ISSN:0263-6352    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0263-6352    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0263-6352    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0263-6352    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0263-6352    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0263-6352    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo examine the effects of hypertension on lung cancer prospectively and to determine the interactive effect of hypertension and smoking on lung cancer risk.DesignA prospective cohort study.ParticipantsThe cohort comprised 452 645 Korean men, aged 35–64 years, who received health insurance from the Korea Medical Insurance Corporation and who had biennial medical evaluations in 1992 and 1994.MethodsMultivariate Cox proportional hazard models were tested, controlling for age, smoking status, exercise, body mass index, alcohol use, diabetes and serum cholesterol concentration.Main outcome measureDeaths from lung cancer.ResultsAt baseline, 261 080 persons (58.3%) were identified as current cigarette smokers. Between 1995 and 1999, 883 deaths from lung cancer (44.8/100 000 person-years) occurred. An initial finding indicated that hypertension increased the mortality risk of lung cancer [risk ratio (RR) 1.3, 95% confidence interval (CI) 1.1–1.5]. However, after stratification for smoking status, the risk ratio was increased only for current smokers (RR 1.4, 95% CI 1.2–1.6). When the interaction term was included in the multivariate model, there was a significant interactive effect of hypertension with current smoking (RR 1.8, 95% CI 1.0–3.1) on the risk of death from lung cancer, whereas the effect of hypertension itself did not attain significance.ConclusionHypertension was not an independent risk factor in lung cancer-related deaths, but it increased the modest risk of lung cancer death among current smokers.

ISSN:0263-6352    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo investigate the association between birth size and hypertension within a genetically homogenous population of high birth weight.DesignCohort-study with retrospectively collected data on size at birth.Subjects and settingThe study included 4601 men and women born 1914–1935 in Reykjavik, Iceland, who participated in the Reykjavik Study of the Icelandic Heart Association.Main outcome measuresBirth size measurements, adult blood pressure (BP) and body mass index (BMI), and family history of hypertension.ResultsBirth weight was inversely related to hypertension in adulthood in women (Pfor trend<0.001). The relationship was of borderline significance in men (Pfor trend = 0.051). A low ponderal index was significantly associated with high BP in women (Pfor trend = 0.025) but not men (P>0.05). For women with an adult BMI>26 kg/m2, the odds ratio for hypertension for those born weighing<3.45 kg was 2.1 [95% confidence interval, 1.3–3.3, compared with women born weighing>3.75 kg. The association was only significant in women without a family history of hypertension.ConclusionsAn inverse association between size at birth and adult hypertension was seen in a population of greater birth size than has previously been investigated. The relation was strongest among women born small who were overweight in adulthood, and for those without a family history of hypertension. The results support the hypothesis that the association between birth weight and hypertension is not of genetic origin only. The large birth size of Icelanders might be protective and partly explain the lower mean systolic blood pressure in Iceland than in related nations.

ISSN:0263-6352    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectSelf-measurement of blood pressure (BP) might offer some advantages in diagnosis and therapeutic evaluation and in patient management of hypertension. Recently, wrist-cuff devices for self-measurement of BP have gained more than one-third of the world market share. In the present study, we validated wrist-cuff devices and compared the results between wrist- and arm-cuff devices. The factors affecting the accuracy of wrist-cuff devices were also studied.MethodThe research group to assess the validity of automated blood pressure measuring device consisted of 13 institutes in Japan, which validated two wrist-cuff devices (WC-1 and WC-2) and two arm-cuff devices (AC-1 and AC-2). They used a crossover method, where the comparison was done between auscultation, by two observers by means of a double stethoscope on one arm and the device on the opposite arm or wrist.ResultsThere was good inter-observer agreement for the auscultation method in each institute (systolic blood pressure (SBP), −0.1±2.8 mmHg; diastolic blood pressure (DBP), −0.1±2.6 mmHg,n= 498). The mean difference between auscultation and the device was minimal both in arm-cuff devices (mean difference for AC-1, 2.2/1.9 mmHg,n= 97 and for AC-2, 5.1/2.9 mmHg,n= 136, SBP/DBP) and wrist-cuff devices (mean difference for WC-1, −2.1/1.2 mmHg,n= 173 mmHg and for WC-2, −2.3/−5.6 mmHg,n= 92). The standard deviation of the difference (SDD) in wrist-cuff devices, however (SDD for WC-1, 9.7/7.3 mmHg and for WC-2, 10.2/8.6 mmHg), was larger than that of the arm-cuff devices (SDD for AC-1, 5.6/6.6 mmHg and for AC-2, 6.3/5.1 mmHg). Grading of AC-1 and AC-2 based on criteria of British Hypertension Society was A/A and B/A, respectively, while that of WC-1 and WC-2 was C/B and D/B, respectively. Using the same validation protocol, the results of validation for one device were divergent in each institute. In wrist-cuff devices, the BP value obtained in palmar flexion was significantly higher and that obtained in palmar dorsiflexion was significantly lower than that in palmar extension. In some cases, finger plethysmogram did not disappear during maximum inflation of the wrist-cuff (≅250 mmHg), even in palmar extension and especially in palmar flexion, suggesting incomplete obstruction of radial and/or ulnar arteries during inflation.ConclusionThe results suggest that wrist-cuff devices in the present form are inadequate for self-measurement of blood pressure and, thus, are inadequate for general use or clinical and practical use. However, there is much possibility in wrist-cuff device and the accuracy and reliability of wrist-cuff device are warranted by an improvement of technology.

ISSN:0263-6352    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectivesThe role of ambulatory blood pressure monitoring (ABPM) in the elderly is unclear. This study has examined differences between clinic and ambulatory blood pressure (BP) in a large cohort of older hypertensives, with particular respect to the factors influencing the direction and magnitude of this difference.DesignThe Second Australian National Blood Pressure Study (ANBP2) is a general practice-based randomized-outcome trial in 6083 older hypertensives treated with an angiotensin-converting enzyme (ACE) inhibitor or diuretic-based regimen. Before starting treatment a subset of 713 patients (age range 65–83 years) had a ‘successful’ 26-hour ambulatory blood pressure recording with a SpaceLabs 90207TMrecorder.ResultsAverage clinic BP (± SD) was 167 ± 12/90 ± 8 mmHg. Average daytime ambulatory BP was 157 ± 15*/89 ± 10* mmHg and night ambulatory BP was 137 ± 16+/74 ± 10+mmHg (different from clinic BP: *P<0.01;from daytime ambulatory BP:+P<0.001). Twenty-one to 45% of all patients had higher daytime systolic or diastolic ambulatory BP than clinic readings, with smoking, previous treatment for hypertension and lower clinic BP being the main predictors of this ‘reverse white-coat effect'.ConclusionsAlthough mean daytime ambulatory blood pressures were lower than clinic readings in this large cohort of untreated older hypertensives, a substantial proportion showed the reverse of the so-called ‘white-coat effect'. These findings identify the important role for ABPM in the elderly, not only for avoiding overtreatment in those with typical ‘white-coat hypertension’ but also for ensuring adequate treatment is given to those with the reverse of this phenomenon.

ISSN:0263-6352    

出版商:OVID    

年代:2002

数据来源: OVID