In adults, hypertension has been shown to be inversely correlated with bone mineral content (BMC); however, the association between blood pressure (BP) and BMC has not been studied in pediatrics.
Total body BMC of 187 overweight (mean BMI=28.7 kg/m2) Latino children and adolescents (mean age=11.2 years) were measured using dual-energy x-ray absorptiometry. Seated systolic (SBP) and diastolic (DBP) blood pressure were measured using a standard mercury sphygmomanometer. Hypertension was defined by SBP or DBP above the 90th percentile for height, age, and gender.
Partial correlations revealed an inverse association between SBP and BMC (r=- 0.24, p=0.02) in boys (n=105); results were non-significant (p=0.27) in girls (n=82). There were no significant correlations between DBP and BMC. When BMI and insulin sensitivity were adjusted for, hypertensive boys (n=21) had lower BMC (1435 versus 1636 g; p=0.03) than normotensive boys (n=84); similarly, hypertensive girls (n=25) had lower BMC (1438 versus 1618 g; p=0.02) than normotensive girls (n=57). In post-pubertal adolescents (Tanner stage 4-5; n= 48), inverse correlations were stronger (r=- 0.40, p=0.007); results were non-significant in pre-pubertal and pubertal children (Tanner stage 1-3; n=139, p=0.57). In post-pubertal girls (n=37), there were no significant correlations (p=0.14); inverse correlations in post-pubertal boys (n=11) became markedly stronger (r= -0.80, p=0.02).
SBP is inversely correlated with BMC in overweight adolescents; additionally, hypertensives have lower adjusted means of BMC than normotensives. These promising new findings suggest that hypertension may be a risk factor for osteopenia in overweight children and adolescents; this risk may be exacerbated in post-pubertal boys.
Pediatric; Latino; Bone Mineral Content; Blood Pressure; Osteopenia
The obesity and hypertension are the major risk factors of several life threatening diseases. The present study was aimed to investigate the relation between body mass index (BMI) the validated index of adiposity and different aspect of blood pressure (BP).
Systolic and diastolic blood pressures and also weight and height of 7 to 18 years old children and adolescent collected in 2002 and 2004 respectively. Data was consisted of 14865 schoolchildren and adolescents from representative sample of country. BMI was classified according to CDC 2000 standards into normal (BMI<85th percentile), at risk of overweight (BMI≥85th and <95th percentile) and overweight (BMI≥95th percentile). Then, age-sex specific prevalence of being overweight was derived. ANOVA was used to investigate the effect of BMI on systolic blood pressure and diastolic blood pressure and mean arterial pressure of participants.
Mean systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial blood pressure (MAP) significantly increased with BMI (P< 0.0001) and age groups (P< 0.0001), and was significantly (P< 0.0001) higher in boys than girls especially in older ages. (P< 0.0001, interaction of age and BMI level). The proportion of being overweight was significantly higher in boys than girls was (7.4% vs. 3.6%; P< 0.0001).
There is an association between BP and BMI in children and adolescence. SBP, DBP and MAP are associated with rise in BMI and age, which was lower in girls. This data can provide basics for public health policy makers and primary prevention policies in the country.
Blood pressure; Body mass index (BMI); Relation; Children; Adolescents
To characterize the distribution of blood pressure (BP), prevalence and risk factors for hypertension in pediatric chronic kidney disease (CKD), we conducted a cross-sectional analysis of baseline BP's in 432 children (mean age 11y; 60% male; mean glomerular filtration rate [GFR] 44 ml/min/1.73m2) enrolled in the Chronic Kidney Disease in Children cohort study. BP's were obtained using an aneroid sphygmomanometer. GFR was measured by iohexol disappearance. Elevated BP was defined as BP≥90th percentile for age, gender and height. Hypertension was defined as BP≥95th percentile or as self-reported hypertension plus current treatment with antihypertensive medications.
For systolic BP, 14% were hypertensive and 11% were pre-hypertensive (BP 90-95th percentile); 68% of subjects with elevated SBP were taking antihypertensive medications. For diastolic BP, 14% were hypertensive, and 9% were pre-hypertensive; 53% of subjects with elevated DBP were taking antihypertensive medications. 54% of subjects had either systolic or diastolic BP≥95th percentile or a history of hypertension plus current antihypertensive use.
