White coat effect and white coat hypertension in pediatric patients

We evaluated the prevalence of white coat (WC) effect in pediatric age patients and that of white coat hypertension (WCH) in hypertensive pediatric patients. Two hundred and six patients (136 normotensive and 70 hypertensive patients, 107 boys and 99 girls, aged 6-25 years, mean 13.4, SD 4.7) were studied. Hypertension was diagnosed when systolic and/or diastolic blood pressure (BP) measurements with auscultatory technique were >or= the 95th percentile for sex and age. WC effect was defined as office BP minus daytime mean ambulatory BP (ABP). WCH was diagnosed in the hypertensive patients when daytime ABP values were < the 95th percentile for sex and height of reference values. There was a positive correlation between office BP and WC effect ( P<0.05). A WC effect of >or= 10 mmHg was observed more frequently in hypertensive patients (50%) than in normotensive patients (25%). Among 70 hypertensive patients, 33 (47%) had WCH. There was no significant difference in the prevalence of WCH in relation to age, gender, or the presence or absence of causes of hypertension. In conclusion, WC effect is frequently seen in pediatric patients, and is more common in subjects with higher office BP.     

Insulin and hypertension. Relationship to obesity and glucose intolerance in Pima Indians

The relationships among blood pressure, obesity, glucose tolerance, and serum insulin concentration were studied in 2873 Pima Indians aged 18-92 yr (mean 37 yr). Age- and sex-adjusted to the Pima population, the prevalence of hypertension (systolic blood pressure greater than or equal to 160 mmHg, diastolic blood pressure greater than or equal to 95 mmHg, or receiving drug treatment) was 7.1% for subjects with normal glucose tolerance compared with 13.0% for subjects with impaired glucose tolerance (IGT) and 19.8% for those with non-insulin-dependent diabetes mellitus (NIDDM) (P less than 0.001). The prevalence ratio of hypertension was 1.8 (95% confidence interval [CI] 1.2-2.5) for IGT and 2.6 (95% CI 2.0-3.2) for NIDDM compared with normal glucose tolerance, controlled for age, sex, and body mass index (BMI). In logistic regression analysis, hypertension was positively related to age, male sex, BMI, glucose tolerance, and fasting but not 2-h postload serum insulin concentration. Among subjects not taking antihypertensive drugs, however, neither fasting nor 2-h postload serum insulin was significantly related to hypertension. Furthermore, in 2033 subjects receiving neither antihypertensive nor antidiabetic drugs, blood pressure was not significantly correlated to fasting insulin concentration, and 2-h postload serum insulin was negatively correlated with diastolic blood pressure. In conclusion, insulin is not significantly related to blood pressure in Pima Indians not receiving antihypertensive drugs. Higher insulin concentrations in drug-treated hypertensive patients might result from the treatment rather than contribute to the pathogenesis of hypertension. Thus, these data do not support a major role for insulin in determining the occurrence of hypertension or regulation of blood pressure in Pima Indians.     

Diabetes and hypertension in South African Indians. A community study

A community survey was done to assess the prevalence of diabetes and hypertension in Indians living in Durban. Each subject, selected by systematic cluster sampling, had blood pressure measured and a glucose tolerance test. Diagnoses of diabetes mellitus and of hypertension were based on World Health Organization criteria. Of the 1,064 subjects studied 9% had diabetes and 14.2% hypertension; diabetes mellitus was more common in women (10.5%) than men (7%), whereas the prevalence of hypertension was similar in both sexes (women 13.5%, men 14.7%). Hypertension was found in 45.8% of the diabetic subjects, 31.4% of those with impaired glucose tolerance and 9.9% of those with normal glucose tolerance. Although hypertension was more common in women (63.3%) than men (37.9%) in the diabetic group, there was no significant difference in the sex distribution in the subjects with impaired glucose tolerance and those with normal glucose tolerance. Of the subjects with hypertension, 29.1% had diabetes; there was no significant difference in the sex distribution. The mean age-adjusted body mass indices were significantly higher in the hypertensive subjects with all degrees of glucose tolerance than in normotensive subjects. There was a trend towards elevation of both systolic and diastolic blood pressure with increasing degrees of glucose intolerance and increasing age.     

Persistent hypertension after removal of adrenal tumours.

