetic subjects. Specific advice is given on the management of hypertension in specific patient groups, ie, the elderly, ethnic subgroups, diabetes mellitus, chronic renal disease and in women (pregnancy, oral contraceptive use and hormone replacement therapy). Suggestions for the implementation and audit of these guidelines in primary care are provided.     

Gender Differences in Office and Ambulatory Control of Hypertension

Background

Gender differences in hypertension control have not been explored fully.

Methods

We studied 15,212 white men and 13,936 white women with treated hypertension who were drawn from the Spanish Ambulatory Blood Pressure Registry. For each participant, we obtained office blood pressure (BP) (average of 2 readings) and 24-hour ambulatory BP (average of measurements performed every 20 minutes during day and night).

Results

Only 16.4% of women and 14.7% of men had both office (<140/90 mm Hg) and ambulatory (<130/80 mm Hg) BP controlled (P < .001). Women had a lower frequency of masked hypertension (office BP < 140/90 mm Hg and ambulatory BP ≥ 130/80 mm Hg) than men (5.9% vs 7.9%, P < .001). Women had a higher frequency of isolated office hypertension (office BP ≥ 140/90 mm Hg and ambulatory BP < 130/80 mm Hg) (32.5% vs 24.2%, P < .001). Although office BP control (office BP < 140/90 mm Hg, regardless of ambulatory values) was similar in women and men (22.3% vs 22.6%, P = .542), ambulatory BP control (ambulatory BP < 130/80 mm Hg, regardless of office values) was higher in women than in men (48.9% vs 38.9%, P < .001). After adjustment for age, number of antihypertensive drugs, hypertension duration, and risk factors, gender differences in BP control remained practically unchanged.

Conclusion

Ambulatory BP control was higher in women than in men. This may be due to the higher frequency of isolated office hypertension in women, and it is not explained by gender differences in other important clinical characteristics.