The Yi Migrant Study: population exposures influencing blood pressure patterns.
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China↗
Biomedical subjects
J Stamler
Publications and source records attributed to J Stamler.
Blood pressure levels, related factors, and hypertension control status of Japanese and Americans.
Blood pressure levels and related factors in Japanese, US whites and US blacks aged 30 to 74 years were compared, using data from the similarly designed national survey of each country in a similar period, i.e., the National Survey on Circulatory Disorders of Japan, 1980 (10,897 persons from all over Japan) and the second National Health and Nutrition Survey of the US, 1976 to 1980 (NHANES-II) (16,204 persons from all over the USA). Data collection methods were judged to be comparable. Data were stratified by age (30-39, 40-49, 50-59, 60-69, 70-74 yrs) and sex. Age-specific and age-adjusted mean systolic BPs of Japanese were generally higher than those of US whites; mean diastolic pressures were similar in the two populations in both men and women. Mean weight and body mass index (BMI) and their standard deviations were lower for Japanese than Americans. In US blacks, BP was higher than in Japanese or in US whites for diastolic in men, and for both systolic and diastolic in women. Systolic BP levels of black men were between those of Japanese and US whites. At specific levels of BMI, Japanese systolic BPs were markedly higher than those of US whites in all age-sex groups, and diastolic pressures were higher in Japanese than in US whites, slightly so at younger ages and more so at ages 60 and over in both sexes. The proportions of all persons with high BP who were receiving antihypertensive treatment and who were controlled were similar in most age-sex groups of the Japanese and US white populations; they were lower in US black men and higher in US black women. In linear regression analyses of BP on BMI controlled for age, slopes were similar for Japanese and Americans. However, given the lower mean BMI and smaller BMI standard deviation (less overweight), partial correlation coefficients between BMI and BP were smaller for Japanese than Americans. These results indicate that overweight plays a lesser role in Japanese than Americans in producing high prevalence rates of hypertension and that other factors are critically involved (e.g., intake of sodium, potassium, calcium, alcohol).
Adult↗
Characteristics of participants at baseline in the Treatment of Mild Hypertension Study (TOMHS).
The Treatment of Mild Hypertension Study (TOMHS) is a randomized, double-blind clinical trial currently being conducted to compare the effects of nonpharmacologic therapy alone with those of 1 of 5 active drug regimens combined with nonpharmacologic therapy, for long-term management of patients with mild hypertension. Six classes of drugs were studied: (1) acebutolol (beta blocker), (2) amlodipine (calcium antagonist), (3) chlorthalidone (diuretic), (4) doxazosin (alpha 1 antagonist), (5) enalapril (angiotensin-converting enzyme inhibitor) and (6) placebo. All participants received nutritional-hygienic advice to reduce weight and sodium and alcohol intakes and to increase physical activity. End points include blood pressure change, side effects and quality-of-life indices; incidence of electrocardiographic and echocardiographic abnormalities; and incidence of cardiovascular clinical events, including death, among participants receiving drugs as first-step treatment as well as nonpharmacologic treatment compared with incidence among those participants randomized to nonpharmacologic treatment only as the initial step.
Aged↗
Blood pressure, stroke, and coronary heart disease. Part 1, Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias.
The associations of diastolic blood pressure (DBP) with stroke and with coronary heart disease (CHD) were investigated in nine major prospective observational studies: total 420,000 individuals, 843 strokes, and 4856 CHD events, 6-25 (mean 10) years of follow-up. The combined results demonstrate positive, continuous, and apparently independent associations, with no significant heterogeneity of effect among different studies. Within the range of DBP studied (about 70-110 mm Hg), there was no evidence of any "threshold" below which lower levels of DBP were not associated with lower risks of stroke and of CHD. Previous analyses have described the uncorrected associations of DBP measured just at "baseline" with subsequent disease rates. But, because of the diluting effects of random fluctuations in DBP, these substantially underestimate the true associations of the usual DBP (ie, an individual's long-term average DBP) with disease. After correction for this "regression dilution" bias, prolonged differences in usual DBP of 5, 7.5, and 10 mm Hg were respectively associated with at least 34%, 46%, and 56% less stroke and at least 21%, 29%, and 37% less CHD. These associations are about 60% greater than in previous uncorrected analyses. (This regression dilution bias is quite general, so analogous corrections to the relations of cholesterol to CHD or of various other risk factors to CHD or to other diseases would likewise increase their estimated strengths.) The DBP results suggest that for the large majority of individuals, whether conventionally "hypertensive" or "normotensive", a lower blood pressure should eventually confer a lower risk of vascular disease.
Adult↗
Post-load plasma glucose and cancer mortality in middle-aged men and women. 12-year follow-up findings of the Chicago Heart Association Detection Project in Industry.
