High normal blood pressure, hypertension, and the risk of type 2 diabetes in Japanese men. The Osaka Health Survey.

OBJECTIVE: To investigate the relationship between high normal blood pressure or hypertension and the risk of developing type 2 diabetes in a large Japanese cohort. RESEARCH DESIGN AND METHODS: We enrolled 7,594 Japanese men aged 35-60 years who did not have diabetes or impaired fasting glucose at study entry. Type 2 diabetes was defined as a fasting plasma glucose level of > or = 126 mg/dl or a 2-h postload plasma glucose level of > or = 200 mg/dl. High normal blood pressure was defined as no history of hypertension and a systolic blood pressure of > or = 130 and < 140 mmHg or a diastolic blood pressure of > or = 85 and < 90 mmHg. Subjects were considered to have hypertension if they had a systolic blood pressure > or = 140 mmHg, if they had a diastolic blood pressure > or = 90 mmHg, or if they were taking anti-hypertensive medications. RESULTS: We confirmed 600 cases of type 2 diabetes during the 72,946 person-years of follow-up. Both high normal blood pressure and hypertension were associated with the risk of type 2 diabetes. Compared with normotensive men, men with high normal blood pressure had a multiple adjusted relative risk (RR) of 1.39 (95% CI 1.14-1.69), and men with hypertension had a multiple adjusted RR of 1.76 (1.43-2.16). Even among lean men (BMI < 22.7 kg/m2), men with high normal blood pressure had a multiple adjusted RR of 1.71 (1.20-2.42), and men with hypertension had a multiple adjusted RR of 2.02 (1.34-3.05) compared with normotensive men. CONCLUSIONS: High normal blood pressure and hypertension are associated with an increased risk of developing type 2 diabetes.     

The association between active and passive smoking and frequent pain in a general population

Background: It is controversial whether the association between back pain, and other types of chronic pain, and smoking is causal or not. Aim: To examine the relationship between frequent pain and smoking, and between frequent pain and exposure to environmental tobacco smoke (ETS) in smokers and non‐smokers. Methods: A randomised population‐based study, Inter99 (1999–2006), Denmark. Subjects in the intervention groups (N=6784; participation rate=52.5%) completed self‐report questionnaires. Cross‐sectional data from baseline were analysed in adjusted logistic regression analyses to investigate the relationship between active and passive smoking and frequent pain in the back, abdomen, joints and head. Results: Daily smokers reported significantly more frequent pain in every of the six locations, and in several, minimum three, locations (OR=1.98 (95%CI=1.6–2.4)) than never smokers. We found a dose–response relationship between frequent pain and intensity of both active and passive smoking (test‐for‐trend p<0.001). Those exposed to 5h or more of ETS reported significantly more frequent pain than those almost never exposed to ETS (non‐smokers: OR=1.46 (95%CI=1.2–1.8), and smokers: OR=2.04(95%CI=1.4–3.0)). Also, an earlier smoking debut and an increasing number of pack‐years increased the probability of frequent pain in daily smokers (test‐for‐trend p<0.05). Conclusion: We found significant association, dose–response and reversibility between active smoking and frequent pain in all six locations. Furthermore, we found that increasing intensity of ETS increased the probability of frequent pain in non‐smokers, which has not been shown before. In conclusion, several findings in this study indicate a causal link between tobacco smoke and pain, which is supported by recent prospective studies.     

