Prevalence, awareness, treatment, and control of hypertension in the adult urban population of Tubarão, Santa Catarina, Brazil, 2003

The aim of this study was to estimate the prevalence, awareness, treatment, and control of systemic arterial hypertension in the adult urban population of Tubar?o, Santa Catarina, Brazil. The cross-sectional approach used a stratified sample, based on an initial list of electric power connections, resulting in the selection of 707 individuals over 18 years of age. A questionnaire was applied and arterial blood pressure was measured twice by medical students during home visits, using a mercury sphygmomanometer. The prevalence of arterial hypertension based on the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (arterial pressure > 140 x 90 mmHg) was 36.4%, increasing to 40.5% when including individuals on anti-hypertensive medication. Of the patients with high blood pressure, 55.6% were aware of their hypertension, 46.8% were on medication, and 10.1% had their blood pressure under control. The high estimated prevalence of hypertension, low level of unawareness, and less than ideal treatment and control levels emphasize the need for preventive measures in Tubar?o.     

Prevalence, awareness, treatment and control of hypertension in Malaysia: a national study of 16,440 subjects

STUDY DESIGN: A cross-sectional study was conducted in all states of Malaysia to determine the prevalence, awareness, treatment and control of hypertension. A stratified two-stage cluster sampling design with proportional allocation was used. METHODS: Trained nurses obtained two blood pressure measurements from each subject. Hypertension was defined as mean systolic blood pressure >140 mmHg, diastolic blood pressure >90 mmHg, or a self-reported diagnosis of hypertension and taking antihypertensive medication. All data were analysed using Stata 9.2 software and took the complex survey design into account. A two-sided P-value of <0.05 was considered to be statistically significant. RESULTS: The overall prevalence of hypertension for subjects aged 15 years was 27.8% (95% confidence interval (CI) 26.9-28.8). The prevalence of hypertension was significantly higher in males (29.6%, 95% CI 28.3-31.0) compared with females (26.0%, 95% CI 25.0-27.1). Multivariate logistic regression showed that the odds of having hypertension increased with increasing age, in males, in subjects with a family history of hypertension, with increasing body mass index, in non-smokers and with decreasing levels of education. Only 34.6% of the subjects with hypertension were aware of their hypertensive status, and 32.4 were taking antihypertensive medication. Amongst the latter group, only 26.8% had their blood pressure under control. The prevalence of hypertension amongst those aged 30 years has increased from 32.9% in 1996 to 40.5% in 2004. CONCLUSION: In Malaysia, the prevalence of hypertension is high, but levels of awareness, treatment and control are low. There is an urgent need for a comprehensive integrated population-based intervention programme to ameliorate the growing problem of hypertension in Malaysians.     

Isolated systolic hypertension in 14 communities

In the Hypertension Detection and Follow-up Program, 158,906 individuals from 14 communities around the United States had their blood pressure measured in their homes in 1972-1973. Of the total population screened, 2.4% had isolated systolic hypertension (systolic blood pressure greater than or equal to 160 mmHg and diastolic blood pressure less than 90 mmHg). Isolated systolic hypertension was present for 0.5% of those aged 30-39 years and 6.8% among those aged 60-69 years. The prevalence in blacks and women was greater than the prevalences in both whites and men. The prevalence among those taking antihypertensive medications at the time of screening was 6.1%, and 1.9% among those not on antihypertensive medications. From the individuals with "normal" diastolic blood pressure on the single home measurement (less than 90 mmHg), a random sample of 5,032 individuals were followed for mortality for eight years. Prevalence of isolated systolic hypertension was similar in this sample to that in the total. Among those not on antihypertensive medications, 8-year life table all-cause mortality rates adjusted for age, race, and sex were 17.6% for those with systolic blood pressure greater than or equal to 160 mmHg and 7.7% for those with systolic blood pressure greater than 160 mmHg. Among this population, all of whom had a diastolic blood pressure less than 90 mmHg, a multiple logistic analysis adjusting for baseline treatment status, age, race, sex, education, smoking, weight, pulse, physical activity, and systolic blood pressure revealed that each millimeter increase in systolic blood pressure was associated with approximately a 1% increase in mortality over the eight years of follow-up (p less than 0.05). Isolated systolic hypertension is both relatively common and a significant risk factor for subsequent mortality.     

Migration, blood pressure pattern, and hypertension: the Yi Migrant Study.

