江苏省心血管病高危人群中高血压患者血压控制的随访研究

目的  探讨心血管病高危人群中高血压患者血压随访控制情况,为高血压及心血管病防治提供理论依据和参考。方法  选取2016—2019年参与项目的心血管病高危人群中20 091名高血压患者作为研究对象,对研究对象进行两次随访。采用广义估计方程对血压控制情况进行分析。结果  在心血管病高危人群中,第1次随访血压控制率为37.8%,第2次随访血压控制率为32.8%。吸烟者、城市居民以及受教育程度越高和家庭年收入越高的人群血压越易控制,而高血压知晓者、饮酒者和BMI高者血压均不易得到控制(均有P＜0.05)。结论  江苏省心血管病高危人群中高血压患者的血压控制水平还有待于提高,应加强重点人群的血压防控工作,且需进行规范化的血压管理和有效的干预措施来提高控制效果。     

Long-term effects of nutritional group education for persons at high cardiovascular risk

BACKGROUND: Treatment of persons at high risk for coronary heart disease (CHD) should include nutritional counselling, but little is known about the effects of different types of education. METHODS: In a quasi-experimental study design the effects of a nutritional education programme (1st year: three group sessions by a dietitian; 2nd year: one group session; 3rd year: additional focus on saturated fat; reinforcement by written nutritional messages annually) (intervention group; n=103) are compared with the effects of a posted leaflet containing standard dietary guidelines (control group; n=163). Participants had hypercholesterolemia (6-8 mmol/l) and at least two other CHD risk factors. RESULTS: After 3 years, no significant differences existed in established CHD risk factors between intervention and control groups (adjusted mean net differences: total cholesterol (0 mmol/l), diastolic blood pressure (-1.1 mm Hg; NS), and body weight (+0.3 kg, NS)). Regarding dietary intake, the intervention group had a lower intake of total (net difference -2.0% of energy, SEM 0.9) and saturated fat (-1.2% of energy, SEM 0.4) and a higher fish (+11 g/day, SEM 4) and vegetables consumption (+21 g/day, SEM 10) during the study period (p<0.05 for all). CONCLUSION: A nutritional education programme with group sessions changed dietary intake more effectively than a posted leaflet, but no additional positive effects were observed on established CHD risk factors after three years of follow-up.     

A prospective study of high blood pressure and cardiovascular disease in women

The relation of self-reported high blood pressure to the subsequent development of coronary heart disease and stroke was examined in a cohort of 119,963 women, aged 30-55 years, who were initially free from cardiovascular disease. Participants in the Nurses' Health Study reported high blood pressure and other cardiovascular risk factors on baseline questionnaires mailed in 1976. During six years of follow-up, there were 308 incident cases of coronary heart disease (66 fatal and 242 nonfatal myocardial infarctions) and 175 strokes (50 fatal and 125 nonfatal). Fatal as well as nonfatal coronary heart disease and stroke were all significantly more frequent among the women who had reported high blood pressure. After adjusting simultaneously for age and other risk factors, the relative risks were 3.5 (95% confidence interval (Cl) 2.8-4.5) for total coronary heart disease and 2.6 (95% Cl 1.8-3.5) for total stroke. This association was evident at all levels of relative weight. The results emphasize the importance of high blood pressure as an independent predictor of coronary heart disease and stroke in middle-aged women and suggest that the increased risk occurs in both lean and obese women.     

Socioeconomic circumstances in childhood and blood pressure in adulthood: the cardiovascular risk in young Finns study

