Prevalence and clinical correlates of ambulatory blood pressure phenotypes in a Saudi hypertensive population

International Guidelines recommend ambulatory blood pressure monitoring (ABPM) for the management of hypertension. ABPM phenotypes predict outcomes independent of office blood pressure (BP). The authors explored the prevalence and clinical correlates of ABPM phenotypes and relationship with office BP in Saudi patients (n = 428, mean age 53.5 ± 14.6, 55% male) referred to a Specialist Hypertension clinic in Riyadh, Saudi Arabia. ABPM phenotypes included sustained normotension (27%), masked hypertension, MHT(32%), sustained hypertension, SHT(52%), and white coat hypertension(2.6%). MHT was more prevalent using asleep than 24‐hours (26.4% vs 12.9%, P < .01) or awake BP (26.4% vs 8.5%, P < .001) and observed in 85% of pre‐hypertensive patients. Isolated nocturnal hypertension was more prevalent in MHT vs SHT (70% vs 30%, P < .001). Office BP overestimated control rates compared with ABPM (48% vs 12.9%, P < .001). Our study shows that one in three Saudi patients will be managed inappropriately if office BP alone was relied upon for management of hypertension.     

Pharmacist‐physician collaborative care model and time to goal blood pressure in the uninsured population

Pharmacist‐physician collaborative practice models (PPCPMs) improve blood pressure (BP) control, but their effect on time to goal BP is unknown. This retrospective cohort study evaluated the impact of a PPCPM on time to goal BP compared with usual care using data from existing medical records in uninsured patients with hypertension. The primary outcome was time from the initial visit to the first follow‐up visit with a BP <140/90 mm Hg. The study included 377 patients (259 = PPCPM; 118 = usual care). Median time to BP goal was 36 days vs 259 days in the PPCPM and usual care cohorts, respectively (P < .001). At 12 months, BP control was 81% and 44% in the PPCPM and usual care cohorts, respectively (P < .001) and therapeutic inertia was lower in the PPCPM cohort (27.6%) compared with usual care (43.7%) (P < .0001). Collaborative models involving pharmacists should be considered to improve BP control in high‐risk populations.     

21322名科技人员血压分类及其与临床心电图诊断类型的关系

目的　研究科技人员的血压水平及其与临床心电图类型的关系。方法　对中国科学院的 2 132 2名科技人员进行了查体 ,计算不同性别的血压分类及高血压患病率 ,分析不同血压水平的临床心电图表现。结果　 (1)血压水平随年龄增高而增高 ,收缩压平均为男 (12 1 3± 2 0 5 )mmHg(1mmHg =0 133kPa) ,女 (116 3± 2 3 4)mmHg ,舒张压平均为男 (79 9± 2 7 8)mmHg ,女 (76 0± 2 7 30mmHg ,均为男性显著高于女性 (P <0 0 1)。 (2 )男性正常高限血压占 10 1% ,高血压病占 2 8 8% ;女性正常高限血压占 8 5 % ,高血压病占 2 0 4% ,男性高血压病患病率显著高于女性 (P <0 0 1)。经过年龄调整后 ,仍存在这种关系。 (3)随着血压升高 ,临床心电图异常分类如左室肥厚、左室高电压、ST T改变、束支传导阻滞、陈旧性心梗、室性早搏等的检出率显著升高。结论　随着血压升高 ,临床心电图异常特别是心室性异常心电图的发生率显著升高。血压达正常高限时 ,临床心电图异常的检出率已开始升高。     

Ambulatory blood pressure monitoring in a young population

Ambulatory twenty four hour blood pressure monitoring (ABPM) is an exact method, enabling by repeated measurements to create blood pressure profile, which shows a close correlation with end organ damage. Normal values were taken from clinical trials, where the mean age of probands was highly above 30 years. The aim of this trial was to determine mean values for ABPM in population aged 18-30 years and to create "normal values" for this population. We have examined 162 probands. The mean office blood pressure was 128.18 +/- 11.2/82.91 +/- 8.29 mm Hg, the mean ABPM (24 hours) was 118.51 +/- 9.11/70.59 +/- 6.30 mm Hg. Systolic, mean and pulse pressure was significantly higher in males. Systolic and pulse blood pressure showed a close correlation with height, weight, waist and waist/hip ratio (r = 0.40-0.47). The upper value of 24 hour BP in young population is between 125/75 mm Hg and 130/80 mm Hg according to our results.     

