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At least 19 recordsLinked to original sources
PubMed1991

Blood pressure and high blood pressure. Aspects of risk.

This report deals with three aspects of risk related to blood pressure and high blood pressure. The first aspect of risk concerns distributions of systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the adult population and their relation to long-term risk of morbidity and mortality. By middle age, only a minority (about 20%) of Americans have optimal SBP and DBP levels, less than 120 mm Hg and less than 80 mm Hg, respectively. For the majority with higher levels, risks of major clinical events, including death from cardiovascular diseases and from all causes, are markedly increased. The relations of SBP and DBP with risk are strong, continuous, and graded. Risk is sizable not only for persons with high blood pressure by usual clinical criteria (SBP greater than or equal to 140 mm Hg or DBP greater than or equal to 90 mm Hg), but also for those with "high-normal" blood pressure (e.g., SBP 130-139 mm Hg or DBP 80-89 mm Hg). Thus, the blood pressure problem is a population-wide one and requires for its control a combined population-wide and high-risk strategy. A major component of this strategy must be nutritional-hygienic measures for the primary prevention of the rise in blood pressure during adulthood and of high blood pressure (i.e., primary prevention not only of the complications of high blood pressure but also of high blood pressure itself) through improved lifestyles having the potential to shift downward the blood pressure distribution of the whole population. The second aspect of risk concerns the known risk factors (i.e., aspects of modern lifestyle) leading to the mass occurrence of blood pressure rise during adulthood and of high blood pressure. These risk factors are high salt intake, high dietary sodium/potassium ratio, calorie imbalance and resultant obesity, and high alcohol intake. The extensive data base establishing the role of these common traits in the etiology of the blood pressure/high blood pressure problem is the scientific foundation for efforts to achieve the primary prevention of high blood pressure. The third aspect of risk relates to the combined impact of other risk factors along with blood pressure-high blood pressure in markedly increasing the probabilities of morbidity and mortality (e.g., "rich" diet, diet-dependent serum cholesterol and uric acid, smoking, diabetes, and target-organ damage). Prevention and control of lifestyle-related traits are essential components of the strategy for dealing with the blood pressure-high blood pressure problem.

Blood Pressure↗
PubMed2004

Effects of exercise, diet and weight loss on high blood pressure.

High blood pressure (BP) is a major health problem in the US, affecting more than 50 million people. Although high BP is among the most common reasons for outpatient visits, BP control is often inadequate. It is well established that BP can be lowered pharmacologically in hypertensive individuals; however, anti-hypertensive medications are not effective for everyone, and may be costly and result in adverse effects that impair quality of life and reduce adherence. Moreover, abnormalities associated with high BP, such as insulin resistance and hyperlipidaemia, may persist or may even be exacerbated by some anti-hypertensive medications. Consequently, there has been a great deal of interest in the development and application of behavioural interventions in the management of high BP. The main behavioural interventions that are recommended to reduce BP are exercise and the Dietary Approaches to Stop Hypertension (DASH) diet. Weight loss is also recommended for BP reduction in overweight individuals. Exercise alone is associated with reductions of approximately 3.5 and 2.0mm Hg in systolic (SBP) and diastolic blood pressure (DBP), respectively. Patients fed a DASH diet (a diet high in low-fat dairy products and fibre, including fruits and vegetables) had reductions in SBP and DBP of 5.5 and 3.0mm Hg, respectively, compared with those consuming a standard US diet. Reductions of approximately 8.5mm Hg SBP and 6.5mm Hg DBP accompany weight loss of 8 kg. In overweight hypertensive patients, a combined exercise and weight-loss intervention has been shown to decrease SBP and DBP by 12.5 and 7.9 mm Hg, respectively. There is evidence to suggest that these decreases in BP are associated with improvements in left ventricular structure and function, and peripheral vascular health. Both exercise training and weight loss have been shown to decrease left ventricular mass and wall thickness, reduce arterial stiffness and improve endothelial function. These data support the role of behavioural interventions in the treatment of patients with elevations in BP.

