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PubMed1995

Cardiac and carotid structure in patients with established hypertension and white-coat hypertension.

AIM: The introduction of ambulatory blood pressure monitoring in the clinical practice has defined a new subgroup of hypertensive patients called white-coat hypertensives. It has been reported that white-coat hypertensives have less cardiac involvement than established hypertensive patients. This study was designed to examine the extent of cardiac and vascular involvement in patients with white-coat hypertension and established hypertension. PATIENTS AND METHODS: We studied 82 patients with mild essential hypertension, never previously treated, using 24-h ambulatory blood pressure monitoring and an echocardiographic and vascular ultrasonographic study. Left ventricular dimensions and mass were obtained according to the Penn convention. The intima-media thickness of the posterior wall of both common carotid arteries was measured 5, 10 and 20 mm caudally to the flow-divider and the average value was used for analysis. RESULTS: Of the 82 patients, 31 (mean +/- SD age 35 +/- 10 years) had average 24-h systolic/diastolic blood pressure values of below 132/85 mmHg (white-coat hypertensives) and 51 (aged 42 +/- 2 years) had a consistently elevated diastolic blood pressure. Both groups had similar body surface area (1.82 +/- 0.22 versus 1.81 +/- 0.22 m2), sex distribution (20 males and 11 females versus 32 males and 19 females), duration of hypertension, metabolic parameters and smoking habit. The 24-h ambulatory blood pressure monitoring values were, by definition, significantly higher in established hypertensives than in white-coat hypertensives (142 +/- 10/94 +/- 6 versus 127 +/- 6/79 +/- 4 mmHg, P<0.001). The left ventricular mass index and intima-media thickness were significantly higher in the established hypertensives (112 +/- 17 g/m2, 0.67 +/- 0.11 mm, respectively) than in the white-coat hypertensives (98 +/- 18 g/m2, 0.58 +/- 0.09 mm; P<0.001 for both). CONCLUSIONS: The prevalence of left ventricular hypertrophy and cardiac remodeling was significantly more frequent in established hypertensives (51%) compared to white-coat hypertensives (19%). These confirm that structural changes in the left ventricle in white-coat hypertensives are more limited than in established hypertensives and show that in white-coat hypertensives there is significantly less involvement of the conductance vessels than in established hypertensives.

Adult↗
PubMed1996

Probability of having hypertension: effects of sex, history of hypertension in parents, and other risk factors.

The objective of the present study was to determine whether paternal and maternal history of hypertension contributes to the probability of an individual having hypertension before and after other measured traits, including sex, are considered. A cross-sectional sample of 217 men and 196 women was selected from the general Caucasion population of Rochester, Minnesota without respect to the hypertension status of subjects and their parents. Logistic regression analyses indicated that when no other information was considered, paternal history of hypertension contributed to the probability of having hypertension in men (chi 2 = 4.14, df = 1, p = 0.042) and in women (chi 2 = 4.12, df = 1, p = 0.042). The odds ratio associated with paternal history of hypertension was 2.80 in men (95% confidence interval [CI] = 1.0-8.0); the odds ratio was 4.11 in women (95% CI = 0.9-19.3). Maternal history of hypertension provided a marginally significant contribution to the prediction of probability of having hypertension in men (chi 2 = 3.86, df = 1, p = 0.049 in men), and less so in women (chi 2 = 3.31, df = 1, p = 0.068). The odds ratios associated with maternal history of hypertension were 2.85 in men (95% CI = 0.9-8.8) and 3.60 in women (95% CI = 0.8-16.9). A stepwise selection algorithm was used to select other predictors of hypertension in men and women. Other predictors of hypertension identified in men were age and sodium-lithium countertransport level. After these other predictors were considered, paternal but not maternal history of hypertension contributed to the probability of having hypertension in men. In a model that contained these other predictors, the partial odds ratio associated with paternal history of hypertension was 3.38 (95% CI = 1.1 = 10.1). Other predictors identified in women were age, apolipoprotein (apo) B, and apo B squared. After these other predictors were considered, neither paternal nor maternal history of hypertension made a statistically significant contribution to the probability of having hypertension in women. These results suggest that evaluation of the hypertension risk of an individual depends on the sex of the individual, the sexes of the individual's hypertensive parents, and the values of other measured risk factor traits.

