| For medical practitioners and the general public - High Blood Pressure Journal Article Catalog. |
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| Transgenic amplification of glucocorticoid action in adipose tissue causes high blood pressure in mice Masuzaki, H., H. Yamamoto, et al. (2003), J Clin Invest 112(1): 83-90. Abstract: Obesity is closely associated with the metabolic syndrome, a combination of disorders including insulin resistance, diabetes, dyslipidemia, and hypertension. A role for local glucocorticoid reamplification in obesity and the metabolic syndrome has been suggested. The enzyme 11beta-hydroxysteroid dehydrogenase type 1 (11beta-HSD1) regenerates active cortisol from inactive 11-keto forms, and aP2-HSD1 mice with relative transgenic overexpression of this enzyme in fat cells develop visceral obesity with insulin resistance and dyslipidemia. Here we report that aP2-HSD1 mice also have high arterial blood pressure (BP). The mice have increased sensitivity to dietary salt and increased plasma levels of angiotensinogen, angiotensin II, and aldosterone. This hypertension is abolished by selective angiotensin II receptor AT-1 antagonist at a low dose that does not affect BP in non-Tg littermates. These findings suggest that activation of the circulating renin-angiotensin system (RAS) develops in aP2-HSD1 mice. The long-term hypertension is further reflected by an appreciable hypertrophy and hyperplasia of the distal tubule epithelium of the nephron, resembling salt-sensitive or angiotensin II-mediated hypertension. Taken together, our findings suggest that overexpression of 11beta-HSD1 in fat is sufficient to cause salt-sensitive hypertension mediated by an activated RAS. The potential role of adipose 11beta-HSD1 in mediating critical features of the metabolic syndrome extends beyond obesity and metabolic complications to include the most central cardiovascular feature of this disorder. |
| Transient decrease in high blood pressure by in vivo transfer of antisense oligodeoxynucleotides against rat angiotensinogen Tomita, N., R. Morishita, et al. (1995), Hypertension 26(1): 131-6. Abstract: The renin-angiotensin system plays an important role in blood pressure regulation. Angiotensinogen, which is mainly produced in the liver, is a unique component of the renin-angiotensin system, because angiotensinogen is only known as a substrate for angiotensin I generation. It is unclear whether circulating angiotensinogen is a rate-limiting step in blood pressure regulation. Recent findings of genetic studies and analyses suggest that the angiotensinogen gene may be a candidate as a determinant of hypertension. To test the hypothesis that angiotensinogen may modulate blood pressure, we transfected antisense oligonucleotides against rat angiotensinogen into the rat liver via the portal vein using liposomes that contain viral agglutinins to promote fusion with target cells, a technique that has been reported to be highly efficient. Transfection of antisense oligonucleotides resulted in a transient decrease in plasma angiotensinogen levels in spontaneously hypertensive rats from day 1 to day 7 after the injection, consistent with the reduction of hepatic angiotensinogen mRNA. Plasma angiotensin II concentration was also decreased in rats transfected with antisense oligonucleotides. Moreover, a transient decrease in blood pressure from day 1 to day 4 was observed, whereas transfection of sense and scrambled oligonucleotides did not result in any changes in plasma angiotensinogen level, blood pressure, or angiotensinogen mRNA level. Overall, our results demonstrate that transfection of antisense oligonucleotides against rat angiotensinogen resulted in a transient decrease in the high blood pressure of spontaneously hypertensive rats, accompanied by a decrease in angiotensinogen and angiotensin II levels.(ABSTRACT TRUNCATED AT 250 WORDS) |
| Treat high blood pressure sooner: tougher, simpler JNC 7 guidelines Vidt, D. G. and R. A. Borazanian (2003), Cleve Clin J Med 70(8): 721-8. |
| Treating high blood pressure Gordon, R. D. (1972), Australas Nurses J 2(17): 13. |
| Treating high blood pressure following acute stroke Keir, S. L., P. J. Murphy, et al. (1996), J R Coll Physicians Lond 30(3): 269-70. |
| Treating high blood pressure in acute stroke Schrader, J., H. C. Diener, et al. (2004), MMW Fortschr Med 146(11): 45-8. |
| Treating high blood pressure in Africans with type 2 diabetes Okoro, E. O. and B. A. Oyejola (2004), Ethn Dis 14(1): 160-1. |