Characteristics associated with elevated BP included black race, shorter duration of CKD, absence of antihypertensive medication use, and elevated serum potassium. Among subjects receiving antihypertensive treatment, uncontrolled BP was associated with male sex, shorter CKD duration and absence of ACE inhibitor or ARB use.
37% of children with CKD had either elevated systolic or diastolic BP, and 39% of these were not receiving antihypertensives, indicating that hypertension in pediatric CKD may be frequently under- or even un-treated. Treatment with ACE inhibitors or ARB's may improve BP control in these patients.
kidney disease; children; adolescents; hypertension; blood pressure; ACE inhibitors
Automated blood pressure (BP) devices are used by many hypertensive patients in Hong Kong, with or without medical advice. At two community clinics, we invited hypertensive patients aged between 40 and 70 years who used such a device to fill in a questionnaire and to have four sets of BP measurements, automated and mercury, at two visits. Of 290 hypertensive patients 120 fulfilled the criteria, and 73 of these agreed to participate.
53 devices measured arm BP, 21 measured forearm BP. The agreement between the mercury sphygmomanometer and the automated devices was poor, with average differences of 9.5 mmHg for systolic and 9.4 mmHg for diastolic and no clear advantage for either site of measurement. As a means of screening for BP >140/90 mmHg the sensitivity of the automated devices was 81% and the specificity was 80%. There were large variations in how often and under what circumstances the devices had been used. One-fifth of the devices had been acquired on medical advice but only 11% of the participants were aware of the three important conditions for operating such devices.
Discussion of automated devices, their role and proper use, should now be part of routine hypertensive care.
To validate the Dinamap ProCare 200 blood pressure (BP) monitor against a mercury sphygmomanometer in children 7 to 18 years old in accordance with the 2010 International Protocol of European Society of Hypertension (ESH-IP2) and the British Hypertension Society (BHS) protocol.
Forty-five children were recruited for the study. A validation procedure was performed following the protocol based on the ESH-IP2 and BHS protocols for children and adolescents. Each subject underwent 7 sequential BP measurements alternatively with a mercury sphygmomanometer and the test device by trained nurses. The results were analyzed according to the validation criteria of ESH-IP2.
The mean (±SD) difference in the absolute BP values between test device and mercury sphygmomanometer readings was 1.85±1.65 mmHg for systolic BP (SBP) and 4.41±3.53 mmHg for diastolic BP (DBP). These results fulfilled the Association for the Advancement of Medical Instrumentation criterion of a mean±SD below 5±8 mmHg for both SBP and DBP. The percentages of test device-observer mercury sphygmomanometer BP differences within 5, 10, and 15 mmHg were 96%, 100%, and 100% for SBP, and 69%, 92%, and 100% for DBP, respectively, in the part 1 analysis; both SBP and DBP passed the part 1 criteria. In the part 2 analysis, SBP passed the criteria but DBP failed.
Although the Dinamap ProCare 200 BP monitor failed an adapted ESH-IP2, SBP passed. When comparing BP readings measured by oscillometers and mercury sphygmomanometers, one has to consider the differences between them, particularly in DBP, because DBP can be underestimated.
Blood pressure; Oscillometric device; Dinamap; Validation studies; International protocol
Several healthful dietary patterns appear to be effective at lowering blood pressure and preventing hypertension. However, the relationship between dietary patterns and hypertension among a representative Chinese population sample is unclear.
A nationally representative sample of 23 671 participants aged 18-59 years were recruited by the 2002 China National Nutrition and Health Survey. All participants had their blood pressure measured with standardized mercury sphygmomanometers. Hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg. We conducted factor analysis using dietary information from a validated food frequency questionnaire to derive dietary patterns. Information of participants on physical activities, education level, annual household income, smoking status and family history of hypertension was collected by interviewer-administrated questionnaires.
Three major dietary patterns, defined as 'Western', 'traditional northern', and 'traditional southern', were identified. Participants with the highest quartile for the score of the Western pattern had significantly higher blood pressure comparing with counterparts in the lowest quartile. In contrast, participants in the top quartile for the score of the traditional southern pattern presented significantly lower blood pressure comparing with counterparts in the lowest quartile. In multivariate analyses the traditional northern pattern score was associated with an odds ratio (OR) of 1.30 (95% confidence interval (CI) 1.11-1.53, P for trend = 0.0001) comparing with the lowest quartile. The OR for the top quartile of score for the traditional southern pattern was 0.73 (95% CI, 0.59-0.89, P for trend = 0.0040) compared with the lowest quartile of traditional southern pattern score. However, the significant association between the traditional northern pattern and prevalence of hypertension disappeared after further adjusting for body mass index (BMI) (P for trend = 0.3), whereas the association between the traditional southern pattern and prevalence of hypertension persisted after further adjusting for BMI (P for trend = 0.01).
