| For medical practitioners and the general public - High Blood Pressure Journal Article Catalog. |
|
|
|
|
||
|
|
||
|
|
| First Page | Previous Page | Next Page | Last Page |
| Partners for two decades: AOA and the National High Blood Pressure Education Program Nickey, W. A. and C. Lenfant (1998), J Am Osteopath Assoc 98(3): 153-4. |
| Partnership caring: a theory of high blood pressure control in Iranian hypertensives Mohammadi, E., H. A. Abedi, et al. (2002), Int J Nurs Pract 8(6): 324-9. Abstract: This study uses grounded theory methodology to generate a substantive theory that describes and explains the problem of high blood pressure control among Iranian patients. High blood pressure control is a major world health problem on which many studies have been carried out. Most of these studies have been done by quantitative research methods. The main purpose of this qualitative research was to determine the essential structure of high blood pressure control in an Iranian hypertensive population and to identify a theoretical explanation for this problem. Four interrelated concepts: 'non-compliance', 'lack of knowledge', 'lack of effective caring relationship', and 'necessity of partnership' were identified. Based on these processes, a partnership care theory was developed that provides an appropriate context for the active participation of patients, nurses and physicians in the control of hypertensive disease. This theory can be utilized in the control of hypertension as well as other chronic diseases. |
| Pathogenesis of essential hypertension. A link between dietary salt and high blood pressure Blaustein, M. P. and J. M. Hamlyn (1991), Hypertension 18(5 Suppl): III184-95. |
| Pathogenetic interpretation of the acute pulmonary edema of high blood pressure. Galata, G. (1950), Policlinico Prat 57(25): 809-12. |
| Pathophysiological conditions progressing from impaired glucose tolerance: high blood pressure Katayama, S. (2005), Nippon Rinsho 63 Suppl 2: 242-5. |
| Patient behaviors that promote high blood pressure control McKenney, J. M. and J. Mara (1980), Contemp Pharm Pract 3(4): 233-8. Abstract: The most important issue in hypertension control currently is treatment maintenance. This is important to the pharmacist since he or she may have the most patient contact. The decision to adhere to a drug regimen ultimately must be made by the patient. The patient must make the decision to control blood pressure, take the medication as prescribed, monitor his or her progress toward blood pressure control, and resolve the problems that block blood pressure control. The pharmacist can supply information about high blood pressure and emphasize the need for continuing treatment. |
| Patient-reported adherence to guidelines of the Sixth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure Cheng, J. W., M. M. Kalis, et al. (2001), Pharmacotherapy 21(7): 828-41. Abstract: OBJECTIVES: To compare antihypertensive drug compliance with treatment guidelines established by the Sixth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI), and to identify patient adherence to antihypertensive drugs and factors affecting prescribing patterns. METHODS: Patients filling antihypertensive drug prescriptions in metropolitan New York area pharmacies were enrolled. Pharmacy externs collected patient-reported demographics, medical and drug histories, and blood pressure measurements. Compliance with JNC VI guidelines was assessed. RESULTS: Eight hundred twenty-one patients from 102 pharmacies participated. Blood pressure was controlled in 61% of patients at the time of the study. The most prescribed class of antihypertensive agents was angiotensin-converting enzyme inhibitors, followed by diuretics and beta-blockers. Over the study period, compliance with JNC VI guidelines decreased significantly from 85% to 64% (p<0.05). Thirty-seven percent of patients reported consistent adherence to their antihypertensive regimens. Patients' education level was the only factor found to correlate positively with the appropriateness of antihypertensive agents prescribed. CONCLUSION: Compliance with JNC VI guidelines decreased over time, and patient adherence to drug therapy was suboptimal. Continuing-education efforts to reinforce optimal blood pressure management are necessary. |
