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.     

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.     

Rationale and design of a randomized clinical trial on prevention of stroke in isolated systolic hypertension

Isolated systolic hypertension (ISH)-ix. high systolic pressure with nonhypertensive (< 90 mmHg) diastolic pressure—is a recognized risk factor for cardiovascular disease among individuals in the age group 60 years and above. This observation suggests that antihypertensive treatment might be beneficial. Results of the Systolic Hypertension in the Elderly Program Pilot Study (SHEP-PS) indicated the feasibility of a full-scale clinical trial on the efficacy of drug treatment of ISH.

The Systolic Hypertension in the Elderly Program (SHEP) is a randomized, double-blind, placebo-controlled clinical trial with the primary objective of assessing the effect of drug treatment of ISH—systolic pressure 160–219 mmHg and diastolic pressure <90—on occurrence of fatal and nonfatal stroke. This multicenter clinical trial has a sample size of 4736 participants, with high statistical power to detect a reduction of 32% or more in the study's primary end point during the 4–6 year period of treatment and follow-up. Low dosage chlorthalidone is the main study drug. Further features of the design of SHEP and the trial's organization are described.     

Secondary prevention of recurrent stroke by lowering cholesterol levels and blood pressure

The most important risk factor for stroke is blood pressure: lowering the diastolic pressure by 5-6 mmHg or the systolic pressure by 10 mmHg will reduce the number of strokes in the general population (primary prevention) by 30-40% over 4-5 years. This effect is enhanced by the concurrent use of diuretics. The association between stroke and serum cholesterol was unclear until trials on preventing cardiovascular disease showed the introduction of statins to be clearly beneficial on strokes. In the recent 'Stroke prevention by aggressive reduction in cholesterol levels' (SPARCL) trial, high-dose statin therapy was shown to reduce the risk of fatal and non-fatal stroke in patients with a history of ischaemic stroke or transient ischaemic attack (TIA), but without manifest coronary disease (secondary prevention). A difference in LDL-cholesterol of 1.4 mmol/l was associated with a significant absolute 5-year risk reduction of fatal and non-fatal stroke of 2.2%, whereas the risk of major cardiovascular events was reduced by 3.5%. It is already known that stroke or TIA should be regarded as a 'coronary heart disease risk equivalent' for which secondary prevention guidelines apply. However, high-dose statin therapy should be given only after careful selection of the stroke patient at very high risk because of its high cost, adverse effects and a possible increase in haemorrhagic stroke.     

Risk factors to be considered at the beginning of antihypertensive therapy in diabetes mellitus

The treatment of hypertension in diabetic patients due to its high prevalence rate belongs to the everyday clinical practice of internists, diabetologists and general practitioners. The main points of the initiation on of antihypertensive treatment in diabetic patients are reviewed. In order to decrease the target organ damages the treatment of early recognized cardiovascular risk factors are of great importance. The target value of antihypertensive treatment in diabetic patients is < 130/80 mmHg (in case of proteinuria > 1 g daily: < 125/75 mmHg). The global cardiovascular risk is high or very high in diabetic patients both with grade I-III hypertension and with high normal blood pressure, therefore, treatment with antihypertensive drug (besides life style optimalisation) should be initiated promptly in these cases. In case of micro- or macroalbuminuria antihypertensive drug (mainly with characteristics of blocking the renin-angiotensin-system) should be given to each diabetic subject irrespective of actual blood pressure values. Success of antihypertensive treatment in diabetic patients could be achieved mainly with combination therapy only. It is reasonable to initiate antihypertensive therapy primarily with a low dose combination of two agents in diabetic patients with hypertension.     

