Mean Values Of Systolic Blood Pressure Research Articles

Aggressive Antihypertensive Treatment and Serum Lipid Lowering Therapy Are Necessary to Prevent Deterioration of the Renal Function Even in Elderly Type 2 Diabetic Patients with Persistent Albuminuria

Background: In elderly patients with diabetic nephropathy, clinical information aiming at preventing a decline of the renal function is limited. Objective: To clarify factors that could be related to changes in renal function in elderly diabetic patients with persistent albuminuria. Methods: We studied the relationships between the declining rate of creatinine clearance (Ccr) and other clinical features – glycemic control, blood pressure (BP), the degree of albuminuria, and other confounding factors – retrospectively in elderly diabetic patients with persistent albuminuria. Results: We analyzed 17 elderly diabetic patients with persistent albuminuria (4 men and 13 women, mean age 68.0 ± 5.7 years at the beginning of the observation period) for 3.7 ± 1.5 (SD) years. We found that the last value of the urinary albumin excretion (UAE) of the observation period and the individual mean values of systolic BP, mean BP, and serum cholesterol closely correlated with the rate of decline in Ccr estimated by Cockcroft’s formula. The last UAE closely correlated with the individual mean values of systolic BP and mean BP. For patients such as the present subjects, adequate retardation of decline in renal function requires that the estimated goal of antihypertensive treatment should be a BP below 130/70 mm Hg. The level of glycemic control and the use of angiotensin-converting enzyme inhibitors did not correlate with the rate of decline in Ccr. Conclusion: Aggressive antihypertensive treatment and serum lipid lowering therapy may be necessary to prevent deterioration of the renal function in elderly type 2 diabetic patients with persistent albuminuria.

Age-specific differences in blood pressure among inbred and non-inbred north Indian children

Genetic and inbreeding influences on systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial blood pressure (MBP) were examined among 3015 children (1527 males and 1488 females) from the Aligarh district, Uttar Pradesh in north India. The subjects included offspring of first cousins, first cousins once removed, second cousins and unrelated spouses from the same population. The measurements of the inbred children were compared with those of their non-inbred relatives in at least 80% of the cases (matched controls). Two unique findings emerge from this study. First a consistent increase in mean values of SBP, DBP and MBP with increasing inbreeding coefficients have been observed among all age groups, including both the sexes. The results suggest that the hypothesis for a recessive gene or genes could be held responsible for higher BP. Secondly, the effects of inbreeding on mean blood pressure among children and adults may not necessarily be in the same direction. It can be said, therefore, that studies on inbreeding effects using matched controls may provide more direct information regarding the genetics of blood pressure, which has been considerably underestimated in earlier studies.

Trends in the prevalence, detection, treatment and control of arterial hypertension in the Belgian adult population.

To discuss changes during the past decades in the prevalence and in the patterns of detection, treatment and control of arterial hypertension in the general Belgian population aged 25-64 years. Data from two cross-sectional cardiovascular disease risk factor surveys of the general population aged 25-64 years during the first and second halves of the 1980s (the Belgian Inter-university Research on Nutrition and Health study of 1980-1984 and the World Health Organization Multinational Monitoring of Trends and Determinants in Cardiovascular Diseases study of 1985-1992) are compared. Age-stratified and sex-stratified random samples from the general population yielded 9372 participants in the former study and 4904 participants in the latter. In both studies, blood pressure measurements and other variables were collected in the same standardized way and by the same observers. For both sexes, overall age-standardized prevalences of hypertension (subjects with systolic blood pressure > or = 160 mmHg or diastolic blood pressure > or = 95 mmHg or currently being administered antihypertensive drug treatment) were found to be significantly (P< 0.001) higher in the former than they were in the latter study. A significant decline in population mean systolic blood pressure values was observed for both sexes on going from the former data to the latter (falls of 6.0 and 7.3 mmHg for men and women, respectively, P< 0.01). In log-linear models, adjusted for age, a highly significant (P< 0.0001) favourable shift in the population distribution over the various categories of detection, treatment and control of hypertension was observed. This trend exhibited a significant sex difference, however, there being a much more favourable trend for women. In Belgium, favourable trends in the prevalence and in the patterns of detection, treatment and control of arterial hypertension and in the levels of systolic blood pressure were observed. The so-called 'rule of halves' is no longer valid.

Differences in exercise blood pressure response between dipper and non-dipper elderly patients with essential hypertension

We evaluated the circadian variation and exercise stress response patterns of blood pressure (BP) in elderly patients with essential hypertension. Ambulatory BP monitoring for 48 hours every 30 minutes, and treadmill exercise test using a Bruce protocol at PM 3 to 5 were performed in 49 untreated patients with hypertension. Mean daytime (awake), and night-time (sleeping) systolic BP (SBP) and diastolic BP (DBP) values were analyzed by reviewing the patients' diaries, and the nocturnal reduction rate (NRR) of SBP and DBP were calculated according to the following formula. NRR (%) = [(daytime mean-nighttime mean)/daytime mean] x 100. The patients were divided into two groups according to the presence (dipper, n = 25) or absence (non-dipper, n = 24) of a reduction in both SBP and DBP during the night by an average of more than 10% of the daytime BP. Mean values of SBP and DBP measured over 48 hours in the dipper and non-dipper groups were similar. Responses of SBP to dynamic exercise at 2 to 5 minutes in the non-dipper group were significantly smaller than those in the dipper group (p < 0.05). Non-dipper patients with hypertension responded to dynamic exercise stress with smaller increases in SBP than did those in the dipper group. The differences in BP responses to exercise may affect the circadian blood pressure profile in dipper and non-dipper elderly patients with essential hypertension.

