Relationship between migraine, blood pressure and carotid thickness. A population-based study in the elderly.

Tzourio C, Gagniere B, El Amrani M, Alperovitch A, Bousser MG.

INSERM U 360, Hopital Salpetriere, and Department of Neurology, Hopital Lariboisiere, Paris, France. tzourio chups.jussieu.fr

The relationship between migraine and blood pressure is controversial. We studied the association between migraine and blood pressure in a population-based sample of elderly patients. Participants were 1373 subjects 59-71 years of age. Lifetime migraine was diagnosed according to the International Headache Society criteria by a headache specialist. Blood pressure was measured as well as the carotid intima-media thickness (IMT) which is a good marker of the long-term exposure to high blood pressure. Migraine during life was diagnosed in 140 participants. Mean systolic blood pressure was lower in subjects with migraine than in those without headache (128 mmHg vs. 137 mmHg). There was a significant trend of decreasing frequency of migraine with increasing blood pressure and also with increasing IMT. In this study, migraine was associated with lower levels of blood pressure and with smaller values of carotid wall thickness.

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Nomogram of the relation of brachial-ankle pulse wave velocity with blood pressure.

Yamashina A, Tomiyama H, Arai T, Koji Y, Yambe M, Motobe H, Glunizia Z, Yamamoto Y, Hori S.

Second Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan. akyam tokyo-med.ac.jp

The present study was conducted to make a nomogram of the relation of brachial-ankle pulse wave velocity (baPWV) with blood pressure. In 11,375 subjects (age range: 30 to 79 years) in whom we measured baPWV, multivariate linear regression analysis demonstrated that age, systolic blood pressure, and gender were significant determinants of baPWV. Of them, we selected 5,302 subjects (2,630 men and 2,672 women, age 46 +/- 11 years) with either normal blood pressure or with high blood pressure without other atherosclerotic risk factors. Using data from these subjects, we tried to make an age-derived nomogram and a systolic blood pressure-derived nomogram for in both genders. The regression curve analysis demonstrated significant quadratic curves for both associations. The obtained nomograms were applied to 297subjects with coronary heart disease. Their measured baPWV (1,569 +/- 344 cm/s) was significantly higher than the values calculated from the age-derived nomogram (1,502 +/- 241 cm/s) and the systolic blood pressure-derived nomogram (1,418 +/- 236 cm/s) (p < 0.01). Thus, a nomogram of the relation of baPWV with blood pressure was obtained. The comparison of the measured baPWV with the values calculated from the nomograms may be useful to not to underestimate the real risk for atherosclerotic cardiovascular diseases, including the severity of atherosclerotic vascular damage, reflected by measured baPWV in subjects with different blood pressure levels.

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Effect of deep breathing test on finger blood pressure.

Jagomagi K, Raamat R, Talts J, Lansimies E, Jurvelin J.

Institute of Physiology, University of Tartu, 18 Ulikooli Street, 51014 Tartu, Estonia. kersti ut.ee

BACKGROUND: The deep breathing test (DB) is a simple method to measure heart rate variability. However, in most studies the amplitude of blood pressure oscillations has not been considered and little is known about the influence of the deep breathing test on the blood pressure level. DESIGN: The aim of this study is to investigate the effect of DB on finger blood pressure (FBP). METHODS: Continuous beat-to-beat FBP was recorded by the volume clamp method (Portapres model 2 monitor). RESULTS: Thirteen volunteers were studied before, during and after DB at a fixed rate of six breaths/min. After DB, systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean blood pressure (MBP) were lower than before DB by 9.1, 4.3 and 5.9 mmHg, respectively. There was no significant correlation between the reduction in the BP level and the amplitudes of induced oscillations in blood pressure and heart rate during the deep breathing test. CONCLUSIONS: Deep breathing might be used to reduce blood pressure.

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Diurnal blood pressure pattern may predict the increase of urinary albumin excretion in normotensive normoalbuminuric type 1 diabetes mellitus patients.

Lengyel Z, Rosivall L, Nemeth C, Toth LK, Nagy V, Mihaly M, Kammerer L, Voros P.

II Department of Medicine of Szent Istvan Hospital, Semmelweis University, Budapest, Hungary.