| Patients' views of high blood pressure, its treatment and risks Taylor, C. and A. Ward (2003), Aust Fam Physician 32(4): 278-82. Abstract: OBJECTIVE: To examine the understanding and beliefs of a sample of Australian patients about high blood pressure and its therapy, and to examine the accuracy of their assessment of their own risk. METHOD: A cross sectional study in two general practices in Perth, Western Australia. Interviews were conducted with 55 consecutive patients aged 40-80 years of age with uncomplicated hypertension. Qualitative and quantitative data were collected on patients' beliefs about the nature, symptoms, causes and treatment of high blood pressure as well as their adherence to antihypertensive medications during the preceding month. Patients also estimated their own risk of stroke or myocardial infarction. RESULTS: Two-thirds of the patients (65%) described high blood pressure within an appropriate biomedical definition. Forty-five percent attributed a variety of symptoms to their high blood pressure while 55% believed that stress was a cause of their high blood pressure. Three-quarters (73%) were fully adherent to their medications in the preceding month. Seventy-one percent and 62% of patients were aware that stroke and heart attack respectively are possible consequences of high blood pressure. They significantly overestimated their risk of stroke and myocardial infarction. CONCLUSION: One-third of treated hypertensive patients are poorly informed about the causes and effects of hypertension, and overestimate their risk of both stroke and heart attack, as well as the benefit derived from treatment. |
| Patients with high blood pressure Hauteville, A., F. Manoukian, et al. (1980), Inf Dent 62(34): 3009-13. |
| Pattern of blood pressure among high and low altitude residents of southern Arabia Roca-Cusachs, A. (1995), J Hum Hypertens 9(4): 293. |
| Pempidine and other drugs in the treatment of high blood pressure Milne, M. D. (1959), Practitioner 182(1089): 366-73. |
| Periventricular white matter lucencies in patients with lacunar stroke. A marker of too high or too low blood pressure? Chamorro, A., J. Pujol, et al. (1997), Arch Neurol 54(10): 1284-8. Abstract: BACKGROUND: Periventricular white matter lucencies (PWML) have been described in stroke patients with arterial hypertension, hypotensive episodes, or increased nocturnal fall of blood pressure (BP). As a result of these mixed factors, the relationship between PWML and BP remains unsettled and the appropriate management of arterial BP in stroke patients with PWML is unknown. OBJECTIVE: To clarify the relationship between PWML, arterial BP, and cerebral hemodynamics. DESIGN: Cohort study followed up 6 months after index stroke. SETTING: Referral center. PATIENTS: In 41 consecutive patients with first-ever lacunar infarction, the extent of PWML detected on brain magnetic resonance images was measured. Six months after stroke, BP values were monitored during a 24-hour period and transcranial Doppler examinations were performed at rest and following the administration of acetazolamide. MAIN OUTCOME MEASURES: Correlation of cerebral hemodynamics and BP values with the extent of PWML. RESULTS: The severity of PWML varied substantially among patients, suggesting that PWML and lacunar infarctions could be due to several different mechanisms. Older age, elevated awake systolic BP, increased cerebrovascular tone, and the interaction between history of heart disease and the lowest heart rate were the strongest independent predictors of the severity of PWML. Diastolic BP and the vasodilatory capacity of the resistance vessels did not predict the severity of PWML. CONCLUSIONS: Overall, PWML are markers of systolic damage in older lacunar stroke patients with stiffer arteries. In addition, hemodynamic failure may be relevant in patients with concomitant heart disease. |
| Persistence of abnormally high vascular tone in vessels of the finger after digital nerve block in patients with chronic high blood pressure Gaskell, P. and A. Diosy (1959), Circ Res 7: 1006-10. |
| Persistence of high diastolic blood pressure in thin children. The Bogalusa Heart Study Burke, G. L., D. S. Freedman, et al. (1986), Hypertension 8(1): 24-9. Abstract: Relationships between initial anthropometric variables and subsequent diastolic blood pressure (fourth phase) were examined in children identified as being in the upper quintile for diastolic blood pressure at Year 1. Of 156 white children, aged 10 to 14 years, with diastolic blood pressure levels in the upper age-race-sex-specific quintile at Year 1, 38% remained in the upper quintile at Year 4. However, there was a definite trend for leaner children, defined by ponderosity (weight/height3) to remain in the highest diastolic blood pressure quintile (p less than 0.001). Of white children originally identified in the highest quintile for diastolic blood pressure and the lowest quintile for ponderosity (lean group), 67% (18 of 27) remained in the upper quintile at Year 4. In contrast, only 21% (11 of 52) of white children identified as being in the highest quintile for both diastolic blood pressure and ponderosity (obese group) at Year 1 were in the upper diastolic blood pressure quintile at Year 4. Similar results were seen in children examined 5 years later. Pearson correlation coefficients and linear regression analyses confirmed the negative relationship between initial ponderosity and subsequent diastolic blood pressure, especially in older children. A similar relationship was noted in black children. Potential differences in the etiological process of obesity-related and non-obesity-related high blood pressure were examined. These observations indicate that characteristics other than obesity can contribute to high blood pressure in late childhood. |
