Treated hypertensives with good medication compliance are still in a state of uncontrolled blood pressure in the Japanese elderly

Objectives Blood pressure (BP) is poorly controlled in many countries. Poor compliance was suggested as the main cause for poor BP control. The purpose of this study was to examine the association between compliance and the control of both casual blood pressure (BP) and 24-hr ambulatory BP in a Japanese elderly population. Methods The study was a cross-sectional survey. Casual BP and 24-hr ambulatory BP were measured at home. Hypertension was defined as casual systolic BP (SBP)≧140 and/or diastolic BP (DBP)≧90 mmHg, or as treated hypertension. A compliance rate of greater than 80% by the pill count method was defined as good compliance. Results Of the 178 treated hypertensives, 82.6% showed good compliance. Between the treated hypertensives with good compliance and those with poor compliance, no significant difference was found in either casual BP or ambulatory BP. Of the treated hypertensives with good compliance, the prevalence of achieved target ambulatory BP, i.e., daytime BP<135/85 mmHg, nighttime BP<120/75 mmHg, and 24-hr BP<125/80 mmHg, was, respectively, 35.4%, 43.5%, and 20.4%. Conclusions Casual BP and 24-hr ambulatory BP were poorly controlled in the community-living elderly although many of the treated hypertensives showed good compliance. It is unlikely that this inadequate control of hypertension is due to poor compliance on the part of the subjects.     

Trimester-specific blood pressure levels in relation to maternal pre-pregnancy body mass index

We evaluated the influence of maternal pre-pregnancy body mass index (BMI), based on reported pre-pregnancy weight and height, on blood pressure (BP) levels during pregnancy by using information from a prospective cohort of 1733 women recruited before 20 weeks' gestation. Maternal antenatal BP values were abstracted from medical records, and we evaluated the mean BP differences according to BMI group in regression models, using generalised estimating equations to account for repeated BP records within each pregnancy. In each trimester, mean systolic BP (SBP) and diastolic BP (DBP) values were positively associated with maternal pre-gestational BMI. This association persisted after adjustment for maternal age, parity, smoking, education, marital status and physical activity. Overweight women (25-29 kg/m(2)) had first-, second- and third-trimester mean SBPs that were 8.1, 7.7 and 8.2 mmHg, respectively, higher than values observed in lean women (<20 kg/m(2)). Mean DBP values were 4.5, 5.4 and 5.6 mmHg higher for each successive trimester in overweight vs. lean women. Obese (>30 kg/m(2)) women consistently had the highest mean SBP and DBP values. Trimester-specific mean SBP values were 10.7-12.0 mmHg higher among obese women vs. lean women. Corresponding trimester-specific mean DBP values were 6.9-7.4 mmHg higher in obese vs. lean women. Similar patterns were observed when trimester-specific average mean arterial pressures were evaluated. Elevated pregnancy BPs associated with maternal pre-gestational BMI are consistent with a large body of literature that documents increased pre-eclampsia risk among overweight and obese women.     

Randomised, controlled, cross-over trial of soy protein with isoflavones on blood pressure and arterial function in hypertensive subjects

OBJECTIVE: To examine the effects of dietary soy/isoflavones on 24 hr blood pressure profiles and arterial function [systemic arterial compliance (SAC), pulse wave velocity (PWV) and brachial arterial flow mediated vasodilation (FMD)] compared to non legume-based plant protein without isoflavones, in hypertensive subjects. DESIGN: In a 6 month double-blind, placebo controlled, cross-over trial, 41 hypertensive subjects (26 men, 15 postmenopausal women), 30-75 years, received soy cereal (40 g soy protein, 118 mg isoflavones) and gluten placebo cereal, each for 3 months. RESULTS: Thirty-eight subjects completed protocol with results expressed as mean or mean change (+/-SEM) with each intervention. Soy increased urinary isoflavones (daidzein: 8-fold; genistein: 8-fold; equol: 9-fold; ODMA: 18-fold) with no change during gluten placebo. There was no difference in the change in individual 24 hr ambulatory BP parameters (SBP: 2 +/- 2 vs -1 +/- 1 mmHg, p = 0.21; DBP: 1 +/- 1 vs -1 +/- 1 mmHg, p = 0.06) central BP (cSBP: -4 +/- 2 vs 0 +/- 2 mmHg, p = 0.2) or the change in arterial function (FMD: 0.3 +/- 0.5 vs -0.2 +/- 0.5%, p = NS; SAC: 0.02 +/- 0.02 vs -0.02 +/- 0.02 U/mmHg, p = NS; PWV central: -0.2 +/- 0.2 vs 0.0 +/- 0.2 m/sec, p = NS; PWV peripheral: 0.01 +/- 0.3 vs -0.4 +/- 0.4 m/sec, p = NS) noted between interventions. Analysis of the area under curve of 24 hr BP outputs demonstrated that soy protein compared to gluten protein resulted in higher 24 hr systolic BP by 2.3 mmHg (p = 0.003), a higher daytime systolic BP by 3.4 mmHg (p = 0.0002) and a higher daytime diastolic BP by 1.4 mmHg (p = 0.008). Overall 24 hr diastolic BP, night systolic BP and night diastolic BP were not significantly different between groups. Furthermore, soy protein compared to gluten protein resulted in higher 24 hr heart rates by 3.5 bpm (p < 0.0001). CONCLUSIONS: In hypertensive subjects, compared to gluten placebo, soy dietary supplementation containing isoflavones had no effect on arterial function, on average 24 hr ambulatory blood pressure parameters or central blood pressure in men and women with hypertension. Area under the curve of 24 hr profiles demonstrated that daytime BP was higher after soy compared to gluten.     