Biofeedback assisted relaxation in essential hypertension: short-term follow-up of contributing effects of pharmacotherapy on blood pressure and heart rate"Brief communication"

The present study was designed to evaluate the possible beneficial effects of biofeedback-assisted relaxation to pharmacotherapy on blood pressure and heart rate in patients with essential hypertension. Twenty patients with essential hypertension and without any complications or end-organ damage participated in the study. All the patients were using anti-hypertensive drugs. The study protocol consisted of an interview, 10 days baseline, 10 biofeedback-assisted relaxation sessions and a 10-day post-treatment period. Interview blood pressure (BP) and heart rate (HR) measurements, baseline mean values of systolic blood pressure (SBP), diastolic blood pressure (DBP) and HR recorded during the 1st, 10th and 20th minutes of each session and the post-treatment mean values were evaluated. Significant differences were found between the mean values of SBP, DBP and HR after the whole treatment protocol (Wilcoxon signed-ranks test). The mean values of SBP, DBP and HR measurements recorded during the 1st, 10th and 20th minutes of the biofeedback-assisted relaxation sessions, which were evaluated by repeated measures of ANOVA on ranks test, showed a significant decrease only for the 10th minute values at the end of the whole treatment program. Despite a short follow-up, it was suggested that these results were encouraging considering the fact that once the patients are thoroughly instructed in home practice of relaxation and encouraged to develop their own strategies for relaxation, the long term outcome may also be promising.

The Relationship Between Sleep Deprivation and the Nocturnal Decline of Blood Pressure

Blood pressure (BP) has a circadian pattern with a 10% to 15% drop in systolic and diastolic BP comparing nighttime and daytime averages. The mechanism and the "reason" for the decline of nocturnal blood pressure has not been described. If the nocturnal decline is a restorative physiologic process we reasoned that sleep deprivation would increase the nocturnal drop. Thus, we tested the hypothesis that there is a compensatory decline in nocturnal sleep blood pressure after a period of nocturnal sleep deprivation. Twenty-four house staff personnel (normotensive and not taking any BP medications) with a mean age of 29.3 years were recruited for this study (13 men and 11 women). Subjects were randomly assigned to have 24-h BP monitoring after being sleep deprived (on call with 3 +/- 1.3 h of sleep) or after a normal night's sleep (7.3 +/- 0.8 h). There was no significant difference in hours asleep or time to bed or time awake for both 24-h studies. Subjects had similar activities for both monitoring intervals. The percent change in day awake versus night asleep mean values for systolic BP, diastolic BP, and mean arterial pressure for sleep deprived and normal night's sleep intervals were compared using paired t tests. None of these paired parameters were significantly different despite a subjectively "deeper" sleep postcall. In conclusion, sleep deprivation does not appear to result in a compensatory decline in nocturnal blood pressure. Thus, the "reason" for the normal nocturnal decline in blood pressure remains to be explored.

L-threo-DOPS treatment of orthostatic hypotension in Swedish patients with familial amyloidotic polyneuropathy (TTR-met30)

L-threo-DOPS is a synthetic precursor to norepinephrine (NE). In order to study its efficacy and dosage, we carried out an open pilot study in ten patients with orthostatic hypotension and a confirmed diagnosis of familial amyloidoticpolyneuropathy (FAP). The initial dosage was 200 mg of L-threo-DOPS daily, with a weekly increment of 100 mg, until a maintenance dose was reached. Ten patients were treated for 12 weeks and five of them for 24 weeks. The blood pressure (BP) and pulse rate were monitored weekly. Before treatment, after four and 12 weeks, the patients underwent clinical and laboratory examinations. Nine patients completed the study. There was a rise in mean BP values in all measurements. After 12 weeks of treatment the rise in mean systolic BP values were statistically significant (p < 0,01) in all measurements in upright position. When treatment was withdrawn BP fell to almost the same levels as before and when treatment was restarted (five patients), there was again a rise in mean BP values. Before treatment, all patients suffered from mild to severe symptoms of orthostatic hypotension. After 12 weeks of treatment, eight out of nine patients were free of symptoms. Most frequent side effects were tachycardia and nausea, but no severe side effects were seen.

Blood pressure reactivity to stress varies by hypertensive status and sex in Nigerians.

