Stage-1 Hypertension Research Articles

Job stress and hypertension in younger software professionals in India.

Background:We report the results of a moderately large study (1071) to study the prevalence of hypertension among software professionals in the Indian subcontinent employed at 27 different companies in Bangalore. The focus of our study is on the age gradient of hypertension prevalence and exploring the association of workplace psychosocial predictors of hypertension.Materials and Methods:We used mixed methods sampling strategy, the first stage of which involved stratified sampling to select the clusters of software companies in Bangalore and the second stage involved selecting individual companies through purposive sampling. Job stress questionnaire was self-administered to collect information on job stress and blood pressure classification is done based on 7 th report of Joint National Commission.Results:The prevalence of hypertension among Information Technology/Information Technology Enabled Services professionals was 31% and pre-hypertension was 45.7%. The prevalence of stage-1 hypertension in the age group of 19-25 years was 18% and 23% in 26-30 years group while the prevalence of stage-2 hypertension in the age group of 19-25 years was 5% and 3% in 26-30 years group. The results indicate that dimensions of workplace autonomy and workplace environment are associated with hypertension.Conclusions:Hypertension affects the young urban Indians a decade earlier compared to available evidence. Furthermore, there is an association of autonomy and work-environment with hypertension. This signifies further exploration of underlying endocrine mechanisms.Funding:The funding UCLA International Research and Training Program and the Public Health Foundation of India provided the funding for this study.Results:The study was supported through Fogarty/UCLA International Research and Training Program (Grant Number: D43 TW000013) and the Public Health Foundation of India

Cocoa, Hazelnuts, Sterols and Soluble Fiber Cream Reduces Lipids and Inflammation Biomarkers in Hypertensive Patients: A Randomized Controlled Trial

BackgroundCocoa, mixed with other food ingredients, intake can have beneficial effects on cardiovascular disease (CVD) biomarkers. We compared the effects of 4 cocoa cream products on some of these biomarkers.Methods and FindingsIn this multi-centered, randomized, controlled, double-blind, parallel trial, volunteers (n = 113; age range: 43–65 years) who were pre-hypertensive, stage-1 hypertensive and hypercholesterolemic received one of 4 cocoa cream products (13 g/unit; 1 g cocoa/unit, 6 units/d; 465 Kcal/d) added to a low saturated fat diet for 4 weeks. The groups were: A) (n = 28), cocoa cream considered as control; B) (n = 28), cocoa+hazelnut cream (30 g/d hazelnuts); C) (n = 30), cocoa+hazelnuts+phytosterols (2 g/d); and D) (n = 27), cocoa+hazelnuts+phytosterols+soluble fiber (20 g/d) the patented “LMN product”. Primary outcome measures were BP, LDL-c, apolipoprotein B-100 (Apo B), ApoB/ApoA ratio, oxidized LDL (oxLDL) and high-sensitive C-reactive protein (hsCRP) determined at baseline and post-cocoa cream product intake. Statistical analysis used was ANCOVA or mixed models (in case of repeated measurements), with baseline observation included as a covariate. After 4 weeks, compared to product A, product C reduced LDL-c by 11.2%, Apo B by 8.1% and ApoB/ApoA ratio by 7.8% (P = 0.01). LMN decreased LDL-c by 9.2%, Apo B-100 by 8.5%, ApoB/ApoA ratio by 10.5%, hsCRP by 33.4% and oxLDL by 5.9% (P = 0.01). Surprisingly, even “control” product A reduced systolic BP (−7.89 mmHg; 95%CI: −11.45 to −4.3) and diastolic BP (−5.54 mmHg; 95%CI: −7.79 to −3.29). The BP reductions were similar with the other 3 products. Limitations of the study are that the trial period was relatively short and that a better “BP control” product would have been preferable.ConclusionThe creams (particularly the LMN) have anti-inflammatory and antioxidant effects in addition to lowering LDL-c, Apo B and ApoB/ApoA ratio. Thus, the soluble fiber effects amplified with sterols (as contained in the cocoa creams) provide new dietary therapeutic perspectives.Trial RegistrationClinicaltrials.gov NCT00511420

