Hypertension

Background Moxibustion is a traditional East Asian medical therapy that uses the heat generated by burning herbal preparations containing Artemisia vulgaris to stimulate acupuncture points. The aim of this review was to evaluate previously published clinical evidence for the use of moxibustion as a treatment for hypertension. Methods We searched 15 databases without language restrictions from their respective dates of inception until March 2010. We included randomized controlled trials (RCTs) comparing moxibustion to either antihypertensive drugs or no treatment. The risk of bias was assessed for each RCT. Results During the course of our search, we identified 519 relevant articles. A total of 4 RCTs met all the inclusion criteria, two of which failed to report favorable effects of moxibustion on blood pressure (BP) compared to the control (antihypertensive drug treatment alone). However, a third RCT showed significant effects of moxibustion as an adjunct treatment to antihypertensi...

The renin-angiotensin-aldosterone system (RAAS) is important for the development of hypertension, and several antihypertensive drugs target this system. Our aim was to determine whether specific single nucleotide polymorphisms (SNPs) in RAAS genes were related to the blood pressure (BP) lowering effect of antihypertensive treatment. Methods: Patients with mild to moderate primary hypertension and left ventricular hypertrophy were randomized in a double-blind fashion to treatment with either the angiotensin II type 1 receptor antagonist irbesartan (n ϭ 48) or the ␤ 1 -adrenergic receptor blocker atenolol (n ϭ 49) as monotherapy. A microarray-based minisequencing system was used to genotype 30 SNPs in seven genes in the RAAS. These polymorphisms were related to the antihypertensive response after 12 weeks treatment. Results: The BP reductions were similar in the atenolol and the irbesartan groups. Presence of the angiotensinogen (AGT) -6A allele or the AGT 235T allele were both associated with the most pronounced systolic BP response to atenolol treatment (P ϭ .001 when -6 AAϩAG was compared with GG and P ϭ .008 for presence of the 235T variant compared with 235 MM).

Objectives: To delineate the influences of the Mediterranean diet (MD) on human mortality and agerelated morbid conditions, principally the metabolic syndrome, hypertension, cardiovascular disease, excess body weight, cancer, poor bone mineralization and rheumatoid arthritis, and neurodegenerative disorders. Method: Citations were selected from a PubMed search according to their clinical and experimental relevance. Results and conclusions: Individuals who adhere to the principles of the traditional MD tend to have a longer life-span. Both men and women who report eating foods closest to the MD are about 10-20% less likely to die over the course of a study of heart disease, cancer or any other cause. The longevity of Mediterranean people has been related to olive oil, and its several microcomponents of antioxidant potential, present in all MD variants. The prevalence of the metabolic syndrome may be reduced by a MD. The MD is significantly inversely associated with both systolic and diastolic blood pressure. It also has benefits in relation to the prevention of cardiovascular events, reduces the risk of mortality after myocardial infarction, and reduces peripheral arterial disease. The risk of obesity decreases with increasing adherence to the traditional MD. The MD also has a preventive effect on cancer, through its antiproliferative and proapoptotic effects, mostly due to the components of virgin olive oil and vegetables. There is some evidence of the benefits of the MD in relation to bone metabolism, rheumatoid arthritis, and neurodegenerative age-related diseases (cognitive deficit, Alzheimer's disease, Parkinson's disease).

Long working hours have been associated with an increased risk of cardiovascular disease, but its relationship with hypertension remains unclear. The objective of this study is to examine the relationship between overtime and presence of hypertension using data from a large-scale multi-company study in Japan. Participants were 52 365 workers of four companies that provided both health-checkup data and self-reported data on overtime worked. Hypertension was defined as systolic blood pressure !140 mmHg, diastolic blood pressure !90 mmHg, and/or the use of antihypertensive drug. Logistic regression analysis was performed to determine the odds ratio for hypertension for each category of overtime work (545, 45-79, 80-99 or !100 h/month) with adjustments for age, sex, company, smoking status and body mass index. The prevalence of hypertension tended to decrease with increasing overtime work: 17.5, 12.0, 11.1 and 9.1% for the shortest (545 h/month) through the longest overtime category (!100 h/month). The age-, sex-and company-adjusted odds ratios (95% confidence interval) were 1.00 (reference), 0.81 (0.75-0.86), 0.73 (0.62-0.86), 0.58 (0.44-0.76), respectively (p for linear trend 50.001). In a sub-cohort, the inverse association remained statistically significant after an additional adjustment for other potential confounders. Results of the present large-scale study among Japanese workers suggest an inverse association between overtime work and presence of hypertension.

Hypertension is one of the most important cardiovascular (CV) risk factor, and that lowering blood pressure levels reduces the incidence of CV morbidity and mortality. The higher incidence of hypertension in postmenopausal than in pre-menopausal women raises the attention on the pathophysiological mechanisms potentially involved in post-menopausal ones and outweigh those involved in pre-menopausal women. However, CV disease is one of the leading causes of death in reproductive-age women. Thus, improved awareness, early identification and prompt clinical management of hypertension should be key elements in order to prevent hypertension-related CV morbidity and mortality in pre-menopausal women. However, available data in this specific age group of women are relatively poor and inconsistent, so that the clinical management of young hypertensive women is still debated. The aim of this review is to assess whether there are clear evidences on differences between men and women in epidemiological data, pathophysiological mechanisms, diagnostic options and therapeutic interventions of hypertension and its prognosis, in order to establish the correct approach to this group of hypertensive patients.