The relation of post-load plasma glucose to 12-year cancer mortality was studied in 11,521 white men and 8,591 white women aged 35-64 years at entry in the Chicago Heart Association Detection Project in Industry. There were 298 deaths in which cancer was the underlying cause in men and 186 such deaths in women. Plasma glucose levels at baseline measured one hour after a 50 g oral glucose load were positively related to cancer mortality in men but not in women. This increased mortality in men persisted after controlling for age, body mass index, smoking, serum cholesterol, systolic blood pressure, education, and anti-hypertensive treatment. A site-specific analysis of the male cancer deaths demonstrated higher mean plasma glucose levels for decedents for nearly all sites except oral cancers, liver cancer, and other respiratory cancers. For women, elevations existed for those who died of colon, lung, and hematologic/lymphatic tumors, but not for most other sites. The associations between baseline post-load plasma glucose levels and cancer mortality were similar for earlier and later cancer deaths, which indicates that incipient or occult neoplasm at baseline was not responsible for elevated glucose levels in men who subsequently died of cancer. Cancer mortality rates were also higher for those with a clinical diagnosis of diabetes than for those without, but the numbers of persons with diabetes were small as were the numbers of cancer deaths (19 in the men and 10 in the women).
Administration, Oral↗
Comparison of three weight-for-height indices in blood pressure studies in children.
Associations between blood pressures and three indices commonly used to assess relative obesity (weight (kg)/height (m)2, weight (kg)/height (m)3, and weight (kg)/height (m)p) were examined in a multiracial sample of children attending private schools in Chicago, Illinois. The 1,723 boys and 1,878 girls were 5-10 years old at the time of the survey (1975-1978). Inclusion of white, black, Hispanic, and Asian children permitted comparison of the relation between anthropometric variables and blood pressures across racial groups. The three weight-for-height indices used as estimates of relative obesity yielded nearly identical regression models, suggesting that, in spite of ongoing debate about the most appropriate index for describing relative obesity in children, it makes little difference which index is used.
Blood Pressure↗
Hypertension and sodium transport in 390 healthy adults in Chicago.
A total of 390 people undergoing routine examinations at the Portes Center, a screening center in Chicago, and at the Northwestern Memorial Hospital employee health service, underwent an in-depth battery of tests designed to explore the relationships of both intracellular erythrocyte sodium and sodium-lithium countertransport with age, race, gender, body mass index, pattern of alcohol intake, exogenous hormone use and the presence of hypertension. Erythrocyte sodium was significantly higher in blacks than in whites and in men than in women aged 20-39 years. Relationships of erythrocyte sodium with race and gender, as well as inverse associations with alcohol intake in men, and positive associations with age and the presence of hypertension in women were significant on multivariate analysis after control for other variables. Sodium-lithium countertransport was significantly higher in whites than in blacks and in men than in women aged 20-59 years. Associations of sodium-lithium countertransport with race and gender as well as positive associations of sodium-lithium countertransport with body mass index in men and women were significant on multivariate analysis after control for other variables. Age-related gender differences in both sodium-lithium countertransport and erythrocyte sodium, as well as the association of erythrocyte sodium with the presence of hypertension in women but not in men, suggest a hormonal interaction with sodium transport in the development of hypertension.
Adult↗
Sodium-lithium countertransport and systolic blood pressure response to exercise.
This study examined the relationship between erythrocyte sodium-stimulated lithium countertransport (Na-Li CT) and systolic blood pressure (SBP) response to exercise in 22 white normotensive men (mean age 40.6 years) completing a submaximal (85% of target heart rate) graded exercise tolerance test. These men were assessed to be at risk of hypertension on the basis of a high normal diastolic blood pressure (DBP; 80-89 mmHg), being overweight and having a rapid resting pulse rate. Na-Li CT was positively and significantly associated with the maximal SBP reached during exercise (P less than 0.01) and the lowest SBP achieved during post-exercise supine rest (P less than 0.01). The relationship with resting blood pressure was not significant. Standing DBP was the only resting blood pressure measurement significantly associated with Na-Li CT (P less than 0.05). We found an association between Na-Li CT, a membrane sodium transport system associated with blood pressure and hypertension, and the maximal SBP reached during exercise, a blood pressure measurement predictive of future hypertension, in people with normotensive resting blood pressure. This suggests that altered membrane sodium transport may occur before the establishment of hypertension, and supports the possibility that Na-Li CT may be a risk factor for this disease.
Adult↗
Multiple risk factors in hypertension: results from the Gubbio study.
