Blood Pressure In Mild Hypertension Research Articles

Low Frequency Regular Exercise Improves Flow-Mediated Dilatation of Subjects with Mild Hypertension

Although exercise is recommended for the primary prevention of hypertension, and although it is generally known to have a beneficial effect on endothelial function, working individuals often find it difficult to maintain a consistent exercise regimen. In the present study, therefore, we examined the effects of infrequently performed exercise on flow-mediated dilatation (FMD), which is an index of endothelial function, in 15 subjects with hypertension (mild hypertensives) and 10 normotensive subjects (normotensives). All subjects performed mild bicycle exercise twice a week for 12 weeks. To assess the FMD, the diameter of the brachial artery was measured using ultrasound at baseline, during reactive hyperemia, and following sublingual administration of nitroglycerin. Measurement of these parameters was performed twice, at the beginning and the end of the exercise program. At the baseline, FMD was significantly lower in the mild hypertensives than in the normotensives. Nitroglycerin-mediated dilatation (NTG-D) was similar in the two groups. The exercise decreased blood pressure in the mild hypertensives, and increased high-density lipoprotein (HDL) cholesterol in both groups. The exercise improved FMD without altering NTG-D in the mild hypertensives, but did not result in any change in the normotensives. Multiple regression analysis revealed that the elevation in FMD was positively associated with changes in HDL cholesterol, and negatively associated with changes in plasma norepinephrine and systolic blood pressure. These findings suggest that regular exercise at a low frequency improves FMD, and thereby endothelial function, and lowers blood pressure in mild hypertensives.

1P-0292 Vitamin E can reduce blood pressure in mild hypertensives

1P-0292 Vitamin E can reduce blood pressure in mild hypertensives

The influence of marital adjustment on 3-year left ventricular mass and ambulatory blood pressure in mild hypertension.

Of psychosocial stressors, job strain has been associated with a sustained increase in blood pressure. The impact of marital factors on blood pressure and target organ has not been explored. To evaluate whether marital adjustment, measured at baseline by self-report (Dyadic Adjustment Scale) influences left ventricular mass index (LVMI) and ambulatory blood pressure measured over 3 years in patients with mild hypertension. A prospective cohort study was conducted on 103 cohabiting males or females, including 72 with technically adequate echocardiograms, who at baseline were unmedicated, employed, and living with a significant other, all for a minimum of 6 months and had repeated elevated office diastolic blood pressure. Left ventricular mass by M-mode echocardiography indexed to body surface area and blood pressure were measured by ambulatory blood pressure every 15 minutes (daytime) and hourly between 11 PM and 7 AM. Marital adjustment, smoking, drinking, and baseline LVMI contributed significantly to the prediction of 3-year LVMI (semipartial correlation, sr(2) = 0.04, 0.07, 0.03, and 0.22; P =.03,.008,.08, and <.001, respectively) together accounting for 36% of the total variability in follow-up LVMI. Three-year ambulatory blood pressure measures were not significantly related to marital adjustment but there were correlations with Dyadic Adjustment Scale subscales. Low or high levels of spousal contact during 3-year ambulatory blood pressure monitoring were associated with an increase or decrease of 3-year, 24-hour diastolic blood pressure, consistent with the quality of marital adjustment (P =.04) or marital satisfaction (Dyadic Adjustment Scale subscale, P =.008). In a cohort of subjects with mild essential hypertension, marital adjustment had an influence on 3-year LVMI. Depending on the quality of marital adjustment, spousal contact at 3 years was associated with an increase or decrease of 3-year diastolic blood pressure. Confirmation of these results, including objective marital assessment and the participation of normotensive subjects, is required. Arch Intern Med. 2000;160:3453-3458.

Effect of Medium-term Supplementation with a Moderate Dose of n-3 Polyunsaturated Fatty Acids on Blood Pressure in Mild Hypertensive Patients

Several studies have shown that n-3 polyunsaturated fatty acids (n-3 PUFA) are able to lower blood pressure (BP) in humans, but large doses of fish oils have been often used. Moreover, most of the studies available in the literature were not able to evaluate the specific effects of n-3 PUFA because they employed fish oils which contain, together with n-3 PUFA, many other different components. The aim of this preliminary study was to evaluate if medium-term supplementation with a moderate dose of highly purified eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) ethyl esters is able to reduce BP in mild hypertensive patients. Sixteen mild essential hypertensive (diastolic BP: 95–104 mm Hg), non-diabetic, normolipidemic male outpatients and 16 normotensive male controls were recruited to participate in the study. Both hypertensive and control subjects were randomly assigned to receive either EPA and DHA ethyl esters (2.04 g EPA and 1.4 g DHA) as active treatment or olive oil (4 g/day) as a placebo for a period of 4 months. These subjects were followed up with 24-hour ambulatory BP monitoring and blood chemistry analyses at 2 and 4 months of treatment and 2 months after its discontinuation. The intake of n-3 PUFA was checked by red blood cell (RBC) phosphatidylcholine (PC) fatty acid composition. The effect of n-3 PUFA on BP in the active group was maximum after 2 months. Both systolic (−6 mm Hg, p<0.05) and diastolic (−5 mm Hg, p<0.05) BP significantly decreased during the n-3 PUFA ethyl ester supplementation. No further effect was observed at 4 months with a return to baseline values during the recovery period. These data indicate that 4 g/day of highly purified EPA+DHA ethyl esters are able to favorably affect BP in mild hypertensives.

