Socioeconomic inequality in blood pressure and its determinants: cross-sectional data from Trinidad and Tobago.

Gulliford MC, Mahabir D, Rocke B.

Department of Public Health Sciences, King's College London, London, UK. martin.gulliford kcl.ac.uk

We evaluated income- and education-related inequalities in blood pressure, hypertension and hypertension treatment in the general population of Trinidad and Tobago. The design included survey of 300 households in north central Trinidad, including 631 adults in 2001. Measurements of blood pressure, weight, height, waist and hip circumferences, and educational attainment, household income and alcohol intake by questionnaire. The slope index of inequality (SII) was used to estimate the difference in blood pressure between those with highest, as compared to lowest, socioeconomic status. Complete measurements and questionnaires were obtained for 461 (73%) including 202 men and 259 women. In women, after adjusting for age and ethnicity, the SII for systolic blood pressure by income was -12.6, 95% confidence interval -22.6 to -2.6 mmHg (P=0.013); and -10.8 (-21.4 to -0.2) mmHg (P=0.045) by educational attainment. After additionally adjusting for body mass index, waist-hip circumference ratio and self-reported diabetes, the SII for income was -7.3 (-16.5 to 1.9) mmHg (P=0.120) and for educational attainment was -3.0 (-13.0 to 6.9) mmHg (P=0.551). In men, after adjusting for age and ethnicity, the SII for systolic blood pressure by income was -4.3 (-15.4 to 6.8) mmHg (P=0.447) and for education -8.1 (-19.0 to 2.8) (P=0.145). There is a negative association of systolic blood pressure with increasing income or education in women. This is associated with body mass index, abdominal obesity and diabetes. There is no consistent association between education or income and blood pressure in men. Journal of Human Hypertension (2004) 18, 61-70. doi:10.1038/sj.jhh.1001638

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Association between physical activity and blood pressure is modified by variants in the G-protein coupled receptor 10.

Franks PW, Bhattacharyya S, Luan J, Montague C, Brennand J, Challis B, Brage S, Ekelund U, Middelberg RP, O'Rahilly S, Wareham NJ.

University of Cambridge, Department of Public Health and Primary Care, Cambridge, UK.

Hypertension is strongly related to cardiovascular disease and all-cause mortality. Exercise reduces blood pressure but the response varies between individuals. The mechanisms by which physical activity energy expenditure (PAEE) modifies blood pressure are not fully defined but include modulation of sympathetic tone. Novel polymorphisms in the G-protein coupled receptor (GPR10) have been linked with high blood pressure. GPR10 may mediate the relationship between PAEE and blood pressure via central nervous mechanisms. We examined whether two GPR10 polymorphisms (G-62A and C914T) modify the association between PAEE and blood pressure in the MRC Ely study (N=687). When stratified by the C914T genotype, there were between-group differences for body mass index (BMI) (P=0.05), diastolic blood pressure (DBP) (P=0.006), and systolic blood pressure (SBP) (P=0.005). No differences were found between G-62A genotypes. The previously reported inverse relationship between PAEE and blood pressure was not observed in minor allele carriers for either polymorphism (A62 carriers: DBP beta-1.11, P=0.52; SBP beta-1.66, P=0.52. T914 carriers: SBP beta=3.27; P=0.60) but was in common allele homozygotes (G62G: DBP beta-6.18 P=0.00001; SBP beta-8.54 P=0.0001. C914C: SBP beta-7.07; P=0.00001). This corresponded to a significant interaction between PAEE and GPR10 polymorphisms on DBP (G-62A: P=0.006) and SBP (G-62A: P=0.008. C914T: P=0.068). Significant interactions were observed between haplotype (derived from G-62A and C914T), PAEE, and blood pressure (DBP: P=0.08; SBP: P=0.023). The effect of physical activity on blood pressure is highly variable at population level. Knowledge of GPR10 genotype may define those who are least likely to benefit from physical activity. These findings may have relevance in the targeted treatment of hypertensive disease.

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Alterations in blood pressure due to chronic exposure to natural sour gas leakage containing sulfur compounds.

Saadat M, Bahaoddini A, Nazemi S.

