Waist circumference and cardiovascular risk factors in prepubertal children

OBJECTIVE: Intra-abdominal fat has been identified as being the most clinically relevant type of fat in humans. Therefore, an assessment of body-fat distribution could possibly identify subjects with the highest risk of adverse lipid profile and hypertension. Few data on the relationship between body-fat distribution and cardiovascular risk factors are available in children, especially before puberty. RESEARCH METHODS AND PROCEDURES: This cross-sectional study was undertaken to explore the relationship between anthropometric variables, lipid concentrations, and blood pressure (BP) in a sample of 818 prepubertal children (ages 3 to 11 years) and to assess the clinical relevance of waist circumference in identifying prepubertal children with higher cardiovascular risk. Height, weight, triceps and subscapular skinfolds, waist circumference, and BP were measured. Plasma levels for triacylglycerol, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, apolipoprotein A1 (ApoA1), and apolipoprotein B (ApoB) were determined. RESULTS: Females were fatter than males (5.8 [3.5] vs. 4.8 [3.3] kg of fat mass; p < 0.01). Males had higher HDL cholesterol and ApoA1/ApoB plasma concentrations than females (p < 0.001 and p < 0.01, respectively). Waist circumference had a higher correlation with systolic and diastolic BP (r = 0.40 and 0.29, respectively; p < 0.001) than triceps (r = 0.35 and 0.21, respectively; p < 0.001) and subscapular (r = 0.28 and 0.16, respectively; p < 0.001) skinfolds and relative body weight (0.33 and 0.23, respectively; p < 0.001). Multivariate linear model analysis showed that ApoA1/ApoB, HDL cholesterol, total cholesterol/HDL cholesterol, and systolic as well as diastolic BP were significantly associated with waist circumference and triceps and subscapular skinfolds, independently of age, gender, and body mass index. DISCUSSION: Waist circumference as well as subscapular and triceps skinfolds may be helpful parameters in identifying prepubertal children with an adverse blood-lipids profile and hypertension. However, waist circumference, which is easy to measure and more easily reproducible than skinfolds, may be considered in clinical practice. Children with a waist circumference greater than the 90th percentile are more likely to have multiple risk factors than children with a waist circumference that is less than or equal to the 90th percentile.     

Blood lead concentration, renal function, and blood pressure in London civil servants.

Blood lead concentration was measured in 398 male and 133 female London civil servants not subject to industrial exposure to heavy metals. The relation between blood lead and serum creatinine concentrations and blood pressure were examined. Blood lead concentration ranged from 0.20 to 1.70 mumol/l with a geometric mean concentrations of 0.58 mumol/l in men and 0.46 mumol/l in women (p less than 0.001). In women blood lead concentration increased with age (r = +0.27; p = 0.002). In the two sexes blood lead concentration was positively correlated with the number of cigarettes smoked a day (men r = +0.17 and women r = +0.22; p less than or equal to 0.01), with the reported number of alcoholic beverages consumed a day (men r = +0.34 and women r = 0.23; p less than 0.01), and with serum gamma-glutamyltranspeptidase (men r = +0.23 and women r = +0.14; for men p less than 0.01). Blood lead concentration was not correlated with body weight, body mass index, and employment grade. In men 14% of the variance of blood lead concentration was explained by the significant and independent contributions of smoking and alcohol intake and in women 16% by age, smoking, and alcohol consumption. In men serum creatinine concentration tended to rise by 0.6 mumol/l (95% confidence interval from -0.2 to +1.36 mumol/l) for each 25% increment in blood lead concentration. In men and women the correlations between blood lead concentration and systolic and diastolic blood did not approach statistical significance. In conclusion, in subjects not exposed to heavy metals at work gender, age, smoking, and alcohol intake are determinants of blood lead concentration. At a low level of exposure, lead accumulation may slightly impair renal function, whereas blood pressure does not seem to be importantly influenced. Alternatively, a slight impairment of renal function may give rise to an increase in blood lead concentration.     

