Evaluation and comparison of blood pressure profiles of Pakistani cohort of children.

Aziz K, T M, Aziz S, Faruqui AM, C e D, Patel N, Chaghani H, Hafeez SA, Ghuari SA, Memon F, Ashraf T, Sultana H, She L.

Department of Cardiology, NICVD, Karachi. nicvdedo khi.comsats.net.pk

OBJECTIVE: To determine the blood pressure profile of children in Metroville, a lower middle class urban community of Karachi, Pakistan, and compare it to Pakistan National Health Survey of children. DESIGN: A research survey. PLACE AND DURATION OF STUDY: The study was conducted by National Institute of Cardiovascular Diseases, Karachi from 1996 2002. SUBJECTS AND METHODS: The blood pressure data was generated at the base line examination of MHS and was used to define the BP profile of urban Metroville children, age 2-17 years. Similar data of Pakistan National Health Survey (PNHS) undertaken by Pakistan Medical Research Council (PMRC), was used for comparison. RESULTS: A comparison of the blood pressure profile of the MHS with that of the PMRC showed that blood pressure was lower in the MHS. Additionally, comparison of the PMRC profile with USA data showed higher diastolic pressure in the PMRC. Comparison of Pakistani profiles with European data also showed higher blood pressure in Pakistani children. CONCLUSION: It is concluded that the MHS represents the BP profile of children in newly emerging lower middle class urban communities in Pakistan. PMRC data represents national average and can be used to define the blood pressure characteristics of urban communities similar to Metroville. The comparison with affluent countries highlighted the urgent need for community based preventive programs to combat hypertensive diseases in Pakistan.

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The C677T polymorphism of the methylenetetrahydrofolate reductase gene is associated with the level of decrease on diastolic blood pressure in essential hypertension patients treated by angiotensin-converting enzyme inhibitor.

Jiang S, Hsu YH, Xu X, Xing H, Chen C, Niu T, Zhang Y, Peng S, Xu X.

School of Life Sciences, University of Science and Technology of China, Hefei, China.

OBJECTIVES: Elevated plasma homocysteine has been implicated as a risk factor for hypertension. C677T polymorphism in methylenetetrahydrofolate reductase gene (MTHFR) is a major determinant of hyperhomocysteinemia, which results in endothelial dysfunction. Angiotensin-converting enzyme (ACE) inhibitors appear to remedy the endothelial dysfunction and restore endothelium-dependent vasodilatation. The co-existence of genetic polymorphisms in drug metabolizing enzymes, targets, receptors, and transporters may influence the drug efficacy. The purpose of this study was to investigate whether short-term blood pressure control by benazepril, an ACE inhibitor, was modulated by C677T MTHFR gene polymorphism. METHODS AND RESULTS: A total of 444 hypertensive patients, aged 27 to 65 years, without any anti hypertensive therapy within 2 weeks were included. All of them were treated orally with benazepril at a single daily fixed dosage of 10 mg for 15 consecutive days. Blood pressures were measured at baseline and on the 16th day of treatment. Among them, the frequency of MTHFR C677T genotype CC, CT and TT was 24.3%, 51.8%, and 23.9%, respectively. In a recessive model (CC+CT versus TT genotype), both baseline diastolic blood pressure (DBP) and diastolic blood pressure response (DeltaDBP) were significantly higher in patients with the TT genotype than in those with the CT or CC genotype (P value=0.0076 for DBP, and P value=0.0005 for DeltaDBP). We further divided all patients into three groups based on the tertiles of the DeltaBP distribution. Compared to subjects in the lowest tertile of DeltaDBP, the adjusted relative odds of having the TT genotype among subjects in the highest tertile was 2.6 (95% CI, 1.4 to 4.9). However, baseline systolic blood pressure (SBP) and SBP response did not significantly associate with MTHFR C677T polymorphism. CONCLUSIONS: Our finding suggests that MTHFR C667T polymorphism modulated baseline DBP and DBP responsiveness by short-term treatment of ACE inhibitor in Chinese essential hypertensive patients.

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Trends in blood pressure over 10 years in adolescents: analyses of cross sectional surveys in the Northern Ireland Young Hearts project.

Watkins D, McCarron P, Murray L, Cran G, Boreham C, Robson P, McGartland C, Davey Smith G, Savage M.

