Effects of exposure to carbon disulphide on low density lipoprotein cholesterol concentration and diastolic blood pressure.

The relation of carbon disulphide (CS2) exposure to risk factors for ischaemic heart disease was recently examined using data from a 1979 cross sectional study of 410 male textile workers, of whom 165 were exposed and 245 were unexposed to CS2. Average eight hour CS2 exposure concentrations ranged from 0.6 to 11.8 ppm by job title category among the exposed workers. A significant and positive linear trend in low density lipoprotein cholesterol concentration (LDLc) and diastolic blood pressure with increasing CS2 exposure was found after adjustment for potential confounders. When exposure was examined as a categorical variable (none, low, moderate, and high), the high exposure group had an adjusted mean LDLc that was 0.32 mmol/l greater than the non-exposed group (p = 0.02), and an adjusted mean diastolic blood pressure that was 3.16 mm Hg greater than the non-exposed group (p = 0.09). The effect of CS2 on diastolic blood pressure was strengthened in analyses limited to exposed workers: the high exposure group had an adjusted mean diastolic blood pressure that was 5 mm Hg greater than that of the low exposed group (p = 0.03). Triglyceride, high density lipoprotein cholesterol, and fasting glucose concentration, and systolic blood pressure were not affected by exposure. Blood lead concentration was positively associated with systolic and diastolic blood pressure. The results indicate that relatively modest exposure to CS2 may raise LDLc concentration and diastolic blood pressure and suggest mechanisms by which exposure to CS2 may influence risk of ischaemic heart disease. Also the results provide further support for the hypothesis of a possible association between blood lead concentration and blood pressure.     

Effects of exposure to carbon disulphide on low density lipoprotein cholesterol concentration and diastolic blood pressure.

The relation of carbon disulphide (CS2) exposure to risk factors for ischaemic heart disease was recently examined using data from a 1979 cross sectional study of 410 male textile workers, of whom 165 were exposed and 245 were unexposed to CS2. Average eight hour CS2 exposure concentrations ranged from 0.6 to 11.8 ppm by job title category among the exposed workers. A significant and positive linear trend in low density lipoprotein cholesterol concentration (LDLc) and diastolic blood pressure with increasing CS2 exposure was found after adjustment for potential confounders. When exposure was examined as a categorical variable (none, low, moderate, and high), the high exposure group had an adjusted mean LDLc that was 0.32 mmol/l greater than the non-exposed group (p = 0.02), and an adjusted mean diastolic blood pressure that was 3.16 mm Hg greater than the non-exposed group (p = 0.09). The effect of CS2 on diastolic blood pressure was strengthened in analyses limited to exposed workers: the high exposure group had an adjusted mean diastolic blood pressure that was 5 mm Hg greater than that of the low exposed group (p = 0.03). Triglyceride, high density lipoprotein cholesterol, and fasting glucose concentration, and systolic blood pressure were not affected by exposure. Blood lead concentration was positively associated with systolic and diastolic blood pressure. The results indicate that relatively modest exposure to CS2 may raise LDLc concentration and diastolic blood pressure and suggest mechanisms by which exposure to CS2 may influence risk of ischaemic heart disease. Also the results provide further support for the hypothesis of a possible association between blood lead concentration and blood pressure.     

年龄与原发性高血压患者血压晨峰的相关性研究

目的：探讨年龄对血压晨峰发生的影响。方法：选取2009年10月-2011年10月在本院查体的320例原发性高血压患者,根据患者的年龄将其分为≥60岁组148例和〈60岁组172例。所有患者均监测24 h动态血压,比较两组血压晨峰发生情况并分析年龄与血压晨峰之间的相关性。结果：≥60岁组的年龄、甘油三酯、舒张压、动态血压参数均明显高于〈60岁组,差异均有统计学意义（P〈0.01或P〈0.05）。≥60岁组高血压患者血压晨峰发生率53.4%明显高于〈60岁组的41.9%,血压晨峰值（33.1±18.1）mm Hg明显高于〈60岁组的（27.1±15.5）mm Hg,差异均有统计学意义（P〈0.01或P〈0.05）。Pearson相关性分析显示,血压晨峰与高血压患者年龄呈显著正相关（r=0.583,P〈0.05）。多元线性逐步回归显示,年龄、空腹血糖、24 h收缩压是引起血压晨峰现象的主要危险因素。结论：年龄与血压晨峰的发生显著相关,因此对于老年高血压患者监测24 h血压具有重要的临床意义。     