| Treating high blood pressure in diabetes: the evidence Adler, A. I. (2002), Semin Vasc Med 2(2): 127-37. Abstract: Increases in blood pressure, even at modest levels, are associated with an increased risk of complications in diabetes. Trials have shown that treatment with blood pressure-lowering agents in type 2 diabetes lowers the risk of complications of cardiovascular and microvascular complications. ACE inhibitors appear superior in patients with microalbuminuria, although the choice of other agents is less clear, making blood pressure control itself more important than the particular agent used. The probability that a patient will require multiple therapies is increased in patients with diabetes, in part because of the increased likelihood of concurrent cardiovascular illness for which antihypertensives may have benefit. Finally, some drugs used to lower blood pressure have a benefit in individuals not considered hypertensive and appear to have a mechanism of action independent of blood pressure lowering. |
| Treatment of high arterial blood pressure with parenteral administration of guanethidine (ismalin) Wasyluk, J. and E. Ruzyllo (1969), Pol Tyg Lek 24(18): 683-5. |
| Treatment of high blood pressure Cobb, S. (1977), Jama 237(18): 1927. |
| Treatment of high blood pressure in Germany Faulhaber, H. D. and F. C. Luft (1998), Am J Hypertens 11(6 Pt 1): 750-3. Abstract: The reunification of Germany has made it possible to compare the health care in two independently developed social structures. The prevalence of hypertension was considerably greater in East German men and women, compared with West German men and women, although salt intake was lower in East Germany than in West Germany. Cardiovascular mortality was correspondingly greater. A centralized public health effort was used in East Germany, whereas in West Germany, the activities were decentralized and to a large extent dependent on private philanthropists. In the last two decades, cardiovascular mortality declined in West German men and women, whereas the same was not true for East German men and women. Hypertension incidence, awareness, treatment, and control have improved slightly in Germany, but not enough to explain the improved morbidity figures. Twenty percent of men and women remain unaware of their hypertension, 40% are aware but not treated, and only half are aware and controlled. Complacency is unjustified in Germany and much needs to be done. |
| Treatment of high blood pressure in overweight patients MacMahon, S. and G. Macdonald (1987), Nephron 47 Suppl 1: 8-12. Abstract: Weight reduction was compared with metoprolol (200 mg daily) in a randomized placebo-controlled trial of first-line treatment of mild hypertension (diastolic blood pressure 90-109 mm Hg) in 56 overweight patients aged under 55 years. After 21 weeks of follow-up the weight-reduction group had lost an average of 7.4 kg. The fall in their systolic pressure of 13 mm Hg was significantly greater than that in the placebo group (7 mm Hg) but not different from that in the metoprolol group (10 mm Hg). Their fall in diastolic pressure (10 mm Hg) was greater than that in both the metoprolol (6 mm Hg) and placebo (3 mm Hg) groups. At the end of the follow-up period, 50% of patients in the weight-reduction group had a diastolic pressure of less than 90 mm Hg. In the weight-reduction group, left ventricular mass decreased by 18% in comparison with placebo; in the metoprolol group left ventricular mass was unchanged. In the weight-reduction group there was a decrease both in total cholesterol and in the ratio of total to HDL-cholesterol; in the metoprolol group there was a decrease in high density lipoprotein(HDL)-cholesterol and an increase in the ratio of total to HDL-cholesterol. In this study, weight reduction produced significant falls in both blood pressure and left ventricular mass but not the adverse effects on plasma lipids commonly associated with antihypertensive drug therapy. |
| Treatment of high blood pressure in patients with acute apoplexy Olsen, T. S., H. S. Jorgensen, et al. (1995), Ugeskr Laeger 157(25): 3623-5. Abstract: The study was performed to investigate how often reduction of high blood pressure (> or = 220 mmHg systolic and or > or = 120 mmHg diastolic) was attempted in patients with acute stroke or transient ischemic attacks (TIA). Of 1351 consecutive patients with acute stroke or TIA 119 had high blood pressure on admission. In 15 patients the stroke was so severe that treatment was not considered. In the remaining 104 patients reduction of the blood pressure was attempted in 28 (27%); in 23 patients immediately following admission. None of the patients had symptoms or signs of hypertensive encephalopathy. It is concluded that reduction of high blood pressure in patients with stroke or TIA is attempted too often. As autoregulation is commonly impaired in acute stroke, reduction of systemic blood pressure may enhance ischaemic tissue damage. Reduction of blood pressure in acute stroke should be considered only in case of hypertensive encephalopathy. |
