Measures of blood pressure and myocardial infarction in treated hypertensive patients.

Objective: To identify entry characteristics associated with subsequent myocardial infarction in treated hypertensive patients.

Design: Nested case-control study and cohort study.

Setting And Patients: The 5730 participants (mean age 53 years; 61% male and 45% Caucasian) were selected from a worksite-based, union-sponsored, systematic hypertension control program from 1973 to 1992.

Renal function during antihypertensive treatment.

To determine the association of renal function and the course of blood pressure in antihypertensive therapy, we studied the changes in serum creatinine as a measure of renal function and in-treatment blood pressure in black and white hypertensive patients. We measured serum creatinine in 2125 mild and moderately hypertensive men during treatment over an average of 5 years. Both unadjusted mean initial and final serum creatinine of 758 blacks (113 and 117 mumol/L respectively) were significantly higher than those of 1367 whites (108 and 107 mumol/L), with a small increase of 4 mumol/L (p < 0.

Plasma renin activity and coronary heart disease: are they related?

Both a retrospective and a prospective study of hypertensive patients have detected a significant positive relationship between pretreatment renin and sodium profiles, and the occurrence of coronary artery disease events during treatment. The subgroup of patients with the highest renin-sodium profile, while controlling for other known coronary risk factors as well as pre-existing disease, were significantly more likely to experience a fatal or nonfatal myocardial infarction compared with those with normal or low renin-sodium profiles. A population of almost entirely normotensive subjects failed to show a similar relationship for plasma renin activity alone.

Differential mortality in New York City (1988-1992). Part Two: excess mortality in the south Bronx.

To display the extent of variations in mortality according to geographic regions in New York City, we have compared mortality in New York City as a whole with that of the South Bronx. Mortality records for 1988 to 1992 and 1990 US census data for New York City were linked. The 471,000 residents of the South Bronx were younger, less educated, and more likely to lack health insurance than other New Yorkers.

Differential mortality in New York City (1988-1992). Part One: excess mortality among non-Hispanic blacks.

To determine the distribution of mortality for non-Hispanic blacks and non-Hispanic whites in New York City, death certificates issued in New York City during 1988 through 1992, and the relevant 1990 US census data for New York City, have been examined. Age-adjusted death rates for blacks and whites by gender and cause of death were computed based on the US population in 1940. Also, standard mortality ratios and excess mortality were calculated using the New York City mortality rate as reference.

The determinants of hypertension awareness, treatment, and control in an insured population.

Objectives: The purpose of the study was to identify the determinants of awareness, treatment, and control of hypertension in a population with full access to medical care.

Methods: Unionized New York City health care workers (n = 1394) with comprehensive medical insurance were screened for hypertension. Union records documenting all physician visits and prescription medications for the year before screening provided the opportunity to relate patterns of treatment to blood pressure outcomes.

Assessment of left ventricular function by the midwall fractional shortening/end-systolic stress relation in human hypertension.

Objectives: This study examined left ventricular performance in relatively unselected hypertensive patients by use of physiologically appropriate midwall shortening/end-systolic stress relations.

Background: Supranormal left ventricular function has been reported in hypertensive patients, possibly due to an artifact of mismatching endocardial rather than midwall fractional shortening to mean left ventricular end-systolic stress.

Methods: Samples of 474 hypertensive patients (150 women, 324 men) and 140 normal subjects (68 women, 72 men) were drawn from a large urban employed population.

Relation of obesity and gender to left ventricular hypertrophy in normotensive and hypertensive adults.

Although it is recognized that both hypertension and obesity are associated with increased left ventricular mass, the relative impacts of obesity, arterial hypertension, and gender on the prevalence of ventricular hypertrophy remain uncertain. Accordingly, echocardiographic left ventricular mass normalized for height to the power of the allometric or growth relation between ventricular mass and height was compared in 164 normotensive subjects (85 men [24 obese] and 79 women [28 obese], aged 45 +/- 12 years) and 475 hypertensive patients (325 men [126 obese] and 150 women [85 obese], aged 54 +/- 10 years) from an adult employed population. Gender-specific upper normal limits were used to identify ventricular hypertrophy.

Relation of pulse pressure and blood pressure reduction to the incidence of myocardial infarction.