| Persistence of high leucocyte sodium and blood pressure after pre-eclampsia Forrester, T. E., G. A. Grell, et al. (1990), J Hum Hypertens 4(1): 25-30. Abstract: Blood pressure and leucocyte sodium content were measured in black Jamaican patients with pre-eclampsia and pregnant controls. Similar measurements were made in a group of mothers who had pre-eclampsia 36-38 weeks previously and their controls. An increase in cell sodium accompanied the high blood pressure in patients with pre-eclampsia. There was also some elevation of both blood pressure and cell sodium in patients who had had pre-eclampsia 36-38 weeks previously. These findings suggest that disturbances of cellular electrolytes continue into the post-partum period. Changes in intracellular sodium may be important in the pathogenesis of pre-eclampsia as they parallel the increase in blood pressure levels. |
| Persistent high job demands and reactivity to mental stress predict future ambulatory blood pressure Steptoe, A. and M. Cropley (2000), J Hypertens 18(5): 581-6. Abstract: OBJECTIVE: To test the hypothesis that work stress (persistent high job demands over 1 year) in combination with high reactivity to mental stress predict ambulatory blood pressure. DESIGN: Assessment of cardiovascular responses to standardized behavioural tasks, job demands, and ambulatory blood pressure over a working day and evening after 12 months. PARTICIPANTS: We studied 81 school teachers (26 men, 55 women), 36 of whom experienced persistent high job demands over 1 year, while 45 reported lower job demands. METHODS: Participants were divided on the basis of high and low job demands, and high and low systolic pressure reactions to an uncontrollable stress task. Blood pressure and concurrent physical activity were monitored using ambulatory apparatus from 0900 to 2230 h on a working day. RESULTS: Cardiovascular stress reactivity was associated with waist/hip ratio. Systolic and diastolic pressure during the working day were greater in high job demand participants who were stress reactive than in other groups, after adjustment for age, baseline blood pressure, body mass index and negative affectivity. The difference was not accounted for by variations in physical activity. CONCLUSIONS: Cardiovascular stress reactivity and sustained psychosocial stress may act in concert to increase cardiovascular risk in susceptible individuals. |
| Persons in the United States with high blood pressure Mann, G. V. (1988), Am J Prev Med 4(1): 60. |
| Phagocytic capacity of a leukocyte concentrate from donor blood preserved under high pressure and a temperature lower than 0 degrees C Pavlenko, R. A., B. M. Zel'manovich, et al. (1988), Gematol Transfuziol 33(7): 16-8. |
| Pheochromocytoma in childhood and its relation to high blood pressure. Seelemann, K. (1950), Z Kinderheilkd 68(2-3): 191-208. |
| Planning for community high blood pressure control Gima, A. S., C. J. Mundt, et al. (1981), Fam Community Health 4(1): 85-96. |
| Plasma catecholamines determination using high pressure liquid chromatography and their roles in blood pressure regulation and experimental hypertension in rats Nishimura, T., I. Nishio, et al. (1979), Jpn Circ J 43(9): 855-65. Abstract: Plasma catecholamine levels have been used experiemtally and clinically as the indices of the sympathetic nerve activity. We measured plasma catecholamines using high pressure liquid chromatography in rats to assess the significance of plasma catecholamines as an index of the sympathetic nerve activity and its role in hypertension. Pentobarbital anesthesia depressed plasma catecholamine levels, especially plasma adrenaline. Sodium loading for 5 weeks suppressed plasma noradrenaline, while administration of furosemide (1 mg/kg) produced the elevation of plasma noradrenaline. Experimental hypertension, one-kidney and two-kidney types of Goldblatt hypertension and DOCA-salt hypertension, raised plasma noradrenalines both in acute and chronic phases. The infusion of pressor doses of angiotensin II suppressed plasma noradrenaline by the reflex mechanism. Sar1, Ile8-angiotensin II and SQ 14,225 did not suppress plasma cathecholamine elevation due to hemorrhage. L-Hydroxyldopamine produced elevation of plasma catecholamines in experimental nypertension and controls in rats. After adrenal demedullation, plasma noradrenaline was decreased by the administration of 6-hydroxy-dopamine. Acute reduction of circulating blood volume and blood pressure fall produced the elevation of plasma catecholamine, especially plasma adrenaline. In rats, the adrenal medulla plays an important role in the regulation of blood pressure. |