| Treatment of high blood pressure in pregnancy Oukhouia, B., H. Benjelloun, et al. (1981), Maroc Med 3(4): 757-61. |
| Treatment of High Blood Pressure in the Elderly: A Position Paper from the Society of Geriatric Cardiology Moser, M., M. D. Cheitlin, et al. (1998), Am J Geriatr Cardiol 7(4): 41-42. |
| Treatment of high blood pressure in the young Kotchen, J. M., J. Holley, et al. (1989), Semin Nephrol 9(3): 296-303. Abstract: Children with high normal or high BP should also be evaluated for other cardiovascular risk factors, and interventions should address overall cardiovascular risk. Nonpharmacologic interventions include weight reduction when appropriate, avoidance of dietary salt excess, and dynamic exercise. Drug treatment should be required in a minority of children with hypertension. There are concerns about the longterm effects of drug therapy on lipid and carbohydrate metabolism and on physical and cognitive growth and development. Beta adrenergic antagonists and diuretics are usually the first line drugs to be added to the nonpharmacologic therapeutic strategies for BP control in children. After a sufficient period of BP control, a stepped-down approach and discontinuation of drug therapy should be considered. |
| Treatment of high blood pressure still unchanged. Diuretics and beta-blockaders are first choice preparations Lindholm, L. H. and O. Samuelsson (1998), Lakartidningen 95(7): 648-51. |
| Treatment of high blood pressure with Betadrenol 100. Results of a clinical study Malig, W., R. Grund, et al. (1980), ZFA (Stuttgart) 56(30): 2047-52. |
| Treatment of high blood pressure with prazosin (Peripress). An open study by 123 general physicians and 24 specialists in internal medicine Fauchald, P., A. Helgeland, et al. (1978), Tidsskr Nor Laegeforen 98(30): 1494-9. |
| Treatment of high blood pressure. From diuretics to the present and future Nogueira da Costa, J. (1995), Cardiologia 40(12): 893-8. |
| Treatment of high blood pressure: should clinical practice be based on results of clinical trials? Wilcox, R. G., J. R. Mitchell, et al. (1986), Br Med J (Clin Res Ed) 293(6544): 433-7. |
| Treatment of high blood pressure--a comment Wilhelmsen, L. (1980), Lakartidningen 77(1-2): 19-21. |
| Treatment of high blood pressure--the effect on coronary morbidity and mortality Reid, J. L., J. L. Curzio, et al. (1989), J Hum Hypertens 3 Suppl 2: 35-8;discussion 39-40. Abstract: Established drugs used in the treatment of hypertension have reduced stroke but have had disappointingly little impact on coronary artery disease and its complications. This could be due to inadequate falls in blood pressure (or excessive falls). It is possible that the role of blood pressure in ischaemic heart disease has been over-estimated compared to other risk factors. Alternatively, the drugs used previously may have adversely affected other factors. Mortality in treated hypertensives remains higher than normotensives but so does their blood pressure. The blood pressure on treatment is a much better predictor of outcome than initial blood pressure. This suggests that improved blood pressure control may be desirable. In our hospital-based hypertension clinic many patients have more than one risk factor. In spite of intensive efforts between 1980 and 1988, smoking habits changed little and serum cholesterol and random blood glucose actually rose. Cholesterol is high in our population of hypertensive patients and the mean (+/- SD) rose from 6.4 +/- 1.3 to 6.6 +/- 1.3 (n = 127; P less than 0.01). These observations highlight the importance of a multiple risk factor approach. The benefits of alternative drugs which can lower total cholesterol and/or low-density lipoprotein (LDL) and/or raise high-density lipoprotein (HDL) deserve study in this population. A final possibility is that the widely observed association between hypertension and ischaemic heart disease is not causal (or is weak compared to other risk factors). If a common underlying mechanism caused both atheroma and hypertension then reduction of blood pressure would not be expected to reverse atheroma and its complications. At present this possibility cannot be excluded. |
