Hypertensive Blood Pressure Values Research Articles

Blood pressure in preterm infants with bronchopulmonary dysplasia in the first three months of life

BackgroundNeonatal hypertension is common in preterm infants with bronchopulmonary dysplasia (BPD). Our study aimed to examine blood pressure variation in the first three months of life in preterm BPD patients.MethodsWe conducted a retrospective, single-centre study at the Neonatal Intensive Care Unit of the University of Szeged, Hungary. We collected blood pressure data from 26 preterm infants (born at < 30 weeks gestation) with moderate or severe BPD over three years (2019–2021). We calculated the BPD group's daily average blood pressure values and used previously defined normal blood pressure values from a preterm patient group born at < 30 weeks gestation as a reference. We used 19,481 systolic, diastolic and mean blood pressure measurement data separately to calculate daily average blood pressures.ResultsWe found a statistically significant correlation between the blood pressure values of the BPD patient group and the reference data. The difference between the blood pressure curve of the group with BPD and that of the reference group was also statistically significant. We also analysed individual patients' daily average blood pressure values and found that 11 patients (42%) had hypertensive blood pressure values for three or more days within the first 90 days of life. Within this group, our statistical analysis showed a 25% chance of acute kidney injury.ConclusionThe blood pressure of the BPD group not only correlated with but also significantly differed from the reference data. Hypertension lasting three or more days occurred more frequently in patients with acute kidney injury accompanied by BPD.Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information

PREVALENCE AND INCIDENCE OF ARTERIAL HYPERTENSION OVER 36 MONTHS IN AMBULATORY HIV INFECTED PATIENTS ON ANTIRETROVIRAL THERAPY IN LILONGWE, MALAWI

Objective: According to a meta-analysis hypertension (HT) prevalence is higher in HIV infected patients (PLHIV) on antiretroviral therapy (ART) compared to ART-naïve patients. As part of the prospective LighTen Cohort Study (ClinicalTrials.gov NCT02381275) we examined blood pressure (BP) changes in ambulatory PLHIV who had initiated tenofovir-containing ART. Design and method: Anthropometric measurements of study participants (age &gt; = 18 years) were documented at baseline and during study visits after 1, 3, 6 and every 6 months thereafter. Systolic and mean office BP values (OBP, oscillometric measurements) for PLHIV, who were still active study participants at month 36 were analyzed. Age, gender, and anthropometric measurements were included in univariate and multivariate multilevel analysis to test for their effects on changes in BP (R statistical software, version 4.1.2). Results: BP measurements on at least two occasions were available for 1,288 PLHIV and HT was confirmed at baseline and during follow-up in 173 (13.4%) and 50 cases (4.7%), respectively. For the whole cohort systolic and mean BP increased from month 12 onwards with a significant (p &lt; 0.001) impact of weight gain and age while female sex was protective. 36-month data from 799 (474 females, 325 males, mean age 37.1 ± 9.2 years) could be analyzed. Although the number of patients on antihypertensive drug treatment (HT Tx) nearly tripled (23 vs. 61), BP was uncontrolled in 125/799 PLHIV (15.6%) compared to 115/799 (14.4%) at baseline (Chi2-test p &lt; 0.001). Conclusions: The proportion of patients with hypertensive BP values increased after initiating ART despite higher HT Tx rates. Counselling of PLHIV on measures regarding control of body weight and improved HT Tx compliance should be embedded into patient education programs at HIV centers.

BLOOD PRESSURE CHANGES OVER 18 MONTHS AFTER INITIATION OF ANTIRETROVIRAL THERAPY IN HIV INFECTED PATIENTS IN LILONGWE, MALAWI

