| For medical practitioners and the general public - High Blood Pressure Journal Article Catalog. |
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| Lack of effect of oral magnesium on high blood pressure: a double blind study Cappuccio, F. P., N. D. Markandu, et al. (1985), Br Med J (Clin Res Ed) 291(6490): 235-8. Abstract: Seventeen unselected patients with mild to moderate essential hypertension and whose average supine blood pressure after two months' observation with no treatment was 154/100 mm Hg were entered into a double blind randomised crossover study of one month's treatment with magnesium aspartate (15 mmol magnesium/day) and treatment with placebo for a further month. This preparation of magnesium was well tolerated and did not cause diarrhoea. Despite a significant increase in plasma magnesium concentration and a significant increase in urinary excretion of magnesium while taking magnesium aspartate there was no fall in blood pressure compared with either treatment with placebo or values before treatment. The results provide no evidence for a role of dietary magnesium in the regulation of high blood pressure and are contrary to recent speculations. |
| Latest guidelines on the treatment of high blood pressure Thomson, G. E. (1985), J Natl Med Assoc 77 Suppl: 7-8. |
| Lay beliefs about high blood pressure in a low- to middle-income urban African-American community: an opportunity for improving hypertension control Wilson, R. P., A. Freeman, et al. (2002), Am J Med 112(1): 26-30. Abstract: PURPOSE: Lay beliefs about illness are a potential barrier to improving the control of hypertension. We investigated the extent to which lay beliefs about hypertension diverge from current medical understanding. METHODS: We conducted street intercept interviews and focus group discussions in six predominantly African-American census tracts in the southern sector of Dallas County, Texas. Sixty subjects, aged 18 to 67 years, were stopped along popular thoroughfares and administered a brief survey. Additionally, 107 participants were interviewed in 12 homogeneous focus groups, balanced by sex and age (18 to 74 years). Participants were asked about the meaning, causes, consequences, and treatment of high blood pressure. RESULTS: The street intercept data indicated that 35% (n = 21) of respondents related high blood pressure to eating pork or other foods that makes the blood travel too fast to the head, and only 15% (n = 9) related hypertension to an elevated pressure in blood vessels. The focus group data indicated that hypertension was causally linked to eating pork in 8 of the 12 groups; was perceived as a symptomatic illness in all 12 groups; and was considered treatable with vitamins, garlic, and other herbs in 11 groups, with prescription medications in 10 groups and with lifestyle modifications such as weight loss in 8 groups. Hypertension was mentioned as a leading cause of death among African Americans in none of the 4 focus groups of 18-year-old to 29-year-old participants, in 2 of the 4 focus groups of 30-year-old to 49-year-old participants, and in 3 of the 4 focus groups of 50-year-old to 74-year-old participants. CONCLUSIONS: In a low- to middle-income urban African-American community, the predominant beliefs about hypertension diverged sharply from current medical understanding. Lack of appreciation of these lay beliefs by providers may contribute to noncompliance and poor rates of hypertension control. |
| Learned control of blood pressure in patients with high blood pressure Kristt, D. A. and B. T. Engel (1975), Circulation 51(2): 370-8. Abstract: Five patients with documented histories of essential hypertension of at least ten years' duration participated in a triphasic study of training to control systolic blood pressure (SBP). Phase 1 was a seven week period during which patients took their BP (systolic and diastolic) at home and mailed these data to us daily. Phase 2 was a three week period during which patients were taught to control SBP using a noninvasive technique: patients were trained to raise, to lower and to alternately lower and raise SBP. Phase 3 was a three month period during which patients again took their BP at home and mailed these data to us daily. Results: (1) all patients learned SBP control: average increas 15%; average decrease 11%; (2) during SBP control heart rates, breathing rates, triceps brachii muscle tension and EEG activity did not change; (3) follow-up tests at one and three months showed evidence of retained SBP control; (4) baseline SBP fell from 153 mm Hg during laboratory training to 135 mm Hg at the three month follow-up; (5) phase 3 home BPs fell 18/8 mm Hg from phase 1 levels; (6) at home patients also were able to reduce SBP from 141 mm Hg (average) to 125 mm Hg (average) by means of the lowering technique learned in the laboratory. |
| Left high R wave amplitude and blood pressure levels before and after 5 minutes' rest in a mass screening program Kasagi, F., H. Horibe, et al. (1990), Nippon Koshu Eisei Zasshi 37(6): 413-7. Abstract: In order to evaluate the implication of blood pressures measured without 5 minutes' rest in mass screening programs, blood pressures were measured before and after 5 minutes' rest on 820 subjects in a rural community, aged 35 to 65 years and not receiving hypertensive treatment. Although the systolic blood pressure showed a significant drop of an average of 3 mmHg among males and 4 mmHg among females after rest, 23.3% of 820 subjects had higher systolic blood pressure reading after rest than before. The relationship between left high R (LHR) in electrocardiograms and blood pressure (BP) before and after rest was studied. The presence of LHR was significantly related to BP both before and after rest among males, but more strongly associated to BP before rest. The relationship of the difference between BP before and after rest to the prevalence of LHR was analyzed by multiple logistic method. A significantly higher prevalence of LHR with greater difference between systolic BP before and after rest was observed among males, even with age and systolic BP level after rest taken into account. These findings suggest the potential significance of blood pressure readings before 5 minutes' rest which may be a response to mental stress of having the initial blood pressure reading taken by the observer. It would seem worthy to obtain blood pressure before rest as well as after rest in detecting blood pressure abnormalities. |