Algorithms↗
PubMed1996

Retinol-binding protein and transferrin in urine. New markers of renal function in essential hypertension and white coat hypertension?

We studied the 24 h urinary excretion of albumin, transferrin, immunoglobulin G, and retinol-binding protein in individuals with essential hypertension, white coat hypertension, and normotension. In 56 individuals, we measured the 24 h ambulatory blood pressure (AMBP). The individuals could be divided into three groups: 26 hypertensives, 14 white coat hypertensives, and 16 normotensives. Daytime AMBP values were (median values with range in parentheses, mm Hg): hypertensives 158/105 (198 to 121/95 to 120), white coat hypertensives 141/83 (161 to 129/72 to 90), and normotensives 123/75 (148 to 102/63 to 86). We determined with immunochemical methods the 24 h urinary excretions of albumin, transferrin, and immunoglobulin G, all markers of glomerular dysfunction, and retinol-binding protein, a marker of impaired proximal tubular function. We found a significantly higher excretion of albumin and transferrin in hypertensives (P < .0000/P < .0001) and in white coat hypertensives (P < .003/P < .02) compared to normotensives. Out of 26 hypertensives, seven had microalbuminuria (> or = 30 to < 300 mg albumin/ 24 h). Two cases of microalbuminuria were found among the 14 white coat hypertensives. Immunoglobulin G excretion was not significantly increased in any of the hypertensive groups. Retinol-binding protein excretion was significantly higher in hypertensive patients (P < .007), whereas no elevation was observed in persons with white coat hypertension. In hypertensives, a significant correlation was found between urinary excretion of albumin and transferrin and office blood pressure and systolic AMBP. There was no significant correlation between the urinary excretions of IgG and retinol-binding protein and blood pressures in any of the three groups. Our findings indicate that patients with white coat hypertension, like hypertensives, have a selective type of glomerular dysfunction. However, proximal tubular dysfunction was seen only in hypertensives. Urinary excretions of albumin, transferrin, and retinol-binding protein may be useful as markers of glomerular and tubular dysfunction in essential hypertension.

Biomarkers↗
PubMed2006

Public education on hypertension: a new initiative to improve the prevention, treatment and control of hypertension in Canada.

High blood pressure is one of the leading risk factors for death. Nevertheless, there is a lack of awareness of hypertension as a risk factor, as well as significant misconceptions about hypertension in the Canadian population. Furthermore, according to the Canadian Heart Health Surveys (1985 to 1992), 42% of hypertensive adult Canadians are unaware of their hypertensive status. A collaboration between Blood Pressure Canada, the Heart and Stroke Foundation of Canada, the Canadian Hypertension Society and the Canadian Hypertension Education Program has been formed to improve public and patient awareness and knowledge of hypertension. The effort will involve the translation of Canadian Hypertension Education Program recommendations for the prevention and management of hypertension to a public level with a broad and evolving dissemination strategy; the training of health professionals to speak to the public and patients on hypertension, coupled with opportunities to speak in forums organized in their local communities; and, media releases and information on hypertension in association with World Hypertension Day and the release of the annually updated public recommendations. Based on higher rates of awareness of hypertension in countries with sustained public education programs on hypertension, it is anticipated that this evolving program will result in improvement in the rates of awareness, treatment and control of hypertension and, ultimately, in lower cardiovascular disease rates in Canada. Public health programs that could reduce the prevalence of hypertension will be integrated into key public recommendations. The program outcomes will be monitored using Statistics Canada national surveys and by specific surveys examining hypertension knowledge in the Canadian population.

Canada↗
PubMed2006

Progression of pre-hypertension, stage 1 and 2 hypertension (JNC 7): a population-based study in Keelung, Taiwan (Keelung Community-based Integrated Screening No. 9).

