Mean values of risk factors for ischemic heart disease and their percentile distributions in the Alma-Ata population of men aged 20-54]

The authors analyze the results of a one-stage epidemiological study of the open population of men aged 20-54 years (n-2886), carried out with a purpose of revealing coronary heart disease (CHD) and its risk factors (RF). The study was performed with the aid of the standard WHO methods of epidemiological investigations. The prevalence of the main CHD RF (arterial and borderline hypertension, overweight, tobacco-smoking, dyslipoproteinemias) was established. The mean values of RF in different age groups were calculated. The regional 90% cut-off points of RF distributions were defined: the body weight index (30.0), systolic arterial pressure (141 mm Hg), diastolic arterial pressure (95 mm Hg), cholesterol level (6.50 mmol/l, triglycerides (2.15 mmol/l). The 10% cut-off point for alpha-cholesterol amounted to 0.98 mmol/l. The regional values obtained can be used in prophylactic screenings when making up groups to be placed under dispensary observation.     

Arterial hypertension: its prevalence, risk factors and the priority trends in its prevention]

All male population aged 40-59 years (n = 7413) of small towns of Lithuania underwent an epidemiological survey. Of these, 5204 persons (70.2% of the group) responded. The prevalence of arterial hypertension was determined (32.7%) as was its relation to three risk factors and five sociodemographic parameters. A more pronounced positive correlation was established between the incidence of arterial hypertension and overweight, a pronounced one between AH and alcohol use and tobacco-smoking giving up, and a partial one between AH and educational level, official standing, and salary. Recommendations as to prevention of and priority trends in further studies into arterial hypertension are under discussion.     

Results of 5-year multifactorial primary and secondary prevention of coronary heart disease in Tashkent

The program of multifactorial primary prophylaxis was carried out for 5 years among the non-organized male population aged 40-59 years. A possibility of the disease control was demonstrated in respect to such risk factors as arterial hypertension and tobacco-smoking. No substantial changes were discovered in the prevalence of hypercholesterolemia, overweight, low physical activity as well as in the lethality due to coronary heart disease or in the rate of new cases of myocardial infarction. In the group of patients suffering from coronary heart disease, measures aimed at multifactorial secondary prophylaxis promoted a significant reduction of the lethality due to that disease and of the rate of new cases of myocardial infarction since the third year of intervention.     

Clinical, metabolic, age-related, and biorhythmologic aspects of daily arterial pressure profiles in patients with arterial hypertension

The work was designed to study daily arterial pressure (AP) profile in 103 patients aged 20-70 (48.6 +/- 12.) years with grade I-II arterial hypertension and its relation to selected metabolic parameters, heliogeophysical factors and age. The patients underwent 24-hr AP monitoring, calculation of body mass index, measurement of blood glucose and cholesterol levels. Non-dippers showed higher mean nocturnal AP values than dippers probably due to higher BMI, glucose and cholesterol levels. These patients were more sensitive to heliophysical factors. Patients above 60 years displayed higher AP values in morning hours compared with 21-40 year-old ones. These data can be used in the development of primary and secondary prophylaxis of arterial hypertension.     

The incidence of ischemic heart disease and its risk factors in 20- to 54-year-old male workers in physical and intellectual jobs]

The low incidence of coronary heart disease (CHD) was established in the course of a one-stage epidemiological examination of 2562 men aged 20-54 years (a random sample from an open city population). It was found to be associated with an insignificant prevalence of lipid metabolism abnormalities (excluding hypoalphacholesterolemia) and did not depend on the nature of labour (4.3% among white collars and 4.4% among blue collars). The incidence of overweight and high AP turned out approximately identical, whereas tobacco-smoking, hypercholesterolemia and hypertriglyceridemia were mostly recorded in blue collars. The prevalence of CHD and its risk factors increased with age, excluding tobacco-smoking. In the latter case, it reduced with age.     