| Trends in antihypertensive drug use in the United States: do the JNC V recommendations affect prescribing? Fifth Joint National Commission on the Detection, Evaluation, and Treatment of High Blood Pressure Siegel, D. and J. Lopez (1997), Jama 278(21): 1745-8. Abstract: CONTEXT: The choice of pharmacological treatment for the approximately 50 million people in the United States with hypertension has important therapeutic and financial implications. OBJECTIVES: To describe national antihypertensive medication prescribing patterns for 1992 and 1995; to explore the influence of the Fifth Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure (JNC V), published in 1993, which recommended diuretics and beta-blockers as first-line antihypertensive therapy unless contraindicated; and to estimate the impact of these prescribing patterns on the cost of antihypertensive treatment. DESIGN: All prescriptions for drugs approved for the treatment of hypertension dispensed by 35000 retail pharmacies were tabulated for 1992 and 1995 (62% of all US retail pharmacies were surveyed). MAIN OUTCOME MEASURES: Number of prescriptions for each dosage form of medication and national cost estimates based on wholesale costs of medications dispensed. RESULTS: In 1992, of the 10 most frequently prescribed antihypertensive drugs, 3 were calcium antagonists, 3 were angiotensin-converting enzyme (ACE) inhibitors, 3 were beta-blockers, and 1 was the combination of triamterene and hydrochlorothiazide. In 1995, 4 were calcium antagonists, 3 were ACE inhibitors, 1 was a beta-blocker, 1 was the combination of triamterene and hydrochlorothiazide, and 1 an alpha-blocker. In 1992, calcium antagonists accounted for 33% of antihypertensive prescriptions compared with 38% in 1995, ACE inhibitor use went from 25% to 33%, beta-blocker use from 18% to 11%, and diuretic use from 16% to 8%. The estimated wholesale costs for calcium antagonists in 1995 dollars increased from $2.67 billion in 1992 to $2.86 billion in 1995; ACE inhibitor costs increased from $1.37 billion to $1.67 billion; costs for diuretics declined from $353 million to $168 million; and costs for beta-blockers declined from $763 million to $433 million. CONCLUSIONS: From 1992 to 1995 use of calcium antagonists and ACE inhibitors for treatment of hypertension increased and diuretics and beta-blockers declined, suggesting that the recommendations from JNC V had little effect on prescribing patterns. The cost implications of these practice patterns are enormous. |
| Trends in risk factor control in Germany 1984-1998: high blood pressure and total cholesterol Laaser, U. and J. Breckenkamp (2005), Eur J Public Health Abstract: BACKGROUND: Diagnosis and treatment of the two primary cardiovascular risk factors, hypertension and hypercholesterolaemia, are well established. Nevertheless, according to earlier analyses of representative health questionnaire and examination surveys in 1984, 1988 and 1991, control of risk factors in the sense of normalized values through drug therapy did not improve to any relevant degree in former West Germany. The National Health Survey of 1998 now allows the reconsideration of the hypothesis that medical treatment has been improving and lead to a reduction of risk factor values measured in the population. METHODS: Datasets of independent cross-sectional studies in 1984, 1988, 1991 and 1998 with net random sample sizes between 3458 and 5335 were analysed for actual (persons with elevated values and persons successfully treated) and population (persons with elevated values) prevalence, awareness of the risk factors under question, treatment coverage (risk factor aware and treated) and effectiveness (risk factor aware, treated and normalized), and the resulting parameters of controlled (successfully treated persons among actual prevalence) and uncontrolled prevalence (persons with elevated values among actual prevalence), respectively. Thresholds chosen were blood pressure values >/=160/95 mmHg for hypertension and values >/=250 mg/dl for hypercholesterolaemia. Regarding medication, the answer of 'one to two times weekly' or more was considered to indicate a relevant drug intake. RESULTS: For hypertension the population prevalence (population 30-69 years old) increased significantly (P < 0.0001) from 19.6% to 24.0% between 1984 and 1998, whereas the actual prevalence rose less steeply but still significantly (P < 0.0002) from 32.5% to 34.4%. For hypercholesterolaemia the population prevalence stagnated at 37.0% (1998), whereas the actual prevalence was 47.5% in 1998 (39.1% in 1984; P < 0.0001). For hypertension treatment, coverage improved from 45.4% to 63.0%, but treatment effectiveness decreased from 51.7% to 41.3%, both trends being highly significant. For hypercholesterolaemia, awareness increased from 18.3% to 57.6%, but treatment coverage decreased from 33.5% to 15.5%, whereas treatment effectiveness improved from 23.8% to 47.7%, all trends being highly significant (P < 0.0001). CONCLUSIONS: The results do not support the hypothesis that medical care for the large population at cardiovascular risk in (Western) Germany was adequate and successful in the 1980s and 1990s. |