OBJECTIVE: To assess the long-term results of operation for adrenal hypertension and to evaluate reasons and potential risk factors for the persistence or recurrence of hypertension. DESIGN: Retrospective clinical study. SETTING: Teaching hospital, Italy. SUBJECTS: 48 patients with benign adrenal tumours who were preoperatively hypertensive and treated by adrenalectomy between 1980 and 1996. MAIN OUTCOME MEASURES: Factors that influenced the persistence of hypertension after removal of the adrenal tumours. RESULTS: During a mean (SD) follow-up of 77 (12) months, 4 (8.3%) patients developed cardiovascular or cerebrovascular complications. 24 patients had had a history of hypertension for less than 5 years and the remaining 24 for 5 years or more. Blood pressure returned to the normal range after operation in 22 patients (46%). 14 patients (29%) had persistent hypertension that required treatment with antihypertensive drugs, but 12 required less intensive treatment than before adrenalectomy. Multivariate analysis showed that age at presentation was the only significant factor predictive of persistent hypertension (p < 0.05); sex, haematochemical tests, raised preoperative blood pressure, duration of hypertension preoperatively, and size of tumour were not. CONCLUSION: The success in reversing hypertension after adrenalectomy for benign tumour is strongly related to age at presentation.     

Hypertension in the hemodialysis population: A survey of 649 patients

Accurate information on prevalence and status of blood pressure control among US hemodialysis patients is lacking. We have surveyed the status of blood pressure control in 649 hemodialysis patients (89.8% black) from 10 dialysis units in Mississippi. Our results show a hypertension prevalence of 72% (hypertension defined as mean arterial pressure prior to dialysis session ≥114 mm Hg). This mean arterial pressure did not differ among black patients compared with white patients (P = 0.51). The majority of hypertensive patients (80%) had elevation of both systolic and diastolic blood pressure. Isolated systolic hypertension was present in only 20% of hypertensive patients and was not different between black and white patients (P = 0.10). Three hundred eighty-one patients (58.7% of the total population and 81.5% of the hypertensive patients) were receiving antihypertensives. Age was the only significant factor that correlated with blood pressure: older patients (>65 years) had lower blood pressure (P < 0.0001). Race, time on dialysis, etiology of end-stage renal disease, adequacy of dialysis, and several excess volume parameters had no influence on the blood pressure level. Treated hypertensive patients had a predialysis mean blood pressure only 3 mm Hg less than the untreated hypertensive patients. No differences were found among four classes of antihypertensives with regard to the degree of blood pressure control. Patients with hypertension requiring more than one antihypertensive did not achieve a lower blood pressure than the untreated patients. There was no correlation between use of antihypertensives and the magnitude of decrease in blood pressure after dialysis. Our results document the high prevalence and resistant nature of hypertension in the hemodialysis population. It also casts doubt on the effectiveness of our current methods of treatment. Excess volume may not be as important in these patients as once thought.     

重庆市渝东南地区成年女性压力性尿失禁发病率和危险因素调查

目的调查重庆市渝东南地区成年女性压力性尿失禁（SUI）的发病率和危险因素，为SUI的预防、治疗提供参考。方法随机抽取重庆市渝东南地区20岁以上女性675例，采用自填问卷和调查员向被调查者一对一当面问卷相结合的方法调查SUI的发病率和危险因素。问卷内容包括是否患SUI、人口学特征（年龄、职业、BMI等）、慢性疾病、月经状况、生育史等12个问题。结果重庆市渝东南地区成年女性SUI发病率为20．27％，40岁以前患病率随年龄的增加而上升，30-40岁年龄段是SUI发病高峰，工人、农民易患SUI，BMI、盆腔手术史、高血压、糖尿病、便秘、慢性咳嗽等慢性疾病及围绝经期、多次妊娠流产、分娩次数、顺产、会阴裂伤、会阴切开等妇产科因素是SUI的易患因素。结论重庆市渝东南地区成年女性SUI患病率较高，需引起医务人员和广大群众的高度重视，应进行早期宣传、早期预防、早期治疗。     

Peripheral arterial disease - high prevalence in rural black South Africans.

