Blood pressure control in a population where antihypertensives are given free.

Salako BL, Ajose FA, Lawani E.

Department of Medicine, University of Ibadan, University College Hospital, Ibadan, PMB 5116, Ibadan, Nigeria.

BACKGROUND: Analysis of blood pressure control has shown that optimal blood pressure control is generally low in many studies. Poor adherence to therapeutic plans and non-compliance are perhaps the most important factors responsible for poor control. In most cases poverty has been adduced to be responsible for non-compliance especially in the sub-Saharan Africa. Assessment of blood pressure control in situations where antihypertensives are given free is necessary. OBJECTIVES: To assess blood pressure control in a population where antihypertensives are given free. SETTING: International institute for tropical Agriculture (IITA). DESIGN: Cross-sectional study. SUBJECTS: One hundred and forty three consecutive hypertensive subjects (106 males and 37 females) being followed-up in the medical clinic of the International Institute for Tropical Agriculture (IITA) for variable numbers of years were studied. Blood pressure was considered to be well controlled if it was less than 140/90 mmHg and uncontrolled if higher than 140/90 mmHg. RESULTS: About 51 (36%) of the subjects may be described as being fully controlled on the treatment instituted while 54 (38%) of the subjects were not controlled at all. In about 18% of the patients, the systolic blood pressure alone was controlled while in 8% the diastolic blood pressure alone was controlled. MAIN OUTCOME MEASURES: Level of blood pressure control in this study is poor suggesting that availability of free drug alone is not enough to improve adherence to antihypertensives. CONCLUSION: The percentage of hypertensive patients with optimal blood pressure control in this population is low, although this was higher when compared to a report from a similar study where drugs were not given free to patients. Physicians managing hypertension in such establishments should pay attention to adequate dosing and appropriate combination of drugs.

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Dual blockade of the renin-angiotensin system compared with a 50% increase in the dose of angiotensin-converting enzyme inhibitor: effects on proteinuria and blood pressure.

Kincaid-Smith P, Fairley KF, Packham D.

Epworth Hospital, Richmond, Victoria, Australia. priscillk epworth.org.au

BACKGROUND: Several publications in the past 2 years have demonstrated that combined angiotensin-converting enzyme inhibitors (ACEI) and angiotensin-II receptor antagonist (AIIRA) are more effective in reducing blood pressure and proteinuria in patients with chronic renal disease than ACEI or AIIRA alone. This study compares the effect of increasing the ACEI dose by 50% with that of adding an AIIRA to a standard ACEI dose. METHODS: This study was designed as part of a previous comparison of ACEI with ACEI plus candesartan. Directly after completion of the randomized intervention periods of that study, the dose of ACEI was increased by 50% in all patients. Proteinuria and blood pressure were compared in both groups of patients in the three periods, on standard ACEI, on ACEI plus candesartan and on a dose of ACEI increased by 50%. RESULTS: No significant differences in the primary end-point proteinuria or secondary end-points were observed when the ACEI dose was increased by 50%. Proteinuria was 1.8 g in 24 h on candesartan and ACEI and 2.4 g in 24 h when the ACEI dose was increased by 50% (P<0.02). Systolic blood pressure was 126.6 mmHg on candesartan and ACEI and 134.47 mmHg when the ACEI dose was increased by 50% (P<0.002). Diastolic blood pressure, serum creatinine, urea and potassium were not different between groups. CONCLUSIONS: Standard ACEI plus candesartan is more effective in reducing systolic blood pressure and proteinuria than a 50% increase in ACEI dose. This has implications for the prevention of renal failure in chronic renal disease.

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Association of QT interval with blood pressure in 80-year-old subjects.

Matsumura K, Takata Y, Ansai T, Awano S, Takehara T, Fujii K, Iida M.

Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. matsumk intmed2.med.kyushu-u.ac.jp

Few data are available on the association between the prolonged heart rate-adjusted QT (QTc) interval and high blood pressure in elderly individuals, particularly in subjects over 80 years old. The aim of the present study was to determine the association between the QTc interval and blood pressure in 80-year-old subjects. This study was part of the 8020 Data Bank Survey, which was designed to collect the baseline data of systemic and dental health conditions in 80-year-old subjects. We studied the cross-sectional association of the QTc interval with blood pressure in 642 Japanese (257 men and 385 women), all 80 years old. Mean systolic blood pressure (SBP) rose from 146.0 mmHg in the first quartile of QTc interval to 149.1 mmHg in the second, 154.6 mmHg in the third, and 152.3 mmHg in the fourth quartile (test for trend, p=0.008). Mean diastolic blood pressure (DBP) also rose from 76.9 mmHg in the first quartile of QTc interval to 77.7 mmHg in the second, 81.8 mmHg in the third, and 79.0 mmHg in the fourth quartile (test for trend, p=0.003). We performed multiple regression analysis, controlling for factors known to influence the QTc intervals-e.g., SBP, heart rate, sex, and left ventricular hypertrophy assessed by the voltage amplitudes recorded in the precordial leads of the electrocardiogram. The association between the QTc interval and SBP was highly statistically significant in all analyses. These results show that SBP by itself may influence the QTc interval in very old subjects.