Cardiovascular risk is poorly managed in women, especially during the menopausal transition when susceptibility to cardiovascular events increases. Clear gender differences exist in the epidemiology, symptoms, diagnosis, progression, prognosis, and management of cardiovascular risk. Key risk factors that need to be controlled in the peri-menopausal woman are hypertension, dyslipidaemia, obesity, and other components of the metabolic syndrome, with the avoidance and careful control of diabetes. Hypertension is a particularly powerful risk factor and lowering of blood pressure is pivotal. Hormone replacement therapy is acknowledged as the gold standard for the alleviation of the distressing vasomotor symptoms of the menopause, but the findings of the Women's Health Initiative (WHI) study generated concern for the detrimental effect on cardiovascular events. Thus, hormone replacement therapy cannot be recommended for the prevention of cardiovascular disease. Whether the findings of WHI in older post-menopausal women can be applied to younger peri-menopausal women is unknown. It is increasingly recognized that hormone therapy is inappropriate for older post-menopausal women no longer displaying menopausal symptoms. Both gynaecologists and cardiovascular physicians have an important role to play in identifying peri-menopausal women at risk of cardiovascular morbidity and mortality and should work as a team to identify and manage risk factors such as hypertension.

n engl j med 360;5 nejm.org january 29, 2009 538 Zaman K, Roy E, Arifeen SE, et al. Effectiveness of maternal 1. influenza immunization in mothers and infants. N Engl J Med 2008;359:1555-64. Ali HM, Scott R, Toms GL. The effect of foster feeding and 2. bottle feeding expressed breast-milk on the susceptibility of guinea-pig infants to influenza virus. Br J Exp Pathol 1989;70: 183-91. Chantry CJ, Howard CR, Auinger P. Full breastfeeding dura3. tion and associated decrease in respiratory tract infection in US children. Pediatrics 2006;117:425-32.

Understanding basic medical statistics is important in today's medical practice, not merely as an academic exercise but to translate medical information into day-today patient care. This review article tries to address basics of medical statistics to the end user.

The global prevalence of dementia has been estimated to be as high as 24 million, and is predicted to double every 20 years until at least 2040. As the population worldwide continues to age, the number of individuals at risk will also increase, particularly among the very old. Alzheimer disease is the leading cause of dementia beginning with impaired memory. The neuropathological hallmarks of Alzheimer disease include diffuse and neuritic extracellular amyloid plaques in brain that are frequently surrounded by dystrophic neurites and intraneuronal neurofibrillary tangles. The etiology of Alzheimer disease remains unclear, but it is likely to be the result of both genetic and environmental factors. In this review we discuss the prevalence and incidence rates, the established environmental risk factors, and the protective factors, and briefly review genetic variants predisposing to disease.

The electrocardiogram has been shown in epidemiologic studies to be an independent predictor of survival. These studies have adjusted for selected covariates simultaneously. This article assesses the value of the electrocardiogram as a predictor of survival when introduced at progressive stages of the common clinical encounter. Data collected from 4,518 patients ages of 60 to 96 years with isolated systolic hypertension who were followed-up for up to 6 years as part of the Systolic Hypertension in the Elderly Project were analyzed. Survival curves and 3-and 5-year survival rates (Cox regression methods) of groups with normal and abnormal resting electrocardiograms were compared. Blocks of covariates representing demographic information, risk factors for cardiovascular disease, clinical history, and physical examination findings were added to the survival models sequentially to mimic the sequence of the common clinical encounter, and the independent significance of the electrocardiogram as a predictor of survival was assessed at each step. An abnormal electrocardiogram was associated with reduced survival when no adjustment for covariates is made. Survival was also significantly (P Ͻ .05) different for groups with normal and abnormal electrocardiograms when demographic and risk factor variables were included in the statistical models, but not after findings from the clinical history and physical examination were added. The prognostic value of the electrocardiogram varies with the stage in the clinical encounter in which it is introduced.

In the management of hypertension, blood pressure (BP) monitoring and medication use are key strategies, but they are dependent on patients' motivation to practice self-care. To gauge patients' approaches to monitoring their blood pressure, as well as explore their attitudes toward, and actions relating to, high blood pressure readings, as the key components of their self-management of hypertension. This qualitative study, comprising individual telephone interviews, involved patients attending community pharmacies in Sydney (Australia). Patients' perspectives were elicited using a purpose-designed, semi-structured interview guide. The verbal responses were audio-recorded, transcribed verbatim, and thematically analysed. Three key themes arose: (1) approaches to monitoring blood pressure, (2) attitudes to variability in BP, (3) responses to high BP readings. Many patients self-regulated the frequency of monitoring based on perceived need and/or opportunity. Most were indi...

From the New England Research Institutes, Watertown, Massachusetts (VK, GRC, RCR), Loyola University Medical Center, Maywood, Illinois (MPF), Cornell University, Weill Medical College, New York, New York (SAK), and Ferring International Pharmascience Center, ...