| UCP-2 does not modulate angiotensin II-induced high blood pressure but limits the development of hypertensive renal sclerosis Sabaa, N., B. Miroux, et al. (2005), J Hypertens 23(8): A11. |
| Uncontrolled blood pressure in a treated, high-risk managed care population Andros, V. (2005), Am J Manag Care 11(7 Suppl): S215-9. Abstract: The prevalence of hypertension in the United States is increasing, and the estimated cost of care is more than $55 billion annually, including direct and indirect expenditures. The most recent National Health and Nutrition Examination Survey data show an improvement in awareness, treatment, and control of hypertension compared with previous surveys. Nonetheless, fewer than one third of adults with hypertension are achieving blood pressure control. The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) states that most patients will require more than 1 drug to achieve goal blood pressure (<140/90 mm Hg, or <130/80 mm Hg for those with diabetes or chronic kidney disease). Hypertension is common in patients with diabetes, and aggressive blood pressure control has been shown to reduce the risk of these complications. In a study conducted from 2002 to 2005, the medical charts of 9492 adults with hypertension and diabetes from physician practices across the United States were reviewed. Only 27.5% of this high risk study population achieved the blood pressure goal of <130/80 mm Hg. Ninety-eight percent of patients were receiving antihypertensive therapy; 37.1% were using 1 agent, 34.4% were using 2, and 26.2% were using 3 or more agents. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers were the most frequently used antihypertensive agents in this study population, but they were underutilized, being used by 55.4% and 32.3%, respectively. These findings, which are consistent with other studies, suggest a need for improvement in management of hypertension in patients with diabetes and other high-risk groups. |
| Unrecognized high blood pressure. A major public health issue for the workplace Capriotti, T., L. G. Kirby, et al. (2000), Aaohn J 48(7): 338-43. Abstract: Hypertension continues to be prevalent in the general population despite the public's increased awareness of cardiovascular disease. Population-wide detection and prevention of hypertension are high priority goals within preventive health care. According to recent National Heart, Lung, and Blood Institute (NHLBI) guidelines, high normal blood pressure (BP) (systolic 130 to 139 mm Hg or diastolic 85 to 89 mm Hg) is not an innocuous condition (NHLBI, 1997). High normal BP is a detectable, modifiable, antecedent condition to overt hypertension. Little is known about the incidence of high normal BP in the general population and of its relationship to stress. This study examined the prevalence of high normal and hypertensive levels of blood pressure in a convenience sample of 94 volunteer employees from a midsize corporation. Blood pressure and level of reported stress were assessed. Findings revealed rates of 11% and 30% high normal and hypertensive blood pressure levels, respectively. Ninety-six percent of participants assumed their blood pressures were normal. As in other studies, those employees with hypertensive blood pressure reported higher stress levels than normotensive employees. However, the population with high normal BP did not report significantly higher stress levels than normotensive employees. These findings suggest high normal and hypertensive blood pressures are prevalent cardiovascular disease risk factors among employees in the workplace. Most employees are unaware of their elevated BP and the risk of high normal BP. Occupational health nurses are in a strategic position to take a proactive approach to population-wide hypertension prevention by initiating worksite BP screening and education programs. |
