Predicting the dynamics of elevated arterial pressure in 12--13-year-old children of Kaunas and Berlin

The increased arterial blood pressure (BP) variation between 12-13 and 15-16 years of age was examined in 119 schoolchildren of Kaunas and 169 schoolchildren of Berlin. The 90th percentile for systolic and/or diastolic BP was used as a criterion of increased arterial BP. The data were treated by multivariate logistical regression analysis. Independent samples were used to construct and test the model. The reproducibility of increased arterial BP was shown to be affected by physical developmental status as well as baseline systolic and diastolic BP, the influence being more pronounced in girls, as compared to boys. The derived formulas are presented as a nomogram to facilitate their practical application.     

Arterial pressure and race. A study in pauper children attending schools in an urban strip in Lisbon]

OBJECTIVE: To determine whether race is a factor of blood pressure levels in school-age children of similar social status, and to investigate other potential determinants of the levels of blood pressure. DESIGN: Inquiry in schools of the suburbs of Lisbon. SETTING: Three schools, four medical observers (general practitioners with school-health functions). SUBJECTS: Three hundred ninety seven children, aged 6-14 years, both sexes, 296 being white and 101 non-white. INTERVENTIONS: Inquiry to the following individual characteristics--sex, age, race, birthplace, type of housing, house availability of water, electricity and waste water, type of transportation to school, number of cohabitans, family income, school marks. Individual determination of systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), weight and height. MEASUREMENTS AND MAIN RESULTS: Blood pressure values were cross-analyzed with all the determined variables, and the virtual correlations were checked. Main results as follows: Race does not influence either SBP or DBP. In this age group, sex does not influence blood pressure values. The used markers of socioeconomical status have equally no influence on blood pressure. Age has only a significant repercussion on SBP. No significant correlation was found between height and blood pressure. Body weight, however, influence either SBP or DBP. SBP was found to be lower in the second of two successive measurements, and the difference increases with age. CONCLUSIONS: In this school-aged biracial population, body weight seems to be the major factor of blood pressure levels, in the sense-bigger weight, higher SBP and DBP.     

Lowering of blood pressure leads to decreased circulating interleukin-6 in hypertensive subjects

Interleukin-6 (IL-6), the major proinflammatory cytokine, has been described to be associated with the hypertensive and atherosclerotic states. We aimed to explore whether the concentration of circulating IL-6 and adhesion molecules could be modified by decreasing blood pressure in hypertensive subjects. A total of 30 subjects (18 men), aged 34-48 years, were enrolled in this study, 17 hypertensive never-treated patients (HTA) and 13 normotensive subjects (C). HTA subjects were treated with irbesartan, 150-300 mg/day for 3 months, and serum IL-6, vascular cell adhesion molecule-1, intercellular adhesion molecule-1, sP-selectin, sE-selectin and monocyte chemoattractant protein-1 were measured at 0 and 12 weeks. The two study groups were similar in age, body mass index (BMI) and gender. At baseline, circulating IL-6 levels, but not adhesion molecules, were significantly associated with systolic blood pressure (r=0.41; P=0.03) and BMI (r=0.53; P=0.005). Systolic and diastolic blood pressure decreased significantly (P<0.01) in parallel to serum IL-6 levels (from 3.72+/-0.82 to 3.23+/-0.19 pg/ml, P=0.02) reaching a similar concentration to normotensive patients (3.33+/-0.3 pg/ml) after treatment with irbesartan. No significant changes were observed in any other of the tested parameters. In conclusion, the treatment of high blood pressure lowers circulating IL-6 in young hypertensive patients.     

