Relation between birthweight and blood pressure among 7-8 year old rural children in India.

Kumar R, Bandyopadhyay S, Aggarwal AK, Khullar M.

Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India. rajeshkum sancharnet.in

BACKGROUND: Fetal malnutrition has been proposed as a cause of higher blood pressure. However, some studies have shown no or little effect of birthweight on blood pressure. Confounding and selection bias have been a problem in some of the studies. The ideal approach for avoiding selection bias is to conduct a prospective cohort study with minimal loss during follow-up. Therefore, the relationship of birthweight with blood pressure was examined in a cohort born during 1992-1993. METHODS: A cohort of 214 babies, born to usual residents in 10 villages of Haryana state in India on weekdays from September 1992 to November 1993 whose birthweight had been recorded by a trained field worker within 24 hours of delivery, were followed up during 2000-2001. During the 7-8 year period, 17 children had died and 12 had migrated. A trained public health nurse examined the remaining 185 children and measured their weight, height, and blood pressure. RESULTS: Mean birthweight was 2.7 kg and 21.1% had low birthweight (<2500 g). Current weight, height, and body mass index (BMI) were associated with birthweight (P < 0.05). Systolic blood pressure (SBP) increased significantly with rise in current weight and height. Relationship of SBP with birthweight seems to be a U-shaped distribution. Compared with the middle birthweight tertile group, in the lowest and highest birthweight groups boys have higher SBP in the higher BMI category (>or=13.5 kg/m(2)) and girls have higher SBP in both lower and higher BMI categories. ANOVA analysis showed that SBP and diastolic blood pressure (DBP) were not significantly different in birthweight tertile groups among boys, but for SBP the difference was statistically significant among girls (P = 0.03). However, multivariate linear regression analysis that included socioeconomic status and current anthropometeric measures (weight, height, BMI) revealed that birthweight is not associated with SBP or DBP, and the interaction between birthweight and gender was also not significant for SBP and DBP (P = 0.09). CONCLUSION: The findings of this population-representative cohort from rural India with 94% follow-up suggest that birthweight is not associated with blood pressure among 7-8 year old children.

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Birthweight and arterial stiffness and blood pressure in adulthood--results from the Amsterdam Growth and Health Longitudinal Study.

te Velde SJ, Ferreira I, Twisk JW, Stehouwer CD, van Mechelen W, Kemper HC; Amsterdam Growth and Health Longitudinal Study.

Institute for Research in Extramural Medicine (EMGO-institute), VU University Medical Center, Amsterdam, The Netherlands.

BACKGROUND: The association between low birthweight and increased blood pressure in later life has repeatedly been confirmed. Increased arterial stiffness may be an underlying mechanism for this phenomenon. This study investigated whether birthweight was related to blood pressure and local and regional arterial stiffness. METHODS: In 281 subjects (161 women), with a mean age of 36, blood pressure was measured. The diameter, distension, and local pulse pressure of three large arteries were measured simultaneously using ultrasound imaging. Local and regional arterial compliance and distensibility were calculated. Information on birthweight was retrieved with a questionnaire. RESULTS: Linear regression analyses showed a 3.3 mmHg lower systolic blood pressure (SBP) and a 1.8 mmHg lower diastolic blood pressure (DBP), per 1kg higher birthweight. These associations were statistically significant after adjustment for adult weight. Birthweight was significantly and positively related to carotid arterial compliance (P = 0.050), but less so to brachial (P = 0.114) and femoral arterial compliance (P = 0.058). However, after adjustment for adult height, the strength of these associations decreased. Birthweight was not related to arterial distensibility. The association between birthweight and arterial compliance could only partly explain the association between birthweight and blood pressure. CONCLUSIONS: Lower birthweight is related to increased blood pressure, and increased arterial stiffness. However, the latter relationship can only partly explain the association between birthweight and blood pressure. Therefore, mechanisms other than arterial stiffness contribute to the birthweight-blood pressure relationship.

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Manidipine versus enalapril monotherapy in patients with hypertension and type 2 diabetes mellitus: a multicenter, randomized, double-blind, 24-week study.

Otero ML, Claros NM; Study Investigators Group.

Unidad de Hipertension, Hospital Clinico San Carlos, Madrid, Spain. mluqueo telefonica.net