Blood lead concentration, renal function, and blood pressure in London civil servants

Blood lead concentration was measured in 398 male and 133 female London civil servants not subject to industrial exposure to heavy metals. The relation between blood lead and serum creatinine concentrations and blood pressure were examined. Blood lead concentration ranged from 0.20 to 1.70 mumol/l with a geometric mean concentrations of 0.58 mumol/l in men and 0.46 mumol/l in women (p less than 0.001). In women blood lead concentration increased with age (r = +0.27; p = 0.002). In the two sexes blood lead concentration was positively correlated with the number of cigarettes smoked a day (men r = +0.17 and women r = +0.22; p less than or equal to 0.01), with the reported number of alcoholic beverages consumed a day (men r = +0.34 and women r = 0.23; p less than 0.01), and with serum gamma-glutamyltranspeptidase (men r = +0.23 and women r = +0.14; for men p less than 0.01). Blood lead concentration was not correlated with body weight, body mass index, and employment grade. In men 14% of the variance of blood lead concentration was explained by the significant and independent contributions of smoking and alcohol intake and in women 16% by age, smoking, and alcohol consumption. In men serum creatinine concentration tended to rise by 0.6 mumol/l (95% confidence interval from -0.2 to +1.36 mumol/l) for each 25% increment in blood lead concentration. In men and women the correlations between blood lead concentration and systolic and diastolic blood did not approach statistical significance. In conclusion, in subjects not exposed to heavy metals at work gender, age, smoking, and alcohol intake are determinants of blood lead concentration. At a low level of exposure, lead accumulation may slightly impair renal function, whereas blood pressure does not seem to be importantly influenced. Alternatively, a slight impairment of renal function may give rise to an increase in blood lead concentration.     

Diet, alcohol, body mass, and social factors in relation to blood pressure: the Caerphilly Heart Study.

Data for 387 men who had completed seven-day weighed dietary records as part of the Caerphilly Heart Study were examined for relations of alcohol, diet, body mass index (BMI), and other variables to blood pressure. These included age, smoking, exercise, and social class. For men not on antihypertensive treatment (n = 356) regression analysis showed that age (p less than 0.001), BMI (p less than 0.05), and alcohol intake (p less than 0.01) were significantly related to systolic blood pressure, and BMI (p less than 0.001) and alcohol intake (p less than 0.01) to diastolic blood pressure. In addition, protein intake (p less than 0.05) was significantly and inversely related to the risk of being hypertensive, but other dietary variables were not related to blood pressure. For men on antihypertensive treatment (n = 31) significant inverse correlations were observed between diastolic blood pressure and the intakes of potassium (p less than 0.01), fibre (p less than 0.001), polyunsaturated fat (p less than 0.01), and a number of other dietary variables. Reasons for these differences are discussed.     

Infant blood pressure and heart rate: relation to ethnic group (black or white), nutrition and electrolyte intake.

Blood pressure (BP) and heart rate were measured during non-rapid-eye-movement sleep in 392 full-term newborns and in 318 of these infants at age six months. Two-day records of food intake were collected at age six months for 150 infants. Black babies did not differ substantially in BP from white babies either at birth or at six months. The earliest BP tracking was from age six to 15 months (systolic (SBP): r = .29, p less than .001; diastolic:r = .45, p less than .001). No relationship was found between BP at six months and breast- or bottle-feeding, infant weight or weight change, or nutrient intake. The relationship between parental BP, on the one hand, and infant electrolyte intake and BP on the other, suggested that electrolyte intake was related to BP in the six-month-old infant, and that the relationship was different in white babies than in black babies. Among 56 white infants whose mother's mean BP was above the median for this population, infant sodium intake correlated with infant SBP (r = .31, p less than .009). Among 32 black infants, regardless of parents' BP, sodium intake was negatively correlated with SBP (r = -.36, p less than .021).     