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Captopril lowers blood pressure without increasing heart rate and plasma norepinephrine, which suggests that this drug may potentiate arterial baroreflexes. In eight subjects with untreated essential hypertension, blood pressure was monitored intraarterially and the effects of baroreceptor stimulation OC deactivation were assessed by measuring (1) the slopes of the relations between increase or reduction in systolic pressure (intravenous phenylephrine or nitroglycerin) and the resulting lengthening or shortening in R-R interval, and (2) the increase or decrease in mean arterial pressure induced by increasing and decreasing carotid transmural pressure (neck chamber). The measurements were made before and after a hypotensive oral dose of captopril(50 mg). Before captopril, the slopes of the R-R interval changes with increase and reduction in systolic pressure were 8 and 4 ms/mm Hg, respectively. The slopes of the mean arterial pressure changes with increase and reduction in carotid transmural pressure were 0.51 and 0.40 mm Hg, respectively. After captopril, the responses to baroreceptor stimulation were unaltered but those to baroreceptor deactivation were augmented. The pressor and heart rate responses to hand-grip and cold exposure were unchanged by captopril. Administration of captopril is accompanied by a baroreflex potentiation which involves the lower portion of the stimulus-response curve of the reflex. This phenomenon (which may originate at the afferent baroreceptor fibers or centrally) may avoid a reduction in the tonic baroreflex influence during captopril-induced hypotension, thus contributing to the hemodynamic effects of the drug.

The prevalence and short-term outcomes of hypertensive urgency (systolic blood pressure ≥180 mm Hg and/or diastolic blood pressure ≥110 mm Hg) are unknown. Guidelines recommend achieving blood pressure control within 24 to 48 hours. However, some patients are referred to the emergency department (ED) or directly admitted to the hospital, and whether hospital management is associated with better outcomes is unknown. To describe the prevalence of hypertensive urgency and the characteristics and short-term outcomes of these patients, and to determine whether referral to the hospital is associated with better outcomes than outpatient management. This retrospective cohort study with propensity matching included all patients presenting with hypertensive urgency to an office in the Cleveland Clinic Healthcare system from January 1, 2008, to December 31, 2013. Pregnant women and patients referred to the hospital for symptoms or treatment of other conditions were excluded. Final follow-up wa...

In the US, it is currently estimated that 3% of pregnant women have chronic hypertension, or more than 100,000 pregnant women each year. The aim of our study was to investigate the adaptation of autonomic control during pregnancy based on heart rate variability analysis and to determine whether chronic hypertension during pregnancy has an impact on this adaptation. Sixteen pregnant women with chronic hypertension (CH group; mean age, 30 years; range, 25-33 years) and 35 healthy pregnant women serving as controls (CON group; mean age, 28 years; range, 24-30 years) were recruited for this longitudinal study. Beginning at the 20th week of pregnancy, the women were monitored every 4th week until delivery. For the analysis of heart rate variability, Portapres signals (200 Hz) were recorded for 30 min under resting conditions. Women in the CH group had significantly elevated blood pressure compared to controls (CON, 111 mmHg [105-132]; CH, 140 mmHg [132-148]; p <0.001). An increased heart rate was found in both groups during the second half of pregnancy. Consequently, decreased heart rate variability was observed, but was more pronounced in the CON group. There was a shift in the frequency bands indicated by an elevation of the low-to-high frequency ratio (LF/HF) in both groups due to a decrease in HF, and thus a significant increase in LFn (LF power in normalized units). However, VLF (power of very low frequency range) increased exclusively in the CON pregnancies. Our data showed no significant difference in heart rate variability between the subjects of the CH and CON groups. Longitudinal variations were detectable in normal pregnancies and also, albeit to a lesser degree, in chronic hypertensive pregnant women. Thus, our data indicate that patients with long-term hypertension are still able to respond to the physiological changes occurring during pregnancy.

Background. In the United Kingdom, diabetic nephropathy is a leading cause of end-stage renal disease. There is a higher incidence amongst subjects of Indo-Asian and African-Caribbean origin compared with Caucasians that is not wholly explained by the differences in the prevalence of diabetes. Therefore, we postulated that this observation could be related to variations in the rate of progression of renal disease according to racial origin. Methods. We conducted a retrospective case-note review of 1684 adult attendees of the diabetes clinic. Forty-®ve patients were found with renal impairment (serum creatinine P170 mmolul) due to diabetic nephropathy. The patients were of Indo-Asian (ns10), African-Caribbean (ns11), and Caucasian (ns24) origin. Progression of nephropathy was assessed by analysing (i) the doubling of serum creatinine through construction of Kaplan±Meier curves and (ii) the slope (b) of the rate of change in serum creatinine using linear regression analysis in relation to demographic variables, putative risk factors for nephropathy and antihypertensive drug therapy. Results. There were no statistically signi®cant differences between systolic and diastolic blood pressure, glycaemic control, smoking habit, baseline proteinuria, and usage of angiotensin-converting enzyme inhibitors between the three groups. The proportion of patients doubling their creatinine was signi®cantly higher in the Indo-Asian compared with the African-Caribbean and Caucasian groups (100, 45 and 50%; Ps0.025 respectively). In addition, the mean (95% CI) of b (mmolulumonth) was highest in the Indo-Asian (5.36 (2.21±8.52)) compared with the African-Caribbean (3.14 (0.82±5.46)) and Caucasian (2.22 (1.31±3.14)) groups (Ps0.035). The mean ranks of b were highest in the Indo-Asian group (Ps0.038) after adjusting for marginal differences in blood pressure age, gender, baseline proteinuria, anti-hypertensive treatment, and smoking habit. Conclusions. In this small cohort of type 2 diabetic subjects with established renal disease, the rate of decline in renal function is accelerated in Indo-Asian subjects. This observation could be related to differences in renoprotection from antihypertensive therapy.