The association between hypertension and a number of cardiovascular disease risk factors was assessed in the large population sample of Gubbio, a town in central Italy that dates back to medieval times. The data confirm those of previous studies showing that hypertension is strongly associated with other metabolic abnormalities, such as markedly overweight subjects, hyperuricaemia, hyperglycaemia, hypercholesterolaemia, that may be related to the aetiopathogenesis of high blood pressure and, in addition, compound the risk of major clinical cardiovascular events in people with hypertension. The findings are therefore relevant for prevention strategies. In addition, the association between erythrocyte sodium-stimulated lithium countertransport and hypertension is being studied.
Adult↗
Flow stimulates endothelial cells to release a nitrovasodilator that is potentiated by reduced thiol.
We designed a novel system to study flow-mediated endothelium-dependent vasodilation. Vascular rings of rabbit thoracic aorta were mounted for isometric tension recording in a flow chamber filled with physiological saline solution. The flow chamber contained a stir bar and was mounted on a magnetic stirrer to induce vortical flow. Norepinephrine (NE, 10(-6) M) induced contraction of the vascular rings. Bovine endothelial cells on microcarrier beads added to the chamber had little effect on contraction to NE in the absence of flow. Flow induced endothelium-dependent relaxation of the vascular rings that was dependent on the flow rate. Relaxations were annulled or reversed to a contraction with methylene blue, bovine hemoglobin, or N-monomethyl-L-arginine. Conversely, N-acetyl-L-cysteine augmented the flow-mediated relaxation. Furthermore, in the presence of N-acetyl-L-cysteine, the half-life of the endothelium-dependent relaxing factor was increased. In conclusion, the stimulus of flow induces the release by endothelial cells of a diffusible, short-lived factor with the attributes of a nitrovasodilator. The action of this endogenous vasodilator is augmented by the reduced thiol N-acetyl-L-cysteine.
Acetylcysteine↗
Primary prevention of hypertension by nutritional-hygienic means. Final report of a randomized, controlled trial.
A 5-year trial involving 201 men and women with high-normal blood pressure at baseline demonstrated the ability to reduce the incidence of hypertension in participants randomized to nutritional-hygienic intervention compared with a control group. The incidence of hypertension was 8.8% among 102 intervention group participants vs 19.2% among 99 control group members. The odds ratio for the incidence of hypertension in the control group was 2.4. Mean trial blood pressure also was lower in the intervention compared with the control group (-1.2 and -1.9 mm Hg, respectively, for diastolic blood pressure at work-site and office visits and -1.3 and -2.0 mm Hg, respectively, for systolic blood pressure at the two sites). Net weight loss in the intervention group averaged 2.7 kg during the trial; sodium intake was reduced by 25% and reported alcohol intake decreased by 30%. The majority of intervention participants also reported an increase in physical activity. Effect on blood pressure was related particularly to degree of weight loss. Results indicate that even a moderate reduction in risk factors for hypertension among hypertension-prone individuals contributes to the primary prevention of the disease.
Adult↗
Dietary cholesterol and ischaemic heart disease.
In a cohort of 1824 middle-aged men followed for 25 years, intake of dietary cholesterol was associated with risk of death from ischaemic heart disease, from other cardiovascular diseases combined, from all cardiovascular diseases combined, and from all causes combined. The relative hazard of death from all cardiovascular diseases combined, associated with the difference between the mean of the first and fifth quintiles of cholesterol intake (a difference of 184 mg cholesterol/1000 kcal intake) was 1.46 (95% confidence interval 1.10-1.94) after adjustment for age, intake of other dietary lipids, and other coronary risk factors (including serum cholesterol). When stratified into three groups according to serum cholesterol (less than 220 mg/dl, 220-259 mg/dl, and 260 mg/dl or above), the corresponding relative hazards were 1.58, 1.50, and 1.41, respectively. These results are further evidence for the concepts that dietary cholesterol is atherogenic in man, and that the effect is partly independent of total serum cholesterol. They reinforce the recommendation that intake of dietary cholesterol should be low in people without overt hyperlipidaemia as well as those with raised serum cholesterol.
Adult↗
Initial antihypertensive drug therapy--a comparison of alpha-blocker (prazosin) and diuretic (hydrochlorothiazide). Brief summary of a randomized, controlled trial.
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Blood Pressure↗
Electrocardiographic left ventricular hypertrophy and effects of antihypertensive drug therapy in hypertensive participants in the Multiple Risk Factor Intervention Trial.
