How family history and risk factors for hypertension relate to ambulatory blood pressure in healthy adults

BACKGROUND: Although family history is a major predictor of hypertension, other risk factors have been linked to elevated blood pressure (BP). This study explored the relationship of norepinephrine (NE), insulin resistance and lipids to family history of hypertension, and attempted to determine the combined effects of family history and these factors on BP. METHODS: A total of 220 healthy men and women, aged 22-50 years, completed two 24 h ambulatory BP sessions. Based on family history information obtained from parents, three groups were formed: subjects with two hypertensive parents, one hypertensive parent or normotensive parents. Plasma samples were obtained to derive fasting catecholamine levels, insulin, glucose and lipids. RESULTS: Individuals with two hypertensive parents had high insulin, insulin resistance and low-density lipoprotein cholesterol. Although NE was not directly linked to family history, high NE levels were associated with increased BP, after controlling for family history and body mass index. Women with two hypertensive parents and elevated NE levels had higher systolic BP and diastolic BP during waking and sleep periods. In men the combination of two hypertensive parents and high NE was related only to diastolic BP during waking. CONCLUSIONS: NE results provide evidence of sympathetic activation in the identification of individuals at risk for hypertension. Studying family history of hypertension and other risk factors in healthy individuals provides a unique opportunity to explore factors leading to elevated BP long before a diagnosis of hypertension is made.     

Family history of hypertension and arterial elasticity characteristics in healthy young people

Family history of hypertension is a primary predictor of high blood pressure (BP). This study attempted to determine whether there is a gradual increase in BP and an early change in arterial elasticity characteristics between young healthy individuals with or without a family history of hypertension and whether or not this increase is apparent in males as well as in females. A total of 270 normotensive healthy individuals (112 men and 158 women, aged 16 to 30 years) with or without a family history of hypertension, participated in conventional BP measurement and completed questionnaires covering basic information and a detailed family history of cardiovascular disease. Large arterial (capacitive) compliance (C1) and small arterial (oscillatory or reflective) compliance (C2) were derived from HDI/PulseWave CR-2000 (Hypertension Diagnostics, Minneapolis, USA). Based on family history information about parents and grandparents, three groups were formed: subjects with at least one hypertensive parent (group A), subjects with only hypertensive grandparents (group B), and subjects with normotensive parents and grandparents (group C). Men in group A had lower C1 and C2 along with higher systolic BP (SBP), diastolic BP (DBP), and heart rate than men in group C. Those in group B had intermediate C1, C2 and BP levels. C1 had a linear relationship with SBP, DBP, and heart rate. In the logistic regression model of family history of hypertension, C2 was lower in young normotensive males with parental hypertension (B = -0.315, exp B = 0.73, p = 0.03), independently of SBP, DBP, and heart rate. Among females, subjects with parental hypertension had higher systolic, mean arterial pressure, and pulse pressure (p < 0.05), and there were no significant differences in C1 and C2 between those with and those without parental hypertension. In conclusion, compared with normotensive offspring of normotensive parents, normotensive offspring of hypertensive parents had increased BP and impaired arterial properties, namely large and small arterial compliance as measured noninvasively by HDI. These differences were exhibited conspicuously in men but not in women. Alteration in arterial function in young non-hypertensive subjects may be a risk factor for hypertension and may contribute to the progression to hypertension later in life.     

T594M variant of the epithelial sodium channel beta-subunit gene and hypertension in individuals of African ancestry in South Africa

BACKGROUND: The T594M variant of the beta-subunit of the sodium epithelial channel (ENaC) gene may contribute to hypertension in individuals of African origin. METHODS: A case-control study was performed to assess the role of the ENaC gene variant as an independent risk factor for hypertension in subjects of African ancestry. The effects of the ENaC gene variant on ambulatory blood pressure (BP) in hypertensive individuals and on office BP in hypertensive individuals and control subjects were also assessed. A total of 519 hypertensive patients with 24-h ambulatory BP (ABP) values determined while off medication, and 514 normotensive South African individuals of African ancestry were genotyped for the T594M polymorphism of the ENaC gene. RESULTS: A total of 22 (4.2%) hypertensive participants compared with 23 (4.5%) normotensive participants possessed the T594M variant (odds ratio = 1.06, confidence interval = 0.58 to 1.92, not significant). A similar genotype frequency distribution was noted in subjects representing the two predominant chiefdoms (Nguni and Sotho) in both case and control groups. No differences in frequency distribution of the T594M variant were noted with respect to either body mass index or gender. There were no differences in clinic or ambulatory mean, day, or night BP between hypertensive patients with or without the variant. Similarly, no differences were noted in clinic BP between control subjects with or without the variant. Other phenotypic parameters (including age and hypertension duration and severity) were also similar among hypertensive patients with or without the variant. CONCLUSION: These results do not support an important role for the T594M variant of the ENaC gene contributing to either the development or severity of hypertension in subjects of African ancestry.     

