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An examination of the notes of 697 patients in a random sample of seven general practices in one part of inner London showed that 164 (24%) of 669 had had a blood-pressure recording in a five-year period. Proportions varied between 4% and 36% in the different practices. The blood pressure was raised (systolic greater than or equal to 160 mm Hg or diastolic greater than or equal to 100 mm Hg or both) in 74 patients (45%) whose blood pressure had been recorded, and another recording had subsequently been made in 45 (61%) of these patients. Fifteen (21%) of those with hypertension had not had a blood-pressure recording during the five years before the study. Tranquillisers or sedatives were the commonest drugs used in the treatment of hypertension. As in a study of the management of hypertension in hospital, opportunities provided by visits to the general practitioner were not commonly used for blood-pressure screening, and the discovery of hypertension often did not lead to further action.

An automatic device for measuring blood pressure was used to screen all patients aged 30 to 65 years registered at a health centre. Of those who were eligible, 55% attended. Patients with previously recognised hypertension were more common among the attenders than among the non-attenders. High readings obtained on the automatic device possibly deterred some patients from reattending for follow up measurements of blood pressure. Although the device is quick and easy to use, the logistic challenge of formal blood pressure screening is considerable. Hypertension was discovered in 52 patients (mean diastolic pressure greater than 100 mm Hg). Retrospective analysis of their medical records showed that a third had had an abnormal blood pressure reading noted during the past 10 years and no further action had been taken, and almost three quarters had attended their practitioner during the previous year without having a blood pressure measurement recorded. One year after the screening procedure two fifths of the newly discovered hypertensive patients had defaulted from follow up and treatment. Automatic devices are not a short cut to the discovery of occult hypertension. Case finding by routine measurement of blood pressure at surgery visits is more efficient.

The feasibility of blood pressure measurement by general practice pharmacists was examined in nine pharmacies. Two hundred and fifteen subjects were screened and 13 were referred to their general practitioners. Ten subjects (five per cent of the initial sample) were confirmed to be hypertensive by their doctors. The upper limits of normotension were 160/100 mmHg aged up to 50 years, 160/105 mmHg aged 51-60 years and a diastolic pressure of 110 mmHg over 60 years. Ninety-eight per cent of a sample of the lay public who completed a written questionnaire were in favour of blood pressure measurement by pharmacists. The study showed that general practice pharmacists were able to measure blood pressure within acceptable limits of accuracy and that, with the collaboration of general practitioners, the pharmacies were suitable agencies for screening for hypertension.

Self-recording of the blood pressure by patients away from hospital or office ("home blood pressure") has been advocated as providing a better estimate of "true" blood pressure. The reliability of home blood-pressure recording has been assessed only by standard indirect methods which themselves are subject to considerable error and variability. The accuracy of self-recorded blood pressures was therefore assessed in 57 patients with essential hypertension by comparison with simultaneous measurements of clinic blood pressures and with intra-arterial blood pressures recorded at home and at hospital. Home systolic blood pressures showed good agreement with clinic and intra-arterial pressures, but home diastolic blood pressures overestimated intra-arterial pressures, as did clinic diastolic pressures. The clinic and home diastolic pressures showed good agreement. There was considerable variability in individual differences comparing the indirect and intra-arterial methods, though the two indirect methods showed much closer agreement. This study suggests that home blood pressures are as accurate as clinic readings but may be recorded more frequently and thus provide more useful information. Neither is likely to approximate the intra-arterial blood pressure.

In this report we describe the distributions of blood pressure and its associations in adolescence. Six hundred and twenty-five subjects aged 13 to 18 were drawn from three general practices in different urban and rural settings. Systolic pressures were higher and rose with age in boys (mean = 119 mm Hg) compared with girls (mean = 114 mm Hg), who showed no age association. Diastolic pressures (phase 5) were higher in girls (mean = 64 mm Hg) than in boys (mean = 60 mm Hg) and showed no association with age in either sex. Initial blood pressures were generally higher than those recorded after a further five minutes' rest in the sitting position, although diastolic pressures rose on the second reading in the older subjects. Systolic pressures of subjects from the suburban practice and in the late autumn were relatively low; diastolic pressures tended to be lower in the spring and in subjects from the rural practice. Systolic pressures were lower in the morning and this was found to be primarily related to fasting status. Individuals with a positive family history of hypertension had significantly higher blood pressures than those with a negative history. Boys who frequently played sports had lower diastolic pressures, largely accounting for the above sex difference. We conclude that although blood pressure measurement in adolescence is a difficult screening procedure it should be offered to selected groups such as those with a family history of hypertension.