We observed a positive relationship between the traditional northern pattern and hypertension that was mediated through differences in BMI. In addition, the traditional southern pattern was significantly associated with lower odds of presenting with hypertension.
Seven types of sphygmomanometer were used in random order on each of nine hypertensive patients and the readings compared with simultaneous intra-arterial blood-pressure recordings. All the devices gave significantly different values for systolic pressure, and only two measured diastolic pressure without significant error. Systolic pressure was consistently underestimated (range 31-7 mm Hg), and all but one instrument overestimated diastolic pressure (range 10-2 mm Hg). The variability of readings was least with the standard mercury sphygmomanometer and the random-zero machine, while with some of the more automated devices single readings were in error up to -68/33 mm Hg. The strong correlations found between intra-arterial and cuff systolic pressures with all devices tested and significant correlations for diastolic pressure with all but one device indicate that, with one possible exception, the sphygmomanometers would give accurate results where a change in blood pressure was the main concern.
We measured ambulatory blood pressure using the AM5600 in children and adolescents participating in a research study to assess the relationship of BP to risk factors for cardiovascular disease. Although this use of this monitor has been previously reported in adults, it has not been validated in pediatric subjects. In this study, we assess the accuracy of the monitor as compared to the mercury sphygmomanometer in children ages 7-18 years of age. We found that the mean of the difference between the monitor and the mercury device was 0.29 ± 3.5 and 0.045 ± 3.7 mmHg for systolic and diastolic BP respectively, which fulfills the AAMI standard for use of a device. The cumulative percent of readings between the two devices which differed assigned the device a grade of A according to the British Hypertension Society..
hypertension; ambulatory blood pressure monitoring; Blood pressure measuring device
The random-zero sphygmomanometer has been widely used in observational studies and clinical trials for blood pressure measurement. We examined the agreement of blood pressure measurements between random-zero and standard mercury sphygmomanometers among 2,007 Chinese study participants aged 15–60 years. Three blood pressure readings were obtained by trained observers using random-zero and standard mercury sphygmomanometers, respectively, in a random order. Overall, blood pressure readings obtained using the random-zero device were significantly lower than those obtained with the standard mercury sphygmomanometer, with a mean difference ranging from −3.0 to −2.7 mm Hg for systolic and −1.4 to −0.9 mm Hg for diastolic blood pressure (all p <0.01). Correlation coefficients between mean blood pressure measurements obtained using the random-zero and standard mercury sphygmomanometers were high (0.90 for systolic and 0.85 for diastolic blood pressure, both p< 0.0001). In conclusion, our study indicated that there was strong agreement between blood pressure measurements obtained using the random-zero and standard mercury sphygmomanometers although blood pressure values were on average lower with the random-zero sphygmomanometer.
blood pressure measurements; random-zero sphygmomanometer; standard mercury sphygmomanometer; agreement
Background and Objectives
In Korea, there hasn't been any previous literature that describes auscultatory blood pressure (BP) normative tables for adolescents. Using BP data, from the Korean National Health and Nutrition Examination Survey (KNHANES), we created normative auscultatory BP percentile tables for Korean adolescents.
Subjects and Methods
A total of 3508 adolescents (boys 1852, girls 1656), aged 10-17 in 2001, 2005 and 2007 from the KNHANES database years, were included. Auscultatory BP measurement was performed, using a Baumanometer Mercury Gravity Sphygmomanometer.
The mean systolic BP of boys was higher than that of girls in adolescents older than 13 years of age, and the mean diastolic BP of boys was higher than that of girls in those older than 15 years. Systolic and diastolic BP was correlated with weight, height and age. Age-specific normative auscultatory systolic and diastolic BP percentiles for boys and girls were completed. The graph that showed age-specific prehypertensive and hypertensive systolic and diastolic BP for boys and girls was presented. For adolescents, the height-specific auscultatory BP percentiles for boys and girls were completed. A graph that shows the height-specific prehypertensive and hypertensive BP for boys and girls was also made.