Objective: The improved survival of people living with HIV (PLHIV) and the economic and demographic changes in sub-Saharan Africa are accompanied by a rising number of patients suffering from cardiovascular disease. According to a recent meta-analysis hypertension prevalence is higher in PLHIV on antiretroviral therapy (ART) compared to ART-naïve patients. As part of the ongoing prospective LighTen Cohort Study (ClinicalTrials.gov NCT02381275) we examined blood pressure (BP) changes in ambulatory PLHIV who initiated ART in urban Lilongwe, Malawi. Design and method: Anthropometric measurements of adult study participants at baseline and during study visits after 1, 3, 6 and every 6 months thereafter were recorded in an electronic patient registry. For the present analysis we surveyed systolic and diastolic BP values (oscillometric measurements) and body weight (BW) from this data base for patients who were still alive and active study participants at month 18. Student's t-test was used to compare systolic and diastolic BP, BW and their changes between baseline and month 18. Pearson's r was calculated to test for correlations between changes in BW and BP. Results: Data from 995 (577 females, mean age 36.7 ± 9.2 years) of the originally included 1436 PLHIV were analyzed. BW (p &lt; 0.001) and systolic BP (p &lt; 0.01) differed significantly between baseline and month 18. The change in systolic and diastolic BP correlated with the change in BW (r = 0.312 and r = 0.220, respectively; p &lt; 0.01). There were significant differences (p &lt; 0.001) in the mean change of systolic/diastolic BP between the lowest (-9.6 ± 18.8/-3.8 ± 12.9 mmHg) and highest (6.8 ± 19.2/4.3 ± 13.9 mmHg) quartile of the distribution of BW changes (decrease &gt;1.39 kg vs. increase &gt;6.09 kg). Also, the mean change in BW for normotensive patients at baseline who still had a BP &lt; 140/90 at month 18 (n = 722, 89.6%) compared to those whose BP values had increased to 140/90 mmHg or higher (n = 84, 10.4%) was significantly lower (2.3 ± 6.2 kg vs. 5.6 ± 7.6 kg, p &lt; 0.001). Conclusions: Increasing body weight due to the improved health status after ART initiation was associated with hypertensive BP values. Counselling of PLHIV regarding measures to control body weight should be embedded into patient education programs at HIV centers in countries like Malawi.

Improved agreement and diagnostic accuracy of a cuffless 24-h blood pressure measurement device in clinical practice

A cuffless blood pressure (BP) device (TestBP) using pulse transit time is in clinical use, but leads to higher BP values compared to a cuff-based 24 h-BP reference device (RefBP). We evaluated the impact of a recent software update on BP results and TestBP’s ability to differentiate between normo- and hypertension. 71 individuals had TestBP (Somnotouch-NIBP) and RefBP measurements simultaneously performed on either arm. TestBP results with software version V1.5 were compared to V1.4 and RefBP. Mean 24 h (± SD) BP for the RefBP, TestBP-V1.4 and TestBP-V1.5 were systolic 134.0 (± 17.3), 140.8 (± 20) and 139.1 (± 20) mmHg, and diastolic 79.3 (± 11.7), 85.8 (± 14.1) and 83.5 (± 13.0) mmHg, respectively (p-values < 0.001). TestBP-V1.5 area under the curve (95% confidence interval) versus RefBP for hypertension detection was 0.92 (0.86; 0.99), 0.94 (0.88; 0.99) and 0.77 (0.66; 0.88) for systolic and 0.92 (0.86; 0.99), 0.92 (0.85; 0.99) and 0.84 (0.74; 0.94) for diastolic 24 h, awake and asleep BP respectively. TestBP-V1.5 detected elevated systolic/diastolic mean 24 h-BP with a 95%/90% sensitivity and 65%/70% specificity. Highest Youden’s Index was systolic 133 (sensitivity 95%/specificity 80%) and diastolic 87 mmHg (sensitivity 81%/specificity 98%). The update improved the agreement to RefBP. TestBP was excellent for detecting 24 h and awake hypertensive BP values but not for asleep BP values.

ELITE study - Nutrition, lifestyle and individual information for the prevention of stroke, dementia and heart attack - Study design and cardiovascular status

