Clinical decision-making in hypertension using an automated (BpTRU) measurement device.

Graves JW, Nash C, Burger K, Bailey K, Sheps SG.

Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA. graves.john mayo.edu

Mercury sphygmomanometers are being removed from clinical practice in the United States due to environmental concerns about mercury toxicity. Accurate blood pressure measurement is central to high-quality hypertension management. In this study of 106 patients, the BpTRU(TM) device was compared to nurse blood pressure measurements that complied with all the JNC VII/American Heart Association guidelines in evaluation of a random casual blood pressure. The intermethod difference in systolic blood pressure was +1.8+/-5.1 mmHg, and for diastolic blood pressure it was 4.8+/-5.1 mmHg (both P<0.001). For the primary study end point of clinical decision-making, there was 92% (97/106) agreement between the hypertension nurse specialist and the BpTRU (kappa 0.8280, 95% confidence interval, 0.721-0.9350). The oscillometric blood pressure measurement with the BpTRU is recommended as a replacement for poorly performed auscultatory blood pressure measurement in clinical practice.

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Blood pressure and left ventricular geometric pattern determine diastolic function in hypertensive myocardial hypertrophy.

Muller-Brunotte R, Kahan T, Malmqvist K, Edner M; Swedish ibesartan left ventricular hypertrophy investigation vs atenolol (SILVHIA).

Division of Internal Medicine, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden.

Abnormal left ventricular (LV) diastolic relaxation is an early sign of hypertensive heart disease. Whether LV diastolic dysfunction is caused directly by raised blood pressure, or by structural changes related to LV hypertrophy remains controversial. We examined 115 hypertensive patients with LV hypertrophy, and two age- and gender-matched groups (38 hypertensive patients without LV hypertrophy and 38 normotensive subjects) by echocardiography to assess determinants of LV diastolic function, and the relation between diastolic function and LV geometric pattern. Diastolic function was evaluated by the E/A-ratio, E wave deceleration time (E-dec), isovolumic relaxation time (IVRT), and the atrioventricular plane displacement method (AV-LA/AV-mean). A multivariate analysis (including gender, age and body mass index) shows diastolic function to be inversely related to blood pressure, LV wall thickness and LV mass, but not to LV end diastolic diameter. The E/A-ratio generally showed the strongest relations. Only the E/A-ratio and AV-LA/AV-mean were related to heart rate. By stepwise regression analysis, age was the strongest determinant for the E/A-ratio, E-dec and AV-LA/AV-mean, followed by systolic blood pressure, heart rate and LV wall thickness. For IVRT, however, LV wall thickness appeared strongest, followed by systolic blood pressure and age. In conclusion, blood pressure and LV wall thickness both have independent influence on LV diastolic function. Age and blood pressure are the most important factors to determine the E/A-ratio and E-dec, whereas LV geometry and blood pressure are most important when IVRT is used. AV-LA/AV-mean may not be useful in hypertensive LV hypertrophy.

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Loss of circadian rhythm of blood pressure following acute stroke.

Jain S, Namboodri KK, Kumari S, Prabhakar S.

Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India 160012. drsjain glide.net.in

BACKGROUND: Epidemiology of acute stroke in developing countries differs from that in the developed world, for example, the age at stroke, risk factors, subtypes of stroke and prognosis. Hypertension remains a dominant risk factor and prognostic indicator in patients with stroke in all communities. The risk of stroke is directly related to elevations of blood pressure. A number of clinical studies have shown that the control of hypertension leads to a reduction in the incidence of stroke in a community. However there is still considerable controversy surrounds the changes in blood pressure in various subtypes of strokes and problem of management of elevated BP after stroke. We studied the circadian rhythm of blood pressure in patients following acute stroke. METHODS: To study the circadian rhythm of blood pressure, fifty consecutive patients with an acute stroke who were admitted to medical emergency within 120 hours of onset were included in the study. After a detailed history and clinical examination, a continuous blood pressure monitor (Spacelab 90207) was attached on the side ipsilateral to intracranial lesion (unaffected arm). The blood pressure was recorded for 24 hours at 15 minutes interval during daytime (6.00 am-6.00 pm) and 20 minutes interval overnight (6 pm to 6 am). RESULTS: Risk factors for stroke in 50 patients included hypertension in 31(62%), diabetes mellitus in 4 (8%), smoking in 13 (26%) and previous history of transient ischemic attack in 7 (14%) patients. Mean systolic pressure and diastolic pressure at admission were higher in patients with hemorrhagic stroke -29 patients (177 +/- 24 mmHg and 105 +/- 19 mmHg respectively) compared to patients with ischemic strokes-21 patients (150 +/- 36 mm Hg and 89 +/- 18 mm Hg respectively, p value <0.01 in both comparisons). The normal diurnal variation in blood pressure (night time dipping of more than 10%) was abolished in 44 (88%) of patients. Out of 44 nondippers, 29 patients showed reverse dipping i.e. rise of BP during night time compared to day time levels. None of the risk factors, clinical or laboratory variables, type of stroke or blood pressure changes differed significantly between these two groups. CONCLUSIONS: Therefore, we showed a pathologically reduced or abolished circadian BP variation after stroke. Absence of normal dipping results in a higher 24 hour blood pressure load and may have more target organ damage than those with normal diurnal variation of blood pressure.