Rural-urban migration provides an ideal opportunity to examine the effects of environment and genes on blood pressure. The effect of migration on the Yi people of China was studied. The Yi people live in a remote mountain area in southwestern China. In 1989, blood pressure was measured in 14,505 persons (8,241 Yi farmers, 2,575 urban Yi migrants, and 3,689 Han urban residents) aged 15-89 years. Different patterns were seen for men and women. Among the men, Yi farmers had the lowest mean blood pressure, the least rise in blood pressure with age (systolic blood pressure, 0.13 mmHg/year; diastolic blood pressure, 0.23 mmHg/year), and the lowest prevalence of hypertension (0.66%). In contrast, both Yi migrant men and Han men had higher levels of mean blood pressure, rise in blood pressure with age (Yi migrants: systolic pressure, 0.33 mmHg/year; diastolic pressure, 0.33 mmHg/year; Han: systolic pressure, 0.36 mmHg/year; diastolic pressure, 0.23 mmHg/year), and prevalence of hypertension (Yi migrants, 4.25%; Han, 4.91%). Among the women, however, mean systolic pressure was higher in Yi farmers than in Yi migrants or in Han. Diastolic pressure was similar among the three groups. However, the Yi farmer women's age-related rise in blood pressure (systolic pressure, 0.06 mmHg/year; diastolic pressure, 0.14 mmHg/year) and their prevalence of hypertension (0.33%) were lower than those in the other two groups. Yi migrant women had an intermediate rise in blood pressure with age (systolic pressure, 0.37 mmHg/year; diastolic pressure, 0.23 mmHg/year) and prevalence of hypertension (2.40%). Han women had the greatest rise in blood pressure with age (systolic pressure, 0.56 mmHg/year; diastolic pressure, 0.36 mmHg/year) and the highest prevalence of hypertension (4.76%). For both men and women, the above differences were only partially explained by age, body mass index, heart rate, smoking, and alcohol use. This study, using standardized methods, demonstrates an important effect of migration on rise in blood pressure with age and on the prevalence of hypertension.     

Exposure to famine during gestation, size at birth, and blood pressure at age 59 y: evidence from the dutch famine

We compared blood pressure of individuals (mean age 59 y) born in western Holland between January 1945 and March 1946 (mothers exposed to the Dutch Famine before or during gestation; n = 359) to blood pressure of unexposed individuals born before or conceived after the famine (n = 299) or same-sex siblings of subjects in series 1 or 2 (n = 313). Mean (SD) systolic and diastolic blood pressure were 140.3 (20.3) and 85.8 (11.0) mmHg, respectively; prevalence of hypertension (prior diagnosis of hypertension or with measured systolic/diastolic blood pressure above 140/90 mmHg) was 61.8%. Birth weight was inversely related to systolic (−4.14 mmHg per kg; 95% confidence interval (CI) −7.24, −1.03; p < 0.01) and diastolic (−2.09 mmHg per kg; 95% CI −3.77, −0.41; p < 0.05) blood pressure and to the prevalence of hypertension (odds ratio 0.67 per kg, 95% CI: 0.49, 0.93) (all age- and sex-adjusted). Any famine exposure of at least 10 weeks duration was associated with elevated systolic (2.77 mmHg; 95% CI 0.25, 5.30; p < 0.05) and diastolic (1.27 mmHg; 95% CI −0.13, 2.66; p = 0.08) blood pressure and with hypertension prevalence (odds ratio 1.44; 95% CI 1.04, 2.00; p < 0.05) in age- and sex-adjusted models. Exposure to famine during gestation may predispose to the development of hypertension in middle age.     

Detection and treatment of hypertension in older individuals

The Hypertension Detection and Follow-up Program screened 34,012 individuals aged 60-69 years old in their homes in 14 communities around the United States during 1972 and 1973. The prevalence of hypertension, defined as diastolic blood pressure greater than or equal to 90 mmHg or on antihypertensive medication, was 42.1%. After a second clinic screen, 2,376 hypertensives were identified and randomized into Stepped Care, a special intensive treatment group, or Referred Care, a group referred to their usual medical care sources. These individuals were followed for five years (until they reached the ages of 65-74 years). Over the five years, 79.4% of older individuals remained under active care and 81.4% of those were at their goal diastolic blood pressure. Side-effects tended to be less frequent in older individuals than in younger ones. Older Stepped Care participants with mild hypertension (diastolic blood pressure 90-104 mmHg) had a 17.2% reduction in all-cause mortality over five years compared to Referred Care, which was primarily due to a reduction in deaths attributed to cardiovascular causes. Thus, antihypertensive treatment can be safely and beneficially administered to individuals in this age range with diastolic hypertension, including those with mild hypertension.     