For the prevention of cardiovascular risk factors (RF) there are numerous recommendations of professional societies, which relate to the personal way of life of individuals (for example nutrition/diet, physical activity, stress reduction etc.). The implementation of these recommendations is so far poor. In the ELITE study, data on RF, nutritional behavior, physical activity and quality of life in the Oldenburger Münsterland region are to be collected prospectively and improved by individual information. Reasons for the lack of implementation of preventive measures should be recognized. The study is conducted as an interventional cohort study (DRKS-No.: 00 006 813, Ethics vote University of Göttingen). Up to 5000 people (with or without pre-existing RF) are aimed to be included. All participants receive a computer-generated report of their personal risk profile with detailed recommendations based on current guidelines. In addition, it is recommended to visit the family doctor to discuss the findings and, if necessary, initiate diagnostic or therapeutic measures. Every year, follow-up examinations take place for up to 5years. By 31.12.2017 4602 participants (mean age 51.5 (± 15.7) years, 53.7 % female) were admitted. Overweight were 39 % of the participants, obese 20.4 %. Most frequent anamnestic RF is hypertension (31.4 %), mean blood pressure was 138.4 ± 16.6/83.0 ± 9.9 mmHg. 2165 (47.0 %) participants show hypertensive blood pressure values. The second most frequent anamnestic RF are lipid metabolism disorders (16.6 %). The incidence of participants with at least one cardiovascular RF is very high (49.5 %, 16.6 % multiple RF). The incidence of RF is similar to other epidemiological data in Germany, so the ELITE collective allows a good comparison with other surveys.

Steroid withdrawal improves blood pressure control and nocturnal dipping in pediatric renal transplant recipients: analysis of a prospective, randomized, controlled trial.

Variable effects of steroid minimization strategies on blood pressure in pediatric renal transplant recipients have been reported, but data on the effect of steroid withdrawal on ambulatory blood pressure and circadian blood pressure rhythm have not been published so far. In a prospective, randomized, multicenter study on steroid withdrawal in pediatric renal transplant recipients (n = 42) on cyclosporine, mycophenolate mofetil, and methylprednisolone, we performed a substudy in 28 patients, aged 11.2 ± 3.8years, for whom ambulatory blood pressure monitoring (ABPM) data were available. In the steroid-withdrawal group, the percentage of patients with arterial hypertension, defined as systolic and/or diastolic blood pressure values recorded by ABPM > 1.64 SDS and/or antihypertensive medication, at month 15 was significantly lower (35.7%, p = 0.002) than in controls (92.9%). The need of antihypertensive medication dropped significantly by 61.2% (p < 0.000 vs. control), while in controls, it even rose by 69.3%. One year after steroid withdrawal, no patient exhibited hypertensive blood pressure values above the 95th percentile, compared to 35.7% at baseline (p = 0.014) and to 14.3% of control (p = 0.142). The beneficial impact of steroid withdrawal was especially pronounced for nocturnal blood pressure, leading to a recovered circadian rhythm in 71.4% of patients vs. 14.3% at baseline (p = 0.002), while the percentage of controls with an abnormal circadian rhythm (35.7%) did not change. Steroid withdrawal in pediatric renal transplant recipients with well-preserved allograft function is associated with less arterial hypertension recorded by ABPM and recovery of circadian blood pressure rhythm by restoration of nocturnal blood pressure dipping.

Whole Red Grape Juice Reduces Blood Pressure at Rest and Increases Post-exercise Hypotension

ABSTRACTObjective: The objective of this study was to evaluate the effect of whole red grape juice (juice) on blood pressure (BP) at rest and on the magnitude of post-exercise hypotension (PEH).Methods: This double-blind, randomized controlled study was performed with 26 individuals with hypertension (40 to 59 years old) who were divided into experimental (n = 14) and control (n = 12) groups. Subsequently, the experimental group was subdivided according to the initial BP values. The subjects performed 2 sessions of aerobic exercise on a treadmill (60 minutes, 60%–85% maximum heart rate), separated by a 28-day period of supplementation with a daily dose of juice (150 ml for men and 100 ml for women) or a control drink. BP was measured before, during, and immediately after each exercise session as well as every 10 minutes during the 60-minute post-exercise recovery period.Results: The BP at rest did not change in the experimental group, but when this group was subdivided by initial BP, the subjects with controlled initial BP (EGCP) achieved a significant reduction (133.3 ± 5.6 to 114.6 ± 12.2 mmHg, p = 0.02); in contrast, the experimental group with borderline hypertensive BP values (EGBP) did not. Intervention with juice did not modify PEH in the experimental group, but when this group was divided as a function of the initial BP, PEH was potentiated at some times in EGCP.Conclusions: We conclude that juice promotes a reduction in BP at rest and is also capable of improving PEH in individuals with hypertension, but these effects are dependent on the initial BP values.