Sports and blood pressure: association in a population of wage-earners

In a cross-sectional epidemiological survey, we examined the association between the practice of sports and blood pressure (BP). The study included 3,388 male employees (representing 90.1% of the target population) who were questioned about their habitual sports activity, in terms of average duration per week and intensity. The proportion of subjects who stated to engage in sports activity decreased with age, from 50.9% in the age class 20-29 years to 16.4% in the age class 50-59 years. We found a negative relationship between both systolic and diastolic BP and the weekly duration of sports activity. However this association increased with age and reached the statistical significance only in the age classes 40-49 years and 50-59 years (p less than 0.01 and p less than 0.001, respectively). Similar results were obtained when intensity of sports was used instead of duration. In order to test the independence of the observed association, the duration of sports activity (hours/week) was included as an independent variable in a multiple linear regression analysis, along with the following potential confounders: age, Quetelet index, alcohol consumption, cigarette smoking, heart rate, and level of education. In this analysis the sports-BP relationship was considerably attenuated or entirely disappeared. It remained statistically significant only in the age class 50-59 (p less than 0.01 for systolic BP an p less than 0.05 for diastolic BP). Our results support those of others showing a modest beneficial effect of leisure time physical exercise on BP.(ABSTRACT TRUNCATED AT 250 WORDS)     

Home blood pressure measurement and its relationship with blood pressure control in a large selected hypertensive population

Despite the impressive increase of home blood pressure monitoring (BPM) among hypertensive patients over the last few years, a limited number of studies have analysed the rate of home BPM and its relationship with target blood pressure (BP) control, in representative samples of the hypertensive population. The objectives of the study were first to evaluate the prevalence of home BPM in a large selected group of treated hypertensive patients referred to our outpatient hypertension hospital clinic. Second, to assess the rate of satisfactory clinic BP control in patients with or without familiarity with home BPM. In all, 1350 consecutive hypertensive patients who attended our hypertension centre during a period of 12 months and were regularly followed up by the same medical team were included in the study. After informed consent all patients underwent the following procedures: (1) accurate medical history (implemented by a structured questionnaire on demographic and clinical characteristics, including questions concerning home BPM); (2) physical examination; (3) clinic BP measurement; (4) routine examinations; and (5) standard 12-lead electrocardiogram. A total of 897 patients (66%) out of 1350 (687 men, 663 women, age 58.6 +/- 12.3 years, mean clinic BP 141 +/- 16/87 +/- 9 mmHg ) were regularly practising home BPM. In this group of patients, home BPM was associated with a significantly greater rate of satisfactory BP control (49.2 vs 45.6%, P < 0.01). Patients performing home BPM were more frequently men (54 vs 46%, P < 0.02 ) younger (average age 57.8 +/- 12.0 vs 60.3 +/- 12.7 years, P < 0.001) and with a higher educational level (defined by more than 8 years of school, 71 vs 55%, P < 0.05) than their counterparts. There were no significant differences in duration of hypertension, hypercholesterolaemia, obesity, smoking, diabetes, associated cardiovascular diseases, left ventricular hypertrophy and compliance with drug treatment. This study demonstrates that: (1) home BPM is widely performed by hypertensive patients managed in a hypertension hospital clinic; (2) this practice is associated with a significantly higher rate of clinic BP control; and (3) age, male gender and educational level influence the adoption of home BPM.     

