Blood pressure change and risk of hypertension associated with parental hypertension: the Johns Hopkins Precursors Study

BACKGROUND: Parental hypertension is used to classify hypertension risk in young adults, but the long-term association of parental hypertension with blood pressure (BP) change and risk of hypertension over the adult life span has not been well studied. METHODS: We examined the association of parental hypertension with BP change and hypertension risk from young adulthood through the ninth decade of life in a longitudinal cohort of 1160 male former medical students with 54 years of follow-up. RESULTS: In mixed-effects models using 29 867 BP measurements, mean systolic and diastolic BP readings were significantly higher at baseline among participants with parental hypertension. The rate of annual increase was slightly higher for systolic (0.03 mm Hg, P= .04), but not diastolic, BP in those with parental hypertension. After adjustment for baseline systolic and diastolic BP and time-dependent covariates--body mass index, alcohol consumption, coffee drinking, physical activity, and cigarette smoking--the hazard ratio (95% confidence interval [CI]) of hypertension development was 1.5 (1.2-2.0) for men with maternal hypertension only, 1.8 (1.4-2.4) for men with paternal hypertension only, and 2.4 (1.8-3.2) for men with hypertension in both parents compared with men whose parents never developed hypertension. Early-onset (at age 相似文献   

Insulin resistance, body mass index, waist circumference are independent risk factor for high blood pressure

OBJECTIVES: The purpose of the present study was to investigate the relationships between blood pressure (BP), insulin resistance as determined by a homeostasis model (HOMA-IR), and body fat distribution. METHODS: Anthropometric indices of adiposity, metabolic variables (fasting serum insulin and a homeostasis model assessment [HOMA] index of insulin sensitivity), BP and several cardiovascular risk factors were measured during a cross sectional survey of 53477 apparently healthy Korean subjects who requested a health status check. Hypertension was defined as a systolic BP > or = 140 mmHg or a diastolic BP > or = 90 mmHg and we excluded the subjects taking BP-lowering medication. RESULTS: Systolic and diastolic blood pressure (SBP, DBP) were positively and significantly associated with age, body mass index, waist circumference, and waist/hip ratio. In addition, SBP and DBP were positively associated with fasting serum insulin levels and the HOMA index. By multiple regression analysis age, waist circumference, body mass index, HOMA index and female sex were independently associated with either increased SBP or DBP. When the population is divided into quintiles according to insulin resistance (measured by HOMA analysis) prevalence of hypertension in the second, third, fourth and fifth quintiles compared to subjects in the first quintile are 1.004(95% CI 0.875-1.152, p = 0.957), 1.200(95% CI 1.052-1.369, p = 0.007), 1.312(95% CI 1.151-1.494 p < 0.001 ), and 1.603(95% CI 1.408-1.825 p < 0.001). In addition age, sex, body mass index and waist circumference were found to be significantly associated with hypertension. CONCLUSION: Our results showed that insulin resistance, body mass index and waist circumference are independent risk factors of a high BP in Koreans.     

Determinants of hypertension among adults in Bangladesh as per the Joint National Committee 7 and 2017 American College of Cardiology/American Hypertension Association hypertension guidelines

We investigated determinants of hypertension in Bangladesh using both Joint National Committee 7 (JNC7) and 2017 American College of Cardiology/American Hypertension Association (2017 ACC/AHA) guidelines. After reporting background characteristics, odds ratios (ORs) were obtained by multilevel logistic regression. Among 7839 respondents aged ≥35 years, 25.7% (n = 2016) and 48.0% (n = 3767) respondents had hypertension as per the JNC7 and 2017 ACC/AHA guidelines, respectively. The following factors were significant according to the 2017 ACC/AHA guideline: ≥65 years (adjusted OR [AOR]: 2.4, 95% confidence interval [CI]: 2.2–3.0), 55–64 years (AOR: 1.6, 95% CI: 1.4–1.9), and 45–54 years (AOR: 1.4, 95% CI: 1.3–1.6) age groups, females (AOR: 2.0, 95% CI: 1.7–2.2), overweight/obesity (AOR: 2.4, 95% CI: 2.0–2.8), diabetes (AOR: 1.4, 95% CI: 1.2–1.6), secondary (AOR: 1.2, 95% CI: 1.1–1.4), or college education level (AOR: 1.8, 95% CI: 1.4–2.3), middle (AOR: 1.3, 95% CI: 1.1–1.6), richer (AOR: 1.5, 95% CI: 1.2–1.8) or richest (AOR: 2.0, 95% CI: 1.6–2.4) wealth quintiles, residence in Khulna (AOR: 1.5, 95% CI: 1.2–1.9), and Rangpur (AOR: 1.7, 95% CI: 1.3–2.2) divisions. All factors were significant as per the JNC7 guideline too. Both guidelines found similar determinants. Prevention and control programs should prioritize increasing awareness among people with higher likelihood of hypertension.     