BACKGROUND: The prevalence of peripheral arterial disease (PAD) worldwide has been estimated at between 4.5% and 29%. PAD has been associated with male gender, advanced age, diabetes, hypertension, hypercholesterolaemia and smoking. Clinical experience with amputations at Mthatha General Hospital, a district hospital in the Eastern Cape, suggests that PAD is common, but the actual prevalence has not been determined. The Eastern Cape is a rural area and patients attending the hospital are mostly Xhosa-speakers. OBJECTIVES: To assess the prevalence of PAD and associated risk factors among patients attending the hospital. METHODS: Five hundred and forty-two patients over 50 years of age attending the outpatient department were systematically selected. Gender, body mass index (BMI), blood pressure, capillary blood glucose and smoking status were determined. The ankle-brachial pressure index (ABPI) was measured by Doppler ultrasound, and PAD was defined as a ratio less than 0.9. RESULTS: Of 542 patients (315 females, 227 males), 159 (29.3%) had an ABPI of less than 0.9. The mean age was 62.4 years and the range 50 - 95 years. In a stepwise logistical regression analysis smoking had a significant adjusted odds ratio for PAD of 4.29 (2.68 - 6.95), diabetes 1.72 (1.11 - 2.69) and male sex 1.69 (1.06 - 2.68). Obesity as measured by BMI and hypertension were not associated with PAD. CONCLUSION AND RECOMMENDATIONS: Prevalence of PAD was relatively high in this sample of rural black patients when compared with findings from other countries. Preventive interventions should focus on control of diabetes and smoking cessation. Surprisingly, the prevalence was higher in those with a normal BMI and without hypertension, and risk factors in this community should be studied further. Physicians in this setting should be more aware of the possibility of undetected PAD.     

上海地区胆囊结石病的流行病学调查

目的: 研究上海地区居民胆囊结石病（以下简称胆石病）的患病情况及其相关的危险因素。方法: 2010年8月至2011年7月期间,对上海三个区部分20~79岁自然人群15 256人进行横断面调查。其中男8 617人,女6 639人。使用问卷调查、体格检查和实验室生化分析等方法收集参加者相关临床数据。胆囊疾病采用空腹B超检查确诊。采用t检验和Logistic逐步回归分析与胆石病相关的危险因素。结果: ①胆石病总体患病率为7.02%,女性（8.10%）略高于男性（6.19%）（P<0.05）。不论性别,胆石病的患病率随年龄递增（P<0.05）。②胆囊总体切除率为2.48%,女性（3.42%）是男性（1.75%）的约2倍（P<0.05）,也随年龄递增（P<0.05）。③Logistic逐步回归分析显示,女性、高龄、脂肪肝、胆石病家族史、高血压、体质量指数增加为胆石病相关的危险因素。结论: 本研究调查显示,当前上海地区人群总体胆石病患病率为7.02%,胆囊切除率为2.48%。性别、年龄、脂肪肝、胆石病家族史、高血压和体质量指数与胆石病发生密切相关。     

Hypertension remission 1 year after bariatric surgery: predictive factors

BackgroundThere is scarce information about predictive factors of hypertension (HT) remission after bariatric surgery (BS). The aims of this study were to determine the clinical characteristics differentiating obese patients with and without HT and to evaluate the predictive factors associated with the risk of persistence of HT after BS.Patients and MethodsFrom January 2007 to December 2009, a review of patients who had undergone BS was performed. Patients were classified as hypertensive if having permanent use of antiHT drugs or clinical BP≥140/90 mm Hg. Weight, waist circumference (WC), and blood pressure were determined with standardized procedures.ResultsFive hundred twenty-6 patients met the inclusion criteria; 264 (50%) were hypertensive, 74 (34%) of whom had type 2 diabetes. Before BS, older age, male gender, and greater WC differentiated hypertensive from normotensive patients. The prevalence of HT significantly fell to 35% (P<.0001) at 12 months after BS. The use of multivariate logistic regression showed that age≥40, male gender and WC≥130 cm were significant predictors of having HT before surgery. Regarding persistence of HT at the 12-month follow-up, the only independent predictors observed were time since diagnosis of HT≥10 years and the number of antiHT drugs used. Presurgical BMI, WC, excess weight (EW), EW loss, surgical procedure, type 2 diabetes, and vitamin D status were not significant predictors.ConclusionsBariatric surgery is associated with a high rate of HT remission. Older age, male gender, and higher WC differentiated hypertensive-obese from normotensive patients. After BS, longer duration and severity of HT were independently associated with no remission of HT.     

