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R Fagard

Publications and source records attributed to R Fagard.

At least 55 records · Page 3Linked to original sources
PubMed1999

Biochemical analysis of interleukin-2 receptor beta chain phosphorylation by p56(lck).

Tyrosine phosphorylation of multiple proteins, including the receptor itself, is an initial event in IL-2 signaling and leads to recruitment of SH2 or PTB domain-containing proteins to the receptor. In this study, we have used subdomains of the IL-2 receptor beta chain (IL-2Rbeta) expressed in Escherichia coli as GST fusion proteins to identify the tyrosine residues that could be phosphorylated by p56(lck), one of the critical tyrosine kinases activated by IL-2. We report that recombinant p56(lck) phosphorylates in vitro tyrosine residues within the IL-2Rbeta chain but not those within the IL-2Rgamma chain. p56(lck) phosphorylates tyrosine residues 355, 358 and 361 but not 338 of the IL-2Rbeta chain acidic subdomain. Interestingly, phosphorylation of Tyr-358 appears to require the presence of either Tyr-355 or Tyr-361. p56(lck) also phosphorylates very efficiently the two tyrosines present in the IL-2Rbeta chain C-terminal region, Tyr-392 and Tyr-510. We also investigated the association of p56(lck) with the IL-2Rbeta chain which was found to depend on a short stretch of the IL-2Rbeta chain acidic subdomain, and to be independent of the presence of its tyrosine residues.

Base Sequence↗
PubMed1999

Antihypertensive drugs in very old people: a subgroup meta-analysis of randomised controlled trials. INDANA Group.

BACKGROUND: Beneficial clinical effects of treatment with antihypertensive drugs have been shown in middle-aged patients and in those hypertensive patients over 60 years old, but whether treatment is beneficial in patients over 80 years old is not known. METHODS: We collected data from all participants aged 80 years and over in randomised controlled trials of antihypertensive drugs through direct contact with study investigators. Our primary outcome was fatal and non-fatal stroke. Secondary outcomes were death from all causes, cardiovascular death, fatal and non-fatal major coronary and cardiovascular events, and heart failure. FINDINGS: There were 57 strokes and 34 deaths among 874 actively treated patients, compared with 77 strokes and 28 stroke deaths among 796 controls, representing 1 non-fatal stroke prevented for about 100 patients treated each year. The meta-analysis of data from 1670 participants aged 80 years or older suggested that treatment prevented 34% (95% CI 8-52) of strokes. Rates of major cardiovascular events and heart failure were significantly decreased, by 22% and 39%, respectively. However, there was no treatment benefit for cardiovascular death, and a non-significant 6% (-5 to 18) relative excess of death from all causes. INTERPRETATIONS: The inconclusive findings for mortality contrast with the benefit of treatment for non-fatal events. Results of a large-scale specific trial are needed for definite conclusion that antihypertensive treatment is beneficial in very elderly hypertensive patients. Meanwhile, an age threshold beyond which hypertension should not be treated cannot be justified.

Aged↗
PubMed1999

Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. Systolic Hypertension in Europe Trial Investigators.