Urinary cadmium and lead concentrations and their relation to blood pressure in a population with low exposure.

The 24 hour urinary excretion of cadmium (U-Cd) and lead (U-Pb), and the excretion of beta-2- microglobulins and retinol binding protein concentration in spot urines, were determined in a random 4% sample of the population of a small Belgian town. Blood pressure and body weight were measured on two separate occasions. U-Cd averaged 2.4 nmol/24 h in 46 youths, increased with age, and was significantly higher in 57 adult men as compared with 59 women (9.3 v 7.2 nmol/24 h; p less than 0.01). U-Pb averaged 28 nmol/24 h in youths and similarly increased with age: adult men excreted more lead than women (64 v 40.0 nmol/24 h; p less than 0.001). Among men, manual workers excreted more cadmium (12.6 v 7.5 nmol/24 h; p less than 0.05) but a similar amount of lead (62 v 61 nmol/24 h) compared with office workers. After adjusting for sex and age, U-Cd and U-Pb were not related to body weight and cigarette consumption. In simple regression analysis, U-Cd was positively correlated with both systolic (r = +0.30; p less than 0.05) and diastolic (r = +0.38; p less than 0.01) blood pressure in women. After adjusting for other contributing variables, however, a weak but negative relation became apparent between systolic pressure and U-Cd in women (t = -2.21; p = 0.033) and between diastolic pressure and U-Cd in men (t = -2.04; p = 0.047). In women urinary beta-2-microglobulin was related to diastolic pressure (r-0.44; p<0.01) and after adjusting for age to both systolic (t=2.75; p=0.009) and diastolic (t=-3.07; p=0.004) pressure. In none of the sex-age groups did U-Pb and retinol binding protein contribute to the blood pressure variability.     

Urinary cadmium and lead concentrations and their relation to blood pressure in a population with low exposure

The 24 hour urinary excretion of cadmium (U-Cd) and lead (U-Pb), and the excretion of beta-2- microglobulins and retinol binding protein concentration in spot urines, were determined in a random 4% sample of the population of a small Belgian town. Blood pressure and body weight were measured on two separate occasions. U-Cd averaged 2.4 nmol/24 h in 46 youths, increased with age, and was significantly higher in 57 adult men as compared with 59 women (9.3 v 7.2 nmol/24 h; p less than 0.01). U-Pb averaged 28 nmol/24 h in youths and similarly increased with age: adult men excreted more lead than women (64 v 40.0 nmol/24 h; p less than 0.001). Among men, manual workers excreted more cadmium (12.6 v 7.5 nmol/24 h; p less than 0.05) but a similar amount of lead (62 v 61 nmol/24 h) compared with office workers. After adjusting for sex and age, U-Cd and U-Pb were not related to body weight and cigarette consumption. In simple regression analysis, U-Cd was positively correlated with both systolic (r = +0.30; p less than 0.05) and diastolic (r = +0.38; p less than 0.01) blood pressure in women. After adjusting for other contributing variables, however, a weak but negative relation became apparent between systolic pressure and U-Cd in women (t = -2.21; p = 0.033) and between diastolic pressure and U-Cd in men (t = -2.04; p = 0.047). In women urinary beta-2-microglobulin was related to diastolic pressure (r-0.44; p<0.01) and after adjusting for age to both systolic (t=2.75; p=0.009) and diastolic (t=-3.07; p=0.004) pressure. In none of the sex-age groups did U-Pb and retinol binding protein contribute to the blood pressure variability.     

Nutrient intakes and blood pressure in normotensive males.

The association of dietary intakes with blood pressure levels was examined in a cross-sectional sample of 805 men aged 40-69 years free from clinical hypertension, coronary heart disease or cancer. After controlling for age, body habitus, and alcohol consumption, blood pressure levels were inversely associated with the intake of fruit (r = -0.09, p less than 0.05, for both systolic (SBP) and diastolic (DBP) blood pressure) and of fruit fibre (r = -0.07, p = 0.05 for SBP; r = -0.07, p = 0.07 for DBP). This association was independent of the intake of minerals and fibre from other sources. Calcium and magnesium intake were not significantly associated with blood pressure levels, but our results are statistically compatible with the modest inverse associations previously reported. These cross-sectional data suggest that some component of fruit has a blood pressure lowering effect.     