| Plasma expansion in surgical patients with high central venous pressure (CVP); the relationship of blood volume to hematocrit, CVP, pulmonary wedge pressure, and cardiorespiratory changes Baek, S. M., G. G. Makabali, et al. (1975), Surgery 78(3): 304-15. Abstract: There was no correlation of blood volume measurements with central venous pressure (CVP) or hematocrit determinations and only minimal suggestive trends with wedge pressure in a large series of postoperative patients; the lack of correlations emphasize the unreliability of venous pressure and hematocrit determinations to predict blood volume alterations. To evaluate the physiological problems, to define optimal therapeutic goals, and to measure therapeutic effectiveness of volume loading with an oncotically active agent, we measured the hemodynamic and oxygen transport responses to 500 ml. of 5 percent albumin given over 1 hour in 22 patients with CVP greater than 15 cm. H2O. The patients were separated into two groups according to the CVP response to volume therapy. The CVP decreased in 14 (64 percent) of these patients (Group 1), but it increased slightly but not significantly in eight (36 percent) patients (Group 2). In Group 1 patients, there was increased flow, improvement of tissue perfusion as reflected by increased oxygen consumption, and augmentation of the ventricular function. In Group 2 there were slight increases in mean flow, mean pulmonary arterial pressure, and mean transit time and slightly decreased pulmonary vascular resistance; there was appreciable improvement in left ventricular function without significant deterioration of right ventricular function. The high initial central venous pressure is not a reliable index of either hypervolemia or cardiac failure in critically ill patients. It is concluded that a trial of volume loading with an oncotically active agent with frequent auscultation of the chest and careful observation of the CVP trends will give the maximum diagnostic as well as therapeutic information. |
| Plasma renin activity, aldosterone and sodium excretion in women with high and low casual blood pressure levels Thulin, T., B. E. Karlberg, et al. (1978), Acta Med Scand 203(5): 405-10. |
| Platelet aggregation in young men with contrasting predisposition to high blood pressure Dockrell, M. E., B. R. Walker, et al. (1999), Am J Hypertens 12(2 Pt 1): 115-9. Abstract: In essential hypertension, abnormal platelet function may induce vasospasm and predispose to thrombotic vascular occlusion. We studied in vitro aggregability in platelets from young men with contrasting predisposition to hypertension, defined by their own blood pressure and blood pressures of their parents. Among offspring of parents with low blood pressure, higher blood pressure was associated with impaired aggregation in response to epinephrine (2 x 10(-8) to 5 x 10(-6) mol/L), which was unaffected by endothelin-1 (10(-9) mol/L). By contrast, among offspring of parents with high blood pressure, higher blood pressure was associated with normal aggregation to epinephrine and potentiation of the primary phase of aggregation by endothelin-1. We conclude that enhanced platelet sensitivity to endothelin-1 appears to be a feature of the familial predisposition to hypertension, rather than a nonspecific consequence of high blood pressure. |
| Platelet and haemorheological markers in 'high risk' hypertensives are improved by tighter blood pressure control and cardiovascular risk management: a substudy of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) Spencer, C. G., D. Gurney, et al. (2004), J Intern Med 255(1): 59-67. Abstract: OBJECTIVE: To investigate the impact of intensified cardiovascular risk management on soluble markers of platelet, endothelial and rheological function in a population of middle-aged hypertensive patients at high risk of cardiovascular complications. DESIGN: Prospective follow-up study. SUBJECTS AND METHODS: A total of 159 hypertensive patients 138 male, mean age 64 (+/-8) years and 80 healthy controls were studied. Plasma levels of soluble P-selectin (sP-sel, a marker of platelet function), von Willebrand factor (vWF, an index of endothelial damage/dysfunction) and rheological indices fibrinogen (Fib), plasma viscosity (PV), haematocrit (HCT), white blood count (WBC) and platelet count were measured at baseline and again (in the patients) after 6 months' treatment. RESULTS: As expected, 6 months of intensified cardiovascular risk management resulted in a significant fall in mean blood pressure (BP) and