Smoking and incidence of diabetes among U.S. adults: findings from the Insulin Resistance Atherosclerosis Study

OBJECTIVE: The objective of this study was to determine the association between smoking and incident diabetes among U.S. adults. RESEARCH DESIGN AND METHODS: The Insulin Resistance Atherosclerosis Study (IRAS) was a prospective study of the associations of insulin sensitivity and cardiovascular risk factors. We examined the relationship between smoking status categories (never, former, and current) and incident 5-year type 2 diabetes among 906 participants free of diabetes at baseline. We also considered the effect of pack-year categories (never, former <20 pack-years, former > or = 20 pack-years, current <20 pack-years, and current > or = 20 pack-years) upon diabetes incidence. RESULTS: Of current smokers, 96 (25%) developed diabetes at 5 years, compared with 60 (14%) never smokers. After multivariable adjustment, current smokers exhibited increased incidence of diabetes compared with never smokers (odds ratio [OR] 2.66, P = 0.001). Similar results were found among current smokers with > or = 20 pack-years with normal glucose tolerance (5.66, P = 0.001). CONCLUSIONS: Smoking shares a robust association with incident diabetes, supporting the current Surgeon General's warnings against cigarette smoking.     

Interaction between smoking and PON2 Ser311Cys polymorphism as a determinant of the risk of myocardial infarction

BACKGROUND: Increased oxidative stress is thought to play a role in the pathogenesis of the atherothrombotic process. Paraoxonases (PONs) are closely related antioxidant enzymes encoded by clustered genes on chromosome 7q. We evaluated three PON polymorphisms (PON1 Leu55Met and Gln192Arg; PON2 Ser311Cys) as possible risk factors for coronary atherosclerotic disease (CAD) and/or its main thrombotic complication, myocardial infarction (MI). MATERIALS AND METHODS: We studied 890 subjects with angiographic documentation of coronary vessels (272=CAD-free; 618=CAD). In the CAD group, 341 subjects had a previous MI. RESULTS: Frequencies of various genotypes were not significantly different between CAD-free subjects and the entire CAD population. In the latter group, there were more carriers of the PON2 311Cys variation among those who had suffered a MI than among those who had not (P<0.01 by chi2). The adjusted OR for MI among PON2 311Cys carriers was 1.5 (95%CI, 1.03-2.19). A gene-environmental interaction was found between PON2 Ser311Cys and smoking. Smoking by itself was associated with an increased MI risk. Among smokers, however, the MI risk was related to PON2 genotype: Cys/Cys homozygotes (OR=5.3; 95%CI, 1.7-16.4) and Ser/Cys heterozygotes (OR=2.1; 95%CI, 1.3-3.6) were at greater risk than Ser/Ser subjects (OR=1.2; 95%CI, 0.8-1.8). The PON2 polymorphism did not influence the MI risk among nonsmokers. CONCLUSIONS: In CAD subjects, a proportion of the risk of MI may be influenced by the interaction between smoking and a polymorphism in the antioxidant enzyme PON2.     

Rural-urban differences in factors associated with poor blood pressure control among outpatients

BACKGROUND: The purpose of this study was to determine which patient-related factors are most strongly associated with having uncontrolled hypertension among outpatients. METHODS: A sample of 300 outpatients with diagnosed hypertension from three different settings was reviewed, focusing on demographics, comorbidity, adherence, and treatment factors. Regression analyses were conducted to determine which factors were associated with poor BP control (> 140 mmHg systolic or > 90 mmHg diastolic). RESULTS: Those most strongly associated with blood pressure control were men (OR 2.04, 95% CI 1.17-3.55) living in a rural setting (OR 0.30, 95% CI 0.16-0.55). Age, race, total number of medicines, number of visits, and the number of comorbidities were not significantly associated with poor blood pressure control in this population. CONCLUSIONS: Being urban and male are strongly associated with uncontrolled hypertension. Public health blood pressure control efforts in the Southeast region should be directed toward this population.     

