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

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

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.     

Blutdruck in Deutschland 2008–2011

High blood pressure is one of the most important risk factors for cardiovascular diseases and chronic kidney disease. It is a main determinant of morbidity and mortality in Germany. In the German Health Interview and Examination Survey for Adults (DEGS1) the blood pressure of 7,096 adults aged 18–79 years was measured in a standardised way using oscillometric blood pressure devices (Datascope Accutorr Plus). The average of the second and third measurements was used for analysis. The mean systolic blood pressure was 120.8 mmHg in women and 127.4 mmHg in men, while the mean diastolic blood pressure was 71.2 mmHg in women and 75.3 mmHg in men. Blood pressure values were hypertensive (systolic blood pressure ≥?140 mmHg or diastolic blood pressure ≥?90 mmHg) in 12.7?% of women and in 18.1?% of men. Hypertension (defined as having hypertensive blood pressure or taking antihypertensive medication in known cases of hypertension) was present in 29.9?% of women and 33.3?% of men. Almost 75?% of the survey’s highest age group, 70–79, had hypertension. DEGS1 demonstrates that high blood pressure remains a highly prevalent risk factor in the population at large. The methodology employed in measuring blood pressure has been improved as compared to that of the German National Health Interview and Examination Survey 1998 (GNHIES98) and it will be possible to draw comparisons soon, once a procedure for calibrating the 1998 data has been finalised. An English full-text version of this article is available at SpringerLink as supplemental.     

Blood Pressure Success Zone: You Auto Know. A worksite-based program to improve blood pressure control among auto workers

Worksite-based wellness programs can be a means to improve employee health awareness and potentially reduce health care costs. The "BP Success Zone: You Auto Know" program was a worksite-based intervention to reduce the incidence of hypertension among auto workers at Chrysler LLC. This 6-month program comprised an intervention consisting of education, awareness, and support intended to intensify the engagement of Chrysler employees at moderate-to-high cardiovascular risk who were not adequately controlling their blood pressure. The 539 participants had systolic blood pressure of ≥ 120 mmHg, diastolic blood pressure of ≥ 80?mmHg, or were told by a health care provider that they had hypertension. Questionnaires compared awareness and knowledge of hypertension and lifestyle choices before and at the end of the intervention. After the 6-month intervention, mean systolic blood pressure had decreased from a baseline value of 133 mmHg to 129 mmHg (P < 0.0001) and mean blood diastolic pressure had decreased from 85 mmHg to 82 mmHg (P < 0.0001). The proportion of participants with controlled blood pressure increased from 52% to 62% (P < 0.0001) over the course of the intervention. Eighty-six percent of the participants reported that the program helped them to better understand and control their blood pressure and 84% reported that they had a better understanding of their treatment options. In conclusion, a program of hypertension awareness, education, and lifestyle modification helped to improve blood pressure control among a group of Chrysler LLC employees.     

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.     

The association of birth weight with developmental trends in blood pressure from childhood through mid-adulthood: the Bogalusa Heart study

Low birth weight has been found to be associated with cardiovascular mortality and morbidity and with an adverse profile of several cardiovascular risk factors. The inverse association between birth weight and blood pressure was consistently reported from many populations. Using longitudinal data from the Bogalusa Heart Study (Louisiana), the authors investigated the association between birth weight and progression of blood pressure through early adulthood, comparing that relation between African Americans and Whites. Birth data of 2,275 participants, screened two or more times in the Bogalusa Heart Study between 1973 and 2001, were retrospectively obtained from birth certificates and were linked to their clinical, laboratory, and socioeconomic and lifestyle data in the Bogalusa Heart Study data sets. Birth weight was inversely associated with systolic blood pressure, diastolic blood pressure, and pulse pressure (p相似文献   

The natural history of blood pressure in childhood

To find out whether there is a relationship between the level of blood pressure in childhood and later on in life, and whether future hypertensives can be identified early in life, we selected a random sample of 596 Dutch children. At the first examination they were 5-19 years of age. In 386 of them (65%) at least five consecutive annual blood pressure measurements were made between 1975 and 1982. The stability of a child's position in the blood pressure distribution ('tracking') was studied by linear regression of follow-up blood pressure on initial blood pressure. 'Tracking' coefficients were 0.4 to 0.6 mmHg/mmHg for systolic pressure, and 0.2 to 0.5 mmHg/mmHg for diastolic pressure after four years of follow-up. Twenty-seven per cent of the boys and 44% of the girls who were in the upper 10% of the systolic blood pressure distribution at the first examination were still there after four years. For diastolic pressure these figures were 25% and 22%, respectively. These observations indicate that there is a moderate degree of blood pressure 'tracking' in childhood. They further imply that it is impossible to detect future hypertensives early in life by measurement of blood pressure only.     