Measures in the campaign against smoking and their efficacy according to the results of a 3-year observation under the conditions of a district polyclinic

Examination of 4185 men aged 30 to 59 years, carried out within the framework of investigations into multifactorial prevention of coronary heart disease enabled one to establish that the number of tobacco-smokers among that group men amounts to 45.1%. The percentage of tobacco-smokers appreciably decreases with age. Every second tobacco-smoker starts smoking at the age of 15 to 25 years and smokers out up to 20 and over cigarettes a day. It has been established that 86% of the tobacco-smokers have been smoking for more than 20 years, which allows attributing them to a group of persons suffering from stage III-IV tobacco-smoking, needing therapeutic care. Tobacco-smoking control consisting in group and individual interviews made it possible to lower the populational level of tobacco-smoking by 8.4% for 2 years. In the reference group, that indicator decreased by 1.4%. A new narcologic method of the treatment of tobacco-smoking has been elaborated, the efficacy of which amounted to 85.3% for a year. The use of the method led to the lowering of the populational level of tobacco-smoking by 15.1% during 3 years. In the reference group, the number of tobacco-smokers dropped by 4.7%.     

Epidemiologic aspects of tobacco smoking in connection with its clinical course among men aged 20-69 years living in Kiev

An epidemiological study was carried out among 1500 men aged 20-69 years in order to study the prevalence of risk factors of coronary heart disease. 51.1% of the men turned out to be tobacco-smokers. Every tenth man smoked up over 20 cigarettes, every fourth man smoked up from 10 to 20 cigarettes a day. The number of tobacco-smokers decreased with age, namely from 61% at an age of 20-29 years to 33% at an age of 60-69 years. The structure of tobacco-smoking was found to change with age. This is related to the fact that the age-associated dynamics of its prevalence and intensity correlates with the dynamics of formation and course of the toxicomanic dependence on tobacco smoke. The data obtained are important for the planning of measures aimed at tobacco-smoking control among the population in cases where it is necessary to estimate whether carrying out of the sanitary instructive measures alone is sufficient.     

Reference data for distal blood pressure in healthy elderly and middle-aged individuals measured with the strain gauge technique. Part I: resting distal blood pressure

OBJECTIVE: Most patients referred to our department for distal blood pressure (DBP) determination on suspicion of arterial peripheral vascular disease (apvd) are more than 60 years of age, whereas the only available reference data for resting pressure are based on data from healthy individuals aged between 43 and 57 years. Our aim was to investigate whether newly collected reference data for DBP measured using the strain-gauge technique in healthy subjects older than 60 years and in others between 45 and 58 years were significantly different from the old reference data used in daily practice. MATERIAL AND METHODS:. Group I comprised 31 healthy persons aged between 61 and 87 years and group II 14 healthy middle-aged hospital staff members aged between 45 and 58 years. Strict rules of inclusion were followed. RESULTS: For group I, significantly greater gradients (DBP(toe) - systolic arm blood pressure and DBP(toe) - DBP(ankle)) were found in the new reference data compared to the old. No significant difference between the mean values of the gradient (DBP(ankle) - systolic arm blood pressure) was found between the old and new reference data, although the variation was significantly wider in the new reference data; the lower level of normality was therefore -15 mmHg compared to 0 mmHg in the old reference data. For group II, no significant differences between the gradients were found comparing the new and old reference data. CONCLUSION: These new data indicate that reference data gathered from middle-aged subjects should be changed when DBP measurements are used in patients older than 60 years of age.     

Controlled hypotension with sodium nitroprosside in patients placed in the sitting position during intracranial operations (author's transl)]

Sodium nitroprusside was used to induce hypotension during continuous neuroleptanalgesia in 11 neurosurgical patients aged between 13 and 53 years placed in the sitting position. No patient had cardiovascular disease. 14 patients aged between 18 and 72 years without induced hypotension were used as controls to compare the action of our standardized method of anaesthesia on the same parameters that were also monitored during blood pressure lowering. Cerebral perfusion of these 14 patients with highly elevated intracranial pressure with or without cardiovascular disease already seemed to be threatened by the upright position. Therefore, induced hypotension was not performed. The average dosage of sodium nitroprusside was 2.08 mcg/kg/min. The initial medium arterial pressure was lowered by a mean of 32.4%, associated with an average increase in pulse rate of 38.9%. The values of arterial PO2 never fell below 100 mmHg and the PCO2 remained between 25 and 35 mm Hg, indicating adequate cardiovascular function and gas exchange. Careful monitoring of the patients during and after blood pressure lowering with sodium nitroprusside made it possible to take advantage of the induced hypotension also in strictly-selected neurosurgical patients who have to be operated on in upright position.     