BACKGROUND: Recent reports suggest that calcium-channel blockers may be harmful in patients with diabetes and hypertension. We previously reported that antihypertensive treatment with the calcium-channel blocker nitrendipine reduced the risk of cardiovascular events. In this post hoc analysis, we compared the outcome of treatment with nitrendipine in diabetic and nondiabetic patients. METHODS: After stratification according to center, sex, and presence or absence of previous cardiovascular complications, 4695 patients (age, > or =60 years) with systolic blood pressure of 160 to 219 mm Hg and diastolic pressure below 95 mm Hg were randomly assigned to receive active treatment or placebo. Active treatment consisted of nitrendipine (10 to 40 mg per day) with the possible addition or substitution of enalapril (5 to 20 mg per day) or hydrochlorothiazide (12.5 to 25 mg per day) or both, titrated to reduce the systolic blood pressure by at least 20 mm Hg and to less than 150 mm Hg. In the control group, matching placebo tablets were administered similarly. RESULTS: At randomization, 492 patients (10.5 percent) had diabetes. After a median follow-up of two years, the systolic and diastolic blood pressures in the placebo and active-treatment groups differed by 8.6 and 3.9 mm Hg, respectively, among the diabetic patients. Among the 4203 patients without diabetes, systolic and diastolic pressures differed by 10.3 and 4.5 mm Hg, respectively, in the two groups. After adjustment for possible confounders, active treatment was found to have reduced overall mortality by 55 percent (from 45.1 deaths per 1000 patients to 26.4 deaths per 1000 patients), mortality from cardiovascular disease by 76 percent, all cardiovascular events combined by 69 percent, fatal and nonfatal strokes by 73 percent, and all cardiac events combined by 63 percent in the group of patients with diabetes. Among the nondiabetic patients, active treatment decreased all cardiovascular events combined by 26 percent and fatal and nonfatal strokes by 38 percent. In the group of patients receiving active treatment, reductions in overall mortality, mortality from cardiovascular disease, and all cardiovascular events were significantly larger among the diabetic patients than among the nondiabetic patients (P=0.04, P=0.02, and P=0.01, respectively). CONCLUSIONS: Nitrendipine-based antihypertensive therapy is particularly beneficial in older patients with diabetes and isolated systolic hypertension. Thus, our findings do not support the hypothesis that the use of long-acting calcium-channel blockers may be harmful in diabetic patients.

Aged↗
PubMed1999

Cytosolic calcium and lymphoproliferative response during calcium antagonism in men.

OBJECTIVE: A double-blind, placebo-controlled parallel study was conducted on the effect of mibefradil, both an L- and T-type Ca2+-channel blocker with a more selective blockade of T-type channels, administered once daily for 1 week to normal male subjects, on blood pressure, intracellular cationic concentrations, sodium-proton exchange rate and 3H-thymidine incorporation in peripheral blood mononuclear cells (PBMC). METHODS: After a 1-week run-in period on placebo, the subjects (n = 40) were allocated to a placebo or a mibefradil group. Placebo or 50 mg mibefradil was administered once daily in the morning for 1 week. All subjects were investigated at baseline and after 1 week of placebo or mibefradil administration. Standing or recumbent blood pressure and heart rate of subjects in the mibefradil group was decreased (P < 0.05 or less) compared with that of subjects in the placebo group. RESULTS: Decreased (P < 0.001) intracellular free Ca2+ concentration and reduced (P < 0.001) 3H-thymidine incorporation in the PBMC were observed in the mibefradil-treated subjects. The intracellular sodium, potassium or magnesium concentration as well as the sodium-proton exchange rate were not changed during mibefradil administration. CONCLUSION: The blood pressure lowering action of mibefradil in men is accompanied by a decrease in intracellular free Ca2+ concentration. Mibefradil also reduced the 3H-thymidine incorporation or de novo DNA synthesis in PBMC by modulating the calcium homeostasis.

Adult↗
PubMed1999

Differential development of Toxoplasma gondii in neural cells.

In this article, Remi Fagard and colleagues discuss the properties of neurons that lead to their low infection by Toxoplasma gondii, and the role that cytokines such as tumour necrosis factor alpha (TNF-alpha) and interferon gamma (IFN-gamma) might play.

Animals↗
PubMed1999

Out-patient versus in-hospital ambulatory 24-h blood pressure monitoring in heart transplant recipients.

