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:

ObjectivesTo examine the interplay between childhood growth and living conditions in the development of hypertension.DesignA longitudinal study of people whose growth between birth and 12 years, and social circumstances during childhood and adult life, were recorded.SettingHelsinki, Finland.ParticipantsEight thousand seven hundred and sixty men and women born in Helsinki University Central Hospital during 1934–44, who attended child welfare clinics in the city and were still resident in Finland in 1971.Main outcome measuresIncidence of hypertension defined by prescription of medication.ResultsThe 1404 children who later developed hypertension grew differently to other children. Low birthweight and shortness or thinness at birth were followed by rapid compensatory growth in weight and height, and an above-average body mass index (BMI, kg/m2) from the age of 8 years onwards. Some 25% of children with low birthweight but high BMI at 12 years subsequently developed hypertension, compared to 9% of those with high birthweight but low BMI. Growth had large effects on the risk of later hypertension in children living in poor social conditions, but only small effects in children in good living conditions. Living conditions in adult life did not affect the risk of hypertension.ConclusionsHypertension originates in slow fetal growth followed by rapid compensatory growth in childhood. This path of growth has a greater effect on the risk of disease among children who live in poor social conditions. Living conditions in adult life do not seem to be important.

ISSN:0263-6352    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveAlterations in microvascular function have been hypothesized as a possible mechanism explaining the negative association of weight at birth with blood pressure and insulin resistance in adult life. However, these variables are closely associated, so that it has been difficult to establish whether microvascular dysfunction is a cause or a consequence of increased blood pressure or insulin resistance.DesignCohort study.SettingVU University Medical Center, Amsterdam, The Netherlands.SubjectsTwenty-one prepubertal healthy children showing a wide range in birth weight.Main outcome measuresBirth weight data were obtained from hospital records. Blood pressure was measured with an ambulatory 24-h blood pressure monitor, and insulin sensitivity was assessed with the hyperinsulinaemic euglycaemic clamp technique. Microvascular function (i.e. capillary recruitment during post-occlusive reactive hyperaemia and endothelium (in)dependent vasodilatation of the skin) was evaluated by videomicroscopy and iontophoresis of acetylcholine and sodium nitroprusside.ResultsBirth weight was positively and significantly associated with capillary recruitment [slope, 22%/kg birth weight; 95% confidence interval (CI), 0.1–43;P<0.05]. Birth weight was not associated with insulin sensitivity and systolic blood pressure (slope, −0.11 mg/kg per min per pmol/l; 95% CI, −2.4 to 2.2;P= 0.9; and slope, 1.4 mmHg; 95% CI, −5.0 to 7.7/kg birth weight;P= 0.7, respectively). The association between low birth weight and impaired capillary recruitment was not affected by adjustment for blood pressure and insulin sensitivity. Birth weight was not associated with endothelium-(in)dependent vasodilatation.ConclusionThese results suggest that the association between birth weight and capillary recruitment is independent of blood pressure and insulin sensitivity. These findings are consistent with the hypothesis that an impaired capillary recruitment plays a mechanistic role in the association of birth weight with blood pressure and insulin resistance in adult life.

ISSN:0263-6352    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo estimate the prevalence, awareness, treatment and control of hypertension in a Canarian population; and their relationship with the glucose tolerance categories.DesignFrom a population of 6355 subjects over 29 years old, 690 were chosen in a random sampling. Blood pressure measurements, a standard oral glucose tolerance test (excluding known diabetic patients), and a questionnaire on diabetes and hypertension history and medication use was performed.ResultsThe total prevalence of hypertension was 50.3%; 62.0% of the hypertensive subjects were aware of their condition; 60.6% had their diastolic and 11.0% their systolic blood pressure controlled and 8.6% had both. For diabetic, glucose intolerant and normoglycemic subjects, the respective prevalences of hypertension were 79.4, 60.2 and 43.1% (higher in diabetic subjects,P<0.001); the awareness of hypertension was 66.7, 61.8 and 59.5% (differences not significant); systolic blood pressure control was 4.8, 14.7 and 13.7% (lower in diabetic subjects,P= 0.017 versus glucose intolerant andP= 0.011 versus normoglycemic subjects); diastolic blood pressure control was 50.4, 72.1 and 63.2% (lower in diabetic subjects,P= 0.004 versus glucose intolerant andP= 0.025 versus normoglycemic subjects). There were no differences in the number and type of antihypertensive drugs among the different glucose tolerance categories.ConclusionsBlood pressure was comparable in our population and in other European populations. The prevalence of hypertension was higher, the awareness was similar, and control was worse in diabetic than in non-diabetic subjects; the drug treatment pattern was not different.