The auscultatory age-and height-specific BP percentiles for Korean adolescents are established. These can be useful in screening the prehypertension and hypertension of Korean adolescents in a clinical setting.
Blood pressure; Adolescent; Auscultation
To estimate the prevalence of hypertension through a screening campaign in the Eastern Province of Saudi Arabia, and examine its association with lifestyle factors.
Research Design and Methods:
In 2004, all Saudi residents in the Eastern Province, aged 30 years and above were invited to participate in a screening campaign for the early detection of diabetes and hypertension. Blood pressure was recorded by trained nurses using a mercury sphygmomanometer, based on the recommendations of (JNC- VII). A positive screening test for hypertension was defined as systolic and/or diastolic blood pressure of ≥ 140 and 90 mm Hg, respectively. Subjects who had positive screening tests were asked to come on the following day for a confirmation of the reading. Hypertension was considered if there was a persistent reading of systolic and/or diastolic blood pressure of ≥ 140 and 90 mmHg after confirmation, or when there was history of a previous diagnosis.
21% of the sample was positive from previous history or screening. After confirmation, the prevalence of hypertension dropped to 15.6%, pre-hypertension was 3.7%, whereas the prevalence of undiagnosed hypertension was 2.8%. The prevalence rose with age. It was higher in women than in men of all age groups and in all sectors of the eastern province, although the mean systolic and diastolic BP was higher in men than women. It was higher with lower education, in widows and divorcees than others (P<0.0001).
The yield of the screening for abnormal blood pressure was high. Systematic follow-up of subjects with abnormal screening results is vital.
Hypertension; Screening; Saudi Arabia
There are no time trends in prevalence, unawareness, treatment, and control of hypertension in Switzerland. The objective of this study was to analyze these trends and to determine the associated factors.
Population-based study conducted in the Canton of Geneva, Switzerland, between 1999 and 2009. Blood pressure was measured thrice using a standard protocol. Hypertension was defined as mean systolic or diastolic blood pressure ≥140/90 mmHg or self-reported hypertension or anti-hypertensive medication. Unawareness, untreated and uncontrolled hypertension was determined by questionnaires/blood pressure measurements. Yearly age-standardized prevalences and adjusted associations for the 1999–2003 and 2004–2009 survey periods were reported. The 10-year survey included 9,215 participants aged 35 to 74 years. Hypertension remained stable (34.4%). Hypertension unawareness decreased from 35.9% to 17.7% (P<0.001). The decrease in hypertension unawareness was not paralleled by a concomitant absolute increase in hypertension treatment, which remained low (38.2%). A larger proportion of all hypertensive participants were aware but not treated in 2004–2009 (43.7%) compared to 1999–2003 (33.1%). Uncontrolled hypertension improved from 62.2% to 40.6% between 1999 and 2009 (P = 0.02). In 1999–2003 period, factors associated with hypertension unawareness were current smoking (OR = 1.27, 95%CI, 1.02–1.59), male gender (OR = 1.56, 1.27–1.92), hypercholesterolemia (OR = 1.31, 1.20–1.44), and older age (OR 65–74yrs vs 35–49yrs = 1.56, 1.21–2.02). In 1999–2003 and 2004–2009, obesity and diabetes were negatively associated with hypertension unawareness, high education was associated with untreated hypertension (OR = 1.45, 1.12–1.88 and 1.42, 1.02–1.99, respectively), and male gender with uncontrolled hypertension (OR = 1.49, 1.03–2.17 and 1.65, 1.08–2.50, respectively). Sedentarity was associated with higher risk of hypertension and uncontrolled hypertension in 1999–2003.
Hypertension prevalence remained stable since 1999 in the canton of Geneva. Although hypertension unawareness substantially decreased, more than half of hypertensive subjects still remained untreated or uncontrolled in 2004–2009. This study identified determinants that should guide interventions aimed at improving hypertension treatment and control.