OBJECTIVE: To study the effect of the environment--in-hospital vs. out-patient situation--on blood pressure as measured by ambulatory blood pressure monitoring (ABPM). PATIENTS AND METHODS: Twenty-four hour ABPM was performed sequentially in-hospital and again 9+/-3 days later on an out-patient basis, in 30 consecutive heart transplant recipients (27 men, median age 56 years, median time post-transplant 3 years). The same equipment was used on both occasions, without any interim change in medical treatment. RESULTS: Both systolic and diastolic blood pressure were higher in-hospital than as an out-patient: +7+/-7 and +6+/-5 mm Hg respectively for the 24-h average (P<0.001). Daytime and night-time pressures were affected similarly. Depending on the specific cut-off values used, 37 to 87% of the individual patients were hypertensive in-hospital; 31 to 73% of these had an acceptable blood pressure as an out-patient. The converse was very rare (0 to 3% of the total group). CONCLUSIONS: In heart transplant patients blood pressure as assessed from 24-h ABPM is lower in the home environment than during a hospital stay. The post-transplant attenuation of the circadian variation in blood pressure is not influenced by the environment. Checking an unsatisfactory in-hospital ABPM with an outpatient recording may obviate the need for an (intensified) antihypertensive treatment in a substantial number of patients.

Adolescent↗
PubMed1999

Overview of the outcome trials in older patients with isolated systolic hypertension.

AIMS: Isolated systolic hypertension affects over 8 to 15% of all subjects older than 60 years. In the elderly, systolic hypertension is the major modifiable cardiovascular risk factor. Three placebo-controlled outcome trials on antihypertensive drug treatment of this disorder have been published. The aim of this article was to shortly review each of these three trials and to present the pooled estimates of benefit of antihypertensive drug treatment in isolated systolic hypertension in the elderly. METHODS AND RESULTS: The Systolic Hypertension in the Elderly Program (SHEP) in the United States, the Systolic Hypertension in Europe (Syst-Eur) trial and the Systolic Hypertension in China (Syst-China) trial published their main findings in 1991, 1997 and 1998, respectively. The outcome results of these trials were pooled by calculating the common odds ratio for active versus placebo treatment for five major end-points. Zelen's exact test for homogeneity did not reach statistical significance for any of the end-points considered. Thus, the hypothesis of a common underlying treatment effect across the three trials was not rejected. Overall, active treatment compared with placebo, reduced all-cause mortality by 17%, cardiovascular mortality by 25%, all cardiovascular end-points by 32%, total stroke by 37% and myocardial infarction including sudden death by 25%. CONCLUSIONS: The pooled results of the outcome trials in older patients with isolated systolic hypertension prove that antihypertensive drug treatment must be prescribed, if on repeated measurement systolic blood pressure is 160 mm Hg or higher.

Aged↗
PubMed1999

Symptoms reported by elderly patients with isolated systolic hypertension: baseline data from the SYST-EUR trial. Systolic Hypertension in Europe.

OBJECTIVES: To determine the symptomatic well-being of elderly persons with isolated systolic hypertension. DESIGN AND SETTING: Well-being determined during the placebo run-in period prior to entry to the Systolic Hypertension in Europe (SYST-EUR) trial. SUBJECTS: 641 People, 60 years or older with an average sitting blood pressure of 173/86 mm Hg. OUTCOME MEASURES: 33 Symptomatic complaints determined by a standard interview. RESULTS: The 437 women complained of 25% of the symptoms and the 204 men 21% (P<0.001). A markedly higher prevalence was observed in women compared with men for: pain in the joints of the hands (35% of women complained of this against 22% of men); 'racing heart' (33% against 17%); dry eyes (16% against 6%); blurring of vision (35% against 23%); cramps in the legs (43% against 31%); and a sore throat (15% against 7%). Nocturia was the most frequent complaint (68% in both sexes). Eight symptoms increased with age and one (rash) tended to decline. With increasing systolic pressure women also reported more headaches, unsteadiness, blurring of vision, irregular heart beat and 'racing heart' but, of these, only headaches increased with diastolic pressure. These observations were made after adjusting for age, blood sugar and body mass index (BMI) and were not observed in men. Higher blood sugars were associated with mouth ulcers, 'racing heart', blurring of vision and cramps in the legs. A higher BMI was associated with six symptoms, and a lower age of leaving education with eight. In men, alcohol consumption was related to 'racing heart', and smoking to wheezing and having a dry cough. CONCLUSIONS: A high level of complaint was associated with female gender, increasing age, blood sugar and BMI and a low age of leaving education.