The prevalence and risk factors of hypertension in Klong Toey slum and Klong Toey government apartment houses

We have investigated the prevalence and factors associated with hypertension in 976 residents of Klong Toey Slum and 909 residents of government apartment houses, aged 30 and above, selected by probability sampling after systematic household surveys with an average response rate of over 80%. Hypertensives were those who had, on at least three measurements, average diastolic blood pressure equal to or above 95 mmHg and/or systolic blood pressure equal to or above 160 mmHg or had blood pressure below 160/95 mmHg but were currently on antihypertensive medication. The prevalence of total hypertensives were found to be 17.3% and 14.0% for residents of slum and government apartment houses respectively. Men and women had more or less equal mean blood pressure and similar prevalence of hypertension. The mean systolic blood pressure increased with age while the mean diastolic blood pressure, after an initial rise with age in lower age groups, tended to level off from the age group 55-64 years upwards. Only one quarter to one third were aware of their illness and less than 15% were receiving treatment. Significant risk factors include age, duration of smoking, duration of alcohol intake, high body mass index, high Cholesterol, high Triglyceride, high Low Density Lipoprotein Cholesterol (LDLC), low High Density Lipoprotein Cholesterol (HDLC), high Total Cholesterol (TC) to High Density Lipoprotein ratio (TC/HDLC), high LDLC to HDLC ratio and diabetes mellitus. The data suggested that hypertension was an important public health problem in low socioeconomic groups in Bangkok. Some of the risk factors were related to an unhealthy lifestyle which should receive due consideration in planning for appropriate control.     

某体检人群血压水平与颈动脉斑块相关性的横断面研究

目的探讨血压水平与颈动脉斑块患病风险的相关性。方法选取2017年在解放军总医院第四医学中心进行颈部超声检查的某单位体检人群为研究对象,采集血压等生理、生化指标。将血压指标按连续变量(收缩压、舒张压和脉压差)和分类变量(是否高血压、血压分级和脉压差四分类)进行分析,采用Logistic回归模型分析该人群血压水平与颈动脉斑块的关联性。结果共纳入研究对象716名,其中男性321名(44.8%),女性395名(55.2%),高血压和颈动脉斑块的患病率分别为40.9%(293例)和40.4%(289例)。≥60岁、糖尿病、高血压以及腰围增加、收缩压、空腹血糖、糖化血红蛋白升高者的颈动脉斑块患病率更高(P<0.05)。随着血压分级和脉压差四分类水平的升高,颈动脉斑块患病风险呈现增高趋势(Ptrend<0.05)。Logistic回归模型分析结果显示,收缩压每升高1 mmHg使颈动脉斑块的患病风险增加了1.4%(95%CI:1.005~1.024);以非高血压人群为对照组,高血压人群的颈动脉斑块的患病风险增加了62.9%(95%CI:1.146~2.316),其中,女性高血压人群的颈动脉斑块患病风险增加106.3%(95%CI:1.242~3.427);以正常血压人群为对照组,正常高值、1级高血压、2和3级高血压的颈动脉斑块的患病风险分别增加了86.8%(95%CI:1.175~2.946)和84.8%(95%CI:1.098~3.110)和119.6%(95%CI:1.165~4.142);以脉压差<60 mmHg(1 mmHg=0.133 kPa)人群为对照组,脉压差≥60 mmHg组的颈动脉斑块的患病风险增加56.2%(95%CI:1.049~2.326),其中女性脉压差≥60 mmHg人群的颈动脉斑块风险增加了73.3%(95%CI:1.007~2.983);以脉压差四分类Q1(≤42 mmHg)人群为对照组,Q3(50~61 mmHg)和Q4(≥62 mmHg)人群颈动脉斑块的患病风险分别增加了92.2%(95%CI:1.173~3.149)和95.0%(95%CI:1.147~3.316)。结论血压和脉压差水平升高与颈动脉斑块患病风险升高相关联,防控血压和脉压差升高可能是防控颈动脉斑块的有效措施之一。     

Daily calcium intake and its relation to blood pressure, blood lipids, and oxidative stress biomarkers in hypertensive and normotensive subjects