The aim of this study was to determine the associations between the presence and extent of calcified atherosclerosis in multiple vascular beds and systolic blood pressure, diastolic blood pressure, pulse pressure, mean arterial pressure, isolated systolic hypertension, and hypertension. 9,510 patients (42.5% women) underwent electron beam computed tomography scanning as part of a routine health maintenance screening. At the same visit, blood pressure was measured with the participant in the seated position using a mercury sphygmomanometer. Mean age was 58±11.4 years and body mass index was 27.1±4.5. The prevalence of any calcification in the carotids, coronaries, subclavians, thoracic aorta, abdominal aorta, and iliacs were 31.9, 57.2, 31.7, 37.0, 54.3, and 48.8% respectively. In separate multivariable logistic models containing traditional cardiovascular disease risk factors, pulse pressure and systolic blood pressure were significantly associated with presence of calcification in all vascular beds except the iliacs and subclavians, respectively, with pulse pressure having stronger magnitudes of the associations for most of the vascular beds. Age stratified analyses indicated that these associations were stronger in those over 60 years of age, compared to subjects less than 60 years of age, and gender stratified analyses demonstrated that men had a greater association compared to women. Also, the magnitudes of the associations for isolated systolic hypertension were, in general, larger than those for hypertension. Pulse pressure and isolated systolic hypertension are robust and important correlates for calcified atherosclerosis in different vascular beds. Isolated systolic hypertension may be clinically relevant in diagnosing or preventing calcified atherosclerosis.
Pulse Pressure; Isolated systolic hypertension; Systolic Blood Pressure; Calcification; Atherosclerosis; Hypertension; Vascular beds
To assess the effect of age, body mass index (BMI) and parity on systolic and diastolic blood pressures (BPs) and hypertension.
Subjects and Methods:
A cross-sectional prospective study of 441 non-pregnant married women ranging in age from 15-60 years. For each woman selected, a detailed questionnaire dealing with sociodemographic profile including reproductive data was completed. Systolic and 5th phase diastolic BPs were measured using a standard mercury sphygmomanometer. Body weight and height were measured using an Avery Beam weighing scale and a stadiometer respectively.
In this study sample, the overall prevalence of hypertension was 4.3%. Statistical analysis showed that age and BMI were positively and significantly associated with BPs (p<0.0001 for systolic BP & <0.002 for diastolic BP and p<0.0001 for systolic BP & <0.005 for diastolic BP respectively) and positively and significantly (p<0.0001 & <0.003 respectively) associated with an increase in the risk of hypertension (Odds ratio, 95% confidence interval: 1.53 (1.1-1.2) and 1.11 (1.04-1.19) respectively) while parity was negatively and insignificantly associated with BPs (p<0.4 and <0.1 for systolic and diastolic BPs respectively) and negatively and insignificantly (P<0.1) associated with an increase in the risk of hypertension (Odds ratio, 95% confidence interval: 0.87 (0.74-1.03).
Age and BMI were significant contributors to BPs and hypertension rather than parity. The negative association between parity and hypertension, although insignificant, implies that nulliparity rather than multiparity imposed an important effect on hypertension.
Parity; BMI; blood pressures; hypertension
Early diagnosis of hypertension (HT) is an important strategy in its control. Previous studies have documented that hypertension may begin in adolescence, perhaps even in childhood. The purpose of this study was to determine the prevalence of hypertension and risk factors among school going children in Surat city, south Gujarat, India.
Materials and Methods:
School going children aged between 6 to 18 years, of two schools were selected by purposive sampling method and blood pressure measurements were taken by mercury sphygmomanometer as per recommendation of American heart association. Hypertension is considered when blood pressure is more than 95th percentile according to update on task force report (2004) and children having hypertension in first and second recording repeat measurement was done to confirm hypertension after a week.
Total prevalence of hypertension in our study was 6.48%. Hypertension in males was 6.74% (<10 yrs 5.88%, 10-13yrs 6.04%, >13yrs 9.19%) and in females was 6.13% (<10yrs 0.62%, 10-13yrs 8.67%,.13yrs 8.48%). Prevalence of obesity in hypertension was 8.7% against normotensive 1.1% (P <0.05). Prevalence of hypertension in family members of hypertensive was 18.6% and in normotensive 13.1% (P =0.1). Prevalence of diabetes mellitus in family members of hypertensive was 23.4% and 13.7% in normotensive (P<0.05); while prevalence of ischemic heart disease in family members was 12.34% in hypertensive and 8.3% in normotensive (P <0.05).
Prevalence of hypertension was 6.48% in the study subjects. We identified obesity, family history of diabetes mellitus, ischemic heart disease was found to be significant association for childhood hypertension.
Children; hypertension; India; risk factors
To determine associations between body mass index (BMI) and sleep on blood pressure over a 5-year period from childhood to adolescence.