Previous studies among American and European populations have demonstrated larger blood pressure responses to behavioral challenges among men and hypertensive individuals. This is the first report of cardiovascular responses to behavioral challenges in a West African population. Blood pressure and heart rate changes in mirror image tracing and speech making tasks were recorded for 787 Nigerian civil servants participating in a comprehensive blood pressure survey conducted in Benin City, Nigeria, during 1992. Similar to findings in other populations, greater task-induced increases in systolic blood pressure (SBP) and diastolic blood pressure (DBP) were present among men than women (mean values of SBP = 22.1 vs. 18.3 mmHg, p < 0.001; and DBP means = 13.3 vs. 11.2 mmHg, p < 0.0001) and among hypertensives than normotensives (SBP means = 27.6 vs. 19.2, p < 0.0001; and DBP means = 14.1 vs. 12.1 mmHg, p < 0.05). An elevated prevalence of hypertension among men of higher staff status has been found in this population; however, higher staff status was not consistently related to cardiovascular reactivity, independent of hypertensive status. Additionally, hypertensive men who had speech-induced increases of SBP > 40 mmHg had significantly greater left ventricular mass index than did those hypertensive men with smaller SBP increases (p < 0.04). This study demonstrates that measures of cardiovascular reactivity to behavioral challenges have cross-cultural application, suggesting the need for further investigations of the interrelation of hypertension, cardiovascular reactivity, and left ventricular mass.

Longitudinal outcome among patients with ischemic vascular dementia 1

Longitudinal studies carried out in this laboratory for the past 12 years among patients with ischemic vascular dementia (IVD) are summarized. The criteria for the diagnosis of probable IVD and definite IVD are described and are consonant with the State of California Alzheimer's Disease Diagnostic and Treatment Centers recommended criteria. Demography of IVD patients and associated risk factors are described, and the types of cerebral infarcts causing IVD are listed. Control of risk factors for stroke stabilizes patients with IVD as judged by serial cognitive testing. Control of hypertension and cigarette smoking and a reduction in hyperlipidemia all benefit IVD patients. Best cognitive results are obtained if hypertension is controlled within the upper limits of normal with mean systolic blood pressure values maintained above and around 137 mm Hg. Serial measurements of cerebral perfusion indicate that cognition and cerebral perfusion fluctuate together. When demented and nondemented patients with stroke are compared, overall cerebral perfusion is reduced to a greater extent in the stroke patients with dementia, particularly within cortical gray matter and subcortical white matter. Leuko-araiosis is twice as great in demented stroke patients compared to stroke patients who are cognitively intact. In longitudinal studies, cerebral perfusion declined further among stroke patients with cognitive deterioration, but, when cerebral perfusion became stabilized, cognitive performance likewise stabilized or improved.

Trends of Diet and Blood Pressure in Guangzhou, South China

As part of the International Cooperative Cardiovascular Diseases and Alimentary Comparison (CAR-DIAC) Study surveys to determine the relationship of dietary factors to blood pressure were carried out in 1985 (pilot study) and 1989 (core study). Thirteen men and 16 women, and 102 men and 115 women aged 50-54 in the rural population of Panyu county in Guangzhou were randomly selected for the pilot and core studies, respectively. Blood pressure was measured by an automatic system and 24-h urine collection by aliquot cups. All urinary specimens were analyzed in the WHO Collaborating Center (Izumo, Japan). Seven hypertensive cases and 17 borderline cases of hypertension were found in 1989 but none in 1985. Mean systolic blood pressure (SBP) and diastolic blood pressures (DBP) were increased, and the intake of dietary sodium (Na), sodium chloride (NaCl), and the ratio of sodium to potassium (Na/K) were increased markedly. The intake of magnesium (Mg) was decreased in 1989. Correlation analyses showed that body mass index was positively related to SBP and DBP (p less than 0.05), Na and NaCl were positively related only to DBP (p less than 0.05), and Mg was inversely related to SBP but with no statistical significance. These results indicate that trends of rise of prevalence rate of hypertension and mean values of SBP and DBP in association with increased dietary Na and decreased Mg intake may be due to rapid changes in dietary habits, changes in lifestyle, and the differing socioeconomic status in the area and may highlight the importance of dietary factors in the prevention of hypertension.

Effects of chronic congestive heart failure secondary to coronary artery disease on the circadian rhythm of blood pressure and heart rate

In 20 subjects with chronic congestive heart failure due to coronary artery disease, the 24-hour variability of ambulatory intraarterial blood pressure (BP) was studied using an improved Oxford Medilog system, and correlated with left ventricular function at rest. The mean radionuclide ejection fraction was 27% (range 10 to 42), the mean pulmonary arterial wedge pressure was 18 mm Hg (5 to 37) and the mean cardiac index was 2.8 liters/ min/m 2 (2 to 3.8). The 24-hour systolic BP and heart rate (HR) variability indexes were less than those of 22 normal volunteers (p < 0.05) and were strongly correlated (p < 0.05) with ejection fraction at rest and pulmonary arterial wedge pressure. Stepwise regression showed that a combination of the mean nocturnal HR and the standard deviation of the hourly mean systolic BP values accounted for 67% of the variability in ejection fraction between patients. Similarly, 73% of the variation in pulmonary wedge pressure was explained by combining the 24-hour mean HR and the mean nocturnal HR.