The spectrum of left ventricular geometric adaptation to hypertension was investigated in 165 patients with untreated essential hypertension and 125 age- and gender-matched normal adults studied by two-dimensional and M-mode echocardiography. Among hypertensive patients, left ventricular mass index and relative wall thickness were normal in 52%, whereas 13% had increased relative wall thickness with normal ventricular mass (“concentric remodeling”), 27% had increased mass with normal relative wall thickness (eccentric hypertrophy) and only 8% had “typical” hypertensive concentric hypertrophy (increase in both variables).Systemic hemodynamics paralleled ventricular geometry, with the highest peripheral resistance in the groups with concentric remodeling and hypertrophy, whereas cardiac index was supernormal in those with eccentric hypertrophy and low normal in patients with concentric remodeling. The left ventricular shortaxis/long-axis ratio was positively related to stroke volume (r = 0.45, p < 0.001), with cavity shape most elliptic in patients with concentric remodeling and most spheric in those with eccentric hypertrophy. Normality of left ventricular mass in concentric remodeling appeared to reflect offsetting by volume “underload” of the effects of pressure overload, whereas eccentric hypertrophy was associated with concomitant pressure and volume overload.Thus, arterial hypertension is associated with a spectrum of cardiac geometric adaptation matched to systemic hemodynamics and ventricular load. Concentric left ventricular remodeling and eccentric hypertrophy are more common than the typical pattern of concentric hypertrophy in untreated hypertensive patients.

Endothelin (ET) 1 is a potent vasoconstrictor peptide produced by vascular endothelial cells and implicated in various pathophysiologic states involving abnormal vascular tone. Homozygous ET-1 null mice have craniofacial and cardiac malformations that lead to neonatal death. To study the role of ET-1 in adult vascular physiology, we generated a mouse strain (ET-1 flox/flox ;Tie2-Cre mice) in which ET-1 is disrupted specifically in endothelial cells. ET-1 peptide levels in plasma, heart, lung, kidney, and brain homogenates were reduced by 65% to 80% in these mice. mRNA levels for ET receptors were unaltered except that the ET A receptor mRNA was upregulated in the heart. ET-1 flox/flox ;Tie2-Cre mice had mean blood pressures 10 to 12 mm Hg lower than genetic controls. In contrast, the blood pressure of mice systemically heterozygous for the ET-1 null allele (ET-1 dlox/ϩ mice) was unchanged compared with wild-type littermates. Despite the lower basal blood pressure, acute pharmacological responses to angiotensin II, captopril, phenylephrine, bradykinin, N G -nitro-L-arginine methyl ester, and exogenous ET-1 were normal in ET-1 flox/flox ;Tie2-Cre mice. These results support an essential role of endothelial-derived ET-1 in the maintenance of basal vascular tone and blood pressure. Normal pharmacological responses of ET-1 flox/flox ;Tie2-Cre mice suggest that the renin-angiotensin system, the adrenergic system, and NO are not significantly altered by endothelial ET-1. Taken in conjunction with other lines of genetically altered mice, our results provide evidence for a paracrine vasoregulatory pathway mediated by endothelial cell-derived ET-1 acting on the vascular smooth muscle ET A receptor. (Hypertension. 2010;56:121-128.) Key Words: hypertension Ⅲ endothelium Ⅲ ET A Ⅲ ET B Ⅲ cre/loxP Ⅲ blood pressure Ⅲ gene knockout E ndothelin (ET) 1, originally identified as a potent vaso-

Endothelium-dependent responses are impaired in various models of hypertension. The effects of antihypertensive treatment on endothelium-dependent relaxations were studied in Dahl salt-sensitive (DS) and Dahl salt-resistant rats (DR) on a high or low sodium diet. The rats were given either a diet containing 8% NaCI or 0.1% NaCI for 8 weeks or a diet containing 8% NaCI and a combination of reserpine, hydrochlorothiazide, and hydralazine for 8 or 2 weeks. DS on the 8% NaCI diet developed hypertension, while the other rats did not. Antihypertensive therapy for 8 or 2 weeks prevented or reversed hypertension in DS and lowered blood pressure in DR on the 8% NaCI diet. Aortic rings with and without endothelium were suspended in organ chambers for isometric tension recording. In all groups, acetylcholine, adenosine 5'-diphosphate, and thrombin caused endotheliumdependent relaxations. The relaxations in response to all agonists were significantly decreased in DS on 8% NaCI compared to relaxations in the other rats. Antihypertensive treatment for 8 or 2 weeks prevented or reversed the decreased endothelium-dependent relaxations in response to all agonists tested, but not those to the endothelium-independent agonist, sodium nitroprusside. These results suggest that antihypertensive treatment normalizes endothelium-dependent relaxations. This effect of antihypertensive treatment might be important for the prevention of cardiovascular complications in patients with hypertension. (Hypertension 9 [Suppl III]: IIM93- III-197, 1987) KEY WORDS * acetylcholine • adenosine 5'-diphosphate • Dahl rats • norepinephrine sodium nitroprusside • thrombin • thoracic aorta From the Department of Physiology and Biophysics, Mayo Clinic and Foundation, Rochester, and the Renal Section, Veterans