Several studies revealed that low calcium intake is related to high prevalence of cardiovascular diseases such as hypertension. The prevalence of hypertension is high in Koreans along with their low dietary calcium consumption. Thus, the aim of this study was to evaluate the status of calcium intake between the hypertension and normotension groups and to investigate the correlation between dietary calcium intake and blood pressure, blood lipid parameters, and blood/urine oxidative stress indices. A total of 166 adult subjects participated in this study and were assigned to one of two study groups: a hypertension group (n = 83) who had 140 mmHg or higher in systolic blood pressure (SBP) or 90 mmHg or higher in diastolic blood pressure (DBP), and an age- and sex-matched normotension group (n = 83, 120 mmHg or less SBP and 80 mmHg or less DBP). The hypertension group consumed 360.5 mg calcium per day, which was lower than that of the normotension group (429.9 mg) but not showing significant difference. In the hypertension group, DBP had a significant negative correlation with plant calcium (P < 0.01) after adjusting for age, gender, body mass index (BMI), and energy intake. In the normotension group, total calcium and animal calcium intake were significantly and positively correlated with serum triglycerides. No significant relationship was found between calcium intake and blood/urine oxidative stress indices in both groups. Overall, these data suggest reconsideration of food sources for calcium consumption in management of the blood pressure or blood lipid profiles in both hypertensive and normotensive subjects.     

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。     

Alcohol-induced macrocytosis and blood pressure.

The effect of alcohol on blood pressure was studied prospectively in consecutive general practice patients with macrocytosis (MCV greater than or equal to 100 fl). The patients were separated into misuser and non-misuser groups on the basis of the Malm? modified Michigan Alcoholism Screening Test. There was no significant difference in the prevalence of antihypertensive medication between the misuser and non-misuser groups. When patients using antihypertensive medication were excluded and the groups were age-adjusted, male misusers (n = 95) compared to control patients (n = 22) had significantly higher diastolic (88 mmHg and 81 mmHg, respectively, P = 0.001) and systolic (146 mmHg and 137 mmHg, respectively, P less than 0.001) blood pressure values. Female misusers (n = 24), as compared to female non-misusers (n = 59) had significantly higher diastolic (83 mmHg and 82 mmHg, respectively, P = 0.04) but not systolic blood pressure values. Thus, alcohol seems to have a pressor effect predominantly among men. As 72% of men with macrocytosis were alcohol misusers and 41% of them either had elevated systolic or diastolic blood pressure, all patients with macrocytosis should be asked about their alcohol consumption and at least the males should have blood pressure measured.     

Casual blood pressure: Its relationship to several cardiovascular risk factors in middle-aged men

The relationship between casual blood pressure and other cardiovascular risk factors in presumably healthy middle-aged men (in the age range of 50–60 years) was investigated in a cross-sectional study. It was found that people with high casual blood pressure (> 160 and/or > 95 mmHg) and who have no history of previous cardiovascular disease were older, heavier, had higher heart rates and blood glucose, smoked more and had more evidence of L.V.H. on E.C.G. than a control group who had normal or borderline casual blood pressure. It was concluded that even casually found hypertension in seemingly healthy individuals is associated with higher prevalence and degree of certain behavioral, physical and biochemical parameters frequently seen in people with ischaemic heart disease.     

Prevalence of hypertension in the population of Castile-Leon (Spain)

OBJECTIVE: Cardiovascular disease causes one out of 3 deaths in Spain. Hypertension is involved in ischemic heart disease and in other diseases provoking high morbidity and mortality. The aim of the present study was to describe the prevalence of hypertension and other indicators of this disorder in Castile-Leon in 2004. METHODS: We performed a cross-sectional study in a random sample of 4,012 persons aged 15 years old or above, extracted through a two-stage, stratified design. Systolic and diastolic blood pressure was measured, a history was taken and clinical records were reviewed. A person was considered to be hypertensive when there was known hypertension (hyper-tension was recorded in the clinical records or the person was receiving treatment for hypertension) or when systolic blood pressure was 140 mmHg or more and diastolic blood pressure was 90 mmHg or more. RESULTS: The prevalence of hypertension in the population was 38.7% (95%CI: 36.5-40.9). The prevalence was higher in men (40.4% [95%CI: 37.4-43.4]) than in women (37.4% [95%CI: 34.7-40]). Hypertension was already known in 22.2%, representing 57.4% of all hypertensive individuals. In the remainder of the sample, 44% had prehypertension, 17.5% had stage 1 hypertension and 4% had stage II hypertension, according to the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure. CONCLUSIONS: The prevalence of hypertension in the population studied was consistent with that reported in other Spanish studies. A substantial proportion of hypertensive individuals were unaware of their status as such. Equally, a large proportion had prehypertension, which carries a high risk of cardiovascular disease.     