Long term changes of 24-hour hour ambulatory blood pressure in mild hypertension: A 4-year follow-up study

Long term changes of 24-hour hour ambulatory blood pressure in mild hypertension: A 4-year follow-up study

Stopping antihypertensive drug therapy in elderly people—a dangerous experiment?

Journal of Internal MedicineVolume 235, Issue 6 p. 577-579 Free Access Stopping antihypertensive drug therapy in elderly people—a dangerous experiment? Professor P. Lund-Johansen, Corresponding Author Professor P. Lund-Johansen Department of Heart Disease, Haukeland Hospital, University of Bergen, Bergen, NorwayDepartment of Heart Disease, 5021 Haukeland Hospital, Bergen, Norway.Search for more papers by this author Professor P. Lund-Johansen, Corresponding Author Professor P. Lund-Johansen Department of Heart Disease, Haukeland Hospital, University of Bergen, Bergen, NorwayDepartment of Heart Disease, 5021 Haukeland Hospital, Bergen, Norway.Search for more papers by this author First published: June 1994 https://doi.org/10.1111/j.1365-2796.1994.tb01264.xCitations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat References 1 Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure: the Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNCV). Arch Int Med 1993: 153: 154– 83. 2 Zanchetti A., Chalmers JP, Arakawa K.. Gyarfas I., Hamet P., Hansson L., Julius S., MacMahon S., Mancia G., Menard J., Omae T., Reid J., Safar M. The 1993 guidelines for the management of mild hypertension: memorandum from a WHO/ISH meeting. Blood Pressure 1993: 2: 86– 100. 3 SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. JAMA 1991: 265: 3255– 64. 4 Veterans Administration cooperative study group. Return of elevated blood pressure after withdrawal of antihypertensive drugs. Circulation 1975: 51: 1107– 13. 5 Medical research council working party on mild hypertension. Course of blood pressure in mild hypertensives after withdrawal of long term antihypertensive treatment. Br Med J 1986: 293: 988– 92. 6 Levinson PD, Khatri IM, Freis ED. Persistence of normal BP after withdrawal of drug treatment in mild hypertension. Arch Intern Med 1982: 142: 2265– 8. 7 Ekblom T., Lindholm LH, Odén A. Dahlöf B., Hansson L., Wester P-O. et al. A 5-year prospective, observational study of withdrawal of antihypertensive treatment in elderly. J Intern Med 1994: 235: 581– 8. 8 Straand J., Fugelli P., Laake K. Withdrawing long-term diuretic treatment among elderly patients in general practice. Family Practice 1993; 10: 38– 42. 9 Langford HG, Blaufox D., Oberman A., Hawkins M., Curb JD, Cutter GR et al. Dietary therapy slows the return of hypertension after stopping prolonged medication. JAMA 1985: 253: 657– 64. 10 Devereux R., Alderman MH. Role of preclinical cardiovascular disease in the evolution from risk factor exposure to development of morbid events. Circulation 1993; 88 (Part 1): 1444– 55. 11 Lund-Johansen P., Omvik P. Hemodynamic patterns of untreated hypertensive disease. In: JH Laragh, B. Brenner, eds. Hypertension: Pathophysiology, Diagnosis and Management. New York: Raven Press, 1990: 305– 27. Citing Literature Volume235, Issue6June 1994Pages 577-579 ReferencesRelatedInformation

Relaxation therapy and continuous ambulatory blood pressure in mild hypertension: a controlled study.