Predictors of long-term mortality after hospitalization for primary unstable angina pectoris and non-ST-elevation myocardial infarction

Data are sparse regarding long-term outcomes after hospitalization for unstable angina pectoris (UAP) and non-ST-elevation myocardial infarction (NSTEMI), as defined by contemporary criteria. We extended follow-up in a preexisting database of unselected patients with primary UAP and NSTEMI admitted by way of the emergency department from 1991 to 1992. Stepwise Cox models were used to identify multivariate predictors of long-term mortality. There were 275 patients (mean age 66 +/- 12 years, 33% women) who survived to hospital discharge; 134 patients (49%) died during follow-up (median 9.4 years). Significant multivariate predictors of long-term mortality were: age (hazard ratio [HR] per decade 1.7, 95% confidence interval [CI] 1.4 to 1.9); prior MI (HR 1.7, 95% CI 1.2 to 2.5); diabetes (HR 1.7, 95% CI 1.2 to 2.4); congestive heart failure (HR 2.2, 95% CI 1.5 to 3.4); elevated creatinine (HR 2.5, 95% CI 1.7 to 3.8); elevated leukocyte count (HR 1.7, 95% CI 1.1 to 2.5); systolic blood pressure <120 mm Hg at presentation (HR 2.0, 95% CI 1.1 to 3.6); lack of coronary revascularization during the index hospitalization (HR 2.0, 95% CI 1.3 to 3.0); and lack of discharge beta-blocker therapy (HR 1.5, 95% CI 1.1 to 2.2). A clinical prediction rule was generated by assigning weighted point scores for the presence of each significant covariate. Long-term mortality increased markedly with each quintile of score; for quintiles 1 to 5, mortality rates were 8.5%, 29.4%, 47.6%, 75.0%, and 91.5%, respectively (p value for trend <0.001). These data are among the first assessments of long-term mortality after hospitalization for primary UAP and NSTEMI, as defined by contemporary guideline criteria. Easily obtained clinical covariates provide excellent prediction of long-term mortality up to 10 years after hospitalization for primary UAP and NSTEMI.     

Continuous relation between left ventricular mass and cardiovascular risk in essential hypertension

The detection of left ventricular (LV) hypertrophy on echocardiography is a powerful risk indicator in essential hypertension. However, the prognostic impact of LV mass values within the "normal" range and the shape of the relation between LV mass and prognosis remain unclear. Thus, 1925 white subjects with uncomplicated essential hypertension underwent off-therapy 24-hour blood pressure monitoring and M-mode echocardiography. During 4. 0+/-2 years of follow-up, there were 181 major cardiovascular events (2.4/100 patient-years) and 49 deaths from all causes. In the 5 gender-specific quintiles of LV mass distribution (partition values: 92, 105, 120, and 138 g/m(2) in men and 79, 91, 102, and 116 g/m(2) in women), cardiovascular event rates were 0.8, 1.7, 2.2, 2.9, and 4. 3 per 100 patient-years. After adjustment for several risk factors, including 24-hour ambulatory blood pressure, the relative risk (RR) of developing a cardiovascular event increased progressively from the first quintile (RR 1) to the second (RR 1.6, 95% CI 0.8 to 3.1), third (RR 1.9, 95% CI 1.01 to 4.0), fourth (RR 3.0, 95% CI 1.5 to 5. 8), and fifth (RR 3.5, 95% CI 1.8 to 6.8) quintile. For all-cause death, the RR in the fifth quintile compared with the first quintile was 4.3 (95% CI 1.2 to 13.4). In conclusion, the powerful relation between LV mass and risk of cardiovascular disease in subjects with uncomplicated essential hypertension is continuous over a wide range of LV mass values, even below the current "upper normal" limits. The relation remains significant after control for traditional risk factors, including ambulatory blood pressure.     