Evaluating a community-based walking intervention for hypertensive older people in Taiwan: a randomized controlled trial

OBJECTIVE: To study the effect of a community-based walking intervention on blood pressure among older people. METHOD: The study design was a randomized controlled trial conducted in a rural area of Taiwan between October 2002 and June 2003. A total of 202 participants aged 60 years and over with mild to moderate hypertension was recruited. Participants randomized to the intervention group (n=102) received a six-month community-based walking intervention based on self-efficacy theory. A public health nurse provided both face-to-face and telephone support designed to assist participants to increase their walking. Control group participants (n=100) received usual primary health care. Primary outcome was change in systolic blood pressure and secondary outcomes were exercise self-efficacy, self-reported walking and diastolic blood pressure. RESULTS: At six-month follow-up the mean change in systolic blood pressure was a decrease of 15.4 mmHg and 8.4 mmHg in the intervention and control group, respectively. The difference in mean change between the two groups was -7.0 mmHg (95% CI, -11.5 to -2.5 mmHg, p=0.002). Improvement in exercise self-efficacy scores was greater among intervention group participants (mean difference 1.23, 95% CI, 0.5 to 2.0, p=0.001). Intervention group participants were more likely to report walking more (p<0.0005) but no differences were observed in diastolic blood pressure (p=0.19). CONCLUSIONS: Among hypertensive older people, a six-month community-based walking intervention was effective in increasing their exercise self-efficacy and reducing systolic blood pressure.     

Prevalence, awareness, treatment, and control of hypertension in Japanese rural communities]

BACKGROUND: In Japan, a national survey indicated that only 7% of hypertensive patients had a blood pressure less than 140/90 mmHg. There have been no reports of studies investigating all of the prevalence of hypertension, the percentage of subjects who are aware of hypertension, the percentage being treated, and the percentage that are well-controlled (awareness, treatment and control, respectively) among hypertensives in the Japanese general population. OBJECTIVE: To investigate the prevalence of hypertension, and awareness, treatment and control of hypertension among hypertensives in a Japanese rural population. DESIGN: A cross-sectional analysis of base-line data of the Jichi Medical School Cohort Study. SETTING: Twelve rural communities is 8 prefectures in Japan. PARTICIPANTS: Community-dwelling people who participated in the health examination program in 1992-1995. MAIN OUTCOME MEASURES: Blood pressure (BP) measured once in the sitting position after a 5-minute rest using oscillometric automatic BP monitors (BP203RV-II; Nippon Colin, Japan), and history of hypertension assessed using a self-administered questionnaire. RESULTS: We analyzed data from 11,302 subjects (4,415 men and 6,887 women). The mean (standard deviation) age was 55(12) years for men and 55(11) years for women. Mean systolic BP and diastolic BP levels were, respectively, 131(21) mmHg and 79(12) mmHg for men and 128(21) mmHg and 76(12) mmHg for women. Prevalence of hypertension (systolic BP > or = 140 mmHg or diastolic BP > or = 90 mmHg or on antihypertensive medication) was 37% for men and 33% for women. Percentages for awareness (on medication or present past history), treatment and control (both systolic BP < 140 mmHg and diastolic BP < 90 mmHg) were, respectively, 39%, 27% and 10% for men and 46%, 38% and 13% for women. CONCLUSIONS: About one third of the study popUlation were hypertensive, and awareness, treatment and control of hypertension among the hypertensives were 43%, 34% and 12%, respectively. Less than half of the hypertensives were well-controlled even when measurement bias was considered. In the rural Japanese population, improvements are required with regard to awareness, treatment and control of hypertension.     

Adolescent hypertension: a follow-up study in the community

This study evaluates the acceptability, the predictive value and the utility of a hypertension screening programme for Swiss adolescents from 16 to 19 years of age, using private physicians' records as an end-point: 3,386 young people had their blood pressure (BP) measured in a standardized way: 113 teenagers were sent to their private physician, 14 patients were considered to be hypertensive, and 29 others borderline hypertensive. The predictive value of the test is 38%; the prevalence of hypertension in the screened population is 1.3%; no secondary hypertension was detected. The acceptability of the programme is good, its predictive value fair, but its utility can be questioned because of the low prevalence of hypertension in this age group and the absence of secondary or very high hypertension.     