Sex, cardiac hypertrophy and diurnal blood pressure variations in essential hypertension.

OBJECTIVE: To test the hypothesis of a difference between men and women in the left ventricular hypertrophic response to diurnal variations of ambulatory blood pressure in essential hypertension. DESIGN: Non-invasive ambulatory blood pressure monitoring and echocardiography in untreated hypertensive patients and healthy normotensive subjects. SETTING: Community-based ambulatory population in tertiary care centers. PATIENTS: Two hundred and sixty hypertensive patients and sixty-three healthy normotensive subjects. MAIN OUTCOME MEASURE: Patients with average daytime systolic blood pressure (SBP) and diastolic blood pressure (DBP) falling by less than 10% during the night were defined as non-dippers, the others as dippers. RESULTS: In the hypertensive group, dippers and non-dippers did not differ, in either gender, in several covariates possibly affecting left ventricular structure, including daytime ambulatory blood pressure, prevalence of white coat hypertension, age, body mass index, family history and known duration of hypertension, funduscopic changes, diabetes, alcohol consumption and renal function. Left ventricular mass (LVM) did not differ between dippers and non-dippers in hypertensive men whilst in hypertensive women it was significantly lower in dippers than in non-dippers. This sex difference held for all quartiles of the distribution of mean daytime blood pressure. In hypertensive women there was an inverse correlation between LVM and the per cent reduction of SBP and DBP from day to night, but this relationship was absent in hypertensive men. Other indices of left ventricular structure differed between dippers and non-dippers in both genders, as did LVM. CONCLUSIONS: For any level of daytime ambulatory blood pressure, a reduction of SBP and DBP by less than 10% from day to night identifies a subset of hypertensive patients at increased risk of left ventricular hypertrophy only in the female gender. These data suggest that, compared with men, hypertensive women require a longer duration of exposure to high blood pressure levels during the 24 h to develop left ventricular hypertrophy.     

Effects of coffee on ambulatory blood pressure in older men and women: A randomized controlled trial

This study assessed the effects of regular coffee drinking on 24-hour ambulatory blood pressure (ABP) in normotensive and hypertensive older men and women. Twenty-two normotensive and 26 hypertensive, nonsmoking men and women, with a mean age of 72.1 years (range, 54 to 89 years), took part in the study. After 2 weeks of a caffeine-free diet, subjects were randomized to continue with the caffeine-free diet and abstain from caffeine-containing drinks or drink instant coffee (5 cups per day, equivalent to 300 mg caffeine per day) in addition to the caffeine-free diet for a further 2 weeks. Change in systolic and diastolic blood pressures (SBP, DBP) determined by 24-hour ambulatory BP monitoring showed significant interactions between coffee drinking and hypertension status. In the hypertensive group, rise in mean 24-hour SBP was greater by 4.8 (SEM, 1.3) mm Hg (P=0.031) and increase in mean 24-hour DBP was higher by 3.0 (1.0) mm Hg (P=0.010) in coffee drinkers than in abstainers. There were no significant differences between abstainers and coffee drinkers in the normotensive group for 24-hour, daytime, or nighttime SBP or DBP. In older men and women with treated or untreated hypertension, ABP increased in coffee drinkers and decreased in abstainers. Restriction of coffee intake may be beneficial in older hypertensive individuals.     