Department of Child Health, Queens University of Belfast, Institute of Clinical Science, Royal Victoria Hospital, Belfast BT12 6JB. david.watkins stockport-tr.nwest.nhs.uk

OBJECTIVE: To examine secular trends in blood pressure over a 10 year period between two representative cohorts of adolescents from Northern Ireland. DESIGN: Repeat cross sectional study. SETTING: Randomly selected post-primary schools from Northern Ireland. PARTICIPANTS: 1015 adolescents studied between 1989 and 1990, and 2017 adolescents studied between 1999 and 2001. Participants were aged 12 or 15 years. MAIN OUTCOME MEASURES: Systolic and diastolic blood pressure measured by one observer in each study. RESULTS: The four groups for sex and age showed decreases in both systolic blood pressure (mean decrease 7.7 mm Hg to 10.0 mm Hg) and diastolic blood pressure (8.8 mm Hg to 11.0 mm Hg). These decreases were not accounted for by adjustment for potential confounders including age, height, body mass index, smoking, physical activity, aerobic fitness, and stratification of school by education board area and type. The findings were not altered by additional adjustment for social class, pubertal status, birth weight, and infant feeding. No evidence was found of systematic variation between observers. CONCLUSIONS: Substantial decreases in systolic and diastolic blood pressure over the past decade in adolescents from Northern Ireland are likely to have important benefits to public health and may help offset the increasing risk of cardiovascular disease due to increases in obesity.

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Prevalence of blood pressure levels and hypertension-related diseases in Japanese dental patients.

Miyawaki T, Nishimura F, Kohjitani A, Maeda S, Higuchi H, Kita F, Shimada M.

Department of Dental Anesthesiology, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan. miyawaki md.okayama-u.ac.jp

OBJECTIVE: To investigate the prevalence of blood pressure levels and hypertension-related diseases and to evaluate the risks associated with dental patients in Japan. RESEARCH DESIGN: Retrospective cross-sectional. METHOD: Blood pressure levels and medical histories of hypertension-related diseases obtained from 3,811 adult outpatients consulting a University Dental Hospital were investigated. Blood pressure levels were compared with those reported in the Japanese national survey obtained from a standard Japanese population. The relationships between gender or age and blood pressure level or the rate of the subjects with a hypertension-related disease were evaluated. RESULTS: Mean values of blood pressure in the present study were similar to those in the Japanese national survey. Among hypertension-related diseases, hypertension showed the highest prevalence (10.9%) in subjects. Blood pressure levels and the rates of subjects with hypertension-related diseases were significantly related to increasing age. Elderly subjects had a tendency to combine hypertension or high blood pressure with hypertension-related diseases. Further, 20.4% of subjects who had not been diagnosed with hypertension had high blood pressure. Among them, 1.5% had blood pressure more than 180/110 mmHg. CONCLUSIONS: The results suggested that blood pressure levels of dental patients would reflect the prevalence of blood pressure levels and hypertension in the Japanese general population, and that high blood pressure and increasing age are the greatest risk factors in the medical status of dental patients. Furthermore, because many subjects examined were unaware of their high blood pressure levels, caution is required prior to performing dental procedures.

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The degree and timing of orthostatic blood pressure changes in relation to falls in nursing home residents.

Maurer MS, Cohen S, Cheng H.

Clinical Cardiovascular Research Lab for the Elderly, Columbia University, College of Physicians and Surgeons, New York, NY 10034, USA. msm10 columbia.edu

BACKGROUND: Orthostatic hypotension (OH) is traditionally defined as a decline in systolic or diastolic blood pressure of >20 or >10 mm Hg, respectively, after 1 or 3 minutes of upright posture. OH is common in the elderly, but has not been consistently demonstrated to be an independent risk factor for falls in nursing home residents. Previous studies have used the standard definition of OH in assessing fall risk. No study has sought to determine if the timing of postural changes in blood pressure adds prognostic value; if changes in systolic, diastolic, or mean blood pressure are equivalent in predicting subsequent falls; and what degree of decline in blood pressure has the best predictive value. OBJECTIVE: We sought to define the timing and degree of orthostatic changes in blood pressure in a cohort of elderly nursing home residents during active standing and to explore the relationship to subsequent falls to test the hypothesis that orthostatic changes in blood pressure with noninvasive beat-to-beat technology would predict falls in nursing home residents better than the standard definition of OH. METHODS: One hundred eleven elderly (88 +/- 7 years) residents of a long-term care facility had measurement of orthostatic blood pressure changes during active standing for up to 3 minutes with a real-time continuous, noninvasive beat-to-beat blood pressure device. Falls were determined prospectively over a median follow-up period of 270 days (range, 8-657 days). The degree and timing of declines in systolic, diastolic, or mean blood pressure and their association with subsequent falls was determined using a time-to-event analysis. RESULTS: Forty-six subjects (41%) fell. The standard definition of OH was not predictive of subsequent falls (hazard ratio 1.03 at 1 minute and 1.32 at 3 minutes, P = not significant). Other measures of orthostatic blood pressure changes were also not associated with a significant increase in risk for subsequent falls, including declines in blood pressure within the first minute of standing. CONCLUSION: The standard definition of OH was not an independent predictor of falls in frail nursing home residents. A one-time measure for the presence of postural hypotension using beat-to-beat tonometry was not predictive of fall risk. The timing and degree of orthostatic changes in blood pressure does not significantly enhance risk prediction for falls.