PURPOSE: Prospective evidence suggests an inverse association between socioeconomic circumstances in childhood and adolescence and blood pressure (BP) in adulthood, but uncertainty remains about whether this association is confounded by risk factors acting in utero, early infancy, and adulthood. The authors investigated this question in a population-based cohort of 2270 Finnish children and adolescents aged 3 to 18 years at study entry. METHODS: Information about early socioeconomic circumstances, birth weight, and breast-feeding were requested from participants or their mothers in 1980 and 1983. Adulthood socioeconomic position, lifestyle factors, and systolic BP were measured at ages 24 to 39 years in 2001. RESULTS: There was a graded association between lower parental socioeconomic position in childhood and adolescence and higher systolic BP in adulthood for men and women in different birth cohorts and across different socioeconomic indicators. This association was independent of adulthood socioeconomic position. Adjustment for risk factors, including birth weight, breast-feeding, adult body mass index, smoking, and alcohol consumption, had little effect on the association between parental socioeconomic position and systolic BP. CONCLUSION: Early socioeconomic disadvantage seems to carry a long-lasting harmful effect on BP that is not counteracted by risk profiles in later life.     

Isoflavone intake in persons at high risk of cardiovascular events: implications for vascular endothelial function and the carotid atherosclerotic burden

BACKGROUND: Epidemiologic studies have suggested that a high phytoestrogen intake is inversely associated with cardiovascular disease risk factors and the incidence of cardiovascular events. However, the relation between the intake of isoflavone, a major component of phytoestrogen, and vascular endothelial function and the atherosclerotic burden remains unclear. OBJECTIVE: We aimed to investigate the effects of various dietary soy isoflavone intakes on brachial artery flow-mediated dilation and mean maximum carotid intima-media thickness. DESIGN: We studied 126 consecutive patients (x +/- SD age: 66.5 +/- 11.1 y; 69% male) at high risk of cardiovascular events (94% had documented coronary artery disease or stroke; 44% had diabetes). A validated food-frequency questionnaire was used to estimate their dietary intake after they achieved stable dietary patterns for 3 mo. RESULTS: The median intakes of isoflavone and soy protein were 5.5 (range: 2.2-13.3) mg/d and 1.2 (range: 0.4-2.8) g/d, respectively. Persons in the 4th quartile of daily isoflavone intake had significantly (P < 0.05) greater flow-mediated dilation-but not mean maximum carotid intima-media thickness-than did those in the lower quartiles. After adjustment for potential confounders, a higher isoflavone intake in the 4th than in the 1st quartile (>13.3 mg/d), but not a higher intake of soy protein, predicted an absolute 2.71% increase in flow-mediated dilation (relative increase: 103%; P = 0.02) and a 0.17-mm decrease in mean maximum carotid intima-media thickness (relative decrease: 14.5%; P = 0.04). CONCLUSION: In persons at high risk of cardiovascular events, a greater isoflavone intake is associated with better vascular endothelial function and lower carotid atherosclerotic burden.     

Bone quantitative ultrasound measurements in relation to the metabolic syndrome and type 2 diabetes mellitus in a cohort of elderly subjects at high risk of cardiovascular disease from the PREDIMED study

Objective  

The aim of this study is to determine whether metabolic syndrome, its individual components, or the presence of type 2 diabetes mellitus are associated with a better bone status estimated by quantitative ultrasound at the calcaneus.     

Frequency of dairy consumption and functional disability in older persons

Objectives  

To examine the association between dairy products consumption frequency and functional disability in older persons.     

High blood pressure and cardiovascular disease mortality risk among U.S. adults: the third National Health and Nutrition Examination Survey mortality follow-up study

PURPOSE: We sought to examine whether prehypertension is associated with increased cardiovascular disease (CVD) mortality risk and whether the association of blood pressure with CVD outcome is modified by social demographics or hypertension treatment and control. METHODS: Data from the Third National Health and Nutrition Examination Survey and mortality follow-up through 2000 were used to estimate the relative risk of death from CVD associated with hypertension and prehypertension, after adjusting for confounding and modifying factors. RESULTS: Compared with normotension, the relative risks of CVD mortality were 1.23 (95% confidence interval [95% CI] 0.85-1.79, p=0.26) for prehypertension, 1.64 (95% CI 1.11-2.41, p=0.01) for hypertension, 1.74 (95% CI 1.28-2.49, p=0.007) for uncontrolled hypertension, and 1.15 (95% CI 0.79-1.80, p=0.53) for controlled hypertension. Hypertensive adults <65 years and non-Hispanic blacks had a 3.86-fold and a 4.65-fold increased CVD mortality risk respectively. Age, gender, and race/ethnicity stratified analyses showed no associations between prehypertension and CVD mortality. However, blood pressure at a high range of prehypertension (130-139/84-89 mmHg) was associated with increased risk of CVD mortality (hazard ratio 1.41, p<0.05) relative to blood pressure less than 120/80 mmHg. CONCLUSIONS: This study supports a strong, significant, and independent association of elevated blood pressure with CVD mortality risk. Hypertension continued to greatly increase CVD morality risk, particularly among persons <65 years and non-Hispanic blacks. Treatment and control of hypertension eliminated the excess CVD mortality risk observed among the hypertension population.     