Association of Aldosterone and Cortisol with Cardiovascular Risk Factors in Prehypertension Stage

Background. The Pakistani population has higher incidence of cardiovascular (CV) diseases at younger ages, due to undiagnosed, uncontrolled hypertension (HTN). A variety of associated HTN stressors is also reported. The study plans to understand the variables associated with initiation of HTN in this population. Objective. To find plasma aldosterone and cortisol relationship with some CV risk factors (obesity, dyslipidemia, hyperglycemia, sodium and potassium) in different stages of HTN particularly prehypertension. Subjects and Methods. The study conducted on 276 subjects (25–60 years), classified into prehypertensive (n = 55), HTN stage-1 (n = 70) and II (n = 76) according to 7th JNC report and compared with normotensive controls (n = 75). The anthropometric profiles (height, weight, waist circumference, Body Mass index) and BP recorded. Serum cortisol, aldosterone, total cholesterol, Low density lipoproteins, blood glucose, Na+ and K+, using standard laboratory techniques, were determined in fasting blood samples. Results. Subjects were mostly overweight and obese (80%, 90%, and 76% in pre-HTN, stage-I and II versus 69% in controls). The aldosterone level (ng/dl) was in higher normal range (9.17–12.41) and significantly correlated to BMI (0.587) in controls, and to TC (0.726) and LDL (0.620) in pre-HTN stage-I. The cortisol level was positively correlated (P < 0.01) to BMI (0.538), Na+ (0.690) and K+ (0.578) in control, and to BMI (0.628) and WC (0.679) in pre-HTN group, showing its association with BMI > 25. Conclusion. Pre-HTN stage among Pakistani population with successive increase in various risk factors of HTN in relation to aldosterone and cortisol has been identified. Interaction of the risk factors with endogenous levels of these hormones may initiate stages of HTN.

Undiagnosed Hypertension and Proteinuria in a Market Population in Ile-Ife, Nigeria

Hypertension and chronic kidney disease (CKD) are common in our urban and rural communities but the majority of affected individuals are not aware of their condition. We conducted free medical examination and screening during one of the market days in Odo-Ogbe market, Ile-Ife, Nigeria to evaluate the magnitude of undiagnosed hypertension and proteinuria. Participants were taken through a brief medical history and had their socio-demographic data taken. Weight and height were measured and body mass index (BMI) calculated. Blood pressure (BP) was measured using a mercury sphygmomanometer and urinalysis was done with the aid of dipstick test. A total of 286 participants aged 13-90 years (Mean 49.5 ± 15.7 years) were screened. Females constituted 90.2% of the study population. One-hundred and eight (37.7%) of participants had hypertension and only 20 (6.7%) were previously diagnosed. Sixty-nine participants (24.1%) had stage-1 hypertension while 39 (13.6%) had stage-2 hypertension. Fifty-nine percent of participants had BMI above 25 kg/m2. Eighty five participants (29.7%) had proteinuria while only 13 (4.5%) had glycosuria. A significantly higher percentage of participants with stage-1 and stage-2 hypertension had proteinuria compared with non hypertensives. There was a positive correlation between age and BMI (r=0.171, P=0.004), age and systolic BP (r=0.378, P < 0.0001) as well as age and diastolic BP (r=0.197, P=0.001). A high percentage of the studied population (31%) had undiagnosed hypertension and proteinuria (29.7%). Community screening for these disabling non communicable diseases and lifestyle modifications should be encouraged.

Olivenblätter-Extrakt wirksam gegen Bluthochdruck?