Sleep status and blood pressure in a healthy normotensive female population

Sleeplessness can be linked to hypertension and its consequent complications such as cardiovascular disease. We investigated the cross-sectional relationship between blood pressure (BP) and self-reported sleep status among 227 healthy normotensive Japanese females (mean age: 47.0 years) in a clinical setting. Multiple logistic regression analysis for the highest quartile of diastolic BP (DBP) showed the body mass index (BMI) (odds ratio=1.26 [95% confidence interval=1.12-1.41]) and sleep status (sometimes lack: 2.19 [1.00-4.79], poor: 2.82 [1.17-6.80]) as significantly associated factors. The same analysis for systolic BP or pulse pressure showed that both age and BMI were significant factors and sleep status was not associated. A poorer sleep status may contribute to elevated DBP in healthy normotensive females.     

糖尿病患者的血压控制目标

糖尿病的患病率在全世界范围都在不断地增长,成为一个非常重要的公共卫生问题。在中国,由于经济的高速发展、生活水平的快速提高,人均寿命的不断延长,糖尿病的发病率的增高速度更快,甚至超出了我们的想象。据杨文英教授新近发表的有关中国糖尿病患病率的文献报道,中国20岁以上的成年人中2型糖尿病的人数可以达到9200万,另外还有将近1500万的糖尿病前期患者。中国将成为或者可能已经是世界上糖尿病人数最多的国家。     

Relation between blood pressure and smoking in a population of Quebec workers

Relations between blood pressure and cigarette smoking were investigated on the basis of a health survey conducted in a population of 3034 mine workers from Quebec Province. Blood pressure was found to be lower among smokers than among non-smokers, the difference between these two groups being: systolic pressure 2.3 mmHg, diastolic pressure 3.0 mmHg. After adjustment for age and bodyweight this relation persisted but only as far as diastolic pressure was concerned. The prevalence of hypertension was 1.5 times higher in non-smokers than in smokers. On the other hand, the number of cigarette-smoking years and the number of cigarettes smoked per day seemed to have little effect on mean arterial pressure.     

Burden of concomitant asthma and COPD in a Medicaid population

BACKGROUND: Asthma and COPD can significantly affect patients and pose a substantial economic burden for both patients and managed-care plans. This study compares utilization outcomes in patients with asthma, COPD, or co-occurring asthma and COPD in a Medicaid population, and assesses the incremental burden of COPD in patients with asthma. METHODS: We queried medical claims of Medicaid patients aged 40 to 64 years with asthma and/or COPD filed between January 1, 2001, and December 31, 2003, from encounter data. COPD patients were identified based on at least one claim with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) codes 491, 492, 496; and asthma patients were identified on the basis of ICD-9 code 493 as diagnosis. We analyzed annual utilization and cost of hospitalizations, physician, and outpatient services attributable to asthma and/or COPD. RESULTS: The analysis included a total of 3,072 asthma, 3,455 COPD, and 2,604 COPD/asthma patients. COPD/asthma co-occurring disease has higher utilization of any service type than either disease alone. Compared with asthma patients, COPD patients were 16% and 51% more likely to use physician (odds ratio [OR], 1.16; 95% confidence interval [CI], 1.01 to 1.34) and inpatient services (OR, 1.51; 95% CI, 1.31 to 1.74), respectively; and 60% less likely to use outpatient services (OR, 0.40; 95% CI, 0.35 to 0.46). Compared with asthma patients, COPD patients and COPD/asthma co-occurring patients cost 50% (OR, 1.50; 95% CI, 1.3 to 1.74) and five times (OR, 5.25; 95% CI, 4.59 to 6.02) more for total medical services, respectively. CONCLUSION: Our data suggest that patients with COPD and co-occurring COPD/asthma were sicker and used more medical services than asthma patients. The incremental burden of COPD to patients with asthma is significant.     