The prognostic value of pretreatment pulse pressure as a predictor of myocardial infarction and the relation of pulse pressure and in-treatment diastolic blood pressure reduction to myocardial infarction were investigated in a union-sponsored systematic hypertension control program. In a prospective study, 2207 hypertensive patients with a pretreatment systolic blood pressure greater than or equal to 160 mm Hg and/or diastolic pressure greater than or equal to 95 mm Hg grouped according to tertile of pulse pressure (PP1, < or = 46; PP2, 47 to 62; PP3, > or = 63 mm Hg) were further stratified by the degree of diastolic fall: large (L), > or = 18; moderate (M), 7 to 17; small (S), < or = 6 mm Hg. During an average follow-up of 5 years, 132 cardiovascular events (50 myocardial infarctions, 23 strokes) were observed.

Response to the captopril test is dependent on baseline renin profile.

Objective: To determine prospectively the relationship between the renin-sodium profile and the renin response to captopril challenge in patients with essential hypertension.

Design: A standard captopril test was performed in 108 uncomplicated, untreated hypertensive subjects with normal renal function and urinary sodium excretion in the range 50-240 mmol/day. The subjects were selected from a working population with a low expected prevalence of renovascular disease.

Ethnicity and the relationship of sodium intake to blood pressure.

Objective: To examine the impact of race on the relationship between sodium intake and blood pressure.

Methods: We examined the blood pressure levels and 24-h urinary sodium excretion of 808 (355 Black, 453 Caucasian) union members who participated in a workplace hypertension control program. The 808 study subjects, who met the criterion for accuracy of urine collection, included 627 untreated hypertensives (systolic blood pressure > or = 160 mmHg or diastolic blood pressure > or = 95 mmHg, or both) and 181 normotensives (blood pressure < 160/95 mmHg).

Role of preclinical cardiovascular disease in the evolution from risk factor exposure to development of morbid events.

Conventional risk factors (especially high arterial pressure, elevated cholesterol and glucose levels, and cigarette smoking) are useful predictors of morbid atherosclerotic and hypertensive events, and their control variably reduces the incidence of events. However, both the ability to predict risk and the ability to reduce it by modification of established risk factors are limited. These limitations occur in part because the progression from risk factor exposure to morbid events depends on the variable likelihood that individuals exposed to the same risk factors will progress through two stages: the development of asymptomatic or "preclinical" anatomic and functional cardiovascular disease in response to standard risk factors and other variables, and the precipitation of morbid events by progression of preclinical disease or by the action of additional "triggering" mechanisms in the presence of preclinical disease.

A review of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. The Fifth Report, 1993.

JNC-V is a comprehensive document that also contains a variety of specific information about drug actions, interactions, and specific indications and contraindications for each class of antihypertensive drugs. In addition, there are recommendations regarding patient evaluation and follow-up. Individual sections deal with blood pressure management in special situations and in different populations.

Blood pressure management: individualized treatment based on absolute risk and the potential for benefit.

Clinical practice often conflicts with epidemiologic evidence in the management of blood pressure. Antihypertensive therapy is generally prescribed if blood pressure exceeds some arbitrary level, thus committing many persons with minimal cardiovascular risk to long-term drug therapy. By contrast, below that level, regardless of cardiovascular risk, blood pressure reduction is rarely sought.

Intracellular and extracellular magnesium depletion in type 2 (non-insulin-dependent) diabetes mellitus.

To investigate alterations of magnesium metabolism in Type 2 (non-insulin-dependent) diabetes mellitus, we utilized a new magnesium-specific selective ion electrode apparatus to measure serum ionized magnesium (Mg-io) in fasting subjects with and without Type 2 diabetes, and compared these values to levels of serum total magnesium, and of intracellular free magnesium (Mgi) analysed by 31P-NMR spectroscopy. Both Mg-io (0.630 +/- 0.

Enhancing athletic injury rehabilitation adherence.

Contemporary sports medicine literature has begun to address more centrally the idea that treatment adherence is a complex issue. Not only must certified athletic trainers (ATCs) possess knowledge about injuries and subsequent rehabilitation protocols, they also must be able to deliver essential services in a manner that predisposes treatment success. Effective treatment of athletic injuries necessitates consideration of various psychosocial factors shown to enhance rehabilitation adherence.

Parallel cardiac and vascular adaptation in hypertension.

Background: Although vascular damage in the noncoronary circulation is a major cause of complications in hypertension, relatively little is known of the in vivo geometry and function of the arterial circulation in patients with uncomplicated hypertension or of their relation to left ventricular hypertrophy, a marker of enhanced risk of cardiovascular complications.

Methods And Results: Wall thickness and internal diameter of the common carotid artery and the presence of atherosclerosis within the extracranial carotid arteries were determined by ultrasound in 43 asymptomatic hypertensive patients and 43 normotensive subjects matched for sex, age, and body size. Vascular stiffness was estimated from simultaneous superimposed carotid pressure waveforms obtained with an external solid-state transducer.