The Bergen Blood Pressure Study: Definition of Hypertensive and Normotensive Families Based on 27 Years' Follow-up

The familial aggregation of hypertension is well documented. However, many studies on the familial predisposition have suffered from insufficient knowledge of parental blood pressure (BP). In the present study, the family history is defined according to parental data from two BP surveys conducted almost 30 years apart. Data from a population screening in Bergen in 1963-64 were linked with information on marital status to define couples with or without a history of hypertension. Within the screened population a total of 344 married couples, 688 individuals, matched defined age and BP criteria. Four hundred and thirty individuals, representing 270 of the 344 families initial included (79%), attended a follow-up examination in 1990. Six hundred and ninety-one offspring were registered. In all families represented at follow-up, parental BP data from the 1963-64 screening were available. In 160 families (n_offspring = 393), both parents also attended the follow-up examination in 1990. In 23 families (n_offspring = 54) both parents were hypertensive in 1963-64 as well as in 1990. In 22 families (n_offspring = 55) both parents were normotensive at both examinations. Thus, a family data base which is assumed to be useful for studies on offspring with or without a family history of hypertension, has been established. The offspring studies include BP, 24-h ambulatory BP, electrocardiography, echocardiography, endocrine parameters, electrolytes and anthropometric variables.     

Changes in 24 Hour Blood Pressure and in Cardiac and Vascular Structure in Normotensive Subjects with Parental Hypertension

Subjects with family history of hypertension represent a suitable model to investigate the mechanisms responsible for early cardiovascular structural and functional changes occurring in essential hypertension. In our study we have addressed the factors involved in determining the mild elevation in office blood pressure frequently observed in normotensive subjects with hypertensive parents. In 15 normotensive subjects with both parents hypertensive (FH++) and in 15 normotensive subjects with one parent hypertensive (FH+?) we found no evidence of a hyperreactivity to stress as compared to the responses of 15 normotensive subjects with no parental hypertension (FH–). On the contrary FH++ subjects were characterized by a significant although mild increase in their blood pressure values recorded either at rest and in ambulatory conditions over the 24 hours, including night sleep. FH++ and FH+? subjects also showed a greater left ventricular mass thickness and a greater minimal forearm vascular resistence than FH subjects. Thus, the elevation in blood pressure found in the pre-hypertensive stage in subjects with positive family history for hypertension does not reflect a hyperreactivity to the stress associated with physician's visit but indicates an early and persistent blood pressure elevation. This blood pressure elevation is accompanied by early cardiovascular structural changes which may indicate that these subjects are exposed to a higher risk even before developing overt hypertension.     

Early 24-hour blood pressure elevation in normotensive subjects with parental hypertension

Subjects with a family history of parental hypertension are reported to have a slightly higher office blood pressure in the prehypertensive stage. Whether this reflects a hyperreactivity to blood pressure measurement or a more permanent blood pressure elevation, however, is not known. In the present study, blood pressure was measured in 15 normotensive subjects whose parents are both hypertensive (FH++), 15 normotensive subjects with one hypertensive parent (FH(+)-), and 15 normotensive subjects whose parents are not hypertensive (FH--); among the three groups, subjects were matched for age, sex, and body mass index. The measurements were made in the office during a variety of laboratory stressors and during a prolonged resting period, and for a 24-hour period (ambulatory blood pressure monitoring). Office blood pressure was higher in the FH++ group than in the FH-- group (p less than 0.05). The pressor responses to laboratory stressors were similar in the two groups, but the FH++ group had higher prolonged resting and 24-hour blood pressure than the FH-- group; the difference was always significant (p less than 0.05) for systolic blood pressure. The FH++ group also had a greater left ventricular mass index (on echocardiographic examination) than the FH-- group (p less than 0.01). The blood pressure values and echocardiographic values of the FH(+)- group tended to be between those of the other two groups. Thus, the higher blood pressure shown by individuals in the prehypertensive stage with a family history of parental hypertension does not reflect a hyperreactivity to stress but an early permanent blood pressure elevation.(ABSTRACT TRUNCATED AT 250 WORDS)     

Arterial characteristics in normotensive offspring of parents with or without a history of hypertension