Twenty-four hour ambulatory blood pressure in a population of elderly men

OBJECTIVES: The principal aim was to study ambulatory and office blood pressure in a population of elderly men. We also wanted to describe the prevalence of hypertension and investigate the blood pressure control in treated elderly hypertensives. DESIGN: A cross-sectional study of a population of elderly men, conducted between 1991 and 1995. SUBJECTS: Seventy-year-old men (n = 1060), participants of a cohort study that began in 1970. MAIN OUTCOME MEASURES: Office and 24 h ambulatory blood pressure. RESULTS: Average 24 h blood pressure in the population was 133 +/- 16/75 +/- 8 mmHg, and daytime blood pressure 140 +/- 16/80 +/- 9 mmHg. Corresponding values in untreated subjects (n = 685) were 131 +/- 16/74 +/- 7 and 139 +/- 16/79 +/- 8, respectively. An office recording of 140/90 mmHg corresponded to an ambulatory pressure of 130/78 (24 h) and 137/83 mmHg (daytime) in untreated subjects. In subjects identified as normotensives according to office blood pressure (n = 270), the 95th percentiles of average 24 h and daytime blood pressures were 142/80 and 153/85 mmHg, respectively. The prevalence of hypertension, defined as office blood pressure greater than or = 140/90 mmHg, was 66%. Despite treatment, treated hypertensives (n = 285) showed higher office (157/89 vs. 127/76 mmHg) and 24 h ambulatory (138/78 vs. 122/71 mmHg) pressures than normotensives (P < 0.05). Fourteen per cent of the treated hypertensives had an office blood pressure < 140/90 mmHg. CONCLUSIONS: Our results provide a basis for 24 h ambulatory blood pressure reference values in elderly men. The study confirms previous findings of a high prevalence of hypertension at older age. It also indicates that blood pressure is inadequately controlled in elderly treated hypertensives.     

Rheological determinants of blood pressure in a Scottish adult population.

OBJECTIVES: To examine the relationship of blood pressure with haematocrit, plasma viscosity, whole blood viscosity and plasma fibrinogen. DESIGN: A random population sample of 1264 men and women aged 25-64 years from the west of Scotland, UK. RESULTS: Strong correlations between age, body mass index and blood pressure were noted: these were higher for women than men. Blood viscosity, haematocrit and plasma viscosity correlated with blood pressure independently of age, body mass index and smoking status. No evidence was found for an effect of erythrocyte rigidity upon blood pressure; plasma fibrinogen showed an inverse correlation with blood pressure and the rheological variables on multivariate analysis. CONCLUSIONS: Our findings support the role of blood viscosity in determining blood pressure as suggested by other, smaller studies. The magnitude of the effect upon blood pressure levels across the normal range of blood viscosity was of clinical importance. Further studies of factors that influence blood and plasma viscosity may help in the understanding of the aetiology of essential hypertension and its management.     

Association between blood pressure and intracranial artery stenosis in a Chinese population

The association between blood pressure and intracranial artery stenosis (ICAS) in different age groups has not been elucidated. Using data from the “China Hypertension Survey,” we conducted a cross‐sectional analysis of the association between blood pressure parameters and ICAS. In this study, participants older than 35 years were selected by stratified, multistage random sampling. Blood pressure was measured repeatedly at rest, and ICAS was assessed by transcranial doppler ultrasound. Binary logistic regression analysis was used to demonstrate the association between different blood pressure indicators and ICAS. Of the 3640 participants included (mean age 63 ± 13 years old, 57.8% female), systolic blood pressure (SBP) and pulse pressure (PP) were associated with ICAS in the general population; the multivariable adjusted odds ratio (OR) and corresponding 95% confidence interval (95% CI) of ICAS and multivessel stenosis were 1.32 (1.21, 1.45) and 1.29 (1.14, 1.46) per standard deviation (SD) increase in SBP and 1.44 (1.30, 1.59) and 1.52 (1.33, 1.74) for PP, respectively. Further analysis of this association in different age groups revealed inconsistent results between SBP and ICAS. Prehypertension (120 ≤ SBP < 140) could predict ICAS in the older group but not in the younger group, and the positive association between SBP and multivessel stenosis disappeared in the younger age group (P > .05 in all SBP subgroups). In conclusion, SBP and PP could not only identify ICAS in the middle‐aged and elderly population but could also provide some information about ICAS burden; however, these associations need to be interpreted differentially based on age subgroup.     