OBJECTIVE: To investigate the prevalence and progression of, and identify risk factors for, pre-hypertension, stage 1 and 2 hypertension in a population-based study. DESIGN: A prospective cohort study. SETTING: An integrated community-based multiple screening program in Keelung, Taiwan. PARTICIPANTS: A total of 67 011 individuals aged 20-79 years between 1999 and 2003 were included. Of these, 22 111 re-attended, yielding 53 689 repeated recordings of blood pressure, including movement between normal and pre-hypertension and progression from pre-hypertension to stage 1 or stage 2 hypertension. MAIN OUTCOME MEASURES: Blood pressure was defined and classified according to the JNC 7 Report as normal, pre-hypertension, stage 1, and stage 2 hypertension. RESULTS: Below 50 years of age, males had a higher progression rate, particularly from normal to pre-hypertension, than females. Annual regression rates from pre-hypertension to normal were higher in the young age group than in the old age group, particularly for females. Factors associated with the occurrence of pre-hypertension were old age, male gender, high waist circumference, abnormal blood lipids, smoking, chewing betel nuts, lack of exercise, and having parents with hypertension. Factors associated with regression from pre-hypertension to normal were body mass index, fasting glucose, high-density lipoprotein level, smoking, and parents with hypertension. Progression from pre-hypertension to stage 1 hypertension was positively related to male gender, higher waist circumference, and having parents with hypertension. CONCLUSIONS: The rates of progression and regression of hypertension vary with age and gender, anthropometric and biochemical measurements, and family history.

Age Distribution↗
PubMed1999

Excess stroke among hypertensive men and women attributable to undertreatment of hypertension.

BACKGROUND AND PURPOSE: Most population-based studies indicate that a considerable proportion of hypertensive subjects are undertreated and that undertreatment is more prevalent among hypertensive men than among hypertensive women. The aim of our study was to investigate the consequences of undertreatment of hypertension for women and men in terms of stroke occurrence. METHODS: Approximately 45 000 men and women aged >/=20 years were examined in 2 population-based studies in the Netherlands. A cohort of 2616 hypertensive subjects (pharmacologically treated hypertensives and untreated hypertensives who needed pharmacological treatment according to the severity of their hypertension and the coexistence of additional cardiovascular risk factors) was selected for a follow-up study. Follow-up (mean duration, 4.6 years) was complete for 2369 (91%) of the enrolled hypertensive subjects. RESULTS: Compared with treated and controlled hypertensives, the relative risks of stroke for treated and uncontrolled hypertensives and for untreated hypertensives who needed treatment were 1.30 (95% CI, 0.70 to 2.44) and 1.76 (95% CI, 1.05 to 2.94), respectively. These relative risks and the prevalence of (undertreated) hypertension in the total population of 45 000 subjects were used to estimate the number of strokes in the Netherlands attributable to undertreatment. Among hypertensive men and women aged >/=20 years in the Netherlands, the proportions of strokes attributable to treated but uncontrolled blood pressure were 3.1% (95% CI, -5.2% to 18.7%) and 4.1% (95% CI, -7.2% to 20.7%), respectively. For untreated hypertensive men and women who should have been treated, these proportions were 22.8% (95% CI, 0.8% to 38.4%) and 25.4% (95% CI, 0. 5% to 42.5%), respectively. CONCLUSIONS: Increasing the detection of hypertension and improving adherence to current guidelines might prevent a considerable proportion of the incident strokes among hypertensives. The potential impact of achieving control of blood pressure in patients already being treated on the reduction of strokes requires further investigation.

Adult↗
PubMed1998

["White-coat hypertension": variation of normality or of hypertension?].