BACKGROUND: In this study we compared the arterial characteristics and blood pressure (BP) of normotensive offspring of two normotensive parents (OFF/NT) and normotensive offspring who had at least one hypertensive parent (OFF/HT). METHODS: A total of 174 OFF/HT (17 to 40 years of age) and 59 OFF/NT (16 to 34 years) were recruited in Cracow, Poland (n = 138) and Pilsen, Czech Republic (n = 95). Peripheral pulse pressure (PPp) was determined from conventional and 24-h ambulatory BP. A SphygmoCor device was used to measure the central (CAIx) and peripheral (PAIx) systolic augmentation indexes, central pulse pressure (PPc), and the aortic pulse wave velocity (PWV). In multivariate analyses family clusters and significant covariates were accounted for. RESULTS: The OFF/HT had higher (.14 < P < .0007) conventional BP and PPp on conventional BP measurement (121/75 v 114/71 mm Hg and 46 v 42 mm Hg) as well as on 24-h ambulatory monitoring (118/70 v 114/67 mm Hg and 48 v 47 mm Hg). OFF/HT, compared with OFF/NT, also had higher (.05 < P < .0008) PPc (28 v 26 mm Hg), PAIx (54.7% v 44.9%), CAIx (108.8% v 99.8%), and PWV (7.4 v 6.6 m/sec). However, complex adjustment including mean arterial pressure and age removed the differences between the offspring in the PAIx, CAIx, and PWV. CONCLUSIONS: Large-artery properties are altered in OFF/HT compared with OFF/NT. The findings from this cross-sectional study suggest that the alterations in arterial function in subjects with a family history of hypertension are determined mainly by an increased BP and age-related hemodynamic changes.     

White-coat hypertension and carotid artery atherosclerosis: a matching study

BACKGROUND: Blood pressure (BP) measurements obtained in the clinic have long served as the basis for determining risk of hypertensive vascular disease, yet many patients with high BP in the physician's office are normotensive elsewhere. It remains unclear whether such patients with "white coat" hypertension elude the risk of atherosclerosis. METHODS: Community residents 40 to 70 years of age and not receiving any cardiovascular medications were recruited to participate in a study of cardiovascular risk factors. On the basis of clinic and daytime ambulatory BP and a threshold criterion of 140/90 mm Hg, subjects were classified as having persistent hypertension, white-coat hypertension, or persistent normotension. One-to-one matching was conducted in male participants on the basis of race and BP. Subjects with persistent hypertension and white-coat hypertension were matched on clinic BP, and those with white-coat hypertension and normotension were matched on daytime ambulatory BP. RESULTS: The 3 matched groups of men (n=40 in each group) were similar in age, smoking status, and fasting glucose and lipid levels. Compared with the normotensive subjects, subjects with either persistent or white-coat hypertension had greater mean body mass index, waist-hip ratio, and fasting insulin concentration. On the basis of standardized duplex ultrasound examination of the carotid arteries, mean maximal intimal-medial thickness and plaque index in subjects with white-coat hypertension were greater than among normotensive subjects and equal to that of the subjects with persistent hypertension. CONCLUSION: When compared with unmedicated individuals with comparable elevations in clinic BP, individuals with white-coat hypertension appear not to be protected from the atherosclerotic sequelae of hypertension.     

Angiotensin converting enzyme gene insertion/deletion polymorphism,angiotensinogen gene polymorphisms,family history of hypertension,and childhood blood pressure

Earlier epidemiologic studies have yielded inconsistent results on the extent and timing of the blood pressure (BP) increase in offspring of hypertensive parents. We hypothesized that a familial influence on the BP of the offspring exists from birth on, but becomes significant only later in childhood. We studied the influence of familial occurrence of hypertension on the BP of 3596 children aged 6 to 18 years during a 6-year follow-up. In addition, we examined the possible associations of BP variations with polymorphisms of two candidate genes for hypertension, ie, those coding for the angiotensin converting enzyme (ACE) and those coding for angiotensinogen.A positive family history of hypertension was reflected as the occurrence of higher systolic BP values from the age of 9 years and upward among the females and from the age of 12 years and upward among the males. The mean differences in BP varied from 3.2 to 5.8 mm Hg (systolic) and 2.1 to 5.9 mm Hg (diastolic) between the female offspring of normotensive and hypertensive parents and grandparents. The systolic BP values were significantly higher among females with a hypertensive history in two generations in comparison with females from normotensive families. Among the male offspring of hypertensive and normotensive families, the BP differences were inconsistent. The deletion/deletion males had higher systolic BP values than those with other ACE genotypes. In contrast, variation at the angiotensinogen gene locus was not significantly associated with BP.We conclude that parental history of hypertension is a risk factor for high blood pressure among the offspring from the ages of 9 to 12 years and upward, and hypertension within two generations may enhance this effect. Although the common genetic variation of ACE may influence blood pressure in male children and adolescents, our data do not suggest a role for the common variation of the angiotensinogen gene as a BP regulator during childhood.     

Does gender affect the association between right ventricular strain and arterial hypertension?