Blood pressure and blood selenium: a cross-sectional and longitudinal population study.

AIMS: Western Europeans have low blood levels of selenium (BSe), an antioxidant trace element. In a Flemish population, we investigated the cross-sectional and longitudinal association of blood pressure (BP) with BSe. METHODS AND RESULTS: We randomly recruited 710 subjects (mean age 48.8 years; 51.8% women). We measured BP and BSe and kept participants in follow-up for BP. At baseline, systolic/diastolic BP averaged (SD) 130/77 (17.3/9.2) mmHg. BSe was 97.0 (19.0) microg/L. Of 385 participants with normal baseline BP (<130 and <85 mmHg), over 5.2 years (range 3.4-8.4 years), 139 developed high-normal BP (130-139/85-90 mmHg) or hypertension (>or=140/90 mmHg). In multivariate-adjusted cross-sectional analyses of men, a 20 microg/L ( approximately 1 SD) higher BSe was associated with lower BP with effect sizes of 2.2 mmHg systolic (95% CI -0.57 to -5.05; P = 0.009) and 1.5 mmHg diastolic (95% CI -0.56 to -2.44; P = 0.017). In prospective analyses of men, a 20 microg/L higher baseline BSe was associated with a 37% (95% CI -52 to -17; P = 0.001) lower risk of developing high-normal BP or hypertension. None of these associations was significant in women. CONCLUSION: Deficiency of selenium might be an underestimated risk factor for the development of high BP in European men.     

A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study

PURPOSE: To describe the effect of atrial fibrillation on long-term morbidity and mortality. SUBJECTS AND METHODS: The Renfrew/Paisley Study surveyed 7052 men and 8354 women aged 45-64 years between 1972 and 1976. All hospitalizations and deaths occurring during the subsequent 20 years were analyzed by the presence or absence of atrial fibrillation at baseline. Lone atrial fibrillation was defined in the absence of other cardiovascular signs or symptoms. Cox proportional hazards models were used to adjust for age and cardiovascular conditions. RESULTS: After 20 years, 42 (89%) of the 47 women with atrial fibrillation had a cardiovascular event (death or hospitalization), compared with 2276 (27%) of the 8307 women without this arrhythmia. Among men, 35 (66%) of 53 with atrial fibrillation had an event, compared with 3151 (45%) of 6999 without atrial fibrillation. In women, atrial fibrillation was an independent predictor of cardiovascular events (rate ratio [RR] = 3.0; 95% confidence interval [CI]: 2.1-4.2), fatal or nonfatal strokes (RR = 3.2; 95% CI: 1.0-5.0), and heart failure (RR = 3.4; 95% CI: 1.9-6.2). The rate ratios among men were 1.8 (95% CI: 1.3-2.5) for cardiovascular events, 2.5 (95% CI: 1.3-4.8) for strokes, and 3.4 (95% CI: 1.7-6.8) for heart failure. Atrial fibrillation was an independent predictor of all-cause mortality in women (RR = 2.2; 95% CI: 1.5-3.2) and men (RR = 1.5; 95% CI: 1.2-2.2). However, lone atrial fibrillation (which occurred in 15 subjects) was not associated with a statistically significant increase in either cardiovascular events (RR = 1.5; 95% CI: 0.6-3.6) or mortality (RR = 1.8; 95% CI: 0.9-3.8). CONCLUSIONS: Atrial fibrillation is associated with an increased long-term risk of stroke, heart failure, and all-cause mortality, especially in women.     