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Adaptive defense use and resting blood pressure in a population-based sample.

MacGregor MW, Davidson KW, Barksdale C, Black S, MacLean D.

University of Saskatchewan, Saskatoon, SK, Canada.

OBJECTIVES: There is an accumulating body of research related to the psychosomatic study of blood pressure. One variable that has received attention is defense use. We examined the relation between defense use and blood pressure in men and women of different ages. METHODS: A random sample of 667 participants was selected from a population-based study. Resting blood pressure was obtained, and each participant was rated for defense use by a trained observer using Defense-Q. An Adaptive Defense Profile (ADP) score was calculated for each participant, and this score was related to blood pressure. RESULTS: Regression analyses revealed a significant main effect for the ADP score for both diastolic and systolic blood pressure. Those persons with higher ADP scores had lower diastolic and systolic blood pressure. As well, a significant Age x Sex x ADP score interaction was found for diastolic blood pressure. Older women with a less ADP score had higher diastolic blood pressure. CONCLUSIONS: These findings suggest the continued investigation of defense use and blood pressure.

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Hostility, interpersonal interactions, and ambulatory blood pressure.

Brondolo E, Rieppi R, Erickson SA, Bagiella E, Shapiro PA, McKinley P, Sloan RP.

Department of Psychology, St. John's University, New York, NY, USA. brondole stjohns.edu

OBJECTIVE: This study examined aspects of the transactional model of hostility and health by investigating relationships among hostility, interpersonal interactions, and ambulatory blood pressure in a healthy community sample. MATERIALS AND METHODS: Participants included 65 female and 39 male healthy adults between the ages of 18 and 46 years. Ambulatory blood pressure (ABP) and diary data on mood and social interactions were obtained every 20 minutes for 1 day. Mixed models regression analyses were used to evaluate the relationships among hostility, interpersonal interactions, and ABP. RESULTS: Trait hostility was positively associated with the frequency and intensity of negative interactions and was negatively associated with the frequency and intensity of positive interactions. Interacting with others was associated with increases in systolic blood pressure (SBP) and diastolic blood pressure (DBP). The magnitude of the increase in blood pressure was positively associated with the degree to which the interaction was perceived as negative. Hostility was not directly associated with ABP/heart rate (HR) or ABP/HR responses during any interactions or negative interactions. However, there was an interaction between hostility and negative interaction intensity for DBP, suggesting that hostility moderates the effects of negative interactions on DBP. Specifically, increases in the intensity of negative interactions were associated with increases in DBP for participants with high, but not low, hostility. CONCLUSIONS: The results provide partial support for the notion that hostility may be associated with risk for cardiovascular disease through its effects on interpersonal interactions and their cardiovascular correlates.

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Parental history of hypertension and coping responses predict blood pressure changes in black college volunteers undergoing a speaking task about perceptions of racism.

Clark R.