We review data from our institution demonstrating the benefits of cardiac rehabilitation and exercise training on coronary risk factors, exercise capacity, behavioral characteristics, and quality of life in various subgroups of patients. In addition, we discuss our research in several other areas of preventive cardiology, including lipid disorders, hypertension, left ventricular hypertrophy, fish oils, and antioxidants. We believe that we are now in a very exciting era in which a multifactorial approach to the primary and secondary prevention of coronary artery disease is needed in order to further reduce morbidity and mortality rates.

Background: Existing studies suggest that music therapy can have favorable effects on hypertension and anxiety. We therefore set out to investigate the effect of Turkish classical music. Objectives: To investigate whether Turkish classical music has positive effects on blood pressures and anxiety levels in elderly patients. Design, setting and subjects: This was a randomized controlled trial performed on 60 hypertensive patients living in a local elderly home in Adana, Turkey. Methods: Following the completion of a socio-demographic form for each patient, Hamilton anxiety scale was applied. Thereafter, the subjects were randomly divided into two equal-size groups and were allowed to either listen to Turkish classical music (music therapy group) or have a resting period (control group) for 25 min. Outcome measures: The primary and secondary outcome measures were blood pressure and Hamilton anxiety scale scores, respectively. Results: The mean reduction in systolic blood pressure was 13.00 mmHg in the music therapy group and 6.50 mmHg in the control group. The baseline adjusted between treatment group difference was not statistically significant (95% CI 6.80-9.36). The median reductions in diastolic blood pressures were 10 mmHg both in the music therapy and control groups. The between treatment group difference was not statistically significant (Mann-Whitney U test, P = 0.839). The mean reduction in HAMA-A was 1.63 in the music therapy group and 0.77 in the control group. The baseline adjusted between treatment group difference was not statistically significant (95% CI 0.82-1.92). Conclusion: The study demonstrated that both Turkish classical music and resting alone have positive effects on blood pressure in patients with hypertension.

Developing countries are disproportionately affected by hypertension, with Black women being at greater risk, possibly due to differences in body fat distribution. The objectives of this study were: (1) To examine how different measures of body composition are associated with blood pressure (BP) and incident hypertension; (2) to determine the association between baseline or change in body composition, and hypertension; and (3) to determine which body composition measure best predicts hypertension in Black South African women. The sample comprised 478 non-hypertensive women, aged 29-53 years. Body fat and BP were assessed at baseline and 8.3 years later. Body composition was assessed using dual-energy X-ray absorptiometry (DXA) (n = 273) and anthropometry. Hypertension was diagnosed based on a systolic/diastolic BP 140/90 mmHg, or medication use at follow-up. All body composition measures increased (p<0.0001) between baseline and followup. SBP and DBP increased by 20%, resulting in a 57.1% cumulative incidence of hypertension. Both DXA-and anthropometric-derived measures of body composition were significantly associated with BP, explaining 3-5% of the variance. Baseline BP was the most important predictor of hypertension (adjusted OR: 98-123%). Measures of central adiposity were associated with greater odds (50-65%) of hypertension than total adiposity (44-45%). Only change in anthropometric-derived central fat mass predicted hypertension (adjusted OR: 32-40%). This study highlights that body composition is not a major determinant of hypertension in the sample of black African women. DXA measures of body composition do not add to hypertension prediction beyond anthropometry, which is especially relevant for African populations globally, taking into account the severely resource limited setting found in these communities.

To examine the association of body mass index (BMI), triceps skinfold thickness (TST) and percentage body fat (%BF) from bioelectrical impedance analysis (BIA) with blood lipids, systolic blood pressure (SBP) and diastolic blood pressure (DBP) in children. Cross-sectional study was conducted on 1280 schoolchildren aged 8-11 years from the Cuenca province (Spain). Data collection was conducted under standardized conditions, taking several measurements of each variable to enhance accuracy. Analyses were performed using age-adjusted correlation coefficients, and multiple linear regression adjusted for age, BMI, TST and %BF. Correlations between %BF and apolipoprotein (apo) B, total cholesterol, low-density lipoprotein cholesterol (LDL-c), total cholesterol/HDL-c ratio and DBP were higher than those for BMI and TST. In contrast, the correlations between BMI, and apo A-I and SBP were higher than those for %BF and TST. The results were similar across the sexes. The correlations between each of the three measures of body fatness, and blood lipids and blood pressure were highest in children with greatest BMI and %BF. When analyses were adjusted for the three body fatness measures, %BF showed stronger associations than did BMI or TST with blood lipids and blood pressure, with the exception of apo A-I and SBP, which were more closely associated with BMI. %BF from BIA is more strongly associated than either BMI or TST with most of the blood lipid fractions in schoolchildren aged 8-11 years.