Behavior Therapy↗
PubMed1985

Geographical and socioeconomic distribution of high blood pressure and borderline high blood pressure in a Swedish rural county.

This report on "high" blood pressure (HBP) and "borderline high" blood pressure (BHBP) is based on a cross-sectional study in a rural Swedish county. The study was initiated in the Spring of 1977, selecting 7986 individuals aged 25-75 years, in 5-year intervals, in the 16 municipalities of Skaraborg County. A combination of health examination and a survey using polling of the population by interview was used. The blood pressure values that are presented are based on a casual measurement taken after a 5-minute rest period. The limits of HBP and BHBP correspond to the Swedish standard limits. Only a few researchers in Sweden have focused on the correlation between socioeconomic factors and hypertension. Moreover, few examinations have been made internationally concerning the correlation between socioeconomic factors and borderline hypertension. There was a significant variation in mean values of high blood pressure when comparing socioeconomic groups and comparing occupations. These differences associated with educational level were more pronounced for women than for men. Workers, especially men and persons with less formal education, had the highest mean blood pressure. Significant differences between socioeconomic groups existed even after adjustment for age, sex, weight index, smoking and treatment of hypertension. The socioeconomic differences constitute the most plausible explanation of differences seen between municipalities. "Borderline high" blood pressure was more prevalent than "high" blood pressure. Socioeconomic differences were greater within the borderline high blood pressure group than in the high blood pressure group. i.e., the differences between workers and civil servants were somewhat greater in the borderline high blood pressure group. Since there are socioeconomic differences, it might be possible to concentrate preventive activities in local communities on risk groups.

Adult↗
PubMed1990

The stability of high blood pressure in Dunedin children: an eight year longitudinal study.

Resting blood pressures were recorded for children in the Dunedin Multidisciplinary Health and Development Study at two year intervals five times from age seven to fifteen. Correlations between pairs of readings were modest but significant, and higher for systolic (0.39 to 0.62) than for diastolic blood pressure. However, although children with normal blood pressure were likely to continue to have normal blood pressure, high blood pressures at age seven, nine, eleven and thirteen were not stable--only 28% of those whose systolic blood pressure at age seven was in the highest 5% had two subsequent readings in the highest 5%. On the other hand 56% of those in the highest 20% had two subsequent readings in the highest 20%, and 9% had all subsequent readings in the highest 20%. We do not believe that adult essential hypertensives can be recognised early by annual blood pressure measurement in childhood and the assignation of blood pressure rank according to a set of normal values.

Adolescent↗
PubMed2002

State-specific trends in self-reported blood pressure screening and high blood pressure--United States, 1991-1999.

High blood pressure (HBP) increases the risk for heart disease and stroke, the first and third leading causes of death in the United States, respectively. An estimated one in four U.S. adults has HBP, which is defined as taking antihypertensive medication or having either a systolic blood pressure (SBP) of > or = 140 mmHg or a diastolic blood pressure (DBP) of > or = 90 mmHg. Optimal blood pressure is defined as SBP of < or = 120 mmHg or DBP of < or = 80 mmHg. To reduce the prevalence of HBP in the United States, the National Heart, Lung, and Blood Institute initiated the National High Blood Pressure Education Program (NHBPEP) in 1972, recommending that all adults aged > or = 20 years have their blood pressure (BP) checked at least once every 2 years. Although HBP is easily detectable and can usually be controlled with treatment, greater awareness of BP levels among U.S. adults is needed. This report summarizes data from the Behavioral Risk Factor Surveillance System (BRFSS) on state-specific trends in recent BP screening and prevalence of HBP (both by self-report). The findings indicate that during 1991-1999, BP screening levels were very high, and the percent of adults reporting HBP increased among some populations. Innovative education and intervention programs are needed to prevent and treat HBP in five high-risk groups: men, blacks, Hispanics, persons with less education, and older adults.

Adult↗
PubMed1996

Follow up of young people with high casual blood pressure.

