High-normal Blood Pressure Levels Research Articles

Arterial stiffness, blood pressure progression and penile vascular disease in males with erectile dysfunction: a closer look at microcirculatory damage

Abstract Background Elevated aortic stiffness may be associated with microvascular remodelling and damage, which may be an important causal contributor to incident cardiovascular disease. Recent evidence supports the independent of age and blood pressure (BP) level predictive value of severe penile arterial insufficiency for adverse cardiovascular events. Purpose Aim of the study is to examine in men with erectile dysfunction the association of increased aortic stiffness with penile vascular damage by taking into account BP level. Methods We measured carotid-femoral pulse wave velocity (PWV) and assessed microvascular (penile vascular damage) changes in four age-matched groups without a history of diabetes and cardiovascular disease; Normal BP (n=137), high-normal BP (n=94), stage I hypertension (n=82) and stage II and III hypertension (n=76). Microvascular damage was examined by measuring penile peak systolic velocity (PSV) with a dynamic penile color Doppler ultrasonography after intracavernous injection of prostaglandin E1. Lower PSV values indicate severe penile vascular disease. Results Carotid-femoral PWV increased and PSV decreased across BP groups (all P<0.001). In regression analysis increased systolic BP (b= -0.185, P<0.01) and PWV (b= -0.170, P<0.05) are significant determinants of low penile PSV after controlling for age, body mass index, cholesterol and smoking. We dichotomized carotid-femoral PWV taking into account the mean value in the whole study population. Figure shows the differences in PSV across the BP groups considering the cut-off PWV value of 8.5m/s (high vs low PWV). Individuals with higher PWV had lower penile PSV in normal BP (P<0.01) and in high normal BP group (P=0.02) after adjusting for age and systolic BP. On the contrary, hypertensive patients already have significant structural damage in the penile arteries and high PWV does not further reduce penile blood flow. Interestingly, figure shows the comparable PSV measurements between individuals with high-normal BP level who had high PWV and patients in stage 1 hypertension group denoting significantly impaired microvascular damage in males with high-normal BP and increased aortic stiffness. The high normal BP group has significantly lower PSV compared to normal BP group independently of PWV value. Conclusion Increased aortic stiffness may promote penile microvascular remodelling and damage in men without increased BP level. Additionally, in men with high-normal BP higher arterial stiffness is associated with comparable penile microvascular damage of men with arterial hypertension. Because aortic stiffening may be preventable, further clinical research on earlier preventive measures that focus on aortic stiffness and microvascular remodelling within individuals with erectile dysfunction who have normal BP is warranted.Aortic stiffness, BP level and PSV

Intensive reduction of high normal blood pressures: PRINT-TAHA9 randomized clinical trial

Abstract Background Currently, the best treatment strategy for patients with (Prehypertension) a high normal blood pressure (130 mmHg < systolic blood pressure [SBP]<140 mmHg) is controversial. While the ESC guideline does not recommend treating high normal blood pressure, the ACC/AHA recommends pharmacological treatments in these patients if the 10-year ASCVD risk is above 10%. Purpose We aimed to determine whether pharmacological reduction of SBP to a normal level (<120mmHg) would prevent cardiac morbidity and mortality in patients with high normal blood pressure levels. Methods We randomly assigned 466 persons with high normal blood pressure (130 mmHg < SBP<140 mmHg and a DBP<90 mm Hg) and an increased cardiovascular risk (10-year ASCVD risk ≥7.5%), but without diabetes, and apparent clinical cardiovascular diseases to standard treatment (n=235) which consisted of clinical follow up till SBP goes above 140 mmHg and then staring medications to keep SBP<140 mmHg or to the intensive treatment (n=231) receiving pharmacological SBP reduction to <120 mmHg upon enrollment. The primary composite outcome was myocardial infarction, stroke, heart failure, or death. Results Throughout the 1.66 years of follow-up, a primary outcome event was confirmed in 5 participants (0.13% per year) in the intensive-treatment group and 16 (0.39% per year) in the standard-treatment group (hazard ratio (HR), 0.31; 95% confidence interval [CI], 0.11 to 0.85; P=0.024). Rates of serious adverse events were not increased by intensive-treatment (HR, 1.78; 95% CI, 0.68 to 2.03; P=0.57). Conclusion Based on this clinical trial, intensive SBP reduction may probably be beneficial for primary prevention of cardiovascular morbidity and mortality in patients with high normal blood pressure level. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Shiraz University of Medical Sciences