| Left ventricular diastolic function in young men with high normal blood pressure Escudero, E., S. De Lena, et al. (1996), Can J Cardiol 12(10): 959-64. Abstract: OBJECTIVE: Abnormalities in left ventricular (LV) diastolic filling have been reported in hypertensive patients. This study was designed to compare LV diastolic filling between individuals with high normal blood pressure (HNBP) and optimal blood pressure (OBP). SUBJECTS AND DESIGN: From a survey of 219 young male individuals (age 21 +/- 0.1 years), two groups were selected according to their BP (group A: systolic BP SBP 120 mmHg and diastolic BP DBP 80 mmHg, n = 23 and group B: SBP 130 to 139 mmHg and/or DBP 85 to 89 mmHg, n = 21). Subjects habits, anthropometric characteristics, LV structure and systolic and diastolic function were compared. RESULTS: No differences were detected between the two groups in habits, systolic function or early diastole. LV mass index (LVMI) was higher in group B (103.6 +/- 4.58 g/m2 versus 90.49 +/- 3.27 g/m2 in group A, P < 0.05), though the values were not high enough to indicate LV hypertrophy. The pattern of LV late filling was different between the two groups. The peak late diastolic flow velocity (A) was 0.45 +/- 0.02 m/s in group B and 0.52 +/- 0.03 m/s in group A (P < 0.05). The early peak velocity (E):A ratio was 1.82 +/- 0.08 in group A and 1.59 +/- 0.08 in group B (P < 0.05). The early filling fraction also demonstrated a significant shift to more prominent late diastolic filling in group B (0.68 +/- 0.01% versus 0.73 +/- 0.01% in group A, P < 0.05). This pattern in LV filling did not correlate to inheritance, age, sex, heart rate, habits or body mass index. CONCLUSIONS: This shift in filling pattern to a late flow in young men with HNBP seemed to be an early indicator of an increased dependence of LV filling on atrial contraction and may reflect an impairment in LV relaxation. |
| Left ventricular diastolic function of children in high blood pressure tracking group Harada, Y., C. Mori, et al. (1990), Acta Paediatr Jpn 32(5): 530-9. Abstract: The purpose of this study was to determine whether left ventricular (LV) diastolic function in children with high blood pressure (BP) is abnormal. We measured the corrected LV isovolumic relaxation time (IRT), peak velocity of increase in LV dimension (dD/dt) and the LV muscle volume in a high systolic BP tracking group (10 boys and 22 girls) and a low BP tracking group (22 boys and 11 girls) at 3-year intervals from the ages of 6 to 15. The corrected IRT of the high BP tracking group was significantly longer than the low BP tracking group. Left ventricular dD/dt/D of the high BP tracking group was significantly lower than the low BP tracking group from the ages of 12 in boys and 9 in girls. The left ventricular muscle volume index of both groups, however, was not significantly different. Both corrected IRT and dD/dt/D were well correlated with diastolic BP. These data suggest that children in the high BP tracking group might have LV diastolic abnormalities from age 12 or 15, in contrast to children of the low BP tracking group, without increased LV muscle volume. Therefore, it might be useful to examine BP and LV function of children from ages 12 or 15 for prevention of hypertension. |
| Left ventricular hypertrophy in elderly hypertensive patients: a report from the European Working Party on High Blood Pressure in the Elderly trial Van Hoof, R. (1991), Am J Med 90(3A): 55S-59S. Abstract: In a double-blind, placebo-controlled trial, 840 elderly hypertensive patients were randomly assigned to treatment with a combination of hydrochlorothiazide and triamterene or placebo; methyldopa or matching placebo was added to the treatment regimen if blood pressures remained high. After adjustment for age, gender, and body mass index, initial electrocardiographic (ECG) voltage measures of RaVL and SV1 + RV5 were significantly related to systolic blood pressure; RaVL was also related to diastolic blood pressure. After one year of treatment, the decrease in RaVL and SV1 + RV5 in the treated patients, adjusted for age and body mass index, were not correlated with the changes in systolic blood pressure, but the decreases in SV1 + RV5 were positively related to the decrease in diastolic blood pressure. After four years of treatment, the decreases in RaVL and SV1 + RV5 were significantly and positively related to the decrease in systolic blood pressure after adjustment for age and changes in body mass index. In a four-year cohort of 222 patients, most of the decreases in ECG voltages in the treated patients and the increases in the placebo patients were found to have occurred during the first year of treatment. The type of treatment (diuretics alone or diuretics plus methyldopa) did not affect ECG voltages during the first year of follow-up. Total and cardiovascular mortality were related to initial amplitude of RaVL, but the significant correlation disappeared after adjustment for age. |
| Lessons from the real world about patients with high blood pressure Dorsey, J. L. (1979), Am J Public Health 69(1): 11-3. |
| Lessons taught by experimental high blood pressure research Weiner, H. (1976), Psychosom Med 38(5): 297-9. |
| Letter: High blood-pressure and cancer Needham, C. D. (1975), Lancet 1(7922): 1424-5. |
| Letter: High blood-pressure and cancer? Gillis, G. R., D. Hole, et al. (1975), Lancet 2(7935): 612. |
| Letter: National high blood pressure month Ward, G. W. (1975), Am J Hosp Pharm 32(11): 1094. |
| Letter: Obesity and high blood pressure Jones, J. (1974), Cent Afr J Med 20(9): 197. |
| Letter: On high blood pressure Berman, C. L., M. A. Guarino, et al. (1974), J Am Dent Assoc 88(6): 1242. |
| Letter: Urges action by dentist on high blood pressure Berman, C. L. (1975), J Am Dent Assoc 90(5): 907. |
| Level of blood sugar in rabbits investigated under atmospheric pressure and high pressure after acute carbon monoxide intoxication Damm, K. H., T. Gerhardt, et al. (1972), Arch Toxikol 29(2): 159-70. |
| Licorice-induced high blood pressure Astrup, A. V. (2001), Ugeskr Laeger 163(51): 7284-5. |
| Life styles and blood pressure: the protective effect of apple-eating habits on high blood pressure in a high-salt population Sasaki, N. (1990), Nippon Eiseigaku Zasshi 45(5): 954-63. Abstract: Prospective epidemiological studies of blood pressure in a high-salt population in northeastern Japan were investigated along with dietary habits such as miso soup, rice, apple, fish, milk and sake consumption as well as smoking habits. Blood pressures of the populations in 3 villages were determined once or twice a year by mass surveys from 1954, 1957 or 1958 through 1975. The means and transitions of the personal blood pressure were calculated by regression analysis of the data obtained during each entire period. The number of persons was 1127 males and 1369 females and the response rate was 98.7 percent. The average number of times of determination of blood pressure for a person was 12.9. Stepwise multiple regression analyses were run with the means and transitions of systolic and diastolic blood pressure as the dependent variables and the life styles of the population in 1958 as an independent variable based on data of persons whose blood pressures were determined 5 or more times during the entire period. According to the backward stepwise method this study confirmed the positive relationship of age and sake drinking and the negative relationship of apple eating habits to blood pressure. |