Beat-to-beat agreement of non-invasive finger artery and invasive radial artery blood pressure in hypertensive patients taking cardiovascular medication

Summary. The aim of this study was to investigate and quantify the agreement between simultaneous and ipsilateral non-invasive finger artery blood pressure (Finapres®) and intra-arterial radial blood pressure among 13 volunteer hypertensive patients, aged 36–71 years and taking cardiovascular medication, during steady-state fluctuation of arterial blood pressure and during an increase in blood pressure induced by static exercise. Eight patients were being treated with beta-blocking agents, eight with calcium antagonists, four with angiotensin-converting enzyme inhibitors, four with diuretics and one with prazosin in combination therapy. Their auscultatory brachial artery blood pressures ranged in systole from 142 to 206 mmHg and in diastole from 88 to 120 mmHg during the treatment. The mean systolic finger artery blood pressure deviated by -14±5 mmHg (P=0.02, mean value±SEM) and the diastolic finger artery blood pressure deviated by 0.6±3 mmHg (P=0.70) from the corresponding radial artery pressure. The maximal beat-to-beat difference between systolic and diastolic finger and radial artery pressure, respectively, showed that a range of less than 10 mmHg in the steady state after individual adjustment for bias. In general, neither systolic nor diastolic differences between the methods exceeded the limits of ±10 mmHg, and the bias did not significantly increase (P≥0.12) during a 10-mmHg increase in arterial blood pressure caused by static exercise. Among three subjects, an increase in bias and poorer agreement was associated with atrial fibrillation and steplike changes in the Finapres output after autocalibration. The results support usage of the Finapres technique to measure beat-to-beat changes of peripheral arterial blood pressure in hypertensive patients taking cardiovascular medication, with a feasible agreement with beat-to-beat radial artery blood pressure.     

Estimation of central aortic pressure by SphygmoCor requires intra-arterial peripheral pressures

Central arterial pressure, measured close to the heart, may be of more patho-physiological importance than conventional non-invasive cuff blood pressure. The technique of applanation tonometry using SphygmoCor has been proposed as a non-invasive method of estimating central pressure. This relies on mathematically derived generalized transfer functions, which have been previously validated using invasive peripheral pressure measurements. We compared simultaneous estimates of central aortic pressure using this technique with those measured directly during the routine diagnostic cardiac catheterization of 30 subjects (age range 27-84 years), half of whom were aged 65 years or more. This was done by applanating the left radial artery and recording the non-invasive brachial cuff blood pressure to generate a central aortic pressure estimate, using the SphygmoCor radial transfer function. The comparative results were analysed using Bland-Altman plots of mean difference. SphygmoCor, on average, underestimated systolic central arterial pressure by 13.3 mmHg and overestimated diastolic pressure by 11.5 mmHg. The results were similar in patients aged under and above 65 years. Furthermore, non-invasively measured brachial pressures were seen to give an overall closer estimate of the central arterial pressure than the SphygmoCor system. The transfer function has been validated from invasively measured arterial pressures and the current use by the system of non-invasive measures may explain the discrepancies. However, age, drugs and arterial disease would also be expected to play a role.     

Doppler-determined peak systolic tricuspid pressure gradient in persons with normal pulmonary function and tricuspid regurgitation.