Susalit E, Agus N, Effendi I et al. Olive (Olea europaea) leaf extract effective in patients with stage-1 hypertension: Comparison with Captopril. Phytomedicine 2011; 18: 251-258

Limb venous compliance responses to lower body negative pressure in humans with high blood pressure

This study tested the hypothesis that limb venous responses to baroreceptor unloading are altered in individuals with high blood pressure (HBP) compared with normotensive (NT) controls. Calf venous compliance was assessed in 20 subjects with prehypertension and stage-1 hypertension (mean arterial pressure, MAP: 104±1 mm Hg) and 13 NT controls (MAP: 86±2 mm Hg) at baseline and during lower body negative pressure (LBNP), using venous occlusion plethysmography. Baroreflex sensitivity (BRS) was measured using the sequence technique and total peripheral resistance (TPR) was estimated from finger plethysmography. Baseline venous compliance was not different between groups, but the HBP group had lower baseline lnBRS (2.22±0.14 vs 2.7±0.18 ms mm Hg(-1)) and greater baseline TPR (3828±138 vs 3250±111 dyn sec(-1) cm(-5) m(2), P<0.05). Calf venous compliance was reduced in response to LBNP only in the NT group (P<0.05). The HBP group had a greater increase in TPR (ΔTPR) compared with the NT group (+1649±335 vs +718±196 dyn sec(-1) cm(-5) m(2), P<0.05). In conclusion, the early stages of hypertension are characterized by an attenuated venoconstrictor response to baroreceptor unloading, which may compensate for an exaggerated vasoconstrictor response and protect against further increases in blood pressure.

Olive (Olea europaea) leaf extract effective in patients with stage-1 hypertension: Comparison with Captopril

A double-blind, randomized, parallel and active-controlled clinical study was conducted to evaluate the anti-hypertensive effect as well as the tolerability of Olive leaf extract in comparison with Captopril in patients with stage-1 hypertension. Additionally, this study also investigated the hypolipidemic effects of Olive leaf extract in such patients. It consisted of a run-in period of 4 weeks continued subsequently by an 8-week treatment period. Olive (Olea europaea L.) leaf extract (EFLA(®)943) was given orally at the dose of 500 mg twice daily in a flat-dose manner throughout the 8 weeks. Captopril was given at the dosage regimen of 12.5 mg twice daily at start. After 2 weeks, if necessary, the dose of Captopril would be titrated to 25 mg twice daily, based on subject's response to treatment. The primary efficacy endpoint was reduction in systolic blood pressure (SBP) from baseline to week-8 of treatment. The secondary efficacy endpoints were SBP as well as diastolic blood pressure (DBP) changes at every time-point evaluation and lipid profile improvement. Evaluation of BP was performed every week for 8 weeks of treatment; while of lipid profile at a 4-week interval. Mean SBP at baseline was 149.3±5.58 mmHg in Olive group and 148.4±5.56 mmHg in Captopril group; and mean DBPs were 93.9±4.51 and 93.8±4.88 mmHg, respectively. After 8 weeks of treatment, both groups experienced a significant reduction of SBP as well as DBP from baseline; while such reductions were not significantly different between groups. Means of SBP reduction from baseline to the end of study were -11.5±8.5 and -13.7±7.6 mmHg in Olive and Captopril groups, respectively; and those of DBP were -4.8±5.5 and -6.4±5.2 mmHg, respectively. A significant reduction of triglyceride level was observed in Olive group, but not in Captopril group. In conclusion, Olive (Olea europaea) leaf extract, at the dosage regimen of 500 mg twice daily, was similarly effective in lowering systolic and diastolic blood pressures in subjects with stage-1 hypertension as Captopril, given at its effective dose of 12.5-25 mg twice daily.