total cholesterol. It also resulted in reduced haematocrit, vWF, sP-sel, WBC and PV levels (all P < 0.001), but not plasma fibrinogen. There were no correlations between the fall in BP and the improvement in any of the research indices. CONCLUSIONS: Intensified cardiovascular risk management results in significant improvements in indices of endothelial, platelet and rheological function in a population of hypertensives at high risk of cardiovascular events. These improvements appear to be independent of the degree of change in BP. Given the fundamental role of interactions between the endothelium and circulating blood components in the pathogenesis of hypertensive complications this may be of importance in preventing adverse cardiovascular outcomes. |
| Polymorphism of the angiotensin I converting enzyme gene is apparently not related to high blood pressure: Dutch Hypertension and Offspring Study Schmidt, S., I. M. van Hooft, et al. (1993), J Hypertens 11(4): 345-8. Abstract: OBJECTIVE: Studies in genetically hypertensive rats and their normotensive Wistar-Kyoto control rats have revealed a linkage of a chromosomal region containing the angiotensin converting enzyme (ACE) gene with blood pressure. This led to the hypothesis that ACE is a possible candidate gene for primary hypertension in humans. We defined the genotypes and allele frequencies of an insertion-deletion (I/D) polymorphism in parental couples who both had either high or low blood pressure and in their offspring. SUBJECTS: Parents (n = 111) and offspring (n = 75) with defined blood pressure status from the Dutch Hypertension and Offspring Study. METHODS: Genomic DNA was amplified by polymerase chain reaction using primers flanking the polymorphic region in intron 16 of the ACE gene. Alleles were detected on agarose gels stained with ethidium bromide. RESULTS: Allele frequencies for the D-allele were similar in parents with high (0.66) and low blood pressure (0.59) and in their offspring (0.67 and 0.69, respectively). A similar lack of difference was found with respect to the complementary I-allele. CONCLUSIONS: In the present rather large sample we failed to find a significant association between I/D polymorphism of the ACE gene and blood pressure status in subjects with high or low blood pressure and in their offspring. |
| Possibilities in organized associated work for control of high blood pressure Georgievski, N. (1975), Nar Zdrav 31(7-8): 208. |
| Possible role of vascular oscillatory activity in the development of high blood pressure in spontaneously hypertensive rats Mulvany, M. J. (1988), J Cardiovasc Pharmacol 12 Suppl 6: S16-20. Abstract: Many investigators have shown that vascular smooth muscle from hypertensive individuals shows oscillatory activity, i.e., spontaneous or rhythmic contractions. This paper reviews work performed in the author's laboratory designed to determine if the oscillatory activity of mesenteric resistance vessels taken from spontaneously hypertensive rats (SHR) is associated with the cause of the high blood pressure in these animals, as well as to determine the mechanism producing the oscillatory activity. Cross-breeding of SHR and normotensive control Wistar-Kyoto rats (WKY) was used to produce F2-SHR/WKY rats. In the F2-SHR/WKY rats, there was a correlation between systolic blood pressure and mesenteric resistance vessel oscillatory activity, but no correlation between systolic blood pressure and mesenteric resistance vessel calcium sensitivity. The oscillatory activity appeared to be associated with changes in membrane potential and is inhibited by inhibitors of potential-dependent calcium channels. This is consistent with reports from other laboratories that the oscillatory activity could be associated with an interaction between potential-dependent calcium channels and calcium-dependent potassium channels. The results suggest that the increased oscillatory activity of the mesenteric resistance vessels of the SHR is associated with a cause of high blood pressure in these animals and may be due to an abnormal activity of the calcium-dependent potassium channels. |