Inhibition of NHE3-mediated Sodium Absorption in the Gut Reduced Cardiac End-organ Damage Without Deteriorating Renal Function in Obese Spontaneously Hypertensive Rats.

Increased sodium absorption in the gut is one mechanism contributing to hypertensive blood pressure values. The sodium-proton-exchanger subtype 3 (NHE3) is an important mediator of intestinal sodium absorption. The compound SAR is a new specific NHE3 inhibitor with extremely low oral absorbability leading to decreased sodium absorption in the gut and substantial systolic blood pressure reduction. The effects of intestinal NHE3 inhibition on cardiac and renal hypertensive end-organ damage are unknown. The effects of SAR (1 mg·kg⁻¹·d⁻¹ in chow) on left ventricular (LV) and renal remodeling processes were studied by magnetic resonance imaging and biochemical and histological analysis in obese spontaneously hypertensive rats (SHR-ob SAR) compared with placebo-treated SHR-ob (SHR-ob PLAC). Inhibition of intestinal NHE3 by SAR lowered blood pressure and reduced LV end-diastolic pressure from 21 ± 3.0 to 15 ± 2.0 mm Hg (P = 0.0016), whereas heart rate kept unchanged. LV mass indices, LV myocyte diameters, and LV fibrosis formation were lower in SHR-ob SAR compared with SHR-ob PLAC. SAR did not influence urinary albumin to creatinine ratio or glomerular filtration rate. Renal interstitial fibrosis formation, as well as podocyte damage and glomerulosclerosis remained unchanged. Reduction of intestinal sodium absorption by selective NHE3 inhibition in the gut lowered high blood pressure and reduced LV remodeling without deteriorating renal functional and structural parameters in SHR-ob.

Efecto de la Terapia Trombolítica sobre la Variación de la Presión Arterial y la Frecuencia Cardíaca en las Primeras 24 h del Infarto de Miocardio en Pacientes Hipertensos

Se realizó un estudio descriptivo parcial comparativo en el Hospital Nacional Arzobispo Loayza, para describir el comportamiento de las curvas de presión arterial (PA) y frecuencia cardíaca (FC) durante la fase aguda del infarto agudo de miocardio (IAM) en pacientes con antecedentes de hipertensión arterial (HTA), planeándose que tanto los niveles previos de HTA así como de variación cardíaca volverían a niveles de HTA en quienes reciben terapia trombolítica, reflejando así la liberación de la zona isquémica y abolición de los efectos barorreflejos sobre PA y FC. Entre Mayo de 1996 y Mayo 1997, se estudió a 16 pacientes con IAM y antecedentes de HTA que recibieron tratamiento trombolítico con Estreptoquinasa y se les comparó con 15 pacientes con HTA pero sin dicho tratamiento. La FC media del grupo trombolizado fue de 78 ± 9,7 lat/m (Grupo A) y de 72 ± 13 lat/m en el grupo control (Grupo B) durante el día (p = 0,4061) y de 79 ± 12,9 en el grupo A y 69 ± 10 en B por la noche (p = 0,5869). En relación a la PA durante las 24 horas se obtuvo una presión de 128/79 mmHg en el grupo A y 121/75 en B, durante el día fue de 127/79 mmHg en el grupo A y 124/78 en B, durante la noche fue de 128/78 mmHg en A y 118/71 en B (p &amp;gt; 0,05 para ambos grupos). En conclusión, no se observa variación circadiana en la PA y FC en los pacientes hipertensos con IAM, independientemente del tratamiento trombolítico. Los niveles de PA están por debajo de los descritos en el estudio PAMELA, independientemente de si reciben o no trombolisis.