| Lifestyle approaches to managing high blood pressure. New Canadian guidelines Petrella, R. J. (1999), Can Fam Physician 45: 1750-5, 1760-5. |
| Lifestyle modification as a means to prevent and treat high blood pressure Appel, L. J. (2003), J Am Soc Nephrol 14(7 Suppl 2): S99-S102. Abstract: High BP is one of the most important and common risk factors for atherosclerotic cardiovascular disease and renal disease. The contemporary approach to the epidemic of elevated BP and its complications involves pharmacologic treatment of hypertensive individuals and "lifestyle modification," which is beneficial for both nonhypertensive and hypertensive persons. A substantial body of evidence strongly supports the concept that lifestyle modification can have powerful effects on BP. Increased physical activity, a reduced salt intake, weight loss, moderation of alcohol intake, increased potassium intake, and an overall healthy dietary pattern, termed the Dietary Approaches to Stop Hypertension (DASH) diet, effectively lower BP. The DASH diet emphasizes fruits, vegetables, and low-fat dairy products and is reduced in fat and cholesterol. Other dietary factors, such as a greater intake of protein or monounsaturated fatty acids, may also reduce BP but available evidence is inconsistent. The current challenge to health care providers, researchers, government officials, and the general public is developing and implementing effective clinical and public health strategies that lead to sustained lifestyle modification. |
| Lifestyle modifications to prevent and control hypertension. 1. Methods and an overview of the Canadian recommendations. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada Campbell, N. R., E. Burgess, et al. (1999), Cmaj 160(9 Suppl): S1-6. Abstract: OBJECTIVE: To provide updated, evidence-based recommendations for health care professionals on lifestyle changes to prevent and control hypertension in otherwise healthy adults (except pregnant women). OPTIONS: For people at risk for hypertension, there are a number of lifestyle options that may avert the condition--maintaining a healthy body weight, moderating consumption of alcohol, exercising, reducing sodium intake, altering intake of calcium, magnesium and potassium, and reducing stress. Following these options will maintain or reduce the risk of hypertension. For people who already have hypertension, the options for controlling the condition are lifestyle modification, antihypertensive medications or a combination of these options; with no treatment, these people remain at risk for the complications of hypertension. OUTCOMES: The health outcomes considered were changes in blood pressure and in morbidity and mortality rates. Because of insufficient evidence, no economic outcomes were considered. EVIDENCE: A MEDLINE search was conducted for the period January 1996 to September 1996 for each of the interventions studied. Reference lists were scanned, experts were polled, and the personal files of the authors were used to identify other studies. All relevant articles were reviewed, classified according to study design and graded according to level of evidence. VALUES: A high value was placed on the avoidance of cardiovascular morbidity and premature death caused by untreated hypertension. BENEFITS, HARMS AND COSTS: Lifestyle modification by means of weight loss (or maintenance of healthy body weight), regular exercise and low alcohol consumption will reduce the blood pressure of appropriately selected normotensive and hypertensive people. Sodium restriction and stress management will reduce the blood pressure of appropriately selected hypertensive patients. The side effects of these therapies are few, and the indirect benefits are well known. There are certainly costs associated with lifestyle modification, but they were not measured in the studies reviewed. Supplementing the diet with potassium, calcium and magnesium has not been associated with a clinically important reduction in blood pressure in people consuming a healthy diet. RECOMMENDATIONS: (1) It is recommended that health care professionals determine the body mass index (weight in kilograms/height in metres2) and alcohol consumption of all adult patients and assess sodium consumption and stress levels in all hypertensive patients. (2) To reduce blood pressure in the population at large, it is recommended that Canadians attain and maintain a healthy body mass index. For those who choose to drink alcohol intake should be limited to 2 or fewer standard drinks per day (maximum of 14/week for men and 9/week for women). Adults should exercise regularly. (3) To reduce blood pressure in hypertensive patients, individualized therapy is recommended. This therapy should emphasize weight loss for overweight patients, abstinence from or moderation in alcohol intake, regular exercise, restriction of sodium intake and, in appropriate circumstances, individualized cognitive behaviour modification to reduce the negative effects of stress. VALIDATION: The recommendations were reviewed by all of the sponsoring organizations and by participants in a satellite symposium of the fourth international Conference on Preventive Cardiology. They are similar to those of the World Hypertension League and the Joint National committee, with the exception of the recommendations on stress management, which are based on new information. They have not been clinically tested. SPONSORS: The Canadian Hypertension Society, the Canadian Coalition for High Blood Pressure Prevention and Control, the Laboratory Centre for Disease Control at health Canada, and the Heart and Stroke Foundation of Canada. |