Left ventricular mass in normotensive,prehypertensive and hypertensive children and adolescents

The purpose of this study was to investigate differences in left ventricular mass index (LVMI) and the prevalence of left ventricular hypertrophy (LVH) in children and adolescents classified as normotensives, prehypertensives and hypertensives by ambulatory blood pressure (BP) levels. A total of 124 consecutive children and adolescents aged 5 to 18 years were analysed. Patients underwent 24 h ambulatory blood pressure monitoring (ABPM) and echocardiography. Hypertensive and prehypertensive subjects had significantly higher LVMI than normotensives (36.8 ± 8.4 g/m^2.7 and 34.1 ± 3.4 g/m^2.7 vs. 29.5 ± 8.3 g/m^2.7, P < 0.01 and P < 0.05, respectively). In multivariate analysis predictors for LVMI were body mass index (BMI) z score and hypertension (R-squared = 0.31). LVMI values in hypertensive subjects were significantly higher than those of normotensives even after adjustment for age, sex and BMI z score. The prevalence of LVH was significantly higher in the prehypertensive compared to normotensive subjects, and was equal to that of the hypertensive subjects. Hypertension and prehypertension in children and adolescents were associated with pathologically elevated LVMI values. If confirmed in a larger group prehypertensive children may be at risk for target organ damage similar to the condition of established hypertension.     

上海市浦东新区肾结石流行病学调查报告

目的 了解上海市浦东新区肾结石患病的流行病学现况及相关因素,为肾结石的预防提供依据.方法 采取整群分层随机抽样的调查方法对上海市浦东新区12565名常住居民进行肾脏B超检查和性别、年龄、地区、文化、职业和肾结石家族史等问卷调查.结果肾结石总患病率3.15%(396/12565),男女分别为4.05%(247/6096)、2.30%(149/6469)(P<0.05).男性随着年龄增加,肾结石患病率增加,女性结石患病高峰在50～59年龄段.城市与乡村<60岁肾结石患病率比较差异无统计学意义(2.58%与2.62%,P>0.05),≥60岁差异则有统计学意义(6.28%与3.36%,P<0.05).有肾结石家族史者肾结石患病率明显高于无家族史者(32.02%与2.06%,P<0.01).管理人员、司机患病率最高.结论 上海市浦东新区肾结石的患病率低于我国南方地区.中老年男性、围绝经期妇女、有肾结石家族史者以及管理人员、司机等为肾结石高危人群.对城市及乡村的高危人群应给予同等重视,加强健康教育及监测可能有助于降低结石的发生.     

老年女性冠心病人群骨质疏松的患病率及相关因素分析

目的 调查老年女性冠心病人群骨质疏松的患病率及相关影响因素,为两种疾病的协同防治提供更多的理论依据.方法 成功搜集并调查了181例诊断为冠心病并行骨密度检测的老年女性患者,包括年龄、家庭、身高、体重、收入、居住地等基本情况,根据是否存在骨质疏松分为观察组(骨质疏松人群)及对照组(骨量正常人群).通过单因素及多因素Log...     