Prevalence and determinants of controlled hypertension in a German population cohort

BackgroundData of the German population-based cohort SHIP (Study of Health in Pomerania) were analysed to examine treatment rates, antihypertensive substances prescribed, and the proportion of hypertensive study participants reaching target values for blood pressure as well as determinants.MethodsThe study population was defined using baseline data of the cohort (collected between 1997 and 2001). Participants with blood pressure values ≥140/90 mmHg and/or antihypertensive medication with known hypertension and participants with risk-comorbidity (diabetes, stroke, angina pectoris, and/or myocardial infarction) and blood pressure values ≥130/80 mmHg were included. The analysis of treatment and target values was based on the 5-year follow-up of the cohort (collected between 2002 and 2006). Logistic regression was used to identify determinants for a normotensive blood pressure.Results3278 SHIP-participants with hypertensive blood pressure values were included (mean age: 55.5 years; SD 13.6, range 21–80 years). The raw hypertension prevalence was 50.9% (N = 1761). 58.7% (N = 1074) of all hypertensive patients reported some form of antihypertensive treatment. Thereof 65.1% (N = 728) received combination therapy. Of the patients without risk-comorbidity, 42.1% (N = 489) reached their target blood pressure values at the time of the 5-year follow-up of the cohort. Of the patients with any risk-comorbidity this proportion was only 21.7% (N = 131). Significant determinants for reaching the target values were being female and having antihypertensive combination therapy. Increasing age, having risk-comorbidities, and obesity were negatively associated with reaching the target values.ConclusionsBoth the proportion of participants receiving therapy and the number of participants reaching their target blood pressure values are very low. Combination therapy is associated with better blood pressure control as compared to mono therapy. However, even in the subgroup of hypertensive patients under combination therapy only 36% (both patients with and without comorbidity) reach target values.

Changes in blood pressure in patients with hypertension in the context of delegated GP-home visits

The AGnES-concept (GP-supporting, community-based, e-health-assisted, systemic intervention) includes the delegation of general practitioner (GP)-home visits to qualified practice assistants, especially in underserved areas. Most visited patients were elderly, multimorbid patients with limited mobility. We analyzed a subgroup of hypertension patients to assess the proportion of patients with controlled hypertension, the number of patients that changed between different categories of blood pressure during the project, and to identify possible determinants for these changes. Eligible patients were selected by the participating GPs. Hypertensive patients with at least two blood pressure measurements were included. Two-level mixed-effects multiple binary logistic regression analyses were conducted to evaluate possible determinants for the found effects. Overall, 776 patients (mean age 79.2 years; SD 8.1 years; range 38-98 years) were included in the analysis. During the project, the mean values for systolic (from 136.1 to 131.0 mmHg, P<0.0001) and diastolic (from 77.0 to 75.7 mmHg, P=0.0026) blood pressure decreased. In 26.0% of the patients there was a change from hypertensive blood pressure values to normotensive values and vice versa in 14.3% (P<0.0001). Multilevel regression models did not show single elements of the complex intervention as determinants for changing to normotensive blood pressure values. Although the study was conducted under real life conditions and therefore had some methodological limitations, the delegation of home visits to qualified practice assistants may have had a positive influence on changes of blood pressure with elderly hypertension patients. The study population represents a relevant population for medical care, which might benefit from the implementation of the AGnES-concept.

A simplified table improves the recognition of paediatric hypertension

Unrecognised and untreated hypertension can lead to significant morbidity and mortality over time. In a 2003 chart review, we found that our providers only recognised 15% of hypertensive blood pressure (BP). Our objective was to determine whether a simplified BP table improves the recognition of elevated BP in children. We developed a simplified BP table for children 3-18 years and posted it in provider work areas beginning August 2006. We reviewed a retrospective sample of well visits for children aged 3-18 years, with equal numbers by sex and year of age, presenting at a university-based paediatric clinic between January and August 2007. Visit notes for all children with elevated BP values ≥ 90th percentile were reviewed to identify whether the provider recognised that the BP was elevated. In 493 well visits, 85 (17.2%) children had pre-hypertensive (90th to < 95th percentile) and 100 (20.3%) had hypertensive (≥ 95th percentile) BP values. Providers recognised elevations in 34 (40%) pre-hypertensive and 77 (77%) hypertensive measurements. Recognition was significantly more common for those in the hypertensive than the pre-hypertensive range (χ² = 24.9, degrees of freedom= 1, P < 0.001). Compared with our 2003 data, recognition of hypertensive BP values was significantly greater (77% vs. 15%) (t = 14.479, degrees of freedom = 98, P <0.001) after introduction of the simplified BP table. Use of a simplified BP table can lead to significantly improved recognition of elevated BP in children.