OBJECTIVE--To evaluate the relative contributions of factors acting at different stages in life to regional differences in adult blood pressure. DESIGN--Prospective cohort study (British regional heart study). SETTING--One general practice in each of 24 towns in Britain. SUBJECTS--7735 Men aged 40-59 years when screened in 1978-80 whose geographic zone of birth and zone of examination were classified as south of England, midlands and Wales, north of England, and Scotland. Non-migrants (n = 3144) were born in the town where they were examined; internal migrants (n = 4147) were born in Great Britain but not in the town where they were examined; and international migrants (n = 422) were born outside Great Britain. MAIN OUTCOME MEASURES--Systolic and diastolic blood pressures and height. RESULTS--Regardless of where they were born, men living in the south of England had lower mean blood pressures than men living in Scotland (142.5/80.1 v 148.1/85.2 mm Hg). The effects of the place of birth and place of examination on adult blood pressure were examined in a multiple regression model. For internal migrants the modelled increase in mean systolic blood pressure across adjacent zones of examination was 2.1 mm Hg (95% confidence interval 1.3 to 2.9); for adjacent zones of birth the corresponding increase was 0.1 mm Hg (-0.7 to 0.7). The place of examination seemed to be a far more important determinant of mean adult blood pressure than the place of birth. Height is an accepted marker of genetic and early life influences. Regional differences in height were therefore analysed to test whether the multiple regression model could correctly distinguish between the influence of place of birth and place of examination. As expected, men born in Scotland were shorter on average than men born in the south of England irrespective of where they lived in Britain (172.6 cm v 175.1 cm for internal migrants). CONCLUSION--Regional variations in blood pressure were strongly influenced by where the men had lived for most of their adult lives rather than by where they were born and brought up. Among middle aged men, factors acting in adult life seemed to be more important determinants of regional differences in blood pressure than those acting early in life such as genetic inheritance, intrauterine environment, and childhood experience.

An examination of the practice notes and attached correspondence of 900 patients aged 30 to 65 years in a random sample of 18 general practice in north west London showed that 340 (47%) of 716 patients consulting in a 10 year period had no blood pressure readings in their records. The blood pressure was equal to or above 160 mm Hg systolic or 95 mm Hg diastolic, or both, in 115 (31%) of those whose blood pressures were recorded; 18 (16%) of these were not followed up. Seventy four patients were being treated for hypertension. Diuretics were the most commonly prescribed drugs. Treatment was started after one blood pressure reading in 34 (46%). Nine of those who had an initial raised blood pressure reading were normotensive on follow up. A further 14 patients had subsequent raised blood pressure readings but were not treated. Sixty one (69%) of the 88 patients with hypertension did not have a blood pressure recording after diagnosis for one or more periods exceeding 12 months. Of 84 hypertensive patients with complete records, 62 (74%) apparently had had no physical examination performed by the general practitioner and 61 (72%) did not seem to have had any investigations initiated by the general practitioners. Fifteen (35%) of 43 patients taking oral contraceptive pills apparently had no blood pressure recordings during the time they were taking these. The results of this study suggest that there are still deficiencies in the detection and management of hypertension in general practice.

We investigated the management of a group of 322 hypertensive patients by 71 general practitioners in the Lothian Health Board Area by a survey of the general practitioners' records. Eighty-five per cent of patients were diagnosed by the general practitioner and 57 per cent were cared for entirely by him. Two thirds of the patients were women. Hospital referral was more common in men and in patients with high initial blood pressures. One third of patients had only one blood pressure recorded before treatment. The result of treatment as measured by the latest diastolic blood pressure was similar for patients treated by the general practitioner and those referred to hospital, being 100 mm Hg or less in 77 per cent of patients.