Chlamydia pneumoniae and newly diagnosed asthma: a case-control study in 1 to 6-year-old children

OBJECTIVE: The aim of the study was to evaluate the association between antibodies to Chlamydia pneumoniae and the onset of asthma in children. METHODOLOGY: In 1996-2000, 122 children aged 1-6 years, who were treated for new asthma as inpatients or outpatients in our hospital, were recruited. For each patient, two controls, matched by age, sex and municipality, were randomly selected from the same population. In 2000, 104 serum samples were available from patients (85%) and 120 from controls (49%) for microimmunofluorescence (MIF) assay for C. pneumoniae and C. trachomatis antibodies, and for enzyme immunoassay (EIA) for C. pneumoniae antibodies. RESULTS: In EIA, the median IgG concentrations were 20 EIU (EIA units) in the patients, and 16 EIU in the controls. IgG was positive (> 30 EIU) in 37 (36%) patients and in 36 (31%) controls. IgA was positive (> 12 EIU) in four (4%) patients and in eight (7%) controls. In MIF, four (4%) patients and seven (6%) controls were IgG positive, and seven were also IgA positive. IgM antibodies were detected in four children by EIA, and in none by MIF. CONCLUSION: IgG antibodies to C. pneumoniae, though common in 1 to 6-year-old children as detected by EIA, did not differ between newly diagnosed asthma patients and controls in this case-control study.     

Components of arterial stiffness in a population of 65-year-old subjects: PROOF study

OBJECTIVES: Arterial stiffness increases with age, diabetes and hypertension, and is linked to the occurrence of cardiovascular complications, independently of traditional risk factors. The important influence of age and blood pressure on arterial stiffness and cardiovascular risk complicates analysis of factors involved in increased arterial stiffness. Study of the PROOF cohort supplied further information by analysis of subjects of identical age using a method that eliminates the immediate influence of blood pressure on pulse wave velocity. METHODS: The PROOF cohort comprised 1011 subjects, aged 65 years, from the city of Saint-Etienne (France). All benefited from 24-h ambulatory blood pressure monitoring coupled with measurement of QKD interval. Ambulatory Arterial Stiffness Index and QKD(100-60), were calculated for each recording. Measurements were performed again 2 years later. RESULTS: Height-predicted QKD(100-60) was correlated with pulse pressure and the presence of diabetes. We found no significant influence of sex, current smoking or total serum cholesterol. Ambulatory Arterial Stiffness Index, whether it was height predicted or not, only had a significant relationship with blood pressure. Two years later, although the QKD(100-60) remained stable for the overall population, it was reduced in the normotensive subjects. Over the whole population, there was a correlation between the changes in 24-h systolic blood pressure and QKD(100-60). CONCLUSION: QKD(100-60), an isobaric index of arterial stiffness, is significantly linked to blood pressure and blood sugar levels in a population of 65-year-old subjects. Two years later, the arterial stiffness increased significantly in the normotensive subjects, whereas it remained stable in the hypertensive subjects.     

Simkania negevensis and newly diagnosed asthma: a case-control study in 1- to 6-year-old children

BACKGROUND: Simkania negevensis is an intracellular bacterium, sharing many characteristics with Chlamydophila and Chlamydia species. S. negevensis infection has been associated with bronchiolitis in infants and with pneumonia and exacerbations of COPD in adults. OBJECTIVE: The aim of the present study was to evaluate, in a case-control setting, whether S. negevensis serology had any association with the onset of asthma in children. METHODS: S. negevensis-specific IgM, IgA and IgG antibodies were measured by microimmunofluorescence in 104 children below school-age with newly diagnosed asthma, and in 122 control children. RESULTS: S. negevensis-specific IgM was detected in two (2%) cases and in nine (8%) of the controls. IgG was detected in 12 (12%) cases and 12 (10%) of the controls. IgA antibodies were absent in all children. The age distribution of the 35 children with S. negevensis-specific antibodies was even, the positivity rate being 11% in the 12- to 23-month-old group and 20-23% in the children aged between 2 and 5 years. CONCLUSION: Although S. negevensis appears to cause infections in the Finnish preschool-aged population, there was no association with asthma.     

