Olive oil, the Mediterranean diet, and arterial blood pressure: the Greek European Prospective Investigation into Cancer and Nutrition (EPIC) study.

Psaltopoulou T, Naska A, Orfanos P, Trichopoulos D, Mountokalakis T, Trichopoulou A.

Department of Hygiene and Epidemiology, University of Athens Medical School, Athens, Greece.

BACKGROUND: Diet has been reported to influence arterial blood pressure, and evidence indicates that the Mediterranean diet reduces cardiovascular mortality. OBJECTIVE: The objective was to examine whether the Mediterranean diet, as an entity, and olive oil, in particular, reduce arterial blood pressure. DESIGN: Arterial blood pressure and several sociodemographic, anthropometric, dietary, physical activity, and clinical variables were recorded at enrollment among participants in the Greek arm of the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Of these participants, 20 343 had never received a diagnosis of hypertension and were included in an analysis in which systolic and diastolic blood pressure were regressed on the indicated possible predictors, including a 10-point score that reflects adherence to the Mediterranean diet and, alternatively, the score's individual components and olive oil. RESULTS: The Mediterranean diet score was significantly inversely associated with both systolic and diastolic blood pressure. Intakes of olive oil, vegetables, and fruit were significantly inversely associated with both systolic and diastolic blood pressure, whereas cereals, meat and meat products, and ethanol intake were positively associated with arterial blood pressure. Mutual adjustment between olive oil and vegetables, which are frequently consumed together, indicated that olive oil has the dominant beneficial effect on arterial blood pressure in this population. CONCLUSIONS: Adherence to the Mediterranean diet is inversely associated with arterial blood pressure, even though a beneficial component of the Mediterranean diet score-cereal intake-is positively associated with arterial blood pressure. Olive oil intake, per se, is inversely associated with both systolic and diastolic blood pressure.

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Using the area under the curve to reduce measurement error in predicting young adult blood pressure from childhood measures.

Cook NR, Rosner BA, Chen W, Srinivasan SR, Berenson GS.

Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215-1204, USA. ncook rics.bwh.harvard.edu

Tracking correlations of blood pressure, particularly childhood measures, may be attenuated by within-person variability. Combining multiple measurements can reduce this error substantially. The area under the curve (AUC) computed from longitudinal growth curve models can be used to improve the prediction of young adult blood pressure from childhood measures. Quadratic random-effects models over unequally spaced repeated measures were used to compute the area under the curve separately within the age periods 5-14 and 20-34 years in the Bogalusa Heart Study. This method adjusts for the uneven age distribution and captures the underlying or average blood pressure, leading to improved estimates of correlation and risk prediction. Tracking correlations were computed by race and gender, and were approximately 0.6 for systolic, 0.5-0.6 for K4 diastolic, and 0.4-0.6 for K5 diastolic blood pressure. The AUC can also be used to regress young adult blood pressure on childhood blood pressure and childhood and young adult body mass index (BMI). In these data, while childhood blood pressure and young adult BMI were generally directly predictive of young adult blood pressure, childhood BMI was negatively correlated with young adult blood pressure when childhood blood pressure was in the model. In addition, racial differences in young adult blood pressure were reduced, but not eliminated, after controlling for childhood blood pressure, childhood BMI, and young adult BMI, suggesting that other genetic or lifestyle factors contribute to this difference. 2004 John Wiley & Sons, Ltd.

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[A comparison of the management of severe high blood pressure between 1999 and 2003 in France]

[Article in French]

Bertin N, Salanave B, Tilly B, Guilhot J, Ricordeau P, Fender P, Dematons MN, Treppoz H, Allemand H.

Direction du service medical de l'assurance-maladie, Paris. nicole.bertin cnamts.fr

AIM: To measure the change in blood-pressure control in two populations of patients with severe high blood pressure between 1999 and 2003. METHOD: The French National Healthcare Fund performed two observational, cross-sectional surveys on the medical management of high blood pressure, the first in 1999 and the second in 2003. Each survey enrolled patients aged between 20 and 80 years old who filed a first-time request for exemption from co-payments for this long-term disorder. Study data was collected by the health fund's salaried physician advisors who directly examined the patients and from information gathered from each patient's attending physician. Adequate blood pressure control was defined according to the guidelines set out by the ANAES in 1997 and determined by calculating the average of the last three blood pressure figures recorded by the patient's attending physician (systolic [SBP] and diastolic [DBP] arterial blood pressures). RESULTS: 10,665 patients were enrolled in the 1999 survey and 2,584 were enrolled in the 2003 survey. The average age was 63.1 +/- 0.2 years in 1999 and 64.4 +/- 0.4 years in 2003. The proportion of diabetic patients in the two surveys remained stable: 27.5% +/- 1.0 in 1999 and 28.4% +/- 1.7 in 2003. Between 1999 and 2003, the percentage of patient who were treated for hypercholesterolemia increased from 44.0% +/- 1.1 to 54.3% +/- 1.9. Between 1999 and 2003, the proportion of patients who were considered well-controlled (SBP and DBP < 140/90 mmHg) or, if older than 60 years with isolated systolic high blood pressure (DBP < 90 mmHg and SBP < or = 160 mmHg) increased almost 5% points, going from 40.8% +/- 1.1 in 1999 to 45.5% +/- 1.9 in 2003. In diabetic patients, in whom the cut-off threshold is 130/85 mmHg, 6.7% +/- 1.1 were considered well-controlled in 1999 while 5.4% +/- 1.7 were deemed well-controlled in 2003. The proportion of well-controlled patients in the sub-group of hypertensive patients with renal failure (cut-off thresholds: 125/75 mmHg) remained relatively stable between 1999 and 2003: 5.2% [2.5; 7.9] versus 2.8% [0.5; 8.6]. CONCLUSION: There was a significant increase in the proportion of well-controlled hypertensive patients between 1999 and 2003. This increase occurred at the same time as a number of initiatives (scientific societies, federal government as well as the National Health Fund) intended to sensitize physicians to the need to obtain adequate blood pressure control.

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