Objective To determine the optimal timing of delivery in pregnancies with pre-existing (chronic) hypertension by quantifying the gestational age-specific risks of stillbirth associated with ongoing pregnancy and the gestational age-specific risks of neonatal mortality or serious neonatal morbidity following the induction of labour. Design Population-based cohort study. Setting USA. Population A total of 171 669 singleton births to women with pre-existing hypertension between 1995 and 2005. Pregnancies additionally complicated by diabetes mellitus, cardiac, pulmonary or renal disease were excluded. Methods The week-specific risks of stillbirth between 36 and 41 completed weeks of gestation were contrasted with the weekspecific risks of neonatal mortality or serious neonatal morbidity among births following induction of labour in women with pre-existing hypertension. Main outcome measures Stillbirth, neonatal mortality or serious neonatal morbidity (defined as a composite outcome which included any of the following: neonatal seizures, severe respiratory morbidity or 5-minute Apgar score £3). Results The risk of stillbirth in women with pre-existing hypertension remained stable at 1.0-1.1 per 1000 ongoing pregnancies until 38 weeks, before rising steadily to 3.5 per 1000 [95% confidence interval (CI): 2.4, 5.0] at 41 weeks. The risk of serious neonatal morbidity/neonatal mortality decreased sharply between 36 and 38 weeks from 137 [95% CI: 127, 146] to 26 [95% CI: 24, 29] per 1000 induced births, before stabilising beyond 39 weeks. Conclusions Among women with otherwise uncomplicated pre-existing hypertension, delivery at 38 or 39 weeks appears to provide the optimal trade-off between the risk of adverse fetal and adverse neonatal outcomes.

Background: Departing from the hypotheses that over the past decades patients have become more active participants and physicians have become more task-oriented, this study tries to identify shifts in GP and patient communication patterns between 1986 and 2002. Methods: A repeated cross-sectional observation study was carried out in 1986 and 2002, using the same methodology. From two existing datasets of videotaped routine General Practice consultations, a selection was made of consultations with hypertension patients (102 in 1986; 108 in 2002). GP and patient communication was coded with RIAS (Roter Interaction Analysis System). The data were analysed, using multilevel techniques. Results: No gender or age differences were found between the patient groups in either study period. Contrary to expectations, patients were less active in recent consultations, talking less, asking fewer questions and showing less concerns or worries. GPs provided more medical information, but expressed also less often their concern about the patients' medical conditions. In addition, they were less involved in process-oriented behaviour and partnership building. Overall, these results suggest that consultations in 2002 were more task-oriented and businesslike than sixteen years earlier. Conclusion: The existence of a more equal relationship in General Practice, with patients as active and critical consumers, is not reflected in this sample of hypertension patients. The most important shift that could be observed over the years was a shift towards a more businesslike, task-oriented GP communication pattern, reflecting the recent emphasis on evidence-based medicine and protocolized care. The entrance of the computer in the consultation room could play a role. Some concerns may be raised about the effectiveness of modern medicine in helping patients to voice their worries.

Objectives: To assess the risk of obstructive sleep apnea (OSA) and its associated risk factors among patients with type 2 diabetes in the south of Saudi Arabia. Methodology: This is a cross-sectional study conducted in the Armed Forces Hospital in Jazan. The prevalence of OSA was assessed through a validated Arabic translation of the STOP-BANG screening questionnaire. The odds of a higher OSA risk were calculated via regression analysis according to the measured clinical and demographic variables. Results: The total number of participants was 306, of which 213 (70%) were over the age of 50; 247 (81%) were married, and 161 (53%) were females. The overall median score of the OSA risk level assessed by the STOP-BANG items was three on a scale of 0-8 of which 193 (63.1%) of the participants in the sample were classified as being at high risk of developing OSA. Several statistically significant associations were identified where odds ratios (ORs) with a higher OSA risk level were detected according to age, gender, social status, waist and neck circumference, hemoglobin A1c (HbA1c) and body mass index (BMI) levels, duration of diabetes, and comorbidity with hypertension (p-values <0.05). Conclusions: The higher risk of OSA identified in our sample of diabetic patients can be related to a high prevalence of obesity, larger neck circumferences, hypertension, and other factors related to the duration and treatment of diabetes. Additionally, the association between waist circumference, HbA1c, and duration since the diagnosis of diabetes suggests an interaction effect requiring further investigations. Response to Reviewers: Dear Journal Office Thank you for your feedback. All responses to reviewers' comments have been .attached with the submission. Below are responses to your editorial comments Best wishes Corresponding author Ibrahim Gosadi Itemized Responses to Editorial Comments Comment 1. Article category Response: The article title was modified to indicate the type of the article category as the : following Assessment of Risk of Obstructive Sleep Apnea among Patients with Type 2 diabetes and Associated Factors using STOP-BANG questionnaire: a cross-sectional study (Comment 2. 3 names of each author (first, last, and initial of middle name Response: The 3 names of each author (first, last, and initial of middle name) have