Mean arterial pressure at 11(+0) to 13(+6) weeks in the prediction of preeclampsia

This study aimed to determine the performance of screening for preeclampsia (PE) by maternal medical history and mean arterial pressure (MAP) at 11(+0) to 13(+6) weeks. In 5590 women with singleton pregnancies attending for routine care at 11(+0) to 13(+6) week's gestation we recorded maternal variables and measured the MAP. We excluded 397 because they had missing outcome data or the pregnancies resulted in miscarriage or termination. In 104 patients there was subsequent development of PE, 97 developed gestational hypertension, 574 delivered small-for-gestational-age newborns, and 4418 were unaffected by PE, gestational hypertension, or small for gestational age. A multivariate Gaussian model was fitted to the distribution of log multiple of the median MAP in the PE and unaffected groups. Likelihood ratios for log multiple of the median MAP were computed and used together with maternal variables to produce patient-specific risks for each case. Detection rates and false-positive rates were calculated by taking the proportions with risks above a given risk threshold. In the unaffected group, log MAP was influenced by maternal age, ethnic origin, smoking, family and personal history of PE, and fetal crown-rump length. In the prediction of PE, significant contributions were provided by log multiple of the median MAP, ethnic origin, body mass index, and personal history of PE. The detection rate of PE by log multiple of the median MAP and maternal variables was 62.5% for a false-positive rate of 10%. Maternal variables, together with MAP, at 11(+0) to 13(+6) weeks identify a group at high risk for development of PE.     

Association between blood pressure and mortality in 80-year-old subjects from a population-based prospective study in Japan.

Hypertension is one of the greatest risk factors for cardiovascular disease, but the contribution of high blood pressure to cardiovascular morbidity and mortality is weakened with aging. In the present study, we examined whether high blood pressure would be a risk factor for total and cardiovascular mortality in a group of very elderly Japanese. Six hundred and thirty-nine participants who were 80 years old in 1997 were enrolled. The subjects were divided into three groups on the basis of their systolic blood pressure (SBP) (below 140 mmHg [group 1, n=212], from 140 mmHg to 159 mmHg [group 2, n=217], over 160 mmHg [group 3, n=210]). During the 4-year follow-up period, 87 individuals died and 24 of these deaths were due to cardiovascular diseases. Cox multivariate regression analysis revealed that there was no association between total mortality and SBP levels (relative risk [RR] 1.71; confidence interval [CI] 0.81-3.58; group 3 compared with group 1, p=0.35). However, the subjects taking antihypertensive medication showed significantly higher mortality with increasing SBP level (RR 5.72, CI 1.03-31.6, p=0.04, group 3 compared with group 1). Furthermore, in the subjects with a cardiovascular disease such as angina or stroke, high SBP increased the total mortality (RR 13.4, CI 2.39-75.1, p=0.004, group 3 compared with group 1). The present study did not find an association between blood pressure and mortality in the very elderly. However, our results did suggest that high SBP increases the risk of mortality in patients with cardiovascular diseases and/or taking antihypertensive medication.     

Changes in leucocyte sodium transport in normotensive relatives of hypertensive subjects. Dissociation from blood pressure

It has been postulated that depressed membrane sodium transport is a necessary step in blood pressure elevation in essential hypertension. Accordingly, leucocyte sodium efflux-rate constants were estimated in 14 normotensive subjects who had one or more first-degree relatives with essential hypertension, and also in 14 matched control subjects with no such family history, before and after taking bendrofluazide for 7 days. Efflux rates in the controls did not change after the diuretic. However, in the relatives, mean total sodium efflux-rate constant was at first significantly depressed but later rose to normal with the diuretic. This was due almost entirely to an increase in glycoside-sensitive sodium pump activity. Blood pressure remained unchanged in both groups. Thus, assuming that perturbations in leucocytes reflect similar abnormalities in other cell lines, major changes in sodium transport in the normotensive individual without accompanying changes in blood pressure suggest that, while these changes may be a marker for later hypertension, they do not participate directly in blood pressure control.     