Ambulatory blood pressure in hypertensive patients with left ventricular hypertrophy: efficacy of first-line combination perindopril/indapamide therapy

Background

Ambulatory blood pressure (BP) is more sensitive than office BP and is highly correlated with the left ventricular mass (LVM) of hypertensive patients with left ventricular hypertrophy (LVH).

Methods

In this prospectively designed ancillary study of the PICXEL trial, the effects of first-line combination perindopril/indapamide on ambulatory BP were compared with those of monotherapy with enalapril in 127 patients. Hypertensive patients with LVH received once daily either perindopril 2 mg/indapamide 0.625 mg (n = 65) or enalapril 10 mg (n = 62) for 52 weeks. Dose adjustments were allowed for uncontrolled BP. Twenty-four-hour ambulatory BP and echocardiographic parameters were measured at baseline, week 24, and week 52.

Results

At study end, both treatments significantly improved ambulatory BP compared with baseline (p ≤ 0.01). Perindopril/indapamide treatment reduced 24-hour and daytime systolic BP (SBP) and pulse pressure (PP) significantly more than enalapril treatment (p < 0.01). No significant between-group differences were noted for diastolic BP (DBP) or for night-time measurements. Trough/peak ratios were higher with perindopril/indapamide than with enalapril (88.5 vs 65.8 for SBP and 86.7 vs 63.9 for DBP, respectively). The global smoothness index was higher with perindopril/indapamide than with enalapril (6.6 vs 5.2 for SBP and 5.6 vs 4.9 for DBP, respectively). With perindopril/indapamide treatment, LVM index was significantly reduced (−9.1 g/m² from baseline; p vs baseline <0.001). More patients required dose increases with enalapril (87%) than with perindopril/indapamide (71%). No unusual safety elements were noted.

Conclusions

First-line perindopril/indapamide combination decreased ambulatory SBP and PP, and LVM more effectively than enalapril.     

Alcohol consumption, %CDT, GGT and blood pressure change during alcohol treatment

AIMS: Blood pressure (BP) changes in alcohol-dependent individuals during a 12-week alcohol relapse prevention study were examined in light of drinking status and biomarkers of alcohol consumption [carbohydrate-deficient transferrin (%CDT) and gamma-glutamyl transpeptidase (GGT)]. METHODS: Of 160 randomized alcoholic individuals, 120 who had hypertension and in whom daily drinking data was available, at 6 and 12 weeks of treatment were included. The impact of alcohol consumption on change in systolic BP (SBP) and diastolic BP (DBP) was examined. Further analysis determined the relationship between BP and alcohol-use biomarkers. RESULTS: A significant effect of complete abstinence on both SBP (-10 mmHg; P = 0.003) and DBP (-7 mmHg; P = 0.001) when compared to any drinking (SBP and DBP = -1 mmHg) was observed. At week 12, participants with a positive %CDT (> or =2.6) had 7 mmHg greater SBP (P = 0.01) and DBP (P < 0.001) than those with negative %CDT. Participants with positive GGT (> or =50 IU) had 10 mmHg greater SBP (P = 0.12) and 9 mmHg greater DBP (P = 0.03) than those with negative GGT. The percent change in SBP was correlated with percent change in %CDT (P = 0.003) but not GGT (P = ns). The percent change in DBP was correlated with both percent change in %CDT (P < 0.0001) and GGT (P = 0.03). CONCLUSIONS: Abstinence from alcohol significantly decreased the BP and a positive relationship between BP and both alcohol-use biomarkers was illustrated. Since %CDT is more specific than GGT for heavy alcohol consumption, clinicians may monitor the role of alcohol in hypertension using %CDT as a supplemental aid, providing an objective assessment of drinking to influence BP treatment decisions.     

