Isolated uncontrolled hypertension at home and in the office among treated hypertensive patients from the J-HOME study

OBJECTIVES: To evaluate the current status of blood pressure (BP) control as measured at home and in the office, as well as to clarify and compare the prevalence and characteristics of isolated uncontrolled hypertension as measured at home (home hypertension) and in the office (office hypertension). DESIGN: A cross-sectional study. SETTING: Primary care offices in Japan. PARTICIPANTS: A sample of 3400 patients with essential hypertension (mean age, 66 years; males, 45%) receiving antihypertensive treatment. RESULTS: Overall, the mean home systolic BP (SBP)/diastolic BP (DBP) was 140/82 mmHg, and the mean office SBP/DBP was 143/81 mmHg. Of the 3400 subjects, 19% had controlled hypertension (home SBP/DBP < 135/85 mmHg and office SBP/DBP < 140/90 mmHg), 23% had isolated uncontrolled home hypertension (home SBP/DBP >/= 135/85 mmHg and office SBP/DBP < 140/90 mmHg), 15% had isolated uncontrolled office hypertension (home SBP/DBP < 135/85 mmHg and office SBP/DBP < 140/90 mmHg), and 43% had uncontrolled hypertension (home SBP/DBP >/= 135/85 mmHg and office SBP/DBP >/= 140/90 mmHg). Compared to controlled hypertension, factors associated with isolated uncontrolled home hypertension included obesity, relatively higher office SBP, habitual drinking, and the use of two or more prescribed antihypertensive drugs. Compared to uncontrolled hypertension, factors associated with isolated uncontrolled office hypertension included female gender, lower body mass index, and relatively lower office SBP. CONCLUSIONS: The use of all four, three of four, or all three predictive factors might be useful for the clinician to suspect isolated uncontrolled home or office hypertension.     

Tolerability and antihypertensive efficacy of Fosinopril on 24-hr ambulatory blood pressure in hypertensive elderly subjects

The tolerability and antihypertensive efficacy of Fosinopril were assessed in 34 elderly patients with mild to moderate hypertension. Twenty-four-hour ambulatory blood pressure (BP) was measured before and after 5 months of therapy. The patients' mean age was 67 years. At the end of the treatment the mean 24-hour systolic BP (SBP) fell from 153.4 +/- 14 to 137.7 +/- 13 mmHg and the mean 24-hour diastolic BP from 91 +/- 11 to 84.2 +/- 9 mmHg (p < 0.01). The mean decrease in SBP was 15.9 mmHg during the day and 10.3 during the night, and in diastolic BP (DBP) 8.3 mmHg during the day and 10.3 mmHg during the night (p < 0.05 between day and night). There was no significant percentage difference between the SBP and DBP decreases. The mean morning maximum of SBP decreased from 171 +/- 18 to 158 +/- 19 mmHg and there was a reduction in pressure increase between the night and day. The number of SBP peaks over 180 mmHg and 160 mmHg numerically decreased to 20.1% and 37.6% versus baseline, those of DBP over 105 mmHg and 95 mmHg to 41.6% and 58.3% versus baseline, respectively. There were no variations in the blood chemistry parameters and the drug had no adverse side effects. The authors conclude that Fosinopril is useful and well tolerated in the treatment of moderate hypertension in the elderly.     

不同时间服用苯那普利对非勺型高血压的降压效果

目的：观察不同时间给药对非勺型高血压患者血压昼夜节律的影响。方法：选择80例经24h动态血压监测（ABPM）,属非勺型的轻中度原发性高血压患者,随机均分为对照组、治疗组,对照组上午7时服用苯那普利10mg,治疗组上午7时和晚上7时各服用苯那普利5mg。给药6周后复测ABPM。比较两组血压昼夜节律的变化。结果：两组治疗后24h,白昼、夜间平均收缩压、舒张压,均显著下降（P〈0．01）,且治疗组的夜间平均收缩压[（121．3±4．9）mmHg]、舒张压[（77．6±8．0）mmHg],白昼、夜间血压负荷[（12．7±9．6）％,（8．5±6．7）％]较对照组显著下降（P〈0．05）。对照组和治疗组血压昼夜节律改变有效率分别为SBP48．65％和77．78％;DBP45．95％和72．22％,有显著性差异（P〈0．01）。结论：对于非勺型高血压,苯那普利分为早晚两次服用,可以更好改变血压昼夜节律,从而达到保护靶器官的目的。     