High blood pressure and the incidence of non-insulin dependent diabetes mellitus: Findings in A 11.5 year follow-up study in the Netherlands

To examine the contribution of cardiovascular risk factors to the development of non-insulin dependent diabetes mellitus, a prospective follow-up study was performed of a cohort, initially examined in a population survey on cardiovascular risk factors. The survey was conducted from 1975 to 1978 in the Netherlands among 5700 men and women aged 20 to 65. In 1988 a questionnaire on the prevalence of chronic diseases, including diabetes mellitus, was sent to all living participants of the initial survey. The general practitioners of the persons who indicated to have diabetes mellitus were asked to confirm the diagnosis. Diabetes mellitus was defined as current use of oral hypoglycemic drugs or insulin. After exclusion of the prevalent cases at the initial survey, 65 incident confirmed cases remained. All others responding to the questionnaire served as controls.The incidence of diabetes mellitus was associated with body mass index, use of diuretics, systolic and diastolic blood pressure. After adjustment for age and body mass index systolic and diastolic blood pressure were still associated with the incidence of non-insulin dependent diabetes mellitus in men; relative risks 1.28 (95% confidence interval 1.06–1.54) and 1.40 (95% CI 1.06–1.85) per 10 mmHg respectively. For women, only the relative risk associated with the use of diuretics remained statistically significant (2.26, 95% CI 1.04–4.90). This probably reflects the risk of (treated) hypertension: adjusted for blood pressure, the relative risk lost statistical significance.These findings suggest that elevated blood pressure is a risk for the development of non-insulin dependent diabetes mellitus (NIDDM). This supports the view that NIDDM and hypertension may have a similar origin.     

Blood pressure and mortality risk in the elderly

Blood pressure was assessed between 1981 and 1983 in all persons over age 65 years in three communities (East Boston, Massachusetts; New Haven, Connecticut; and Iowa and Washington countries, Iowa), and cause-specific mortality was monitored annually over the subsequent 5 years as part of the National Institute on Aging-sponsored Established Populations for Epidemiologic Studies of the Elderly. Each community had 80% or more participation: in East Boston, 3,809 persons with 903 deaths, in New Haven, 2,812 persons with 804 deaths, and in Iowa, 3,673 persons with 763 deaths. At 2 years, odds of death from all causes were higher in the low (less than 130 mmHg) than the middle (130-159 mmHg) systolic blood pressure group for persons aged 65-79 years in all three populations. By 5 years, cardiovascular death increased with increasing systolic pressure in all three communities and reached significance in Iowa. Cancer death was highest in the low systolic pressure stratum in all three centers. All-cause, cardiovascular death, and cancer mortality was highest in the low (less than 75 mmHg) diastolic blood pressure group in East Boston, even at 5 years. Blood pressures obtained 9 years earlier in 2,079 (68%) of the East Boston participants showed a significantly higher risk of cardiovascular death with increasing systolic pressure and no relation between diastolic pressure and mortality risk. In the elderly, excess mortality at lower levels of blood pressure during early follow-up may in part be due to the effects of illness and disability present at baseline. This may obscure the usual rise in mortality with increasing systolic pressure. There is no consistent relation between diastolic pressure and mortality.     