The Doppler-estimated peak systolic tricuspid pressure gradient is the most reliable noninvasive method for the evaluation of pulmonary artery systolic pressure in patients with tricuspid regurgitation. Our goal was to evaluate the range of this gradient in healthy persons and determine a normal upper limit. We studied 53 healthy persons (34 women, 19 men; aged 14 to 55 years, mean 38.9 +/- 12.7 years) who did not smoke and who had an adequate Doppler signal of tricuspid regurgitation. The presence of pulmonary or cardiac disorders was excluded by a review of the subject's medical history in addition to physical examination, spirometry, arterial blood gasses determination, electrocardiography, chest x-ray examination, and rest echocardiography. Tricuspid gradient ranged from 12.6 to 29. 3 mm Hg (mean 19.3 +/- 4.0); 35.8% of patients had values higher than 20 mm Hg. In conclusion, a tricuspid gradient of 30 mm Hg may be considered as the upper normal limit. The different approaches for estimating mean right atrial pressure are also discussed.     

Arterial pressure mean values and distribution, and relation to duration of residence in the North in school children living in the north of Tumen region

AIM: To elicit regularities significant for epidemiological situation by arterial hypertension among schoolchildren of Tumen North with reference to duration of living in the North. MATERIAL AND METHODS: 2525 schoolchildren (the response 85.3%) aged 7-15 years entered a one-stage epidemiological study. RESULTS: Tables were made of arterial pressure distribution in the schoolchildren population. The pressure was higher in children living in the North for more than 5 years. Arterial hypertension was registered in 12.7% of the examinees (14.1% of boys and 11.6% of girls). CONCLUSION: Prevalence of arterial hypertension in schoolchildren living in the North was high. A correlation was found between mean arterial pressure and duration of the exposure to North conditions.     

Physical activity, cardiovascular risk factors, and mortality among Finnish adults with diabetes

OBJECTIVE: The aim of this study was to examine both single and joint associations of physical activity and conventional cardiovascular risk factors with total and cardiovascular mortality among patients with diabetes. RESEARCH DESIGN AND METHODS: We prospectively followed 3,708 Finnish patients with type 2 diabetes aged 25-74 years. Physical activity, smoking status, blood pressure, height, weight, and serum cholesterol level were determined at baseline. Cox proportional hazard models were used to estimate single and joint effects of physical activity and other cardiovascular risk factors on the risk of mortality. RESULTS: During a mean follow-up of 18.7 years, 1,423 deaths were recorded, 906 of which were due to cardiovascular disease. Moderate or high levels of physical activity were associated with decreased total and cardiovascular mortality, whereas higher levels of BMI and blood pressure and current smoking were associated with increased total and cardiovascular mortality. High serum cholesterol levels also increased cardiovascular mortality. The protective effect of physical activity was consistent in diabetic patients with any levels of BMI, blood pressure, total cholesterol, and smoking. CONCLUSIONS: A moderate or high level of physical activity was associated with a reduced risk of total and cardiovascular mortality among patients with type 2 diabetes. The favorable association of physical activity with longevity was observed regardless of the levels of BMI, blood pressure, total cholesterol, and smoking.     

Ways to decrease blood loss during total hip joint endoprosthesis

Total replacement (endoprosthesis) of the hip joint was carried out in 93 patients aged 18-60 years. Sixteen operations were performed under prolonged epidural blockade, 66 under neuroleptanalgesia, and 16 under ataralgesia. A deficiency of circulating blood volume was detected in all patients before surgery. The lowest mean arterial pressure was recorded in the prolonged epidural block group, while in the neuroleptanalgesia and ataralgesia groups the mean arterial pressure was virtually the same. Isovolemic hemodilution in patients with preoperative deficit of circulating blood volume decreased blood loss during long traumatic operations. Prolonged epidural blockade in combination with isovolemic hemodilution and spontaneous respiration led to a notable (70%) decrease of the true blood loss in comparison with the traditional neuroleptanalgesia.     

The assessment of processes of lipoperoxidation in adolescents with essential arterial hypertension using the integral indicator

The sample of 69 male adolescents aged of 14-17 years (46 of them with essential arterial hypertension) is examined. The control group included 23 adolescents. The intensity of oxidizing stress assessed according to the oxidizing stress coefficient. The calculation of coeffcient was based on testing in blood serum the content of products of peroxidation of lipids (substrates with double bonds, diene conjugate, malonic dialdehyde). The indices of antioxidant system (content of alpha-tocopherol, retinol, reduced glutathione and activity of superoxid dismutase) were used too. It is established that the oxidizing stress coefficient characterizes the degree of intensity of oxidizing process.     