北京社区自然抽样人群冠状动脉钙化的多排螺旋CT初步研究

目的 探讨住院2型糖尿病(T2DM)患者血压控制的影响因素。方法 169例合并高血压的T2DM患者给予降压等综合治疗,以出院时血压130/80mmHg为界限分为达标组(n=97)及未达标组(n=72),比较两组入院时临床及实验室指标,并通过回归分析观察各种因素对出院时平均动脉压(MAP)水平的影响。结果 全组T2DM入院时收缩压(SBP)为143±15 mmHg,舒张压(DBP)为 78±8 mmHg,控制达标率仅17.8%;出院时血压达标率57.4%,降压药物种类平均增加0.8种。未达标组患者入院时SBP(151±15 vs. 137±12 mmHg, P=0.000)、DBP(80±9 vs. 77±7 mmHg, P=0.000)均高于达标组,且总胆固醇(TC)及24h尿白蛋白排泄率(UAE)显著升高。回归分析显示MAP与入院时SBP、DBP、TC及高血压病程显著正相关,与年龄负相关;MAP与UAE显著正相关(r=0.303, P=0.000)。合并糖尿病肾病(DN)患者随UAE增多而SBP显著升高,大量蛋白尿者需要多种降压药物联合且血压难以控制。结论 T2DM患者门诊血压控制达标率低;住院T2DM患者血压控制受入院时血压水平、高血压病程、高胆固醇血症、高UAE等因素影响;UAE增加可能是合并DN患者血压难以控制的直接原因。     

住院2型糖尿病患者短期血压控制及影响因素探讨

目的:探讨住院2型糖尿病(T2DM)患者短期血压控制效果及影响因素.方法:169例伴发高血压的T2DM患者给予降压等综合治疗,以出院时血压130/80 mmHg(1 mmHg=0.133 kPa)为界限分为达标组(97例)及未达标组(72例),比较2组入院时临床及实验室指标,并通过回归分析观察各种因素对出院时平均动脉压(MAP)水平的影响.结果:全组T2DM入院时收缩压(SBP)为(143±15)mmHg,舒张压(DBP)为(78±8)mmHg,控制达标率仅17.8%;出院时血压达标率57.4%,降压药物种类平均增加0.8种.未达标组患者入院时SBP[(151±15)∶(137±12)mmHg,P<0.01]、DBP[(80±9)∶(77±7)mmHg, P<0.01]均高于达标组,且TC及24 h尿白蛋白排泄率(UAE)显著升高.回归分析显示MAP与入院时SBP、DBP、TC及高血压病程显著正相关,与年龄呈负相关;MAP与UAE显著正相关(r=0.303, P<0.01).并发糖尿病肾病(DN)患者随UAE增多而SBP显著升高,大量蛋白尿者需要多种降压药物联合且血压难以控制.结论:T2DM患者门诊血压控制达标率低,住院短期治疗明显改善了血压控制水平;住院T2DM患者血压控制受入院时血压水平、高血压病程、高胆固醇血症、高UAE等因素影响;UAE增加可能是并发DN患者血压难以控制的直接原因.     

老年高血压患者合并抑郁的早期诊断及帕罗西汀应用安全性研究

目的探讨老年高血压患者合并抑郁的早期诊断及帕罗西汀应用的安全性。方法选择老年高血压患者260例,通过老年抑郁量表和汉密尔顿抑郁量表筛查抑郁状态,并分为抑郁组113例和非抑郁组147例,抑郁组患者随机分为帕罗西汀组56例和心理治疗组57例2个亚组。同时检测血浆5-羟色胺(5-HT)、白细胞介素6(IL-6);观察治疗前后收缩压、舒张压、脉压指数、5-HT、IL-6变化。结果与非抑郁组比较,抑郁组患者血浆5-HT、IL-6含量明显增高(P0.05);与同组治疗前比较,帕罗西汀组和心理治疗组收缩压均明显下降,IL-6也明显下降(P0.05);帕罗西汀组脉压指数较心理治疗组下降明显(P0.05)。结论 5-HT与IL-6可作为老年高血压患者早期诊断抑郁状态的参考指标,帕罗西汀在老年患者应用虽副作用较多,但疗效肯定。     