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Retrospective analysis of patients clinical manifestations before and after pheochromocytoma surgery.

Balazovjech I, Davidova H, Breza J.

IInd Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia. bll fmed.uniba.sk

MAIN PURPOSE: A retrospective analysis of presurgical clinical picture and blood pressures of 34 patients with histologically verified pheochromocytoma. Assessment of clinical state, blood pressure and prognosis in the course of patients control hospitalizations from 2001 to 2002. PATIENTS AND METHODS: The study was designed as a synoptic one, based on a retrospective analysis of 34 patients records with histologically verified pheochromocytoma (26 women and 8 men). Our assessments of clinical symptomatology, maximum paroxysmal hypertension values, average blood pressure values in patients with persistent arterial hypertension, arterial hypertension grade and circadian index were based on patients records. Patients epinephrectomies were followed during their control hospitalizations to assess their clinical state. Their blood pressures were evaluated by means of their circadian monitoring. RESULTS: From the 34 patients, 21 were diagnosed with solitary pheochromocytomas. The circadian index persistence analysis prior to the surgery was associated with circadian blood pressure monitoring in 21 patients. It was lost in 57% of patients. During their control hospitalization as many as 82% of patients preserved their circadian blood pressure variability with a more than 10% decrease in the night time, 5 patients did not preserve their circadian blood pressure variability. Seven from the original 34 patients died: Three of them died from their primary disease, one 63-year old man died from shock following tumour extirpation. The death of other 3 patients was not associated with their primary disease. CONCLUSION: Long-lasting survival of patients with pheochromocytoma after surgical treatment--except for those with malignant disease--was demonstrated. Although our assessment of the resulting treatment effects was positive, a long-term follow-up is inevitable because of a difficult pathologic-anatomical verification of the malignant nature of the disease as well as of the risk of tumour relapse assessment. (Tab. 1, Fig. 5, Ref 36.)

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Circadian melatonin concentration rhythm is lost in pregnant women with altered blood pressure rhythm.

Tranquilli AL, Turi A, Giannubilo SR, Garbati E.

Department of Obstetrics and Gynecology, University of Ancona, Salesi Hospital, Ancona, Italy.

We assessed the correlation between the rhythm of melatonin concentration and circadian blood pressure patterns in normal and hypertensive pregnancy. Ambulatory 24-h blood pressure and blood samples every 4 h were monitored in 16 primigravidae who had shown an abnormal circadian blood pressure pattern (eight pre-eclamptic and eight normotensive) in pregnancy and 6-12 months after pregnancy. The circadian rhythm was analyzed by chronobiological measures. Eight normotensive women with maintained blood pressure rhythm served as controls. During pregnancy, melatonin concentration was significantly higher in pre-eclamptic than in normotensive women (pre-eclampsia, 29.4 +/- 1.9 pg/ml, normotensin, altered rhythm, 15.6 +/- 2.1; controls, 22.7 +/- 1.8; p < 0.001). This difference faded after pregnancy, owing to the fall observed in pre-eclampsia (11.8 +/- 3.2 pg/ml, 9.8 +/- 2.1, and 11.1 +/- 2.0, respectively; NS). The rhythm of melatonin concentration was lost in all pregnant women with loss of blood pressure rhythm. After pregnancy, normotensive women showed a reappearance of both melatonin and blood pressure rhythm, whereas pre-eclamptic women showed a reappearance of blood pressure but not melatonin rhythm. The loss of blood pressure rhythm in pregnancy is consistent with the loss of melatonin concentration rhythm. In pre-eclamptic women, the normalization of blood pressure rhythm, while melatonin rhythm remained altered, suggests a temporal or causal priority of circadian concentration of melatonin in the determination of blood pressure trend.

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Does refractive error influence the association of blood pressure and retinal vessel diameters? The Blue Mountains Eye Study.

Wong TY, Wang JJ, Rochtchina E, Klein R, Mitchell P.