A longitudinal, community-based sample of 334 children recruited at ages 6 through 11 years. Each participant underwent in-home polysomnography initially and then 5 years later. Individual systolic (SBP) and diastolic (DBP) blood pressures were calculated at both time points during wake periods and classified as hypertensive if SBP or DBP was ≥ 95th standardized percentiles for height and weight.
Hypertension was present in 3.6% of the sample at time one and increased to 4.2% 5- years later. Obesity prevalence increased from 15.0% to 19.5%. Normal changes in sleep architecture were observed in the sample. Random effects modeling which controlled for age, sex and ethnicity indicated that change in obesity status and decrease in total sleep time were associated with increases in SBP. Change in obesity status was also associated with increases in DBP over the 5-year period. A trend for sleep-disordered breathing to increase SBP was noted.
Increases in SBP and DBP were associated with increasing BMI and decreased total sleep time over a 5-year period from childhood to adolescence.
We evaluated the agreement between office blood pressure (OBP) measured by mercury sphygmomanometer (Sphyg) and automatic (Auto) device without any observers, and compared Auto and Sphyg OBP to ambulatory (ABP) and home blood pressure (HBP).
OBP was measured in 75 hypertensive patients at 2 sites using an automatic monitor without a doctor or nurse present and by Sphyg during 3 clinic visits. Between visits, ABP and HBP monitoring were also performed.
Mean Auto OBP was similar to Sphyg OBP and they were closely correlated (ICC=0.84 for systolic and 0.91 for diastolic OBPs); however, the difference between Auto and Sphyg systolic OBP (1.6±8.2 mmHg) varied by the first office visit, gender, and the site. Auto systolic OBP was lower than both systolic awake ABP (137.1±14.7 mmHg) and HBP (139.2±15.6 mmHg). Auto systolic OBP and Sphyg OBP were similarly correlated with systolic awake ABP (both r=0.59, P<0.001). Mean Auto diastolic OBP was similar to Sphyg OBP (81.1±11.3 vs. 80.3±13.3 mmHg, P=0.20, ICC=0.91), diastolic awake ABP and HBP. Auto diastolic OBP and Sphyg OBP were related to diastolic awake ABP (both r>0.68, P<0.001). In multivariable analyses, neither OBP measure was a significantly stronger predictor of out-of-office BP than the other.
Auto systolic OBP measured without a doctor or nurse present was lower than systolic awake ABP and HBP. Auto and rigorously assessed Sphyg OBP had similar means and were similarly related to awake ABP. Auto OBP might be an advantageous alternative to Sphyg measurements in the usual clinic setting.
Ambulatory blood pressure monitoring; home blood pressure; self-measured blood pressure; office blood pressure
The Action to Control Cardiovascular Risk in Diabetes (ACCORD) Blood Pressure Trial reported no differences in most cardiovascular disease (CVD) outcomes between intensive and standard blood pressure therapy in individuals with diabetes mellitus (DM) and hypertension. Many such individuals are centrally obese. Here we evaluate whether the trial outcomes varied by the level of central obesity.
RESEARCH DESIGN AND METHODS
The cohort included 4,687 people (47.7% women) with DM and hypertension. Mean age was 62.2, and mean follow-up was 4.7 years. Participants were randomly assigned to one of two blood pressure treatment strategies: intensive (systolic <120 mmHg) or standard (systolic <140 mmHg). Sex-specific quartiles of waist-to-height ratio were used as the measure of central obesity. The primary ACCORD outcome (a composite of nonfatal myocardial infarction [MI], nonfatal stroke, or CVD death) and three secondary outcomes (nonfatal MI, fatal or nonfatal stroke, and CVD death) were examined using proportional hazard models.
There was no evidence that the effect of intensively lowering blood pressure differed by quartile of waist-to-height ratio for any of the four outcomes (P > 0.25 in all cases). Controlling for waist-to-height quartile had no significant impact on previously published results for intensive blood pressure therapy. Waist-to-height ratio was significantly related to CVD mortality (hazard ratio 2.32 [95% CI 1.40–3.83], P = 0.0009 comparing the heaviest to lightest quartiles), but not to the other outcomes (P > 0.09 in all cases).
Intensive lowering of blood pressure versus standard treatment does not ameliorate CVD risk in individuals with DM and hypertension. These results did not vary by quartile of waist-to-height ratio.