BACKGROUND: Blood pressure reduction is associated with a reduced risk for cardiovascular events and death, particularly in patients with both hypertension and type 2 diabetes mellitus. OBJECTIVE: The aim of this study was to compare the antihypertensive efficacy, tolerability, and effect on metabolic risk factors of manidipine, a new dihydropyridine calcium channel antagonist, and enalapril, a widely used angiotensin-converting enzyme inhibitor, in patients with mild to moderate essential hypertension and type 2 diabetes. METHODS: This multicenter, double-blind trial compared manidipine and enalapril in patients with type 2 diabetes and hypertension (diastolic blood pressure [DBP] 90-104 mm Hg, systolic blood pressure [SBP] < or =190 mm Hg). Following a 3-week, single-blind placebo run-in period, eligible patients were randomized to receive either manidipine 10 mg or enalapril 10 mg once daily for 24 weeks. The dose was doubled after 3 weeks in patients who had not responded to treatment (DBP > or =90 mm Hg). The primary efficacy end point was change in DBP from baseline to the end of the study. Secondary outcomes were the responder rate (DBP <90 mm Hg and/or a DBP reduction of > or =10 mm Hg) at the end of the study. Other secondary measures were changes from baseline to the end of the study in heart rate and in the following measures obtained by ambulatory blood pressure monitoring (ABPM): 24-hour, daytime, and nighttime mean DBP and SBP, and the trough:peak ratio. Blood glucose, glycosylated hemoglobin (HbA1c), total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, uric acid, and creatinine were measured at the end of the placebo run-in period and the end of treatment. The study had 80% power to detect a between-treatment difference in mean sitting DBP of >3 mm Hg. RESULTS: One hundred twenty-four patients were enrolled in the study. After the placebo run-in period, 13 patients were excluded from the study: 4 for DBP values outside the specified limits, 7 at their request, and 2 for adverse events. Thus, 111 patients met the eligibility criteria and were randomized to treatment (53 manidipine, 58 enalapril). The population consisted of 61 men and 50 women with a mean (SD) age of 62 (11) years and a body mass index of 28.2 (2.4) kg/m2. Among patients who completed the study, drug doses were doubled in 67.6% (25/37) of patients in the manidipine group and 60.0% (24/40) of patients in the enalapril group (P = NS). Similar reductions in blood pressure were observed in both groups, from a mean (SD) of 164 (12)/97.5 (5) mm Hg at baseline to 141 (12)/84.5 (6) mm Hg at the end of the study in the manidipine group (P < 0.01), and from 159 (12)/98 (4) mm Hg to 139 (12)/86 (8) mm Hg in the enalapril group (P < 0.01). The proportion of responders was 66.7% (32/48) in the manidipine group and 60.0% (30/50) in the enalapril group; the difference between groups was not significant. Twenty-four-hour ABPM revealed significant (P < 0.01) and similar reductions in blood pressure in both groups, with a trough:peak ratio of approximately -50%. Neither drug affected heart rate. Among the statistically significant changes in metabolic parameters, significant reductions in HbA(1c) (from 6.7% [1.4%] to 6.2% [1.1%]) and blood glucose concentrations (from 152 [44] to 143 [44] mg/dL) were observed only in the manidipine group (P < 0.05). The incidence of adverse events was similar between groups. CONCLUSIONS: In the present study, manidipine was as metabolically neutral and as effective as enalapril in reducing blood pressure in hypertensive patients with type 2 diabetes, providing a sustained 24-hour antihypertensive effect.

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Blood pressure dipping is reproducible in clinical practice.

Ben-Dov IZ, Ben-Arieh L, Mekler J, Bursztyn M.

Department of internal medicine, Hadassah University Hospital, Mount-Scopus, Jerusalem, Israel.

OBJECTIVE: Blood pressure dipping pattern has clinical and prognostic consequences. However, reproducibility of night-time blood pressure fall during 24-h ambulatory blood pressure monitoring is considered limited. This limited reproducibility is possibly a result of inadequate day-night definitions. We retrospectively examined the reproducibility of blood pressure dipping in clinical practice, applying a method that accounts for sleep-awake states and does not rely on arbitrary day-night definitions. We also examined dipping repeatability in subjects with changing blood pressure. METHODS: Of 962 consecutive ambulatory measurements performed in our unit during a 3-year period, 100 patients (age 60+/-15) had a prior session, and were the subjects of this study. Based on patients' report we defined 'awake blood pressure' as the average of pressure recordings while the subject was awake, including night-time arousals, and 'sleep blood pressure' as the average of pressure recordings while the subject was sleeping, including afternoon naps. RESULTS: We found systolic blood pressure dipping not less reproducible than 24-h, awake- and sleep systolic blood pressure, as evaluated by both Pearson correlations (r=0.52 versus 0.5, 0.5, 0.49, respectively, P</=0.0002 in all), and Bland-Altman repeatability. In a subgroup of 35 subjects (age 63+/-15) with at least 10 mmHg change in systolic blood pressure between the two sessions, systolic blood pressure dipping remained reproducible (r=0.45, P<0.007). CONCLUSIONS: When interpreted in a way that accounts for sleep-awake pattern, sleep-induced systolic blood pressure dipping in clinical practice is a very reproducible feature of ambulatory blood pressure monitoring, in accordance with its vital prognostic implications.

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Ambulatory blood pressure variations relative to sitting or standing position in renal transplant patients.

Baguet JP, Coste D, Bayle F, Quesada JL, Pierre H, Mallion JM.

aDepartment of Cardiology and Hypertension bDepartment of Nephrology, Grenoble University Hospital, Grenoble, France.