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Serum aldosterone and the incidence of hypertension in nonhypertensive persons.

Vasan RS, Evans JC, Larson MG, Wilson PW, Meigs JB, Rifai N, Benjamin EJ, Levy D.

National Heart, Lung, and Blood Institute Framingham Heart Study, Framingham, Mass 01702-5827, USA. vasan bu.edu

BACKGROUND: Primary hyperaldosteronism is a well-recognized cause of secondary hypertension. It is unknown whether serum aldosterone levels within the physiologic range influence the risk of hypertension. METHODS: We investigated the relation of baseline serum aldosterone levels to increases in blood pressure and the incidence of hypertension after four years in 1688 nonhypertensive participants in the Framingham Offspring Study (mean age, 55 years), 58 percent of whom were women. We defined an increase in blood pressure as an increment of at least one blood-pressure category (as defined by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) and defined hypertension as a systolic blood pressure of 140 mm Hg or higher, a diastolic blood pressure of 90 mm Hg or higher, or the use of antihypertensive medications. RESULTS: At follow-up, the blood-pressure category had increased in 33.6 percent of the participants, and hypertension had developed in 14.8 percent. In multivariable models, a 16 percent increase in the risk of an elevation in blood pressure (P=0.002) and a 17 percent increase in the risk of hypertension (P=0.03) were observed per quartile increment in the serum aldosterone level. The highest serum aldosterone quartile, relative to the lowest, was associated with a 1.60-fold risk of an elevation in blood pressure (95 percent confidence interval, 1.19 to 2.14) and a 1.61-fold risk of hypertension (95 percent confidence interval, 1.05 to 2.46). The associations between the serum aldosterone level and blood-pressure outcomes were not significantly affected by adjustment for urinary sodium excretion or left ventricular thickness or internal dimensions. CONCLUSIONS: In our community-based sample, increased aldosterone levels within the physiologic range predisposed persons to the development of hypertension. Copyright 2004 Massachusetts Medical Society

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[Blood pressure in healthy women with positive and negative family history of hypertension during pregnancy]

[Article in Polish]

Niegowska J.

Instytut Kardiologii w Warszawie-Aninie.

I studied levels of blood pressure on 120 healthy primigravides aged between 22-40 years during physiological pregnancy. Blood pressure had been taken by standard methods (mercury sphygmomanometer). 60 of these women had a positive family history of hypertension and 60 pregnancies were with no family history of hypertension. Phase I of Korotkoff sound was used as the ausculatory criterion of systolic blood pressure and phase V was used as the criterion of diastolic blood pressure. The group of healthy pregnant women with a positive family history of hypertension presented statistically significantly higher values of systolic as well as diastolic blood pressure than the group of pregnancies with no family history of hypertension. The lowest systolic value has shown in the 6th month, diastolic in the 5th month of pregnancy and the highest values of both-were determined in the 9th month of pregnancy CONCLUSION: Hypertension during pregnancy of healthy women is strongly influenced by their positive family history of hypertension.

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[Analysis on the trend of long-term change of blood pressure in hypertensive patients treated with benazepril]

[Article in Chinese]

Lu J, Li LM, He PP, Cao WH, Zhan SY, Hu YH.

Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100083, China.

OBJECTIVE: To introduce the application of mixed linear model in the analysis of secular trend of blood pressure under antihypertensive treatment. METHODS: A community-based postmarketing surveillance of benazepril was conducted in 1831 essential hypertensive patients (age range from 35 to 88 years) in Shanghai. Data of blood pressure was analyzed every 3 months with mixed linear model to describe the secular trend of blood pressure and changes of age-specific and gender-specific. RESULTS: The changing trends of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were found to fit the curvilinear models. A piecewise model was fit for pulse pressure (PP), i.e., curvilinear model in the first 9 months and linear model after 9 months of taking medication. Both blood pressure and its velocity gradually slowed down. There were significant variation for the curve parameters of intercept, slope, and acceleration. Blood pressure in patients with higher initial levels was persistently declining in the 3-year-treatment. However blood pressures of patients with relatively low initial levels remained low when dropped down to some degree. Elderly patients showed high SBP but low DBP, so as with higher PP. The velocity and sizes of blood pressure reductions increased with the initial level of blood pressure. CONCLUSION: Mixed linear model is flexible and robust when applied to the analysis of longitudinal data but with missing values and can also make the maximum use of available information.

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