The Effect of Dietary Patterns on Estimated Coronary Heart Disease Risk

The Dietary Approaches to Stop Hypertension (DASH) diet is recommended in the 2005 US Dietary Guidelines. To understand the potential benefits of DASH on coronary heart disease (CHD), we applied the Framingham risk equations to calculate 10-year risk of developing CHD using data from the DASH trial. In the DASH trial, 459 individuals with prehypertension or stage-1 hypertension not taking antihypertensive medication were randomly assigned to 1 of 3 diets: control, fruits and vegetables (F/V), or DASH (rich in fruits, vegetables, low-fat dairy, and reduced in fats and cholesterol). Weight was held constant. Estimated 10-year CHD risk was the primary outcome of this secondary analysis. Among 436 participants with complete data, mean (SD) age was 44.7 (10.7) years, 51% were male, and 60% were African-American. Median 10-year CHD risk was 0.98% at baseline and decreased in all groups. Compared with control, the relative risk ratio comparing 8-week with baseline 10-year CHD risk was 0.93 (95% confidence interval, 0.85 to 1.02; P=0.12) for F/V and 0.82 (95% confidence interval, 0.75 to 0.90; P<0.001) for DASH. Comparing DASH with F/V, the relative risk ratio was 0.89 (95% confidence interval, 0.81 to 0.97; P=0.012). With the exception of an interaction between dietary pattern and race suggesting a greater risk reduction in blacks than whites (P for interaction=0.038), results were similar across subgroups. Compared with control and F/V, the DASH diet reduced estimated 10-year CHD risk by 18% and 11%, respectively. In addition to reducing blood pressure, the DASH diet should substantially reduce the risk of CHD.

Comparison of Tissue Doppler Dynamics with Doppler Flow in Evaluating Left Atrial Appendage Function by Transesophageal Echocardiography in Prehypertensive and Hypertensive Patients

Increased blood pressure (BP) is associated with an increase in cardiovascular mortality and morbidity. We aimed to analyze the effect of increased BP onto the function of left atrial appendage (LAA) in early stages of hypertension. Transesophageal echocardiography (TEE) was prospectively performed to assess LAA functions in 120 patients with increased BP, and in 58 normotensive subjects without cardiovascular disease. Patients with increased BP were divided according to Joint National Committee VII (JNC VII) report: prehypertensive, stage-1 hypertensive and stage-2 hypertensive patients. During TEE, LAA late-emptying velocities (LAAEV) were significantly reduced only in stage-2 hypertensives as compared with control group (P < 0.001). In contrast, LAA late-contracting velocity (LAA TDI-D2) was significantly reduced in prehypertensive,stage-1 hypertensive and stage-2 hypertensive patients, when compared with control group (P < 0.05, P < 0.001, and P < 0.001, respectively). The LAA maximal areas were increased significantly only in stage-2 hypertensive patients when compared with control group (P < 0.05). During TEE, left atrial spontaneous echocardiographic contrast was found in 2 of 36 patients in prehypertension group, in 7 of 40 patients in stage-1 hypertension group, and in 10 of 44 patients in stage-2 hypertension group. Left atrial thrombi were observed in 3 (6.8%) patients of stage-2 hypertension group. In conclusion, in patients with untreated prehypertension and hypertension, elevation of afterload imposed on left atrium involved both left atrium and LAA, resulting in impairment of the LAA function. Tissue Doppler imaging (TDI) enables the detection of this functional impairment in early stages of hypertension, even in prehypertensive phase, when compared with conventional Doppler flow measurement of the LAA. Even in prehypertensive phase, BP should be decreased to normal levels to prevent the LAA dysfunction.