Heart rate, employment status, and prevalent ischaemic heart disease confound relation between cereal fibre intake and blood pressure.

Cross sectional data from a survey of 2512 men aged 45-49 years were used to examine the confounding effects of heart rate, employment, and ischaemic heart disease (IHD) on the relation between cereal fibre intake and blood pressure. Daily cereal fibre intake (g/day) was associated with systolic pressure (r = -0.053, p less than 0.01), diastolic pressure (r = -0.057, p less than 0.01), and heart rate (r = -0.071, p less than 0.01). The associations were strengthened in employed men and inapparent in unemployed men. Unemployed men had more IHD than employed men. Persons with any manifestation of IHD had significantly higher blood pressure and heart rates but ate less cereal fibre (7.0 v 7.9 g/day, p less than 0.001) than those without IHD, regardless of employment status. In employed men, after adjustment for age, body mass index, prevalent IHD, and heart rate, systolic pressure changed -0.186 mmHg (95% CI = -0.362, -0.009) and diastolic pressure changed -0.111 mmHg (95% CI = 0.228, 0.005) for each gram of cereal fibre eaten daily. The association between cereal fibre and blood pressure was inapparent in unemployed men. Heart rate, employment, and prevalent IHD confound the association between cereal fibre intake and blood pressure. Future work concerning this relationship will have to account for the effects of these variables.     

Isolated systolic hypertension in Dutch middle aged and all-cause mortality: a 25-year prospective study

In the early 1950s, the blood pressure of 3901 Dutch civil servants and their spouses aged 40-65 years was measured in a general health survey. Isolated systolic hypertension (systolic pressure greater than 160 mmHg, diastolic pressure less than 90 mmHg) was observed in 6.3% of the women and 3.0% of the men. The prevalence increased with age and it was more common in women in all age groups. Using logistic regression, with adjustment for potential confounders (age, smoking, serum cholesterol, Quetelet index, alcohol consumption, haemoglobin level, pulse rate and diastolic blood pressure) the association of 15- and 25-year total mortality with isolated systolic hypertension was determined. Compared to normotensive people (systolic pressure less than or equal to 135 mmHg, diastolic pressure less than 90 mmHg), the risk of death from all causes was significantly higher for men with isolated systolic hypertension after 15 and 25 years of follow-up (odds ratio OR = 2.4, 95% confidence interval (CI) 1.2-4.8 and OR = 3.2, 95% CI 1.3-8.0). For women 15-years mortality risk was strongly associated with isolated systolic hypertension (OR = 3.7, 95% CI 1.4-9.7). The increased risk was less pronounced after 25 years of follow-up (OR = 1.7, 95% CI 0.96-3.0). Our results support those of other studies and indicate that isolated systolic hypertension is an important independent risk factor for all-cause mortality. Since isolated systolic hypertension may be an indicator for the early onset of ageing, it is important to study its determinants and to pay more attention to its diagnosis and treatment in middle-aged populations.     

Energy intake and other determinants of relative weight

The relationships of relative weight to energy intake and to physical activity were studied among 141 females aged 34-59 y. As observed in previous studies Quetelet index (wt/ht2) was inversely related to energy intake (r = -0.11). However, obese women tended to be older (r = 0.16), exercise less (r = -0.30), and drink less alcohol (r = -0.16) than nonobese women. Older women had lower energy intake (r = -0.23) and exercised less (r = -0.12) than younger women. Energy intake and physical activity were positively related (r = 0.23). After adjustment for age, physical activity, alcohol, and smoking, the inverse correlation between relative weight and energy intake was significantly reduced (p = 0.04) from r = -0.11 to r = -0.02. Obese women reported higher intakes of total fat, and relative weight was significantly correlated with intakes of total fat (r = 0.20) and saturated fatty acids (r = 0.16). These data highlight the importance of considering factors that may confound the relationship between energy intake and obesity, and they suggest that fat intake may play a role in obesity that is independent of total energy intake.     