Postural changes in blood pressure and pulse rate among black adolescents and white adolescents: the Minneapolis Children's Blood Pressure Study

Because studies have suggested a possible relation between vascular responsiveness to postural changes and risk of subsequent myocardial infarction, the reactivity of blood pressure and pulse rate to change from supine to standing positions was examined in 158 black males, 144 black females, 342 white males, and 272 white females aged 14-16 years. The study was part of the Minneapolis Children's Blood Pressure Study and was conducted during October to December 1985. Two blood pressure readings and one pulse reading were taken after five minutes of supine rest, immediately upon standing, and five minutes after standing. After adjustment for body mass index, mean systolic blood pressure decreased, and fourth- and fifth-phase diastolic blood pressures and pulse rate increased from supine to standing positions in all race and sex groups. Black males had significantly larger changes in systolic pressure than did white males (-5.9 vs. -4.1 mmHg), and males had significantly larger changes in fourth- and fifth-phase diastolic pressures compared with females of the same race (fourth-phase diastolic pressure, 8.0 vs. 4.1 mmHg for blacks and 10.0 vs. 4.8 mmHg for whites). Fifth-phase diastolic pressure increased more than did fourth-phase diastolic pressure in all groups. No race or sex differences were seen for pulse changes. For all race-sex groups, decreases in systolic pressure were positively correlated with initial levels of supine systolic pressure, whereas increases in fourth- and fifth-phase diastolic pressures were negatively correlated with corresponding initial levels. Measurement of postural changes may provide a clinically simple and reproducible way of testing for abnormalities in blood pressure and may better discriminate those at high risk of hypertension and its cardiovascular complications than would the commonly used single-seated blood pressure measurement.     

Summary of the practice guideline 'Hypertension' (third division) from the Dutch College of General Practitioners

The revised practice guideline on hypertension from the Dutch College of General Practitioners has been brought in agreement with the guideline on hypertension from the Dutch Institute for Health Care Improvement. The main changes with regard to the former edition are: The threshold values for the diagnosis 'hypertension' have been lowered to 140 mmHg and 90 mmHg for the systolic and diastolic blood pressures, respectively. Annual screening for hypertension in the elderly is no longer recommended. Henceforth, blood pressure measurement once every five years is considered sufficient, unless the blood pressure is known to be in a borderline area in which treatment is being considered. Often, the decision as to whether a patient should take antihypertensive drugs no longer depends on the presence of hypertension as such: to receive drug treatment, the patient should have at least a 20% risk of developing a cardiovascular disease in the next 10 years. To aid in estimating this risk for individual patients a risk table has been devised. Diuretics and beta-blockers are the drugs of first choice. If the blood pressure remains too high, angiotensin-converting-enzyme (ACE) inhibitors and calcium-channel blockers may be added.     

Exposure to famine during gestation, size at birth, and blood pressure at age 59 y: evidence from the dutch famine

We compared blood pressure of individuals (mean age 59 y) born in western Holland between January 1945 and March 1946 (mothers exposed to the Dutch Famine before or during gestation; n = 359) to blood pressure of unexposed individuals born before or conceived after the famine (n = 299) or same-sex siblings of subjects in series 1 or 2 (n = 313). Mean (SD) systolic and diastolic blood pressure were 140.3 (20.3) and 85.8 (11.0) mmHg, respectively; prevalence of hypertension (prior diagnosis of hypertension or with measured systolic/diastolic blood pressure above 140/90 mmHg) was 61.8%. Birth weight was inversely related to systolic (−4.14 mmHg per kg; 95% confidence interval (CI) −7.24, −1.03; p < 0.01) and diastolic (−2.09 mmHg per kg; 95% CI −3.77, −0.41; p < 0.05) blood pressure and to the prevalence of hypertension (odds ratio 0.67 per kg, 95% CI: 0.49, 0.93) (all age- and sex-adjusted). Any famine exposure of at least 10 weeks duration was associated with elevated systolic (2.77 mmHg; 95% CI 0.25, 5.30; p < 0.05) and diastolic (1.27 mmHg; 95% CI −0.13, 2.66; p = 0.08) blood pressure and with hypertension prevalence (odds ratio 1.44; 95% CI 1.04, 2.00; p < 0.05) in age- and sex-adjusted models. Exposure to famine during gestation may predispose to the development of hypertension in middle age.     