To determine the long term effects of relaxation therapy on 24 hour ambulatory intra-arterial blood pressure in patients with mild untreated and uncomplicated hypertension. Four week screening period followed by randomisation to receive either relaxation therapy or non-specific counselling for one year. Ambulatory intra-arterial blood pressure was measured before and after treatment. Outpatient clinic in Amsterdam's university hospital. 35 Subjects aged 20-60 who were being treated by general practitioners for hypertension but were referred to take part in the study. At three consecutive screening visits all subjects had a diastolic blood pressure without treatment of 95-110 mm Hg. Subjects were excluded if they had damaged target organs, secondary hypertension, diabetes mellitus, a cholesterol concentration greater than 8 mmol/l, or a history of malignant hypertension. The group allocated to relaxation therapy was trained for eight weeks (one hour a week) in muscle relaxation, yoga exercises, and stress management and continued exercising twice daily for one year with monthly visits to the clinic. The control group had the same attendance schedule but had no training and were requested just to sit and relax twice a day. All subjects were asked not to change their diet or physical activity. Changes in ambulatory intra-arterial blood pressure after one year of relaxation therapy or non-specific counselling. Mean urinary sodium excretion, serum concentration of cholesterol, and body weight did not change in either group. Diastolic pressures measured by sphygmomanometry were 2 and 3 mm Hg lower in subjects in the relaxation group and control group respectively at the one year follow up compared with initial readings. The mean diastolic ambulatory intra-arterial pressure during the daytime had not changed after one year in either group, but small treatment effects could not be excluded: the mean change for the relaxation group was -1 mm Hg (95% confidence interval -6 to 3.9 mm Hg) and for the control group -0.4 mm Hg (-5.3 to 4.6 mm Hg). Mean ambulatory pressure in the evening also had not changed over the year, and in both groups nighttime pressure was 5 mm Hg higher. The variability in blood pressure was the same at both measurements. Relaxation therapy was an ineffective method of lowering 24 hour blood pressure, being no more beneficial than non-specific advice, support, and reassurance--themselves ineffective as a treatment for hypertension.

Fish oils in cardiovascular disease.

Although several studies have reported an inverse relationship between the dietary history of fish intake and the prospective incidence of death from coronary heart disease, it is unclear whether these results represent the effects of n-3 fatty acids themselves or whether they merely reflect a more fundamental alteration in diet, such as a reduction in saturated fatty acids. n-3 fatty acids alter platelet eicosanoid formation, replacing arachidonate derived thromboxane (Tx)A2 with the biologically inert TxA3. However, they are a relatively inefficient approach to platelet inhibition. This is evident from results obtained in a model of coronary thrombosis followed by thrombolysis with tissue plasminogen activator (tPA). By contrast, high doses of n-3 fatty acids (15 g day-1) significantly reduced blood pressure in mild hypertensives in a double-blind, controlled study characterized by a prolonged run-in period and adequate follow-up. Fish oils inhibit the vascular proliferative response to injury in a variety of animal models, apparently independently of their effects on lipoprotein metabolism. Recent results imply that they may selectively interfere with the vascular expression of mitogenic peptides.

The effect of slow‐release nicardipine on ambulatory and clinic blood pressure in mild hypertension.

1. The antihypertensive efficacy of a long acting formulation of the calcium channel blocking drug, nicardipine, was assessed using clinic and ambulatory (Remler M2,000) blood pressure measurements. 2. Eleven patients with essential hypertension (mean +/- s.e. mean; 173 +/- 6.6/103 +/- 1.9 mmHg) completed a randomised double-blind, placebo-controlled, cross-over study. The dose of nicardipine used was 60 mg twice daily for 4 weeks. 3. Mean ambulatory blood pressure was reduced from 164 +/- 5.3/97 +/- 2.9 to 151 +/- 5.2/88 +/- 2.4 mmHg (P less than 0.01); this effect was shown to be sustained for 8 h after the morning dose. Mean ambulatory heart rate was not significantly affected by treatment. 4. Clinic lying systolic blood pressure was reduced on treatment from 169 +/- 7.1 to 157 +/- 5.9 mmHg (P less than 0.2) and diastolic blood pressure from 99 +/- 3.6 to 89 +/- 3.9 mmHg (P less than 0.05). 5. One patient was withdrawn because of dizziness and flushing while on nicardipine; vasodilatory side effects such as headache, palpitations and flushing on nicardipine were noted by three patients. 6. We conclude that the long acting formulation of nicardipine studied in a dose of 60 mg twice daily is effective as monotherapy and is relatively well tolerated in mild hypertension. 7. This study highlights the importance of ambulatory blood pressure measurement in detecting significant changes in blood pressure, thereby permitting the study of small numbers of patients.