Risk factors among patients with acute coronary syndrome in rural Kerala

Sir, We found the article by Deb et al.(1) both interesting and thought provoking. It was noted that all forms of cardiovascular diseases were included in their study and it was therefore hypothesized that persons with acute coronary syndromes (ACS) may have different risk factors. We report our findings of risk factors among intensive care unit (ICU) patients with ACS from rural Kerala. A retrospective study of patients admitted to the ICU with ACS during the year 2006-2007 was analyzed. A total of 130 patients were identified from the records. Of these 130 cases, 74.6% (97) were males and 25.4% (33) females with a mean age of 58.4 ± 12.5 years with a range between 24 and 91 years. Of those getting admitted with ACS, 27.9% were above the age of 70 while 66.3% were between the ages of 40 and 60 showing that middle-aged persons were more affected by ACS in this community. The risk factors [Table 1] for ACS seen in this set-up in rural Kerala were: hypertension (HT), smoking, previous myocardial infarction (MI) and type 2 diabetes mellitus (DM). Alcohol consumption, dyslipidemia and obesity were seen in fewer people. HT was seen to occur in 82.3% of those with ACS. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) classification was used to stratify persons into pre-HT, stage-1 HT and stage-2 HT [Table 1].(2) Most persons in this area were found to have stage-1 HT. Comparison with other studies was not possible due to the variation in classification systems used to grade HT. Table 1 Risk factors for acute coronary syndrome Smoking was seen to be a major risk factor in 50.4% of the patients. A recent study from West Bengal found that 20.5% of the persons with ischemic heart disease were smokers. (3) The high rate of smokers observed here could be due to lack of awareness on the effects of smoking and its relation to coronary artery disease (CAD) in rural Kerala. (4) Previous MI and type 2 DM were found to occur among 43/130 persons. Of the 33.1% with type 2 DM, 18.5% had it under control with appropriate measures. The number of persons with type 2 DM and CAD was higher in this area than those reported from other parts of India. (1,5,6) A recent study by Gupta et al.,(7)found a low prevalence of multiple risk factors among young people which increased considerably between the age of 30-39 years. In this sub-group of persons admitted to the ICU, the high rates of risk factors were mainly seen between the ages of 40-49 years. As this age group was not studied by Gupta et al.,(7) it can only be assumed that a similar rising trend of risk factors is present in this area as well. In conclusion, different parts of India seem to demonstrate the same risk factors, but in varied proportions. This sample is not a true representation of the community burden as only cases admitted to the hospital were included. Therefore, large-scale studies covering more geographical areas will be necessary to investigate the risk factors of a particular area and the required preventive measures needed to reduce the prevalence of ACS. Patient education and awareness programs are of great importance in the rural areas to help reduce the burden of ACS.

Effectiveness of initiating treatment with valsartan/hydrochlorothiazide in patients with stage-1 or stage-2 hypertension

This prospective, 6-week, multicenter, double-blind study examined the benefits of initiating treatment with combination valsartan/hydrochlorothiazide (HCTZ) compared with initial valsartan monotherapy for 648 patients with stage-1 or stage-2 hypertension (age=52.6±10 years; 54% male; baseline blood pressure (BP)=161/98 mm Hg, 32% stage 1). Patients were randomized to valsartan 80 mg (V-low), valsartan 160 mg (V-high) or valsartan/HCTZ 160/12.5 mg (V/HCTZ), and electively titrated after weeks 2 and 4 to the next dosage level (maximum dose valsartan/HCTZ 160/25 mg) if BP remained >140/90 mm Hg. At end of the study, patients initiated with V/HCTZ required less titration steps compared with the initial valsartan monotherapy groups (63 vs 86% required titration by study end, respectively) and reached the target BP goal of <140/90 mm Hg in a shorter period of time (2.8 weeks) (P<0.0001) vs V-low (4.3 weeks) and V-high (3.9 weeks). Initial combination therapy was also associated with higher BP control rates and greater reductions in both systolic and diastolic BP from baseline (63%, −27.7±13/–15.1±8 mm Hg) compared with V-low (46%, −21.2±13/−11.4±8 mm Hg, P<0.0001) or V-high (51%, −24.0±13/−12.0±10 mm Hg, P<0.01). Overall and drug-related AEs were mild to moderate and were similar between V/HCTZ (53.1 and 14.1%, respectively) and the two monotherapy groups, V-low (50.5 and 13.8%) and V-high (50.7 and 11.8%). In conclusion, initiating therapy with a combination of valsartan and low-dose HCTZ results in early, improved BP efficacy with similar tolerability as compared with starting treatment with a low or higher dose of valsartan for patients with stage-1 and stage-2 hypertension.

Anthropometric and metabolic indicators in hypertensive patients.