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Background

In an elderly, community based population we aimed at investigating antihypertensive and lipid lowering medication use in relation to own and familiar cardiovascular morbidity and diabetes mellitus, as well as to lifestyle factors and general health. We also examined levels of blood pressure in untreated and treated residents, to investigate factors correlating with blood pressure control.

Methods

A health survey carried out in 1997-9 in the county of Hordaland, Norway included a self-administered questionnaire mailed to 4 338 persons born in 1925-7. Drug use the day prior to filling in the questionnaire was reported. A health check-up was carried out, where their systolic and diastolic blood pressure (SBP and DBP), body mass index (BMI), and serum-cholesterol level were recorded.

Results

One third of respondents used one or more antihypertensive drugs, while 13% of men and women were treated with a statin. Diabetes mellitus, own or relatives'cardiovascular disease, having quit smoking, physical inactivity, and overweight correlated with antihypertensive treatment. Mean blood pressure was lower in respondents not on treatment. Among those on treatment, 38% of men and 29% of women had reached a target BP-level of lower than 140/90 mm Hg. Own cardiovascular disease and a low BMI correlated with good BP-control.

Conclusion

One third of 70–74 year old individuals living in the community used one or more antihypertensive drugs. Only around one third of those treated had reached a target BP-level of less than 140/90 mm Hg. Own cardiovascular disease and a low BMI correlated with good BP-control.

OBJECTIVE: To determine whether ambulatory blood pressure eight weeks after withdrawal of antihypertensive medication is a more sensitive measure than seated blood pressure to predict blood pressure in the long term. DESIGN: Patients with previously untreated diastolic hypertension were treated with antihypertensive drugs for one year; these were withdrawn in patients with well controlled blood pressure, who were then followed for one year. SETTING: Primary care. SUBJECTS: 29 patients fulfilling the criteria for withdrawal of antihypertensive drugs. MAIN OUTCOME MEASURES: Sensitivity, specificity, and positive and negative predictive value of seated and ambulatory blood pressure eight weeks after withdrawal of antihypertensive drugs. RESULTS: Eight weeks after withdrawal of medication, mean diastolic blood pressure returned to the pretreatment level on ambulatory measurements but not on seated measurements. One year after withdrawal of medication, mean diastolic blood pressure had returned to the pretreatment level both for seated and ambulatory blood pressure. For ambulatory blood pressure, the sensitivity and the positive predictive value eight weeks after withdrawal of medication were superior to those for seated blood pressure; specificity and negative predictive value were comparable for both types of measurement. Receiver operating characteristic curves showed that the results were not dependent on the cut off values that were used. CONCLUSION: Ambulatory blood pressure eight weeks after withdrawal of antihypertensive drugs predicts long term blood pressure better than measurements made when the patient is seated.

Aging is often associated with increased systolic blood pressure and decreased diastolic blood pressure. Isolated systolic hypertension or an elevated systolic blood pressure without an elevated diastolic blood pressure is a known risk factor for incident heart failure in older adults. In the current study, we examined whether isolated diastolic hypotension, defined as a diastolic blood pressure <60 mm Hg and a systolic blood pressure ≥100 mm Hg, is associated with incident heart failure. Of the 5795 Medicare-eligible community-dwelling adults age ≥65 years in the Cardiovascular Health Study, 5521 were free of prevalent heart failure at baseline. After excluding 145 individuals with baseline systolic blood pressure <100 mm Hg, the final sample included 5376 participants, of whom 751 (14%) had isolated diastolic hypotension. Propensity scores for isolated diastolic hypotension were calculated for each of the 5376 participants and used to match 545 and 2348 participants with and without isolated diastolic hypotension, respectively who were balanced on 58 baseline characteristics. During over 12 years of median follow-up, centrally-adjudicated incident heart failure developed in 25% and 20% of matched participants with and without isolated diastolic hypotension respectively (hazard ratio associated with isolated diastolic hypotension, 1.33; 95% confidence interval, 1.10–1.61; p=0.004). Among the 5376 pre-match individuals, multivariable-adjusted hazard ratio for incident heart failure associated with isolated diastolic hypotension was 1.29 (95% confidence interval, 1.09–1.53; p=0.003). As in isolated systolic hypertension, among community-dwelling older adults without prevalent heart failure, isolated diastolic hypotension is also a significant independent risk factor for incident heart failure.