In Peru, cardiovascular disease was the second most common cause of death in those aged 65 years or more in 2000. Hypertension is a major modifiable risk factor for cardiovascular disease, and if treated can significantly reduce cardiovascular disease risk. The objectives of this study were to investigate the prevalence of hypertension and levels of awareness, treatment and control in a deprived urban area of Peru.
A cross-sectional study was completed. Blood pressure measurements were recorded in triplicate. Hypertension was defined as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, or self report of receiving antihypertensive medication at the time of interview.
The study sample was 584 adults (29.1% male, mean age 35.3 years). Age standardized prevalence of hypertension was 19.5% (95% CI 9.9%, 29.1%) in men, 11.4% (95% CI 3.7%, 19.1%) in women, and 13.2% (95% CI 5.0%, 21.5%) overall. Among those with hypertension 38.3% (95% CI 22.7%, 53.9%, n = 18/47) were aware of their condition with greater awareness among women than men. Of those aware, 61.1% (n = 11/18) were treated, equating to 23.4% (95% CI 10.1%, 36.7%, n = 11/47) of all adults with hypertension. Of those treated 63.6% (n = 7/11) had controlled hypertension, equating to 14.9% (95% CI 3.0%, 26.8%, n = 7/47) of all adults with hypertension.
Levels of awareness and control in this population were low. Lack of control is likely to be due to both a failure to diagnose hypertension, especially among men, and initiate or comply with treatment, especially among women. These results suggest a considerable burden of undiagnosed hypertension, and poor levels of control in those treated, in a deprived urban area of Lima, Peru.
The age-, gender-, and height-percentile requirements of the 'gold-standard' for the diagnosis of (pre)hypertension in adolescents make it time-consuming for clinicians and difficult-to-use by non-professionals. Simplified diagnostic tools are therefore needed. The use of blood pressure-to-height ratio (BPHR) - systolic BPHR (SBPHR) and diastolic BPHR (DBPHR) - has been reported in Han adolescents, but it requires validation in other racial groups. The diagnostic accuracy of SBPHR and DBPHR in a population of 1,173 Nigerian adolescents aged 11-17 years, was therefore studied.
Blood pressures were measured using standard procedures and (pre)hypertension were defined according to international recommendations. ROC curve analyses were used to assess the diagnostic accuracy of BPHR in defining (pre)hypertension in this population. Sex-specific threshold values for SBPHR and DBPHR were determined, and thereafter used to define (pre)hypertension. The sensitivity/specificity of this method was determined.
The accuracies of SBPHR and DBPHR in diagnosing (pre)hypertension, in both sexes, was >92%. The optimal thresholds for diagnosing prehypertension were 0.72/0.46 in boys and 0.73/0.48 in girls; while for hypertension, they were 0.75/0.51 in boys and 0.77/0.50 in girls. The sensitivity and specificity of this method were >96%.
The use of BPHR is valid, simple and accurate in this population. Race-specific thresholds are however needed.
adolescents; blood pressure-to-height ratio; diagnosis; (pre)hypertension
A prediction model, developed in the Framingham Heart Study (FHS), has been proposed for use in estimating a given individual’s risk of hypertension. We compared this model with systolic blood pressure (SBP) alone and age-specific diastolic blood pressure (DBP) categories for the prediction of hypertension. Participants in the Multi-Ethnic Study of Atherosclerosis, without hypertension or diabetes (n=3013), were followed for the incidence of hypertension (SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg and/or the initiation of antihypertensive medication). The predicted probability of developing hypertension between four adjacent study examinations, with a median of 1.6 years between examinations, was determined. The mean (standard deviation) age of participants was 58.5 (9.7) years and 53% were women. During follow-up, 849 incident cases of hypertension occurred. The c-statistic for the FHS model was 0.788 (95% CI: 0.773, 0.804) compared with 0.768 (95% CI: 0.751, 0.785; p=0.096 compared to the FHS model) for SBP alone and 0.699 (95% CI: 0.681, 0.717; p<0.001 compared to the FHS model) for age-specific DBP categories. The relative integrated discrimination improvement index for the FHS model versus SBP alone was 10.0% (95% CI: −1.7%, 22.7%) and versus age-specific DBP categories was 146% (95% CI: 116%, 181%). Using the FHS model, there were significant differences between observed and predicted hypertension risk (Hosmer-Lemeshow goodness of fit p<0.001); re-calibrated and best-fit models produced a better model fit (p=0.064 and 0.245, respectively). In this multi-ethnic cohort of U.S. adults, the FHS model was not substantially better than SBP alone for predicting hypertension.