Vitamin E can reduce blood pressure in mild hypertensives

This triple-blind placebo-controlled clinical trial was performed to determine the effects of the anti-oxidant vitamin E on blood pressure and heart rate in patients with mild hypertension. A total of 70 new mild hypertensive subjects (systolic blood pressure, SBP: 140-160 mmHg; diastolic blood pressure, DBP: 90-100 mmHg) without secondary hypertension were selected from among people referred to the Hypertension Unit of Isfahan Cardiovascular Research Center and divided randomly into two groups of drug (DG) and placebo (PG). All subjects were aged from 20 to 60 years old, without any other cardiovascular risk factors. The drug group received vitamin E tablets (200 IU/day) and the placebo group received placebo only for 27 weeks. At the beginning and the end of the study, the blood vitamin E level was measured fluorimetrically in all subjects according to the Hansen and Warwick method [14, 15]. Blood pressure and heart rate were measured at the beginning, during, and at the end of the study. Blood pressure was measured by a physician using one random zero mercury sphygmomanometer. Personal information and dietary habits of subjects were collected by separate questionnaire. At the end of the study, it was found that the vitamin E supplement had caused a remarkable decrease in SBP (-24% in DG versus -1.6% in PG) and a less remarkable decrease in DBP (-12.5% in DG versus -6.2% in PG) (p < 0.05). The change in heart rate was -4.3% in DG, and -14.0% in PG (p < 0.05). It is concluded that a vitamin E supplement of 200 IU/day can be effective in mild hypertensive patients in the long term, probably due to nitric oxide, and improve their blood pressure status. Therefore, vitamin E supplement could be recommended to such patients.     

中国四个大规模抗高血压临床试验Meta分析

目的评估中国四个大规模抗高血压临床试验的疗效。方法采用固定效应模型进行数据分析。结果分析显示平均治疗时间为3．7a，血压平均降低9／4mmHg。脑卒中危险降低36％（95％CI为25％～46％，P〈0．001），心血管死亡和总死亡减少22％和20％（P〈0．05），总的心血管事件减少33％（P〈0．001）。冠心病事件减少无显著性差异（P〉0．05）。结论抗高血压治疗的效果很大程度上源于脑卒中事件的减少。     

宁夏农村成年人群高血压患病率、知晓率、治疗率和控制率现况分析

目的评估宁夏回族自治区农村成年人群高血压患病、治疗和控制现况。方法采用分层整群抽样的流行病学调查方法,将调查地区按经济状况分为好、差两层,利用随机抽样方法确定两个调查市(固原市和吴忠市),从抽到的市中随机选取一个乡镇,将抽中的乡镇中的全部自然村按民族聚居分为回族自然村和汉族自然村两层,采用整群抽样方法,在样本乡镇的全部回族自然村和汉族自然村中,随机抽取一个自然村作为调查单元,对抽中的自然村25～74岁(10岁为一个年龄组)且居住四代及以上居民进行调查,回汉各半,男女各半。采用标准问卷询问高血压病史以及高血压的治疗情况。调查人数3324人,对全部样本测定体重指数和血压等,运用《中国高血压防治指南》2004年诊断标准对高血压分类并对资料进行分析。结果宁夏农村成年人群高血压患病率为28.5%,经WH0世界标准人口年龄构成WASR(2000-2025)标化后高血压患病率为15.8%。在高血压患者中有299人(31.5%)高血压患者知道患有高血压,129人(13.6%)高血压患者服用降压药物,24人(2.7%)高血压患者血压得到控制。女性高血压的知晓率36.4%高于男性24.6%(P=0.005)。回族高血压知晓率低于汉族,但治疗率和控制率与汉族比较均无统计学意义(分别为26.8%、11.9%、2.1%vs36.4%、15.4%、3.2%)(P=0.019,P=0.097,P=0.209)。结论宁夏农村成年人群具有较高的高血压患病率,以中青年人群为主;高血压患者中的知晓率、治疗率和控制率均较全国水平较低。     

A prospective evaluation of persistence on antihypertensive treatment with different antihypertensive drugs in clinical practice