The importance of right ventricular (RV) structure and function in cardiovascular and total morbidity and mortality has been confirmed previously. The purpose of this study was to evaluate the influence of gender on RV structure and function in untreated hypertensive patients. This cross‐sectional study included 243 subjects who underwent 24‐hour ambulatory blood pressure (BP) monitoring and comprehensive echocardiographic examination including strain evaluation. There was no difference in RV diameter between hypertensive and normotensive women and men. RV wall thickness, right atrial volume index (RAVI), and tricuspid E/e’ ratio were significantly higher in hypertensive women and men than in their normotensive counterparts. RV global longitudinal and RV free wall longitudinal strains were significantly lower in hypertensive women and men than in their normotensive counterparts. Arterial hypertension affected RV wall thickness, RAVI, tricuspid E/e’, and RV longitudinal strain. Gender affected RV diameter, RAVI, tricuspid E/e’, and RV longitudinal strain, whereas hypertension‐gender interaction affected RAVI, E/e’, and RV longitudinal strain. The 24‐hour systolic BP and LV mass index were independently associated with RV free wall longitudinal strain. RV wall thickness was independently associated with RV free wall longitudinal strain only in women, and tricuspid E/e’ was independently associated only in men. In conclusion, RV longitudinal strain was significantly decreased in hypertensive patients in both sexes. Hypertensive men suffered more evident RV mechanical changes than hypertensive women. Gender, arterial hypertension, and their interaction had the important role in RV structural and mechanical remodeling.     

White-coat hypertension and sex

OBJECTIVES: To compare, by sex, selected behavioral and biologic characteristics among normotensive, white-coat hypertensive, and essential hypertensive patients, and to assess the similarities and differences in these characteristics between men and women diagnosed as having white-coat hypertension. METHODS: The subjects of this study were 764 men (80 normotensives, 112 white-coat hypertensives, and 572 essential hypertensives) and 442 women (53 normotensives, 81 white-coat hypertensives and 308 essential hypertensives) who were a nonrandom subset of a larger cohort of patients being assessed to determine the prognostic significance of ambulatory blood pressure measurements. Physician-measured technician-measured and ambulatory (average awake and asleep) blood pressures, daytime blood pressure variability, the difference between awake and sleeping blood pressures, cholesterol levels, plasma renin activity (PRA) and anthropometric and demographic characteristics were compared across the patient classifications within each sex group and between male and female white-coat hypertensives using one-way analysis of variance. Student's t tests and chi squared analysis. RESULTS: Among men, cholesterol levels of normotensives were significantly lower than those of either white-coat or essential hypertensives (P < 0.05 and P < 0.01, respectively). White-coat hypertensives were significantly younger than the essential hypertensives. The ambulatory and technician-measured blood pressures of the white-coat hypertensives were similar to those of the normotensives, as were most measures of variability of blood pressure. Among women, there were no differences in cholesterol level; however, white-coat hypertensives had lower PRA than did the essential hypertensives (P < 0.01) In contrast to the men, women with white-coat hypertension were similar in age to those with essential hypertension, and 10 years older than normotensives (P < 0.01). The ambulatory blood pressures of white-coat hypertensives were similar to those of normotensives, but their technician-measured blood pressures were intermediate between those of the normotensive and essential hypertensive groups. The daily variability of diastolic blood pressure among the white-coat-hypertensive women was greater than that of the normotensive women and similar to that of the essential hypertensive women. For all other measures of variability, data for white-coat-hypertensive women were similar to those for the normotensive women. There was no anthropometric or demographic difference among the patients either for men or for women. White-coat-hypertensive women were older than white-coat-hypertensive men and had higher systolic blood pressures and variabilities of blood pressure (P < 0.05). They also had lower PRA. CONCLUSIONS: These results are consistent with the ideas that the phenomenon of white-coat hypertension is similar for the two sexes, women may exhibit white-coat hypertension at a greater age than do men, and women with white-coat hypertension may further exhibit a broader white-coat effect, reflected in blood pressures measured by other medical personnel.     