Exercise blood pressure and the risk of incident cardiovascular disease (from the Framingham Heart Study)

Exaggerated systolic blood pressure (BP) augmentation with exercise has been associated with impaired endothelial function and cardiovascular risk. However, previous studies were largely restricted to men, did not evaluate diastolic BP, and focused on peak exercise measures, which are influenced by effort and fitness level. The aim of this study was to determine the association of exercise BP responses with risk of incident cardiovascular disease (CVD). BP was assessed during stage 2 of the Bruce protocol and during recovery in 3,045 Framingham Study subjects (mean age 43 years; 53% women). The association between exercise BP and CVD events during 20 years of follow-up was examined using Cox proportional hazards models. In age- and sex-adjusted analyses, exercise systolic and diastolic BP were associated with incident CVD (adjusted hazard ratios [HRs] for top quintile 1.55, 95% confidence interval [CI] 1.18 to 2.04; and 1.77, 95% CI 1.35 to 2.31, respectively, relative to the lower 4 quintiles; p <0.005). After adjustment for BP at rest and conventional risk factors, exercise diastolic BP (HR 1.41, 95% CI 1.01 to 1.95, p = 0.04), but not exercise systolic BP (HR 0.97, 95% CI 0.68 to 1.38, p = 0.86), remained a significant predictor of CVD. Similarly, in recovery responses after exercise, only diastolic BP (HR 1.53, 95% CI 1.08 to 2.18, p = 0.02) predicted incident CVD in multivariable models. In conclusion, in middle-aged adults, diastolic BP during low-intensity exercise and recovery predicted incident CVD. Our findings support the concept that dynamic BP provides incremental information to BP at rest and suggest that exercise diastolic BP may be a better predictor than exercise systolic BP in this age group.     

Insulin Resistance,Body Mass Index,Waist Circumference are Independent Risk Factor for High Blood Pressure

Objectives: The purpose of the present study was to investigate the relationships between blood pressure (BP), insulin resistance as determined by a homeostasis model (HOMA‐IR), and body fat distribution. Methods: Anthropometric indices of adiposity, metabolic variables (fasting serum insulin and a homeostasis model assessment [HOMA] index of insulin sensitivity), BP and several cardiovascular risk factors were measured during a cross sectional survey of 53477 apparently healthy Korean subjects who requested a health status check. Hypertension was defined as a systolic BP ≥ 140 mmHg or a diastolic BP ≥ 90 mmHg and we excluded the subjects taking BP‐lowering medication. Results: Systolic and diastolic blood pressure (SBP, DBP) were positively and significantly associated with age, body mass index, waist circumference, and waist/hip ratio. In addition, SBP and DBP were positively associated with fasting serum insulin levels and the HOMA index. By multiple regression analysis age, waist circumference, body mass index, HOMA index and female sex were independently associated with either increased SBP or DBP. When the population is divided into quintiles according to insulin resistance (measured by HOMA analysis) prevalence of hypertension in the second, third, fourth and fifth quintiles compared to subjects in the first quintile are 1.004(95% CI 0.875–1.152, p=0.957), 1.200(95% CI 1.052–1.369, p=0.007), 1.312(95% CI 1.151–1.494 p < 0.001), and 1.603(95% CI 1.408–1.825 p < 0.001). In addition age, sex, body mass index and waist circumference were found to be significantly associated with hypertension. Conclusion: Our results showed that insulin resistance, body mass index and waist circumference are independent risk factors of a high BP in Koreans.     