INTRODUCTION: Previous studies have demonstrated a high prevalence of "white coat" hypertension (20%), but it is still controversial if it implies an increase in cardiovascular risk. PATIENTS: Between 1992 and 95 we prospectively studied 175 untreated hypertensive patients aged over 18 years (V Joint National Committee's stage I-II), and 91 controls. DESIGN AND METHODS: The subjects were submitted to clinical evaluation, ambulatory blood pressure monitoring, 24-hour Holter monitoring, signal-averaged ECG, echocardiography/Doppler and ergometry. "White coat" hypertension was defined as mean daytime (6.00-22.00 H) ambulatory blood pressure < 136/87 mm Hg (males) and < 131/86 mm Hg (females). RESULTS: "White coat" hypertension was present in 29 patients (18%). "White coat" hypertension patients had an identical prevalence of smoking, family history of cardiovascular disease, abnormal ECG and retinopathy (> Keith-Wagener II) as patients with daytime hypertension. Ambulatory blood pressure values (24 hour, 6.00-22.00 h, 22.00-6.00 h, sleep, blood pressure load, heart rate) were all significantly different from controls (p < 0.03 to 0.0007). In patients with daytime hypertension, only 24 hour and daytime diastolic ambulatory blood pressure (p < 0.005) were different from "white coat" hypertension patients. Exercise testing blood pressure values (6 min exercise, maximal, 3 min recovery) were significantly different between "white coat" hypertension patients and the control group (n = 70) (p varying from 0.05 to 0.005) but not between "white coat" hypertension and daytime hypertension (n = 33) patients. Diastolic function was studied only in 39 daytime hypertension patients, 10 individuals with "white coat" hypertension and 34 controls (for technical reasons and because we only analyzed individuals younger than 55 years). E velocity and E/A ratio were similar in "white coat" hypertension and daytime hypertension, but only in daytime hypertension patients they reached a significant difference from controls (p = 0.04; p = 0.01), probably due to the small number of patients. CONCLUSIONS: These data (clinical, ambulatory blood pressure, ergometric, diastolic function) suggest that "white coat" hypertension might not be a benign entity.

Blood Pressure↗
PubMed1998

Are spouses of patients with hypertension at increased risk of having hypertension? A population-based case-control study.

BACKGROUND: Studies of couples, who tend to share an environment but are genetically dissimilar, can shed light on the contribution of environmental factors to hypertension. There has been renewed interest in these environmental factors following the re-analysis of the INTERSALT study. AIM: To determine whether patients whose spouses have hypertension are at increased risk of hypertension, using a population-based case-control study. METHOD: The total study population consisted of all 3923 patients over 30 years old registered with one general practice. Male cases with hypertension were matched to male controls without hypertension. Female cases with hypertension were matched to female controls without hypertension. The variables were: diagnosed hypertension; having a spouse with diagnosed hypertension; age; sex; weight; height; body-mass index; couple status; diabetes; and systolic and diastolic blood pressure readings. RESULTS: On multivariate analysis, when age, body-mass index, diabetes, couple status, and having a blood pressure reading were included, men whose spouses had hypertension had a two-fold increased risk of hypertension (adjusted odds ratio (OR) 2.24; 95% CI 1.77-2.72; P = 0.001). Similarly, on multivariate analysis, women whose spouses had hypertension had a two-fold increased risk of hypertension (adjusted OR = 2.23; 95% CI 1.75-2.72; P = 0.001). The risk for both male and female subjects persisted after adjustment for other variables. There was a significant correlation between systolic (r = 0.41; P < 0.0001) and diastolic (r = 0.25; P < 0.0001) blood pressures between spouse pairs. CONCLUSION: The independent association between having a spouse with hypertension and increased risk of hypertension supports the view that there are significant environmental factors in the aetiology of hypertension. The finding has implications for the screening and treatment of hypertension in primary care.

Adult↗
PubMedDate not supplied

Left ventricular changes in isolated office hypertension: a blood pressure-matched comparison with normotension and sustained hypertension.

BACKGROUND: Isolated office (IO) hypertension is a benign condition according to some researchers, whereas others believe it is associated with cardiovascular abnormalities and increased cardiovascular risk. The aim of this study is to compare morphofunctional characteristics of the left ventricle (LV) in IO hypertensive subjects, normotensive subjects (hereafter, hypertensives and normotensives), and never-treated sustained hypertensives. The 3 groups were matched not only by age, sex, and body mass index but also by clinic blood pressure (BP) (IO hypertensives and sustained hypertensives) and daytime BP (IO hypertensives and normotensives). METHODS: We enrolled 42 IO hypertensives (clinic BP > 140 and/or 90 mm Hg and daytime BP < or = 130/80 mm Hg), 42 sustained hypertensives (clinic BP > 140 and/or 90 mm Hg and daytime BP > or = 140 and/or 90 mm Hg) and 42 normotensives (clinic BP < 135 and/or 85 mm Hg and daytime BP < or = 130/80 mm Hg). Left ventricular morphologic features and function were assessed using digitized M-mode echocardiography. RESULTS: Compared with normotensives, IO hypertensives had significantly thicker LV walls, increased LV mass, reduced diastolic function, increased prevalence of LV hypertrophy, and preclinical diastolic dysfunction. Sustained hypertensives, compared with IO hypertensives, had significantly thicker LV wall, higher LV mass, and lower diastolic function, whereas the prevalence of LV hypertrophy and preclinical diastolic dysfunction was greater than in IO hypertensives, but the difference did not reach statistical significance (P = .29). CONCLUSIONS: Comparing matched BP groups, IO hypertensives have LV morphofunctional characteristics considerably different from normotensives and qualitatively similar to sustained hypertensives. Therefore, our results support the hypothesis that IO hypertension should not be considered as simply a benign condition.