The effect of chronic alcohol consumption on blood pressure

In 1984, a hypertension screening programme was carried out on 13,772 adult subjects in conjunction with a radiological tuberculosis project in the Hungarian town of Csongrád. Among other factors, the effects of a long-lasting and heavy alcohol intake on blood pressure levels were investigated. 21.4% of the men and 2.3% of women admitted to being regular alcohol consumers. Direct and significant relationships were found between the quantity of alcohol consumed and both the systolic (p less than 0.001) and diastolic (p less than 0.05) blood pressures. The prevalence of hypertension (WHO criteria) was higher in heavy drinkers (29.9%) than in abstinent subjects (20.5%, p less than 0.001). When participants were subgrouped according to age groups only the men provided sufficient data. The systolic blood pressure of heavy drinkers was elevated as compared with that of non-drinkers.     

Sex and age interactions in the association between alcohol and blood pressure

The cross-sectional association between alcohol intake and blood pressure was examined in a probability sample of Michigan adults surveyed in 1983. Despite adjustments for race, sex, age, Quetelet index, and current treatment with antihypertensive medications, heavier alcohol intakes (more than one drink daily) were associated with increased systolic blood pressure, diastolic blood pressure, and prevalence of elevated blood pressure. These associations were somewhat exaggerated in women and in younger persons. Statistically significant differences in blood pressure were demonstrated only among consumers of more than one drink daily. Attributable risk calculations indicated that no more than 8.4 and 8.5% of instances of elevated blood pressure (systolic pressure greater than or equal to 140 mmHg or diastolic pressure greater than or equal to 90 mmHg) in men and women, respectively, could be attributed to alcohol intakes exceeding one drink daily.     

Association of blood pressure with intake of soy products and other food groups in Japanese men and women

BACKGROUND: Soy diet has been suggested to have antihypertensive effect in animal studies. The present study examined the cross-sectional relationship between blood pressure and intake of soy products and other food groups in Japanese men and women. METHODS: Blood pressure was measured in Japanese 294 men and 330 women (246 premenopausal and 84 peri- and postmenopausal women) who participated in a health check-up program provided by a general hospital. Intake of various food groups and nutrients was estimated from a validated semiquantitative food frequency questionnaire. RESULTS: In men, soy product intake was inversely significantly correlated with diastolic blood pressure (r = -0.12, P = 0.04) after controlling for age, total energy, smoking status, body mass index, and intake of alcohol, salt and seaweeds. The correlation of soy product intake with systolic blood pressure was of borderline significance (r = -0.10, P = 0.09). Systolic blood pressure was inversely correlated with intake of vegetables (r = -0.12, P = 0.04) and dairy products (r = -0.12, P = 0.05). There were no significant correlations between soy product intake and diastolic blood pressure in women. CONCLUSIONS: These results indicate a mild effect of soy intake on blood pressure reduction in men.     

Sex differences in the coronary heart disease risk profile: a possible role for insulin. The Beaver County Study