High blood pressure (BP), often borderline hypertension, can be also found in adolescents. In these subjects the haemodynamic pattern, high cardiac output and normal vascular resistance, differs from that of older hypertensives. Although the risk for hypertension is higher in this group than in the general population, only a minority of them will develop sustained hypertension later in life. They can therefore be viewed as an enriched pool of future hypertensives but not as true prehypertensives. The aim of this longitudinal study was to analyse the relation between casual BP measured in high school students and in the same subjects 3 years later. In 1990, an extensive study on BP was carried out in 1062 high school students aged 18 years. Sitting BP, heart rate, weight, and body mass index (BMI) were measured in each subject. After 3 years, the 50 subjects with the highest BP level recorded in 1990 were recalled. Forty-five subjects (90%, 30 males and 15 females) agreed to undergo a second examination. They were seen as outpatients in the Hypertension Centre of our institute. BP was measured with a mercury sphygmomanometer after a 10 min rest three times in 5 min. Systolic and diastolic BP were significantly reduced after 3 years (137 +/- 13 vs 132 +/- 10 P = 0.002; 92 +/- 4 vs 85 +/- 6 P = 0.0001, mm Hg). By means of a multiple regression test, including parameters recorded in 1990, systolic blood pressure (SBP) (R = 0.53 Slg F = 0.0002) and diastolic blood pressure (DBP) (R = 0.60 Slg F = 0.0001) were shown as the main determinants of SBP, while DBP was related only to previous BMI (R = 0.37 Slg F = 0.01). The reduction of both SBP and DBP after 3 years could be explained either by a true, spontaneous decrease of BP or as a consequence of different environmental conditions during the second examination (more prolonged resting time, repeated measurements). However, data of this study demonstrate that casual SBP and DBP are the main determinants of future SBP, thus confirming the prognostic value of casual BP measurement in young people. Moreover, our data emphasises the role of BMI as the main determinant of future high DBP.

Adolescent↗
PubMed1996

Changes in average blood pressure and incidence of high blood pressure 1983-1984 to 1987-1988 in four population cohorts in the People's Republic of China. The PRC-USA Cardiovascular and Cardiopulmonary Epidemiology Research Group.

OBJECTIVE: To assess comparative changes in systolic and diastolic blood pressure and incidence of high blood pressure over 4 years, and factors related to these changes, in northern and southern, urban and rural adults in the People's Republic of China. SETTING: This is a prospective study of populations surveyed by standardized methods in 1983-1984 and 1987-1988 in north China, Beijing area steel mill workers and farmers, and south China, Guangzhou area shipyard workers and farmers. SUBJECTS: The subjects were 8805 men and women aged 35-54 years at baseline (1983-1984), of whom 7338 were non-hypertensive (systolic blood pressure < 140, diastolic blood pressure < 90 mmHg, not being administered antihypertensive drugs). MAIN OUTCOME MEASURES: The main outcome measures were 4-year changes in systolic and diastolic blood pressures and the 4-year incidence of high blood pressure in persons not hypertensive at baseline. RESULTS: At baseline, the average systolic and diastolic blood pressures were higher for Beijing than for Guangzhou cohorts. At resurvey the average systolic blood pressure had increased for seven of eight sex-city-setting cohorts (all but Guangzhou urban men). The Beijing urban cohorts had the greatest increases (men 6.2 mmHg, women 4.9 mmHg, slopes of 1.6 and 1.2 mmHg/year). The incidence of high blood pressure was higher for Beijing than for Guangzhou cohorts in all four comparisons (men and women, urban and rural). Beijing men, urban and rural, had the highest incidence rates (about 21%). In multiple logistic analyses by sex, variables significantly related to 4-year high blood pressure incidence were city, baseline systolic blood pressure and body mass index, change in weight, and, for men, baseline alcohol use and heart rate. CONCLUSION: Modifiable lifestyle traits, previously shown to be related to blood pressure and high blood pressure in cross-sectional studies, also relate to the incidence of hypertension.

Adult↗
PubMed1998

Hypertension and the eye: applications of the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.