Adult↗
PubMed1998

Target-organ damage in stage I hypertensive subjects with white coat and sustained hypertension: results from the HARVEST study.

Controversy remains on whether white coat hypertension is a benign clinical condition or carries an increased risk of target-organ damage. Nine hundred forty-two stage I hypertensive subjects enrolled in the HARVEST trial underwent 24-hour ambulatory blood pressure monitoring and urine collection for albumin measurement. Reliable echocardiographic data were obtained in 722 subjects. White coat hypertensive subjects were defined on the basis of three different partition values: mean daytime blood pressure <130/90 mm Hg, <135/85 mm Hg, or <140/90 mm Hg. Ninety-five normotensive subjects with similar age and sex distribution were studied as controls. With all threshold levels, left ventricular mass index and wall thicknesses were greater in the sustained hypertensive subjects than in the white coat hypertensive subjects, also when these differences were adjusted for blood pressure readings taken in the office. Relative wall thickness was similar in the two hypertensive groups. All echocardiographic dimensional data were greater in the white coat hypertensive subjects than in the normotensive subjects. Urinary albumin and the prevalence of microalbuminuria were also greater in the sustained hypertensive subjects than in the white coat hypertensive subjects. No significant differences in urinary albumin were found between the white coat hypertensive and the normotensive subjects. These results show that within a population of subjects with stage I hypertension, subjects with white coat hypertension have a smaller degree of hypertensive complications than those with sustained hypertension, irrespective of their blood pressure levels taken in the office. However, in comparison with normotensive subjects, white coat hypertensive subjects seem to be at greater risk. Cardiac involvement seems to precede glomerular damage in the early stage of hypertension.

Adult↗
PubMed1984

Altered control of hindlimb vascular resistance by vagal afferents in spontaneously hypertensive rats. Difference in the early and late stage of hypertension.

The aim of this study was to examine whether control of vascular resistance by vagal afferents is altered in the early as well as late stage of hypertension. We examined the effects of vagotomy on hindlimb vascular resistance as well as on arterial baroreflex control of hindlimb vascular resistance in spontaneously hypertensive rats and Wistar-Kyoto rats, 12 and 35 weeks old. Vagotomy in rats with the intact arterial baroreceptors increased hindlimb vascular resistance in all four groups. Hindlimb vascular responses to graded sympathetic nerve stimulation were closely linear up to 6 Hz in all groups, and the slope of the response was approximately 1.4 times steeper in spontaneously hypertensive than in Wistar-Kyoto rats, in both the young and old groups. The increase in hindlimb vascular resistance after vagotomy normalized by the slope of the response to sympathetic nerve stimulation was greater in young spontaneously hypertensive rats than in young Wistar-Kyoto rats, but was less in old spontaneously hypertensive rats than in old Wistar-Kyoto rats. Vagotomy increased the gain of arterial baroreflex control of hindlimb vascular resistance in young spontaneously hypertensive rats, and in two groups of Wistar-Kyoto rats, but not in old spontaneously hypertensive rats. The percent increase in the gain of arterial baroreflex control of hindlimb vascular resistance after vagotomy tended to be greater in young spontaneously hypertensive than in young Wistar-Kyoto rats, but was less in old spontaneously hypertensive than in old Wistar-Kyoto rats. Central venous pressure and left ventricular end-diastolic pressure were higher in spontaneously hypertensive than in Wistar-Kyoto rats in both young and old groups. Left atrial distensibility assessed by obtaining the atrial pressure-volume relationship was comparable between young spontaneously hypertensive and young Wistar-Kyoto rats, but was less in old spontaneously hypertensive than in old Wistar-Kyoto rats. These results indicate that vagal afferents exert tonic inhibition on control of hindlimb vascular resistance in spontaneously hypertensive as well as in Wistar-Kyoto rats, and that tonic inhibitory influence of vagal afferents on control of hindlimb vascular resistance is altered in spontaneously hypertensive rats, augmented in young, but attenuated in old, spontaneously hypertensive rats, compared with that in age-matched Wistar-Kyoto rats. It is considered that altered control of vascular resistance by vagal afferents in spontaneously hypertensive rats may result from changes in vagal afferent activity.