| Lifestyle modifications to prevent and control hypertension. 2. Recommendations on obesity and weight loss. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada Leiter, L. A., D. Abbott, et al. (1999), Cmaj 160(9 Suppl): S7-12. Abstract: OBJECTIVE: To provide updated, evidence-based recommendations concerning the effects of weight loss and maintenance of healthy weight on the prevention and control of hypertension in otherwise healthy adults (except pregnant women). OPTIONS: The main options are to attain and maintain a healthy body weight (body mass index BMI 20-25 kg/m2) or not to do so. For those at risk for hypertension, weight loss and maintenance of healthy weight may prevent the condition. For those who have hypertension, weight loss and maintenance of healthy weight may reduce or obviate the need for antihypertensive medications. OUTCOMES: The health outcome considered was change in blood pressure. Because of insufficient evidence, no economic outcomes were considered. EVIDENCE: A MEDLINE search was conducted for the years 1992-1996 with the terms hypertension and obesity in combination and antihypertensive therapy and obesity in combination. Other relevant evidence was obtained from the reference lists of the articles identified, from the personal files of the authors and through contacts with experts. The articles were reviewed, classified according to study design and graded according to level of evidence. VALUES: A high value was placed on the avoidance of cardiovascular morbidity and premature death caused by untreated hypertension. BENEFITS, HARMS AND COSTS: Weight loss and the maintenance of healthy body weight reduces the blood pressure of both hypertensive and normotensive people. The indirect benefits of a health body weight are well known. The negative effects of weight loss are primarily the frustrations associated with attaining and maintaining a healthy weight. The costs associated with weight loss programs were not measured in the studies reviewed. RECOMMENDATIONS: (1) It is recommended that health care professionals determine weight (in kilograms), height (in metres) and BMI for all adults. (2) To reduce blood pressure in the population at large, it is recommended that Canadians attain and maintain a healthy BMI (20-25). (3) All overweight hypertensive patients (BMI greater than 25) should be advised to reduce their weight. VALIDATION: These recommendations are similar to those of the World Hypertension League, the National High Blood Pressure Education Program Working Group on Primary Prevention of Hypertension, the Canadian Hypertension Society and the Canadian Coalition for High Blood Pressure Prevention and Control. They have not been clinically tested. SPONSORS: The Canadian Hypertension Society, the Canadian Coalition for High Blood Pressure Prevention and Control, the Laboratory Centre for Disease Control at Health Canada, and the Heart and Stroke Foundation of Canada. |
| Lifestyle modifications to prevent and control hypertension. 3. Recommendations on alcohol consumption. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada Campbell, N. R., M. J. Ashley, et al. (1999), Cmaj 160(9 Suppl): S13-20. Abstract: OBJECTIVE: To provide updated, evidence-based recommendations concerning the effects of alcohol consumption on the prevention and control of hypertension in otherwise healthy adults (except pregnant women). OPTIONS: There are 2 main options for those at risk for hypertension: avert the condition by limiting alcohol consumption or by using other nonpharmacologic methods, or maintain or increase the risk of hypertension by making no change in alcohol consumption. The options for those who already have hypertension include decreasing alcohol consumption or using another nonpharmacologic method to reduce hypertension; commencing, continuing or intensifying antihypertensive medication; or taking no action and remaining at increased risk of cardiovascular disease. OUTCOMES: The health outcomes considered were changes in blood pressure and in morbidity and mortality rates. Because of insufficient evidence, no economic outcomes were considered. EVIDENCE: A MEDLINE search was conducted for the period 1966-1996 with the terms ethyl alcohol and hypertension. Other relevant evidence was obtained from the reference lists of articles identified, from the personal files of the authors and through contacts with experts. The articles were reviewed, classified according to study design, and graded according to the level of evidence. VALUES: A high value was placed on the avoidance of cardiovascular morbidity and premature death caused by untreated hypertension. BENEFITS, HARMS AND COSTS: A reduction in alcohol consumption from more than 2 standard drinks per day reduces the blood pressure of both hypertensive and normotensive people. The lowest overall mortality rates in observational studies were associated with drinking habits that were within these guidelines. Side effects and costs were not measured in any of the studies. RECOMMENDATIONS: (1) It is recommended that health care professionals determine how much alcohol their patients consume. (2) To reduce blood pressure in the population at large, it is recommended that alcohol consumption be in accordance with Canadian low-risk drinking guidelines (i.e., healthy adults who choose to drink should limit alcohol consumption to 2 or fewer standard drinks per day, with consumption not exceeding 14 standard drinks per week for men and 9 standard drinks per week for women). (3) Hypertensive patients should also be advised to limit alcohol consumption to the levels set out in the Canadian low-risk drinking guidelines. VALIDATION: These recommendations are similar to those of the World Hypertension League, the National High Blood Pressure Education Program Working Group on Primary Prevention of Hypertension and the previous recommendations of the Canadian Coalition for High Blood Pressure Prevention and Control and the Canadian Hypertension Society. They have not been clinically tested. The low-risk drinking guidelines are those of the Addiction Research Foundation of Ontario and the Canadian Centre on Substance Abuse. SPONSORS: The Canadian Hypertension Society, the Canadian Coalition for High Blood Pressure Prevention and Control, the Laboratory Centre for Disease Control at Health Canada, and the Heart and Stroke Foundation of Canada. The low-risk drinking guidelines have been endorsed by the College of Family Physicians of Canada and several provincial organizations. |
| Lifestyle modifications to prevent and control hypertension. 4. Recommendations on physical exercise training. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada Cleroux, J., R. D. Feldman, et al. (1999), Cmaj 160(9 Suppl): S21-8. Abstract: OBJECTIVE: To provide updated, evidence-based recommendations for health care professionals concerning the effects of regular physical activity on the prevention and control of hypertension in otherwise healthy adults. OPTIONS: People may engage in no, sporadic or regular physical activity that may be of low, moderate or vigorous intensity. For sedentary people with hypertension, the options are to undertake or maintain regular physical activity and to avoid or moderate medication use; to use another lifestyle modification technique; to commence or continue antihypertensive medication; or to take no action and remain at increased risk of cardiovascular disease. OUTCOMES: The health outcomes considered were changes in blood pressure and in morbidity and mortality rates. Because of insufficient evidence, no economic outcomes were considered. EVIDENCE: A MEDLINE search was conducted for the period 1966-1997 with the terms exercise, exertion, physical activity, hypertension and blood pressure. Both reports of trials and review articles were obtained. Other relevant evidence was obtained from the reference lists of these