IDF21-0652 Blood pressure-lowering for prevention of major cardiovascular diseases in persons with and without type 2 diabetes

Background: There is insufficient randomised evidence as to whether the effect of blood pressure (BP)-lowering treatment differs in people with type 2 diabetes versus those without this metabolic condition, particularly at a normal or high-normal BP level. Aim: To investigate the effects of BP-lowering treatment on the risk of major cardiovascular events in people with and without type 2 diabetes, and by baseline levels of systolic and diastolic BP. Method: We used the resource provided by the Blood Pressure Lowering Treatment Trialists' Collaboration (BPLTTC) to conduct a one-stage individual participant data meta-analysis of major randomised trials. The primary outcome was total major cardiovascular events, defined as the first occurrence of fatal or non-fatal stroke or cerebrovascular disease, fatal or non-fatal myocardial infarction, and heart failure causing death or requiring hospitalisation. The analysis was stratified for type 2 diabetes status at baseline, and baseline categories of systolic BP (in 10 mm Hg increments from <120 mm Hg to ≥170 mm Hg) and diastolic BP from <70 mm Hg to ≥110 mm Hg diastolic). Cox proportional hazard model stratified by the trial was used to estimate hazard ratio (HR). A Poisson regression model with an identity link was used to calculate the absolute risk reduction (ARR). Results: Data for 358,533 participants (58.4% men) from 51 randomised clinical trials were included in the analysis, in which 28.8% (n=103,325) of the participants had diagnosis of type 2 diabetes at baseline. Baseline mean systolic/diastolic BPs were 149/84 mm Hg in participants with type 2 diabetes (n=103,325) and 153/88 mm Hg in participants without type 2 diabetes (n=255,208). The incidence risks of primary events during the study follow-up time in participants with and without type 2 diabetes were 16.5% and 10.2%, respectively. Over 4.2 years of median follow-up, a fixed value of 5-mm Hg reduction in systolic BP was associated with a lower risk of major cardiovascular events both in participants with type 2 diabetes (HR 0.94 [95% CI 0.91 to 0.98]; ARR -0.015 [95% CI -0.020 to -0.010]) and in those without history of type 2 diabetes (HR 0.89 [95% CI 0.87 to 0.92]; ARR =-0.016 [95% CI -0.018 to -0.013]). In stratified analyses, we did not find reliable evidence for heterogeneity of treatment effects by baseline systolic or diastolic BP level in participants with or without type 2 diabetes (all P for interaction > 0.78). Discussion: The effect of BP reduction for primary and secondary prevention of major cardiovascular events was broadly comparable among people with and without type 2 diabetes, with no clinically important evidence that the level of systolic or diastolic BP at baseline is a determinant of treatment effect. Recommendations by guidelines on different BP reduction treatment in people with and without diabetes, or initiation of BP reduction therapy at a specific BP threshold, are not substantiated by these findings. This work will be presented on behalf of the Blood Pressure Lowering Treatment Trialists' Collaboration. Working group: Milad Nazarzadeh, Zeinab Bidel, Dexter Canoy, Emma Copland, Abbas Dehghan, Derrick A Bennett, George Davey Smith, Rury R. Holman, Mark Woodward, Ajay Gupta, Amanda Adler, Naveed Sattar, Richard J McManus, Koon Teo, Barry R Davis, John Chalmers, Carl J. Pepine, Kazem Rahimi.

Питательные вещества и пищевые добавки для лечения высокого нормального артериального давления: консенсусный документ на основе доказательств

Эссенциальная гипертензия по-прежнему представляет собой наиболее распространенный фактор риска сердечно-сосудистой системы, отвечающий за большую часть глобального бремени заболеваний во всем мире. Антигипертензивная терапия, направленная на снижение уровня артериального давления (АД) в рекомендованных терапевтических целях, доказала снижение риска развития сердечно-сосудистых, цереброваскулярных и почечных осложнений. Несмотря на эти доказательства, общий уровень контроля АД остается достаточно низким в большинстве европейских и западных стран, а также в развивающихся странах, что способствует увеличению расходов на лечение и инвалидность, связанных с гипертензией. По этим причинам превентивные стратегии, направленные на улучшение уровня контроля АД у больных артериальной гипертензией (АГ), которые принимают медикаментозную терапию, и снижение АД при его высоком нормальном уровне у бессимптомных здоровых лиц могут способствовать уменьшению бремени заболеваний, связанных с гипертензией. С этой точки зрения было показано, что использование определенных питательных веществ и пищевых добавок может обеспечить благоприятные эффекты в лечении и контроле АГ, вне приема фармакологических препаратов и нефармакологических вмешательств. Их применение может эффективно и безопасно снижать уровень АД до целевых показателей и предотвращать прогрессирование заболевания с высокого нормального уровня АД к гипертензии 1-й степени. В этом консенсусном документе представлены систематический обзор и критический анализ имеющихся в настоящее время доказательств в пользу использования питательных веществ и пищевых добавок у лиц с высоким нормальным уровнем АД при различных степенях сердечно-сосудистого риска.