To determine the relationship between anthropometric variables with blood glucose and lipid concentrations in different stages of hypertension and evaluate the risk factors involved in progression of pre-hypertension stage in to clinical hypertension stage-1. Case-control study. National Institute of Cardiovascular Disease and General Practitioner's Clinics, Karachi, from 2005 to 2007. The study was conducted on 276 participants aged 25-65 years and classified into four categories of control, prehypertension (pre-HTN), hypertension (HTN) stage I and II, according to 7th JNC report. Anthropometric measurements and blood chemistry were obtained. The relationship between obesity indices (Body Mass Index [BMI], Waist Circumference [WC], Waist Hip Ratio [WHpR], Waist Height Ratio [WHtR], Basal Metabolic Rate [BMR] and Cardiovascular Disease [CVD] risk factors [blood pressure, serum lipids and glucose levels]) were investigated. The analysis of variance and test of Pearson's coefficient correlation were applied to assess relationship of all the variables. The mean WHR had significant correlation with both systolic and diastolic BP in all groups of HTN, as well as with blood glucose level in control and pre-HTN groups. BMI was positively correlated with cholesterol (r=0.29) and triglyceride (r=0.25) in HTN stage-1. Impaired and high blood glucose levels were found in pre-HTN group; all lipid parameters except triglycerides were higher in HTN stage I. WHR was positively and independently related to occurrence of arterial hypertension. Elevated levels of WHR, BMI, fasting blood glucose, total cholesterol and triglycerides were responsible for progression of pre-HTN stage in to HTN stage-1.

The endothelial nitric oxide synthase −786 T>C polymorphism and the exercise-induced blood pressure and nitric oxide responses among men with elevated blood pressure

Objective A polymorphism (−786 T>C) in the promoter region of the endothelial nitric oxide synthase gene (eNOS) has important functional characteristics. We examined the influence of eNOS −786 T>C (rs2070744) on the BP and NO response to acute dynamic exercise. Methods Subjects ( n = 49, 43.7 ± 1.4 yr) had pre- to Stage-1 hypertension (145.6 ± 1.5/85.9 ± 1.1 mmHg). Volunteers performed three experiments; a non-exercise control session, and two cycle exercise bouts at 40% (LIGHT) and 60% (MODERATE) of peak oxygen consumption. Subjects wore an ambulatory BP monitor upon leaving the laboratory. NO was measured by chemiluminescence assay before (baseline), during, and after the experiments. eNOS genotypes were determined by polymerase chain reaction and restriction enzyme digestion. Repeated measure ANOVA tested if BP and NO differed over time among experiments and by eNOS genotypes ( n = 25, TT; n = 24, TC/CC). Results Among carriers of the eNOS C 786 allele, systolic BP (SBP) was reduced 5.3 ± 2.4 mmHg after MODERATE versus non-exercise control over 9 h compared to those with the eNOS T786T genotype ( p < 0.05). Under these conditions, SBP tended to be lower 4.6 ± 2.9 mmHg after LIGHT ( p = 0.076). The exercise-induced diastolic BP and NO responses were not different from non-exercise control between eNOS genotype ( p > 0.05). Conclusion Men who were carriers of the eNOS C 786 allele responded more favorably to the antihypertensive effects of aerobic exercise than men with the eNOS T786T genotype. The eNOS C 786 allele is associated with reduced eNOS gene transcription and promoter activity. Future work is needed to determine how exercise may override genetic predispositions to down regulate eNOS gene activity.

Sex differences in the effects of aerobic and anaerobic exercise on blood pressure and arterial stiffness

Exercise can be used as an antihypertensive prescription for individuals with pre- to stage-1 essential hypertension, but the outcomes differ between the sexes and depend on the mode of exercise employed. Both aerobic exercise and resistance training lower blood pressure in men and women; however, resistance training lowers diastolic blood pressure to a greater extent in women but increases arterial stiffness to a greater extent in men. These studies emphasize the need for further research on the effect of resistance exercise training on blood pressure and arterial stiffness so that sex differences in response to exercise treatment programs are fully taken into account when devising individual antihypertensive treatment regimens.