articles, from the personal files of the authors and through contacts with experts. The articles were reviewed, classified according to study design and graded according to level of evidence. VALUES: A high value was placed on avoidance of cardiovascular morbidity and premature death caused by untreated hypertension. BENEFITS, HARMS AND COSTS: Physical activity of moderate intensity involving rhythmic movements with the lower limbs for 50-60 minutes, 3 or 4 times per week, reduces blood pressure and appears to be more effective than vigorous exercise. Harm is uncommon and is generally restricted to the musculoskeletal injuries that may occur with any repetitive activity. Injury occurs more often with jogging than with walking, cycling or swimming. The costs include the costs of appropriate shoes, garments and equipment, but these were not specifically measured. RECOMMENDATIONS: (1) People with mild hypertension should engage in 50-60 minutes of moderate rhythmic exercise of the lower limbs, such as brisk walking or cycling, 3 or 4 times per week to reduce blood pressure, (2) Exercise should be prescribed as an adjunctive therapy for people who require pharmacologic therapy for hypertension, especially those who are not receiving beta-blockers. (3) People who do not have hypertension should participate in regular exercise as it will decrease blood pressure and reduce the risk of coronary artery disease, although there is no direct evidence that it will prevent hypertension. VALIDATION: These recommendations agree with those of the World Hypertension League, the American College of Sports Medicine, the report of the US Surgeon General on physical activity and health, and the US National Institutes of Health Consensus Development Panel on Physical Activity and Cardiovascular Health. These guidelines have not been clinically tested. SPONSORS: The Canadian Hypertension Society, the Canadian Coalition for High Blood Pressure Prevention and Control, the Laboratory Centre for Disease Control at Health Canada, and the Heart and Stroke Foundation of Canada. |
| Lifestyle modifications to prevent and control hypertension. 5. Recommendations on dietary salt. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada Fodor, J. G., B. Whitmore, et al. (1999), Cmaj 160(9 Suppl): S29-34. Abstract: OBJECTIVE: To provide updated, evidence-based recommendations concerning the effects of dietary salt intake on the prevention and control of hypertension in adults (except pregnant women). The guidelines are intended for use in clinical practice and public education campaigns. OPTIONS: Restriction of dietary salt intake may be an alternative to antihypertensive medications or may supplement such medications. Other options include other nonpharmacologic treatments for hypertension and no treatment. OUTCOMES: The health outcomes considered were changes in blood pressure and in morbidity and mortality rates. Because of insufficient evidence, no economic outcomes were considered. EVIDENCE: A MEDLINE search was conducted for the period 1966-1996 using the terms hypertension, blood pressure, vascular resistance, sodium chloride, sodium, diet, sodium or sodium chloride dietary, sodium restricted/reducing diet, clinical trials, controlled clinical trial, randomized controlled trial and random allocation. Both trials and review articles were obtained, and other relevant evidence was obtained from the reference lists of the articles identified, from the personal files of the authors and through contacts with experts. The articles were reviewed, classified according to study design and graded according to level of evidence. In addition, a systematic review of all published randomized controlled trials relating to dietary salt intake and hypertension was conducted. VALUES: A high value was placed on the avoidance of cardiovascular morbidity and premature death caused by untreated hypertension. BENEFITS, HARMS AND COSTS: For normotensive people, a marked change in sodium intake is required to achieve a modest reduction in blood pressure (there is a decrease of 1 mm Hg in systolic blood pressure for every 100 mmol decrease in daily sodium intake). For hypertensive patients, the effects of dietary salt restriction are most pronounced if age is greater than 44 years. A decrease of 6.3 mm Hg in systolic blood pressure and 2.2 mm Hg in diastolic blood pressure per 100 mmol decrease in daily sodium intake was observed in people of this age group. For hypertensive patients 44 years of age and younger, the decreases were 2.4 mm Hg for systolic blood pressure and negligible for diastolic blood pressure. A diet in which salt is moderately restricted appears not to be associated with health risks. RECOMMENDATIONS: (1) Restriction of salt intake for the normotensive population is not recommended at present, because of insufficient evidence demonstrating that this would lead to a reduced incidence of hypertension. (2) To avoid excessive intake of salt, people should be counselled to choose foods low in salt (e.g., fresh fruits and vegetables), to avoid foods high in salt (e.g., pre-prepared foods), to refrain from adding salt at the table and minimize the amount of salt used in cooking, and to increase awareness of the salt content of food choices in restaurants. (3) For hypertensive patients, particularly those over the age of 44 years, it is recommended that the intake of dietary sodium be moderately restricted, to a target range of 90-130 mmol per day (which corresponds to 3-7 g of salt per day). (4) The salt consumption of hypertensive patients should be determined by interview. VALIDATION: These recommendations were reviewed by all of the sponsoring organizations and by participants in a satellite symposium of the fourth International Conference on Preventive Cardiology. They have not been clinically tested. SPONSORS: The Canadian Hypertension Society, the Canadian Coalition for High Blood Pressure Prevention and Control, the Laboratory Centre for Disease Control at Health Canada, and the Heart and Stroke Foundation of Canada. |