EFFECTIVENESS AND SAFETY OF A NEW GENERATION OF NUTRACEUTICAL COMPOUNDS ON LIPID PROFILE AND SERUM GLYCAEMIA IN SUBJECTS WITH HIGH-NORMAL BLOOD PRESSURE LEVELS

Objective: In the 2018 ESH/ESC hypertension guidelines is recommend that patients with high–normal blood pressure (BP) values and low–moderate cardiovascular (CV) risk should be offered lifestyle advice, because this reduces their risk of progressing to established hypertension and may further reduce their CV risk. Treatment strategies include non-pharmacologic interventions and in this respect a relevant role has been shown for nutraceutical compounds (NCs). Design and method: 131 subjects (mean age 55.7 ± 9.6 years, 53% males) with high-normal BP levels (i.e. with systolic BP of 130–139 mmHg and/or with diastolic BP of 85–89 values) without hypertension-mediated organ damage and history of cardio-vascular (CV) diseases were enrolled. 66 subjects were treated with a once-daily oral formulation of a NCs containing red yeast rice (equivalent of 3 mg of Monacolin K), 500 mg of Berberine, 30 mg of Coenzyme Q10, 200 mcg of folic acid and 40 mg of chrome that added to their diet for 3 months and were compared with the 65 patients following a diet program. Differences in serum total cholesterol (TC), low- and high-density-lipo- protein cholesterol (LDLC and HDLC), triglycerides (TG), glucose values, CPK, AST, ALT and BMI were compared by analysis of variance. Results: A significant reduction of TC, LDLC and glucose levels was observed in both treatment groups, while HDLC values significantly increased in the active treatment group (+4.8 %, p < 0.0001). However, a greater reduction of TC (-13.6%) LDLC (-17.7%), and serum glucose (-7.7%) was observed in the treatment group that to the control (p < 0.001 for all). BP, BMI and TG levels remained unchanged (p = N.S.). Gender difference was not found in either group (p = N.S.). No adverse event was observed during the study and safety parameters (i.e AST, ALT and CPK values) was not-different between groups; 2 subjects in the active and 2 in the control group withdrew from the study. Conclusions: In patients with high-normal BP levels, NC supplementation was safe, well tolerated and effective in improving lipid pattern and glucose profile.

Nutrients and Nutraceuticals for the Management of High Normal Blood Pressure: An Evidence-Based Consensus Document.

Essential hypertension still represents the most common cardiovascular risk factor, which is responsible for the vast majority of global burden of disease, worldwide. Antihypertensive treatment aimed at lowering blood pressure (BP) levels to the recommended therapeutic targets has demonstrated to reduce risk of developing major cardiovascular, cerebrovascular and renal complications. Despite these evidence, overall rates of BP control are dramatically low in most European and Western countries, as well as in the so called developing countries, thus contributing to the increasingly amount of hypertension-related costs and disabilities. For these reasons, preventive strategies aimed at improving BP control rates in treated hypertensive patients and reducing high-normal BP levels in asymptomatic otherwise healthy individuals may contribute to reduce the burden of disease related to hypertension. In this view, an extensive use of nutrients and nutraceuticals has demonstrated to provide favorable effects in hypertension management and control, beyond the adoption of pharmacological and non-pharmacological interventions. These interventions can effectively and safely reduce BP levels to targets and prevent disease progression form high-normal BP levels towards stage 1 hypertension. The present consensus document will systematically describe and critically analyze the currently available evidence in favor of the use of nutrients and nutraceuticals in those individuals with high-normal BP levels at different cardiovascular risk profile.