ISSN:0263-6352    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundStratification of population groups according to cardiovascular risk level is recommended for primary prevention.ObjectiveTo assess whether the Framingham models could accurately predict the absolute risk of coronary heart disease (CHD) and stroke in a large cohort of middle-aged European patients with hypertension, and rank individual patients according to actual risk.DesignA prospective cohort study comparing the actual risk with that predicted by either the Framingham equations or models derived from the INSIGHT study.Patients and settingFrom the INSIGHT prospective trial, conducted in eight countries of Western Europe and Israel, we selected 4407 European patients younger than 75 years without previous cardiovascular events.InterventionsNone.Main outcome measuresMajor cardiovascular events.ResultsIn this population (45% men, mean age 64.1 years), 124 (2.8%) patients had CHD and 96 (2.2%) had strokes after a median follow-up of 3.7 years. Overestimation of absolute CHD risk by the Framingham equation was observed in all countries (from 2% in the UK to 7% in France), whereas predicted risk of stroke was close to the actual risk. However, patients in the highest risk quintile within each country had a threefold greater risk of a cardiovascular event than those in the lowest quintile.ConclusionsThe Framingham models should not be used to predict absolute CHD risk in the European population as a whole. However, these models may be used within each country, provided that cut-off points defining high-risk patients have been determined within each country.

ISSN:0263-6352    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundTwenty-four-hour finger arterial pressure (FAP) recordings show a negative bias against intrabrachial artery pressure (BAP) and the bias is greater during the night, thereby overestimating the nocturnal blood pressure dip. We have available a methodology with which to reconstruct BAP from FAP by waveform filtering (transfer function) and generalized level (bias) correction that reduces the bias for short-term blood pressure records.ObjectiveTo investigate if this methodology also decreases the extra bias during the night, thereby yielding a better estimate of the nocturnal dip.MethodsTwenty-four-hour FAP and BAP blood pressure recordings were simultaneously obtained in eight healthy normotensive volunteers and 14 patients with hypertension (ages 19–60 years), during standardized scheduled activities. The data were analysed off-line, applying the brachial reconstruction technique (reBAP) consisting of a waveform filter and level correction. Simultaneous beats yielded systolic, diastolic and mean pressures that were averaged per 30 min, per day, per night, per activity, over the 24-h period, and for volunteers and patients separately.ResultsOver the full 24 h, FAP systolic, diastolic and mean values for the total group differed from BAP by +1 ± 10, −8 ± 7 and −10 ± 8 mmHg (mean ± SD), respectively. Similarly, reBAPs differed by +1 ± 11, −2 ± 7 and −2 ± 7 mmHg. BAPs dipped by 20 ± 8, 13 ± 6 and 15 ± 6 mmHg, respectively, during the night. These dips were overestimated by +8, +4 and +4 mmHg by FAP, but not by reBAP: −1, +1 and +1 mmHg. The volunteer and the patient groups showed slight differences in results, but these were not statistically significant.ConclusionsThe generalized reconstruction technique to obtain near-brachial pressure from non-invasive FAP almost completely removed bias over the full 24-h day–night period and improved tracking of diurnal changes for all three blood pressure values.