BACKGROUND: High blood pressure is a major risk factor for coronary artery disease, kidney disease, and stroke. More people are aware of treating and controlling their blood pressure, but overall control rates are low and the incidence of hypertension-related morbidity and mortality remains high. METHODS: The National Heart, Lung, and Blood Institute released The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) as the most recent national guideline to hypertension control for primary care clinicians. RESULTS: JNC VI identifies 10 hypertension-related public health challenges: (1) prevent the rise of blood pressure; (2) decrease prevalence of hypertension; (3) increase awareness and detection of hypertension; (4) improve control of hypertension; (5) reduce cardiovascular risks; (6) increase recognition of importance of isolated systolic hypertension; (7) improve recognition of importance of high-normal blood pressure; (8) reduce ethnic, socioeconomic, and regional variations; (9) improve treatment; and (10) enhance community programs. CONCLUSIONS: The eye is a target organ and retinopathy is a frequent complication--as well as a prognostic indicator--of sustained hypertension. As part of a multidisciplinary team approach, the optometrist assumes a significant role in the prevention, detection, evaluation, and treatment of high blood pressure and its associated morbidities.

Eye Diseases↗
PubMedDate not supplied

Spouse similarities in high blood pressure knowledge: implications for control of high blood pressure.

This study describes the general knowledge about high blood pressure of husbands and wives using data from all 1,260 white spouse pairs from the 1982 Connecticut Blood Pressure Survey and examines the relationship between high blood pressure knowledge and control of hypertension. We found the average level of knowledge to be high; about 70% of the items were answered correctly. The correlation between spouses' knowledge about high blood pressure was significantly high (r = .41). Multiple regression analysis was used to control for other variables that might influence the spousal correlation in knowledge. When controlling for education, age, socioeconomic status, and hypertension status of both spouses, the correlation between spouses' knowledge remained significant (r = .24). Respondents' knowledge and spouses' knowledge about high blood pressure were significantly related to high blood pressure control among hypertensive persons, particularly to being aware of hypertension and being in current treatment.

Adolescent↗
PubMed2000

Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy.

This report updates the 1990 "National High Blood Pressure Education Program Working Group Report on High Blood Pressure in Pregnancy" and focuses on classification, pathophysiologic features, and management of the hypertensive disorders of pregnancy. Through a combination of evidence-based medicine and consensus this report updates contemporary approaches to hypertension control during pregnancy by expanding on recommendations made in "The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure." The recommendations to use Korotkoff phase V for determination of diastolic pressure and to eliminate edema as a criterion for diagnosing preeclampsia are discussed. In addition, the use as a diagnostic criterion of blood pressure increases of 30 mm Hg systolic or 15 mm Hg diastolic with blood pressure <140/90 mm Hg has not been recommended, because available evidence shows that women with blood pressures fitting this description are not more likely to have adverse outcomes. Management distinctions are made between chronic hypertension that is present before pregnancy and hypertension that occurs as part of the pregnancy-specific condition of preeclampsia, as well as management considerations for women with comorbid conditions. A discussion of the pharmacologic treatment of hypertension during pregnancy includes recommendations for specific agents. The use of low-dose aspirin, calcium, or other dietary supplements in the prevention of preeclampsia is described, and expanded sections on counseling women for future pregnancies and recommendations for future research are included.

Antihypertensive Agents↗
PubMed1996

Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents: a working group report from the National High Blood Pressure Education Program. National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents.