PP.21.07] SERUM URIC ACID LEVELS AND 10-YEAR RISK OF FATAL CARDIOVASCULAR DISEASE. A PROSPECTIVE STUDY

Objective: Serum uric acid (SUA) is associated with many traditional cardiovascular risk factors such as arterial hypertension. Our aim was to investigate the relationship of SUA levels with the 10-year risk of fatal cardiovascular disease. Design and method: We prospectively enrolled 113 subjects (mean age 53 ± 12 years) presented for evaluation in the antihypertensive clinic. In all subjects routine blood chemistry, including SUA determination, echocardiographic examination, office and 24 h ambulatory blood pressure (BP) monitoring were obtained. In all patients data regarding lifestyle habits (smoking, alcohol consumption and exercise) were recorded. The 10-year risk of fatal cardiovascular disease was evaluated by using the SCORE chart for countries with low CVD risk based on the following risk factors: age, sex, smoking, systolic blood pressure, and total cholesterol. Results: Mean average 24 hours systolic blood pressure (SBP) was 124 ± 13 mmHg, mean 24 hours average diastolic blood pressure (DBP) was 75 ± 10 mmHg while mean total cholesterol was 210 ± 36 mg/dl. From 113 subjects included in the study only 26 (23%) were hypertensives. Pearson and spearman analysis showed that SUA levels were significantly and positively associated with the average 24 hours systolic and diastolic blood pressure levels (r = 0.35, p < 0.0001 for SBP) and (r = 0.33, p < 0.0001 for DBP) respectively. Furthermore the kruskal Wallis analysis revealed that SUA levels were significantly associated with 10-year risk of fatal cardiovascular disease (p < 0.0001). Specifically patients with 10-year risk <5%, 5–10%, >10%, presented SUA levels 4.4 ± 0.9 mg/dl, 5.2 ± 1 mg/dl and 6.4 ± 0.1 mg/dl respectively (p < 0.0001). Conclusions: Subjects with lower SUA levels presented lower BP levels as well as 10-year risk of fatal cardiovascular disease and vice versa. SUA levels were significantly associated with blood pressure levels and 10-year risk of fatal cardiovascular disease. The fact that this study included mainly normotensives, shows that SUA levels are also associated with subjects presenting normal or high normal blood pressure levels.

Exaggerated blood pressure response to exercise is not associated with masked hypertension in patients with high normal blood pressure levels.

The association between exaggerated blood pressure (BP) response to exercise (ExBPR) and "masked hypertension" is unclear. Medical records of patients with high-normal BP who were evaluated in the Chaim Sheba Screening Institute Ramat Gan, Israel, during the years 2002-2007 and referred for 24-hour ambulatory BP monitoring (ABPM) and exercise test were reviewed. Data on exercise tests performed in the preceding 5years were retrieved. Reproducible ExBPR was defined when it was recorded at least twice. BP levels on 24-hour ABPM were compared between patients with a normal BP response and those with an ExBPR (systolic BP ≥200mm Hg). Sixty-nine normotensive patients with high normal BP levels were identified. ExBPR was recorded in 43 patients and was reproducible in 28. BP levels on 24-hour ABPM were similar in patients with and without ExBPR. In patients with high-normal BP levels, ExBPR is not associated with masked hypertension.

Advantages and limitations of antihypertensive treatment for stroke risk in a general population: the Akita Stroke Registry

Background Although the association between stroke risk and blood pressure (BP) levels related to antihypertensive medication has been an object of study for a long time, there is little agreement as to the relationship in a general population study.Methods and results We obtained mass health screening data regarding 156,847 (142,989 untreated and 13,858 treated) subjects from the Akita Prefectural Federation of Agricultural Cooperative for Health and Welfare from 1991 to 1998. Stroke events were determined from the Akita stroke registry between 1991 and 2001. A Poisson regression model, adjusting for possible confounding factors, was used to investigate the risk of fi rst stroke among six BP-based categories (BP defi ned according to JNC-6), with or without antihypertensive medication. Stroke developed in 1,323 (0.8%) individuals in the study population within 3 years after the health examination. Among untreated groups, the relative hazard linearly increased with elevation of the BP grade. In the untreated group, stroke risk was signifi cantly higher (relative hazard 2.1, 95% confi dence interval (CI) 1.6-2.7) in the subjects with high-normal BP levels than with optimal BP levels. In the treated group, stroke risk was signifi cantly higher in patients with high-normal BP levels (relative hazard 2.0, 95% CI 1.0-4.2) than with optimal BP levels. Furthermore, stroke risk was signifi cantly higher in the treated groups with normal BP levels (relative hazard 3.1, 95% CI 2.0-4.9) compared with the untreated group with optimal BP levels.Conclusions Although antihypertensive medication can reduce stroke risk, treated patients within non-hypertension levels may still have a higher risk compared with untreated subjects of the same categories.