| Update on high blood pressure: highlights from the 1988 national report Fontana, S. A. (1988), Nurse Pract 13(12): 8, 10-2, 15 passim. Abstract: This article summarizes the highlights of the 1988 Report of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure. In addition, it examines the implications for practice relative to caring for individuals with elevated blood pressure, including individuals with coexisting medical conditions and those from special populations (e.g., young, elderly, pregnant). This article outlines an insightful approach to the definitive clinical recommendations issued in the report. The ways in which nurse practitioners can facilitate greater patient involvement in drug and non-drug therapy as well as in reducing other cardiovascular risk factors are presented. The article addresses the quality of life aspects relative to implementing the treatment guidelines and their importance in clinical decision-making. |
| Update on the factors associated with high blood pressure compliance Bone, L. R., D. M. Levine, et al. (1984), Md State Med J 33(3): 201-4. |
| Urinary kallikrein excretion in grade school children with high and low blood pressure Sinaiko, A. R., R. J. Glasser, et al. (1982), J Pediatr 100(6): 938-40. |
| Use of high-pressure liquid chromatography for monitoring nucleotide concentration in human blood: a preliminary study with stored blood cell suspensions Brown, P. R., R. E. Parks, Jr., et al. (1973), Clin Chem 19(8): 919-22. |
| Use of non-invasive ambulatory blood pressure monitoring to screen for high-risk hypertensive patients Christen, Y., M. Ganslmayer, et al. (1990), J Hypertens Suppl 8(6): S119-24. Abstract: Blood pressures measured casually by a doctor often differ considerably from those recorded during everyday activities away from the medical environment. In the present study, we compared office and ambulatory recorded pressures in 475 consecutive untreated patients diagnosed hypertensive by physicians. Blood pressure monitored non-invasively during the day was, on average 15/7 mmHg lower than the corresponding office pressures. The difference between office and ambulatory recorded pressure tended to be greatest in those patients with the highest office blood pressure levels, although the relationship between the two types of measurement was too weak (r = 0.50 and 0.38 for systolic and diastolic pressure, respectively) to have any predictive value in the individual patient. Office blood pressures were at least 10 mmHg higher than ambulatory pressures in 62% of patients for systolic and 42% for diastolic pressure. Blood pressure levels recorded during ambulatory monitoring were higher than in the doctor's office for 18% of patients for systolic and 22% for diastolic pressure. Among patients with systolic pressures of between 161 and 180 mmHg or diastolic pressures between 96 and 105 mmHg when facing a doctor, 27 and 37% respectively, showed markedly lower systolic (less than 140 mmHg) or diastolic (less than 90 mmHg) ambulatory recorded pressures. These data therefore indicate that ambulatory blood pressure monitoring may help to identify those truly hypertensive patients who are most likely to benefit from antihypertensive therapy. |
| Use of prostaglandin E2 in the treatment of hypertension with high blood pressure levels Nekrasova, A. A., A. K. Dzhusipov, et al. (1982), Kardiologiia 22(9): 37-42. |
| Using the emergency department as a screening site for high blood pressure. A method for improving hypertension detection and appropriate referral Mamon, J., L. Green, et al. (1987), Med Care 25(8): 770-80. Abstract: This study describes the development and testing of a high blood pressure protocol for use in emergency departments (ED) to enhance detection of those patients appropriate for subsequent referral. The protocol involves two serial blood pressure measurements and a patient interview to determine: 1) previous history of high blood pressure (HBP), 2) treatment in past year for HBP, and 3) usual source of medical care. The accuracy of patient reporting was validated by comparison with the patients' hospital record (reflecting outpatient and inpatient visits). Results indicate that these self-reports have high levels of sensitivity (range 90-100%) and specificity (range 79-96%). Use of the additional patient information increased the sensitivity of the screening protocol in identifying when and where a patient should be referred. Use of this methodology indicates that the protocol is a simple and effective method for HBP screening. The findings also suggest that the ED is an ideal site for screening the "hard-to-reach" hypertensive population. |