Blood pressure measured before and after dialysis does not agree well with those recorded outside the dialysis unit. Whether recordings obtained outside the dialysis unit are of greater prognostic value than blood pressure obtained just before and after dialysis remains incompletely understood. Among 326 patients on long-term hemodialysis, blood pressure was self-measured at home for one week, over an interdialytic interval by ambulatory recording and before and after dialysis over two weeks. Over a mean follow up of 32 (SD 20) months, 102 patients died (31%) yielding a crude mortality rate of 118/1000 patient years. Systolic but not diastolic blood pressure was found to be of prognostic importance. Multivariate-adjusted and unadjusted analyses showed increasing quartiles of ambulatory and home systolic blood pressure to be associated with all-cause mortality (adjusted hazard ratios for increasing quartiles of ambulatory: 2.51, 3.43, 2.62 and for home blood pressure: 2.15, 1.7, 1.44). Mortality was lowest when home systolic BP was between 120–130 mm Hg and ambulatory systolic blood pressure was between 110–120 mmHg. Blood pressure recorded before and after dialysis were not statistically significant (p=0.17 for predialysis and p=0.997 for postdialysis) in predicting mortality. Out-of-dialysis unit blood pressure measurement provided superior prognostic information compared to BP within the dialysis unit (likelihood ratio test, p<0.05).

Conclusions

Out-of-dialysis-unit blood pressure among hemodialysis patients is prognostically more informative than that recorded just before and after dialysis. Therefore the management of hypertension among these patients should focus on blood pressure recordings outside the dialysis unit.

Shared-care blood pressure record cards were issued to 149 consecutive hypertensive patients attending our hospital clinic. In 108 (72.5 per cent), general practitioners entered readings they had obtained onto the cards. The use of the record card has proved helpful in the management of patients, and we are encouraged by the co-operation of the family doctors.

A comparison of blood pressures measured in hospital and in general practice showed that general practitioners found systolic pressures to be an average of 5.5 mm Hg lower than hospital doctors, but there were no differences in diastolic pressure. In many cases, wide discrepancies were found both in hospital and general practice. We conclude that it is a myth that patients' blood pressures are lower when they consult their family doctor, or that outpatient blood pressure readings are falsely elevated by the stress of hospital attendance.

OBJECTIVE--To determine the effect of watching a game of Scottish football on heart rate and blood pressure. DESIGN--Prospective study. SETTING--Two Scottish Premier League football grounds. SUBJECTS--10 healthy men, each a supporter of one of two clubs. MAIN OUTCOME MEASURES--Systolic and diastolic blood pressure and heart rate at home, while walking, and during the match. RESULTS--Systolic blood pressure and heart rate were significantly higher when the men were watching the match than when they were at home. While they were watching the match, heart rate was maximal immediately after a goal had been scored by the supported team. CONCLUSION--The emotional stress invoked by Scottish football is associated with significant increases in heart rate and systolic blood pressure.

Background

Lowering of blood pressure by antihypertensive drugs reduces the risks of cardiovascular events, stroke, and total mortality. However, poor adherence to antihypertensive medications reduces their effectiveness and increases the risk of adverse events. In terms of relative risk reduction, an improvement in medication adherence could be as effective as the development of a new drug.

Methods/Design

The proposed randomized controlled trial will include patients with a low adherence to medication and uncontrolled blood pressure. The intervention group will receive a multifactorial intervention during the first, third, and ninth months, to improve adherence. This intervention will include motivational interviews, pill reminders, family support, blood pressure self-recording, and simplification of the dosing regimen.

Measurement

The primary outcome is systolic blood pressure. The secondary outcomes are diastolic blood pressure, proportion of patients with adequately controlled blood pressure, and total cost.

Discussion

The trial will evaluate the impact of a multifactorial adherence intervention in routine clinical practice. Ethical approval was given by the Ethical Committee on Human Research of Balearic islands, Spain (approval number IB 969/08 PI).

Trial registration

Current controlled trials ISRCTN21229328

BACKGROUND:

Hypertension prevention and control are among the most important public health priorities. We evaluated the impacts of a workplace intervention project “Stop Hypertension in Mobarakeh Steel Company” (SHIMSCO) on controlling hypertension in industrial workers.