THERAPEUTIC INERTIA WHEN MANAGING HIGH-NORMAL BLOOD PRESSURE LEVELS IN PATIENTS AT HIGH CARDIOVASCULAR RISK. A STUDY ON PRIMARY-CARE PHYSICIANS’ ATTITUDE: PP.33.333

Objectives: 1)To asses the magnitude of clinical inertia when managing high-normal blood pressure (BP) levels in patients at high cardiovascular (CV) risk; and 2) To analyse physician and patient factors underlying clinical inertia. Design and Methods: An anonymous survey was conducted in primary-care physicians of Madrid in order to assess their attitude towards initiation or intensification of antihypertensive medications in a set of four hypothetical clinical cases. Physicians demographic features and primary-care-centres characteristics were analysed. Each case described a situation in which a patient at high CV risk had high-normal BP levels (BP:135–139/85–89 mmHg). The cases were characterised by one of the following clinical features: 1) metabolic syndrome;2) type II diabetes; 3) moderate renal insufficiency due to glomerulosclerosis; and 4) ischemic stroke. Physicians were asked to decide whether or not to initiate or intensify a previous treatment and otherwise give reasons for not modifying it. Results: Two hundred and seventy-five physicians participated. Overall, the physicians decided to initiate or intensify a previous treatment in 2.5 ± 0.7 cases. Physicians' attitude was very different depending on the clinical cases: Most physicians (87%) decided to intensify the treatment in the renal insufficiency case, while only 47% of them did so in the metabolic syndrome case. Most doctors who did not modify the previous treatment (74%) argued that clinic BP might not reflect “real life” BP. The remaining 26% doctors considered that patients' BP values were acceptable. CV Working Group membership and routine use of CV stratification risk were both associated (p < 0.05) with a more “aggressive” therapeutic attitude. Conclusions: 1) Our results suggest an important therapeutic inertia when managing high-normal BP at primary care settings. However, they might not reflect what physicians actually decide in the real clinical setting. 2) The degree of clinical inertia is influenced by physician factors (routine use to stratification risk tables and membership to CV working groups) and patient factors (specific clinical features related with CV risk).

Analysis on vascular risk factors accompanied with high-normal blood pressure among Uygur, Kazak, Mongolian and Han populations in Boertala region of Xinjiang, China.

To study the prevalence and distribution of high-normal blood pressure (BP) and the prevalence rates of risk factors related to cardiovascular diseases (CVD) among Uygur, Kazak, Mongolian and Han populations in Boertala Mongol Autonomous Prefecture of Xinjiang. 4325 Subjects, with numbers of Uygur, Kazak, Mongolian, Han ethnicities as 1247, 1047, 817, 1214 cases, respectively and aged 20 - 79 years, were selected from the cross-sectional study on hypertension in Boertala Mongol Autonomous Prefecture of Xinjiang. The prevalence rates of related risk factors on CVD were analyzed among multiethnic populations with high-normal BP. (1) The prevalence rates of high-normal BP were 39.2%, 34.5%, 36.0%, 36.5% respectively in Uygur, Kazak, Mongolian, Han populations. The prevalence rate of aged < 40 years in Uygur, Kazak, Mongolian was higher than that of aged 40 - 60 (P = 0.000, 0.006, 0.016 respectively in Uygur, Kazak, Mongolian) and > 60 years (all the P = 0.000 in the three ethnic populations) in the same ethnic population. (2) In the high-normal BP groups, subjects with both SBP (120 - 139 mm Hg) and DBP (80 - 89 mm Hg) at high-normal BP level accounted for the majority (> 45%) while subjects with only DBP (80 - 89 mm Hg) at high-normal BP level had the lowest prevalence rate (> 13%). (3) The prevalence rates of overweight-obesity (body mass index >/= 24.0 kg/m(2)), visceral obesity (waist circumference >/= male 85 cm/female 80 cm), dyslipidemia and >/= 1 risk factors of CVD in multiethnic populations respectively were >/= 57%, 62%, 43% and 82%. (4) Analyzed by multiple regression, aging, over-weight and or obesity, being male etc. were risk factors for high-normal BP. High-normal blood pressure was common among aged 20 - 79 years Uygur, Kazak, Mongolian, Han populations, especially among people < 40 years, in Xinjiang Boertala region, which was often accompanied by others risk factors of cardiovascular disease. Prevention and control programs on risk factors for population with high-normal blood pressure need to be strongly advocated.