北京市1315名公安干警血压水平流行病学分析

目的了解北京市公安干警血压水平。方法于2009年对北京市某区全部1315名在职公安干警进行血压测量等身体检查,分析血压水平及血压分级情况。结果公安干警高血压患病率为43．3％,其中I级高血压25．3％,Ⅱ级高血压12．7％,Ⅲ级高血压5．3％;正常高值血压个体占40．9％;正常血压个体占15．2％。男性血压水平高于女性（P〈0．05）,血压水平随年龄增长呈上升趋势,平均舒张压在41～50岁达到高峰。超重人群血压水平明显高于健康人群。结论公安干警血压水平高于一般人群,正常高值血压人群构成比高。     

上海市一级医院35岁以上首诊病人测血压现状调查

[目的 ]　了解上海市一级医院首诊测血压执行情况。　 [方法 ]　采用问卷及查阅病史的方法进行横断面的流行病学研究 ,共调查 19家一级医院 ,76位门诊医生、92 6份门诊病历。　 [结果 ]　各医院在该项工作的执行中存在不平衡现象 ,医生对 35岁首诊测压的认识也不尽相同 ;门诊被调查就诊人群中高血压患病率高达 44.18% ,且随年龄逐渐递增 ,各年龄组血压水平亦呈现随年龄递增趋势 ;高血压患者新检出率为 2 6 .0 1% ,新检出高血压患者中 78%血压水平处于 14 0～ 15 9和 /或 90～ 99mmHg范围。　[结论 ]　 35岁以上门诊病人中 ,高血压患病率较高 ,尤其以轻型高血压居多。加强落实和规范一级医院中 35岁首诊测压工作 ,可以提高高血压患者的早期检出率和预防并发症的发生 ,同时建议有关部门应尽快在二、三级医院开展此项工作。     

Cadmium exposure and hypertension in the 1999-2004 National Health and Nutrition Examination Survey (NHANES)

INTRODUCTION: Cadmium induces hypertension in animal models. Epidemiologic studies of cadmium exposure and hypertension, however, have been inconsistent. OBJECTIVE: We aimed to investigate the association of blood and urine cadmium with blood pressure levels and with the prevalence of hypertension in U.S. adults who participated in the 1999-2004 National Health and Nutrition Examination Survey (NHANES). METHODS: We studied participants > or = 20 years of age with determinations of cadmium in blood (n = 10,991) and urine (n = 3,496). Blood and urine cadmium were measured by atomic absorption spectrometry and inductively coupled plasma-mass spectrometry, respectively. Systolic and diastolic blood pressure levels were measured using a standardized protocol. RESULTS: The geometric means of blood and urine cadmium were 3.77 nmol/L and 2.46 nmol/L, respectively. After multivariable adjustment, the average differences in systolic and diastolic blood pressure comparing participants in the 90th vs. 10th percentile of the blood cadmium distribution were 1.36 mmHg [95% confidence interval (CI), -0.28 to 3.00] and 1.68 mmHg (95% CI, 0.57-2.78), respectively. The corresponding differences were 2.35 mmHg and 3.27 mmHg among never smokers, 1.69 mmHg and 1.55 mmHg among former smokers, and 0.02 mmHg and 0.69 mmHg among current smokers. No association was observed for urine cadmium with blood pressure levels, or for blood and urine cadmium with the prevalence of hypertension. CONCLUSIONS: Cadmium levels in blood, but not in urine, were associated with a modest elevation in blood pressure levels. The association was stronger among never smokers, intermediate among former smokers, and small or null among current smokers. Our findings add to the concern of renal and cardiovascular cadmium toxicity at chronic low levels of exposure in the general population.     

Waist:hips girth ratio as a predictor of arterial hypertension]

This study aims to define cut-off points for the waist:hips girth ratio (WHR), using arterial hypertension as the outcome. The data refer to 3,282 individuals over twenty years of age examined in a survey conducted in the municipality of Rio de Janeiro in 1995-1996, using a two-stage sample. Sixty census tracts were drawn initially; subsequently, 34 households were selected systematically from each tract. Stature, weight, waist and hips girths, and blood pressure were measured in the households. The criterion for hypertension was a systolic blood pressure of ( 140 mmHg or diastolic pressure of ( 90 mmHg, or use of medication to reduce blood pressure. The sensitivity and specificity of different cut-off points for WHR were calculated in the prediction of arterial hypertension according to sex, age, and presence of overweight, classified according to World Health Organization guidelines. The best cut-off points for WHR were 0.95 for men and 0.80 for women. Compared to the waist:stature ratio and waist circumference, the WHR proved more capable of predicting arterial hypertension and less correlated with body mass index.