Echocardiographic parameters in athlete and nonathlete offspring of hypertensive parents

BACKGROUND: According to several reports, some cardiovascular signs of hypertension (left ventricular [LV] hypertrophy, impaired diastolic filling) can be found in the normotensive offspring of hypertensive parents. It is also well known that regular physical exercise decreases the risk of hypertension. AIM: The aim of the present study is to determine whether or not regular physical training influences these early hypertensive traits in the offspring of hypertensive parents. METHODS: Echocardiographic data of 215 (144 males, 71 females) 22- to 35-year-old nonathlete and athlete offspring of hypertensive (positive family history, FH+) and normotensive parents (negative family history, FH-) were compared in a cross-sectional design. RESULTS: In the nonathlete FH+ males and females, LV dimensions were not larger than in the FH- subjects. The E/A quotient was lower in the FH+ subjects in both genders. Absolute and heart rate adjusted isovolumetric relaxation times were slightly longer in the FH+ men than in their FH- peers. No differences were seen between athlete FH- and FH+ subjects. CONCLUSION: Regular physical exercise decreases the incidence of the adverse cardiac signs, which can be associated with hypertension in the normotensive offspring of hypertensive parents.     

The Bergen Blood Pressure Study: Sodium Intake and Ambulatory Blood Pressure in Offspring of Hypertensive and Normotensive Families

Sodium intake, estimated by the 24-h urine sodium excretion, was assessed in 39 offspring of hypertensive families and 37 offspring of normotensive families. The family history of hypertension or normotension was defined according to parental BP data from two surveys conducted 27 years apart. Urine sodium excretion was similar in offspring of hypertensive and normotensive families, averaging 136 and 137 mmol/24 h, respectively. Monitored by non-invasive methodology in the urine sampling period, the average 24-h ambulatory blood pressure (BP) was approximately 10/10 mmHg higher in offspring of hypertensive than normotensive families. The clinically and statistically significant differences in BP between groups could not be explained by differences in sodium intake. After adjustment for confounding variables, the BP was not associated with the sodium excretion in the material as a whole or in either offspring group.     

Exercise capacity and 24-h blood pressure in prehypertensive men and women

BACKGROUND: Prehypertensive individuals are at increased risk for developing hypertension and cardiovascular disease compared to those with normal blood pressure (BP). Physically active, normotensive individuals are also at lower risk for developing hypertension than sedentary individuals. We assessed the relationship between fitness and 24-h ambulatory BP in prehypertensive men and women. METHODS: We assessed exercise capacity and 24-h BP in 407 men (age 51 +/- 11 years) and 243 women (age 54 +/-10 years) with resting systolic BP 120 to 139 mm Hg and diastolic BP of 80 to 89 mm Hg, defined as prehypertension. Fitness categories (low, moderate, and high) were established according to exercise time and age. RESULTS: Multiple regression analysis revealed that fitness status was inversely associated with ambulatory BP in both genders (P < .001). After adjusting for various confounders, individuals in the lowest fitness category had significantly higher 24-h, daytime, and night-time BP than those in the moderate and high fitness categories. For men, differences between low and moderate fitness categories were 6/4 mm Hg, 8/4 mm Hg, and 7/3 mm Hg for 24-h, daytime, and night-time BP, respectively (P < .05). For women, the differences were 8/5 mm Hg, 9/5 mm Hg, and 8/7 mm Hg for 24-h, daytime, and night-time BP, respectively. Similar differences were evident in both genders between low and high fitness category (P < .05). CONCLUSIONS: Moderate physical activity promotes lower BP during a 24-h period in prehypertensive men and women. The risk for developing hypertension is likely to be lowered if moderate intensity physical activity in this vulnerable population is encouraged.     

A comparison of dietary and non-dietary factors of hypertension and normal blood pressure in a Chinese population.

The aim of this study was to compare the differences of dietary and non-dietary factors in hypertension and normal blood pressure (BP) of Chinese urban people. Two cross-sectional population surveys were carried out in Tianjin, one of the three largest cities in China. A total of 2068 subjects aged 35-64 years were selected by a random stratified cluster sampling, 367 men and 395 women were hypertensive, and 623 men and 683 women had normal BP. The diet was assessed by food weighing plus consecutive individual 3-day food records. Health status, health behaviours and anthropomentry were assessed. The whole population had a high sodium and low potassium consumption level. Hypertensive men and women had significantly higher daily dietary sodium intake (P < 0.05) and hypertensive women had higher dietary sodium-to-potassium ratio (P < 0.01) than men and women with normal BP. Age, body mass index, overweight and family history of hypertension were positively related to high BP. dietary sodium intake and dietary sodium-to-potassium ratio were positively associated with high BP. Education level in women and commuting physical activity in men were inversely associated with high BP.     

Impact of multiple risk factor clustering on the elevation of blood pressure.