hypertension; epidemiology; systolic blood pressure; diastolic blood pressure; risk prediction
Home blood pressure (HBP) monitoring plays an increasingly important role in the diagnosis and treatment of hypertension. We evaluated the independent value of HBP compared to ambulatory blood pressure (ABP) and office blood pressure (OBP) in the prediction of cardiovascular end-organ damage in normotensive subjects and untreated patients with mild hypertension.
163 subjects underwent measurements of OBP, HBP, ABP, and echocardiography. A physician using a mercury column sphygmomanometer performed three OBP measurements. ABP was recorded using a noninvasive ambulatory monitor (mean 35.4 awake readings per subject). Participants took HBP readings with an automatic, oscillometric device over a 10-week period (mean 277.9 readings per subject). Left ventricular mass index (LVMI) was calculated from measurements obtained from 2-dimensionally guided M-mode or linear tracings on echocardiography.
For systolic and diastolic blood pressures (SBP/DBP), the correlation coefficients of LVMI with OBP, awake ABP, and HBP were .29/.27, .41/.26, and .47/.35 respectively (all ps<.01). In a multivariate regression analysis in which age, sex, body mass index, OBP, awake ABP, and HBP were included, only age, sex, and HBP were significant predictors of LVMI. When only the first 12 home readings were used, the superiority of HBP was no longer evident.
In contrast to OBP and ABP, HBP measurements, when averaged over a 10-week period, are independently related to LVMI. HBP adds prognostic information over and above OBP and ABP in the prediction of cardiovascular end-organ damage, but this relation appears to depend on the number of readings taken.
Hypertension; home blood pressure monitoring; ambulatory blood pressure monitoring; echocardiography
A finger sphygmomanometer was compared with a mercury column sphygmomanometer for its ability to screen for hypertension. A total of 881 patients used each machine, both in initial screening and then for monitoring. The finger sphygmomanometer had a specificity of 98.5% in routine screening as compared with 97.6% for the mercury column device. Sensitivity of the finger device was 98.2%. These findings suggest that the finger sphygmomanometer using finger systolic pressure alone is adequate for screening and monitoring blood pressure.
In infants the flush and Doppler methods of blood pressure measurement are usually used. The flush method measures mean pressure; the Doppler method, systolic and diastolic pressures. Normal flush values from 1 to 12 months of age do not exceed 100 mm of mercury; Doppler systolic levels do not exceed 113 mm of mercury.
Data concerning normal limits for children and adolescents are conflicting. For practical purposes, a persistent pressure of 140 mm of mercury systolic or 90 mm of mercury diastolic in patients more than 10 years of age is indicative of hypertension. In those younger than 10 years, systolic pressure does not normally exceed 130 mm of mercury and diastolic pressure does not normally exceed 85 mm of mercury.
Primary hypertension is relatively infrequent in pediatric patients and diagnosis should be made with deliberation and caution. Antihypertensive drug therapy is indicated only for severe hypertension and in selected cases of moderate hypertension.
Both systolic and diastolic pressures can be measured in children with the mercury sphygmomanometer, the Arteriosonde and the Infrasonde. Estimates made blindly with these instruments were compared with directly measured intra-arterial blood pressures in 50 children aged between 4 days and 14 years. Systolic and diastolic estimates with the three techniques showed highly significant correlations with simultaneous intra-arterial measurements (P less than 0.001). The Infrasonde diastolic estimates were least satisfactory and the slope of the regression line against the intra-arterial pressure differed significantly from unity (y=0.54x+29.53). In 11 small children a satisfactory diastolic estimate could not be obtained with the mercury sphygmomanometer. While the mercury sphygmomanometer should remain the standard hospital equipment, an Arteriosonde would be valuable if it is difficult to hear Korotkoff's sounds on auscultation and if a diastolic pressure is required. For research investigations into childhood blood pressure an Arteriosonde or mercury sphygmomanometer, coupled with a device to exclude observer bias, is probably most suitable. Although the Infrasonde is not sufficiently accurate for research purposes, it is acceptable for routine ward use.