Association of the CLC-Kb T481S polymorphism with childhood hypertension

Essential hypertension is a difficult diagnosis in children and the gene of the renal-epithelial chloride channel ClC-Kb is potentially predisposing. In vitro studies have shown that a common ClC-Kb threonine481serine (T481S) polymorphism leads to enhanced chloride channel activity and may predispose for hypertension (HT). We therefore analysed children at risk for HT for the T481S polymorphism and associated genotype with blood pressure (BP) status. A total of 48 children with essential hypertension (mean age 14.4 ± 2.7 years, 26 male; 22 female; mean BP 143.4 ± 7.5/88 ± 5.8 mmHg) were compared with 78 children with white-coat HT (WCHT), who showed occasionally hypertensive BP values, which were not confirmed by ambulatory blood pressure monitoring (mean age 13.7 ± 2.5 years, 49 male, 29 female; mean BP 122.4 ± 4.3/68.2 ± 3.5 mmHg). Other causes of HT were excluded. Allelic frequencies of hypertensive patients were not significantly different from those with WCHT (HT: A 0.84; T 0.16 vs. WCHT: A 0.85; T 0.15). However, the T-allele was observed more frequently in WCHT subjects with systolic and diastolic BP exceeding the 90th percentile (A 0.71; T 0.29, n = 34, p < 0.05, considered as borderline hypertensive). The preliminary data suggest that children with WCHT carry the ClC-Kb T481S polymorphism more often and that this variant may predispose for development of arterial HT.

Prevalence of children with blood pressure measurements exceeding adult cutoffs for optimal blood pressure in Germany

Despite a growing interest in the epidemiology of paediatric hypertension, data on how often blood pressure in children and adolescents already exceeds adult thresholds for optimal blood pressure are scarce. The aim of this study was to estimate the prevalence of higher-than-optimal and hypertensive blood pressure values according to adult cutoffs in an unselected representative sample of children and adolescents living in Germany. Standardized oscillometric blood pressure measurements were performed in 14 730 children aged 3-17 years (7203 girls and 7527 boys) participating in a nationally representative examination survey of children and adolescents living in Germany (The German Health Interview and Examination Survey for Children and Adolescents, KiGGS, response rate 67%). The mean of two measurements was used for this analysis. The prevalences of higher-than-optimal blood pressure values by adult criteria (>or=120/80 mmHg) increased with age and was 52.2% in boys aged 14-17 years and 26.2% in girls aged 14-17 years (including 6.0% of boys and 1.4% of girls with hypertensive values >or=140/90 mmHg). More than half of these adolescents with nonoptimal blood pressure values had additional cardiovascular risk factors (overweight defined as body mass index >or=90th percentile for sex and age, dyslipidaemia defined as total cholesterol >5.0 mmol/l or high-density lipoprotein cholesterol less than 1.0 mmol/l or smoking). These results suggest the need for routine blood pressure measurements in children and adolescents as required by clinical guidelines, for more attention to coexisting other cardiovascular risk factors and for a sustained focus on healthy lifestyles that can be learned best at a young age.