Reappraisal of the relation between blood lead concentration and blood pressure among the general population in Taiwan

OBJECTIVES: The relation between blood lead concentration (PbB) and blood pressure was examined in a Taiwan nationwide population survey of PbB from July 1993 to June 1994. METHODS: After multistage sampling procedures, 2800 subjects (1471 males and 1329 females) with a mean (range) age of 44 (15-85) years were enrolled in this study. Anthropometric, blood pressure, and lifestyle factors were measured during household visits. The PbB was measured with a flameless atomic absorption spectrophotometer and all specimens were analysed in triplicate. RESULTS: The mean (range) PbB among all study subjects was 6.5 (0.1-69.1) micrograms/dl; among males it was 7.3 (0.1-69.1) micrograms/dl and among females 5.7 (0.1-40.1) micrograms/dl). The mean (range) systolic blood pressure among all subjects was 123 (80-210) mm Hg, among males it was 127 (80-200) mm Hg and among females 119 (80- 210) mm Hg. The diastolic blood pressure among all subjects was 78 (40- 150) mm Hg; among males it was 80 (40-130) mm Hg; and among females 75 (40-150) mm Hg. Age, body height, body weight, and body mass index (BMI) were significantly correlated with systolic blood pressure or diastolic blood pressure in both sexes. The PbB (or the natural logarithmic transformed PbB) was not significantly correlated with blood pressure among males or females. After adjustment for the potential confounders of age, age2, BMI, milk intake, alcohol consumption, and cigarette smoking, systolic blood pressure was significantly associated with PbB among males with a regression coefficient (beta) of 0.185 (p = 0.015). No significant association between PbB and blood pressure was found among females. CONCLUSIONS: From this study, only a weak association between systolic blood pressure and PbB was found among males. There was no strong evidence that PbB was a good predictor of blood pressure. However, the possibility that long term high body lead burden could cause high blood pressure could not be ruled out on the basis of this survey.

 

     

接触噪声与粉尘对工人血压的影响

目的 了解噪声、粉尘接触对职业人群血压的影响。
方法 采用整群抽样方法，选取广东省某钢琴制造厂765名工人为研究对象。将研究对象分为不接触粉尘和噪声组（对照组，n=237）、噪声接触组（n=167）、粉尘接触组（n=222）和噪声与粉尘联合接触组（n=139），分析4组人群血压情况。
结果 4组人群在年龄、BMI指数和体育锻炼方面比较，差异无统计学意义（P>0.05）。4组人群的收缩压、舒张压水平差异均有统计学意义（P < 0.05），其中对照组人群收缩压和舒张压水平均低于其他3组。高血压总患病率为20.3%（155/765），4组人群高血压患病率差异有统计学意义（P < 0.01），其中以对照组最低，同时接触噪声与粉尘组高血压患病率最高。多元线性回归分析结果显示，男性、吸烟、噪声、粉尘及噪声粉尘联合暴露均能增加收缩压和舒张压上升的风险。多因素logistic回归结果显示:相比对照组，噪声（OR=2.646）、粉尘（OR=1.713）及噪声和粉尘联合暴露（OR=2.624）能增加人群罹患高血压的风险（P < 0.01）。
结论 噪声、粉尘接触对职业人群的舒张压、收缩压都可产生一定的影响。而同时接触噪声、粉尘危害因素的职业人群罹患高血压的风险可能比单独接触粉尘的人群更高。
     

我国成年人单纯性收缩期高血压患病率调查

目的评估我国成年人单纯性收缩期高血压的患病率及其人群分布。方法亚洲国际心血管病合作研究(InterASIA)于2000至2001年进行,应用多阶段抽样方法选择15540名35～74岁成年人为代表性样本,分析单纯性收缩期高血压和其他亚型高血压的患病率。应用标准问卷调查高血压病史及其治疗情况。血压值为休息5min后3次坐位血压测量值的平均值。未接受抗高血压治疗的个体通过以下标准确定高血压亚型单纯性收缩期高血压为收缩压≥140mmHg(1mmHg=0133kPa),舒张期血压<90mmHg;单纯性舒张期高血压为收缩压<140mmHg,舒张压≥90mmHg,而收缩期和舒张期联合性高血压为收缩压≥140mmHg,舒张压≥90mmHg。结果15540名35～74岁成年人样本中,76%(1181人)患有单纯性收缩期高血压,74%(1150人)患有收缩期和舒张期联合性高血压,而44%(683人)患有单纯性舒张期高血压。收缩期高血压的患病率随着年龄的增长而增加,且老年女性比老年男性更为常见。南方与北方地区的单纯性收缩期高血压患病率没有明显差异;农村单纯性收缩期高血压患病率高于城市。结论我国收缩期高血压患病率较高,应引起重视。     