Few comprehensive studies exist that evaluate the nutrient intake and health indicators of college-aged students. This article describes the University of New Hampshire's Young Adult Health Risk Screening Initiative and examines results from participants evaluated from September 2005 through July 2007. This cross-sectional study included 1,701 students who enrolled in an introductory nutrition course, met age requirements (18 to 24 years), agreed to participate, and completed related assessments. All evaluation components were built into the semester-long course design, thus minimizing participant burden. Anthropometric measurements, blood lipids, blood glucose, and blood pressure were measured directly by research staff. Online dietary intake was self-reported and evaluated using a software program. Health risk data indicate high rates of overweight (33%), elevated low-density lipoprotein cholesterol (53%), and elevated systolic (47%) and diastolic blood pressures (39%). Less than 30 minutes of physical activity per day was reported by 28% of respondents. The majority of males (94%) and females (73%) exceeded sodium guidelines. Although females were less likely to be overweight than males, few met recommended intakes for vitamin D (26%), calcium (25%), potassium (35%), iron (31%), and folate (32%). Undergraduate and graduate dietetics students assisted with biological assessments, data entry, and record maintenance. Data inclusion rates ranged between 84% and 94% for various measurements. The methods employed in this study could be modified by institutions interested in profiling the health status of students. Results have led to an enhanced understanding of the nutrition practices and health status of this population and will serve to inform university programs and policies.

BMI (Kg/m2), waist circumference (cm). Total cholesterol, HDL, LDL, triglycerides (TG) (mg/dl) (Hitachi) 24-hour ambulatory blood pressure monitoring (ABPM): Spacelabs 90207. Average SBP, aDBP, aBP Mean (BPM) (SBP-DBP ϩ DBP/3). Standard S and D BP Burden (SϾ125 and DϾ75 mmHg reading percentages (SSBPB and SDBPB). Hemodynamic Load (HLϭHeart Rate ϫ BPM/ 100). SBP variability (SBPV) and DBP variability (DBPV) Statistical analysis: t-Student. Results: 1-Nϭ106 (55.5%) NSm; Nϭ47 (25.9%) ESm; and Nϭ28 (15.46%) Sm. 2-The Sm patient group was youngest and had lower BMI (pϭ0.04) 3-Whilst comparing Sm and NSm groups, the following significant differences were observed: average SBP (pϭ0.03), SDBPB (pϭ0.02), TG (pϭ0.02). 4-Whilst comparing Sm and ESm groups, the following significant differences were observed: SDBPB (p Ͻ0.05), DBPm (pϽ0.02), HL (pϭ0.034), with the most unfavorable results in the smoking group. 5-No differences were observed between the non-smoker and exsmoker patient groups. Conclusions: 1-The smoking habit is correlated with different hemodynamic and lipid parameters. 2-The above-mentioned cannot be attributed to the changes associated neither to age nor to weight because both of these were lower in smokers, adding even greater importance to our findings. 3-A 3-month period after smoking cessation is enough for the reversion of the hemodynamic alterations. 4-Nowadays we can add new data to justify the suppression of the smoking habit in patients with high cardiovascular risk.

Considering the growing body of evidence that indicates the contribution of superoxide anions (O2) and other reactive oxygen species (ROS) to the development of hypertension, we assessed whether animal models of hypertension have a benefic effect with tempol, a superoxide dismutase mimetic, to help augment the design of future studies. Studies published between July 1998 and December 2012 on blood pressure (BP) in different hypertensive models were obtained after an electronic and manual search of PubMed. In-depth analyses of the methodological quality of the studies and the mean arterial pressure (MAP) changes after treatment with tempol were performed, as well as the subgroup analyses on the route of tempol delivery. Out of the 144 identified studies, 28 were included after screening. The data showed that tempol reduced MAP by computing the standardized mean difference with the value of 4.622 (95% confidence interval 3.24-5.99). The quality of studies included in the meta-analysis was category II; however, omission of details in the trials might have biased the results. There was substantial heterogeneity in the results with an I of 94.45%, which persisted after stratifying for the route of tempol delivery. In conclusion, this analysis shows that antioxidant treatment with tempol can reduce BP, suggesting that ROS plays a role in the pathogenesis of increased BP in the hypertension models used in the current research practice.

The purpose of this investigation was to evaluate the extent to which obesity and/or hypertension may modify the response of rats&#39; periodontium to chronic gingival irritation. Forty-four normal, spontaneously hypertensive, obese, and obese-hypertensive rats were used. Histopathologic evaluation of the periodontal structure showed both hyperplasia and hypertrophy of the walls of blood vessels supplying the periodontium in the hypertensive and obese-hypertensive animals. The results also indicated that obesity significantly contributed to e severity of periodontal disease. Hypertension alone was not a significant factor. The obese-hypertensive rats showed the most severe periodontal response to local irritation.

Volume 152 Number 8 14. Winer BJ. Statistical principles in experimental design. 2d ed. New York: McGraw-Hill, 1971:545. 15. Caritis SN, ToigG, Heddinger LA, Ashmead G. A doubleblind study comparing ritodrine and terbutaline in the treatment of preterm labor. AM J OBSTET GvNECOL 1984;150:7. Evaluation of ritodrine as loading dose 16. Caritis SN, Wong LK, Lin LS. Differences in pharmacokinetic behavior of ritodrine in pregnant and nonpregnant rhesus monkeys [Abstract 349]. San Francisco: Society for Gynecologic Investigation, thirty-first annual meeting, March 21-24, 1984.