Elevation of sympathetic activity by eprosartan in young male subjects

Background Selective blockade of the type 1 angiotensin II receptors (AT1 receptors) reduced blood pressure (BP) elevation caused by sympathetic stimulation in the pithed rat model. This has been attributed to blockade of AT1 receptors located presynaptically on sympathetic nerve endings normally facilitating norepinephrine release. We examined the effects of AT1 receptor blockade on the sympathetic nervous system in humans. Methods Twenty-nine young white men with normal to mildly hypertensive BP values participated in a double-blind, placebo-controlled, randomized cross-over protocol receiving 600 mg/d of eprosartan or placebo for 1 week. At the last day of intake we measured hemodynamic parameters, muscle sympathetic nerve activity by microneurography, and plasma levels of norepinephrine, epinephrine, and angiotensin II during rest and cardiovascular stress. Results Eprosartan lowered resting mean arterial pressure (73.6 ± 11.0 v 78.0 ± 10.3 mm Hg, P < .05; Finapres, Ohmeda, Englewood, CO), and elevated heart rate (64.4 ± 7.6 v 61.1 ± 6.8 beats/min, P = .01), muscle sympathetic nerve activity (14.1 ± 10.4 v 9.8 ± 6.3 bursts/min, P < .05) and plasma angiotensin II (37.0 ± 33.7 v 6.9 ± 2.8 ng/L, P < .01), as well as norepinephrine levels (234.2 ± 87.6 v 187.8 ± 59.3 ng/L, P < .01). Eprosartan did not blunt sympathetic activation caused by lower body negative pressure or mental stress. Conclusions These results contrast with animal data showing antiadrenergic properties of this drug. If any, it appeared, that eprosartan causes augmented central neural vasoconstrictor outflow paralleled by increased plasma levels of norepinephrine, which casts doubt on its ability to dampen norepinephrine release from peripheral sympathetic nerve endings in humans. We hypothesize that eprosartan leads to a resetting of the baroreflex, presumably by the markedly elevated circulating angiotensin II.

Sleep-disordered breathing and systemic hypertension in the older male.

To investigate the relationship between sleep-disordered breathing (SDB) and essential hypertension in a population of older male hypertensives. One-hundred forty consecutive older hypertensive males. Monitoring of sleep-related breathing abnormality with a portable sleep apnea monitor (level III device). Assessment of complaints related to sleep quality using a validated questionnaire. Systemic arterial blood pressure according to WHO standards and biochemical analyses. SDB was defined as more than 10 abnormal respiratory events per hour of sleep. Prospective investigation on a retrospective cohort. Veterans Administrations hypertension clinic. SDB was diagnosed in 80% of this older, hypertensive, male population. Thirty-four percent of all study subjects presented with severe SDB, with more than 30 abnormal respiratory events per hour of sleep. Subjects with SDB were significantly heavier (BMI = 30.0 +/- 5.2 kg/m2) than subjects without SDB (BMI = 26.8 +/- 5.1 kg/m2, P = .004). Furthermore, subjects with SDB slept significantly longer (by a mean of 46 minutes/night, P = .027) and complained significantly more often of daytime sleepiness than subjects without SDB (P = .018). Fifty percent of all 140 subjects snored more than 10% of the total sleep time, and 26% snored for more than one-third of the night. No significant differences in blood pressure values were observed in subjects with compared with subjects without sleep-disordered breathing. However, a considerable number of subjects presenting with hypertensive blood pressure values despite treatment could be identified. Subjects presenting with hypertensive blood pressure values had a significantly higher severity index of SDB than subjects with normotensive blood pressure values (P = .047). This investigation supports data showing that undiagnosed SDB is a common phenomenon in older male individuals, leading to impaired daytime functioning and impairment of overall quality of life. More importantly, our data suggests that untreated SDB may have an adverse effect on the efficacy of antihypertensive treatment in hypertensive individuals with sleep-disordered breathing.

Isolated office hypertension: a prehypertensive state?

Isolated office hypertension, defined as hypertensive blood pressure values in a medical setting but normal self-measured or ambulatory-recorded blood pressures, is frequently encountered in clinical practice. Yet, whether this condition represents a transient state in the development of a sustained ambulatory hypertension is still unknown as no long-term analysis of the evolution of ambulatory blood pressure has been carried out in patients with isolated office hypertension. To evaluate whether such patients should be considered as truly normotensive or hypertensive, we have studied the long-term changes in office and ambulatory blood pressures in 81 patients in whom isolated office hypertension was observed between 1982 and 1988. After a 5-6 year follow-up, 60 of the 81 patients had a mean 12 h daytime ambulatory blood pressure greater than 140/90 mmHg, suggesting an evolution towards ambulatory hypertension. The development of hypertension could not be predicted on the basis of the follow-up office blood pressures as these tended to decrease during the follow-up period. The results of this study suggest that patients with isolated office hypertension should not be considered as truly normotensive individuals. Hence, these patients require a careful medical follow-up. Office blood pressure readings alone, however, do not appear to provide a good indicator of the long-term outcome of isolated office hypertension.