| Validation of self diagnosis of high blood pressure in a sample of the Spanish EPIC cohort: overall agreement and predictive values. EPIC Group of Spain Tormo, M. J., C. Navarro, et al. (2000), J Epidemiol Community Health 54(3): 221-6. Abstract: STUDY OBJECTIVE: High blood pressure is a variable related to several chronic conditions whose repeated measurement in large cohort studies is often not feasible having to rely on the self reporting of the subjects. The aim of the study is to validate such self diagnosis in a sample of members from the Spanish EPIC cohort study. DESIGN: Comparison of high blood pressure self diagnosis with the information provided by the personal medical record drawn from the primary health centre of reference for such population. SETTING: A small town near the EPIC-Murcia centre, one of five Spanish EPIC centres located in the south east, where inclusion in the cohort was offered to the general population. PARTICIPANTS: The agreement between self reported high blood pressure status and data from medical records was measured in a representative sample of men and women (n = 248) aged 30-69 years. Medical records were studied for a diagnosis of high blood pressure, an anti-hypertensive pharmacological treatment or subject's inclusion in a hypertension control programme run in the medical centre only for hypertensive people (definite high blood pressure cases). As well, in the absence of such a diagnosis, medical annotations of systolic or diastolic high blood pressure > or = 140/90 mm Hg (possible high blood pressure cases) were considered. Sensitivity, specificity, positive and negative predictive values and kappa scores were calculated for all, definite and possible high blood pressure cases. Variables associated with the probability of having a true positive or negative self report of high blood pressure were also tested. MAIN RESULTS: As expected, sensitivity was higher among definite cases (72.7%) than among possible cases (31.6%). Accordingly, the agreement between self report and medical record was higher for definite cases (kappa = 0.65) than for possible (kappa = 0.29 cases leading to a moderate overall agreement for all cases (kappa = 0.58; 95% CI: 0.47, 0.69). Having some level of education (OR: 0.31; 95% CI: 0.09, 1.05) was negatively associated to a true self report of high blood pressure while being female was positively associated (OR: 4.01; 95% CI 1.04, 16.8). No variable showed any association with having a true self report of being normotensive. CONCLUSIONS: High blood pressure self report shows a moderate agreement with medical information in this cohort allowing it to be used, with caution, as a surrogate variable of actual blood pressure status. However, because of its moderate sensitivity, it is not possible to rule out some underestimation when using self reported high blood pressure information for high blood pressure frequency measurements such as prevalence or incidence rates. This underestimation will be higher among men and educated people. |
| VALUE trial: Long-term blood pressure trends in 13,449 patients with hypertension and high cardiovascular risk Julius, S., S. E. Kjeldsen, et al. (2003), Am J Hypertens 16(7): 544-8. Abstract: BACKGROUND: The Valsartan Antihypertensive Long-term Use Evaluation (VALUE) study compares cardiovascular outcomes in 15,314 eligible patients from 31 countries randomized to valsartan or amlodipine-based treatment. METHODS: The blood pressure (BP) trends are analyzed in 13,449 of VALUE study patients who had baseline BP and 24 months BP and treatment data. RESULTS: In a cohort of 12,570 patients, baseline 24 and 30 months BP, but not 30 months treatment data, were available. Of 13,449 patients, 92% (N = 12,398) received antihypertensive therapy at baseline. The baseline BP was 153.5/86.9 mm Hg in treated compared to 168.1.8/95.3 mm Hg in 1051 untreated patients. After 6 months both groups had indistinguishable BP values. At 12 months the BP decreased to 141.2/82.9 mm Hg (P <.0001 for systolic BP and diastolic BP versus baseline), at 24 months to 139.1/80 mm Hg (P <.0001 v 12 months), and to 138/79 mm Hg at 30 months (P <.0001 v 24 months). The systolic BP control (<140 mm Hg) at 30 months increased from 21.9% at baseline to 62.2%, the diastolic BP (< 90 mm Hg) from 54.2% to 90.2% and the combined control (<140 and <90 mm Hg) from 18.9% to 60.5%. At 24 months 85.8% of patients were on protocol drugs: monotherapy = 39.7%, added hydrochlorothiazide = 26.6%, add-on drugs = 15.1%, and protocol drugs in nonstandard doses = 4.3%. CONCLUSIONS: The achieved BP control exceeds values reported in most published large-scale trials. The VALUE study is executed in regular clinical settings and 92% of the patients received antihypertensive drugs at baseline. When an explicit BP goal is set, and a treatment algorithm is provided, the physicians can achieve better control rates than in their regular practice. |