The regulation of urinary free 19-nor-deoxycorticosterone and its relation to systemic arterial blood pressure in normotensive and hypertensive subjects

19-Nor-deoxycorticosterone (19-nor-DOC) is a naturally occurring, potent mineralocorticoid present in hypertensive animal models as well as man. To investigate 19-nor-DOC's regulation and possible pathogenesis in hypertension, urinary free (UF) 19-nor-DOC was measured in 14 hypertensives, correlated with other corticosteroids and systemic arterial blood pressure (BP), and compared to basal and ACTH-stimulated values in 8 normotensive subjects. Seven of the 14 hypertensives had low-renin hypertension, 2 had primary aldosteronism, 1 had an adrenal carcinoma, and another had acromegaly. These studies determined that: 1) although the mean UF 19-nor-DOC was not increased in hypertensives (588 +/- 180 vs. 428 +/- 122 ng/day), 2 low-renin hypertensives had quite elevated levels (2186 and 2018); 2) the UF 19-nor-DOC in hypertensives was correlated with BP but not with PRA, aldosterone secretion, plasma potassium, basal plasma cortisol, or 17-hydroxycorticosteroids; 3) likewise, in normotensives, UF 19-nor-DOC did not correlate with basal plasma cortisol, cortisol secretion, or 17-hydroxycorticosteroids excretion but did correlate after ACTH stimulation. Therefore, although 19-nor-DOC is activated by ACTH administration, it is not correlated with basal parameters of cortisol production, suggesting that factors other than ACTH regulate basal 19-nor-DOC secretion. Furthermore 19-nor-DOC is elevated in some hypertensive patients, and it is directly related to the elevation of mean systemic BP. This suggests that, although 19-nor-DOC could contribute to hypertensive disease in some individuals, it does not appear to be due to excess ACTH.     

Assessment of arterial stiffness from ambulatory blood pressure monitoring in children with diabetes mellitus type-1 (DMT1)

Pulse pressure (PP) and ambulatory arterial stiffness index (AASI) can be calculated from ambulatory blood pressure (BP) monitoring (ABPM) and have been suggested as markers of arterial stiffness and predictors of cardiovascular mortality. We retrospectively evaluated PP and AASI from ABPM records in 84 children (43 boys) with diabetes mellitus type-1 (DMT1) compared with 27 non-diabetic normotensive children. Based on office BP and ABPM, patients with DMT1 were divided into three groups: 24/84 (29%) had hypertension (DM HTN), 33/84 (39%) were normotensive (DM NT) and 27/84 (32%) had white-coat hypertension (DM WCH). DM WCH and DM HTN patients had significantly higher PP when compared with DM NT and NT patients alone (47.62 ± 7.31 and 47.43 ± 8.68 versus 41.45 ± 4.44 and 42.18 ± 5.97, respectively, P=0.0002). Similarly, AASI was significantly elevated in both DM WCH and DM HTN patients when compared with NT patients (0.35 ± 0.14 and 0.36 ± 0.15 versus 0.23 ± 0.15, respectively, P=0.007). In conclusion, children with DMT1 and hypertension, including WCH, had significantly higher PP and AASI levels when compared with normotensive patients. This suggests that these children may be at an increased risk for developing cardiovascular complications later on in life.     

Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study

Anatomical abnormalities of the cervical spine at the level of the Atlas vertebra are associated with relative ischaemia of the brainstem circulation and increased blood pressure (BP). Manual correction of this mal-alignment has been associated with reduced arterial pressure. This pilot study tests the hypothesis that correcting mal-alignment of the Atlas vertebra reduces and maintains a lower BP. Using a double blind, placebo-controlled design at a single center, 50 drug na?ve (n=26) or washed out (n=24) patients with Stage 1 hypertension were randomized to receive a National Upper Cervical Chiropractic (NUCCA) procedure or a sham procedure. Patients received no antihypertensive meds during the 8-week study duration. The primary end point was changed in systolic and diastolic BP comparing baseline and week 8, with a 90% power to detect an 8/5 mm Hg difference at week 8 over the placebo group. The study cohort had a mean age 52.7+/-9.6 years, consisted of 70% males. At week 8, there were differences in systolic BP (-17+/-9 mm Hg, NUCCA versus -3+/-11 mm Hg, placebo; P<0.0001) and diastolic BP (-10+/-11 mm Hg, NUCCA versus -2+/-7 mm Hg; P=0.002). Lateral displacement of Atlas vertebra (1.0, baseline versus 0.04 degrees week 8, NUCCA versus 0.6, baseline versus 0.5 degrees , placebo; P=0.002). Heart rate was not reduced in the NUCCA group (-0.3 beats per minute, NUCCA, versus 0.5 beats per minute, placebo). No adverse effects were recorded. We conclude that restoration of Atlas alignment is associated with marked and sustained reductions in BP similar to the use of two-drug combination therapy.     