The effect on blood pressure of a monophasic oral contraceptive containing ethinylestradiol and gestodene

To obtain an overview of the effect of monophasic gestodene on blood pressure and to determine the frequency of “OC elevated BP/hypertension,” the results of blood pressure monitoring from four clinical studies of contraceptive efficacy and safety have been retrospectively analyzed. A total of 1930 women took part in the studies, which recorded BP for up to 24 cycles. Analysis of results revealed that 97 women (5.0%) showed an increase in blood pressure from previously normal to elevated values while taking monophasic gestodene, with only 26 (1.35%) fulfilling the criteria of “OC elevated BP/hypertension.” Only four women dropped out of the trials due to hypertensive blood pressure values, while 67 women (3.5%) experienced a normalization of previously elevated blood pressure measurements. In conclusion, this analysis has confirmed that gestodene has a negligible effect on blood pressure, with increased BP a relatively rare event.

Relationship between vascular factors and white matter low attenuation of the brain.

To study the relationship between vascular factors and white matter low attenuation of the brain (WMLA), computer tomography findings of 251 patients were re-interpreted. Clinical data on patients were collected from the hospital records. It was possible to obtain sufficient clinical data on 204 patients who were included in the study. WMLA changes, on computer tomography, were found in 51.5% of patients. WMLA was most commonly present in patients with vascular (69.8%) and combined (69.2%) dementia. The occurrence of WMLA did not differ between patients with Alzheimer's disease (26.7%) and those without dementia (35.9%). Arterial hypertension, coronary heart disease, or diabetes were not associated with WMLA. Heart failure and orthostatic hypotension, were found to be more commonly present in patients with than in those without WMLA (34.0% vs 14.3%, p = 0.0012; 10.0% vs 2.0%, p = 0.036). Both systolic and diastolic low blood pressure values were associated with WMLA unlike hypertensive blood pressure values. Atrial fibrillation in electrocardiography was associated with WMLA, while neither left ventricular hypertrophy nor myocardial infarction was. When several explanatory variables were adjusted by logistic regression analysis, age, heart failure, and systolic blood pressure below 130 predicted WMLA. In conclusion, the association between WMLA and vascular factors with hemodynamic significance suggests that cerebral hypoperfusion may contribute to the genesis of WMLA.

Screening for hypertension: Results of the Munich blood pressure program

The Munich Blood Pressure Program (MBP) is a community hypertension control program for the metropolitan area of Munich. It tries to improve “incidental screening” in doctors' offices in the city through continuing education programs for physicians and auxiliary personnel and, in addition, emphasizes worksite screening to bring high-risk hard-to-reach groups under treatment and control. Blood pressure (BP) is measured at the worksite under standardized conditions. Those with values ⩾140 mm Hg systolic BP and/or ⩾90 mm Hg diastolic BP at the first visit have BPs measured again within 1–5 days. If their BP values are still elevated, they are referred to their family physicians for further assessment. At the same time, they are given a postage-paid card on which their doctors are asked to note the BP value measured in their offices. This postcard is returned to the MBP for evaluation. A computer-based reminder system informs all MBP participants at certain time intervals to have their BP checked. The text of the letters and the time interval between them depend on the most recent BP and treatment status data available to the MBP. In 1983, screenings were performed in seven firms. Participation rates of up to 57% were achieved for this entirely voluntary examination (3,948 participants). Age- and sex-specific prevalence rates (for the pooled data of the seven firms) were similar to those of a random sample of the Munich population (Munich Blood Pressure Study 1). Seventy-four percent of those with elevated BP at first visit participated in the remeasurement at a second visit. Only 58% of these showed elevated BP values the second time. More than half ( n = 101) of those second-visit hypertensives (⩾ 160/95 mm Hg; n = 183) returned at least one completed postcard. The examining physician confirmed the hypertensive BP values in 60 of those cases. Of the 101, 57 were under treatment, 19 controlled and 38 uncontrolled. The follow-up period considered here lasted until May 1984 and varied from 5 to 15 months according to the date of screening in the respective firm. Only the first returned card has been evaluated thus far.