Animals↗
PubMed2004

Knowledge and awareness of hypertension among patients with systemic hypertension.

BACKGROUND: In Nigeria, systemic hypertension is the commonest noncommunicable disease, and public awareness about hypertension and its determinants is poor. This study aims to assess the knowledge and level of awareness of the disease among hypertensive patients attending the medical outpatient clinic of Olabisi Onabanjo University Teaching Hospital (OOUTH). METHODOLOGY: Hypertensive patients who attended the medical outpatient clinic during the one-year study period and gave their consent were recruited into the study. Response to a questionnaire on various aspects of hypertension was analyzed using the STATA for Windows software. RESULTS: There were 254 hypertensive patients, of which 111 were males and 143 were females, giving a male: female ratio of 1:1.3. The mean age (SD) of the patients was 51 years +/- 12.2; 52.4% of the participants were aware that hypertension was the commonest noncommunicable disease in Nigeria. About one in 10 patients (11.4%) was aware that "nil symptom" is the commonest symptom of hypertension, while 37% were not aware that hypertension could cause renal failure. Only about one-third (35.4%) of the patients knew that hypertension should ideally be treated for life, while 58.3% believed that antihypertensive drugs should be used only when there are symptoms. The remaining 6.3% believed that the treatment of hypertension should be for periods ranging from two weeks to five years but not for life. CONCLUSION: This study has demonstrated inadequate knowledge of hypertension in patients with hypertension in our study population. Conscious efforts should be made and time set aside to health educate hypertensive patients. Organization of "hypertensive club or society" could be encouraged. These will reduce dissemination of false or inaccurate information by hypertensive patients to the public and its attendant dangers.

Adult↗
PubMed1995

Altered membrane microviscosity in essential hypertension: relationship with family history of hypertension and sodium-lithium countertransport activity.

OBJECTIVE: To investigate the alterations in erythrocyte ghost membrane microviscosity in essential hypertensive patients and to determine the relationship between these changes and the sodium-lithium countertransport activity as a sensitive marker of membrane function. SUBJECTS: Forty-three normolipidaemic essential hypertensive patients (23 treated, 20 untreated) and 27 normotensive controls were studied. Patients were attending the hospital hypertension clinic or a local general practitioner's surgery. METHODS: Erythrocyte sodium-lithium countertransport activity was measured. The Michaelis constant (Km) for extracellular sodium and maximal reaction velocity for sodium-lithium countertransport were measured in a subgroup consisting of 22 essential hypertensive patients and 11 normotensive controls. Erythrocyte membrane microviscosity was measured using fluorescence polarization anisotropy of 1,6-diphenyl-1,3,5-hexatriene (DPH) and 1-[4-trimethylammoniumphenyl]-6-phenyl-1,3,5-hexatriene (TMA-DPH). RESULTS: There was no significant difference in the fluorescence polarization anisotropy of DPH or TMA-DPH between normotensive and essential hypertensive patients. However, the fluorescence polarization anisotropy of TMA-DPH was increased significantly (reflecting increased membrane microviscosity) in hypertensive patients with a family history of hypertension compared with in patients without a family history of hypertension. The standard sodium-lithium countertransport activity was elevated in essential hypertensive patients compared with normotensive controls, and the Km for sodium was significantly lower in patients with a family history of hypertension than in patients without a family history of hypertension. Patients with a family history of hypertension were clustered, with significantly lower Km for sodium and higher TMA-DPH anisotropies than either hypertensive patients without a family history of hypertension or normotensive controls. CONCLUSIONS: These findings suggest that a high membrane microviscosity affecting the outer region of the lipid bilayer is associated with altered sodium-lithium countertransport kinetics in a subgroup of essential hypertensive patients consisting of those with a family history of hypertension.