BACKGROUND: The "Report of the Second Task Force on Blood Pressure Control in Children-1987" developed normative blood pressure (BP) data for children and adolescents. These normative data are used to classify BP levels. Since 1987, additional BP data in children and adolescents, the use of newer classes of drugs, and the role of primary prevention of hypertension have expanded the body of knowledge regarding the classification and treatment of hypertension in the young. OBJECTIVE: To report new normative BP data in children and adolescents and to provide additional information regarding the diagnosis, treatment, and prevention of hypertension in children. METHODS: A working group was appointed by the director of the National Heart, Lung, and Blood Institute as chair of the National High Blood Pressure Education Program (NHBPEP) Coordinating Committee. Data on children from the 1988 through 1991 National Health and Nutrition Examination Survey III and nine additional national data sets were combined to develop normative BP tables. The working group members produced initial draft documents that were reviewed by NHBPEP Coordinating Committee representatives as well as experts in pediatrics, cardiology, and hypertension. This reiterative process occurred for 12 draft documents. The NHBPEP Coordinating Committee discussed the report, and additional comments were received. Differences of opinion were adjudicated by the chair of the working group. The final report was sent to representatives of the 44 organizations on the NHBPEP Coordinating Committee for vote. It was approved unanimously by the NHBPEP Coordinating Committee on October 2, 1995. CONCLUSIONS: This report provides new normative BP tables for children and adolescents, which now include height percentiles, age, and gender. The fifth Korotkoff sound is now used to define diastolic BP in children and adolescents. New charts have been developed to guide practicing clinicians in antihypertensive drug therapy selection. The primary prevention of hypertension in these age groups is discussed. A statement on public health considerations in the treatment of children and adolescents is provided.

Adolescent↗
PubMed2003

Lifestyle modification as a means to prevent and treat high blood pressure.

High BP is one of the most important and common risk factors for atherosclerotic cardiovascular disease and renal disease. The contemporary approach to the epidemic of elevated BP and its complications involves pharmacologic treatment of hypertensive individuals and "lifestyle modification," which is beneficial for both nonhypertensive and hypertensive persons. A substantial body of evidence strongly supports the concept that lifestyle modification can have powerful effects on BP. Increased physical activity, a reduced salt intake, weight loss, moderation of alcohol intake, increased potassium intake, and an overall healthy dietary pattern, termed the Dietary Approaches to Stop Hypertension (DASH) diet, effectively lower BP. The DASH diet emphasizes fruits, vegetables, and low-fat dairy products and is reduced in fat and cholesterol. Other dietary factors, such as a greater intake of protein or monounsaturated fatty acids, may also reduce BP but available evidence is inconsistent. The current challenge to health care providers, researchers, government officials, and the general public is developing and implementing effective clinical and public health strategies that lead to sustained lifestyle modification.

Cardiovascular Diseases↗
PubMed2000

Drugs for rapid treatment of very high blood pressure during pregnancy.

BACKGROUND: Very high blood pressure during pregnancy poses a serious threat to women and their fetuses. The use of drugs to lower blood pressure may reduce this risk. OBJECTIVES: The objective of this review was to compare different antihypertensive drugs used for rapid treatment of severe hypertension during pregnancy. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register. SELECTION CRITERIA STUDIES: All randomised trials. Quasi random designs were excluded. PARTICIPANTS: Women with severe hypertension during pregnancy. Women postpartum at trial entry were excluded. INTERVENTIONS: Comparisons of one antihypertensive agent with another. OUTCOMES: For the women: blood pressure control, eclampsia, serious maternal morbidity (such as kidney failure and liver failure), Caesarean section, and use of health service resources (such as admission to hospital or intensive care unit). For the baby: death, serious neonatal morbidity, infant and child development, and use of health service resources (such as admission to a special care nursery). DATA COLLECTION AND ANALYSIS: Data were extracted independently by two reviewers to assess eligibility and describe the trial characteristics, and by one reviewer for the meta-analyses. Discrepancies were resolved by discussion. There was no blinding of authorship or results. Whenever possible, unpublished data were sought from investigators. MAIN RESULTS: Thirteen of the 14 trials included in this review were small (range 19-627 women). Of the eight comparisons, five included hydralazine. Diazoxide given as 75mg bolus injections appears to be associated with profound hypotension requiring treatment, and ketanserin is less effective than hydralazine at reducing blood pressure. There is no other evidence that any one of the other antihypertensive agents is better than another for women with severe hypertension during pregnancy. REVIEWER'S CONCLUSIONS: Until better evidence is available, the choice of antihypertensive should depend on the experience and familiarity of an individual clinician with a particular drug, and on what is known about adverse maternal and fetal side-effects. Exceptions are diazoxide and ketanserin, which are probably not good choices.