| Lifestyle modifications to prevent and control hypertension. 6. Recommendations on potassium, magnesium and calcium. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada Burgess, E., R. Lewanczuk, et al. (1999), Cmaj 160(9 Suppl): S35-45. Abstract: OBJECTIVE: To provide updated, evidence-based recommendations on the consumption, through diet, and supplementation of the cations potassium, magnesium and calcium for the prevention and treatment of hypertension in otherwise healthy adults (except pregnant women). OPTIONS: Dietary supplementation with cations has been suggested as an alternative or adjunctive therapy to antihypertensive medications. Other options include other nonpharmacologic treatments for hypertension. OUTCOMES: The health outcomes considered were changes in blood pressure and in morbidity and mortality rates. Because of insufficient evidence, no economic outcomes were considered. EVIDENCE: A MEDLINE search was conducted for the period 1966-1996 with the terms hypertension and potassium, magnesium and calcium. Reports of trials, meta-analyses and review articles were obtained. Other relevant evidence was obtained from the reference lists of articles identified, from the personal files of the authors and through contacts with experts. The articles were reviewed, classified according to study design, and graded according to the level of evidence. VALUES: A high value was placed on the avoidance of cardiovascular morbidity and premature death caused by untreated hypertension. BENEFITS, HARMS AND COSTS: The weight of the evidence from randomized controlled trials indicates that increasing intake of or supplementing the diet with potassium, magnesium or calcium is not associated with prevention of hypertension, nor is it effective in reducing high blood pressure. Potassium supplementation may be effective in reducing blood pressure in patients with hypokalemia during diuretic therapy. RECOMMENDATIONS: For the prevention of hypertension, the following recommendations are made: (1) The daily dietary intake of potassium should be 60 mmol or more, because this level of intake has been associated with a reduced risk of stroke-related mortality. (2) For normotensive people obtaining on average 60 mmol of potassium daily through dietary intake, potassium supplementation is not recommended as a means of preventing an increase in blood pressure. (3) For normotensive people, magnesium supplementation is not recommended as a means of preventing an increase in blood pressure. (4) For normotensive people, calcium supplementation above the recommended daily intake is not recommended as a means of preventing an increase in blood pressure. For the treatment of hypertension, the following recommendations are made. (5) Potassium supplementation above the recommended daily dietary intake of 60 mmol is not recommended as a treatment for hypertension. (6) Magnesium supplementation is not recommended as a treatment for hypertension. (7) Calcium supplementation above the recommended daily dietary intake is not recommended as a treatment for hypertension. VALIDATION: These guidelines are consistent with the results of meta-analyses and recommendations made by other organizations. They have not been clinically tested. SPONSORS: The Canadian Hypertension Society, the Canadian Coalition for High Blood Pressure Prevention and Control, the Laboratory Centre for Disease Control at Health Canada, and the Heart and Stroke Foundation of Canada. |
| Lifestyle modifications to prevent and control hypertension. 7. Recommendations on stress management. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada Spence, J. D., P. A. Barnett, et al. (1999), Cmaj 160(9 Suppl): S46-50. Abstract: OBJECTIVE: To provide updated evidence-based recommendations for health care professionals concerning the effects of stress management on the prevention and control of hypertension in otherwise healthy adults (except pregnant women). OPTIONS: Alternatives to stress management include other nonpharmacologic interventions and medical therapy; these options are not mutually exclusive. OUTCOMES: The health outcome considered was reduction of blood pressure. There is little evidence to date that stress management prevents death or vascular events. Because of insufficient evidence, no economic outcomes were considered. EVIDENCE: A systematic search of the literature (which yielded, among other sources, 3 meta-analyses) was conducted for the period 1966-1997 with the terms essential hypertension, treatment, psychological, behavioural, cognitive, relaxation, mediation, biofeedback and stress management. Other relevant evidence was obtained from the reference lists of the articles identified, from the personal files of the authors and through contacts with experts. The articles were reviewed, classified according to study design and graded according to level of evidence. VALUES: A high value was placed on the avoidance of cardiovascular morbidity and premature death caused by uncontrolled hypertension. BENEFITS, HARMS AND COSTS: The magnitude of the reduction in blood pressure obtained with multicomponent, individualized cognitive behavioural intervention for stress management was comparable in some studies to that obtained with weight loss or drugs; single-component interventions such as biofeedback or relaxation were less effective. The adverse effects of stress-management techniques are minimal, but the cost for effective interventions is substantial, similar initially to drug costs; continuing costs are probably minimal. RECOMMENDATIONS: (1) In patients with hypertension, the contribution of stress should be considered. (2) For hypertensive patients in whom stress appears to be an important issue, stress management should be considered as an intervention. Individualized cognitive behavioural interventions are more likely to be effective than single-component interventions. VALIDATION: These recommendations were reviewed by all of the sponsoring organizations and by participants in a satellite symposium of the fourth International Conference on Preventive Cardiology. They have not been clinically tested. SPONSORS: The Canadian Hypertension Society, the Canadian Coalition for High Blood Pressure Prevention and Control, the Laboratory Centre for Disease Control at Health Canada, and the Heart and Stroke Foundation of Canada. |
| Little effect of ordinary antihypertensive therapy on nocturnal high blood pressure in patients with sleep disordered breathing Pelttari, L. H., E. K. Hietanen, et al. (1998), Am J Hypertens 11(3 Pt 1): 272-9. Abstract: The antihypertensive effects of four different antihypertensive medications (beta-blocking agent, atenolol 50 mg; calcium-antagonist, isradipine SRO slow release 2.5 mg; diuretic, hydrochlorothiazide HCTZ 25 mg; and angiotension converting enzyme-inhibitor, spirapril 6 mg) on obese patients with sleep disordered breathing and hypertension were compared by the ambulatory blood pressure measurement (ABPM). Eighteen patients were randomized in a double-blind, crossover fashion to receive each of the four different medications for 8 weeks. ABPM was performed at baseline and after an 8-week treatment with these medications. A 2- to 3-week washout period occurred both at baseline and between each of the four medications. Three patients were omitted from statistical analysis because of technical problems of ABPM. Atenolol, isradipine SRO, and spirapril decreased significantly (P <.01) the mean 24-h systolic blood pressure, whereas HCTZ did not. The mean 24-h diastolic blood pressure decreased significantly after all four medications: 12 (SD+/-14) mm Hg with atenolol, 7 (SD+/-10) mm Hg with isradipine SRO, 3 mm Hg (SD+/-14) with HCTZ, and 6 (SD+/-15) mm Hg with spirapril (P <.01). During nighttime none of the medications reduced the mean diastolic or systolic blood pressure significantly. According to the 24-h blood pressure curve the influence of these four medications during the whole measurement period was not similar. Atenolol and spirapril lost their antihypertensive effect during the early morning hours. The antihypertensive effect of HCTZ varied markedly from hour to hour. The trough-to-peak ratio of no medication was >0.50. Negative correlation was observed between the apnea time and the mean systolic 24-h (r = -0.604, P = NS) and the mean systolic nocturnal blood pressure change (r = -0.590, P = NS). Our study revealed that the daytime high blood pressure was quite easily controlled by the ordinary monotherapy in these patients with partial upper airway obstruction and hypertension. Instead none of the medications used decreased nocturnal high blood pressure markedly. |