The mortality rate from coronary heart disease is much higher among men than women except in diabetes mellitus, which appears to reduce this sex difference. It is hypothesized that the female advantage is due, at least partly, to the more efficient insulin mediated glucose homeostasis in females, an advantage lost in the diabetic state. The authors studied 170 young adult men and women aged 20-24 years from a population-based survey in Beaver County, Pennsylvania, in 1981-1982, in an attempt to further elucidate the sex-specific relationships between fasting serum insulin concentrations and several risk factors. Women who used oral contraceptives and subjects whose fasting serum glucose exceeded 110 mg/dl were excluded. Insulin was related to body mass index in both sexes (r = 0.31; p less than 0.01 for men; r = 0.26, p less than 0.01 for women) and to systolic blood pressure (r = 0.27, p less than 0.01 for men; r = 0.36, p less than 0.001 for women). Insulin was related to diastolic blood pressure in men only (r = 0.31, p less than 0.05). Multivariate analysis revealed fasting serum insulin to be an independent predictor of systolic blood pressure in both sexes and of diastolic blood pressure in men only. Insulin was inversely related to high density lipoprotein cholesterol only among men and this relationship appeared to be largely independent of body mass index and triglycerides. Results indicate that insulin concentration is associated with an adverse coronary heart disease risk factor profile especially among men, consistent with their excess risk of cardiovascular disease.     

Dairy products, calcium, and blood pressure

The previously reported inverse association of dietary calcium intake and blood pressure levels was examined in a Southern California community, in order to determine whether this association was independent of age, obesity, and alcohol consumption. In the total population significantly less calcium intake from milk was reported in hypertensive versus normotensive men (but not women) and the association was independent of age and obesity. In a 23% subsample of men from this cohort the effect of total dietary calcium intake from all dairy products was estimated from a 24-h dietary recall. Again hypertensive men consumed significantly less calcium than normotensives. In men, both systolic and diastolic blood pressure levels were inversely associated with calcium intake from dairy products. After controlling for age, obesity, and alcohol, diastolic blood pressure was negatively and significantly associated with total calcium intake from dairy products, while systolic blood pressure was similarly associated with whole milk calcium alone. Although these data are cross-sectional, they suggest that some component of dairy products, probably calcium, exerts a protective effect against hypertension, and are compatible with the protective effect of calcium reported in hypertension-prone rats.     

Alcohol and blood pressure: results from the Luebeck Blood Pressure Study

Data from the Luebeck Blood Pressure Study, a cross-sectional study on a random sample (n = 3,100) of the 30- to 69-year-old population of Luebeck, were analyzed with regard to alcohol consumption and blood pressure. Putative confounders such as obesity, smoking, physical activity, and educational attainment were controlled for by multiple regression analyses. Luebeck men who consumed more than 40 g of alcohol per day revealed 5-6 mm Hg higher mean systolic and 4-5 mm Hg higher mean diastolic blood pressure values. A J-shaped relationship between alcohol consumption and systolic blood pressure was seen in Luebeck men. According to our calculations, about 7% of hypertension among Luebeck men is due to alcohol consumption of greater than or equal to 40 g/day. Among women, strong interactions between age and alcohol consumption were found, therefore two age groups, 30-44 and 45-69 years, were analyzed separately. In the younger age group the alcohol-blood pressure relationship was not pronounced. In the older age group a strong interaction between alcohol consumption and smoking was found. For female smokers steep increases in the adjusted mean diastolic (5.2 mm Hg) and systolic (9.6 mm Hg) blood pressure values were seen for the alcohol consumption category greater than or equal to 20 g/day. For female nonsmokers a flat curve was seen with regard to mean diastolic and systolic blood pressure values. The data from the Munich Blood Pressure Study show a very similar relationship between alcohol consumption and mean systolic and diastolic blood pressure values.     

Longitudinal study of soy food intake and blood pressure among middle-aged and elderly Chinese women