METHODS:

The study was carried out in Mobarakeh Steel Company in Isfahan among 7286 male workers and employees. All individuals were evaluated for the presence of hypertension (HTN). According to examinations, 500 subjects with systolic blood pressure (SBP) ≥ 140 mmHg, and/or diastolic blood pressure (DBP) ≥ 90 mmHg, and/or those using antihypertensive medications were confirmed to have HTN and thus included in this study. They were questioned for sociodemographic characteristics, past medical history and medication use. They received an educational program including healthy lifestyle and self-care recommendations of HTN management and control as well as training for accurate blood pressure measurement and home monitoring for two years. SBP, DBP, weight, height and routine lab tests were measured for all hypertensive subjects before and after the interventions. Paired t-test, generalized estimation equation (GEE) and ordinary linear regression (OLR) were used for statistical analysis in SPSS.

RESULTS:

The comparison of SBP and DBP before and after the educational program showed significant reductions in both parameters (−7.97 ± 14.72 and −2.66 ± 9.96 mmHg, respectively). However, a greater decrease was detected in case of DBP. GEE showed SBP and DBP to decrease about −0.115 and −0.054 mmHg/month. OLR also revealed reductions of 4.88 and 2.57 mmHg respectively in SBP and DBP upon adding each antihypertensive drug.

CONCLUSION:

SHIMSCO, a 3-year interventional project in workplaces, was effective in reducing SBP and DBP among hypertensive employees and workers. We conclude that implementing simple educational programs in worksites can improve the management and control of hypertension and perhaps other chronic diseases.

As part of a study of risk factors for coronary heart disease 24 hour urine collections were obtained from 7354 men and women aged 40-59 selected at random from 22 districts throughout Scotland (Scottish heart health study). The mean of two standardised measurements of blood pressure was related to the reported consumption of alcohol and measurements of height, weight, pulse rate, and electrolyte excretion. Several significant correlations were found with both systolic and diastolic pressure, but only the coefficients for age, body mass index, and pulse rate were greater than 0.1. Alcohol consumption showed a weak positive correlation with blood pressure in men. Sodium excretion showed a weak positive correlation with blood pressure in both sexes, and potassium excretion showed weak negative correlations. In multiple regression analysis age, pulse rate, body mass index, alcohol consumption, and potassium excretion had significant independent effects but sodium excretion did not. Although measuring blood pressure twice on one occasion and 24 hour urinary sodium excretion only once may have weakened any potential correlation, the most likely explantation of these results is that the relation between sodium and blood pressure in the population is weak and that potassium and alcohol are of greater importance.

Background

There is consensus on the importance of early detection and treatment of high blood pressure. Dental care is one of few medical services to which a considerable proportion of the general population comes for regular check-ups. We tested the effects of blood pressure screening in dental care centres with subsequent work-up of subjects screening positive in primary health care (PHCC).

Methods

Altogether 1,149 subjects 40-65 years old or 20-39 years old with body mass index >25, and with no previously known hypertension, who came for a dental examination had their blood pressure measured with an Omron M4® automatic blood pressure reading device. Subjects with systolic blood pressure readings above 160 mmHg or diastolic above 90 mmHg were referred to their PHCC for a check up. Outcome data were obtained by scrutiny of PHCC and hospital patient records for hypertension diagnoses during the three years following screening.

Results

237 (20.6%) subjects screened positive. Of these, 230 (97.1%) came to their PHCC within the 3-year follow-up period, as compared with 695 (76.2%) of those who screened negative (p < 0.0001). Of those who screened positive, 76 (32.1%) received a diagnosis of hypertension, as compared with 26 (2.9%) of those who screened negative. Sensitivity was 79.1%, specificity 84.8% and positive predictive value 30.1%. The number of subjects needed to screen to find one case of hypertension was 18.

Conclusions

Co-operation between dental and primary care for blood pressure screening and work-up appears to be an effective way of detecting previously unknown hypertension.