ISSN:0263-6352    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveRecent evidence suggests that pulse pressure (PP) is an independent predictor of cardiovascular risk. The objective of this study was to compare mean values and reproducibility of PP obtained in the clinic (CPP), at home (HPP) and with ambulatory monitoring (APP) and to evaluate potential implications for trials aiming to assess drug effects on PP.MethodsA total of 393 hypertensive subjects [mean age 51.5±11.5 (SD) years, 59% men, 35% treated] measured CPP (two visits), HPP (6 days) and APP (24 h). The reproducibility of PP was assessed using the SD of differences (SDD) between measurements in 133 untreated subjects who had repeated CPP (five visits), HPP (6 days) and APP measurements (two occasions).ResultsThere was no difference between mean CPP (51.0±13.3 mmHg) and HPP (50.2±11.0) whereas APP (48.8±8.4) was lower than both CPP [mean difference 2.3±10.3 mmHg; 95% confidence interval (CI), 1.2, 3.3;P<0.01] and HPP (1.5±7.8; 95% CI, 0.7, 2.3;P<0.01). The SDD between repeated measurements was about 10 mmHg for CPP (one visit), 5.2 mmHg for HPP (2 days) and 4 mmHg for APP (24-h). For a parallel comparative trial aiming to detect a difference of 3 mmHg PP in the effect of two drugs, 415 subjects would be required when using CPP, compared to 127 using HPP and 63 using APP.ConclusionsThese data suggest that although differences among mean values of CPP, HPP and APP are small, differences in their reproducibility are important and should be taken into account in the design of trials assessing drug effects on PP.

ISSN:0263-6352    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundTwenty-four-hour ambulatory blood pressure monitoring (ABPM) is an essential tool in the diagnosis and therapeutic monitoring of arterial hypertension in children. The statistical use of pediatric ABPM reference values has been compromised by the non-Gaussian distribution of 24-h blood pressure (BP) in children.ObjectiveTo develop distribution-adjusted pediatric ABPM reference tables.MethodsFrom cross-sectional ABPM data obtained in 949 healthy children and adolescents aged 5–20 years, a set of reference tables was developed for 24-h, daytime and night-time mean values of systolic, diastolic, mean arterial BP and heart rate, utilizing the LMS method to account for the variably skewed distribution of ABPM data. Age- and gender-specific estimates of the distribution median (M), coefficient of variation (S) and degree of skewness (L) were obtained by a maximum-likelihood curve-fitting technique. The estimates ofL,MandScan be used to normalize ABPM data to gender and age or height.ResultsRe-application of the establishedL,MandSvalues in the reference population confirmed appropriate normalization of ABPM values. Height standard deviation scores (SDS), body mass index (BMI) SDS and heart rate SDS were independent positive predictors of 24-h systolic BP SDS. Diastolic 24-h mean BP SDS showed a weak correlation with BMI SDS only.ConclusionsThe use of LMS reference tables permits calculation of appropriate SDS values for ABPM in children. Whereas systolic 24-h BP is independently correlated with age, relative height and obesity, diastolic values are almost independent of age and relative height, and weakly associated with relative obesity.

ISSN:0263-6352    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectivesPrevious studies reported that the association between physical activity, measured with a wrist-worn accelerometer, and ambulatory blood pressure is rather weak and that the inter-individual variation in the degree of association is high. The aim of the present study was to quantify the responses of ambulatory blood pressure (BP) and heart rate (HR) to physical activity, and to determine the effect of age, gender, body mass index, mean BP and HR level and the use of antihypertensive medication on these responses.Patients and methodsTwenty-seven subjects (24 hypertensive) underwent 24-h ambulatory monitoring of BP, HR and physical activity. Physical activity was measured with four accelerometers mounted on the trunk and legs. The daytime BP and HR responses to physical activity and the possible modulating effects of the various subject characteristics on these responses were estimated with Random Regression Models.ResultsIncreasing physical activity from a very low level (e.g. watching television) to a moderate level (e.g. shopping) caused an average response of systolic blood pressure (SBP) of 11.6 mmHg, of diastolic blood pressure (DBP) of 7.0 mmHg and of HR of 16.1 beats/min. The SBP response to activity was about 2 mmHg larger for the overweight subjects than for subjects with normal weight, and the SBP, DBP and HR responses increased about 0.8 mmHg, 0.6 mmHg and 0.7 beats/min, respectively, with every 10 years increase in age. The between-subjects variances in estimated responses were low and were almost completely explained by differences in overweight and age between subjects. The average within-subject variances, however, were high.ConclusionsNormal daily physical activity explains only a small part of the BP and HR variability. The BP and HR responses to activity are modestly affected by age. Overweight has a small effect on the SBP response to activity.

ISSN:0263-6352    

出版商:OVID    

年代:2002

数据来源: OVID