Associations of blood pressure and hypertension with lead dose measures and polymorphisms in the vitamin D receptor and delta-aminolevulinic acid dehydratase genes

Evidence suggests that lead and selected genes known to modify the toxicokinetics of lead--namely, those for the vitamin D receptor (VDR) and delta-aminolevulinic acid dehydratase (ALAD)--may independently influence blood pressure and hypertension risk. We report the relations among ALAD and VDR genotypes, three lead dose measures, and blood pressure and hypertension status in 798 Korean lead workers and 135 controls without occupational exposure to lead. Lead dose was assessed by blood lead, tibia lead measured by X-ray fluorescence, and dimercaptosuccinic acid (DMSA)-chelatable lead. Among lead workers, 9.9% (n = 79) were heterozygous for the ALAD(2) allele, and there were no ALAD(2) homozygotes; 11.2% (n = 89) had at least one copy of the VDR B allele, and 0.5% (n = 4) had the BB genotype. In linear regression models to control for covariates, VDR genotype (BB and Bb vs. bb), blood lead, tibia lead, and DMSA-chelatable lead were all positive predictors of systolic blood pressure. On average, lead workers with the VDR B allele, mainly heterozygotes, had systolic blood pressures that were 2.7-3.7 mm Hg higher than did workers with the bb genotype. VDR genotype was also associated with diastolic blood pressure; on average, lead workers with the VDR B allele had diastolic blood pressures that were 1.9-2.5 mm Hg higher than did lead workers with the VDR bb genotype (p = 0.04). VDR genotype modified the relation of age with systolic blood pressure; compared to lead workers with the VDR bb genotype, workers with the VDR B allele had larger elevations in blood pressure with increasing age. Lead workers with the VDR B allele also had a higher prevalence of hypertension compared to lead workers with the bb genotype [adjusted odds ratio (95% confidence interval) = 2.1 (1.0, 4.4), p = 0.05]. None of the lead biomarkers was associated with diastolic blood pressure, and tibia lead was the only lead dose measure that was a significant predictor of hypertension status. In contrast to VDR, ALAD genotype was not associated with the blood pressure measures and did not modify associations of the lead dose measures with any of the blood pressure measures. To our knowledge, these are the first data to suggest that the common genetic polymorphism in the VDR is associated with blood pressure and hypertension risk. We speculate that the BsmI polymorphism may be in linkage disequilibrium with another functional variant at the VDR locus or with a nearby gene.     

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.     

Lead effect on blood pressure in moderately lead-exposed male workers

BACKGROUND: The effect of lead (Pb) and potential confounding variables on blood pressure was examined in healthy male industrial workers 20-43 years of age. METHODS: In 100 Pb workers and 51 reference subjects, the following variables were measured: blood Pb (BPb), activity of delta-aminolevulinic acid dehydratase (ALAD), erythrocyte protoporphyrin (EP), blood cadmium (BCd), serum zinc (SZn), serum copper (SCu), hematocrit (Hct), body mass index (BMI), and blood pressure. The inter-relationship of biomarkers of Pb (BPb, ALAD, EP) and BCd, SZn, SCu, Hct, BMI, age, smoking, and alcohol to systolic and diastolic blood pressure was calculated by forward stepwise multiple regression. RESULTS: There was no significant difference in blood pressure between the two groups, possibly because the reference subjects had relatively high BPb levels and significantly higher BMI (P < 0.05) as compared to the Pb workers. According to the multiple regression results in Pb workers, an increase in systolic blood pressure was significantly associated with increasing EP (P = 0.001) and BMI (P < 0.002), or alternatively with increasing BMI (P < 0.004) and decreasing ALAD (P < 0.04) and BCd (P < 0.05). An increase in diastolic blood pressure was significantly associated with increasing BMI (P < 0.009) and EP (P = 0.05) and decreasing BCd (P < 0.04). With respect to the EP range of 0.73-13.94 micromol/l erythrocytes in 100 Pb workers, an increase of 17 mm Hg in systolic and 6 mm Hg in diastolic blood pressure was found. CONCLUSIONS: Long-term cumulative Pb exposure, which is better reflected by EP than by ALAD or current BPb level, can significantly increase blood pressure in moderately Pb-exposed male workers (long-term average BPb <400 microg/l; exposure duration 2-21 years).     