Blood pressure and other cardiovascular risk factors among treated hypertensives in Swedish primary health care

OBJECTIVE: To evaluate antihypertensive treatment and other cardiovascular risk factors in primary health care. DESIGN: Cross-sectional survey of consecutive patients with treated hypertension in 1999. SETTING: 17 primary care centres in Sweden. SUBJECTS: 512 patients (mean age 67; SD 11 years). MAIN OUTCOME MEASURES: Antihypertensive treatment, cardiovascular risk factors. RESULTS: Patients with high diastolic BP (> or = 100 mmHg) and systolic BP (> 180 mmHg) values were few. The proportions with diastolic BP < 90, BP < 160/95 and < 140/90 mmHg were 64%, 54% and 15%. Mono-therapy was given in 51%, and > or = 3 drugs in 13%. Hypertensives with hyperlipidaemia were 42%, and only 26% of them were given lipid-lowering drugs, mainly statins, 21%. Smokers were 10%, 23% had diabetes, and many had overweight BMI = 25 kg/m2, 72%. CONCLUSION: Although two-thirds had diastolic BP < 90 mmHg, few had BP below the current treatment target < 140/90 mmHg. More than half of the hypertensives had at least one additional cardiovascular risk factor, and these hypertensives also had low proportions within several current treatment targets of hypertension and hyperlipidaemia, implying a need for intensified multiple risk factor intervention.     

Differences in blood pressure: does the length of time between measurements have an effect?

Taking blood pressure measurements correctly is essential in order to successfully evaluate a patient's blood pressure from the initial measurement and subsequent measurements over time. With the purpose to determine if the time between blood pressure measurements in an office or clinic bears an influence on any variation in measurement, a study was carried out under which two blood pressure measurements five minutes apart were taken using an automatic instrument in order to evaluate the existence of any differences as well as to identify which arm should be the control arm and to evaluate the absolute measurements between both arms. During this study, the authors observed a decrease in the mean for the repeated blood pressure measurement of 7.7 mmHg (IC 95%: 4.7-10.7 mmHg, p < 0.0001) for the systolic measurement and of 2.9 mmHg (IC 95%: 1.6-4.2 mmHg) for the diastolic measurement. 78% of the patients in this study registered a difference between the two measurements, either systolic or diastolic > or = 5 mmHg. It was not possible to establish a significant relationship between the decrease in these blood pressure measurements and factors such as age, sex, cardiac frequency or hypertension. The control arm was the right arm in 59.3% of the patients. The absolute mean of the differences between both arms was 8.4 mmHg (IC 95%: 6.8-10 mmHg) for the systolic measurements and 5 mmHg (IC 95%: 3.9-6.1 mmHg) for the diastolic measurements. 26 patients, 44.1%, registered a difference in pressure between their arms > or = 10 mmHg.     

Selective recording in blood pressure readings may increase subsequent mortality

BACKGROUND: Rounding blood pressure (BP) to the nearest 10 mmHg (terminal digit preference) and selecting for particular values near treatment cut-offs (number preference) have both been previously described. Both reduce measurement accuracy, and may have consequences for treatment and survival. AIM: To check for number preference in screening for hypertension, and whether this influenced subsequent mortality. DESIGN: Prospective case-control screening study. METHODS: In the General Practice Hypertensive Study Group (GPHSG), prospective case control study patients (n=23 574) were screened on one occasion for high phase-IV diastolic BP (DBP4) (> or =90 mmHg). Identified cases were matched with normotensive controls for age, sex, date of screen and ethnic group, and were registered for mortality follow-up (n=6310). Patients with a high DBP4 had two further readings, and were treated if it remained elevated. RESULTS: For DBP4 terminal digit, '0' was over-represented (28.2% vs. 20%), and the number '88' was over-represented in both men and women. There was an excess adjusted death rate for females with DBP4 88-89 mmHg vs. 90-99 mmHg for both cardiovascular (RR 2.56, 95%CI 1.43-4.56, p=0.0015) and all-cause (1.56, 95%CI 1.06-2.29, p=0.023) mortality. For males, the corresponding rates were non-significantly reduced: cardiovascular RR 0.69, 95%CI 0.42-1.14, p=0.15; all-cause RR 0.93, 95%CI 0.68-1.27, p=0.64. DISCUSSION: The quality of BP measurements should be monitored both in research studies and in clinical practice as part of clinical governance procedures.     