Intake of dairy fat and dairy products, and risk of myocardial infarction: a case-control study

The role of dairy fat in the aetiology of myocardial infarction (MI) is controversial. The aim of this study was to evaluate the association between intake of dairy fat and dairy products, and risk of a first acute MI. A total of 111 MI patients with a first acute MI and 107 population controls (men and women, age 45 75 years) were studied. Diet was assessed using a 180-item food frequency questionnaire. The MI cases had higher intake of total fat, but lower intake of saturated fat and dairy fat than the control persons. No effect of dairy fat or saturated fat on the odds ratio for MI was observed, however. A significant inverse trend in odds of MI for intake of cheese was observed, but the trend was no longer significant after adjustment for smoking. The results suggest that intake of fat from dairy products may not be associated with increased risk of having a first MI. The healthy control persons had a diet that differed from the diet of the MI patients in many aspects, and dairy products were a part of this diet. This may have protected them from having a first MI.     

Nutritional influence on risk of high blood pressure in Bangladesh: a population-based cross-sectional study

BACKGROUND: The nutritional determinants of hypertension in Bangladesh and other low-income countries are largely unknown. OBJECTIVE: We assessed the associations of general hypertension with nutrient intakes and diet patterns in Bangladesh. DESIGN: This was a cross-sectional analysis of 11 116 participants enrolled in the Health Effects of Arsenic Longitudinal Study in Bangladesh. Dietary intakes were measured by use of a validated food-frequency questionnaire. RESULTS: Three major dietary patterns were identified by using principal component analysis: 1) the "balanced" pattern, which was characterized by rice, some meat, small fish, fruit, and vegetables; 2) the "animal protein" pattern, which was more heavily weighted on meat, milk, poultry, eggs, bread, large fish, and fruit; and 3) the "gourd and root vegetable" pattern, which consisted largely of squashes and root and leafy vegetables. Adjusted prevalence odds ratios for general hypertension in increasing quintiles of balanced pattern scores were 1.00 (reference), 0.81 (95% CI: 0.79, 0.97), 0.82 (0.68, 0.97), 0.79 (0.66, 0.94), and 0.71 (0.59, 0.85) (P for trend < 0.01). Prevalence odds ratios for general hypertension in increasing quintiles of animal protein pattern scores were 1.00 (reference), 1.30 (1.01, 1.52), 1.20 (1.01, 1.47), 1.22 (1.00, 1.44), and 1.21 (1.03, 1.49) (P for trend = 0.23). Markers of high socioeconomic status were positively associated with the animal protein pattern. CONCLUSION: Our findings suggest the importance of dietary patterns in general hypertension in a low-income population undergoing the early stage of the epidemiologic transition.     