妊娠高血压患者血压变异性与尿微量白蛋白关系的研究

目的 探究妊娠高血压患者血压变异性与其尿微量白蛋白(MAU)的关系.方法 选取2014年10月至2016年10月期间成都市第五人民医院妇产科就诊的首诊妊娠高血压患者125例作为临床研究对象,根据患者的MAU水平将其分为MAU阳性试验组和MAU阴性对照组两组,其中MAU阳性试验组患者55例,MAU阴性对照组患者70例,同时回顾性分析患者的临床一般资料,比较两组患者的24h动态血压变化情况及血压变异参数的变化.结果 MAU阳性的试验组患者24h平均收缩压、24h平均舒张压、白天平均收缩压、夜间平均收缩压、白天平均舒张压、夜间平均舒张压等24h动态血压值均明显高于MAU阴性对照组患者,组间差异具有统计学意义(t =56.3 ～6.46,均P＜0.05).试验组患者的24h平均收缩压标准差、24h平均舒张压标准差、24h平均收缩压变异系数、24h平均舒张压变异系数等血压变异参数指标也明显高于对照组患者,组间差异具有统计学意义(f =4.53 ～6.46,均P＜0.05).结论 妊娠期高血压患者的血压变异性与患者的尿微量白蛋白水平具有明显相关性.MAU可做为妊娠期高血压患者肾功能早期损伤检测指标,且具有良好的临床应用价值.     

Repeatability of automated ambulatory blood pressure measurements.

BACKGROUND. The repeatability of 24-hour automatic ambulatory blood pressure measurements recorded by noninvasive equipment (Del Mar Pressurometer IV) was assessed to determine the intrapatient variability of this test. METHODS. The usual antihypertensive medications of 73 patients with documented essential hypertension (supine diastolic blood pressure of 95 to 119 mm Hg) were withdrawn, and the patients were treated with placebo medication for 6 weeks. At the end of the placebo period, ambulatory blood pressure measurements of each patient were recorded every 15 minutes for 24 hours on two separate occasions 1 week apart. RESULTS. There was no significant difference in either the 24-hour systolic or diastolic blood pressure for the entire group between weeks. A mean difference for individual patients between the first and second recording within 5 mm Hg was observed in 49.3% and 52.1% of patients for 24-hour systolic and diastolic blood pressure, respectively. The correlation coefficient for 24-hour systolic blood pressure was greater than 24-hour diastolic blood pressure (r = .87 vs r = .67). A difference greater than 18.1/14.9 mm Hg for systolic/diastolic blood pressure would be required to assign a significant (P less than .05) change in blood pressure between two recordings in the same patient. CONCLUSIONS. These data quantify the usefulness of 24-hour ambulatory blood pressure measurements for a group of subjects. However, mean 24-hour ambulatory blood pressure varies significantly for individuals. Intrapatient variability may limit the usefulness of a single 24-hour ambulatory recording for an individual patient and suggests the need for more than one measurement to establish a level of blood pressure.     

家庭远程血压监测在社区高血压患者中的应用研究

目的 探讨家庭远程血压监测在社区高血压患者血压控制中的应用效果,以期探索社区高血压患者血压控制的有效模式。 方法 选取2014年8月-2016年6月在江阴市已确诊并建档管理的高血压患者1 372例,随机分为实验组(690例)和对照组(682例),进行两个月的干预研究。对照组进行常规社区高血压管理,实验组采用家庭远程血压监测技术实时监测血压,社区医生根据患者血压及时给予生活方式指导和调整药物治疗方案。比较两组间血压控制、高血压知识知晓率和生活方式改变情况的差异。 结果 两组入组前年龄、性别、体质指数、高血压分级、收缩压和舒张压水平相比较,差异均无统计学意义(P＞0.05)。实验组和对照组两组自身前后相比较,无论是收缩压还是舒张压水平均下降,差异有统计学意义(P＜0.001);出组时实验组收缩压水平低于对照组,差异有统计学意义(P＜0.001),而舒张压之间差异无统计学意义(P＞0.05)。出组时实验组血压控制率(42.0%)高于对照组(34.6%),差异有统计学意义(χ²=7.999,P=0.005),且实验组的收缩压达标率(50.1%)高于对照组(49.9%)(χ²=13.356,P＜0.001);经过两个月的干预,实验组的患者对高血压危险因素和治疗原则两项知识的知晓率(分别为98.8%、98.6%)优于对照组(分别为97.5%、96.2%),差异有统计学意义(P＜0.05);两组间生活方式相比较,实验组的经常锻炼人数比例(46.8%)高于对照组(43.8%,χ²=4.493,P=0.037)。 结论 家庭远程血压监测是一种有效的社区高血压管理模式,有助于提高患者的血压控制率,并能提高患者的高血压知识知晓率和改善不健康的生活方式,值得在社区推广应用。     