南昌市部分社区40岁以上人群骨质疏松症流行现状调查及影响因素分析

目的 明确南昌市部分社区40岁以上人群骨质疏松症(Osteoporosis,OP)的患病状况及其影响因素,为OP的社区干预提供基础信息和依据.方法 应用HOLOGIC公司生产的Sahara定量超声骨密度检测仪测量南昌部分社区10071名40岁以上人群跟骨骨密度.对所有受试者进行问卷调查,检测其肝肾功能、血糖、糖化血红蛋白(HbA1C)、甘油三脂(TG)、高密度脂蛋白胆固醇(HDL-c)、低密度脂蛋白胆固醇(LDL-c)、总胆固醇(TC);测量血压、身高、体重、腰围、臀围,计算其腰臀比(WHR)、体质指数(BMI).首先行单因素Logistic分析,有统计学意义者(P＜0.1)进一步行二分类Logistic回归分析,计算OR值及其95％置信区间.结果 (1)OP的总患病率为9.3％,男性7.1％,女性10.8％;年龄、性别标化后的总患病率为11.3％,男性7.9％,女性11.7％;(2)在男性,单因素分析显示年龄、文化程度、饮酒、饮牛奶、舒张压、HDL-c、BMI、体力劳动、OP家族史等与OP患病可能相关(P＜0.1).二分类Logistic回归分析显示增龄、OP家族史为OP可能危险因素;高文化程度、饮酒、饮牛奶、大BMI为OP的可能保护性因素;(3)在女性,单因素分析显示年龄、婚姻状况、文化程度、吸烟、饮牛奶、收缩压、HDL-c、LDL-c、TG、TC、HbA1c、BMI、WHR、体力劳动、孕次、产次、初潮年龄、绝经状态、绝经年龄、绝经年限、哺乳是OP的可能影响因子(P＜0.1);二分类Logistic回归分析显示增龄、无配偶、多产次、已绝经、长绝经年限和大WHR是OP的可能危险因素;经常饮用牛奶、晚绝经年龄、高BMI为其可能保护性因素.结论 南昌市部分社区OP骨质疏松症的主要危险因素在男性是OP家族史和增龄;在女性是增龄、绝经、无配偶、多产次以及中心性肥胖.饮牛奶和合适的体质指数是男女共同的OP保护因素,在男性良好的教育和适量饮酒,女性晚的绝经年龄可能有助于减少OP的患病风险.应要采取相应的干预措施,控制OP的可控因素,预防和延缓骨质疏松症的发生.     

Hypertension, glomerular number, and birth weight in African Americans and white subjects in the southeastern United States

Low nephron number has been related to low birth weight and hypertension. In the southeastern United States, the estimated prevalence of chronic kidney disease due to hypertension is five times greater for African Americans than white subjects. This study investigates the relationships between total glomerular number (Nglom), blood pressure, and birth weight in southeastern African Americans and white subjects. Stereological estimates of Nglom were obtained using the physical disector/fractionator technique on autopsy kidneys from 62 African American and 60 white subjects 30-65 years of age. By medical history and recorded blood pressures, 41 African Americans, and 24 white subjects were identified as hypertensive and 21 African Americans and 36 white subjects as normotensive. Mean arterial blood pressure (MAP) was obtained on 81 and birth weights on 63 subjects. For African Americans, relationships between MAP, Nglom, and birth weight were not significant. For white subjects, they were as follows: MAP and Nglom (r=-0.4551, P=0.0047); Nglom and birth weight (r=0.5730, P=0.0022); MAP and birth weight (r=-0.4228, P=0.0377). For African Americans, average Nglom of 961 840+/-292 750 for normotensive and 867 358+/-341 958 for hypertensive patients were not significantly different (P=0.285). For white subjects, average Nglom of 923 377+/-256 391 for normotensive and 754 319+/-329 506 for hypertensive patients were significantly different (P=0.03). The data indicate that low nephron number and possibly low birth weight may play a role in the development of hypertension in white subjects but not African Americans.     

Carotid ultrasonography for detection of vascular abnormalities in hypertensive children

To determine whether hypertension and overweight status are associated with increased carotid intimal-medial thickness (cIMT) in children, vascular ultrasonography was performed in newly diagnosed hypertensive patients (n=53) and normotensive controls (n=33). Hypertensive subjects were identified either by referral or by systematic school-based hypertension screening. Hypertension was defined as blood pressure above the 95th percentile based on current Task Force criteria, and overweight was defined as body mass index (BMI) >25 kg/m². cIMT was assessed by high-resolution vascular ultrasonography of the distal common carotid artery. Hypertensive subjects had a higher cIMT than normotensive subjects (0.62 vs. 0.53 mm, P<0.00001). This difference remained significant after controlling for the effects of gender, race, age, height, weight, and BMI. Similarly, overweight subjects had a higher cIMT than normal-weight subjects (0.63 vs. 0.54 mm, P<0.0001). Subjects with both systolic and diastolic hypertension had higher cIMT than those with isolated systolic hypertension (0.67 vs. 0.60, P<0.05). cIMT showed significant positive pairwise correlation with age, height, weight, BMI, and systolic blood pressure. Among all clinical variables analyzed, cIMT was most strongly correlated with BMI (r=0.53, P<0.001). These results provide further evidence that vasculopathy occurs in association with known cardiovascular risk factors such as hypertension and obesity during childhood.     