Antiporters↗
PubMed1999

Frequency and determinants of white coat hypertension in mild to moderate hypertension: a primary care-based study. Monitorización Ambulatoria de la Presión Arterial (MAPA)-Area 5 Working Group.

Most of the previous studies on white coat hypertension were performed in hypertension clinics or academic settings and included relatively small series of patients. Consequently, the prevalence of white coat hypertension in primary care settings and the clinical and epidemiologic characteristics of this subgroup of patients are not well known. We performed this study to estimate the frequency of white coat hypertension in a population of mildly to moderately hypertensive subjects attended in a primary care setting and to examine possible epidemiologic and clinical factors that may identify these patients. Patients included in the study underwent clinical interview, measurement of clinic blood pressure (BP) on three visits, determination of serum lipids, glucose, uric acid, and urinary albumin excretion, 24-h ambulatory BP monitoring, and M-mode and Doppler echocardiography. Patients were classified as white coat hypertensives if their daytime ambulatory BP were < 135/85 mm Hg. We studied 345 patients, 136 (39%) of whom were diagnosed with white coat hypertension. The frequency of white coat hypertension was inversely proportional to the severity of clinic BP values. The diagnosis of white coat hypertension was independently associated with female gender and low educational level. Left ventricular mass index and urinary albumin excretion were lower in the white-coat hypertensive group compared with the group with sustained hypertension. Our results show that a high proportion of patients with mild to moderate hypertension attended in a primary care setting have white coat hypertension. Some clinical characteristics may be helpful in the identification of this group of subjects. White coat hypertensives show less target-organ damage than sustained hypertensive patients.

Adult↗
PubMed1994

Prevalence, awareness, treatment and control of hypertension in a population over the age of 65 years: results from the Starnberg Study on Epidemiology of Parkinsonism and Hypertension in the Elderly (STEPHY).

OBJECTIVE: To assess the prevalence of hypertension and isolated systolic hypertension and the level of awareness, treatment and control of hypertension, in a population aged over 65 years. DESIGN: Cross-sectional survey of the total population aged > or = 65 years of two Bavarian villages with a representative age distribution. PATIENTS: From a total of 1190 inhabitants aged > or = 65 years, 982 (394 male, 588 female) participated (response rate 82.5%). METHODS: All of the participants were visited at home by physician observers. After a standardized questionnaire, blood pressure was measured three times on one occasion with the subject in the sitting position, using a standard mercury sphygmomanometer. 'Actual' hypertension was defined as systolic blood pressure (SBP) > or = 160 or diastolic blood pressure (DBP) > or = 95 mmHg, or both, or current use of antihypertensive drugs given for the indication hypertension in patients with blood pressure < 160/95 mmHg. Isolated systolic hypertension was defined as SBP > or = 160 and DBP < 90 mmHg. All 'actual' hypertensives were further classified as 'unaware' of hypertension, 'aware' (but not treated), 'treated' (current use of antihypertensive drugs for the indication hypertension and blood pressure > or = 160/95 mmHg) or 'controlled' (treated and blood pressure < 160/95 mmHg). RESULTS: Mean +/- SD blood pressure was 154.5 +/- 24.4/84.9 +/- 11.6 mmHg (when 52 institutionalized participants were excluded, 155.6 +/- 24.4/85.3 +/- 11.6 mmHg). The SBP was significantly higher in females than in males and increased up to the age group 80-84 years both in males and in females. The DBP decreased with age. The prevalence of 'actual' hypertension was 53% and increased up to the age group 75-79 years in males and 80-84 years in females. The prevalence of isolated systolic hypertension was 17% (with patients currently using antihypertensive drugs excluded). Of the patients with 'actual' hypertension, 34% were 'unaware' of the diagnosis, 12% 'aware', 32% 'treated' and 22% 'controlled'. CONCLUSIONS: In central Europe hypertension, with a prevalence of > 50%, remains the most common cardiovascular risk factor in the elderly. Although most elderly hypertensives are currently treated with antihypertensive agents, less than one-quarter are controlled, and more than one-third are still unaware of the diagnosis. These levels of awareness and control call for better strategies in the diagnosis and treatment of hypertension in the elderly.