Persistence on treatment affects the efficacy of antihypertensive treatment. We prospectively investigated the persistence on therapy and the extent of blood pressure (BP) control in 347 hypertensive patients (age 59.4 +/- 6 years) randomly allocated to a first-line treatment with: angiotensin-converting enzyme (ACE) inhibitors, calcium-channel blockers (CCBs), beta-blockers, angiotensin-II receptor blockers (ARBs), or diuretics and followed-up for 24-months. Persistence on treatment was higher in patients treated with ARBs (68.5%) and ACE inhibitors (64.5%) vs CCBs (51.6%; p < 0.05), beta-blockers (44.8%, p < 0.05), and diuretics (34.4%, p < 0.01). No ARB, ACE inhibitor, beta-blocker, or diuretic was associated with a higher persistence in therapy compared with the other molecules used in each therapeutic class. The rate of persistence was significantly higher in patients treated with lercanidipine vs others CCBs (59.3% vs 46.6%, p < 0.05). Systolic and diastolic BP was decreased more successfully in patients treated with ARBs (-11.2/-5.8 mmHg), ACE inhibitors (-10.5/-5.1 mmHg), and CCBs (-8.5/-4.6 mmHg) compared with beta-blockers (-4.0/-2.3 mmHg p < 0.05) and diuretics (-2.3/-2.1 mmHg, p < 0.05). No ARB, ACE inhibitor, beta-blocker, or diuretic was associated with a higher BP control compared with the other molecules used in each therapeutic class. A trend toward a better BP control was observed in response to lercanidipine vs other CCBs (p = 0.059). The present results confirm the importance of persistence on treatment for the management of hypertension in clinical practice.     

The effect of mefenamic acid on controlling irregular uterine bleeding secondary to Norplant use.

The aim of this double-blind, placebo-controlled study was to evaluate the effect of mefenamic acid and placebo on controlling irregular uterine bleeding secondary to Norplant use. A total of 67 Norplant users attending the Family Planning Clinic of Chulalongkorn Hospital all had irregular bleeding. These women were randomly allocated into two groups. A total 34 users received mefenamic acid, 500 mg twice a day for 5 days, and placebos were given to the other 33 in the same manner. The total days of bleeding and spotting and the percentage of women in whom bleeding was stopped were analyzed in weeks 1 and 4. The percentage of subjects in whom bleeding was stopped during week 1 after initial treatment was significantly higher in the mefenamic acid group than the placebo group (76%, 27%; p < 0.001). In the follow-up period (4 weeks after initial treatment), a bleeding-free interval of > 20 days was found in 68% of the subjects treated with mefenamic acid and 33% treated with the placebo; the mean number of bleeding/spotting days was lower with mefenamic acid treatment (11.6 and 17.2 days; p < 0.05). The difference was statistically significant. It is concluded that mefenamic acid was more effective than placebo in short-term control of irregular bleeding and spotting associated with Norplant use.     

Long-term anticoagulant treatment after acute myocardial infarction. The Warfarin Re-Infarction Study.

High levels of fibrinogen and clotting factor VII are associated with an increased risk for subsequent death and cardiovascular disease in apparently healthy individuals. Furthermore, pathoanatomic studies and coronary angiography have confirmed a relationship between coronary thrombus formation and acute Q-wave infarction. Effective antithrombotic agents may prevent or limit thrombus formation and events related to thrombosis. The Warfarin Re-Infarction Study (WARIS) studied the effect of warfarin in survivors of acute myocardial infarction. Patients aged 75 years or less were randomized in a double-blind, placebo-controlled study to test whether long-term treatment with warfarin reduces the risk of death, reinfarction, and thromboembolic morbidity. A total of 1918 patients were screened for participation; 1214 were recruited. The mean follow-up was 37 months. Analyzed on an intention-to-treat basis, 123 (20%) in the placebo group died, versus 94 (15%) in the warfarin group, a risk reduction of 24% (P = 0.026). Considering patients on treatment or within 28 days after discontinuing the test medication, 92 in the placebo group died, as compared with 60 of the warfarin-treated patients, a risk reduction of 35% (P = 0.005). Relapsing myocardial infarction (fatal and nonfatal) was reduced by 43% (P = 0.0001). The incidence of cerebrovascular attacks was lower in the warfarin group (16 patients) than the placebo group (41 patients), a highly significant reduction of 61% (P = 0.0003). Serious bleeding occurred in 11 patients taking warfarin, an incidence of 0.6% per year. In conclusion, long-term anticoagulant therapy may be recommended after acute myocardial infarction.     