Prevalence of silent kidney disease in Hong Kong: the screening for Hong Kong Asymptomatic Renal Population and Evaluation (SHARE) program

BACKGROUND: End-stage renal disease (ESRD) is epidemic worldwide. In Hong Kong, the annual incidence of ESRD has risen from 100 pmp (per million population) in 1996 to 140 pmp in 2003. SHARE (Screening for Hong Kong Asymptomatic Renal Population and Evaluation program) is a population-based screening program aimed at identifying the prevalence of unrecognized renal disease in asymptomatic individuals, allowing further evaluation and disease-modifying interventions. METHODS: From November to December 2003, SHARE was conducted in several large residential communities in Hong Kong. The screening tool included a questionnaire documenting demographics and history or family history of diabetes mellitus (DM), hypertension (HT), and chronic kidney disease (CKD), together with on-site measurements of blood pressure (BP) and urine dipstick for protein, blood, and glucose. RESULTS: There were a total of 1811 participants. One thousand two hundred and one subjects were entered into the final analysis. Among the 1201 who were apparently "healthy" (asymptomatic and without history of DM, HT, or CKD), the prevalence of positive (> or =1+) urine dipstick for protein, glucose, blood, protein or blood, any urine abnormality, and HT (BP> or =140/90) was 3.2%, 1.7%, 13.8%, 16%, 17.4%, and 8.7%, respectively. Thirty three percent of the age over 60 years old group had either hypertension or urine abnormalities, compared with 24.0% in the 41- to 60-year-old group and 9.7% in the 20- to 40-year-old group. Having a family history of diabetes or hypertension increases the risk of having urine abnormalities, while a family history of hypertension also increases the risk of high blood pressure. CONCLUSION: It is concluded that subclinical abnormalities in urinalysis or BP readings are prevalent across all age groups in the adult population. An effective screening program at the primary care level that identifies these subjects for further evaluation is warranted, and the public in Hong Kong should be educated toward the significance of such findings in order to have regular health check for asymptomatic renal diseases.     

Intima-media thickness and arterial elasticity in hypertensive children: controlled study

The objective of this cross-sectional controlled study was to evaluate the intima-media thickness (IMT) of the common carotid artery (cIMT) and superficial femoral artery (fIMT), as well as the elastic properties of the common carotid artery, in children with essential arterial hypertension. The study included 49 children with newly detected essential hypertension [mean age 14.5 (range 6–20) years] and 61 healthy normotensive children [mean age 13.5 (range 6–20) years]. The cIMT and fIMT were evaluated by ultrasonography. The elastic properties of the carotid artery were calculated from actual blood pressure values, arterial dimensions, and carotid wall thickness. Hypertensive children had greater values of both cIMT (0.45±0.05 mm) (P=0.0001) and fIMT (0.37±0.05 mm) (P=0.005) than controls (0.41±0.04 and 0.33±0.06 mm, respectively). The internal systolic and diastolic diameters of the common carotid artery were also significantly greater in hypertensive patients. The distensibility and elasticity of the common carotid artery were significantly decreased in hypertensive patients, while arterial compliance was significantly greater than in controls. cIMT and fIMT correlated with systolic and pulse pressure values, body mass index (BMI), homocysteine, low high-density lipoprotein, and apolipoprotein AI. After subdividing the control group and patients according to BMI below or above the 95th percentile for age and sex, there were differences only between normal-weight normotensive children and the two groups of hypertensive children. The stepwise regression analysis showed that the predictive factor for cIMT was pulse pressure and for fIMT body mass and homocysteine. Hence, in newly diagnosed children with essential hypertension, functional and anatomical changes in elastic and muscular arteries are observed. Pulse pressure and biochemical risk factors for cardiovascular damage were predictors of vessel wall injury, even if it remained within the normal range. BMI is an important factor influencing IMT values.     