The relationship between shift work and the onset of hypertension in male Japanese workers

We assessed the effect of shift work on the onset of hypertension. The design of this study was that of a cohort study from 1991-2001. In sum, 5338 workers comprised this cohort. The event was the onset of hypertension (systolic blood pressure >or=140 mm Hg and/or diastolic blood pressure >or=90 mm Hg and/or medication). Pooled logistic regression analysis was performed, including job schedule type, age, body mass index, lifestyle, and the results of blood chemistries as covariates. The odds ratio of the onset of hypertension in shift workers for daytime workers was 1.10 and significant. Our study revealed that shift work independently affected the onset of hypertension, and suggested that shift work is a risk factor for the onset of hypertension.     

Effects on blood pressure of calcium supplementation of women

The relationship between dietary and supplemental (1.5 g/d) calcium intake and blood pressure was examined in 81 normotensive and 34 medicated hypertensive women between the ages of 35 and 65 years who completed a 4-yr clinical trial to assess age-associated bone loss in women. Calcium intakes were monitored during the entire study. Resting blood pressures and systolic blood pressure response (SBPR) to a stress test were recorded three times during the study. At the end of the study there was no relationship between systolic or diastolic blood pressure or SBPR and total calcium intake in normotensive women (n = 81). In the medicated hypertensive group (n = 34) there was a 13 mm Hg decrease in systolic pressure of supplemented women (n = 18) and a 7 mm Hg increase in unsupplemented women (n = 16) over the 4 yr (p less than .02).     

Evidence for a dose-response relationship between occupational noise and blood pressure

In this study, we investigated the role of occupational noise exposure and blood pressure among workers at 2 plants. A noise-exposed plant (plant 1, > or = 89 dBA) and a less-noise-exposed plant (plant 2, < or = 83 dBA) were chosen. Exposure was based on department-wide average noise measures; on the basis of job location and adjusting for layoffs during their employment at the plant, a cumulative time-weighted average noise level was calculated for each worker. The study population comprised 329 males in plant 1 and 314 males in plant 2. Their ages ranged from 40 to 63 y (mean ages = 49.6 and 48.7, respectively), and they had worked at least 15 y at the plant. The clinical examination was administered prior to the workday and measured height, weight, pulse, and blood pressure. In addition, we noted medical and personal-habits histories, including alcohol intake and cigarette smoking patterns. We used a questionnaire to determine in-depth occupation, military history, noisy hobbies, and family history of hypertension. When individuals who took blood-pressure medication were removed from the analysis, t tests for differences in average blood pressure between plants showed a mean systolic blood pressure of 123.3 mm Hg in plant 1 versus 120.8 mm Hg in plant 2 (p = .06) and a mean diastolic blood pressure of 80.3 mm Hg versus 77.8 mm Hg in Plant 1 and 2, respectively (p = .014). On the basis of data from the combined plants, multivariate analysis revealed that age, body mass index, cumulative noise exposure, current use of blood pressure medications, and alcohol intake were significant predictors for systolic blood pressure. Cumulative noise exposure was a significant predictor of diastolic blood pressure in plant 1 but not in plant 2, possibly reflecting a threshold effect.     

Abstracts on Vitamin Metabolism

The vegetarian diet has been associated with lower blood pressure (BP) in elderly white Americans. This study was undertaken to determine whether or not long-term adherence (at least 5 years) to a plant-based diet is similarly related to lower BP in older black Americans, a group exhibiting significant risk for hypertension (HT). Anthropometric characteristics, nutrient intake, and resting systolic and diastolic BP were measured in older black vegetarians (n = 27, age = 69.3 +/? 1.7 years), black nonvegetarians (n = 37, age = 65.4 +/? 1.2 years), white vegetarians (n = 85, age = 66.7 +/? 1.0 years), and white nonvegetarians (n = 54, age = 65.2 +/? 0.9 years). Older black vegetarians were significantly leaner and exhibited lower average systolic BP (131.4/76.8 mm Hg) and less hypertension than the black omnivores (141.6/76.2 mm Hg), but had significantly higher average BP than either dietary group of older white adults (vegetarians: 120.9/66.7 mm Hg; nonvegetarians: 122.8/67.6 mm Hg). These data suggest that long-term adherence to a vegetarian diet by older black Americans may afford some protection against hypertension, but in comparison to older white adults, does not completely offset their apparently greater susceptibility to untoward elevation of BP.     