Elevated blood pressure, decreased heart rate variability and incomplete blood pressure recovery after a 12-hour night shift work

Shift work has been associated with increased risk of cardiovascular disease. This study was designed to determine the hemodynamic effects of 12-hour (12-h) shifts, and changes in blood pressure (BP) and heart rate variability (HRV) during 36 h rest time following 12-h shifts. Fifteen male shift workers with a mean age of 32.9 yr were recruited from a semiconductor factory. Ambulatory BP (AmBP) monitoring was performed for a total of 48 h for each participant. Six workers were monitored for 48 h by Holter electrocardiogram on both the day and night shifts. Paired self-comparison was used to estimate the difference between two hourly measurements of 12-h BP, HR, and HRV using the same timetable intra-individually. We also applied mixed models to estimate the effects of 12-h shifts on the delayed recovery of BP and heart rate (HR) in six workers who completed 96-h AmBP monitoring, including a 48-h night shift-rest period and another day shift period. Results showed that 12-h night shift work gave a persistently elevated systolic and diastolic BP (SBP and DBP) and HR, and decreased HRV compared to 12-h day shift work with the corresponding resting time. In addition, there was delayed SBP and DBP recovery on the first 12-h rest time in night shift workers, which was further demonstrated on the second 12-h rest time after adjustment for possible confounders through mixed models. In conclusion, 12-h night shift work may elevate BP and HR and decrease HRV. It is also associated with delayed BP recovery.     

The effect of low-dose potassium supplementation on blood pressure in apparently healthy volunteers

Epidemiological and clinical trials suggest an inverse relationship between dietary K intake and blood pressure (BP). Most trials however have been of short duration, the dose of K was high, and the results have been conflicting. The aim of the present study was to evaluate the effect on BP of a low-dose supplementation (24 mmol/d) for an extended period. A double-blind placebo-controlled trial was conducted on fifty-nine volunteers, randomly assigned to receive 24 mmol slow-release KCl/d (n 30) or a placebo (n 29). Measures of BP, anthropometric characteristics and urine analysis for electrolytes were recorded during a 1-week baseline period. Supplementation was for 6 weeks during which BP and changes in weight were assessed and a second 24 h urine collection made. The primary outcome was the change in mean arterial pressure (MAP); systolic BP (SBP) and diastolic BP (DBP) were secondary outcomes. After 6 weeks of supplementation MAP was reduced by 7.01 (95 % CI -9.12, -4.89; P<0.001) mmHg, SBP was reduced by 7.60 (95 % CI -10.46, -4.73; P<0.001) mmHg and DBP was reduced by 6.46 (95 % CI -8.74, -4.19; P<0.001) mmHg. The reduction in MAP was positively associated with baseline urinary Na:K (P<0.034). A low daily dietary supplement of K, equivalent to the content of five portions of fresh fruits and vegetables, induced a substantial reduction in MAP, similar in effect to single-drug therapy for hypertension.     

Influence of albuminuria and glomerular filtration rate on blood pressure response to antihypertensive drug therapy

Background

Albuminuria and glomerular filtration rate (GFR), two factors linked to kidney and vascular function, may influence longitudinal blood pressure (BP) responses to complex antihypertensive drug regimens.

Methods

We reviewed the clinic records of 459 patients with hypertension in an urban, academic practice.