| Potassium in preventing and treating high blood pressure Whelton, P. K. and J. He (1999), Semin Nephrol 19(5): 494-9. Abstract: Our objective was to assess the effects of supplementation with oral potassium on blood pressure (BP) in humans, using pooled analysis of randomized, controlled trials. Results from 33 randomized, controlled trials (2,609 participants) in which potassium supplementation was the only difference between the intervention and control conditions were used. Information on sample size, duration, study design, potassium dose, participant characteristics, and treatment results was independently obtained by the authors using a standardized protocol. The findings from each trial were pooled after weighting the results for individual studies by the inverse of its variance. Using a random-effects model, potassium supplementation was associated with a significant reduction in mean (95% confidence interval) systolic and diastolic BP of -4.44 (range, -2.53 to -6.36) and -2.45 (range, -0.74 to -4.16) mm Hg, respectively. After exclusion of a trial with extreme results, potassium supplementation was still associated with a significant reduction in mean (95% confidence interval) systolic and diastolic BP of -3.11 (range, -1.91 to -4.31) and -1.97 (range, -0.52 to -3.42) mm Hg, respectively. The BP effects of potassium administration appeared to be enhanced in studies where participants were concurrently exposed to a high intake of sodium. Increased potassium intake should be included as a recommendation for prevention and treatment of hypertension, especially in those who are unable to reduce their intake of sodium. |
| Potential of carotid enlargement as a useful indicator affected by high blood pressure in a large general population of a Japanese city: the Suita study Mannami, T., S. Baba, et al. (2000), Stroke 31(12): 2958-65. Abstract: BACKGROUND AND PURPOSE: Few studies have examined whether there is a relationship between carotid arterial diameter and cardiovascular risk factors in a large general population. The aim of this study was to investigate cross-sectionally whether, in a randomly selected general large population of a Japanese city, there is a relationship between common carotid artery (CCA) diameter and conventional cardiovascular risk factors. METHODS: The subjects of the present study were randomly selected from the residents of the city of Suita, located in the second largest urban area of Japan, and consisted of 2284 men and 2568 women aged 30 to 89 years. The outer and inner CCA diameters and intima-media thickness (IMT) of CCA were detected and measured by a single physician with high-resolution ultrasonography. We assessed cross-sectionally by age/sex group the relationships between IMT or CCA diameters and cardiovascular risk factors, especially blood pressure levels divided into 3 groups: the normal group of subjects had a diastolic blood pressure (DBP) <85 mm Hg and systolic blood pressure (SBP) <130 mm Hg and were not taking antihypertensive medication; the high group of subjects had DBP >/=90 mm Hg and/or SBP >/=140 mm Hg and/or were taking antihypertensive medication; and the moderate group consisted of all other subjects. RESULTS: The outer and inner CCA diameters for the high group were significantly (P:<0.05) enlarged in comparison with those for the moderate and normal groups in all age/sex groups of both sexes after adjustment for body mass index, pack-years of smoking, alcohol consumption, and total serum cholesterol. Multiple regression analysis showed that age, body mass index, SBP, pack-years of smoking, alcohol consumption, and IMT were positively and significantly (P:<0.005) related to both outer and inner CCA diameters in both sexes except for between alcohol consumption and outer CCA diameter in women and showed that only serum total cholesterol level was negatively and significantly (P:<0.01) related to inner CCA diameter in both sexes. CONCLUSIONS: Our present study showed that the outer and inner CCA diameters correlated with conventional cardiovascular risk factors, including high blood pressure and IMT. These findings suggest that the outer and inner CCA diameters may be a useful indicator of carotid atherosclerosis, particularly in relation to high blood pressure. |
| Practicability Of Use Of Triamterene In The Treatment Of High Blood Pressure. Rathsach, P. and T. Hilden (1964), Ugeskr Laeger 126: 296-8. |
| Practical details of the methonium treatment of high blood pressure Smirk, F. H. (1950), N Z Med J 49(274): 637-43. |
| Practical surgery in nephrogenous high blood pressure Heberer, G. (1967), Verh Dtsch Ges Kreislaufforsch 33: 73-84. |
| Practical therapeutic possibilities in high blood pressure, based on its pathogenesis. Riehle, E. and H. Speth (1951), Hippokrates 22(10): 271-6. |
| Prazosin in the treatment of high blood pressure Simon, J., O. Topolcan, et al. (1977), Vnitr Lek 23(3): 276-86. |