Haematocrit,hypertension and risk of stroke

Abstract. Objectives . To assess the relationship between haematocrit and risk of stroke. Design . Prospective study of a cohort of men followed up for 9.5 years. Setting . General practices in 24 towns in England, Scotland and Wales (British Regional Heart Study). Subjects . A total of 7735 men aged 40–59 years at screening, selected at random from one general practice in each of 24 towns. Main outcome measures . Fatal and non-fatal strokes. Results . During a follow-up period of 9.5 years for all men there were 123 stroke events (33 fatal) in the 7346 men in whom the haematocrit level had been determined. In the cohort as a whole, risk of stroke was significantly raised at haematocrit levels ≥ 51% (relative risk [RR] = 2.5; 95% confidence intervals [CI] 1.2–5.0) after adjustment for age, social class, smoking, body mass index, physical activity, presence of diabetes and pre-existing ischaemic heart disease. Further adjustment for systolic blood pressure did not attenuate this association (RR = 2.4; 95% CI 1.2–4.9). A raised haematocrit was associated with an increase of stroke only in men with hypertension (systolic blood pressure ≥ 160 mmHg or diastolic blood pressure ≥ 90 mmHg or on regular antihypertensive treatment). No increased risk of stroke was seen at the higher haematocrit level (≥ 51%) in normotensive men. At haematocrit levels below 51%, hypertension was associated with a three-fold increase in risk of stroke compared with normotension (RR = 3.4, 95% CI 2.3, 5.1). At haematocrit levels 51%, hypertension was associated with a nine-fold increase in risk of stroke compared with normotension (RR = 9.3; 95% CI 4.2, 21.0). Exclusion of men receiving regular antihypertensive therapy did not alter the strong associations seen. Conclusion . The data suggest that an elevated haematocrit is an independent risk factor for stroke and that it interacts synergistically with elevated blood pressure.     

Blood pressure and risk of cardiovascular disease in Chinese men and women

BACKGROUND: We examined the relationship between systolic and diastolic blood pressure (BP) and the incidence of cardiovascular disease (CVD) in a nationally representative cohort of 169,871 men and women > or = 40 years of age in China. METHODS: Data on BP and other variables were obtained at a baseline examination in 1991 using standard protocols. Follow-up evaluation was conducted in 1999-2000, with a response rate of 93.4%. RESULTS: After adjustment for age, sex, cigarette smoking, alcohol consumption, physical activity, body mass index, education, geographic region, urbanization, and time-dependent history of diabetes, a strong and linear association between both systolic and diastolic BP and incidence of CVD, coronary heart disease and stroke were observed (all P < 0.0001). For example, the relative risks (95% confidence interval (CI)) of CVD incidence were 1.09 (1.00-1.18), 1.25 (1.16-1.35), 1.49 (1.38-1.62), 2.15 (1.99-2.31), 3.01 (2.78-3.27), and 4.16 (3.84-4.51) for those with systolic/diastolic BP of 110-119/75-79, 120-129/80-84, 130-139/85-89, 140-159/90-99, 160-179/100-109, and > or = 180/110 mm Hg compared to those with BP <110/75 mm Hg. Increases in systolic BP were associated with a greater risk of CVD compared to corresponding increases in diastolic BP. The linear trend for increased CVD risk being related to higher BP levels was observed in all subgroups of gender, age, body weight, and cigarette smoking. CONCLUSIONS: Our results indicate that there is a strong, linear, and independent relationship between BP levels and the risk of CVD in Chinese adults. Systolic BP is a stronger predictor of CVD risk compared to diastolic BP.     

Prognostic value of blood pressure in acute stroke

Manipulation of blood pressure (BP) in acute stroke may improve outcome. Despite various studies, data on the prognostic significance of early BP in stroke remain unclear. Therefore, we studied the relationship between various BP variables in the acute phase of stroke and functional outcome at 3 months. Blood pressures were collected by reviewing BP records of 817 patients who were admitted to our stroke unit between 1987 and 1992. Besides the first systolic and diastolic admission BP (SBP and DBP), we also used the mean of the daytime as well as the night-time systolic and diastolic BP values. Finally, we studied the relationship between the decrease in BP between day 0 and 4 and outcome. As dependent outcome variable we used the Rankin handicap score at 3 months dichotomized in a score >3 (poor outcome) vs a score 3 (good outcome). A total of 430 patients were admitted within 24 h following stroke onset. There was no significant relationship between the systolic and diastolic BP and the outcome at 3 months. Only night-time systolic BP 165 mm Hg (odds ratio (OR) 2.8; 95% CI 1.1-6.8), night-time diastolic BP 60 mm Hg (OR 8.1; 95% CI 1.1-58.3), and a decrease in daytime diastolic BP between day 0 and 4 of 10 mm Hg (OR 3.0; 95% CI 1.1-7.9) showed a significant relationship with poor outcome. Our findings suggest that admission BP values may not reliably reflect any impact of BP on stroke outcome. They also suggest a potential differential effect of BP manipulation: increasing or decreasing BP may be beneficial for patients with BP extremes in one direction, but detrimental for those with BP values in the opposite direction.     