| Vascular alterations in rats with high blood pressure induced by social deprivation stress Parra, L., J. A. Fuentes, et al. (1994), Life Sci 55(9): 669-75. Abstract: While an activation of the opioid system has been found to play a role only in the triggering of the high blood pressure induced by brief (7-14 days) social deprivation stress in Wistar rats, factors responsible for the maintenance of the hypertension after long-term (30-35 days) isolation remained to be elucidated. To this aim, the effects of social deprivation stress on the functional and morphological features of blood vessels were studied. The tail artery, as a muscular vessel, and the aorta, as a large elastic vessel were used in these experiments. In ex vivo experiments, aorta and tail artery strips from rats isolated for 30-35 days were found to be hyperreactive to noradrenaline. |
| Vascular oxidative stress precedes high blood pressure in spontaneously hypertensive rats Nabha, L., J. C. Garbern, et al. (2005), Clin Exp Hypertens 27(1): 71-82. Abstract: This study examines whether longitudinal antioxidant treatment initiated in prehypertensive spontaneously hypertensive rats (SHR) can attenuate vascular oxidant stress and prevent blood pressure elevation during development. Male SHR and age-matched Wistar-Kyoto rats (WKY) were treated from 6 to 11 weeks of age with Tempol (4-hydroxy-2,2,6,6-tetramethylpiperidinoxyl) (1 mmol/l in drinking water), a membrane-permeable superoxide dismutase mimetic. Mean systolic blood pressures (SBPs) were measured by tail-cuff Agonist-induced and basal O2- production was measured in thoracic aortas of 6- and 11-week-old SHR and WKY by lucigenin-derived chemiluminescence and oxidative fluorescent microscopy, respectively. SBP of 6-week-old SHR (131 +/- 5 mmHg) and WKY (130 +/- 4 mmHg) were not different; however, 11-week-old SHR SBP (171 +/- 4 mmHg) was significantly greater (p =.0001) than 11-week-old WKY SBP (143 +/- 5 mmHg). Tempol treatment completely, but reversibly, prevented this age-related rise in SHR SBP (SHR + Tempol: 137 +/- 4 mmHg; p <.0001 versus untreated SHR). Agonist-induced vascular O2- was increased in 6- (p =.03) and 11-week-old SHR (p <.0001) and 11-week-old WKY (p =.03) but not in 6-week-old WKY. Long-term Tempol treatment significantly lowered O2- production in both strains. Basal O2- measurements in both 6- and 11-week-old SHR were qualitatively increased compared with age-matched WKY; this increase in SHR was inhibited with in vitro Tempol treatment. These data show that antioxidant treatment to reduce oxidative stress prevents the age-related development of high blood pressure in an animal model of genetic hypertension. |
| Vascular reactivity of mesenteric arteries and veins to endothelin-1 in a murine model of high blood pressure Perez-Rivera, A. A., G. D. Fink, et al. (2005), Vascul Pharmacol 43(1): 1-10. Abstract: We characterized vascular reactivity to endothelin-1 (ET-1) in mesenteric vessels from DOCA-salt hypertensive and SHAM control mice and assessed the effect that endothelial-derived vasodilators have on ET-1-induced vasoconstriction. Changes in the diameter of unpressurized small mesenteric arteries and veins (100- to 300-microm outside diameter) were measured in vitro using computer-assisted video microscopy. Veins were more sensitive than arteries to the contractile effects of ET-1. There was a decrease in arterial maximal responses (E(max)) compared to veins, this effect was larger in DOCA-salt arteries. The selective ET(B) receptor agonist, sarafotoxin 6c (S6c), contracted DOCA-salt and SHAM veins but did not contract arteries. The ET(B) receptor antagonist, BQ-788 (100 nM), but not the ET(A) receptor antagonist, BQ-610 (100 nM), blocked S6c responses. BQ-610 partially inhibited responses to ET-1 in mesenteric veins from DOCA-salt and SHAM mice while BQ-788 did not affect responses to ET-1. Co-administration of both antagonists inhibited responses to ET-1 to a greater extent than BQ-610 alone suggesting a possible functional interaction between ET(A) and ET(B) receptors. Responses to ET-1 in mesenteric arteries were completely inhibited by BQ-610 while BQ-788 did not affect arterial responses. Nitric oxide synthase inhibition potentiated ET-1 responses in veins from SHAM but not DOCA-salt mice. There was a prominent role for ET-mediated nitric oxide release in DOCA-salt but not SHAM arteries. In summary, these studies showed a differential regulation of ET-1 contractile mechanisms between murine mesenteric arteries and veins. |