Age Factors↗
PubMed2005

Endothelial progenitor cell senescence is accelerated in both experimental hypertensive rats and patients with essential hypertension.

OBJECTIVES: Recent studies have revealed an association between coronary risk factors and both the number and function of bone marrow-derived endothelial progenitor cells (EPCs). Although hypertension is an important coronary risk factor, the influence to the EPCs is not fully understood. We investigated the effect of hypertension on EPC senescence. METHODS: Experimental study We investigated the number and senescence of EPCs in spontaneously hypertensive rats (SHR/Izm) and deoxycorticosterone acetate (DOCA)-salt hypertensive rats. EPCs were isolated from peripheral blood of rats and were characterized. EPC senescence was detected by acidic beta-galactosidase staining. In addition, we measured the telomerase activity using polymerase chain reaction-enzyme-linked immunosorbent assay. CLINICAL STUDY: EPCs were isolated from peripheral blood samples in 37 patients with essential hypertension. After ex-vivo cultivation, we detected senescence and measured the telomerase activity. The total severity index of hypertension-induced organ damage was calculated by the summation of each severity index in the classification of hypertension severity by Tokyo University (1984). RESULTS: Experimental study The EPC senescence in SHR/Izm and DOCA-salt hypertensive rats was significantly increased compared with that of control rats. The telomerase activities in SHR/Izm and DOCA-salt hypertensive sensitive rats were also significantly lowered compared with those of control rats. Clinical study Compared with the control group, EPCs from hypertensive patients showed accelerated senescence and also showed reduced telomerase activity. In hypertensive patients, the degree of hypertension-induced organ damage was negatively correlated with telomerase activity, and was positively correlated with EPC senescence. CONCLUSIONS: EPC senescence is accelerated in both experimental hypertensive rats and patients with essential hypertension, which may be related to telomerase inactivation. The hypertension-induced EPC senescence may affect the process of vascular remodeling.

Aged↗
PubMed1988

Effect of chronic hypertension on acute hypertensive disruption of the blood-brain barrier in rats.

The effect of chronic hypertension on acute hypertensive disruption of the blood-brain barrier has been studied in only two models of hypertension, with inconsistent results. The purpose of this study was to reinvestigate whether chronic hypertension has a consistent effect on acute hypertensive disruption of the blood-brain barrier and to determine whether one of the previously studied models has an unusual response to chronic hypertension. We studied four rat models of chronic hypertension: spontaneously hypertensive rats (SHR), two-kidney, 1 clip Goldblatt rats (2K1C), rats treated with deoxycorticosterone acetate (DOCA) and NaCl, Dahl salt-sensitive rats fed a high salt diet, and two groups of normotensive controls: Wistar-Kyoto rats (WKY) and Dahl salt-sensitive rats fed a low salt diet. We caused acute hypertension in some rats with the use of bicuculline (1.2 mg/kg) and aortic occlusion. Rats without acute hypertension served as controls. Blood-brain barrier disruption was quantitated using the brain/blood ratio of 125I-labeled albumin. Acute hypertensive disruption was less in SHR, rats treated with DOCA-NaCl, and Dahl salt-sensitive rats fed a high salt diet, but not in 2K1C rats, as compared with normotensive controls. Acute hypertensive disruption was greater in Dahl salt-sensitive rats fed a low salt diet than in WKY. A series of control WKY, SHR, rats treated with DOCA-NaCl, 2K1C rats, and Dahl salt-sensitive rats fed low or high salt diets, but not subjected to acute hypertension, were also studied. Brain/blood 125I-albumin ratios were significantly less in these control rats not subjected to acute hypertension than in rats subjected to acute hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