Projected effects of high-risk versus population-based prevention strategies in coronary heart disease

The potential benefits of a high-risk and a population strategy to prevent cardiovascular disease deaths by lowering total serum cholesterol and diastolic blood pressure were estimated. The first strategy concentrates on the top 10% of the risk distribution, and the second strategy changes risk factor distributions of the entire population. With the high-risk strategy, lowering total serum cholesterol 20% and diastolic blood pressure to 90 mmHg would result in a 28% reduction in death from cardiovascular disease. Lowering total serum cholesterol to 190 mg/dl and diastolic blood pressure to 80 mmHg with this strategy would result in a 33 per cent reduction in death from cardiovascular disease. These expected changes approximate those expected by lowering total serum cholesterol by 10% and diastolic blood pressure by 5% with the population strategy. Changes in total serum cholesterol (20% lowering) and diastolic blood pressure (10% lowering) that have been achieved in nutrition intervention trials would result in a 50% decline in cardiovascular disease death rates if applied to the whole population. If population mean total serum cholesterol could be lowered to 190 mg/dl and population mean diastolic blood pressure could be lowered to 80 mmHg, a 70% reduction in cardiovascular disease death rates would be expected. This suggests that only a population approach can prevent the majority of deaths from cardiovascular disease in a community.     

Prevalence of high blood pressure among schoolchildren in Cuiabá, Midwestern Brazil

OBJECTIVE: The ways in which basal blood pressure levels are obtained may lead to different prevalence estimates. The objective of the study was to estimate the prevalence of high blood pressure among schoolchildren and to compare systolic and diastolic means obtained from three measurements of arterial pressure. METHODS: This was a cross-sectional study among seven to ten-year-old schoolchildren (N=601) from public and private schools in the urban area of Cuiabá, midwestern Brazil, in 2005. Three different blood pressure measurements at ten-minute intervals were made during a single visit. Children were considered to have high blood pressure when their systolic and/or diastolic blood pressure reached levels greater than or equal to the 95th percentile in the reference table, in accordance with their gender, age and percentile height. To calculate the prevalence, the first and third blood pressure measurements were considered separately. RESULTS: There were statistically significant differences between the systolic and diastolic means from the three measurements of the study. The mean systolic and diastolic pressures from the third measurement of the study were 97.2 mmHg (SD=8.68) and 63.1 mmHg (SD=6.66) respectively. The prevalence of high blood pressure was 8.7% (95% CI: 6.4;10.9) from the first measurement and 2.3% (95% CI: 1.1;3.5) from the third measurement. There was no statistical difference in prevalence in relation to age, sex, skin color and type of school. CONCLUSIONS: In studies with a single visit, blood pressure measurements decrease significantly from the first to the third measurement. The third measurement seems to reveal blood pressure levels closer to the basal levels.     

Risk factors for hypertensive crisis: importance of out-patient blood pressure control

OBJECTIVES: The purpose of this study was to identify independent risk factors for development of hypertensive crisis. METHODS: This was a retrospective, case-controlled study. Cases were 143 patients who presented during a 3-year period to the Emergency Department with the diagnosis of hypertensive crisis, defined as systolic pressure >/=180 mmHg and/or diastolic pressure >/=110 mmHg and symptoms of hypertensive emergency during the Emergency Department presentation. Controls were 485 patients with hypertension, matched to cases on the basis of age, sex and race, who were not admitted to the Emergency Department with an episode of hypertensive crisis during the study period. Co-morbid conditions were identified from computerized health system databases and medical records. Out-patient blood pressures were obtained from medical records from randomly selected out-patient clinic visits. RESULTS: The average blood pressure during Emergency Department presentation in patients with hypertensive crisis was 197 +/- 21/108 +/- 14 mmHg. Less successful out-patient systolic blood pressure control was an independent risk factor for hypertensive crisis [odds ratio (OR) 1.30 (1.18-1.42), per 10 mmHg, P < 0.001]. Higher out-patient diastolic blood pressures [OR 1.21 (0.99-1.43 per 10 mmHg, P = 0.07] and history of heart failure [OR 3.48 (0.94-12.94), P = 0.06] trended towards independence as risk factors. CONCLUSION: Less effective blood pressure control, based on out-patient systolic blood pressure measurements, is an independent risk factor for an Emergency Department presentation due to hypertensive crisis.     