Blood pressure parameters and risk of fatal stroke, NHANES II mortality study

BACKGROUND: Recent studies have suggested that systolic blood pressure (BP) is a better predictor of stroke than diastolic BP in apparently healthy white men. Whether these relationships are similar for women and African Americans remains unclear. METHODS: We used data from 6667 (3205 men; 3462 women) adults from the Second National Health and Nutrition Examination Survey Mortality Study to examine whether the relative risk of fatal stroke was associated with a 10 mm Hg increase in BP parameters (systolic BP, diastolic BP, pulse pressure, and mean arterial pressure). RESULTS: During a median of nearly 15 years of follow-up, 113 fatal strokes (62 men; 51 women) occurred. Systolic BP was associated with an increased risk of fatal stroke for men (relative risk [RR] = 1.19), women (RR = 1.15), whites (RR = 1.17), and African Americans (RR = 1.28) after multivariable adjustment (all, P 相似文献   

Impact of Achieved Blood Pressures on Mortality Risk and End-Stage Renal Disease Among a Large,Diverse Hypertension Population

Background

Medical data or clinical guidelines have not adequately addressed the ideal blood pressure (BP) treatment targets for survival and renal outcome.

Objectives

This study sought to evaluate ranges of treated BP in a large hypertension population and compare risk of mortality and end-stage renal disease (ESRD).

Methods

A retrospective cohort study within the Kaiser Permanente Southern California health system was performed from January 1, 2006, to December 31, 2010. Treated hypertensive subjects ≥18 years of age were studied. Cox proportional hazards regression models were used to evaluate the risks (hazard ratios) for mortality and/or ESRD among different BP categories with and without stratification for diabetes mellitus and older age.

Results

Among 398,419 treated hypertensive subjects (30% with diabetes mellitus), mortality occurred in 25,182 (6.3%) and ESRD in 4,957 (1.2%). Adjusted hazard ratios (95% confidence intervals [CI]) for composite mortality/ESRD in systolic BP <110, 110 to 119, 120 to 129, 140 to 149, 150 to 159, 160 to 169, and ≥170 compared with 130 to 139 mm Hg were 4.1 (95% CI: 3.8 to 1.3), 1.8 (95% CI: 1.7 to 1.9), 1.1 (95% CI: 1.1 to 1.1), 1.4 (95% CI: 1.4 to 1.5), 2.3 (95% CI: 2.2 to 2.5), 3.3 (95% CI: 3.0 to 3.6), and 4.9 (95% CI: 4.4 to 5.5) respectively. Diastolic BP 60 to 79 mm Hg were associated with the lowest risk. The nadir systolic and diastolic BP for the lowest risk was 137 and 71 mm Hg, respectively. Stratified analyses revealed that the diabetes mellitus population had a similar hazard ratio curve but a lower nadir at 131 and 69 mm Hg but age ≥70 had a higher nadir (140 and 70 mm Hg).

Conclusions

Both higher and lower treated BP compared with 130 to 139 mm Hg systolic and 60 to 79 mm Hg diastolic ranges had worsened outcomes. Our study adds to the growing uncertainty about BP treatment targets.     

Heterosexual anal intercourse increases risk of HIV infection among young South African men

Data from a nationally representative household survey of South African youth aged 15-24 years found that sexually active men reporting anal intercourse were nearly twice as likely to be HIV infected as men reporting only vaginal sex (OR 1.7, 95% CI 1.0-3.0). The associated risk was more pronounced among men aged 15-19 years (OR 4.3, 95% CI 1.5-12.1). The association among women was not significant (OR 1.2, 95% CI 0.7-2.0).     