Aged↗
PubMed1999

M235T angiotensinogen gene polymorphism and cardiovascular renal risk.

OBJECTIVE: In this meta-analysis, we attempted to derive pooled estimates for the putative associations between various cardiovascular-renal disorders and the M235T polymorphism of the angiotensinogen gene. METHODS: Case-control studies were combined, using the Mantel and Haenszel approach. Joint P values for continuous variables were calculated by Stouffer's method. Continuous measurements reported in different units were expressed on a percentage scale using the intrastudy mean of the MM genotype as denominator. RESULTS: The computerized database used for this analysis included 69 reports with an overall sample size of 27,906 subjects. Overall, possession of the T allele was associated with an increased risk of hypertension. In comparison with the MM reference group (number of studies, n = 32), the excess risk was 31% (P = 0.001) in TT homozygotes and 11% (P = 0.03) in TM heterozygotes. The sensitivity analysis showed that this association was present only in whites (T allelic frequency, f = 42.2%), but not in blacks (f = 77.0%) or Asians (f = 78.0%). Atherosclerotic complications (n = 12), renal microvascular disorders (n = 13), cardiomyopathy (n = 2) or diabetic retinopathy (n = 3) were not correlated with the M235T polymorphism. Publication bias was observed for hypertension, but not for coronary heart disease, including myocardial infarction, and for microvascular nephropathy. Furthermore, in comparison with the MM control group, the circulating angiotensinogen levels (n = 8) were raised by 11 and 7% (P = 0.01) in TT and TM subjects, respectively. In contrast, plasma levels of the angiotensin I converting enzyme (n = 4) and body mass index (n = 15) were not associated with the T allele. CONCLUSION: The T allele encoding angiotensinogen is not associated with atherosclerotic or microvascular complications, but in Caucasians behaves as a marker for hypertension. This association, which may have been inflated by publication bias, does not necessarily imply causality.

Alleles↗
PubMed1999

Prognostic significance of exercise versus resting blood pressure in patients with chronic heart failure.

BACKGROUND: Results on the prognostic value of exercise blood pressure differ among studies; this may be related to the characteristics of the studied population. OBJECTIVE: To assess the prognostic significance of blood pressure measured during exercise in patients with chronic heart failure being considered for heart transplantation. DESIGN AND METHODS: Symptom-limited bicycle exercise testing with measurement of blood pressure and respiratory gas analysis was performed in 274 potential candidates for heart transplantation. They were then followed up for mortality and cardiovascular events. RESULTS: Results are given as the mean +/- SD. The age of the patients was 51.5+/-11.0 years, the resting blood pressure was 114+/-20/75+/-12 mmHg, the peak work load was 91+/-33 W and the peak oxygen uptake was 15.1+/-5.0 ml/min per kg. The systolic blood pressure increased to 128+/-21 mmHg at 30 W and to 133+/-23 mmHg at 50% of the peak work load. During the total follow-up time of 513 years, 55 patients died and 145 suffered at least one cardiovascular event. After controlling for age, gender and body mass index, mortality and incidence of events were inversely related to the systolic pressure at 30 W or at 50% of the peak work load, or to both (P < 0.05). The inverse associations of outcome with the systolic pressure at 50% of the peak work load persisted after additional adjustment for resting pressure and for peak oxygen uptake. CONCLUSION: The data indicate that a lower exercise systolic pressure, particularly at 50% of the peak work load, is associated with a higher mortality and a greater incidence of cardiovascular events.

Adolescent↗
PubMed1999

Mibefradil-induced inhibition of proliferation of human peripheral blood mononuclear cells.