Association between renin-angiotensin-aldosterone system-related genes and blood pressure in a Korean population

AIMS. Blood pressure control is influenced by various genetic and environmental factors, and genetic susceptibility is important in the development of essential hypertension. Because the renin-angiotensin-aldosterone system (RAAS) has a key role in vasoconstriction, vasodilation, and sodium and electrolyte balance, it is central in blood pressure control and so is an appropriate target in hypertension treatments. The present study assessed the association of RAAS-related genes with blood pressure and hypertension in a Korean population. Single nucleotide polymorphisms (SNPs, n = 114) in nine RAAS-related genes (AGT, REN, ACE, ACE2, AGTR1, CYP11B2, NR3C2, MAS1, and CMA1) were assessed for their correlation with blood pressure and hypertension using genotype data of 8842 individuals from the Korea Association Resource subject pool. MAJOR FINDINGS. Linear regression analysis revealed a statistically significant association with blood pressure of 10 SNPs in six genes (ACE, ACE2, CYP11B2, NR3C2, MAS1, and CMA1). An additional hypertension case-control study identified 10 SNPs in NR3C2 and ACE that were linked to hypertension. PRINCIPAL CONCLUSION. Three SNPs (rs11737660, rs6810951, and rs10519963) in NR3C2 correlate with both blood pressure and hypertension. Genetic polymorphisms in RAAS-related genes appear to be associated with hypertension in a Korean population.     

Relation between blood pressure and rhinitis in a Japanese adolescent population.

Recent studies have reported an association between systolic blood pressure (BP) and rhinitis. The prevalence of allergic rhinitis is 20% to 30% in Japan. The present cross-sectional study was performed to assess the relation between BP and allergic rhinitis in a sample of 2,292 male adolescent high school students who attended the annual school health examination. Of the 2,292 students (mean age, 16 years), 26.6% were considered to have allergic rhinitis based on their responses to a questionnaire, 25.1% were diagnosed with allergic rhinitis by an otolaryngologist, and 12.6% were consistently diagnosed with allergic rhinitis by both questionnaire and an otolaryngologist. There was no difference in systolic BP between subjects with and without allergic rhinitis. Diastolic BP, however, was higher in subjects without allergic rhinitis than in those with allergic rhinitis as diagnosed by questionnaire alone or by both questionnaire and an otolaryngologist. When the subjects were divided into three BP categories (normal, high normal, and hypertension) according to the criteria in the JSH 2000, the rates of allergic rhinitis were similar in the three BP categories. These findings do not confirm a relation between allergic rhinitis and systolic BP.     

Urinary cyclic GMP excretion and blood pressure levels in a general population

Dysfunction of the nitric oxide (NO) system is potentially involved in the development of hypertension, but only limited data are currently available from experimental or clinical studies. We investigated cross-sectionally the relation between urinary excretion of cyclic guanosine 3',5'-monophosphate (cyclic GMP), a second messenger of NO, and hypertension in a general population sample of Japanese men and women. The samples comprised 1541 subjects (788 men and 753 women) aged 40-79 years who participated in cardiovascular risk surveys between 1997 and 2002 and underwent a 24h urine collection. Urinary excretion of cyclic GMP was measured using a 125I-labeled cyclic GMP radioimmunoassay, and was adjusted for urinary creatinine excretion (nmol/mmol creatinine). Urinary cyclic GMP excretion was 66.0+/-62.0nmol/mmol creatinine (mean+/-S.D.). Compared with normal blood pressure individuals, the multivariate-adjusted mean value of urinary cyclic GMP excretion was significantly higher in people with moderate hypertension, but not higher in severe hypertension. Among subjects with hypertensive end-organ damage, we observed reduced urinary cyclic GMP excretion in severe hypertension and no increased excretion in moderate hypertension, compared with normal blood pressure. Although we had the limited number of subjects with severe hypertension (n=15), our data suggest that NO bioactivity may be increase in the early stage of hypertension but decreased in severe hypertension with end-organ damage.