中国成年人高血压患病率、知晓率、治疗和控制状况

目的　评估中国成年人高血压的患病率、高血压知晓率、治疗和控制状况。方法　亚洲国际心血管病合作研究 (InterASIA)于 2 0 0 0～ 2 0 0 1年进行 ,应用多阶段抽样方法选择有代表性的样本。共调查了 35～ 74岁的成年人 15 838人。测量血压时 ,先让调查对象休息 5min ,由经过培训合格的调查人员应用标准水银柱血压计测量 3次血压。应用标准问卷询问高血压病史及高血压的治疗情况。高血压定义为收缩压≥ 140mmHg、舒张压≥ 90mmHg或正在服用降压药。结果　 35～ 74岁的中国成年人的高血压患病率为 2 7 2 %,即全国约有 1 3亿高血压患者。 35～ 44、45～ 5 4、5 5～ 6 4和 6 5～ 74岁年龄组的高血压患病专率分别为男性 17 4%、 2 8 2 %、 40 7%和 47 3 %;女性为 10 7%、2 6 8%、38 9%和 5 0 2 %。在高血压病人中 ,44 7%知道自己患有高血压 ,2 8 2 %正在服用降压药 ,8 1%的人血压得到了控制 ( <140 / 90mmHg)。在过去 10年中 ,高血压知晓、治疗和控制率的增长百分率分别为 86 2 %、92 6 %和 145 4%。结论　在过去的 10年中 ,高血压知晓、治疗和控制率有显著的提高。中国成年人高血压的患病率比较高 ,而高血压的知晓率偏低 ,治疗率和控制率又非常低。在我国迫切需要改善高血压的预防、检测和治疗状况     

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.     

小剂量螺内酯在治疗顽固性高血压中的疗效观察

目的研究小剂量螺内酯在顽固性高血压治疗中的价值。方法将52例顽固性高血压随机分为两组:第1组:在常规药物基础上加用螺内酯25～50mg/d;第2组:在常规药物基础上使用安慰剂,6周后评估两组患者的治疗效果。结果第1组收缩压平均下降27mmHg,舒张压平均下降11mmHg,而在对照组的血压没有变化。结论顽固性高血压患者加用小剂量螺内酯可明显增加降压效果。     

Predictors of the development of hypertension: ten-year follow-up study in a community]

Predictors of the development of hypertension were examined in a 10-year follow-up study of normotensive Japanese adults. Subjects (n = 265), aged 30-69 years at entry, normotensive and with no past history of antihypertensive treatment at entry, were studied in terms of the relationship of various physical, biochemical, dietary, and lifestyle data to the subsequent development of hypertension (defined as systolic blood pressure (SBP) more than 140 mmHg and/or diastolic blood pressure (DBP) more than 90 mmHg and/or starting antihypertensive treatment) with analysis accomplished using univariate and multivariate life table methods. Univariate analyses by the generalized Wilcoxon test showed significantly higher incidence of hypertension in those subjects with SBP 120 mmHg or more (p < 0.001), DBP 75 mmHg or more (p < 0.001), serum glutamate oxaloacetate transaminase (GOT) 20 KU or more (p < 0.001), serum glutamate pyruvate transaminase (GPT) 15 KU or more (p < 0.001), serum gamma-glutamyl transpeptidase (gamma-GTP) 10 IU/l or more (p < 0.001), age 50 or older (p = 0.002), body mass index 22 kg/m2 or more (p = 0.012), and serum creatinine less than 1.2 mg/dl (p = 0.020) than in the other subjects. Multivariate analysis by the Cox proportional hazards model confirmed that relatively higher SBP (p < 0.001), lower serum creatinine (p < 0.001), higher gamma-GTP (p = 0.002), and higher age (p = 0.041) were independent and significant predictors of future hypertension.     