Department of Psychology, Wayne State University, Detroit, MI 48202, USA. rclark sun.science.wayne.edu

OBJECTIVE: This investigation explored the relationship of coping responses and parental history of hypertension to task-induced blood pressure changes. MATERIALS AND METHODS: The sample consisted of 215 black college student volunteers (median age = 25.95 y). During the speaking task, participants responded to standardized questions about perceptions of intra-ethnic and inter-ethnic group racism. Systolic blood pressure and diastolic blood pressure were measured via an automated blood pressure monitor. Usual ways of coping with intra-ethnic group racism were assessed with the COPE Scale, and parental history of hypertension (PHH) was self-reported by participants. RESULTS: Findings from the final step of hierarchical general linear models indicated that the main effect of emotion-focused coping was negatively associated with diastolic blood pressure (p = 0.02) and systolic blood pressure (p = 0.002) changes. Further, these analyses revealed that PHH interacted: (1) with the coping responses of planning (p = 0.007) and denial (p = 0.002) to predict changes in systolic blood pressure and (2) with the planning coping response to predict diastolic blood pressure changes (p = 0.02). The direction of these effects indicated that among participants who were high in these coping responses, participants who also had a positive PHH had larger blood pressure changes. Regression analyses also revealed that PHH interacted with the cognitive coping response (p = 0.01) to predict changes in systolic blood pressure. The direction of this effect indicated that among participants who were low in this coping response, participants who also had a positive PHH had larger systolic blood pressure changes. CONCLUSION: This study highlights the importance of examining the joint contribution of biological and psychosocial parameters to blood pressure reactivity in blacks.

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Blood pressure reactions to stress and the prediction of future blood pressure: effects of sex, age, and socioeconomic position.

Carroll D, Ring C, Hunt K, Ford G, Macintyre S.

School of Sport and Exercise Sciences, University of Birmingham, Birmingham, England. carrolld bham.ac.uk

OBJECTIVE: This epidemiological study examined whether the magnitude of blood pressure reactions to mental stress was associated with future blood pressure and whether the strength of association was affected by sex, age, and socioeconomic position. MATERIALS AND METHODS: Resting blood pressure was recorded at initial baseline and in response to mental stress. Five-year follow-up resting blood pressure data were available for 990 (68%) of the participants; 333 were 23 years old at the time of stress testing, 427 were 43, and 230 were 63. There were 541 women and 449 men; 440 came from manual and 550 from nonmanual occupation households. RESULTS: Systolic blood pressure reactions to stress correlated positively with follow-up systolic blood pressure; no association was found for diastolic blood pressure reactions and follow-up diastolic blood pressure. In multivariate tests, systolic reactivity remained predictive of follow-up systolic blood pressure and accounted for 2.3% of the variance not explained by age, body mass index, and initial baseline systolic blood pressure. Systolic and diastolic reactivity predicted 5-year upward drift in systolic and diastolic blood pressure respectively, accounting for an additional 3.6% and 2.9% of variance, respectively, in multivariate models. The predictive value of reactivity was greater for participants from manual occupation households and tended to be greater for men. CONCLUSIONS: The results of this study indicate that blood reactions to mental stress predict future blood pressure status and the increase in resting blood pressure over time. The magnitude of the prediction appears to vary with socioeconomic position and sex.

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Associations between the human insulin gene 5' VNTR and clinical variables of the renin-angiotensin system.

Frossard PM, Parvez SH, Lestringant GG, Kureshi NS.

Department of Pathology, Faculty of Medicine and Health Sciences, Al Ain, United Arab Emirates. frossard emirates.net.ae

BACKGROUND: Blood pressure regulation is a complex process influenced by numerous environmental and genetic factors. Consequently, there's no cookie-cutter approach for the elucidation of of the genetic mechanism involved. One of the goals of molecular geneticists in the field of hypertension is to unravel the genetic architecture of blood pressure regulation. METHODS: With the aim of identifying quantitative trait loci participating in the control of blood pressure, we carried out a pilot study on a sample population of middle-aged, U.S. Caucasians (44 subjects). The design of the study was to search for associations between clinical variables of blood pressure regulation pertaining to the renin-angiotensin-aldosterone system (systolic and diastolic blood pressures, urinary excretion of sodium, potassium and aldosterone, plasma renin activity) and a genetic marker at a candidate gene locus - the human insulin gene (INS) RESULTS: We observed significant associations between a variable number of tandem repeats (VNTR) marker (visualized as a biallelic, class I/class III marker system) localized at the 5' end of the human INS gene, and plasma renin activity and urinary sodium, potassium and aldosterone. CONCLUSION: Our results indicate that between 6 and 10 QTLs with comparable effects could be involved in blood pressure regulation via the rennin angiotensin system.

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