| Predicting high blood pressure in pregnancy: a multivariate approach Broughton Pipkin, F., J. Sharif, et al. (1998), J Hypertens 16(2): 221-9. Abstract: OBJECTIVE: To identify predictors of pregnancy-induced hypertension and pre-eclampsia in 212 nulliparous women before 20 weeks' gestation and at approximately 28 weeks' gestation. STUDY DESIGN: A randomized, prospective study in a teaching hospital. We performed standardized measurements of systolic and diastolic arterial blood pressures, body mass index, urinary calcium:creatinine ratio and components of the renin-angiotensin system, including platelet angiotensin II binding site density. Attending clinicians were blinded to the results. Outcome was assessed by one observer at the end of pregnancy. Discriminant function analysis was used to identify significant predictors. RESULTS: Fifty-five women had transient, presumed 'white-coat', systolic hypertension at the time of first pregnancy visit; they were twice as likely to develop pregnancy-induced hypertension and pre-eclampsia and five times more likely to deliver prematurely. Body mass index, platelet angiotensin II binding site density and urinary calcium:creatinine ratio measured before 20 weeks gestation were also significant predictors. At 28 weeks of pregnancy, measurements of the blood pressure were significant predictors (reflecting the near clinical expression of the disease), together with the plasma angiotensinogen concentration. CONCLUSIONS: A single systolic blood pressure reading of 140 mmHg or more before 20 weeks' gestation indicates a higher than normal risk of pregnancy-induced hypertension and pre-eclampsia and premature delivery. Discriminator biochemical variables were also identified at this time, which might allow the more rational use of prophylactic measures. |
| Prediction of high blood pressure in young people: the limited usefulness of parental blood pressure data Watt, G. C., C. J. Foy, et al. (1991), J Hypertens 9(1): 55-8. Abstract: Blood pressure was measured in 864 young people aged 16-24 years, 8 years after both of their parents had their blood pressures measured as part of the screening phase of the Medical Research Council Mild Hypertension Trial. Only 29% of offspring with a conventional 'family history of hypertension', defined in terms of having at least one parent with a score in the top 10% of the distribution, had a blood pressure score in the top 20% after 8 years. The positive predictive value was increased to 38% in offspring with two parents in the top 20%, but only 4% of offspring met this definition and only 7% of offspring in the top 20% after 8 years were identified by this method. Sensitivity was increased to 46% in offspring with at least one parent in the top 20%, but 33% of offspring met this definition and 74% of them did not have a blood pressure level in the top 20% after 8 years. It is concluded that parental blood pressure data are of limited value for the prediction of high blood pressure in young people and provide no scientific basis for a high risk strategy of prevention. |
| Prediction of stable high blood pressure in adolescents Torok, E., I. Gyarfas, et al. (1986), Clin Exp Hypertens A 8(4-5): 547-55. Abstract: We studied the relative importance of the initial BP and associated factors in adolescents to predict stable high BP. Out of 17,634 children aged 12-13 yrs an upper group/the upper 5% of the distribution curves for both SBP and DBP/a lower group/10% random from the remainder/were yearly followed for 4 yrs/boys: 1680, girls: 1643/. About 2/3 of children remained at the same percentile point: less than 30% and greater than or equal to 70% of SBP and half of them of DBP distribution. Significant positive tracking correlations were found both for SBP and DBP between the initial BP and follow-up BP readings in the same individual. Stepwise regression analysis showed that the SBP taken at the fourth follow-up can be explained by 29% in boys, 24% in girls on the basis of screening SBP and by 47% in boys, 42% in girls on the basis of SBP measured at the four previous examinations. Using discriminant analysis, 6-9 variables out of 18 studied could correctly allocate adolescents with stable SBP or DBP/less than 70% or greater than or equal to 70% at least 3 examinations/. Our study shows the importance of initial BP and a number of factors associated with stable high BP. |
| Predictors of ambulatory blood pressure: identification of high-risk adolescents Meininger, J. C., P. Liehr, et al. (1998), ANS Adv Nurs Sci 20(3): 50-64. Abstract: Within a life span perspective on prevention, adolescence was conceptualized as a pivotal transition in the evolution of risk for hypertension and other cardiovascular morbidity. Resting blood pressure (BP), BP reactivity, and 24-hour ambulatory BP were measured in a multiethnic sample of 41 male and female adolescents aged 15 to 16 years old. Results were consistent with the hypothesis that BP levels during reactivity testing would be better predictors of ambulatory BP than levels of BP measured at rest using a standard protocol. Ethnic group differences in ambulatory BP were statistically significant. The findings warrant further study and may provide a means for early identification of adolescents at risk for developing high BP. |
| Preliminary evaluation of the patient with high blood pressure Janney, J. G., Jr., M. Thurman, et al. (1965), Mo Med 62(9): 760-1. |