多发性脑梗死与单发性脑梗死危险因素对比分析

目的比较多发性脑梗死（MCI）与单发性脑梗死（SCI）的危险因素，以利于对其进行针对性的防治。方法前瞻性连续登记神经内科缺血性脑卒中患者，根据临床和影像学资料分为MCI和SCI组，对可能影响多发性脑梗死发病的24项因素先进行单因素分析，比较可能的危险因素在MCI与SCI组间有无差异，然后进行非条件logistic多元回归分析，校正混杂因素的影响。结果年龄、性别、高血压、糖尿病、心瓣膜病、吸烟、脑梗死史、入院首次收缩压等危险因素在MCI与SCI组间有显著差异，logistic多元回归分析显示，年龄[OR=1.014，95％CI（1.003，1.026）]、高血压[OR=1.566，95％CI（1.185，2.068）]、吸烟[OR=1.473，95％CI（1.052，2.061）]、脑梗死史[OR=1.948，95％CI（1.326，2.864）]为MCI的独立危险因素。结论与SCI相比，年龄、高血压、吸烟、脑梗死史为MCI的独立危险因素。     

High blood pressure despite treatment: results from a cross-sectional primary healthcare-based study in southern Sweden

OBJECTIVE: To study degree of blood pressure (BP) control in primary healthcare (PHC) treated hypertensive patients in relation to sex, age, drug treatment, and concomitant diseases. DESIGN: Random sample of patients with hypertension. SETTING: Ten PHC centres in the Region of Sk?ne, Sweden. SUBJECTS: All the 30- to 95-year-old patients with hypertension who during the period 12 September to 24 September 2004 attended their PHC (146 men and 229 women). MAIN OUTCOME MEASURES: Achievement of BP control (< 140/90 mmHg) according to European guidelines. RESULTS: Some 90% had been treated > 12 months, 40% had mono-therapy, 15% > or = 3 drugs. Use of diuretics was more common in women while use of ACE inhibitors and calcium channel blockers was common in men. Inadequate BP control was related to age; only 22% had BP < 140/90 mmHg, 38% had a BP > or = 160/100 mmHg. BP decline was inversely related to BP measured 12 months or more prior to the present follow-up (r = - 0.64, p < 0.001, for systolic and r = - 0.67, p < 0.001, for diastolic BP). The systolic or diastolic BP had in every fifth patient during treatment increased by > or = 10 mmHg. No association was found between average BP decline and prescribed number of drugs. CONCLUSION: A minority of the patients had BP below the level (< 140/90 mmHg) recommended by European guidelines. This study illustrates the need for continued follow-up of defined groups of patients in order to improve quality of care.     

Maternal and neonatal outcomes in pregestational and gestational diabetes mellitus, and the influence of maternal obesity and weight gain: the DEPOSIT study. Diabetes Endocrine Pregnancy Outcome Study in Toronto.

We prospectively studied pregnancy outcome in 428 women with gestational diabetes mellitus (DM) and 196 women with pregestational DM, with particular reference to the influence of maternal obesity and excessive weight gain. These were consecutive singleton pregnancies delivered in our institution over 5 years. After controlling for multiple risk factors, including maternal BMI and pregnancy weight gain, women with pregestational DM were at increased risk (compared to those with gestational DM) for Caesarean delivery (OR 3.6, 95%CI 2.3-5.6), shoulder dystocia or cephalopelvic disproportion (OR 2.2, 95%CI 1.3-3.6), and gestational hypertension or toxaemia (OR 3.0, 95%CI 1.7-5.4). The offspring of these women were also at increased risk for admission to the neonatal intensive care unit (OR 4.0, 95%CI 2.3-6.8), large-for-gestational-age birthweight (OR 3.5, 95%CI 2.2-5.6), and preterm birth before 37 weeks (OR 3.8, 95%CI 2.5-5.9). Maternal obesity, and, to a lesser degree, excessive weight gain, were also independent risk factors for all these adverse maternal and neonatal outcomes, regardless of the type of DM, except for shoulder dystocia/cephalopelvic disproportion.     