Electronic medical records (EMRS) allow for real time access to blood pressure information on a population basis and improved identification and treatment of individuals with hypertension. Despite the potential uses of the data available from EMRs relatively little research has examined the reliability of this data. To address this gap, we examined the reliability of blood pressure taken at primary care visits and recorded in an electronic medical record with those taken at a research study visit at which standard protocols were used to measure blood pressure among all adults as well as by gender and age. Systolic blood pressure (BP) averaged 3.7 (17.3) points and diastolic BP was 2.8 (10.6) points lower in the EMR than in the study visit across age and gender groups with all differences statistically significant. For this cohort of patients with a diagnosis of hypertension there was moderate correlation between BP measurements taken in clinic and at research. However BP control for individuals, as defined by a BP of less the 140 mm Hg systolic and 90 mm Hg diastolic, differed by almost 25%. Known variability of BP and clinic procedures for measuring and recording BP may account for these differences.

Aim

To asses prevalence of essential arterial hypertension in family members of soldiers killed in 1992-1995 war in Bosnia and Herzegovina.

Methods

The study enrolled 1144 subjects who lost a family member in the war and 582 of their close neighbors who experienced no such loss. Data on their medical history and habits were collected, and their blood pressure was recorded in 1996 and 2003. Arterial hypertension was defined as systolic blood pressure ≥140 mm Hg (≥130 mm Hg in patients with diabetes mellitus), or diastolic blood pressure ≥90 mm Hg (≥80 mm Hg in patients with diabetes mellitus), or taking antihypertensive therapy. Additional laboratory and clinical tests were performed in subjects with hypertension.

Results

The prevalence of hypertension at both time points was higher in the group with a killed family member than in the group without the loss (55.1% vs 42.1%, P<0.001 in 1996, and 50.7% vs 39.0%, P<0.001 in 2003, respectively). However, there was also a significant decrease in the prevalence of hypertension in the group with the loss in 2003 (P<0.001), but not in group without the loss. Posttraumatic stress disorder (PTSD), smoking, and alcohol consumption were more prevalent in the group with a killed family member, but not cholesterol and triglyceride blood concentrations. In both groups, hypertension was more prevalent in subjects with PTSD and smoking or drinking habit. Proportion of subjects with hypertension who smoked and used alcohol was similar in both groups. Proportion of subjects with hypertension who did not smoke or drink was higher in the group with the loss (51.1% vs 36.7%, P<0.001; 46.2% vs 35.0%, P = 0.006; respectively).

Conclusion

This study showed higher prevalence of hypertension in family members of killed soldiers, regardless of the presence of other cardiovascular risk factors. Only the stress of mourning was associated with higher prevalence of hypertension. Over time, proportion of hypertensive subjects with the loss decreased in the group with a killed family member, further suggesting that at least a part of their hypertension might have been of psychological origin.

Objective: To determine whether the inverse relation between blood pressure and all cause mortality in elderly people over 85 years of age can be explained by adjusting for health status, and to determine whether high blood pressure is a risk factor for mortality when the effects of poor health are accounted for.

Design: 5 to 7 year follow up of community residents aged 85 years and older.

Setting: Leiden, the Netherlands.

Subjects: 835 subjects whose blood pressure was recorded between 1987 and 1989.

Main outcome measure: All cause mortality.

Results: An inverse relation between blood pressure and all cause mortality was observed. For diastolic blood pressure crude 5 year all cause mortality decreased from 88% (52/59) (95% confidence interval 79% to 95%) in those with diastolic blood pressures <65 mm Hg to 59% (27/46) (44% to 72%) in those with diastolic pressures >100 mm Hg. For systolic blood pressure crude 5 year all cause mortality decreased from 85% (95/112) (78% to 91%) in those with systolic pressures <125 mm Hg to 59% (13/22) (38% to 78%) in those with systolic pressures >200 mm Hg. This decrease was no longer significant after adjustment for indicators of poor health. No relation existed between blood pressure and mortality from cardiovascular causes or stroke after adjustment for age and sex, but after adjustment for age, sex, and indicators of poor health there was a positive relation between diastolic blood pressure and mortality from both cardiovascular causes and stroke.

Conclusion: The inverse relation between blood pressure and all cause mortality in elderly people over 85 is associated with health status.