Effects of PREMIER Lifestyle Modifications on Participants With and Without the Metabolic Syndrome

Lifestyle modification can reduce blood pressure and lower cardiovascular risk. Established recommendations include weight loss, sodium reduction, and increased physical activity. PREMIER studied the effects of lifestyle interventions based on established recommendations alone and with the addition of the Dietary Approaches to Stop Hypertension (DASH) dietary pattern. This analysis aimed to assess the interventions' impact on cardiometabolic variables in participants with, compared with those without, metabolic syndrome. The primary outcome was 6-month change in systolic blood pressure. Participants with prehypertension or stage-1 hypertension were randomly assigned to an advice only control group, a 6-month intensive behavioral intervention group of established recommendations (EST), or an established recommendations plus DASH group (EST+DASH). Metabolic syndrome was defined per National Cholesterol and Education Program Adult Treatment Panel III. We used general linear models to test intervention effects on change in blood pressure, lipids, and insulin resistance (homeostasis model assessment), in subgroups defined by the presence or absence of metabolic syndrome. Of 796 participants, 399 had metabolic syndrome. Both EST and EST+DASH reduced the primary outcome variable, systolic blood pressure. Within the EST+DASH group, those with and without metabolic syndrome responded similarly (P=0.231). However, within EST, those with metabolic syndrome had a poorer response, with a decrease in systolic blood pressure of 8.4 mm Hg versus 12.0 mm Hg in those without metabolic syndrome (P=0.002). Thus, metabolic syndrome attenuated the systolic blood pressure reduction of EST, but this attenuation was overcome in EST+DASH. Finally, diastolic blood pressure, lipids, and homeostasis model assessment responded similarly to both interventions regardless of metabolic syndrome status. Our data suggest that strategies for lowering BP in individuals with metabolic syndrome may be enhanced by recommendations to adopt the DASH dietary pattern.

GenSalt: rationale, design, methods and baseline characteristics of study participants

Hypertension is a complex disorder influenced by genetic and environmental determinants and their interactions. The objectives of the Genetic Epidemiology Network of Salt Sensitivity (GenSalt) are to localize and identify genes related to blood pressure (BP) responses to dietary sodium and potassium intervention. GenSalt utilizes a family feeding-study design. Each family was ascertained through a proband with untreated prehypertension or stage-1 hypertension in rural China. A medical history, lifestyle risk factors and responses to cold pressor tests, were obtained at baseline visits while BP, weight, blood and urine specimens were collected at baseline and follow-up visits. The dietary intervention included a 7-day low-sodium feeding (51.3 mmol/day), a 7-day high-sodium feeding (307.8 mmol/day) and a 7-day high-sodium feeding with an oral potassium supplementation (60 mmol/day). Microsatellite markers for genome-wide linkage scan and single nucleotide polymorphism (SNP) markers in candidate genes will be genotyped. Overall, 3153 participants from 658 families were recruited for GenSalt. The mean systolic and diastolic BPs were 128.0 and 80.3, 111.6 and 71.0, 112.6 and 72.6, 106.6 and 65.3 and 136.7 and 75.0 mm Hg for probands, siblings, spouses, offspring and parents, respectively. The mean urinary excretion of sodium and potassium were 232.5 and 38.6, 222.9 and 38.2, 213.1 and 37.8 and 207.3 and 36.0 mmol/24-h for probands, siblings, spouses and offspring, respectively. Our study will identify novel genes that influence significantly the effect of dietary sodium and potassium intake on BP. This information is useful for development of targeted intervention for the prevention and treatment of hypertension.

Hypertension Reduction through Forgiveness Training

The objective of this study was to determine if patients with diagnosed stage-1 hypertension could benefit by a forgiveness training program to achieve measurable reductions in anger expression and blood pressure. Twenty-five participants were randomly divided into wait-listed control and intervention groups. The control group monitored blood pressure while the intervention group participated in an 8-week forgiveness training program. At the end of eight weeks, the wait listed group became an intervention group. Those who received forgiveness training achieved significant reductions in anger expression when compared to the control group. While reductions in blood pressure were not achieved by all the participants, those participants who entered the program with elevated anger expression scores did achieve significant reductions in blood pressure. It is suggested that forgiveness training may be an effective clinical intervention for some hypertensive patients with elevated levels of anger.