Centre for Eye Research Australia, University of Melbourne, East Melbourne.

PURPOSE: To determine if refractive errors influence the association of blood pressure and retinal vessel diameters. DESIGN: Population-based, cross-sectional study. METHODS: Retinal photographs from the right eyes of participants (n = 3,654, aged 49+ years) in the Blue Mountains Eye Study taken during baseline examinations (1992 to 1994) were digitized. The diameter of all retinal vessels located half to one disk diameter from the disk margin was measured using a computer-assisted imaging program. These measurements were combined to provide the average diameters of retinal arterioles and venules of that eye, and the ratio of their diameters, the arteriole-to-venule ratio (AVR). The association of blood pressure and retinal vessel diameters was analyzed before and after correction for refraction using the Bengtsson formula. RESULTS: Before correction, each 10-mm Hg increase in mean arterial blood pressure was associated with a 3.7-microm (95% confidence interval [CI], 3.2-4.3) decrease in arteriolar diameter and a 0.9-microm (95% CI, 0.3-0.9) decrease in venular diameter. After correction for refraction, each 1-mm Hg increase in mean arterial blood pressure was associated with a 3.7-microm (95% CI, 3.2-4.2) decrease in arteriolar diameter and a 0.8-microm (95% CI, 0.3-0.9) decrease in venular diameter. Refraction was not associated with the AVR and had no effect on the association of blood pressure and AVR. CONCLUSION: Refraction had no appreciable effect on the association of blood pressure and retinal vessel diameters or on the AVR. Correction for refraction is important for quantifying absolute retinal vessel caliber, but may not be particularly important in epidemiologic studies investigating the association of generalized retinal arteriolar narrowing and hypertension.

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Body mass index and blood pressure influences on left ventricular mass and geometry in African Americans: The Atherosclerotic Risk In Communities (ARIC) Study.

Fox E, Taylor H, Andrew M, Han H, Mohamed E, Garrison R, Skelton T.

Division of Cardiovascular Diseases, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216-4505, USA. efox medicine.umsmed.edu

A unique interaction between the influences of body mass index and blood pressure on left ventricular mass index and geometry may contribute to the higher prevalence of left ventricular hypertrophy in African Americans. This cross-sectional study assessed separate and joint influences of body mass index and blood pressure on left ventricular mass index and geometry in 1729 African American participants of the Atherosclerotic Risk in Communities Study. The association between both left ventricular mass index and relative wall thickness and body mass index in each blood pressure category and between these variables and blood pressure in each body mass index category was assessed adjusting for age, diabetes status, hypertension medication, and smoking status. We found that left ventricular hypertrophy and concentric geometry were highly prevalent and that body mass index and blood pressure were independently associated with left ventricular mass index. The adjusted association between blood pressure and left ventricular mass index was stronger with higher body mass index categories; however, there was no significant interaction suggesting merely an additive relationship (not synergistic/multiplicative as tested for in the interaction analysis). Although relative wall thickness was greater with higher categories of body mass index and blood pressure, the mean difference in relative wall thickness between body mass index and blood pressure categories was not statistically significant. The effect on left ventricular geometry as measured by relative wall thickness supports the theory that there is a pathophysiological component in the mechanism of hypertrophy.

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The relationship between blood pressure and cognitive performance in the Third National Health and Nutrition Examination Survey (NHANES III).

Suhr JA, Stewart JC, France CR.

Department of Psychology, Ohio University, Athens, OH 45701, USA. suhr ohio.edu

OBJECTIVE: The present study examined the relationship between blood pressure and cognitive performance in 2727 healthy men and women between the ages of 20 and 59 years who participated in the Third National Health and Nutrition Examination Survey (NHANES III). METHODS: Participants were selected from a subsample of 5662 NHANES III respondents who completed an initial home interview, a medical examination, and a series of computerized cognitive tests of visuomotor reaction time, complex psychomotor speed (ie, symbol digit substitution), and verbal learning/attention (ie, serial digit learning). RESULTS: Hierarchical regressions tested the contribution of resting blood pressure to the prediction of performance on each of the cognitive tests. Results indicated that, after controlling for demographic variables (age, sex, race/ethnicity, education) and resting blood pressure, the interaction of systolic blood pressure by age was a significant predictor of performance on the test of verbal learning/attention. Follow-up analyses revealed that higher systolic blood pressure was associated with poorer performance in those younger than 40 years. CONCLUSIONS: Expanding on findings from previous epidemiological studies, the present study reports a small but significant relationship between resting blood pressure and cognitive performance that is particularly evident in younger healthy adults.

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