Key messages Among community residents aged 85 and older there was a paradoxical inverse relation between blood pressure and all cause mortality: higher blood pressure was associated with lower mortality This inverse relation seems mainly to be due to higher mortality in those with low blood pressure; low blood pressure seems to be caused by poor health There was no longer a significant relation between blood pressure and all cause mortality after adjusting for health status. However, there was a positive relation between diastolic blood pressure and mortality from both cardiovascular causes and stroke Treating hypertension does not shorten life expectancy among elderly people aged 85 and older, and it might prevent disability from stroke

Generalized osteoarthrosis was found to be significantly more common in older males with high than with low diastolic blood pressure. The excess of osteoarthrosis in those with hypertension was mainly in the hips, knees, carpometacarpal and metacarpophalangeal joints, and was independent of obesity in the hypertensive group. It was not associated with a higher cholesterol or uric acid level in the serum. Radiological evidence of avascular necrosis was present in 36% of males with osteoarthrosis of the hips and diastolic blood pressure above 100 mmHg, in 20% with a diastolic pressure of 81-100 mmHg, but was found in none of those with osteoarthrosis and blood pressure of 80 mmHg or below. Only those with osteoarthrosis and a diastolic pressure above 100 mmHg had significantly more avascular necrosis that expected. Osteoarthrosis of the knee in female was more frequent in the hypertensive groups independent of obesity. It is concluded that vascular disorders are involved in this form of generalized osteoarthrosis.

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The relationship between blood pressure, ponderal index, sex, blood glucose, haemoglobin, serum uric acid, calcium cholesterol and creatinine, and albumin has been examined in 698 subjects aged between 44 and 49 years from the register of a group general practice. Sixty per cent of the variation in systolic pressure could be explained by statistically significant associations with diastolic pressure, sex, blood glucose, serum calcium, and cholesterol. The diastolic blood pressure (not corrected for systolic pressure) was significantly related only to ponderal index, haemoglobin in men, and cholesterol in women. Pulse pressure was also positively related to the risk factors blood glucose, serum cholesterol, and calcium. The possibility is discussed that one or more of these variables reduce aortic compliance and that the serum calcium contributes to this end. Diastolic, but not systolic pressure, had a prime association with relative weight, obesity being only basically associated with an increase in diastolic pressure.

This report describes the 20-year blood pressure behaviour of 3869 selected young North American males.

Initial mean systolic and diastolic pressures were higher than those recorded five years later; after that pressures increased progressively. The effect of initial selection was evident for the first 10 years of exposure.

A significant relationship was demonstrated between all initial systolic and diastolic levels and the 20-year blood pressure behaviour. Systolic pressure was not affected by age until age 50 and diastolic until age 45. After that a significant relationship was demonstrated.

In 20 years multiple readings ≥ 140 and/or ≥ 90 mm. Hg were recorded in 26% of the population. Increases in pressure usually extended over many years. Commonly they were labile, fluctuating above and below 140/90 mm. Hg. In a small, clearly defined group, accelerated increases reached high levels in three to 10 years.

All residents in a suburban community in southern Sweden, 8 years of age and older, were invited to an ophthalmological examination. The examination included a blood pressure determination.

Of the 1917 persons invited 85·5% took part in the study. 3·5% of these were excluded because they were taking antihypertensive drugs. The investigations were conducted during 14 consecutive months and at different times of the day.

The systolic and diastolic blood pressure distribution curves exhibited a positive skewing. The blood pressures rose to a plateau with essentially unchanged pressures in the age groups 28-32 years up to 38-42 years. In these ages, the systolic blood pressure was significantly higher among the males than among the females. The relation was reversed in the age groups above 48 years. The diastolic blood pressure showed no significant sex differences in the various age groups.

A multiple linear regression analysis was used to determine whether there were diurnal and seasonal effects on the blood pressure independent of the age and sex. The systolic blood pressure during the winter months was 4·1 and 5·0 mmHg higher in the male and female subjects respectively, while the diastolic blood pressure during the winter months was 1·7 and 1·9 mmHg higher in the male and female subjects respectively. The time of day had no effect on the systolic blood pressure while the diastolic blood pressure increased by 0·24 and 0·27 mmHg/hr from 8 a.m. to 9 p.m. in the male and female subjects respectively.

It is concluded that the small genuine effects of the time of measurement of casual blood pressure lack practical importance in screening of hypertension.