二甲双胍对原发性高血压伴糖耐量减低患者血压的影响

目的:观察二甲双胍单独或与苯那普利联合应用对原发性高血压(EH)患者的降压作用。方法:将120例伴糖耐量减低非糖尿病EH患者随机分为二甲双胍组(59例)和苯那普利组(61例),分别以二甲双胍500mg,3次/d和苯那普利10mg,1次/d治疗。治疗1个月后对收缩压≥140mmHg(1mmHg=0.133kPa)和(或)舒张压≥90mmHg者,给予上述2种药物联合治疗,剂量同上;达标者继续原治疗不变。总疗程为2个月。观察2组治疗前后血压和胰岛素敏感性变化。结果:①与治疗前比较,二甲双胍组和苯那普利组在治疗1个月后收缩压分别下降(12.5±6.4)mmHg和(14.9±6.5)mmHg,舒张压分别下降(8.5±6.2)mmHg和(9.9±3.8)mmHg;在治疗2个月后收缩压分别下降(16.9±5.0)mmHg和(19.9±6.4)mmHg,舒张压分别下降(13.1±5.3)mmHg和(14.3±1.2)mmHg,2组比较均差异无统计学意义(均P>0.05)。2组联合用药率均为56%。②与治疗前比较,空腹胰岛素、糖负荷1h胰岛素、糖负荷2h胰岛素、胰岛素曲线下面积在二甲双胍组于治疗1、2个月后明显下降(均P<0.01);在苯那普利组除糖负荷1h胰岛素于治疗1个月后开始下降外(P<0.05),其余于治疗2个月后明显下降(均P<0.01)。胰岛素敏感性指数在二甲双胍组于治疗1个月后明显高于苯那普利组(P<0.05),在治疗2个月后2组间比较差异无统计学意义(P>0.05)。结论:二甲双胍与苯那普利对伴糖耐量减低EH患者具有相似的降压效应和良好的协同作用。     

拉西地平联合缬沙坦治疗中、重度高血压病的临床疗效

目的 观察拉西地平联合缬沙坦治疗中、重度高血压病的临床疗效和安全性.方法 纳入中、重度高血压病126例[收缩压（SBP）≥140 mmHg,舒张压（DBP）≥105 mmHg],每日晨服拉西地平（4～6）mg联合缬沙坦80mg,共治疗4周.观察患者血压、心率、血脂、血糖及肝肾功能变化.结果 拉西地平联合缬沙坦治疗中、重度高血压病4周后,SBP平均值较服药前降低33.9mmHg,DBP平均值降低25.7mmHg,血压达标（SBP＜140mmHg,DBP＜90mmHg）率为88.2%,治疗前后患者各项生化指标、肝肾功能均无明显改变,不良反应发生率较低.结论 拉西地平联合缬沙坦降压效果明显,安全性好,可作为中、重度高血压病患者降压治疗的联合用药方案.     

Comparison of the antihypertensive efficacy of irbesartan/HCTZ and valsartan/HCTZ combination therapy: impact of age and gender