To evaluate the role of intracellular calcium and particularly Ca2+-uptake in the initiation of lymphocyte mitogenesis, the effect of mibefradil, which blocks both L- and T-type calcium channels with a more selective blockade of T-type channels, on the proliferation of human peripheral blood mononuclear cells (PBMCs) is compared with the effect of nifedipine, which blocks only the L-type calcium channel. The rate of [3H]thymidine incorporation into control and concanavalin A-stimulated PBMCs in the presence or absence of the calcium channel blockers mibefradil or nifedipine (1, 10, or 50 microM), and of the intracellular calcium antagonist 3,4,5-trimethoxybenzoic acid 8-(diethylamino) octyl ester (TMB-8; 1, 10, 25, or 50 microM) was assayed in the cells cultured for 3 days. The cellular cytotoxicity and the cell number in growing cultures also was determined in mibefradil- or nifedipine-treated control or stimulated cells. Restoration of the proliferative response in mibefradil- or nifedipine-treated cells was investigated by addition of exogenous interleukin-2. Interleukin-2-receptor expression in the cells was monitored by using anti-activated T-cell antigen (Tac) antibody, and the interleukin-2 production in the cell supernatants of the cultures was determined by an enzyme-amplified sensitive immunoassay. Mibefradil and nifedipine concentration-dependently reduced the cell number and the [3H]thymidine incorporation or the de novo DNA synthesis in control and concanavalin A-stimulated human PBMCs. Mibefradil exhibited a more pronounced inhibition of the proliferation of human PBMCs than did nifedipine. The inhibitory effect of mibefradil or nifedipine on DNA synthesis was dependent on the timing of treatment with the drugs. The inhibitory effect of mibefradil or nifedipine on the lymphoproliferative response was nearly abolished if the drugs were added 20 h after cell stimulation. A markedly reduced inhibitory effect was found when mibefradil or nifedipine was added 1-7 h after cell stimulation. However, regardless of time of addition, TMB-8 caused a persistent inhibition of the proliferation of human PBMCs. The inhibitory effect of mibefradil or nifedipine on the proliferation of human PBMCs is nearly abolished by addition of the calcium channel activator Bay K 8644. The proliferative response of mibefradil- or nifedipine-treated cells is restored by addition of exogenous interleukin-2. The normal expression of interleukin-2 receptors was preserved, whereas the interleukin-2 production was blocked in the presence of mibefradil or nifedipine. Our data show that mibefradil has a more pronounced inhibitory effect on the proliferation of human PBMCs than nifedipine and that this inhibitory effect on DNA synthesis is dependent on the timing of treatment with both drugs.

3-Pyridinecarboxylic acid, 1,4-dihydro-2,6-dimethy↗
PubMed1999

Blood Pressure Monitoring. Task force III: Target-organ damage, morbidity and mortality.