Results

Mean patient age was 57-years, 89% of patients were African American, and 69% were women. Mean patient systolic/diastolic BP (SBP/DBP) at baseline was 171/98 mmHg while taking an average of 3.3 antihypertensive medications. At baseline, 27% of patients had estimated (e)GFR <60 ml/min/1.73², 28% had micro-albuminuria (30–300 mg/g) and 16% had macro-albuminuria (>300 mg/g). The average longitudinal BP decline over the observation period (mean 7.2 visits) was 25/12 mmHg. In adjusted regression models, macro-albuminuria predicted a 10.3 mmHg lesser longitudinal SBP reduction (p < 0.001) and a 7.9 mmHg lesser longitudinal DBP reduction (p < 0.001); similarly eGFR <60 ml/min/1.73² predicted an 8.4 mmHg lesser longitudinal SBP reduction (p < 0.001) and a 4.5 lesser longitudinal DBP reduction (p < 0.001). Presence of either micro- or macro-albuminuria, or lower eGFR, also significantly delayed the time to attainment of goal BP.

Conclusions

These data suggest that an attenuated decline in BP in drug-treated hypertensives, resulting in higher average BP levels over the long-term, may mediate a portion of the increased risk of cardiovascular-renal disease linked to elevated urinary albumin excretion and reduced eGFR.     

Effects of environmental noise exposure on ambulatory blood pressure in young adults

Epidemiological studies have demonstrated that environmental noise exposure is associated with hypertension in middle-aged and older populations, but the relationship in the young subpopulation and between the genders is still unclear. This panel study investigated effects of environmental noise exposure on 24-h ambulatory blood pressure in 60 adults aged 18-32 years. Individual noise exposure and personal blood pressure were measured simultaneously for 30 males and 30 females. Linear mixed-effects regression models were applied to estimate effects. Total subjects (56.6±16.5 A-weighted decibels (dBA)) had transient elevations of 1.15 (95% CI=0.86-1.43) mmHg SBP and 1.16 (0.93-1.38) mmHg DBP at daytime, as well as 0.74 (0.21-1.26) mmHg SBP and 0.77 (0.34-1.20) mmHg DBP at nighttime, significantly associated with a 5-dBA increase in noise exposure. Such effects on SBP and DBP still persisted at the 30- and 60-min time-lagged noise exposure. Per 5-dBA increase in 24-h average noise exposure was significantly associated with sustained increments of 1.15 (0.76-1.54) mmHg SBP and 1.27 (0.96-1.58) mmHg DBP in males (57.4±16.0 dBA), as well as the higher levels of 1.65 (1.36-1.94) mmHg SBP and 1.51 (1.27-1.75) mmHg DBP in females (55.9±17.0 dBA). We found that environmental noise exposure may have elevated effects on adults’ blood pressure. Young females are more susceptible to noise exposure than males.     

Effects of a four-month strength training program on blood pressure in older adults

The purpose of this study was to evaluate the effects of a 4-month strength training program on strength and blood pressure (BP) in older adults. The training protocol for the 43 experimental subjects (ES) (age 72.1, Sd 5.5 yr; Wt 72.4, Sd 12.3 kg; BMI 26.3, Sd 3.4) consisted of 8-12 reps at each of 50, 60 and 70% of their one repetition maximum (1RM), three days a week, for 16 weeks. The subjects trained on five upper extremity, three trunk, and three lower extremity muscle groups. They were evaluated for 1RM initially, after 3, 5, 7, 12, and 16 weeks of training. Daily systolic (SBP), diastolic (DBP) and mean arterial blood pressures (MABP) were averaged to produce BP values for baseline, weeks 3, 5, 7, 9, 12, and 16. Eighteen comparison subjects (age 71.8, Sd 4.6 yr--(CS)) were evaluated for strength and BP before and after the 4-month intervention period. The data were evaluated for differences by ANOVA, Scheffe' HSD tests and Pearson correlation coefficients. Baseline and 3, 5, 7, 9, 12, and 16 week BPs were evaluated for changes over time and relationships with trunk, upper, and lower extremity strength measurements for the ES. Following training, there was an overall increase in strength of 45% and each segment increased significantly (p<0.05). Systolic blood pressure remained unchanged, while MABP and DBP decreased 2.4 and 3 mmHg, respectively. Strength and BP shared significant, but moderate relationships before and after the training intervention. These results show that moderate intensity strength training greatly improved strength in older adults and had no adverse affect on BP responses.     