心血管病高危人群腰围和体重变化与血压水平变化关系的随访研究

目的 探讨心血管病高危人群中腰围和体重变化与血压水平变化的关系,为高血压及心血管病防治提供理论依据和参考。方法 选取2016年纳入随访调查的12 931名心血管病高危人群作为研究对象,将其2017-2019年长期随访数据纳入分析。统计学分析采用t检验、χ²检验和广义估计方程。结果 在心血管病高危人群中,腰围、体重和BMI增加,血压水平升高的风险高;腰围、体重和BMI减少,血压水平升高的风险低。腰围每增加1 cm,SBP增加0.200（95%CI：0.164~0.236） mmHg,DBP增加0.085（95%CI：0.066~0.105） mmHg;体重每增加1 kg,SBP增加0.355（95%CI：0.289~0.421） mmHg,DBP增加0.182（95%CI：0.144~0.220）mmHg;BMI每增加1 kg/m²,SBP增加1.100（95%CI：1.194~1.258） mmHg,DBP增加0.365（95%CI：0.273~0.456） mmHg。心血管病高危人群中农村居民相对于城市居民,SBP随腰围和体重变化更大,DBP随腰围变化更大（交互作用P<0.05）;随访高血压不患病相对于随访高血压患病人群,SBP随腰围和BMI变化更大,DBP随BMI变化更大（交互作用P<0.05）。结论 在心血管病高危人群中,腰围、体重和BMI的变化与血压水平的变化均存在正向线性相关。     

Calcium from dairy products, vitamin D intake, and blood pressure: the Tromso Study

BACKGROUND: The present epidemiologic study was conducted in Tromso, Northern Norway, in 1994-1995. OBJECTIVE: The objective was to evaluate the relation between calcium intake from dairy products and the intake of vitamin D on systolic and diastolic blood pressure. DESIGN: Subjects who were taking drugs for hypertension or heart disease, those taking calcium tablets, subjects reporting cardiovascular disease, and pregnant women were excluded, leaving 7543 men and 8053 women aged 25-69 y for analysis. Calcium and vitamin D intakes were calculated from a food-frequency questionnaire. RESULTS: After correction for age, body mass index, alcohol and coffee consumption, physical activity, cigarette smoking, and vitamin D intake, there was a significant linear decrease in systolic and diastolic blood pressure with increasing dairy calcium intake in both sexes (P < 0.05). However, the difference in blood pressure between subjects with the highest and those with the lowest calcium intake was 相似文献   

Elevated risk of high blood pressure: climate and the inverse housing law

BACKGROUND: In previous work the authors identified an 'inverse housing law' in Britain such that housing quality tends to be worse in areas of harsh climate than in areas where the climate is more benign. This study investigates whether an individual's risk of hypertension is associated with such a 'mismatch' between the quality of their housing and the climate to which they have been exposed. METHODS: Cross-sectional observational study based on Britain. Data came from the 5663 Health and Lifestyle Survey (HALS) participants for whom all relevant items were available. A two-stage study design was employed. First, the relationship between exposure to colder climate and housing quality was established. Second, the impact on risk of hypertension was determined for level of exposure to colder climate and housing quality. RESULTS: Analysis confirmed that amongst survey respondents, those with greater exposure to colder climate are more likely (1.32, 95% CI: 1.18-1.42) to live in poor quality housing than those with lower exposure to colder climate. This combination of higher exposure to colder climate plus residence in worse quality housing raises significantly the risk of diastolic hypertension (1.45, 95% CI: 1.18-1.77) and, more weakly, systolic hypertension (1.25, 95% CI: 1.01-1.53). CONCLUSIONS: There appears to be an 'inverse housing law' in Britain, whereby longer term residents of relatively cold areas are also more likely to live in worse quality housing and this combination of circumstances is associated with significantly higher risk of diastolic hypertension. The findings provide an example of how long term exposure to an adverse environment, which may stem from material disadvantage, can damage health.     

A five-year follow-up study on blood pressure and serum cholesterol in junior high school children]

Blood pressure and serum cholesterol changes over a five-year period were studied in 299 junior high school children (127 males and 172 females) examined during 1980-1984 in Akita Prefecture, Japan. The six factors studied were height, weight, body mass index (by Minowa's method), systolic blood pressure, diastolic blood pressure and serum cholesterol. Mean values for systolic and diastolic blood pressure increased more than 10 mmHg during the five years in both sexes. Significant positive correlations between initial and follow-up blood pressure ('tracking') were observed. The correlation coefficients for systolic blood pressure in males and in females were 0.33 and 0.28 respectively, and those for diastolic blood pressure were 0.36 in males and 0.19 in females. While there were no significant differences in serum cholesterol levels between the two periods in either sex, the correlation coefficients, which were higher than those for blood pressure, were 0.55 in males and 0.45 in females. Among the six factors at each period, significant positive correlations were observed between height and systolic blood pressure at the initial period, and between obesity and systolic blood pressure at both periods in males and females. A significant positive relationship between obesity and serum cholesterol was seen at the follow-up period in both sexes. These data suggest that a moderate degree of 'tracking' occurs in blood pressure and serum cholesterol during childhood, and that obesity is an important factor related to blood pressure and serum cholesterol.     