| Living with high blood pressure van Wissen, K., M. Litchfield, et al. (1998), J Adv Nurs 27(3): 567-74. Abstract: This study was undertaken to explore the experience of people taking long-term antihypertensive medication. The study contributes to the understanding health professionals have of people with high blood pressure and the antihypertensive treatments they receive. Consideration was given to the full life context of people taking long-term antihypertensive medication and the health/medical culture in which people find themselves. A qualitative method of inquiry generated the descriptive data. Nineteen participants (four men and 15 women) were interviewed once, of which 16 were interviewed a second time. Data analysis involved extraction of concepts which in turn were clustered into themes. An organizing framework was constructed to integrate the six themes and 18 sub-themes. The framework represents the individual's experience as a sequence, starting broadly in the social context of her/his life, and narrowing down to the particulars of personal routine and patterns referring to living with hypertension and it's medication regimens. The final theme refers to the broader context of the health culture. A vast range of experiences were described by participants taking long-term antihypertensive medication. This accentuates the necessity for health professionals to address the uniqueness of the individual, and consider the context of a person's life when prescribing and monitoring medications for people with high blood pressure. |
| Localization of cytoplasmic collagen mRNA in human aortic coarctation: mRNA enhancement in high blood pressure-induced intimal and medial thickening Jaeger, E., S. Rust, et al. (1990), J Histochem Cytochem 38(9): 1365-75. Abstract: Enhanced synthesis and deposition of extracellular matrix components, including collagen, contribute significantly to arteriosclerotic changes in the arterial vessel wall. We localized cells actively synthesizing collagen by hybridizing 35S-labeled RNA probes complementary to type I and III collagen mRNA with cytoplasmic mRNA in frozen sections of surgically removed aortic coarctations. These were chosen as a model for comparing mRNA levels in areas of high blood pressure-induced wall thickening and in unaffected post-stenotic areas. In situ hybridization revealed increased expression of type I and III collagen mRNA in intimal cells and in cells adjacent to the medial-adventitial border in the pre-stenotic part of the coarctation. In contrast, cells of the post-stenotic area showed only a very low signal. No immunohistologically detectable macrophages were seen in the pre-stenotic subendothelial areas where mRNA levels were enhanced. Higher collagen mRNA levels therefore occur in particular regions of high blood pressure-induced arterial wall thickening in the absence of macrophages. The results suggest that in situ hybridization is suitable for detection of locally occurring transcriptional activation of cells for collagens in the vessel wall. |
| Long term dialysis and high blood pressure Blumberg, A. (1972), Ther Umsch 29(6): 346-8. |
| Long term effects of guar gum on metabolic control, serum cholesterol and blood pressure levels in type 2 (non-insulin-dependent) diabetic patients with high blood pressure Uusitupa, M., J. Tuomilehto, et al. (1984), Ann Clin Res 16 Suppl 43: 126-31. Abstract: A double-blind, placebo-controlled trial was carried out in 17 Type 2 (non-insulin-dependent) diabetic patients, treated with diet therapy alone to study the effects of guar gum on metabolic control, serum lipids, and blood pressure levels. Thirteen of the patients had drug treatment for hypertension. Guar gum was taken with meals three times a day, and the dose was gradually increased to 21 g per day. A slight, but not significant improvement was found in the metabolic control of the patients after the guar gum treatment compared to the placebo. Serum total cholesterol was 11% (p greater than 0.01) lower after the guar gum but no significant differences were found in HDL-cholesterol or serum triglycerides during the guar gum treatment compared to the placebo. Diastolic blood pressure level was significantly lower during the guar gum treatment compared to placebo. No difference was observed in systolic blood pressure levels between the guar gum and placebo treatments. The reduction of diastolic blood pressure was independent of changes in fasting blood glucose level or body weight, but could in part be due to simultaneous reduction in serum cholesterol concentration. The changes associated with guar gum supplementation suggest a reduction in the risk for cardiovascular complications in diabetic patients. |
| Longitudinal study of blood pressure: changes and determinants from adolescence to middle age. The Dormont High School follow-up study, 1957-1963 to 1989-1990 Yong, L. C., L. H. Kuller, et al. (1993), Am J Epidemiol 138(11): 973-83. Abstract: The changes and determinants of blood pressure were examined in the Dormont High School (Pittsburgh, Pennsylvania) cohort of 86 men and 116 women with mean ages of 17 years during high school (1957-1963), 34 years at follow-up I (1977-1978), and 47 years at current follow-up II (1989-1990). Over the 30-year period, the subjects' mean systolic blood pressure changed relatively little, whereas the increase in mean diastolic blood pressure was significantly higher in men than in women (p < 0.01). Based on the criteria of diastolic blood pressure > or = 90 mmHg, and/or current use of antihypertensive medication, 18% developed hypertension. Compared with nonhypertensives, hypertensives had significantly higher baseline systolic blood pressure (p < 0.001); higher weight at all ages (p < 0.05); and gained more weight over the period (p < 0.01). By means of multivariate analyses, it was found that baseline systolic blood pressure, current weight, and weight gain were significantly and independently associated with current systolic blood pressure level and hypertension. These data indicate that initial systolic blood pressure level at adolescence, current weight, and weight gain are important determinants of risk of high blood pressure, and there is a further suggestion of sex and age differences in the critical period of risk. |