Data are reported on electrocardiographic left ventricular hypertrophy (ECG LVH) among 8,012 men classified as hypertensive at baseline in the Multiple Risk Factor Intervention Trial. Compared with those allocated to the usual care (UC) control group, men allocated to the special intervention (SI) group experienced a mean reduction of 4 mm Hg in diastolic blood pressure and 7 mm Hg in systolic blood pressure, over 6 years of follow-up. There were 378 new cases of ECG LVH during follow-up; the incidence in the SI group was about 23% less than that in the UC group (4.2 vs 5.4% 2P less than 0.01). Among the 189 men with ECG LVH at baseline, those in the SI group experienced about 24% more annual follow-up visits at which they were free of ECG LVH (4.6 vs 3.7 visits; 2P less than 0.01). This reduced incidence and increased reversal of ECG LVH in the SI group compared with that in the UC group was consistent with significant overall reductions (2P less than 0.001) among SI men in mean wave amplitude in those leads in which voltage is correlated with left ventricular mass (T wave in V1, R wave in aVL and S wave in V3). In SI and UC groups combined, the presence of ECG LVH either at baseline or at follow-up was associated with several-fold increases in death from cardiovascular diseases in general, and death from coronary artery disease in particular.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Celiac axis compression syndrome caused by sarcoidosis: an acquired form of the syndrome.
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Abdomen↗
Is Italy losing the "Mediterranean advantage?" Report on the Gubbio population study: cardiovascular risk factors at baseline. Gubbio Collaborative Study Group.
The coronary heart disease mortality rate in Italy--lower than in many other industrialized countries--has changed little in the last 20 years, whereas in the United States, a major decline in deaths resulting from coronary heart disease has occurred. These differing trends have reduced considerably the gap between the two countries in coronary mortality rates. Several recent population studies in Italy have found a change in the previously more favorable risk factor profile. In the northern hill town of Gubbio, studied in 1983-1985, median serum cholesterol level of men ages 40-59 was 223 mg/dl, considerably higher than was found in the 1960 Italian population samples of the Seven Countries Study (197-206 mg/dl). In the earlier study, the cholesterol levels in the Italian men who were still mainly consuming the traditional Mediterranean diet were 30-40 mg/dl lower than in the U.S. sample. The 1980 Gubbio levels, however, were at least as high as those of their U.S. contemporaries. Cigarette smoking was much higher among the middle-aged men of Gubbio than among a similar U.S. population sample (56% vs 36%). Hypertension prevalence was high, and several risk factors for hypertension--obesity, high salt intake, and alcohol--were common in the Gubbio as well as in other recent Italian population studies. The changing coronary risk profile in Italy, which now includes higher population levels of serum cholesterol as well as the other major coronary heart disease risk factors of cigarette smoking and hypertension, threatens to reduce markedly the "Mediterranean advantage" enjoyed by Italy in the past.
Adult↗
Serum uric acid and 11.5-year mortality of middle-aged women: findings of the Chicago Heart Association Detection Project in Industry.
The relationships of serum uric acid to mortality from all causes, the cardiovascular diseases, and cancer were evaluated in 6797 white women age 35-64 years followed for an average of 11.5 years in the Chicago Heart Association Detection Project in Industry (CHA). Serum uric acid levels at baseline were strongly and significantly associated with all causes mortality in this cohort, with control for multiple risk factors and with exclusion of hypertensives on treatment. When the analysis was performed on age-specific groups 35-44, 45-54, and 55-64 years of age, the association was observed primarily in women in the oldest age group. All cardiovascular deaths, deaths due to coronary heart disease, and all cancer deaths were also associated with serum uric acid levels in the 55-64 year old group. The relationships persisted with control for multiple risk factors and with exclusion of treated hypertensives. A site-specific analysis of cancer deaths demonstrated elevations in mean serum uric acid levels for nearly all sites. Differences in mean serum uric acid levels between decedents and survivors tended to be largest in the first 5 years of follow-up for the cardiovascular deaths, but for cancer decedents they tended to be larger for subsequent years of follow-up. As an initial report on the association of serum uric acid and cancer in women in this age group, the results of this study require confirmation. Although hormonal influences may play a role, pathophysiologic mechanisms relating serum uric acid to mortality in white women aged 55-64 are currently unknown.
Adult↗
Large fluctuations in body weight during young adulthood and twenty-five-year risk of coronary death in men.
The hypothesis that large fluctuations in weight during young adulthood are associated with increased risk of coronary heart disease was investigated by comparing the 25-year mortality of three groups of middle-aged men with distinctly different patterns of self-reported weight during young adulthood: 98 men who reported large gains and large losses, 133 who reported large gains and no losses, and 178 who reported no substantial change in weight. They were selected from a cohort of 2,107 men aged 40-56 years who participated in the Western Electric Study from 1957 through 1983. The 25-year crude risk of coronary death was 26% in the "gain and loss" group, 15% in the "gain only" group, 14% in the "no change" group, and 17% in the remaining 1,550 men. After adjustment for age and major coronary risk factors, the relative risk of coronary death in the gain and loss group as compared with the no change group was 2.0 (95% confidence interval 1.2-3.5). Risk of death from cancer was highest in the gain only group, and risk of death from all causes combined was lowest in the no change group. These results support the concept that large changes in weight during young adulthood increase the risk of coronary disease and of cancer.
Adult↗