Low job control is associated with higher diastolic blood pressure in men with mildly elevated blood pressure: the Rosai Karoshi study

Job strain is a risk factor for hypertension, but it is not fully understood if components of job strain, or job demand or job control per se could be related to blood pressure (BP), and if so, whether the relationship differs between normotension and mildly elevated BP. We examined resting BP, and job stress components in 113 Japanese male hospital clerks (38.1 ± 4.4 yr). Subjects were classified into normotensive (NT) (<130/85 mmHg, n=83) and mildly elevated BP (ME) (≥130/85 mmHg) groups. Diastolic BP (DBP) showed a significant interaction between group and job control level (p=0.013). Subjects with low job control demonstrated higher DBP than those with high job control (89.1 ± 2.1 vs. 82.3 ± 2.3 mmHg, p=0.042) in ME group even after adjustments for covariates while DBP did not differ between low and high job control subjects in NT group. Systolic BP (SBP) did not differ between high and low job control subjects in both groups. Neither SBP nor DBP differed between high and low demand groups in either group. Among job strain components, job control may be independently related to BP in Japanese male workers with mildly elevated BP.     

Association of dietary sodium intake and blood pressure in the German population

Aim

The present study investigated the association of dietary sodium intake and blood pressure (BP) based on existing data from the German National Health Interview and Examination Survey (GNHIES) and the associated German Nutrition Survey (GeNuS).

Subject and methods

After exclusion of participants with known hypertension and/or anti-hypertensive medication use, complete data of the GeNuS subsample of the 1998 GNHIES were analysed for 1,539 men and 1,553 women aged 18–79?years. The survey included a health and lifestyle questionnaire, a medical examination and a comprehensive diet history interview. Sodium density (g/1,000?kcal) was examined in quartiles of systolic and diastolic BP (SBP and DBP). Multiple linear regression models were used to investigate associations of sodium density and SBP or DBP. Adjustments were made for sex, age and socio- and health-behavioral risk factors previously found to be related to BP in univariate analysis.

Results

Participants with a high SBP and DBP (fourth quartile of SBP: ≥ 142?mmHg in men; ≥ 139?mmHg in women) had a significantly higher dietary sodium intake than individuals with a lower BP. In the multiple models, both SBP and DBP were significantly associated with sodium density when adjusted for other factors such as sex, age, body mass index and alcohol consumption.

Conclusion

An association of dietary sodium intake and BP in the German population could be found. Further research using sodium data collected via 24-h urine samples is urgently needed for evidence-based public health policy reducing risk of BP associated morbidities and mortalities in Germany.     

Noise-induced hearing loss and blood pressure

Summary A sample of 188 male and 92 female engineering industry workers was investigated. Pure-tone audiometric measurements were used as an estimator of prolonged noise exposure. Using the air conductance thresholds at frequencies of 3,4 and 6 kHz, subjects were classified into three hearing classes. Their systolic (SBP) and diastolic blood pressure (DBP) was measured.In the older age group (41–64 years), the mean SBP of subjects with moderate hearing loss was 12 mmHg higher among men (n=35) and 18 mmHg higher among women (n=7) than among subjects with normal hearing (n=27). The mean DBP levels of subjects with moderate hearing loss were 5 mmHg and 4 mmHg higher, respectively. However, in the class of severe hearing loss (n=38; only male workers) the mean SBP was only 2 mmHg and the mean DBP only 1 mmHg higher than among subjects with normal hearing. In the younger age group (26–40 years) no differences in either SBP or DBP between the hearing classes were found.     

State-specific trends in self-reported blood pressure screening and high blood pressure--United States, 1991-1999

High blood pressure (HBP) increases the risk for heart disease and stroke, the first and third leading causes of death in the United States, respectively. An estimated one in four U.S. adults has HBP, which is defined as taking antihypertensive medication or having either a systolic blood pressure (SBP) of > or = 140 mmHg or a diastolic blood pressure (DBP) of > or = 90 mmHg. Optimal blood pressure is defined as SBP of < or = 120 mmHg or DBP of < or = 80 mmHg. To reduce the prevalence of HBP in the United States, the National Heart, Lung, and Blood Institute initiated the National High Blood Pressure Education Program (NHBPEP) in 1972, recommending that all adults aged > or = 20 years have their blood pressure (BP) checked at least once every 2 years. Although HBP is easily detectable and can usually be controlled with treatment, greater awareness of BP levels among U.S. adults is needed. This report summarizes data from the Behavioral Risk Factor Surveillance System (BRFSS) on state-specific trends in recent BP screening and prevalence of HBP (both by self-report). The findings indicate that during 1991-1999, BP screening levels were very high, and the percent of adults reporting HBP increased among some populations. Innovative education and intervention programs are needed to prevent and treat HBP in five high-risk groups: men, blacks, Hispanics, persons with less education, and older adults.     