Arterial pulse pressure in relation to the duration of type 1 diabetes: a cross-sectional controlled study

Diabetes mellitus and arterial pulse pressure (PP) are two independent cardiovascular risk factors. This cross-sectional study investigated the influence of diabetes duration on PP in type 1 diabetic patients without any cardiovascular disease. PP was measured continuously during 3 minutes (active orthostatic test: 1 min standing--1 min squatting--1 min standing) using a fingertip plethysmograph (Finapres) in 159 type 1 diabetic patients aged 20-60 yrs. They were divided into 4 groups according to diabetes duration: (1) G1 : <10 yrs (n=39); G2: 11-20 yrs (n=45); G3: 21-30 yrs (n=57); and G4: >30 yrs (n=18). In order to separate the effects of age from the effects of diabetes duration, diabetic patients were compared to age- and sex-matched non diabetic controls. PP (expressed in mmHg; mean +/- SD) was higher in men than in women in both diabetic (58 +/- 15 vs. 50 +/- 14; p = 0.001) and non diabetic subjects (55 +/- 14 vs. 47 +/- 12; p = 0.001). Overall PP was higher in diabetic than in non diabetic individuals (54 +/- 15 vs. 50 +/- 13; p = 0.025). PP progressively increased according to diabetes duration: 47 +/- 16 vs. 51 +/- 13 vs. 59 +/- 14 vs. 62 +/- 12, from G1 to G4 respectively; p < 0.0001. Such an increase was not observed in age-matched non diabetic subjects: 50 +/- 11 vs. 52 +/- 12 vs. 49 +/- 14 vs. 52 +/- 18, from G1 to G4, respectively; NS. PP was higher in squatting than in standing position in non diabetic subjects (52 +/- 16 vs. 47 +/- 13; p < 0.0001) and even more in diabetic patients (59 +/- 17 vs. 50 +/- 14; p < 0.0001). Overall, PP difference between diabetic and non diabetic individuals was not significant in standing position (50 +/- 14 vs. 47 +/- 13; NS) although it became highly significant in squatting position (59 +/- 17 vs. 52 +/- 16; p = 0.0005). The squatting-standing difference in PP markedly increased with diabetes duration: 69 +/- 14 during squatting vs. 50 +/- 18 during standing in G4 compared to respectively 50 +/- 17 vs. 44 +/- 15 in G1 diabetic patients. Finally, PP was similar (NS) in diabetic patients with HbA1c < 8% (54 +/- 14) or > or =8% (55 +/- 16), with (57 +/- 17) or without (54 +/- 14) microalbuminuria, treated (56 +/- 14) or not (54 +/- 15) by inhibitors of the renin-angiotensin system. In conclusion, PP progressively increased with the duration of type 1 diabetes, independently of age. Such increase was more marked in squatting than in standing position. The role of such PP rise in the increased cardiovascular risk of patients with type 1 diabetes, although suspected in the recent EURODIAB Prospective Complications Study, deserves further investigation.     

Early effects of cigarette smoking in hypertensive and normotensive subjects. An ambulatory blood pressure and thermographic study