Department of Biology, College of Sciences, Shiraz University, Shiraz 71454, Iran. saadat susc.ac.ir

In order to show the alteration of blood pressure in subjects chronically exposed to natural gas containing sulfur compounds, the present study was done. The blood pressure of 94 (43 males, 51 females) of healthy individuals living in the polluted area of Masjid-i-Sulaiman (Khozestan province, southwest of Iran) was measured. The non-parametric Sign test was applied in order to detect differences between the study subjects and the normal mean values according to the sex and age of subjects. Statistical analysis showed that the systolic blood pressure significantly decreased (Z=-2.74; P=0.0031) while the diastolic blood pressure (Z=+2.11; P=0.0174) and heart rate (Z=+3.62; P<0.001) significantly increased in individuals living in the contaminated areas compared with those of normal mean values. The systolic and diastolic blood pressure decreased and increased, respectively, in individuals chronically exposed to natural sour gas containing sulfur compounds.

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[Observation of the change of blood pressure in 835 patients during extraction of teeth]

[Article in Chinese]

Xu QL, Ba Y.

Yangpu Dental Clinic of Shanghai Municipality, Shanghai 200090, China. yabing shcei.com.cn

PURPOSE: To observe the change of blood pressure during extraction of teeth. METHODS: Patients without hypertension who needed extraction were randomly selected, tooth extraction was carried out. The blood pressure and the patient's response to operation were observed and recorded during the procedure. RESULTS: The blood pressure in 825 patients increased significantly. The average increased blood pressure was 45/26 mmHg, 3 patients had arrhythmia, 5 patients had adverse reaction. CONCLUSION: The patient's blood pressure must be fewer than 140/90 mmHg, before a difficult extraction of teeth.

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Anxiety is not manifested by elevated heart rate and blood pressure in acutely ill cardiac patients.

De Jong MJ, Moser DK, An K, Chung ML.

College of Nursing, University of Kentucky/United States Air Force, Lexington, KY, USA. mdejong aol.com

BACKGROUND: Accurate assessment of anxiety in cardiac patients is important because anxiety is associated with adverse outcomes. Clinicians often use heart rate and blood pressure as indicators of anxiety; however, little is known about whether these measures accurately reflect anxiety in acutely ill patients. AIMS: The purpose of this study was to determine whether heart rate and blood pressure were related to level of anxiety in patients with chronic advanced heart failure (HF), patients with acute myocardial infarction (AMI), and healthy individuals. METHODS AND RESULTS: In this descriptive, correlational study, anxiety, heart rate, and blood pressure were measured at the same time in three groups of individuals: (1) 54 patients hospitalized for AMI; (2) 32 patients with chronic advanced HF; and (3) 31 healthy individuals. State anxiety was measured using the anxiety subscale of the Brief Symptom Inventory. Heart rate and blood pressure data were collected immediately prior to the anxiety assessment. Data were collected in the outpatient setting for patients with HF and healthy individuals. For patients with AMI, data were collected a mean of 48+/-33 h after admission. There were no correlations between anxiety and heart rate or diastolic blood pressure. Higher anxiety was associated with lower systolic blood pressure in patients with AMI (r=-0.23, P<0.05) and in healthy individuals (r=-0.27, P<0.05). CONCLUSION: Elevated heart rate and blood pressure do not accurately reflect level of anxiety as reported by patients with HF or AMI and healthy individuals, and thus cannot be used to assess anxiety in acutely ill patients. Clinicians who use changes in heart rate or blood pressure as indicators of anxiety may fail to recognize and treat anxiety, placing their patients at high risk for both immediate and long-term complications.

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Maximizing the benefit of treatment in mild hypertension:three simple steps to improve diagnostic accuracy.

Benediktsson R, Padfield PL.

Department of Endocrinology and Metabolism, Landspitali University Hospital, Reykjavik, Iceland. rafn efnaskipti.com

BACKGROUND: Most patients only have three measurements of blood pressure before being labelled as hypertensive. This may lead to inaccurate classification, unnecessary treatment and dilution in treatment benefit for the population. Aim: To examine the accuracy of current methods of diagnosing mild hypertension, and to explore ways to improving targeting of antihypertensive treatment without entailing lengthy observation. DESIGN: Re-analysis of published data. METHODS: We tested current diagnostic methods using the data for 3965 individuals who were followed for a year in the placebo arm of the MRC Mild Hypertension Trial. We calculated the proportion selected for treatment by current methods and the diagnostic accuracy, using average blood pressure beyond 6 months as representing 'true' long-term blood pressure. We examined the benefit of averaging blood pressures, of prolonging observation modestly and of estimating within-person blood pressure variability. RESULTS: Prolonging observation to 3 months selects a smaller (by about 12%) proportion of the sample for treatment, a proportion similar to that defined as 'truly' hypertensive. The diagnostic accuracy of current methods is poor, with up to 69% discrepancy in classification. This discrepancy was improved by up to 18% in absolute terms by prolonging observation to 3 months and using average blood pressures. Identifying those individuals with low within-person variability allows marked improvement in the prediction of 'true' hypertension. DISCUSSION: Although some inaccuracy in the diagnosis of hypertension is inevitable, observation for 3 months, averaging blood pressures and estimating within-person blood pressure variability can markedly improve upon current practice.