Isolated systolic hypertension in 14 communities

In the Hypertension Detection and Follow-up Program, 158,906 individuals from 14 communities around the United States had their blood pressure measured in their homes in 1972-1973. Of the total population screened, 2.4% had isolated systolic hypertension (systolic blood pressure greater than or equal to 160 mmHg and diastolic blood pressure less than 90 mmHg). Isolated systolic hypertension was present for 0.5% of those aged 30-39 years and 6.8% among those aged 60-69 years. The prevalence in blacks and women was greater than the prevalences in both whites and men. The prevalence among those taking antihypertensive medications at the time of screening was 6.1%, and 1.9% among those not on antihypertensive medications. From the individuals with "normal" diastolic blood pressure on the single home measurement (less than 90 mmHg), a random sample of 5,032 individuals were followed for mortality for eight years. Prevalence of isolated systolic hypertension was similar in this sample to that in the total. Among those not on antihypertensive medications, 8-year life table all-cause mortality rates adjusted for age, race, and sex were 17.6% for those with systolic blood pressure greater than or equal to 160 mmHg and 7.7% for those with systolic blood pressure greater than 160 mmHg. Among this population, all of whom had a diastolic blood pressure less than 90 mmHg, a multiple logistic analysis adjusting for baseline treatment status, age, race, sex, education, smoking, weight, pulse, physical activity, and systolic blood pressure revealed that each millimeter increase in systolic blood pressure was associated with approximately a 1% increase in mortality over the eight years of follow-up (p less than 0.05). Isolated systolic hypertension is both relatively common and a significant risk factor for subsequent mortality.     

Reproducibility and predictive values of routine blood pressure measurements in children. Comparison with adult values and implications for screening children for elevated blood pressure

A study of the variability of blood pressure was conducted among a total of 780 Massachusetts children, 335 children in East Boston and 445 children in Brookline, ages 8-18 years. All children had their blood pressure measured with a standard mercury sphygmomanometer in a school setting on four visits one week apart with three measurements per visit. In East Boston, repeat measurements were made for the same children for four consecutive years. A nested random effects model was used to estimate between- and within-visit variance components. For children aged 8-12 years, these were, respectively, 33.1, 12.0 in boys and 31.2, 11.1 in girls for systolic blood pressure and 57.7, 21.3 in boys and 56.6, 22.6 in girls for systolic muffling blood pressure (Korotkoff phase 4). For children aged 13-18 years of age, they were, respectively, 41.1, 11.8 in boys and 35.2, 12.2 in girls for blood pressure and 40.6, 15.5 in boys and 36.1, 11.4 in girls for diastolic blood pressure (Korotkoff phase 5). Within-person variability for systolic pressure was comparable to previously published data for 434 white adults ages 30-49 years not on antihypertensive medications; however, within-person variability for diastolic pressure was considerably higher in the children, accounting for over 75% of total variability among 8-12-year-old children, compared with 27% for adults. No meaningful effects of age, sex, or blood pressure level on variability of systolic pressure were found. However, age and level of blood pressure each had a large and independent inverse association with variability of diastolic pressure; variance components for younger children (ages 8-12 years) and children with low diastolic pressure (less than 60 mmHg) were approximately twice as large as for older children (ages 13-18 years) and children with diastolic pressure greater than or equal to 60 mmHg, respectively. Finally, predictive value estimates of blood pressure are provided for particular age-sex groups to enable one to efficiently identify children whose true mean level of blood pressure exceeds the 90th percentile for their age-sex group with minimum misclassification. Because of the substantial variability of diastolic pressure in young children, resulting in relatively low predictive value estimates, systolic pressure (either alone or in combination with diastolic pressure) may be more useful as the primary tool for screening children under age 13 years for high blood pressure.     

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

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

Hypertension in Israeli adolescents: prevalence according to weight, sex and parental origin.

We studied the prevalence of hypertension in 57,499 male and 35,803 female Israeli military recruits and its relation with sex, weight, and parents' ethnic origin. The overall prevalence of systolic hypertension (greater than 140 mmHg) was 1.75 per cent for males and 0.32 per cent for females. The prevalence of diastolic hypertension (greater than 90 mmHg) was 0.41 per cent for males and 0.06 per cent for females. For males, the prevalence of systolic and diastolic hypertension increased with weight, exponentially. Males of Ashkenazi origin had a significantly higher prevalence of hypertension (systolic 2.52 per cent, diastolic 0.55 per cent) compared with those of Sephardi origin (systolic 1.12 per cent, diastolic 0.3 per cent). The prevalence of adolescents with systolic or diastolic blood pressure greater than the mean +2SD of each weight group ranged between 1.5-2.3 per cent.