Relationship of blood pressure to cardiovascular death: the effects of pulse pressure in the elderly

PURPOSE: To investigate the relationship of systolic and diastolic blood pressure to fatal myocardial infarction, fatal stroke and other death related to cardiovascular diseases (CVD). METHODS: The study was based on a prospective longitudinal study conducted by the Veterans Administration at the Boston Outpatient Clinic. Participants are male volunteers from the greater Boston area. Main outcome measures are fatal myocardial infarction, fatal stroke and other deaths related to cardiovascular diseases. The method of pooled logistic regression was used for statistical analysis. RESULTS: For younger men (age 21-59), after adjusting for effects of other risk factors, when systolic and diastolic blood pressure were considered separately, SBP was predictive of cardiovascular death (SBP: RR = 1.23; 95% CI = (1.05, 1.45) per 10 mmHg of increase), and DBP showed a nonsignificant positive trend in relation to cardiovascular death (DBP: RR = 1.27; 95% CI = (0.95, 1.69) per 10 mmHg of increase). For older men (age 60-85), when SBP and DBP were considered separately, SBP (RR = 1.26; 95% CI = (1.02, 1.55) per 15 mmHg of increase) was directly related, but DBP (RR = 1.05; 95% CI = (0.83, 1.32) per 8 mmHg of increase) was not related to cardiovascular death. However, for the elderly group, when SBP and DBP were considered jointly in the regression model, then the regression coefficient of DBP (beta = -0.018, p = 0.30) was of approximately the same absolute magnitude as that of SBP (beta = 0.021, p = 0.02) but opposite in sign. For younger men, when SBP and DBP were considered jointly, SBP (beta = 0.021, p = 0.049) but not DBP (beta = -0.001, p = 0.953) was positively related to cardiovascular death. CONCLUSIONS: We found that, for the elderly, pulse pressure (SBP-DBP) may be a more accurate predictor of cardiovascular death than either SBP or DBP alone. The relative risk per 35 mmHg of increase of pulse pressure, which equals the approximate interval from the 10th to the 90th percentile in the elderly group, is 2.1 with 95% CI = (1.1, 3.8). In younger subjects, SBP, but not DBP, is an independent predictor of fatal CVD.     

Is drug treatment of hypertension in clinical practice as effective as in randomized controlled trials with regard to the reduction of the incidence of stroke?

The results from several nonexperimental studies suggest that drug treatment of hypertension in daily clinical practice may not be as effective as in randomized controlled trials. These nonexperimental studies had limitations with regard to the selection of an appropriate control group. The objective of our study was to assess the effect of drug treatment of hypertension under circumstances of everyday medical practice on the incidence of stroke by using a prognostically comparable untreated reference group. Within two prospective, population-based cohort studies among 45,000 men and women 20 years of age and older in the Netherlands, we selected a cohort of 2,301 hypertensive subjects who either received drug treatment for hypertension (N = 1,318) or were untreated for hypertension but were determined to be "candidates" for drug treatment on the basis of their level of blood pressure and the presence of other cardiovascular risk factors (N = 983). Follow-up averaged 4.6 years and was complete for 91% of the hypertensives. Compared with untreated hypertensive subjects who were "candidates" for drug treatment, subjects who received drug treatment for hypertension had, after adjustment for potential confounders, a 39% [95% confidence interval (CI) = 3-61%] reduced risk of stroke. About 46 (95% CI = 29-599) hypertensive patients need to be treated with antihypertensive drugs for 5 years to prevent one stroke in the general Dutch population. When a prognostically comparable reference group is used, the drug treatment of hypertension under circumstances of everyday medical practice appears to be effective in the reduction of the incidence of stroke. The relative risk reduction that we found was similar to those found in randomized controlled trials.     

The long-term relation among retinal arteriolar narrowing, blood pressure, and incident severe hypertension

The authors assessed associations between retinal vascular signs and incident severe hypertension in an older population-based cohort. At baseline (1992-1994), 3,654 residents aged 49-97 years living in the Blue Mountains area west of Sydney, Australia, were examined; respectively, 2,335 (75.1%) and 1,952 (76%) survivors were reexamined 5 and 10 years later. Retinal arteriolar and venular calibers were measured, and average central retinal artery and central retinal vein equivalents for that eye were estimated. Severe hypertension was defined by previous diagnosis of hypertension plus antihypertensive medication use or by systolic blood pressure > or =160 mmHg and/or diastolic blood pressure > or =100 mmHg at examinations. Of the 1,424 participants at risk, 618 developed severe hypertension over 10 years (cumulative incidence = 47.7%, 95% confidence interval: 44.9, 50.5). Participants who subsequently developed severe hypertension had significantly narrower mean central retinal artery equivalents than those who did not (187.0 vs. 191.9 mum, p < 0.0001). After adjusting for age, sex, body mass index, smoking, mean arterial blood pressure, and plasma glucose and triglyceride levels, baseline narrowing central retinal artery equivalent was associated with increased risk of severe hypertension (per standard deviation reduction, odds ratio = 1.1, 95% confidence interval: 1.1, 1.2; narrowest vs. widest quintile, odds ratio = 1.6, 95% confidence interval: 1.2, 2.1). These findings support structural narrowing in small arteries and arterioles antecedent to clinical onset of severe hypertension.     