Comparison of Once‐Daily Captopril or Enalapril in Mild Essential Hypertension

The purpose of this study was to assess the effect of a daily low dose of the angiotensin-converting enzyme (ACE) inhibitors, captopril or enalapril, in mild essential hypertension. Nine men with seated diastolic blood pressure between 95 and 104 mm Hg on placebo participated in the study. After one month of placebo, captopril 25 mg was administered; blood pressure, heart rate, ACE activity and plasma renin activity were measured hourly for 4 hours. Each patient then received captopril 50 mg once daily for 8 weeks and similar measurements were made 24 hours post-dose every 2 weeks. After another month of placebo, the identical protocol was repeated after enalapril 5 mg. Although blood pressure and ACE activity decreased significantly (P less than 0.05) within 2-4 hours of the acute doses of each inhibitor, neither captopril or enalapril produced significant reductions 24 hours after the small daily dose. Thus, neither ACE inhibitor alone was adequate to control blood pressure in mild hypertension when given once daily during 8 weeks of treatment.

Drug treatment of mild hypertension to reduce the risk of CHD: Is it worth‐while?

Although hypertension is regarded as a causal factor for coronary heart disease (CHD) a reduction in the risk of CHD as a result of lowering blood pressure in mild hypertension could not be demonstrated. This conclusion is based on an overview analysis of all published randomized trials in mild hypertension, including more than 25,000 subjects contributing over 125,000 person years of observation. There is evidence that treatment reduces the risk of CHD in moderate to severe hypertension. In addition the pooling of four clinical trials with treated control groups indicates a reduction in the risk of CHD of borderline significance with beta-blockers or aggressive treatment when compared with standard treatment (mostly diuretics). The failure of drug treatment to reduce the risk of CHD in mild hypertension is consistent with the results from epidemiological studies because of derangement of the lipid profile induced by diuretics and beta-blockers.

Relationship between risk of stroke and systolic blood pressure in mild hypertension

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Cardiovascular reactivity to psychological stress in aerobically trained versus untrained mild hypertensives and normotensives.

Cardiovascular reactivity to video game and mental arithmetic stressors was compared among three groups of men: aerobically trained mild hypertensives, untrained mild hypertensives, and a comparison group of untrained normotensives. Relative to the untrained hypertensives, the trained hypertensives reacted to the video game with marginally smaller systolic blood pressure and diastolic blood pressure, but there were no significant differences between these groups in reactivity during the mental arithmetic task. Comparisons between each hypertensive group and the normotensive group showed that blood pressure (BP) reactivity of normotensives during the video game was generally similar to that of trained hypertensives but smaller than that of untrained hypertensives. These results indicate that aerobic training, which has been found to reduce resting BP in mild hypertensives, may also exert a favorable impact in reducing cardiovascular reactivity of hypertensives during some stressful situations.

2 The Effect of Smoking on Blood Pressure in Mild Hypertensives, and on their Response to Antihypertensive Treatment

2 The Effect of Smoking on Blood Pressure in Mild Hypertensives, and on their Response to Antihypertensive Treatment

Effects of withdrawing diuretic therapy on blood pressure in mild hypertension.

A 1-year double-blind placebo-controlled study on the effects of diuretic withdrawal was conducted on a group of 62 previously well-controlled, mildly hypertensive patients. Data were collected on blood pressure (BP), biochemical laboratory values, and subjective reports of side-effects. Twenty-six percent of placebo subjects and 3% of the active treatment subjects reached preset criteria for the return of hypertension (reverters). The average systolic and diastolic pressures of all placebo-treated patients who did not revert showed statistically significant increases. BP control was quickly reestablished in reverters by restarting diuretic therapy. No substantial differences in side-effects were reported between the groups, and laboratory changes were those consistent with known metabolic effects of thiazide and thiazide-like diuretics. This study showed a much lower reversion rate after treatment withdrawal than previously reported by other investigators. It also showed significant increases in BP of placebo patients who did not revert. Long-term diuretic therapy retains its effectiveness in responsive mild hypertensive patients, potentially offering protection against the increased risks of mortality and morbidity associated with even slight elevations of BP. Withdrawal of diuretics cannot be recommended for patients with mild hypertension without use of other equally effective interventions to maintain optimum BP control.

Intrahypnotic and long-term effects of self-hypnosis on blood pressure in mild hypertension.

Abstract Self-hypnosis using the method of Spiegel (1974) was evaluated in 15 patients with labile or mild essential hypertension who were equally hypnotizable and adhered to a regimen of 6–10 daily exercises for a 4-month period. During the hypnotic state, there were consistent rises in both systolic and diastolic pressures in patients, but not in non-hypnotizable controls. Similar but smaller changes were also observed in normotensive subjects. Pressure rose immediately with hypnosis and subsided gradually over 15 minutes. However, the long-term effects of the daily practice of self-hypnosis were variable: ambulatory diastolic pressure fell in 5 patients, was unchanged in 7 patients, and rose in 3 patients. The changes in blood pressure could not be specifically attributed to the daily practice of self-hypnosis; however, all patients experienced improvement in well-being, mood, and behavior patterns during the 4-month period. The study indicates that self-hypnosis can produce changes in behavior and moo...