The role of parental hypertension in the frequency and age of diagnosis of hypertension in offspring with autosomal-dominant polycystic kidney disease

BACKGROUND: Hypertension in autosomal-dominant polycystic kidney disease (ADPKD) patients is associated with more rapid progression of renal disease and a high incidence of left ventricular hypertrophy (LVH). The present study was undertaken to examine the role of parental hypertension in the occurrence of hypertension in 475 ADPKD offspring. METHODS: Adult subjects participating in an ongoing study of the natural history of ADPKD were included in the analysis if they were diagnosed with ADPKD, had a known affected parent, and knew the hypertensive status of both parents. RESULTS: When the affected parent was hypertensive, the ADPKD male (82% versus 62%, P < 0.05) and female (61% versus 37%, P < 0.005) offspring had a significantly higher frequency of hypertension than when the ADPKD-affected parent was normotensive. The median age of diagnosis of hypertension was also significantly earlier in both male (33 years versus 40 years, P < 0.05) and female (38 years versus 50 years, P < 0.05) ADPKD patients when their affected parents were hypertensive as compared with normotensive. These effects of hypertension in the affected parent on hypertension in the ADPKD offspring were independent of age, renal volume, and renal function in the offspring. Hypertension in unaffected parents also increased the frequency of hypertension in the ADPKD female (69% versus 53%, P < 0.01), but not male (89% versus 77%, NS) subjects. CONCLUSION: The results indicate that parental hypertension influences the frequency of hypertension in ADPKD patients.     

Long-term follow-up of kidney donors: a longitudinal study

Background: Kidney donors are not adversely affected by compensatory hyperfiltration of the remaining kidney in the early years after nephrectomy, but long-term longitudinal studies are lacking. Method: The renal function and blood pressure of 75 donors was evaluated in 1984, 1.4-20.7 years after surgery. Forty-seven of the original cohort (23 male, age 38-80 years) underwent repeat study a decade later (12-31 years post-nephrectomy), using identical laboratory techniques. Results: Glomerular filtration rates (GFR) as measured by ⁵¹Cr EDTA clearance was relatively unchanged a decade later with 41 of 47 subjects (87%) having EDTA clearance within the normal laboratory reference range at review. The change in GFR in the remaining six subjects was statistically not significant. No correlation between GFR and time after nephrectomy was detected. Albumin excretion rate (AER), on timed overnight urine collections, was increased (>20 &mgr;/min) in 16 subjects (34%), although 14 of these individuals were also hypertensive. The prevalence of hypertension was significantly increased compared with age/sex matched data from epidemiological studies of the general population (both in the UK and the US), especially in those over the age of 55 years. Conclusion: This study demonstrates that the function of the solitary kidney is not adversely affected by prolonged compensatory hyperfiltration, although there appears to be an increased prevalence of microalbuminuria and hypertension. Regular follow-up of kidney donors is recommended in order to manage their complications effectively and to detect hypertension and or renal impairment early in those who may develop it.     

新乡市部分社区人群骨质疏松症流行病学调查及相关影响因素Logistic 回归分析

目的了解新乡市部分社区人群骨质疏松症(osteoporosis,OP)的患病情况及相关影响因素,为OP的社区干预提供基础资料。方法应用HOLOGIC公司生产的Sahara定量超声骨密度检测仪测量新乡市部分社区4280名人群右侧跟骨骨密度。通过对受试者进行调查问卷,测量身高、体重、体重指数(BMI),是否服用糖皮质激素及其他影响骨代谢的药物等。单因素Logistic分析,有统计学意义者(P0.1)进一步行二分类Logistic回归分析,计算OR值及其95%置信区间。结果 1 OP总患病率为11.7%,男性8.4%,女性16.3%,OP及低骨量发生率随年龄增加呈上升趋势,同年龄组女性较男性更易发生OP及低骨量;2在男性,单因素分析显示年龄、文化程度、饮酒、咖啡、日饮用牛奶量、BMI、固定锻炼、OP家族史等与OP患病可能相关(P0.1)。二分类Logistic回归分析显示增龄、OP家族史、饮酒为OP可能为危险因素;高文化程度、稳定日牛奶饮用、固定锻炼为OP的可能保护性因素;3在女性,单因素分析显示年龄、文化程度、日饮牛奶量、咖啡、BMI、固定锻炼、绝经年龄及年限是OP的可能影响因子(P0.1);二分类Logistic回归分析显示增龄、绝经状态及BMI是OP的可能危险因素;晚绝经、每日稳定牛奶饮用及锻炼为其可能保护性因素。结论新乡市部分社区OP骨质疏松症的发生随着增龄而增加,女性更为明显。影响男性OP的主要危险因素为家族史和增龄及饮酒;在女性是增龄、绝经及BMI。饮用牛奶和规律锻炼是OP可能保护性因素。在社区一级预防中加强宣教,控制可能导致OP的不良因素,预防和延缓骨质疏松症的发生。