儿童期血压偏高对成年期高血压的影响研究

目的 本研究旨在探讨儿童期血压偏高对成年期高血压的影响,为成人高血压的早期防控提供科学依据。方法 基于“中国居民健康与营养调查”资料(1991-2011年),纳入儿童期(6~17岁)和成年期(18~38岁)均进行至少1次随访的研究对象。儿童期血压偏高前期定义采用中国儿童青少年血压参考值性别和年龄的第90百分位(P₉₀)至第95百分位(P₉₅),儿童期血压偏高采用≥P₉₅。成年期高血压前期为收缩压/舒张压≥120/80 mmHg且<140/90 mmHg;成年期高血压为收缩压/舒张压≥140/90 mmHg,或有高血压史,或目前正服用降压药物。采用协方差分析和Cox比例风险回归模型分析儿童期血压偏高对成年期高血压前期和高血压的影响,控制混杂因素包括儿童期性别和年龄,成年期的体重指数(BMI)、吸烟和饮酒。结果 本研究共纳入1 984名数据完整的研究对象,中位随访时间为11.7年。基线儿童期共有108人(5.4%)为血压偏高前期,199人(10.0%)为血压偏高。随访成年期共有697人(35.1%)为高血压前期,104人(5.2%)为高血压。协方差分析表明,成年期收缩压和舒张压水平均随着儿童期血压百分位的增加而增加(P_趋势<0.001)。多因素Cox回归分析显示,儿童期血压偏高者成年后为高血压前期的风险增加(HR=1.41,95%CI:1.12~1.77)。儿童期血压偏高者成年后为高血压的风险显著增加(HR=1.73,95%CI:1.01~2.98)。结论 儿童期血压偏高会增加成年期罹患高血压的风险。应该重视儿童青少年血压监测,对血压偏高的高危儿童应及时采取干预措施。     

Prospective measurement of blood pressure and heart rate over 24 h in women using combined oral contraceptives with estradiol

Objective

Combined oral contraceptives (COCs) containing ethinyl-estradiol are known to increase blood pressure (BP). We evaluated whether COCs containing estradiol (E2) influence 24-h ambulatory BP and heart rate (HR) in normotensive and normal-weight women.

Study design

Twenty-four-hour BP and HR were measured every 30 min with an ambulatory BP device in 18 normotensive healthy non-smoking women prior to (Days 3–6 of menstrual cycle) and after 6 months of use (Days 20–24 of cycle 6) of a COC containing either a quadriphasic combination of E2 valerate plus dienogest (n=11) or a monophasic association of micronized E2 plus nomegestrol acetate (n=7).

Results

Mean age and body mass index of the final sample were 32.50±7.49 years and 22.87±4.08, respectively. E2-based COCs induced no modification of 24-h systolic BP (+ 1.65±8.34 mmHg; p=.41), diastolic BP (+ 0.04±7.36 mmHg; p=.98), mean BP (+ 0.64±6.42 mmHg; p=.68) or HR (− 0.72±5.86 beats/min; p=.61). Differences were not observed even when daytime or nighttime values were separately considered. Though this was not a comparative study, we did not find differences between the effects of the two formulations (24-h mean BP; p=.699).

Conclusions

These data suggest a neutral effect of estradiol-based COCs on independent risk factors for cardiovascular diseases such as BP or HR.

Implications

BP and HR of normotensive women are not increased by E2-based COCs.     

Birth cohort evidence of population influences on blood pressure in the United States, 1887-1994

PURPOSE: Mean blood pressure (BP) has declined in the U.S. for several decades. It is unknown to what extent this decline was due to treatment of persons with recognized high BP or to population-wide influences on BP. Treatment would shift only the highest values lower, whereas, population-wide influences on BP would shift the entire distribution downward. METHODS: We examined changes in the distributions of systolic and diastolic BP (SBP, DBP) across birth cohorts born between 1887 and 1975 in 52,646 individuals examined in the National Health (and Nutrition) Examination Surveys between 1960 and 1994. The BP distributions were estimated as functions of age and birth-year to examine changes between birth cohorts. We postulated that the age-adjusted 10th, 50th and 90th percentiles of SBP and DBP had decreased in more recent versus earlier birth cohorts. RESULTS: The series of birth cohorts exhibited successively lower SBP and DBP at low, middle and high percentiles. In general, the 10th percentile of SBP decreased approximately 1.19 mmHg per decade of birth-year, whereas the 50th percentile decreased 2.40 mmHg per decade, and the 90th percentile decreased 4.62 mmHg per decade. A similar pattern of results was seen for DBP. CONCLUSIONS: The entire distribution of both SBP and DBP shifted downward. The downward shifts at the 50th percentile and below unequivocally demonstrate a strong prevention effect in the U.S. population during the period 1887 through 1975. This epidemiologic analysis indicates that population-wide influences can alter favorably the distribution of BP throughout the whole population.     