Influence of albuminuria and glomerular filtration rate on blood pressure response to antihypertensive drug therapy

Background

Albuminuria and glomerular filtration rate (GFR), two factors linked to kidney and vascular function, may influence longitudinal blood pressure (BP) responses to complex antihypertensive drug regimens.

Methods

We reviewed the clinic records of 459 patients with hypertension in an urban, academic practice.

Results

Mean patient age was 57-years, 89% of patients were African American, and 69% were women. Mean patient systolic/diastolic BP (SBP/DBP) at baseline was 171/98 mmHg while taking an average of 3.3 antihypertensive medications. At baseline, 27% of patients had estimated (e)GFR <60 ml/min/1.73², 28% had micro-albuminuria (30–300 mg/g) and 16% had macro-albuminuria (>300 mg/g). The average longitudinal BP decline over the observation period (mean 7.2 visits) was 25/12 mmHg. In adjusted regression models, macro-albuminuria predicted a 10.3 mmHg lesser longitudinal SBP reduction (p < 0.001) and a 7.9 mmHg lesser longitudinal DBP reduction (p < 0.001); similarly eGFR <60 ml/min/1.73² predicted an 8.4 mmHg lesser longitudinal SBP reduction (p < 0.001) and a 4.5 lesser longitudinal DBP reduction (p < 0.001). Presence of either micro- or macro-albuminuria, or lower eGFR, also significantly delayed the time to attainment of goal BP.

Conclusions

These data suggest that an attenuated decline in BP in drug-treated hypertensives, resulting in higher average BP levels over the long-term, may mediate a portion of the increased risk of cardiovascular-renal disease linked to elevated urinary albumin excretion and reduced eGFR.     

Effects of dietary supplementation with the green tea polyphenol epigallocatechin-3-gallate on insulin resistance and associated metabolic risk factors: randomized controlled trial

Animal evidence indicates that green tea may modulate insulin sensitivity, with epigallocatechin-3-gallate (EGCG) proposed as a likely health-promoting component. The purpose of this study was to investigate the effect of dietary supplementation with EGCG on insulin resistance and associated metabolic risk factors in man. Overweight or obese male subjects, aged 40-65 years, were randomly assigned to take 400 mg capsules of EGCG (n 46) or the placebo lactose (n 42), twice daily for 8 weeks. Oral glucose tolerance testing and measurement of metabolic risk factors (BMI, waist circumference, percentage body fat, blood pressure, total cholesterol, LDL-cholesterol, HDL-cholesterol, TAG) was conducted pre- and post-intervention. Mood was evaluated weekly using the University of Wales Institute of Science and Technology mood adjective checklist. EGCG treatment had no effect on insulin sensitivity, insulin secretion or glucose tolerance but did reduce diastolic blood pressure (mean change: placebo - 0.058 (se 0.75) mmHg; EGCG - 2.68 (se 0.72) mmHg; P = 0.014). No significant change in the other metabolic risk factors was observed. The EGCG group also reported feeling in a more positive mood than the placebo group across the intervention period (mean score for hedonic tone: EGCG, 29.11 (se 0.44); placebo, 27.84 (se 0.46); P = 0.048). In conclusion, regular intake of EGCG had no effect on insulin resistance but did result in a modest reduction in diastolic blood pressure. This antihypertensive effect may contribute to some of the cardiovascular benefits associated with habitual green tea consumption. EGCG treatment also had a positive effect on mood. Further studies are needed to confirm the findings and investigate their mechanistic basis.