出生结局与儿童血压水平及血压偏高的关联

目的探讨出生结局相关因素与儿童期间血压偏高的关系,并阐明其关联的性别差异。方法采用分层随机整群抽样法于2013年9月在中国7个省(自治区、直辖市)调研6～17岁学生62 168名,男生32 064名,女生30 104名,年龄中位数为10.74岁,出生体重中位数为3.3 kg,单胎49 843名(97.0%),双胎1339名(2.6%),三胎及以上180名(0.4%)。问卷调查基本人口学资料、出生体重、出生胎数、膳食和运动相关行为,进行身高、体重、血压等体格检测。依据美国疾病预防控制中心制定的儿童青少年性别、年龄和身高别的血压偏高标准判定是否血压偏高。采用多因素线性回归和多因素Logistic回归分析出生结局(出生体重、出生胎数)与血压水平或血压偏高的关联,并研究关联的性别差异。结果 62 168名调查对象中血压偏高检出5933人(9.5%)。按照出生体重进行分层分析发现,仅在低出生体重者中,校正潜在协变量后出生体重与收缩压(b=-1.628,95%CI-2.571～-0.685,P=0.001)、舒张压(b=-1.463,95%CI-2.186～-0.740,P<0.001)关联...     

Homicide while at work: persons, industries, and occupations at high risk.

The purpose of this study is to identify and describe, epidemiologically, work-related homicides in California from 1979 through 1981. Using the California State Computer Mortality File, an algorithm was developed and a search of the death certificates was made using three factors: "injury at work," injury at a work location, and pertinent external-cause-of-death codes. Only 30 per cent of the 466 homicide deaths identified were also found in the logs of the state Occupational Safety and Health agency. The average annual rate of work-related homicides was 1.5 per 100,000 workers. The male-to-female-rate ratio was 4.2:1. Police and security guards and persons in occupations having frequent public contact involving exchange of money, particularly in late afternoon or evening hours, were at highest risk. Controlling exposures of high-risk individuals and developing strict standards for reducing such exposures might greatly reduce assaults and thus prevent senseless loss of life in the workplace.     

Low-fat dairy consumption and reduced risk of hypertension: the Seguimiento Universidad de Navarra (SUN) cohort

BACKGROUND: Some observational studies have shown a beneficial effect of dairy consumption on blood pressure, especially in overweight and relatively young (<40 y) persons. However, no results from prospective studies conducted in a free-living population exist that show this association in middle-aged adults. OBJECTIVE: The aim of the present study was to assess whether total, low-fat, and whole-fat dairy consumption was associated prospectively with the risk of hypertension. DESIGN: This was a prospective study conducted in 5880 university graduates in Spain, aged >20 y in 2000 (mean age: 37 y), free of hypertension and cardiovascular disease at baseline, and followed-up with mailed questionnaires for a median of 27 mo. Dairy consumption was assessed with a previously validated semiquantitative food-frequency questionnaire. RESULTS: One hundred eighty new cases of hypertension were identified. The hazard ratio of hypertension between extreme quintiles of low-fat dairy product consumption was 0.46 (95% CI: 0.26, 0.84; P for trend = 0.02) after adjustment for the main known risk factors for hypertension and several dietary factors. No significant association between whole-fat dairy products or total calcium intake and incident hypertension was seen. CONCLUSION: In this Mediterranean cohort, low-fat dairy consumption, but not whole-fat dairy consumption, was associated with a lower risk of incident hypertension.