Blood pressure control in Italy: results of recent surveys on hypertension

Blood pressure (BP) control is reported to be poor in hypertensive patients worldwide. BP levels, the rate of BP control, prevalence of risk factors and total cardiovascular risk were assessed in a large cohort of hypertensive patients, derived from recent surveys performed in Italy. Fifteen studies on hypertension, performed in different clinical settings (general population, general clinical practice, specialist outpatient clinics and hypertension centres) over the past decade were considered. The overall sample included 52 715 hypertensive patients (26 315 men and 26 410 women, mean age 57.3 +/- 6.9 years). Despite the high percentage of patients on stable antihypertensive treatment (n = 36 556, 69%), mean systolic and diastolic BP levels were 147.8 +/- 8.5 and 89.5 +/- 5.2 mmHg, respectively. On the basis of the nature of the study (population surveys or clinical referrals), systolic BP levels were consistently higher than the normality threshold in both settings (142.6 +/- 12.4/84.8 +/- 3.7 mmHg and 150.4 +/- 4.6/91.9 +/- 4.1 mmHg, respectively). The BP stratification could be assessed in 40 829 individuals: 4.5% had optimal, 9.2% normal and 8.3% high-normal BP levels, however, the large majority were in grade 1 (39%) or grades 2-3 (32.6%) hypertension. In the overall sample, 55.9% of hypertensive patients had hypercholesterolemia, 28.7% were smokers, 36.4% were overweight or obese and 15.0% had diabetes mellitus. Cardiovascular risk stratification was assessed in 37 813 hypertensives: 23.2% had low, 33.9% moderate, 30.2% high and 12.7% very high added risk. Our analysis demonstrates the persistence of poor BP control and high prevalence of risk factors, supporting the need for more effective, comprehensive and urgent actions to improve the clinical management of hypertension.

A patient with high normal blood pressure – Should we treat?

Currently blood pressure (BP) is considered normal (for most subjects) if below 140 mmHg for systolic and 90 mmHg for diastolic BP. However, the risk of death displays an approximately linear relationship with BP levels below this cut‐off. Therefore more attention is now being paid to the portion of the population characterized by BP levels remaining within normal limits but approaching the 140/90 mmHg level. The 2003 ESH–ESC guidelines define BP between 130/85 and 139/89 mmHg as “high normal”, while the 2003 JNC7 guidelines introduced a new category of “prehypertension” (BP between 120/80 and 139/89 mmHg). Both these conditions affect a significant portion of a general population. Evidence is available that high normal BP is associated with an adverse risk profile and an increased risk of cardiovascular events. Therefore lifestyle changes are recommended in subjects belonging to this category and some trial data indicate that pharmacological treatment may be beneficial in high‐risk subjects with high normal BP levels. Strong evidence on the benefits of therapeutic intervention in this group is, however, still lacking.

Distribution of blood pressure and prevalence of hypertension in Tehran adult population: Tehran Lipid and Glucose Study (TLGS), 1999-2000.

The purpose of this study was to estimate the current prevalence and distribution of hypertension in an adult Tehranian population. Data were collected for 3343 men and 5148 women aged 20-69 years in the Tehran Lipid and Glucose Study (TLGS), which is a cross-sectional phase of a large epidemiologic study, first established in 1999. The study used the mean of two separate blood pressure (BP) measurements in each individual. Twenty-two percent (23% of women vs 20% of men, P = 0.01) had hypertension according to 'JNC-VI' and 'WHO-ISH' criteria. The average systolic BP (SBP), diastolic BP (DBP) and pulse pressure of hypertensive participants were 31, 16, and 15 mm Hg higher than the corresponding value for normotensives, respectively. Thirty-six percent of participants with JNCVI-based hypertension were using antihypertensive medication (23% of men and 43% of women). Of these, 40% (45% of men and 39% of women) had normal BP. Hypertension awareness was 50% in these participants (57% in men vs 37% in women, P < 0.001). Data for 3179 men and 4646 women aged 20-69 years with no antihypertensive treatment were used for analysis of BP measures. Of these, 15% (16% of men and 14% of women, P = 0.006) had high and 85% (84% of men and 86% of women) normal or high-normal BP levels according to JNC-VI. Prevalence of optimal BP was 49% (47% of men and 51% of women). Mean SBP was 117.8 +/- 16.6 and 116.4 +/- 16.4 mm Hg in men and women, respectively (P < 0.001). The equivalent values were 77.4 +/- 10.7 and 77.3 +/- 9.9 mm Hg for DBP (P = 0.5) and 40.4 +/- 12 and 39.1 +/- 11.7 mm Hg for pulse pressure (P < 0.001). A relatively high prevalence of JNC-VI/WHO-ISH defined hypertension was found in the TLGS adult population with 50% undiagnosed and 60% uncontrolled hypertension. These findings emphasise further considerations for detection and better management of hypertension in the urban population of Tehran.