Antihypertensive Agents↗
PubMed1987

Designation of children with high blood pressure--considerations on percentile cut points and subsequent high blood pressure: the Bogalusa Heart Study.

The effects of changing the percentile cut points of prior blood pressure measurements (both single and serial examinations) on prediction of subsequent high blood pressure, and of the definition of subsequent high blood pressure were assessed in 1,501 children from Bogalusa, Louisiana. Subjects were 2-14 years old at initial examination (year 1, 1973-1974) and were reexamined three, five, and eight years after the initial examination. Increasing the stringency of the prior measurement cut point resulted in increased specificity and positive predictive value, but decreased sensitivity and negative predictive value. For prediction of subsequent systolic blood pressure at the 90th percentile from year 1 levels, increasing the year 1 cut point from the 80th to the 95th percentile resulted in decreased sensitivity from 42.8 to 13.0%, and increased specificity from 83.0 to 97.3%. For systolic pressure, requiring all prior serial measurements to be above specified cut points resulted in further increases in specificity (maximizing at 100%) and decreases in sensitivity (minimizing at 2.1%). Using a year 1 cut point at the 90th percentile, increases in the definition of subsequent high blood pressure (from the 80th percentile to 140/90 mmHg or on treatment, respectively) resulted in increased sensitivity (from 20.5 to 33.3%) and negative predictive value, with decreasing specificity (from 93.9 to 91.3%) and positive predictive value. The results indicate that use of stringent criteria (serially at the 95th percentile) to identify children at risk for future essential hypertension will result in a substantial portion of the childhood population who will escape early identification but who will develop adult hypertension. Less stringent criteria will increase sensitivity and thereby provide the opportunity for primary prevention to a larger portion of the general childhood population who are at high risk for adult hypertension.

Adolescent↗
PubMedDate not supplied

Adherence to management of high blood pressure: recommendations of the Canadian Coalition for High Blood Pressure Prevention and Control.

Adherence or compliance, in the context of medical treatment, refers to how well a patient follows and sticks to the management plan developed with her/his health care provider, which may include pharmacologic agents as well as changes in lifestyle. Adherence is of great concern in asymptomatic conditions such as hypertension, where lack of control may have serious ramifications including end organ damage and premature mortality. To address this issue, the Canadian Coalition for High Blood Pressure Prevention and Control established a national Advisory Committee on Adherence to the Management of High Blood Pressure. The Advisory Committee consisted of 11 members from different disciplines of health care providers. The Committee reviewed all evidences to date and drew up four practical recommendations with respect to patient, provider and environment. Based on Canadian Task Force on Periodic Health Examination's guidelines, all four recommendations can be classified as 'level C' with a quality of evidence of II.

Canada↗
PubMed2005

Prevalence of self-reported high blood pressure awareness, advice received from health professionals, and actions taken to reduce high blood pressure among US adults--Healthstyles 2002.

High blood pressure awareness, advice received from health care providers, and adoption of heart-healthy behaviors were assessed using the Healthstyles 2002 survey. About 20% of respondents reported that they had high blood pressure, and 53% of these were currently taking medications to lower blood pressure. Black men had the highest adjusted prevalence of high blood pressure (32%). Medication use among persons with high blood pressure was lower among Hispanics (45%) than among blacks (54%) and whites (54%). Persons reporting having high blood pressure were five times more likely to report having received advice from a health care professional to go on a diet or change eating habits (p<0.05) and reduce salt or sodium in their diet (p<0.05), but five times less likely to have received advice to exercise (p<0.05) than those reporting not having high blood pressure, after adjustment for differences in sex, race/ethnicity, and age. Persons with self-reported high blood pressure were also more likely to be making these modifications (p<0.05). Among people with high blood pressure, current medication use was associated with both receiving and following advice for diet change and salt reduction (p<0.05). Future initiatives are needed to improve the proportion of Hispanics and blacks taking prescribed medications to improve high blood pressure control and reduce risk for serious sequelae such as heart disease and stroke.

Adolescent↗