OBJECTIVE: To reach a consensus on ambulatory blood pressure (ABP) as a predictor of target-organ damage (TOD), morbidity and mortality. METHOD: The members of task force III wrote this article in preparation for the Seventh International Consensus Conference (23-25 September 1999). This article was amended after the meeting to reflect the consensus reached at the conference. POINTS OF CONSENSUS: In most studies, TOD in essential hypertension was more closely associated with ABP than it was with clinic blood pressure, the mean weighted correlation coefficients for the relationship of left ventricular mass with blood pressure being 0.50/0.44 (24h systolic/diastolic blood pressure) and 0.35/0.32 (clinic systolic/diastolic blood pressure), respectively. The above correlation coefficients vary among studies, possibly because of different standardizations of clinic blood pressure measurements and ways of selecting subjects, among other reasons. The closeness of the association between clinic blood pressure and left ventricular mass increases with the numbers of clinic measurements of blood pressure and visits to a clinic. Thus, the variance of left ventricular mass explained by ABP in addition to that explained by clinic blood pressure diminishes with the number of clinic blood pressure readings. The proportion of variability of left ventricular mass that is directly accounted for by the day-night difference in blood pressure is 15% at the most. Thus, the advantage of ABP over clinic blood pressure appears to be, at least in part, a result of the greater number of measurements over the 24h. It might also depend, however, on the information offered by ambulatory blood pressure monitoring (ABPM) on daily-life variations in blood pressure. TOD appears to be more closely associated with ABP than it is with clinic blood pressure for the subjects with reproducible ABP tracings, but not for those with poorly reproducible tracings. The probability of developing sustained clinic hypertension at follow-up seems to be better predicted by clinic blood pressure on several occasions over a 6-month period than it is by ABP at baseline, although, when also ABPM is repeatedly performed at follow-up, its ability to predict clinical outcomes of hypertensive patients remains superior to that of repeated clinic blood pressure measurements. ABPM of the elderly appears feasible and is tolerated well. A blunted day-night fall in blood pressure ('non-dipping') seems to be harmful, while evidence regarding the potentially harmful effect of extreme dipping is still limited. Authors of the Syst-Eur study recently demonstrated the prognostic value of ambulatory systolic blood pressure and in particular, of night-time blood pressure, in assessing old subjects with isolated systolic hypertension. The assessment of variability of blood pressure has been shown to provide a further prediction of cardiovascular risk and the potentially prognostic value of beat-to-beat variability assessed non-invasively (using a Finapres or Portapres device)needs further study. In the published event-based studies, the prognostic value of ABP recorded during a single session was superior to that of clinic blood pressure. Since the authors of published event-based prognostic studies compared ABP with only a few clinic measurements of blood pressure, it is not known how many visits or measurements of blood pressure (and at what cost) would equate to a single session of ABPM in terms of prediction of cardiovascular events. ABPM might allow one to identify a subset with 'normal' ABP (white-coat or isolated clinic hypertension). Daytime ABP levels <135 mmHg systolic and 85 mmHg diastolic can be defined as normal and values <130/80 mmHg could be defined as optimal. Cardiovascular risk for subjects with normal ABP seems to be lower than that for those with abnormally high ABP. Long-term observational and intervention studies concerning subjects with white-coat hypertension are needed. (ABST

Activities of Daily Living↗
PubMed1999

Ventricular premature beats in triathletes: still a physiological phenomenon?

UNLABELLED: Sudden death is a tragic fact, unexpectedly arising in all age groups. Ventricular arrhythmias are the main cause. At the end of a maximal exercise test more ventricular premature beats were noted in a group of well trained triathletes compared with a similar control group. The etiology is multifactorial. When these ventricular premature beats are associated with specific structural and functional heart adaptations, echocardiographically and electrocardiographically well-documented, then those 'banal' ventricular premature beats cannot longer be considered as a physiological phenomenon. In these circumstances the involved subject is a candidate for dangerous arrhythmias and 'sudden cardiac death'. PURPOSE: The principal cause of 'Sudden cardiac death' is ventricular arrhythmias. We explore the incidence of ventricular premature beats (VPB) in triathletes, who engage in enforced endurance sports. METHODS: Fifty-two triathletes were compared with twenty-two control subjects with comparable anthropometric parameters in function of structural and functional cardiac adaptations. Maximal exercise tests were conducted on a stationary bicycle and a treadmill. During the last two minutes of each test, the VPB were registered. RESULTS: Statistically significant differences emerged in the cardiac structure and function between the triathletes and the controls. There were signs of cardiac hypertrophy and arguments for a supernormally diastolic left ventricular function in the triathletes. The performance capacity was also significantly higher in the triathletes. The maximal heart rate was significantly higher in the control group. The number of VPB was significantly higher in the triathletes. The increased risk of VPB in the triathlon group is caused by several factors: the degree of cardiac hypertrophy, the increased diastolic reserve, the duration of the exercise, the existence of an aortic insufficiency jet and some specific electrocardiographic findings. CONCLUSIONS: The triathlete has an increased risk of VPB during maximal efforts. We doubt the traditionally accepted view of the physiological nature of those VPB and suspect that the limit of physiological cardiac adaptations to sport efforts is exceeded with the appearance of VPB. The triathlete with VPB and with specific electrocardiographic and echocardiographic findings is a candidate for 'sudden cardiac death'.