Objective: To assess the prevalence of risk factors and risk for cardiovascular disease and Type 2 diabetes in employees with sedentary occupations enrolled in a workplace health-promotion program. Methods: Participants (n = 762) were recruited from ten Melbourne workplaces, participating in a physical activity program. Demographic, behavioral, biomedical, and physical measurements were collected. Results: The majority of employees were not meeting recommended guidelines for physical activity (62%), fruit intake (70%), vegetable intake (86%), body mass index (58%), or waist circumference (53%). Most had intermediate (53%) or high (7%) risk of developing Type 2 diabetes. Conclusions: The majority of Australian adults in sedentary occupations were not meeting guidelines for a number of chronic disease risk factors and a substantial proportion were unaware of their increased risk. This study supports the potential of chronic disease risk factor detection and intervention programs in the workplace.

In the hierarchy of research designs, the results of randomized, controlled trials are considered to be evidence of the highest grade, whereas observational studies are viewed as having less validity because they reportedly overestimate treatment effects. We used published meta-analyses to identify randomized clinical trials and observational studies that examined the same clinical topics. We then compared the results of the original reports according to the type of research design.

Aim of the study was to detect the prevalence of hypertension among 11-14 years old schoolchildren (n. 487, mean age 12.7 +/- 0.9). The influence on blood pressure (BP) of body mass index (BMI), dietary habits (frequency of breakfast and food items consumption) and life-style was also investigated. Hypertension was defined according to blood pressure tables for children and adolescents of the NIH-Fourth Report (systolic and diastolic BP &gt;95th percentile for age and sex). Overweight and obesity were determined according to the International Obesity Task Force Dietary habits and life-style were investigated by specific questionnaires. The prevalence of overweight and obesity was respectively 31.8% and 10.3% of the subjects studied. Moreover 10.3% of them showed BP values between 90th and 95th percentile and 10.1% was hypertensive. In general the prevalence of overweight (p &lt; 0.05), obesity (p &lt; 0.001) and sedentary activity (p &lt; 0.05) was higher in hypertensive adolescents...

The appropriate treatment target for systolic blood pressure (SBP) in older patients with hypertension remains uncertain. To evaluate the effects of intensive (&lt;120 mm Hg) compared with standard (&lt;140 mm Hg) SBP targets in persons aged 75 years or older with hypertension but without diabetes. A multicenter, randomized clinical trial of patients aged 75 years or older who participated in the Systolic Blood Pressure Intervention Trial (SPRINT). Recruitment began on October 20, 2010, and follow-up ended on August 20, 2015. Participants were randomized to an SBP target of less than 120 mm Hg (intensive treatment group, n = 1317) or an SBP target of less than 140 mm Hg (standard treatment group, n = 1319). The primary cardiovascular disease outcome was a composite of nonfatal myocardial infarction, acute coronary syndrome not resulting in a myocardial infarction, nonfatal stroke, nonfatal acute decompensated heart failure, and death from cardiovascular causes. All-cause mortality w...

To investigate the role of the renin-angiotensin-aidosterone system as a cause of hypertension, 20 hypertensive patients with coarctation of the aorta were studied during normal and low sodium tntake and after diuresis with furosemide. Etght patients wtth essential hypertension and 13 control subjects were similarly studied. Plasma renin activity values in patients with coarctation were similar to those in patients with essential hypertension and in control patients during normal and low sodium diets. However, after the administration of furosemide, plasma renin activity values were signtftcantiy higher in the patients with coarctation than in the other two groups (P CO.005 and <O.Ol, respectively). The values for urinary aidosterone, plasma volume and extraceil fluid volume (bromide space) were increased in patients with coarctation during both normal and low sodium intake. These renin and aidosterone responses and body fluid spaces in patients with coarctation suggest that their hypertension resembles a one-kidney Goidbiatt model. The data help to better define the role of the renin-angiotensin-aidosterone system in the hypertension of coarctation and thus may help guide the clinician in therapeutic interventions.

Introduction: Sleep is an innate and essential part of human life. Various aspects of sleep are negatively affected by beta-blockers. We compared the impact of two beta-blockers, metoprolol succinate (extended release) and nebivolol, on sleep quality in patients with stage 1 hypertension. Methods: This was a prospective, randomized, open-label, parallel-group study. Eligible patients were administered the Pittsburgh Sleep Quality Index (PSQI) questionnaire by a blinded interviewer and were randomized to receive metoprolol (starting dose 25 mg) or nebivolol (starting dose 2.5 mg) once daily for 6 weeks. The first dose was administered before patients left the clinic. Visits were scheduled for 1, 2, 4, and 6 weeks after the initiation of therapy. At the end of the study, patients were readministered the PSQI questionnaire by the same interviewer, as before blinded to treatment allocation. Results: A total of 22 patients in the nebivolol group and 17 patients in the metoprolol group completed the study and were included in the data analysis (mean age of patients, 40.7 years). At study entry, systolic blood pressure