BACKGROUND: Among the acute effects of cigarette smoking there are an increase in the arterial blood pressure and a decrease in skin temperature. The aim of this study is to evaluate whether these effects are more evident in hypertensive subjects (HTS) than in normotensive (NTS) ones. METHODS: A monitored Ambulatory Blood Pressure method, an Agema 880 Thermograph and a Surgitron thermal stimulator have been employed. Ten NTS males and 10 HTS, age paired (50-60 years, mean 57.8), were examined. Area of interest, the volar face of the fingertips. The pressural and thermographic tests were performed with patients staying in a proper room for 2 h, smoking consecutively 4 cigarettes, one every 14 min. The tests were made at 0 time (baseline), after smoking each cigarette and, finally, 60' after the beginning of the last one. RESULTS: A rise in blood pressure and a fall in skin thermal gradients both in HTS and in NTS was seen since the first cigarette, and these values, more evidently in hypertensive subjects, were appeared progressively increased along with the other 3 cigarettes. CONCLUSIONS: These results confirm the damage of smoking on peripheral blood vessels verified and also the cumulative effect of smoking more cigarettes. The similar increased percentage of ABP and telethermography (TT) values in these tests lead us to consider TT as a routinary method for the evaluation of a more general vascular damage provoked by cigarette smoking. Also, the immediate visual thermal effect (=thermal amputation) after smoking is very useful in smoking educative programs.     

Spirometry in an unselected group of 6-year-old children: the DARC birth cohort study

This study presents reference equations for spirometric parameters in 6-year-old children and evaluates the ability of spirometry to discriminate healthy children from children with asthma. Baseline spirometry and respiratory symptoms were assessed in 404 children participating in a longitudinal birth cohort study. Children with known asthma, possible asthma and a control group also performed bronchodilator measurements. At least two acceptable flow-volume curves at baseline were obtained by 368/404 children (91%). The two best values for FEV1 and FVC were within 5% of each other in 88% and 83% of children, respectively. Linear regression analyses for 242 children included in the reference population demonstrated height to be the main predictor of all spirometric indices except FEV1/FVC. FEV1, FEV75, and FVC correlated reasonably to anthropometric data in contrast to flow parameters. Gender differences were found for FEV1, FVC, and FEV75, but not for flow parameters. Asthma was diagnosed in 25/404 children. Baseline lung function in healthy children and children with asthma overlapped, although asthmatic children could be discriminated to some extent. Bronchodilator tests showed a difference in Delta FEV1(mean) between healthy children and children with asthma (3.1% vs. 6.1%, P < 0.05). At a cut-off point of Delta FEV1 = 7.8%, bronchodilator tests had a sensitivity of 46% and a specificity of 92% for current asthma. Spirometry including bronchodilator measurements was demonstrated to be feasible in 6-year-old children and reference values were determined. Spirometry aids the diagnosis of asthma in young children, but knowledge on sensitivity and specificity of these measurements is a prerequisite.     

Greater change of orthostatic blood pressure is related to silent cerebral infarct and cardiac overload in hypertensive subjects.

Greater change of postural blood pressure (BP) is often seen in elderly hypertensives and is recognized as a risk factor for cognitive decline and poorer cerebrovascular outcome, but its clinical significance still remains to be clarified. We performed a head-up tilting test, ambulatory BP monitoring, and brain MRI in 59 hypertensives and 27 normotensive subjects. We measured plasma atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels at rest to assess cardiac burden. The 59 hypertensive patients were classified into 3 groups: an orthostatic hypertension (OHT) group with orthostatic increase in systolic BP (SBP) > or = 10 mmHg (n=16); an orthostatic hypotension (OHYPO) group with orthostatic SBP decrease < or = -10 mmHg (n=18); and an orthostatic normotension (ONT) group with neither of these two patterns (n=25). A group of 27 normotensive subjects (NT) was also included as a control. Plasma BNP (72 +/- 92 vs. 29 +/- 24 pg/ml, p < 0.05) and BNP/ANP ratio (4.6 +/- 3.3 vs. 2.4 +/- 1.5, p < 0.05) were significantly higher in the OHYPO than in the NT group. The BNP/ANP ratio was also higher in the OHT than in the NT group (5.1 +/- 3.9 vs. 2.4 +/- 1.5, p < 0.01). The number of silent cerebral infarct (SCI), prevalence of SCI and number of multiple SCIs was the highest in the OHT group, followed in order by the OHYPO, ONT and NT groups. Blood pressure and left ventricular mass index were not significantly different among the 3 hypertensive groups. In conclusion, hypertensive patients with greater change of postural BP (OHT and OHYPO) were shown to have increased risk of advanced silent brain lesions and greater cardiac burden.