Randomized controlled trial of sour milk on blood pressure in borderline hypertensive men

BACKGROUND: A double-blind randomized controlled trial was carried out to assess the effect of sour milk, containing two tripeptides (valine-proline-proline and isoleucine-proline-proline), on blood pressure (BP). METHODS: A total of 46 borderline hypertensive men aged 23 to 59 years were recruited at their workplace for this trial. Subjects were randomly allocated into two groups; sour milk drink group (S-group, n = 23) and placebo (acidified milk) drink group (P-group, n = 23) for 4 weeks. Blood pressure was measured twice at each occasion by a physician, at the health center of the company, with a mercury at baseline, 2 and 4 weeks. Statistical analysis was performed by SPSS 10.0J. RESULTS: The S-group and P-group showed no significant difference in baseline systolic BP (mean [SD], S: 147.6 [9.6], P: 145.3 [13.0]) or diastolic BP (S: 95.3 [9.9], P: 91.5 [9.6]). In the S-group, change in systolic BP at 2 and 4 weeks were -4.3 mm Hg (95% confidence interval [CI] -8.3 to -0.4; P = .032) and -5.2 mm Hg (95% CI -10.1 to -0.3; P = .039), both statistically significant. Diastolic BP showed change from -1.7 mm Hg (95% CI -5.4 to 2.0) at 2 weeks and -2.0 (95% CI -5.4 to 1.5) at 4 weeks, respectively. In the P-group, change in systolic BP were -0.5 (95% CI -5.8 to 4.8) at 2 weeks and -3.7 (95% CI -8.3 to 0.9) and change in diastolic BP were -0.6 (95% CI -4.7 to 3.6) and -0.3 (95% CI -3.9 to 3.3), which were not statistically significant. CONCLUSIONS: This trial demonstrated the beneficial effect of sour milk on BP in borderline hypertensive men who were not taking antihypertensive medication.     

In normoglycemic Koreans, insulin resistance and adipocity are independently correlated with high blood pressure.

BACKGROUND: There is some controversy about the role of insulin resistance (IR) in the regulation of blood pressure (BP). Moreover, a large study of the association between BP and IR has not been conducted in normal glucose tolerance Asians. The present study investigated the relationships between IR, body mass index (BMI) and waist circumference and BP in normoglycemic Koreans. METHODS AND RESULTS: Anthropometric indices of adiposity, metabolic variables (fasting serum insulin and a homeostasis model assessment (HOMA) index of insulin sensitivity), BP and several cardiovascular risk factors were measured during a cross-sectional survey of 49,076 normoglycemic Korean subjects. A high BP was defined as a systolic BP >/=140 mmHg or a diastolic BP >/=90 mmHg. The prevalence of high BP by HOMA grading was 0.985 (95% confidence interval (CI) 0.857-1.132, p=0.835), 1.180 (95% CI 1.032-1.350, p=0.016), 1.289 (95% CI 1.129-1.472, p<0.001), and 1.540 (95% CI 1.341-1.768, p<0.001) times higher in subjects in the second, third, fourth, and fifth quintiles, respectively, compared with those in the first quintile. In addition, age, sex, waist circumference and BMI were found to be significantly associated with a high BP. CONCLUSION: IR, BMI and waist circumference are independently correlated with high BP in normoglycemic Koreans.     