β2‐Adrenergic Receptor Gene Variations Associated with Stage‐2 Hypertension in Northern Han Chinese

The aim of this study was to investigate the association between polymorphisms in the beta(2)-adrenergic receptor gene (ADRB2) (-47C/T, Arg16/Gly, Gln27/Glu) and stage-2 hypertension in northern Han Chinese. We recruited 503 individuals with stage-2 hypertension and 504 age-, gender-, and area-matched controls from the International Collaborative Study of Cardiovascular Disease in Asia. Genotyping was performed using PCR-RFLP. Logistic regression analyses revealed that carriers of the Gly16 allele had a significantly higher odds ratio (OR) for hypertension, while carriers of the Glu27 allele had a significantly lower OR. In multivariate linear regression analyses, the Arg16/Gly and Gln27/Glu genotypes were significantly associated with systolic blood pressure level (p = 0.004 and p < 0.001, respectively). In haplotype analyses, we found the frequency of haplotypes composed of the Gly16 and Gln27 alleles was significantly higher, whereas the frequency of haplotypes composed of the Arg16 and Glu27 alleles was significantly lower, in hypertensives compared to their controls (both p = 0.001). These results indicate that the Gly16 and Gln27 alleles of the ADRB2 gene confer an increased risk for stage-2 hypertension in this northern Han Chinese population.

Office and out-of-office blood pressure measurement in children and adolescents

Office and out-of-office blood pressure measurements are being used for the diagnosis of hypertension in children and adolescents. The US National Heart, Lung, and Blood Institute have recently presented a new classification of blood pressure. On the basis of office measurements the 90th, 95th and 99th percentile for gender, age and height are used to classify children and adolescents as normotensive, pre-hypertensive and stage-1 or stage-2 hypertensive. Although auscultation using a standard mercury sphygmomanometer remains the recommended method, accumulating evidence suggests that ambulatory blood pressure monitoring is useful for the detection of white-coat hypertension and the prediction of target organ damage in children and adolescents. Studies have shown ambulatory blood pressure to be more reproducible than office measurements and normative tables for ambulatory measurements have been developed from cross-sectional studies in children and adolescents. In regard to home measurements in children, there are limited data from small trials showing lower blood pressure levels than daytime ambulatory blood pressure. In conclusion, ambulatory blood pressure monitoring is already finding a role as a supplementary source of information in children and adolescents, whereas at present home measurements should not be used for decision making in this population.

Haplotypic analyses of the aldosterone synthase gene CYP11B2 associated with stage-2 hypertension in northern Han Chinese.

The objective of this study was to investigate the association of polymorphisms in the aldosterone synthase gene CYP11B2 (-344T/C, Lys173/Arg, and an intronic conversion [IC]) with stage-2 hypertension in northern Han Chinese. A total of 503 hypertensives and their age-, gender-, and area-matched controls were included in this study. The female hypertensives had significantly higher frequencies of the -344T, 173Lys, and IC-conversion alleles (p = 0.002, 0.002, and 0.014, respectively). The estimated frequency of haplotype composed of the -344T, 173Lys, and IC-conversion alleles (haplotype 4) was significantly higher in the female hypertensives compared with their controls (p = 0.007). Using a multivariate score test, we found that haplotype 4 remained associated with female hypertension after the adjustment for covariates (p = 0.003), while the haplotype 3 of T-Arg-WT showed a protective effect both in the males and in the females (p = 0.03 and 0.006, respectively). The odds ratio for haplotype phase of 4-4 was 2.60 (95% CI, 1.21-5.58) and for 3-3, 0.20 (95% CI, 0.03-0.77). These results indicate that the Lys173 and the IC-conversion allele of the CYP11B2 gene confer an increased risk for stage-2 hypertension in northern Han Chinese women.