BACKGROUND: Several small-scale clinical trials have suggested a potential beneficial effect of short-term soy consumption on blood pressure (BP). Data are scanty on long-term effects of the usual intake of soy foods on BP in general populations. OBJECTIVE: Our aim was to examine the association between usual intake of soy foods and BP. DESIGN: The usual intake of soy foods was assessed at baseline, and BP was measured 2-3 y after the baseline survey among 45 694 participants of the Shanghai Women's Health Study aged 40-70 y who had no history of hypertension, diabetes, or cardiovascular disease at recruitment. Multiple regression models were used to estimate mean differences in BP associated with various intakes of soy foods. RESULTS: Soy protein intake was inversely associated with both systolic BP (P for trend = 0.01) and diastolic BP (P for trend = 0.009) after adjustment for age, body mass index, and lifestyle and other dietary factors. The adjusted mean systolic BP was 1.9 mm Hg lower (95% CI: -3.0, -0.8 mm Hg) and the diastolic BP was 0.9 mm Hg lower (-1.6, -0.2 mm Hg) in women who consumed > or =25 g soy protein/d than in women consuming <2.5 g/d. The inverse associations became stronger with increasing age (P for interaction < 0.05 for both BPs). Among women >60 y old, the corresponding differences were -4.9 mm Hg (95% CI: -8.0, -1.9 mm Hg) for systolic BP and -2.2 mm Hg (95% CI: -3.8, -0.6 mm Hg) for diastolic BP. CONCLUSION: Usual intake of soy foods was inversely associated with both systolic and diastolic BPs, particularly among elderly women.     

Rural and urban differences in blood pressure and hypertension in Ghana, West Africa

BACKGROUND: Hypertension, once rare in traditional African societies, is rapidly becoming a major public health problem. OBJECTIVE: To assess urban and rural differences in blood pressure (BP) and hypertension, and to determine factors associated with BP in this sub-Saharan Africa population. STUDY DESIGN: Cross-sectional survey. SETTING: Ashanti region of Ghana, West Africa. PARTICIPANTS: There were 1431 participants (644 males and 787 females). Of these, 578 were from the rural setting (237 males and 341 females) and 853 from the urban setting (407 males and 446 females). RESULTS: Age-adjusted mean systolic and diastolic BP levels were lower in rural men than in urban men (129/75 versus 133/78, P<0.001). The mean systolic and diastolic BP levels were also lower in rural women than in urban women (126/76 versus 131/80, P<0.001). After adjustments for age, the odds ratios (95% CI) for being hypertensive were 1.9 (1.3-2.9; P<0.01) for urban men and 1.9 (1.3-2.8; P<0.0001) for urban women. Urban women were more likely than rural women to be aware of their hypertensive condition (odds ratio 2.3, 95% CI, 1.2-4.2; P<0.001). Treatment and control of hypertension did not differ between the groups in either men or women. In multiple linear regression analysis, age, urban dwelling, BMI and heart rate were independently associated with systolic and diastolic BP in both men and women. Smoking and alcohol consumption were independently associated with systolic and diastolic BP but only in men. CONCLUSION: The findings of this study demonstrate that high BP (hypertension) is an important public health burden in both urban and rural settings in this sub-Saharan African population. Cost-effective public health measures are urgently needed to prevent high BP from becoming another public health burden.     

The Troms? heart study: alcoholic beverages and coronary risk factors.

Frequency of beer, wine, and spirits drinking and inebriation by alcohol were associated with serum lipids and blood pressure in 14,667 free-living men and women aged 20 to 54 years. Regression analysis including several background variables revealed that alcohol was more "favourably" associated with coronary risk factors than previously reported, due to the small consumption of alcohol in the population (only 2.0% of men and 0.3% of women reported drinking every day) or to unknown confounding factors: wine (p less than 0.05) and inebriation (p less than 0.01) were inversely related with total cholesterol in women; the strong positive relation with HDL-cholesterol in both sexes previously reported was confirmed; beer (p less than 0.05) and inebriation p(less than 0.05) in men and spirits (p less than 0.01) in women seemed to decrease triglycerides; and a new observation may be the negative association between wine and blood pressure (systolic p less than 0.01 in both sexes) as opposed to the positive relation with beer (p less than 0.01 both pressures in men) and spirits (p less than 0.05 systolic pressure and p less than 0.01 diastolic pressure in men and p less than 0.05 diastolic pressure in women). Women showed more "favourable effects" of alcohol than men, and one reason may be that they drank less often. Wine gave lower risk factor readings than beer, and especially lower than spirits.