Body weight and weight change in relation to blood pressure in normotensive men

We examined blood pressure (BP) in association with weight change since age 20, body mass index (BMI) at different ages and fat distribution in normotensive individuals using baseline survey data collected in the Shanghai Men's Health Study, an ongoing population-based prospective cohort study of Chinese men aged 40-74 years. All anthropometric and BP measurements were performed by medical professionals. Included in this analysis were 25 619 men who had no prior history of hypertension, diabetes or cardiovascular disease, never took any antihypertensive medication and had both normal systolic BP (SBP) and diastolic BP (DBP) (<140/90 mm Hg). Both SBP and DBP increased linearly across the whole range of weight gain since age 20. The adjusted mean differences between the highest and the lowest quintiles of weight gain were 6.0 mm Hg (95% confidence interval (CI): 5.6, 6.5) for SBP and 3.9 (95% CI: 3.6, 4.2) for DBP. When accounting for BMI at age 20, the multivariate-adjusted odds ratio of prehypertension (SBP, 120-139 and/or DBP, 80-89 mm Hg) was 4.1 (95% CI: 3.7, 4.5; P for trend <0.0001) comparing the extreme quintiles of weight gain. Similar positive associations were also observed for BMI at age 40, current BMI, circumferences of the waist and hips and waist-to-hip ratio. In conclusion, these data suggest that weight gain since age 20 and elevated adiposity may contribute significantly to the rise in BP in normotensive individuals, emphasizing the importance of weight control throughout adulthood in preventing high BP.     

Does metformin decrease blood pressure in patients with Type 2 diabetes intensively treated with insulin?

AIMS: We investigated in a double-blind study whether metformin reduces blood pressure (BP) in patients with Type 2 diabetes intensively treated with insulin. METHODS: A total of 220 patients with Type 2 diabetes were asked to undergo 24-h ambulatory BP monitoring (24-h ABPM). One hundred and eighty-two gave informed consent. Eighty-nine were randomized to metformin and 93 to placebo. Thirty-five subjects dropped out (13 placebo, 22 metformin users); 147 patients underwent a second 24-h ABPM, 16 weeks after randomization. RESULTS: Systolic BP (SBP), diastolic BP (DBP), pulse BP (PP), mean BP (MP) and heart rate (HR) were measured as office BP measurements and as 24-h ABPM for 24-h, day and night. Office BP measurements did not differ significantly between the placebo- and metformin-treated groups for any BP measure, but showed a non-significant trend for SBP reduction with metformin use (mean baseline-adjusted difference, metformin minus placebo: -4.2 mmHg, 95% CI, -9.9 to +1.5; P = 0.15). The baseline-adjusted differences of the ambulatory measurements were -0.2 mmHg (95% CI, -2.9 to +2.6) for the 24-h SBP, and +1.1 mmHg (95% CI, -0.7 to +2.8) for the 24-h DBP. On the whole, BP differences between metformin- and placebo-treated groups were not statistically significant. The only significant difference was for night-time PP (baseline-adjusted difference: -2.2 mmHg; 95% CI, -4.2 to -0.2). These results were not different after adjustment for age and diabetes duration, or for (changes in) body mass index, glycated haemoglobin, insulin dose or plasma homocysteine. CONCLUSION: Metformin does not significantly affect BP in patients with Type 2 diabetes intensively treated with insulin.     

Serum cholesterol, blood pressure, cigarette smoking, and death from coronary heart disease. Overall findings and differences by age for 316,099 white men. Multiple Risk Factor Intervention Trial Research Group.

To assess the combined influence of blood pressure (BP), serum cholesterol level, and cigarette smoking on death from coronary heart disease (CHD) and to describe how these associations vary with age, data on those factors and on mortality for 316,099 men screened for the Multiple Risk Factor Intervention Trial (MRFIT) were examined. Vital status of participants has been determined after an average follow-up of 12 years; 6327 deaths from CHD have been identified. Strong graded relationships between serum cholesterol levels above 4.65 mmol/L (180 mg/dL), systolic BP above 110 mm Hg, and diastolic BP above 70 mm Hg and mortality due to CHD were evident. Smokers with serum cholesterol and systolic BP levels in the highest quintiles had CHD death rates that were approximately 20 times greater than nonsmoking men with systolic BP and cholesterol levels in the lowest quintile. Systolic and diastolic BP, serum cholesterol level, and cigarettes per day were significant predictors of death due to CHD in all age groups. Systolic BP was a stronger predictor than diastolic BP. These results, together with the findings of clinical trials, offer strong support for intensified preventive efforts in all age groups.