This analysis aimed to explore whether low-dose irbesartan/hydrochlorothiazide (HCTZ) has superior blood pressure (BP)-lowering efficacy over low-dose valsartan/HCTZ in the elderly and across both genders. This is a post-hoc analysis of data from a multicenter, parallel group, open-label, blinded-endpoint study in patients with hypertension uncontrolled with HCTZ monotherapy. The reduction in systolic BP (SBP)/diastolic BP (DBP) and rate of BP control achieved following 8 weeks of treatment with irbesartan/HCTZ 150/12.5 mg or valsartan/HCTZ 80/12.5 mg were analyzed for older (≥65 years) vs. younger (<65 years) patients and for men vs. women. Blood pressure measurements were by home BP monitoring (HBPM). In the age and gender subgroups, both treatments significantly decreased home SBP and DBP (p < 0.0001). The reduction in home SBP and DBP was numerically greater with irbesartan/HCTZ compared to valsartan/HCTZ for all subgroups: the difference in DBP was significant for all except the elderly (p < 0.05), and the difference in SBP was significant in the elderly and in men (p < 0.03). In all subgroups, more patients achieved BP control (HBPM ≤135/85 mmHg) in the irbesartan/HCTZ arm (range 45%-58%) than in the valsartan/HCTZ arm (range, 23%-39%; p < 0.02). Both combination therapies were well tolerated and safety parameters were similar in both age and gender subgroups. More patients with mild or moderate hypertension, uncontrolled in HCTZ monotherapy alone, had their BP controlled with irbesartan/HCTZ 150/12.5 mg than with valsartan/HCTZ 80/12.5 mg, irrespective of age or gender.     

Comparison of the Antihypertensive Efficacy of Irbesartan//HCTZ and Valsartan//HCTZ Combination Therapy: Impact of Age and Gender

This analysis aimed to explore whether low-dose irbesartan//hydrochlorothiazide (HCTZ) has superior blood pressure (BP)-lowering efficacy over low-dose valsartan//HCTZ in the elderly and across both genders. This is a post-hoc analysis of data from a multicenter, parallel group, open-label, blinded-endpoint study in patients with hypertension uncontrolled with HCTZ monotherapy. The reduction in systolic BP (SBP)//diastolic BP (DBP) and rate of BP control achieved following 8 weeks of treatment with irbesartan//HCTZ 150//12.5 mg or valsartan//HCTZ 80//12.5 mg were analyzed for older (≥65 years) vs. younger (<65 years) patients and for men vs. women. Blood pressure measurements were by home BP monitoring (HBPM). In the age and gender subgroups, both treatments significantly decreased home SBP and DBP (p < 0.0001). The reduction in home SBP and DBP was numerically greater with irbesartan//HCTZ compared to valsartan//HCTZ for all subgroups: the difference in DBP was significant for all except the elderly (p < 0.05), and the difference in SBP was significant in the elderly and in men (p < 0.03). In all subgroups, more patients achieved BP control (HBPM ≤135//85 mmHg) in the irbesartan//HCTZ arm (range 45%%–58%%) than in the valsartan//HCTZ arm (range, 23%%–39%%; p < 0.02). Both combination therapies were well tolerated and safety parameters were similar in both age and gender subgroups. More patients with mild or moderate hypertension, uncontrolled in HCTZ monotherapy alone, had their BP controlled with irbesartan//HCTZ 150//12.5 mg than with valsartan//HCTZ 80//12.5 mg, irrespective of age or gender.     

Predictive factors for masked hypertension within a population of controlled hypertensives

CONTEXT: Prevalence of masked hypertension (MH) is far from negligible reaching 40% in some studies. The SHEAF study (Self measurement of blood pressure at Home in the Elderly: Assessment and Follow-Up) and others clearly showed that masked hypertension (MH) as detected by home blood pressure measurement (HBPM) is associated with poor cardiovascular prognosis. OBJECTIVE: Systematic HBPM to detect MH is not yet routine. The aim of this work is to better define the clinical profile of masked hypertensives within a population with controlled office blood pressure (BP) and the factors associated with a higher prevalence of MH. MATERIALS AND METHODS: BP was measured at the clinic by the doctor and at home by the patient himself. Risk factors for MH were analysed in a cohort of 1150 treated hypertensive patients over the age of 60 (mean age 70 +/- 6.5, 48.9% men) with controlled office BP. (SBP < 140 mmHg and DBP < 90 mmHg). RESULTS: 463 patients (40%) were masked hypertensives (SBP > or = 135 mmHg or DBP > or = 85 mmHg at home). Three parameters were associated with MH (odds ratio OR): office SBP (OR = 1.110), male gender (OR = 2.214) and age (OR = 1.031). Decision trees showed a 130 mmHg SBP was an efficient threshold to propose HBPM with a higher probability to detect MH. Subsequent variables were male gender and age over 70 in males. CONCLUSION: To detect masked hypertension, it would be logical to first of all select patients whose office SBP is between 130 and 140 mmHg.     