Portapres and differential oscillometric finger blood pressure changes during deep breathing test in the assessment of BRS index

The aim of this study was to investigate changes in the finger blood pressure during a deep breathing test (DB) and to find out whether the mean blood pressure might be used as a substitute for the systolic pressure in calculations of baroreflex sensitivity from data derived from the DB test. Continuous beat-to-beat finger pressure was recorded by the volume clamp method (Portapres model 2 monitor). In addition, the mean arterial pressure was recorded by the modified oscillometric method (UT9201 beat-to-beat monitor, University of Tartu, Estonia). Fifteen healthy volunteers, aged 25-56 years, were studied. The amplitude of respiration-linked oscillations in the Portapres systolic (Psyst) and mean blood pressure (Pmean) was 22.2 +/- 8.8 and 16.6 +/- 5.8 mmHg, respectively. There was no significant difference between the amplitudes of induced changes in Pmean recorded by the two devices: the amplitude of oscillations in the mean blood pressure recorded by the differential oscillometric monitor was 16.0 +/- 5.9 mmHg. The amplitude of oscillations in Psyst correlated significantly with the amplitude of oscillations in Pmean recorded either by Portapres or by UT9201 (r=0.95 and 0.98, respectively). The high correlation between the amplitudes of oscillations in mean and systolic blood pressure allows to conclude that mean arterial pressure changes during a DB test might be used instead of systolic pressure changes in calculation of the ratio of changes in pulse interval to changes in blood pressure, which is considered to reflect baroreflex sensitivity.     

Epidemiology of ischemic heart disease as related to the main risk factors among the male population in various Soviet cities (a cooperative study)

A study was made of the prevalence of coronary heart disease, risk factors (arterial hypertension, hypercholesterolemia, hypertriglyceridemia, hypo-alpha-cholesterolemia, overweight, tobacco-smoking) and of the relation of coronary heart disease to the risk factors in men aged 20 to 39 years and 40 to 54 years, living in 8 cities of the USSR. The study was carried out on material of random representative samples. It has been established that the prevalence of coronary heart disease and risk factors is bigger among the populations living in the European part of the USSR and Siberia, being lower among the populations of Central Asia. The relationship between coronary heart disease and the risk factors is pronounced to a greater measure in arterial hypertension and overweight and to a less degree in other conditions. Besides, the relation of coronary heart disease to the risk factors is marked to a much greater measure among men belonging to the senior age groups.     

卡托普利与硝苯吡啶治疗老年高血压病的临床观察比较

目的 比较卡托普利与硝苯吡啶对老年高血压病的疗效。方法 选择符合WHO诊断标准的老年高血压病患者38例,男28例,女16例,年龄60—82岁。随机分成两组,每组均为19例,单独服用降压药硝苯吡啶或卡托普例,观察治疗前后血压、心率、血胆固醇、甘油三酯、血糖及胰岛素的变化。结果 卡托普列降压作用与硝苯吡啶比较无显著差异(P>0.05)。结论 卡托普利与硝苯吡啶均能显著降低老年高血压,疗效显著。     

Lack of association between arterial blood pressure and erythrocyte fatty acid composition in an Italian population sample

The relation between arterial blood pressure and erythrocyte fatty acid composition was investigated in a large urban female population aged 20-69 years. No significant differences in the relative amounts of saturated, monounsaturated and polyunsaturated (n-6 and n-3 series) fatty acids and in the mean polyunsaturated/saturated and linoleic/oleic ratios were observed in the different quartiles of both systolic and diastolic blood pressure. Moreover, there was no significant correlation between individual erythrocyte fatty acids and their ratios and either blood pressure or other risk factors for atherosclerosis (age, body mass index, total serum cholesterol and triglycerides). In the multivariate analysis no independent correlations between systolic and diastolic blood pressure and the individual erythrocyte fatty acids were observed; age and body mass index were strongly related to blood pressure. Our results do not confirm for erythrocyte fatty acids the reported associations between plasma fatty acids and blood pressure.