广东省罗定市城区中老年人主要慢性病患病率及危险因素流行水平调查

目的 了解中老年人高血压、糖尿病、高脂血症、冠心病等主要慢性非传染性疾病的流行情况。 方法 采用分层多阶段抽样,调查心血管疾病及其危险因素,并对冠心病危险因素进行logistic回归分析。 结果 5 749名调查对象中,男性2 675人(46.53%),女性3 074人(53.47%),冠心病、高血压、糖尿病、高脂血症、超重、肥胖的患病率分别为5.44%、28.58%、9.50%、24.77%、23.64%和6.11%。logistic回归分析结果显示,年龄增加（OR＝1.257,95% CI:1.153～1.361）、体质指数值增加（OR＝1.159,95% CI:1.061～1.257）、吸烟（OR＝1.197,95% CI:1.084～1.310）、饮酒（OR＝1.088,95% CI:1.022～1.154）、有冠心病家族史（OR＝1.385,95% CI:1.121～1.649）、高血压（OR＝1.098,95% CI:1.031～1.165）、糖尿病（OR＝1.501,95% CI:1.206～1.796）和高脂血症（OR＝1.210,95% CI:1.095～1.325）等为冠心病的独立危险因素,经常运动（OR＝0.782,95% CI:0.611～0.953）为冠心病的保护性因素。 结论 抽烟、饮酒、运动缺乏、高血压、糖尿病、血脂异常等发生率均较高,应积极控制危险因素,降低心血管疾病患病率。      

北京地区人群体重指数、性别及年龄对血压的影响

目的 探讨北京地区非体力劳动者人群体重指数(BMI)、性别和年龄对血压的影响.方法 对2008年我院体检人群[共14 237例,男9548例(67.06%),女4689例(32.94%);年龄18.0～93.0岁,平均(49.8±10.2)岁]进行流行病学调查,采用Epidata 3.1软件建立数据库,使用SPSS 12.0统计软件包对数据进行分析.结果 调查人群BMI(22.30±3.08)kg/m2.不论男性还是女性,收缩压及舒张压均随BMI增加而逐渐升高.年龄<60.0岁组,男性高血压患病率明显高于女性[男:24.28%(1662/6844),女:13.77%(493/3581),P=0.000];年龄1>60.0岁组,男性与女性患病率差异无统计学意义(P=0.268).以BMI<18.0 ks/m~2作为对照组,BMI 18.0～23.9 ks/m~2,24.O～27.9 kg/m~2 和≥28.0 kg/m~2组,男性高血压患病风险(OR值)分别为1.709(95%CI:0.920～3.173),3.154(95%CI:1.703～5.839)和5.125(95%CI:2.805～9.696);女,巨高血压患病风险分别为1.988(95%CI:1.033～3.824),5.703(95%CI:2.962～10.982和14.358(95%CI:7.334-28.106).结论 BMI与高血压患病明显相关.有效预防和控制超重和肥胖等高血压发病危险因素,是我国目前亟待解决的公共卫生问题.     

超重和肥胖对青少年血压的影响

目的：研究超重和肥胖对青少年血压的影响。方法：采用整群抽样方法,对上海市青浦区11～17岁在校学生进行流行病学调查。对血压超过正常水平的调查对象,在1个月内复测其血压。结果：入组学生共4175人,其中女性2183人（52．3％）。4175人中,血压正常者3025人（72．5％）,正常高值血压750人（18．0％）,1级高血压346人（8．3％）,2级高血压54人（1．3％）。女性超重和肥胖的检出率分别为6．7％和3．0％,男性则分别为13．7％和6．3％。多因素logistic回归分析结果显示,在调整性别、年龄、父母高血压史和体育活动水平后,超重和肥胖是青少年高血压的独立危险因素,超重的优势比（95％可信区间）为1．42（1．16～1．75）,肥胖为2．35（1．78～3．11）。被动吸烟、高血压家族史与青少年高血压无显著相关性。结论：超重和肥胖是影响青少年血压水平增高的主要因素。     