Arterial stiffness is related to augmented seasonal variation of blood pressure in hypertensive patients

BACKGROUND: Seasonal variation in blood pressure (BP), a usual tendency of both systolic (SBP) and diastolic BP (DBP) to rise during winter in hypertensive patients, may be related to the higher cardiovascular mortality in winter. However, it is not yet clear what factors are relevant to the seasonal BP changes. We hypothesized that arterial stiffness is related to the BP changes between summer and winter. METHODS AND RESULTS: Eighty-five elderly (>55 years) patients with essential hypertension (33 males, 64+/-6.0 years) were enrolled. Seasonal BP profiles over at least 2 years were studied along with arterial stiffness and clinical variables (age, gender, smoking, duration of hypertension, anti-hypertensive medications and body mass index). Both SBP and DBP were significantly higher during winter compared with three other seasons (spring 128+/-10.0/79+/-7.3 mmHg, summer 127+/-9.8/78+/-7.1 mmHg, autumn 127+/-10.3/78+/-8.0 mmHg, winter 136+/-12.5/81+/-7.6 mmHg; SBP changes; p<0.001, DBP changes; p<0.001). There were no significant seasonal differences among spring, summer and autumn. Pulse wave velocity (PWV), a widely used clinical indicator of arterial stiffness was correlated with winter-summer differences in SBP (r = 0.272, p = 0.012), but not in DBP (r = 0.188, p = 0.085). Age, which was correlated with PWV strongly (p<0.001), was not significantly related to the seasonal changes in BP (SBP changes; p = 0.114, DBP changes; p = 0.298). No other clinical variables had significant correlation with seasonal BP changes. Multivariate regression analysis revealed that PWV is the only significant predictor for winter-summer SBP changes. CONCLUSIONS: Our results established a feasible link between arterial stiffness and seasonal BP variation. These findings may partly explain higher cardiovascular risk in patients with increased arterial stiffness.     

Low mortality from all causes, including myocardial infarction, in well-controlled hypertensives treated with a beta-blocker plus other antihypertensives

The aim of the present study was to monitor the efficacy of treatment, morbidity and mortality over a 10-year period in 939 moderate to severe hypertensive patients. All patients were treated in the same hypertension clinic with the beta 1-selective agent atenolol, administered either alone or more usually with a diuretic with or without a vasodilator or other agents. Survival rates were compared with predicted survival rates, had the hypertension not been treated, and also with those of a local reference population matched for age and sex. After a mean follow-up time of 6.1 years, mean blood pressure (BP) was significantly lowered from 183/109 to 145/87 mmHg. Biochemical disturbance was minimal. There were 79 withdrawals from treatment, of whom 37 were lost to follow-up. There were 91 deaths on intention to treat. Systolic blood pressure (SBP) on treatment, and not initial BP, was a powerful predictor of mortality. Patients of all age groups with well-controlled SBP were less likely to die, particularly from myocardial infarction, than those with less well controlled SBP (P less than 0.001). However, due to possible J-curve relationships between treated BP and outcome, lowering SBP below 140-150 mmHg in the elderly, and the diastolic blood pressure (DBP) below about 85 mmHg, may not be beneficial. Total mortality and mortality due to myocardial infarction was about 60% [corrected], of predicted level, had a high BP not been treated, being similar to that in a local reference control population (age- and sex-matched). The death rate from stroke was reduced to about 50% of that predicted. Patients who died showed a mean fall in mean serum triglyceride concentration in contrast to the mean increase that occurred in survivors. It is concluded that patients with moderate to severe hypertension who obtain a high level of general health care and optimal control of BP for up to 10 years, experience a significant decrease in total mortality rate and death from myocardial infarction and stroke.     