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Effects of vitamin C on high blood pressure induced by salt in spontaneously hypertensive rats.

Nishikawa Y, Tatsumi K, Matsuura T, Yamamoto A, Nadamoto T, Urabe K.

Laboratory of Food Science and Nutrition, College of Nutrition, Koshien University, 10-1 Momijigaoka, Takarazuka 665-0006, Japan. nishizen nike.eonet.ne.jp

By breeding and feeding salt to spontaneously hypertensive rats (SHR) continuously over a long period (until 60 wk old), rats with systolic blood pressures (SBP) of over 270 mmHg were prepared. It was studied whether or not supplying large amounts of vitamin C (200 mg/rat/d) over this period might bring any beneficial effect to blood pressure. Moreover, physico-chemical studies were performed to measure the components and enzymes in the blood and urine at 53 and 60 wk-old, and biochemical studies on vitamin C were also carried out in this experiment. Male (14 rats: 7 wk-old, 100-105 g) and female (15 rats: 7 wk-old, 95-100 g) SHR were divided into three groups and bred continuously for 53 wk. The A group rats were given salt (2.5 g/100 g of diet), the B group rats were given salt and vitamin C (500 mg/100 mL of drinking water), and the C group rats were controls. The results showed almost the same tendencies between male and female rats. The body weights of the SHR in groups A and B were slightly lower than group C. The amount of food intake in groups A and B was almost the same as group C. The amount of water intake was, in the order from highest to lowest, group A, B and C. The SBP of group A rats exhibited the highest value among the three groups. The SBP of group B rats given vitamin C simultaneously with the salt resulted in a low blood pressure level close to that of the controls (group C). Furthermore, the DBP (diastolic blood pressure) also reflected the antihypertensive effect of vitamin C as well. The heartbeat of the rats was highest in group A, and was comparable to the value in the rats receiving vitamin C simultaneously with salt. For the tests on occult blood and protein in the urine, group A rats showed strong positive reactions, whereas the group B and C rats had decreased results for both tests. The organ weights of the liver, stomach, spleen, adrenal gland and kidneys per 100 g rat body weight were not different among the three groups. The values for the bilirubin content, and the enzyme activities of ALT and AST in the blood showed to be the highest in the male rats of group A. The values from the group B rats decreased near to the normal value like the control group. Vitamin C was found to decrease the blood pressure in SHR, and also to work effectively to protect liver and kidney functions even under the condition of very high blood pressure, as high as 250 mmHg.

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Overweight and increased blood pressure in preschool-aged children.

[Article in English, Lithuanian]

Zaborskis A, Petrauskiene A, Gradeckiene S, Vaitkaitiene E, Bartasiute V.

Institute for Biomedical Research, Eiveniu 4, 3007 Kaunas, Lithuania.

This paper presents the data on height, weight, body mass index, systolic and diastolic blood pressure of 3-7 year old children. A sample of preschoolers (n=1441) was drawn from the kindergartens in Kaunas city (Lithuania). The 5 ( th ), 10 ( th ), 50 ( th ), 90 ( th ) and 95 ( th ) percentiles were estimated for studied variables and the criteria for the overweight and increased blood pressure were calculated. It was shown that body mass index could be used as an indicator of the child's physical development. Its value 14-18 kg/m ( 2 ) indicates an optimal child's growing, value < or = 14 kg/m ( 2 ) - the underweight, value > or =18 kg/m ( 2 ) - the overweight. According to these criteria it was found that 7.4% of 3-7 year old children were underweight, 5.8% overweight. Increased blood pressure (over 90 ( th ) percentile of systolic or/and diastolic blood pressure) had 21.4% of examined children. The prevalence of increased blood pressure was significantly higher in obese than in normal weight children. We conclude that the significant prevalence of childhood overweight and increased blood pressure emerge in preschool aged children. Thus, we recommend investigations of prevention and intervention programs to be used in the preschool setting.

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