Lower quit rates among African American and Latino menthol cigarette smokers at a tobacco treatment clinic

Background: Lower rates of smoking cessation and higher rates of lung cancer in African American (AA) smokers may be linked to their preference for mentholated cigarettes. Aim: This study assessed the relationship between menthol smoking, race/ethnicity and smoking cessation among a diverse cohort of 1688 patients attending a specialist smoking cessation service. Results: 46% of the patients smoked mentholated cigarettes, but significantly more AA (81%) and Latino (66%) patients than Whites (32%) smoked menthols. AA and Latino menthol smokers smoked significantly fewer cigarettes per day (CPD) than non‐menthol smokers (15.7 vs. 20.3, for AA, and 17.0 vs. 22.1, for Latinos), with no differences among White menthol and non‐menthol smokers. At 4‐week follow up, AA, Latino and White non‐menthol smokers had similar quit rates (54%, 50% and 50% respectively). In contrast, among menthol smokers, AAs and Latinos had lower quit rates (30% and 23% respectively) compared with Whites (43%, p < 0.001). AA and Latino menthol smokers had significantly lower odds of quitting [odds ratio (OR) = 0.34; 95% CI = 0.17, 0.69 for AA, and OR = 0.32; 95% CI = 0.16, 0.62 for Latinos] than their non‐menthol counterparts. At 6‐month follow up, a similar trend was observed for the race/ethnicity subgroups, with AA menthol smokers having half the odds of being abstinent compared with AA non‐menthol smokers (OR = 0.48; 95% CI = 0.25, 0.9). Conclusions: Despite smoking fewer CPD, AA and Latino menthol smokers experience reduced success in quitting as compared with non‐menthol smokers within the same ethnic/racial groups.     

Economic Analysis of a Geographically Defined Cohort of Hospitalized Patients Who Smoke

Objective

To compare the indications for hospital admission between current, former, and never smokers and to compare their costs per hospital admission, testing the hypothesis that the cost per hospital admission would be higher for smokers than for former and never smokers.

Management of uncontrolled hypertension in a nurse-led clinic compared with conventional care for patients with type 2 diabetes

OBJECTIVE: To compare the effectiveness of a nurse-led hypertension clinic with conventional community care in general practice in the management of uncontrolled hypertension in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: We studied 120 men and women outpatient attendees (61% non-Caucasian) with type 2 diabetes and a seated blood pressure (BP) >or=140/80 mmHg. All patients were being treated for hypertension, and 71% had increased urinary albumin excretion (UAE). Patients were allocated to either a nurse-led hypertension clinic or conventional primary care. The primary outcome measure was a change in systolic BP. Secondary outcome measures were total cholesterol, HDL cholesterol, total triglycerides, HbA(1c), UAE, serum creatinine, and changes in absolute stroke and coronary heart disease (CHD) risk scores. RESULTS: The mean (95% CI) difference in the decrement of systolic BP was 12.6 mmHg (5.9-19.3) (P = 0.000) in favor of the nurse-led group, whose patients were three times more likely to a reach target systolic BP <140 mmHg compared with conventional care (P = 0.003). A significant fall in 10-year CHD (P = 0.004) and stroke risk (P = 0.000) scores occurred only in the nurse-led group. There were no significant differences in the reduction of diastolic BP or any of the other secondary outcome measures at 6 months. CONCLUSIONS: Compared with conventional care, a nurse-led hypertension clinic is a more effective intervention for patients with type 2 diabetes and uncontrolled hypertension. A target systolic BP <140 mmHg is more readily achieved and may be associated with significant reductions in 10-year cardiovascular disease risk scores.