Blood pressure level and relation to other cardiovascular risk factors in male hypertensive patients without clinical evidence of ischemic heart disease

Arterial hypertension is accompanied by increased morbidity and mortality and constitutes a substantial part of medical care. Antihypertensive intervention reduces the cardiovascular morbidity and mortality. The aims of the study were to evaluate the relationship between cardiovascular risk factors and the blood pressure (BP), and to evaluate the percentage of patients who had achieved a BP level as recommended by the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). BP was evaluated in relation to age, body mass index, duration of hypertension, cholesterol and triglyceride level, smoking status, information of regular exercise, a family history of ischemic heart disease (IHD) and drug treatment, in 220 men treated for arterial hypertension. In the univariate analyses we found a higher systolic blood pressure (SBP) with older age, higher SBP in smoking patients and lower SBP in patients with regular exercise. In a multivariate model age (p = 0.0004), smoking status (p = 0.01) and regular exercise (p= 0.06) were independently associated with SBP. There was a lower diastolic blood pressure (DBP) with older age, and age was independently associated with DBP. Office SBP was above 140 mmHg in 83% and above 160 mmHg in 44% of patients. During ambulatory blood pressure monitoring (AMBP), SBP was above 135 mmHg in 40% and above 155 mmHg in 15% of patients. In addition to male sex and hypertension there was a high percentage of other cardiovascular risk factors--43% was smoking, 21% had a family history of IHD, 77% had a se-cholesterol above 5.5 mmol/l and 48% had a se-triglyceride above 1.6 mmol/l. In a consecutive group of asymptomatic male treated hypertensive patients SBP is independently associated with age and smoking status, and DBP with age. A high percentage of the patients do not have a well controlled BP, and a high percentage have additional risk factors such as smoking, hypercholesterolaemia, hypertriglyceridaemia and a family history of IHD. This means that there is room for much improvement in the control of hypertension.     

尼群洛尔的降压疗效和安全性

目的观察尼群洛尔治疗高血压伴心血管危险因素患者的临床效果和安全性,并同时观察其对动态血压的影响。方法本研究是一项多中心随机对照临床试验。18~79岁伴心血管病危险因素的高血压患者在知情同意后进入研究。导入期2周,停用正在使用的降压药物。2周后门诊随访血压为收缩压(SBP)140~179 mmHg和(或)舒张压(DBP)90~109 mmHg者被随机分为尼群洛尔组(A组)或氨氯地平组(B组)。目标血压值为140/90 mmHg。随访中根据血压目标增加药物剂量或加其他降压药,治疗随访期6个月。基线、治疗4周和6个月时,各进行1次24小时(h)动态血压监测(ABPM)。研究过程中随时观察不良事件的发生情况。结果全国7个协作中心共随机入选207例高血压患者。治疗1个月后,两组的SBP和DBP就有显著下降,与治疗前相比差异非常显著(P0.01),这种趋势一直持续至研究结束。治疗6个月时,尼群洛尔组和氨氯地平组血压分别显著下降18.9/9.2 mmHg和18.2/9.9 mmHg。治疗4周和6个月后,A、B组动态血压监测24 h,白昼和夜间血压均显著下降。治疗1个月时,二组血压达标率已近似50%,治疗6个月时均达到77%。研究过程中无严重不良事件报告。结论尼群洛尔可快速有效降低高危高血压患者血压水平,研究过程中未发现其对糖脂代谢的影响。     

Effect of dietary fiber intake on blood pressure: a meta-analysis of randomized, controlled clinical trials