Early and late effects of alcohol ingestion on blood pressure and endothelial function.

Previous investigations have shown a biphasic effect of alcohol on blood pressure (BP). However, there are no studies on possible simultaneous influences in endothelial function. This study aims to evaluate the early and late effects of alcohol ingestion on vascular and endothelial function parameters in healthy young men. The diameter of brachial artery (DBA), endothelium-dependent flow-mediated dilatation, endothelium-independent nitroglycerin-mediated dilatation, systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate were measured 30 min before intake, 4 h after intervention (when there is a reported hypotensive effect of alcohol), and after 13 h (subsequent increase in BP). The study group consisted of 100 males aged 18-25 years who were evaluated by brachial artery ultrasound. Subjects were randomized to drink either an alcoholic (60 g of ethanol) or a similar nonalcoholic beverage. Alcohol induced a biphasic effect on SBP and DBP, with a 4-h decrease followed by an increase after 13 h. After 4 h, the alcohol-drinking group presented a DBA increase that was significant at baseline and after hyperemia but not after nitroglycerin administration. There were no DBA differences between the intervention and control groups 13 h after drinking. This study replicates the initial reports of alcohol-induced biphasic alteration in BP. Our results showed that despite the late increase in BP, there were no accompanying changes in endothelial function.     

Relation of the difference between blood pressure before and after 5 minutes' rest to blood pressure status one year later in an epidemiological setting]

The relationship of the difference between blood pressures before and after 5 minutes' rest (before minus after) to resting blood pressures one year later was studied on 439 subjects, aged 35 to 44 years, not being treated for hypertension, in an epidemiological setting. Multiple regression analysis was applied to systolic (SBP) and diastolic blood pressure (DBP) separately. Both the resting SBP level and the SBP difference were significant predictors of the resting SBP one year later in both sexes. For resting DBP one year later, the resting DBP level and DBP difference were found to be significant in females. Multiple logistic analysis was used to identify the factors which predict development from normotension to above borderline hypertension one year later. The SBP difference as well as the resting DBP level were significant predictors in males. These findings suggest that BP difference between before and after 5 minutes' rest may be an important indicator of subsequent BP status, and therefore there would be value in measuring blood pressure before as well as after rest with particular attention to BP difference.     

The effects of drinks made from simple sugars on blood pressure in healthy older people

The objective of the research was to determine the blood pressure (BP) lowering effects in older people of 50 g carbohydrate drinks with varying carbohydrate content using a randomised, cross-over study with ten (six females) healthy older subjects (mean age 72.20 (sem 1.50) years). BP, heart rate and glucometer-derived blood glucose levels were determined at baseline and following the ingestion of equal volumes (300 ml) of water and carbohydrate drinks with varying nutrient content (glucose, sucrose and fructose). A significant decline in BP over the first 60 min was seen following glucose (systolic BP (SBP) P<0.01, diastolic BP (DBP) P<0.01, mean arterial BP (MAP) P=0.03) and sucrose (SBP P<0.01, DBP P<0.01, MAP P<0.01) ingestion, although the decrease occurred earlier after glucose than sucrose ingestion (SBP 7.33 (sem 2.19) v. 21.00 (sem 4.30) min (P=0.03) and MAP 11.22 (sem 3.10) v. 17.00 (sem 3.78) min (P=0.03)). BP increased after water ingestion (SBP P=0.04, DBP P=0.18, MAP P=0.02) but did not change after fructose ingestion (SBP P=0.36, DBP P=0.81, MAP P=0.34). Post hoc analyses revealed that the BP (SBP, DBP and MAP) decrease following glucose and sucrose ingestion were similar but significantly greater than following fructose or water ingestion. Sucrose, which is used widely (table sugar), reduces BP as much as glucose. In contrast to this, fructose ingestion causes no change in BP. Further studies are required to determine if the substitution of glucose or sucrose with fructose may be beneficial in the medical management of older people with severe symptomatic postprandial hypotension.