阻塞性睡眠呼吸暂停综合征与无高血压患者睡眠血压的关系

目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)的严重程度和无高血压患者的昼夜血压变化之间的关系。方法连续对60个无高血压[收缩压(SBP)<140mm Hg和/或舒张压(DBP)<90mm Hg)]的门诊患者进行通宵的多导睡眠监测(PSG)和动态血压监测(ABPM)。根据从PSG结果计算的睡眠呼吸暂停低通气指数(AHI)将患者分为四组:非OSAS组,轻度组,中度组,重度组。结果昼夜收缩压和舒张压显示在OSAS的严重程度上没有差异;然而,睡眠SBP,最低SBP,醒前SBP在重度OSAS组显著高于非OSAS组(分别P=0.02,P=0.04,P=0.006)。重度OSAS的睡眠BPD、最低BPD、醒前BPD的显著高于非OSAS(P=0.01,P=0.02,P=0.0003)。结论轻中度OSAS患者夜间血压水平和非OSAS患者无显著差别,血压昼夜显示的OSAS的严重性没有区别。然而,严重的OSAS组显示有显著的睡眠血压变化。     

Occupational noise exposure, noise-induced hearing loss, and the epidemiology of high blood pressure

The role of noise exposure in the etiology of high blood pressure is unclear. A cross-sectional study of occupational noise exposure and high blood pressure was conducted in March 1981-August 1982 in a group of blue-collar workers from a noisy (greater than or equal to 89 dBA) and a less noisy plant (less than 81 dBA). There were 197 randomly sampled men from the noisier plant and 169 from the comparison factory. Clinical examinations, audiograms and a psychologic inventory were conducted. Body mass index, alcohol intake, and family history of hypertension were comparable for the two groups. There was no difference in mean systolic or diastolic blood pressure between workers in the two plants. There was, however, a strong relationship between severe noise-induced hearing loss (greater than or equal to 65 dBA loss at 3, 4, or 6 k Hz) and high blood pressure (greater than or equal to 90 mmHg diastolic or taking blood pressure medication) in the 56+ age group in both plants after adjusting for risk factors (p less than 0.02). Multiple regression analysis revealed that in the noisier plant, body mass index, severe noise-induced hearing loss, and noisy hobbies explained a significant amount of the variation in diastolic pressure (p less than 0.05) R2 = 0.19. This suggests that there may be a population at increased risk for hearing loss and high blood pressure.     

The prevalence, awareness and control of hypertension in Laval, Quebec, 1986

The prevalence, awareness and control of hypertension were assessed in a representative sample (n = 1,374) of the Laval population (aged 30-69 years). The study was designed to identify people at increased risk for cardiovascular disease because of elevated blood pressure levels rather than to establish a strict clinical prevalence. Defining hypertension as systolic pressure greater than or equal to 140 mm Hg and/or diastolic pressure greater than or equal to 90 mm Hg and/or on anti-hypertensive medication, the study found a prevalence of 25% (32% in men, 19% in women). Two thirds (67%) of the male hypertensives and 41% of the female hypertensives were previously unaware of their condition. One in three hypertensives were on medication, and less than half of these were under control. As observed in other studies, control was better in women. The study suggests the continuing need for high blood pressure education and detection in the Laval population, particularly among men.     

欠发达地区农村高血压患者规范化管理对其血压水平的干预效果评价

目的探索高血压规范化管理的思路,创新解决欠发达地区农村高血压防治问题。方法以甘肃民勤县为研究现场,采用类试验流行病学方法,并评价患者的收缩压和舒张压水平变化情况。结果试验组血压值在结局期较基线期均有显著降低,试验组血压值降低水平与对照组相比,差异有统计学意义;其干预前后的平均净效益值分别为5．27mmHg（1mmHg=0．133kPa）和3．01m／nHg,而与对照组比较差异无统计学意义;试验组结局期血压控制率较基线期显著提高;试验组收缩压和舒张压在不同随访阶段呈逐渐下降的趋势。结论在欠发达地区农村,以乡镇卫生院医务人员为主导的初级卫生保健力量在高血压规范化管理方案的指导下,通过对高血压患者开展主动的筛查、随访和健康教育,可以有效降低人群的血压水平。