OBJECTIVE: We conducted a meta-analysis of 25 randomized controlled trials published in English-language journals before February 2004, to assess the effect of dietary fiber intake on blood pressure (BP). DESIGN: Using a standardized protocol, information on study design, sample size, participant characteristics, duration of follow-up and change in mean BP, was abstracted. The data from each study were pooled using a random effects model to provide an overall estimate of dietary fiber intake on BP. INTERVENTION: Dietary fiber intake was the only significant intervention difference between the active and control groups. RESULTS: Overall, dietary fiber intake was associated with a significant -1.65 mmHg [95% confidence interval (CI), -2.70 to -0.61] reduction in diastolic BP (DBP) and a non-significant -1.15 mmHg (95% CI, -2.68 to 0.39) reduction in systolic BP (SBP). A significant reduction in both SBP and DBP was observed in trials conducted among patients with hypertension (SBP -5.95 mmHg, 95% CI, -9.50 to -2.40; DBP -4.20 mmHg, 95% CI, -6.55 to -1.85) and in trials with a duration of intervention > or = 8 weeks (SBP -3.12 mmHg, 95% CI, -5.68 to -0.56; DBP -2.57 mmHg, 95% CI, -4.01 to -1.14). CONCLUSIONS: Our results indicate that increased intake of dietary fiber may reduce BP in patients with hypertension and suggests a smaller, non-conclusive, reduction in normotensives. An intervention period of at least 8 weeks may be necessary to achieve the maximum reduction in BP. Our findings warrant conduct of additional clinical trials with a larger sample size and longer period of intervention to examine the effect of dietary fiber intake on BP.     

Blood Pressure Level and Relation to other Cardiovascular Risk Factors in Male Hypertensive Patients without Clinical Evidence of Ischemic Heart Disease

Arterial hypertension is accompanied by increased morbidity and mortality and constitutes a substantial part of medical care. Antihypertensive intervention reduces the cardiovascular morbidity and mortality. The aims of the study were to evaluate the relationship between cardiovascular risk factors and the blood pressure (BP), and to evaluate the percentage of patients who had achieved a BP level as recommended by the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). BP was evaluated in relation to age, body mass index, duration of hypertension, cholesterol and triglyceride level, smoking status, information of regular exercise, a family history of ischemic heart disease (IHD) and drug treatment, in 220 men treated for arterial hypertension. In the univariate analyses we found a higher systolic blood pressure (SBP) with older age, higher SBP in smoking patients and lower SBP in patients with regular exercise. In a multivariate model age (p = 0.0004), smoking status (p = 0.01) and regular exercise (p = 0.06) were independently associated with SBP. There was a lower diastolic blood pressure (DBP) with older age, and age was independently associated with DBP. Office SBP was above 140 mmHg in 83% and above 160 mmHg in 44% of patients. During ambulatory blood pressure monitoring (AMBP), SBP was above 135 mmHg in 40% and above 155 mmHg in 15% of patients. In addition to male sex and hypertension there was a high percentage of other cardiovascular risk factors-43% was smoking, 21% had a family history of IHD, 77% had a se-cholesterol above 5.5 mmol/l and 48% had a se-triglyceride above 1.6 mmol/l. In a consecutive group of asymptomatic male treated hypertensive patients SBP is independently associated with age and smoking status, and DBP with age. A high percentage of the patients do not have a well controlled BP, and a high percentage have additional risk factors such as smoking, hypercholesterolaemia, hypertriglyceridaemia and a family history of IHD. This means that there is room for much improvement in the control of hypertension.     

The comparison of blood pressure of community-dwelling elderly subjects in Okinawa and Shikoku

In Japan hypertension is frequent, but the prevalence of hypertension in Okinawa has been known to be lower than in other areas in Japan. Now it has been almost 30 years since Okinawa reverted to Japan. So we investigated to know whether the prevalence of hypertension was still lower today or not. We compared the differences of prevalence of hypertension and blood pressure (BP) levels between the two community-dwelling elderly subjects aged 75 years or more: 305 in Ie in Okinawa (M:F = 107:198, mean age: 81 years old), and 99 in Omogo in Ehime, Shikoku (M:F = 45:54, mean age: 81 years old). We visited the homes of the elderly and measured their BP twice in a sitting position and asked them whether they were taking medicine for hypertension or not. According to the 1999 revised guidelines on the treatment of hypertension in the elderly by the Japanese Society of Geriatrics, we defined hypertension as systolic BP (SBP) > or = 160 mmHg or diastolic BP (DBP) > or = 90 mmHg or taking medicine for hypertension, and normotension as SBP < 160 mmHg and DBP < 90 mmHg and not taking medicine for hypertension. Hypertension rates were 52% in Ie, and 59% in Omogo, indicating no significant difference. However, in Ie only 54% of the elderly with hypertension were taking medicine for hypertension, as opposed to 74% in Omogo. These results suggest the possibility that in Okinawa hypertension is thought to be less important than in other districts in Japan.     