Design of a multicenter trial to evaluate long-term life-style intervention in adults with high-normal blood pressure levels: Trials of hypertension prevention (phase II)

Phase II of the Trials of Hypertension Prevention (TOHP) is a multicenter, randomized trial sponsored by the National Heart, Lung, and Blood Institute designed to test whether weight loss alone, sodium reduction alone, or the combination of weight loss and sodium reduction will decrease diastolic (DBP) and systolic blood pressure (SBP) as well as the incidence of hypertension (DBP > or = 90 mm Hg, SBP > or = 140 mm Hg, and/or use of antihypertensive medications) in subjects with high-normal DBP (83 to 89 mm Hg) and SBP less than 140 mm Hg at entry. These interventions were chosen for longer-term testing with end points including hypertension prevention as well as blood pressure (BP) change based on their demonstrated short-term efficacy in reducing BP in phase I of TOHP. The phase II study population is comprised of 2382 participants (1566 men and 816 women) who are 110 to 165% of desirable body weight, allocated at random to the four treatment arms using a 2 x 2 factorial design. The trial has 80% power to detect an overall treatment effect on DBP of 1.2 mm Hg for weight loss or sodium reduction and a difference of 1.6 mm Hg between the combined intervention and placebo groups. BP observers are blinded to participant treatment assignments. Participants will be followed for 3 to 4 years. This trial may have important public policy implications concerning the ability of life-style modifications to reduce BP and prevent the development of hypertension over the long term, thereby avoiding the need for drug therapy which while effective is costly and may have side effects.

High-Normal Blood Pressure and Early Diabetic Nephropathy

The relationship between high-normal blood pressure (BP) levels and early diabetic nephropathy is currently unknown. Blood pressure levels were checked longitudinally for a mean of 6.6 years in 230 subjects to determine their relationship to early diabetic nephropathy as monitored by microalbuminuria. High-normal BP level correlated with the presence of microalbuminuria. Microalbuminuria was 2.8 times as common in subjects with high-normal BP levels compared with those subjects with BP levels below the 90th percentile for their age. The elevated microalbumin excretion was primarily associated with high-normal diastolic BP levels. Our data suggest that either microalbuminuria or high-normal BP levels can precede the other. In a logistics model, diastolic BP and mean HbA1 (over 6.6 years) entered the model at similar levels, followed by duration of diabetes. When the influence of mean HbA1 was removed using logistic regression, the diastolic BP level remained a significant associated factor for the presence of microalbuminuria.

The Effect of Beta-Aminopropionitrile on the Blood Pressure of Turkeys

Abstract SCHILLING and Strong (1955) characterized the toxic principle found in sweet pea seeds (Lathyrus odoratus), which produced lathyrism in rats, as beta (N-gamma-L-glutamyl) aminopropionitrile. Barnett et al. (1957) likened the natural occurring condition of dissecting aneurysms (aortic rupture) in turkeys to the dissecting aneurysms observed in rats following the artificial induction of lathyrism by B-aminoproprionitrile (BAPN) feeding. These later workers demonstrated that levels of 0.0313 and 0.04 percent BAPN incorporated into the feed of day-old poults resulted in death as a result of aortic rupture in 15 percent and 33 percent of the poults prior to 28 days of age. Ringer and Rood (1959) reported that the Broad Breasted Bronze turkey has an extremely high normal blood pressure level and suggested that the hypertension may contribute to field cases of aortic rupture in turkeys. Ringer (1959) postulated that the lowering of blood pressure in the turkey by the use of…