To characterise the relationship between diurnal blood pressure and the subsequent increase of urinary albumin excretion (UAE) in normotensive normoalbuminuric type 1 diabetic patients, ambulatory blood pressure monitoring (ABPM) was performed in 53 patients, who were then followed for 5 years. Albumin excretion rate changed from 12.4 (8.9-17.2) to 29.3 (15.2-47.0) mg/day. Macroalbuminuria developed in 2 (3.8%), microalbuminuria in 22 (41.5%) patients, 29 (54.7%) remained normoalbuminuric. Night-time diastolic blood pressure was significantly higher (64.3+/-6.5 vs. 60.9+/-5.5 mmHg, P<0.05), diastolic diurnal index significantly lower (15.5+/-9.7 vs. 22.3+/-6.2%, P<0.01) in patients who later progressed to micro- or macroalbuminuria. Diastolic diurnal index (r=-0.40; P<0.01) and nocturnal diastolic pressure (r=0.35; P<0.01) were correlated to the change in albumin excretion. In a multivariate analysis model with the change of albumin excretion as dependent, and means and diurnal indices of systolic and diastolic blood pressure, baseline UAE, cholesterol, triglycerides, HbA1c and retinopathy as independent parameters (r=0.68; P=0.001), diurnal index for diastolic blood pressure (beta=-0.30; r=0.013), baseline HbA1c (beta=0.32; P=0.010) and retinopathy (beta=0.44; P=0.001) were significant independent correlates. We conclude that the relative increase of nocturnal blood pressure is associated with the subsequent increase of albuminuria, which in turn is predictive of overt diabetic nephropathy.

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Spectral analysis of muscle sympathetic nerve activity in heat-stressed humans.

Cui J, Zhang R, Wilson TE, Crandall CG.

Institute for Exercise and Environmental Medicine, Presbyterian Hospital of Dallas, 7232 Greenville Ave., Dallas, TX 75231, USA.

Whole body heating increases muscle sympathetic nerve activity (MSNA); however, the effect of heat stress on spectral characteristics of MSNA is unknown. Such information may provide insight into mechanisms of heat stress-induced MSNA activation. The purpose of the present study was to test the hypothesis that heat stress-induced changes in systolic blood pressure variability parallel changes in MSNA variability. In 13 healthy subjects, MSNA, electrocardiogram, arterial blood pressure (via Finapres), and respiratory activity were recorded under both normothermic and heat stress conditions. Spectral characteristics of integrated MSNA, R-R interval, systolic blood pressure, and respiratory excursions were assessed in the low (LF; 0.03-0.15 Hz) and high (HF; 0.15-0.45 Hz) frequency components. Whole body heating significantly increased skin and core body temperature, MSNA burst rate, and heart rate, but not mean arterial blood pressure. Systolic blood pressure and R-R interval variability were significantly reduced in both the LF and HF ranges. Compared with normothermic conditions, heat stress significantly increased the HF component of MSNA, while the LF component of MSNA was not altered. Thus the LF-to-HF ratio of MSNA oscillatory components was significantly reduced. These data indicate that the spectral characteristics of MSNA are altered by whole body heating; however, heat stress-induced changes in MSNA do not parallel changes in systolic blood pressure variability. Moreover, the reduction in LF component of systolic blood pressure during heat stress is unlikely related to spectral changes in MSNA.

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The relationship between diastolic dysfunction and level of blood pressure in Blacks.

Ike SO, Onwubere BJ.

Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria. sobiajuluike yahoo.com

INTRODUCTION AND OBJECTIVE: Patients with essential hypertension are predisposed to impaired left ventricular relaxation, and consequently, diastolic dysfunction. Because diastolic dysfunction is an early marker of the pathological effects of hypertension on the heart, evaluating the relationship between the development of diastolic dysfunction and the level of blood pressure becomes pertinent. The aim of our study was to evaluate this relationship. PATIENTS AND METHODS: Between November 1998 and January 2000, 692 consecutive hypertensive patients, all Blacks, attending the medical outpatient and cardiac clinics of the University of Nigeria Teaching Hospital, Enugu, Nigeria were screened for the study. One hundred five of them, divided into 3 groups of 35 each according to levels of blood pressure, met the inclusion criteria. Thirty-five age and sex-matched normotensives were used in the control group. Clinical parameters, including systolic and diastolic blood pressures, and echocardiographic indices, were measured. RESULTS: A definite positive relationship between diastolic dysfunction and the level of the blood pressure was established, with the degree of diastolic dysfunction proportionate to increasing level of blood pressure (P<.001). A significant difference between the mean values of the diastolic dysfunction index (A/E ratio) in the hypertensive groups was evident (P<.05). While there was virtually no correlation found between normotensives and diastolic dysfunction (r=0.07), direct relationships existed between moderate and severe hypertensives and diastolic dysfunction (r=0.24 and 0.39 respectively). CONCLUSION: This study has demonstrated that diastolic dysfunction was significantly and progressively higher in the hypertensive groups when compared to the normotensive control group. Further studies, with a large number of patients, are recommended to determine population-based data on diastolic dysfunction and its other confounding variables in our environment, independent from the level of blood pressure.

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The ability of traditional vital signs and shock index to identify ruptured ectopic pregnancy.

Birkhahn RH, Gaeta TJ, Van Deusen SK, Tloczkowski J.

Department of Emergency Medicine, New York Methodist Hospital, Brooklyn, NY 11215, USA. rhbirkhahn pol.net

OBJECTIVE: This study evaluated the correlation between vital signs and hemoperitoneum and the association between abnormal vital signs and tubal rupture. STUDY DESIGN: With the use of a retrospective case-control design, the initial heart rate, systolic blood pressure, and heart rate/systolic blood pressure were correlated with respect to degree of hemoperitoneum; predictive values were calculated. RESULTS: Fifty-two patients were studied (25 ruptured pregnancies and 27 unruptured ectopic pregnancies). Correlation coefficients were heart rate (r=0.50; 95% CI, 0.26-0.68), systolic blood pressure (r=-0.34; 95% CI, -0.56 to -0.08), and heart rate/systolic blood pressure (r=0.69; 95% CI, 0.51-0.81). The sensitivity for heart rate, systolic blood pressure, and heart rate/systolic blood pressure was 28%, 36%, and 72% respectively; the specificity was 96%, 96%, and 67%, respectively. CONCLUSION: Normal vital signs alone are poor predictors of ruptured ectopic pregnancy; the heart rate/systolic blood pressure correlates best with the quantity of intraperitoneal hemorrhage.

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Blood pressure, C-reactive protein, and risk of future cardiovascular events.

Blake GJ, Rifai N, Buring JE, Ridker PM.

Center for Cardiovascular Disease Prevention and the Donald W. Reynolds Center for Cardiovascular Research, Boston, Mass, USA. gblake mater.ie

BACKGROUND: Accumulating data suggest a link between blood pressure and vascular inflammation. METHODS AND RESULTS: We examined the relationship between blood pressure, C-reactive protein (CRP), and incident first cardiovascular events among 15 215 women followed prospectively over a median of 8.1 years. In cross-sectional analyses at baseline, median levels of CRP for women with blood pressure <120/75, 120 to 129/75 to 84, 130 to 139/85 to 89, 140 to 159/90 to 94, and > or =160/95 mm Hg were 0.96, 1.42, 2.20, 2.82, and 3.34 mg/L, respectively (P for trend <0.0001). Increasing categories of blood pressure were significant predictors of CRP levels at baseline. In prospective analyses, both elevated CRP levels (> or =3 mg/L) and increasing categories of blood pressure were independent determinants of future cardiovascular events, and CRP had incremental prognostic value at all levels of blood pressure. The adjusted hazard ratio for women with blood pressure > or =160/95 mm Hg and CRP levels > or =3 mg/L was 8.31 (95% CI, 4.44 to 15.55, P<0.0001) compared with those with blood pressure <120/75 and CRP levels <3 mg/L. After participants had been divided into 4 groups on the basis of CRP levels (<3 or > or =3 mg/L) and blood pressure levels (<130/85 or > or =130/85), the risk factor-adjusted hazard ratios were as follows: low CRP/low blood pressure, 1.0; high CRP/low blood pressure, 1.87 (P=0.002); low CRP/high blood pressure, 2.54 (P<0.0001); and high CRP/high blood pressure, 3.27 (P<0.0001). CONCLUSIONS: CRP and blood pressure are independent determinants of cardiovascular risk, and their predictive value is additive.

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