Determination of prevalence and control level of hypertension in the community: Hypertension Management Audit Project--Vicenza]

As a part of the "Hypertension Management Audit Project" a random sample of 4070 subjects was drawn from the population aged 35-64 living in the city of Vicenza, in order to assess the prevalence and the level of control of hypertension in the community. 2854 (70.1%) were screened in the first step of the survey. Two blood pressure (BP) reading, height and weight measurements were performed and a short questionnaire filled in. Systolic BP (SBP) and diastolic BP (DBP) were (mean and 95% confidence interval) 143.7 (142.6-144.7) and 88.3 (87.7-88.8) mmHg in males; 137.8 (136.8-138.8) and 84.9 (84.5-85.5) mmHg in females, respectively. The BP value corresponding to the 95 degrees percentile of the cumulative distribution of BP was 180 mmHg for SBP and 105 mmHg for DBP in males; 173 mmHg for SBP and 100 mmHg for DBP in females. Systo-diastolic hypertension was present in 12.3% of the screened population; isolated diastolic hypertension in 9.1%; isolated systolic hypertension in 5.3%; borderline hypertension in 31.6%; severe hypertension (DBP > or = 115 mmHg) was present in 1.9% of females and in 2.2% of males. Prevalence in males was significantly higher with respect to females in all three categories of defined hypertension, but not in borderline hypertension. The second step of the survey involved 849 subjects (29.7% of the screened population) who completed two re-examinations because at the screening they had: 1) history of high BP; 2) BP > or = 160/95 mmHg; 3) ongoing antihypertensive treatment. At the end of the survey, 772 of these subjects (91%) were confirmed as hypertensives (mean BP of six readings > or = 140/90 mmHg and/or taking antihypertensive drugs). Patients aware of their high BP were 78.8%; aware and treated 51.0%; treated and controlled (BP < 140/90 mmHg) 19.1%. All indices of control were significantly higher in female with respect to male patients. Treated patients were significantly older than untreated patients; treated females had significantly lower BP than treated males, whereas no difference was detected between untreated patients; patients unaware of high BP had the highest BP values if compared to treated and untreated patients. This survey reveals a high prevalence of hypertension in the adult population of the city of Vicenza; quality of control shows a moderate improvement if compared to previous studies carried out in our country.     

Reverse J-curve relation between diastolic blood pressure and severity of coronary artery lesion in hypertensive patients with angina pectoris.

The existence of the J-curve in hypertension treatment remains controversial. The major question is whether the increase in mortality from coronary disease is induced by the lowering of blood pressure (BP) or by the severity of underlying coronary artery disease. We recruited patients with a history of hypertension (systolic BP (SBP) >160 mmHg and/or diastolic BP (DBP) >90 mmHg) and a diagnosis of angina pectoris with angiographically confirmed coronary artery lesion. The relationship among the treated levels of SBP and DBP, the severity of coronary artery lesion, and the clinical consequences were investigated. Among the 234 enrolled patients, 115 experienced further events, 19 of which were serious. There were no significant differences in the average BP of patients with and those without events, but the coronary severity indices (CSI) were significantly greater in patients with events. As a function of DBP from < or = 74 to 105 < or = mmHg, there was a positive association with the incidence of serious events, and a reversed J-curve in CSI with a nadir at 95-104 mmHg. A similar relationship was observed in SBP, but a potentially unfavorable outcome was suggested in the lowest SBP range of < or = 124 mmHg. In conclusion, there was no J-curve for DBP in hypertensive patients with angina pectoris; rather, the lower the DBP, the better was the prognosis. Interestingly, the severity of coronary lesion is in a reversed J-curve relation with DBP, suggesting that high BP plays a critical role in serious events in hypertensive patients with moderate coronary artery lesions.