OBJECTIVE: High blood pressure is almost constant in renal transplant patients for whom dysautonomia is frequently described. The main objective of this study was to analyse the variations in blood pressure and heart rate recorded by ambulatory measurement during changes in position in renal transplant patients. METHODS: Thirty-nine non-diabetic renal transplant patients with a renal transplant functioning for more than a year, were selected at random. Blood pressure was measured using the validated monitor Diasys Integra with a position sensor to discriminate between standing and sitting/lying. RESULTS: Systolic blood pressure and heart rate were significantly higher when the patient was standing than when sitting/lying (+2.9 mmHg, P<0.05 and +9 beats/min, P<0.001 respectively) and diastolic blood pressure tends to be higher (+1.7 mmHg, NS) when standing. One minute after standing up, the heart rate rises by about 9 beats/min (P<0.001) while systolic and diastolic blood pressures do not vary significantly. Variations in systolic blood pressure and heart rate on changing position are therefore in the same direction as those recorded in elderly normotensive or hypertensive untreated subjects, but with a lower amplitude. CONCLUSIONS: In most of non-diabetic functional renal transplant patients, there is an absence of an orthostatic decline in blood pressure. Thus, it could be considered that there is no real dysautonomia in this specific population.

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Taking blood pressure - no laughing matter!

McMahon C, Mahmud A, Feely J.

Department of Therapeutics and Hypertension Clinic, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland.

BACKGROUND: Humour is used commonly to relax subjects when their blood pressure is being measured. However the short-term effect of laughter on blood pressure is not described. METHODS: Sixteen normotensive volunteers had blood pressure measured using a validated automated oscillometric sphygmomanometric device (Omron 705 CP) as control and during three episodes of laughter while viewing a humorous sit-com video. RESULTS: Blood pressure was stable in the control period. There was a significant rise (P<0.01) in systolic blood pressure from 115 mmHg (108-121, mean 95% confidence interval) to 127 mmHg (120-135) during laughing. The increase in diastolic pressure 71 (67-74) to 73 (69-77) mmHg was not significant. CONCLUSION: Laughing has an acute effect on systolic blood pressure. Patients should not be encouraged to laugh when their blood pressure is being measured.

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Blood pressure-related cognitive decline: does age make a difference?

Elias PK, Elias MF, Robbins MA, Budge MM.

Department of Psychology, University of Maine, Orono, ME 04469, USA. PElias100 aol.com

Systolic and diastolic blood pressures have been inversely related to cognitive performance in prospective and cross-sectional studies. However, in large, community-based samples, these findings have been limited to older adults. In this 20-year longitudinal study, we examined the relationship between baseline blood pressure and cognitive decline for 529 participants using 2 age groups (18 to 46 years and 47 to 83 years). Cognitive performance was measured over multiple examinations with the Wechsler Adult Intelligence Scale from which 4 scores were derived by factor analysis. A 2-stage growth curve method of analysis was used to model cognitive change. Results indicated that higher levels of baseline systolic blood pressure, diastolic blood pressure, mean arterial pressure, and blood pressure categories as defined by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure were significantly associated with decline in Visualization/Fluid abilities in both younger and older age groups. Young adults are as susceptible to blood pressure-related longitudinal decline in cognitive performance as are older adults.

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The association between blood pressure, hypertension, and cerebral white matter lesions: cardiovascular determinants of dementia study.

van Dijk EJ, Breteler MM, Schmidt R, Berger K, Nilsson LG, Oudkerk M, Pajak A, Sans S, de Ridder M, Dufouil C, Fuhrer R, Giampaoli S, Launer LJ, Hofman A; CASCADE Consortium.

Department of Epidemiology & Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands.

Cerebral white matter lesions are frequently observed on magnetic resonance imaging (MRI) scans in elderly people and are associated with stroke and dementia. Elevated blood pressure is presumed one of the main risk factors, although data are almost exclusively derived from cross-sectional studies. We assessed in 10 European cohorts the relation between concurrently and previously measured blood pressure levels, hypertension, its treatment, and severe cerebral white matter lesions. In total, 1805 nondemented subjects aged 65 to 75 years were sampled from ongoing community-based studies that were initiated 5 to 20 years before the MRI. White matter lesions in the periventricular and subcortical region were rated separately using semiquantitative measures. We performed logistic regression analyses adjusted for potential confounders in 1625 people with complete data. Concurrently and formerly assessed diastolic and systolic blood pressure levels were positively associated with severe white matter lesions. Both increases and decreases in diastolic blood pressure were associated with more severe periventricular white matter lesions. Increase in systolic blood pressure levels was associated with more severe periventricular and subcortical white matter lesions. People with poorly controlled hypertension had a higher risk of severe white matter lesions than those without hypertension, or those with controlled or untreated hypertension. Higher blood pressure was associated with an increased risk of severe white matter lesions. Successful treatment of hypertension may reduce this risk; however, a potential negative effect of decreasing diastolic blood pressure level on the occurrence of severe periventricular white matter lesions should be taken into account.

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