Adult↗
PubMed1999

Gender differences in the oxygen transport system during maximal exercise in hypertensive subjects.

STUDY OBJECTIVES: To analyze gender differences in the oxygen transport system at peak exercise with particular emphasis on the difference in systemic arteriovenous oxygen extraction and in mixed venous oxygen saturation. PATIENTS AND METHODS: Cardiopulmonary graded exercise testing and hemodynamic assessment were performed on a cycle ergometer in 64 hypertensive patients (32 female and 32 male) varying in age from 23 to 64 years. Female and male patients were matched for age and BP. MEASUREMENTS AND RESULTS: Peak oxygen uptake was significantly lower in women than in men, and when expressed in absolute units (L/min: -39%) and when normalized for body mass (mL/min/kg: -33%) or statistically adjusted for height and weight (-29%). This resulted essentially from a significantly lower cardiac output in women, both when expressed in absolute units and when adjusted for body size. At the peripheral level, female patients had a lower arteriovenous oxygen content difference at peak exercise, which resulted from a lower hemoglobin concentration and the inability to decrease mixed venous oxygen saturation to the same level as in men. CONCLUSION: The lower peak oxygen uptake of women results from both central and peripheral factors. The significantly higher value for mixed venous oxygen saturation, which contributes to the lower arteriovenous oxygen difference of women, could result from their smaller muscle mass, lower capillary density, and lower oxidative potential.

Adult↗
PubMed1999

The international database of self-recorded blood pressures in normotensive and untreated hypertensive subjects.

OBJECTIVES: To pool data from individual subjects in an attempt to determine an operational threshold for making clinical decisions based on the self-recorded blood pressure (SRBP) and to examine how many hypertensive subjects, diagnosed by conventional blood pressure (CBP) measurement, would have a self-recorded blood pressure within the normotensive range if the proposed thresholds were applied. DATA SOURCES: Thirteen research groups studied 4668 untreated subjects. RESULTS: In total 2401 subjects were normotensive, 494 were borderline hypertensive and 1773 were definitely hypertensive. Hypertension had been diagnosed from the mean of 1-6 (median 3) CBP measurements obtained during 1-3 (median 1) visits. The reference values for SRBP measurements determined from the 95th percentiles of the distributions for normotensive subjects were 137 mmHg systolic and 85 mmHg diastolic. Of the subjects with systolic hypertension, 16% had systolic SRBP </= 137 mmHg. Similarly, 25% of those with diastolic hypertension had diastolic SRBP </= 85 mmHg. The probability that hypertensive subjects had SRBP below these thresholds was 34% (diastolic) to 62% (systolic) greater for women than it was for men, was 2-3 times greater if fewer than three CBP measurements had been averaged for establishing the diagnosis of hypertension, and increased by 50% (diastolic) to 126% (systolic) when SRBP had been measured on more than 3 days. In contrast, for each 10 mmHg increment in systolic CBP, this probability decreased by 35% for systolic SRBP and by 11% for diastolic SRBP; for each 5 mmHg increment in diastolic CBP it decreased by 36% for diastolic SRBP. In addition, for systolic blood pressure, the probability decreased by 31% for each 10-year increment in age. CONCLUSIONS: Until the relationship between SRBP and the incidence of cardiovascular morbidity and mortality has been clarified further by prospective studies, a mean self-recorded blood pressure above 137 mmHg systolic or 85 mmHg diastolic may be considered hypertensive. Among the hypertensive patients 16-31% had SRBP below these thresholds, but this proportion decreased if the hypertensive subjects had higher CBP.

Adolescent↗