A family history of hypertension, obesity, diabetes mellitus, hypercholesterolemia, and hypertriglyceridemia have all been associated with risk of hypertension. We retrospectively conducted a longitudinal study in a large screened cohort to explore the effect of the clustering of these five risk factors on the elevation of blood pressure (BP) in normotensive subjects at baseline. The study group comprised 4,857 normotensive subjects not treated with antihypertensive drugs (systolic BP < 140 mmHg, diastolic BP < 90 mmHg, 3,111 men and 1,746 women) who were followed up from 1997 to 1999. By 1999, 360 subjects had BP at the hypertensive level (systolic BP > or = 140 mmHg or diastolic BP > or = 90 mmHg). The incidence of subjects whose BP became hypertensive was 37 per 1,000 person-years. After adjusting for age, sex, systolic BP and other clinical factors, multiple logistic analysis showed that the relative risk of BP elevation was 1.49 (95% Cl: 1.09 to 2.05) in subjects with one risk factor; 1.65 (95% Cl: 1.15 to 2.27) in those with two risk factors; 1.42 (95% Cl: 0.91 to 2.32) in those with three; and 4.86 (95% Cl: 2.58 to 9.16) in those with four or more when compared with subjects with no risk factors. Multiple regression analysis showed that the number of risk factors was positively correlated with an increase in BP from 1997 to 1999; the regression coefficient was 0.51 (p = 0.001) for increase in systolic BP, and 0.31 (p = 0.008) for increase in diastolic BP after adjusting for age and sex. In conclusion, clustering of risk factors significantly predicted the development of hypertension.     

Acute aerobic exercise reduces ambulatory blood pressure in borderline hypertensive men and women

Ambulatory blood pressure (BP) monitoring was undertaken on two days in 31 men and women (11 with elevated resting and ambulatory BP and 20 who were normotensive), once following each of these treatment conditions: 20 min of moderate aerobic bicycle orgometry, and an equivalent control rest period. The two monitoring days were conducted within a 72 h period with the order of treatments counterbalanced across subjects. Mean BP and heart rate (HR) levels were calculated for each individual on an hourly basis and for work, home, and sleep periods. In the elevated BP group, the exercise day compared to the control day was associated with lower BP at work. Hour-by-hour analyses confirmed that the BP-lowering effect of exercise was significant for 5 h and diminished in magnitude between hours 6 and 9. These effects were not attributable to any marked differences in mood, total daily stress, posture, or activities between test days. Exercise was not associated with any appreciable differences in sleep BP or in the 24-h HR profile. No differences in BP or HR as a function of exercise were seen in the normotensive group; however, the exercise-induced reduction in mean arterial BP (MAP) for hours 2 through 5 was significantly positively correlated with control day MAP levels at work in the total sample. Thus, moderate aerobic exercise, when engaged in prior to the stresses of daily living, seems to confer a protective reduction in ambulatory BP, particularly in individuals with elevated BP.     

Effects of hormone replacement therapy on office and ambulatory blood pressure in Japanese hypertensive postmenopausal women.

No study has demonstrated that hormone replacement therapy (HRT) affects blood pressure (BP) measured by 24-h ambulatory blood pressure monitoring (ABPM) in Japanese postmenopausal women (PMW) with normotension or mild-to-moderate essential hypertension. In the present study, we examined the effects of HRT on office BP and 24-h ambulatory blood pressure (ABP) in Japanese hypertensive or normotensive PMW. Thirty-one hypertensive (HT-HRT group) and 17 normotensive PMW (NT-HRT group) received HRT (0.625 mg of conjugated equine estrogen combined with 2.5 mg of medroxyprogesterone acetate) orally for 12 months, and 30 hypertensive (HT-Control group) and 19 normotensive PMW (NT-Control group) did not receive HRT. In all of the hypertensive PMW, BP was controlled by a variety of antihypertensive drugs before starting HRT. The hypertensive PMW were divided into two groups according to the results of ABP before HRT: nondippers (those without a diurnal change in BP) and dippers (those with a diurnal change in BP). In all patients, office BP measurements and 24-h ABPM were performed before and 12 months after the start of HRT. HRT did not change either the office or the 24-h ambulatory systolic, diastolic, or mean BP in any of the groups. Therefore, HRT did not significantly alter the proportion of nondippers. We conclude that with respect to BP, HRT might not be harmful in hypertensive PMW whose BP has been well-controlled prior to the initiation of HRT, as well as in normotensive PMW.