| Long-term control of blood pressure by rilmenidine in high-risk populations Pillion, G., B. Fevrier, et al. (1994), Am J Cardiol 74(13): 58A-65A. Abstract: Efficacy and acceptability of rilmenidine in populations with high cardiovascular risk has been established in short- or mid-term studies (1.5-6 months) enrolling relatively small numbers of patients. The present open study was undertaken to compare, on a larger scale, the efficacy and acceptability of a 12-month rilmenidine treatment in high-risk outpatients versus the results obtained in the general population and to check for unexpected adverse events. A total of 2,635 hypertensive patients (supine diastolic blood pressure SDBP > 90 mm Hg) were enrolled, including a high-risk population with 1,591 patients aged > 60 (60.3%), 1,007 patients with dyslipidemia (38.2%), 393 with diabetes (14.9%), 328 with chronic renal failure (12.4%), 301 with angina pectoris (11.4%), and 84 with chronic heart failure (3.2%). All patients were treated by rilmenidine 1 mg/day during the first 6 weeks; then (at 1.5 months), if SDBP was > 90 mm Hg, dosage of rilmenidine was 1 mg twice daily during the following 6 weeks. From month 3 to month 12, any other antihypertensive drugs could be added if SDBP remained > 90 mm Hg. In comparison with the general population, the percentage of high-risk patients whose monotherapy normalized blood pressure (SDBP < or = 90 mm Hg) was slightly lower at month 1.5 (58-66%, according to the risk group, vs 68% in the general population) and month 3 (73-82% vs 85%). At month 12, all treatments taken as a whole (monotherapy and combination therapy) led to the normalization of blood pressure in 94% of patients in the general population and in populations at risk.(ABSTRACT TRUNCATED AT 250 WORDS) |
| Long-term effects of cessation of smoking on body weight, blood pressure and serum cholesterol in the middle-aged population with high blood pressure Tuomilehto, J., A. Nissinen, et al. (1986), Addict Behav 11(1): 1-9. Abstract: Smoking habits are continuously changing in the population. Cessation of smoking is not only often difficult but may lead to undesired consequences, esp. to weight gain. A random sample of 2283 persons with mild hypertension was followed up for 5 years in Eastern Finland and examined at the community-based cardiovascular program. During that time 30% of those smoking initially stopped smoking. Men gained weight on the average 3.6 kg upon stopping smoking (p less than 0.001) after controlling for age, change in fat and sugar intake and change in physical activity at leisure time). In women cessation of smoking was not related to weight changes. There was no evidence in this follow-up that smoking or cessation of smoking would have any independent impact on blood pressure or serum total cholesterol level. |
| Long-term evaluation of group education for high blood pressure control Wyka-Fitzgerald, C., P. Levesque, et al. (1984), Cardiovasc Nurs 20(3): 13-8. |
| Long-term observations on high blood-pressure presenting in fit young men Stewart, I. M. (1971), Lancet 1(7695): 355-8. |
| Losartan versus gene therapy: chronic control of high blood pressure in spontaneously hypertensive rats Lu, D., M. K. Raizada, et al. (1997), Hypertension 30(3 Pt 1): 363-70. Abstract: Interruption of the renin-angiotensin system by pharmacological manipulations attenuates high blood pressure (BP) in the spontaneously hypertensive rat (SHR). However, these agents, such as losartan, need to be administered daily to maintain effective BP control. Therefore, we have hypothesized that a genetic intervention in the expression of angiotensin type 1 receptor (AT1R) should attenuate development of hypertension on a long-term basis in SHR. A retroviral-mediated AT1R antisense cDNA gene delivery system (LNSV-AT1R-AS) was used to test this hypothesis and to compare its BP-lowering effects with those of losartan. Introduction of LNSV-AT1R-AS into 5-day-old Wistar-Kyoto rats and SHR resulted in a robust expression of AT1R antisense (AS) within 3 days and persisted for at least 30 days. This expression was associated with a selective attenuation of high BP in SHR by 25 to 30 mm Hg. Although basal lowering of BP was exclusive to SHR, the angiotensin II (Ang II) pressor response was significantly reduced in all LNSV-AT1R-AS-treated rats. The decreased response to Ang II was associated with a similar attenuation of Ang II-induced dipsogenic responses in both strains of rats. The BP-lowering effects of LNSV-AT1R-AS treatment and losartan treatment were similar and primarily observed in SHR. However, the antihypertensive effect lasted less than 24 hours in losartan-treated SHR compared with 90 days in LNSV-AT1R-AS-treated SHR. In addition, losartan was unable to further lower BP in LNSV-AT1R-AS-treated SHR. Collectively, these results suggest that both losartan and LNSV-AT1R-AS treatment produces an antihypertensive response selectively in SHR that is mediated by interruption of AT1R function. However, a single, acute genetic treatment with LNSV-AT1R-AS can result in long-term control of high BP at a similar level of effectiveness as losartan, without altering plasma Ang II levels. |
| Loss of diurnal rhythms of blood pressure and heart rate caused by high-fat feeding Carroll, J. F., J. J. Thaden, et al. (2005), Am J Hypertens 18(10): 1320-6. Abstract: BACKGROUND: Diet-induced obesity using ad libitum high-fat feeding in rabbits causes losses in diurnal rhythms of blood pressure (BP) and heart rate (HR). Because obesity is associated with hypertension, it is difficult to determine independent effects of ad libitum feeding and obesity in altering diurnal rhythms. We studied diurnal rhythms of BP and HR after controlling BP during obesity development using hydralazine. METHODS: New Zealand white rabbits were divided into lean control (LC), lean hydralazine-treated (LH), obese control (OC), and obese hydralazine-treated (OH) groups. Lean animals consumed a maintenance diet, whereas obese animals consumed an ad libitum high-fat diet. Over 12 weeks, BP and HR were monitored from 11:00 to 07:00 using telemetry. Hydralazine treatment consisted of 6 mg/kg/day and 10 to 14 mg/kg/day for LH and OH, respectively. Diurnal rhythms were evaluated using day-night values (day, 11:00 to 16:00 average; night, 02:00 to 07:00 average). RESULTS: Compared with control values, diurnal HR rhythm was abolished on day 1 of high-fat feeding (61.4 +/- 3.6 v 3.1 +/- 4.2 beats/min, respectively; P |