Associations of parental, birth, and early life characteristics with systolic blood pressure at 5 years of age: findings from the Mater-University study of pregnancy and its outcomes.

Lawlor DA, Najman JM, Sterne J, Williams GM, Ebrahim S, Davey Smith G.

Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Rd, Bristol, BS8 2PR, UK. d.a.lawlor bristol.ac.uk

BACKGROUND: We examined the associations of a range of parental and early life characteristics with systolic blood pressure at 5 years of age. METHODS AND RESULTS: Information from 3864 children who were followed up prospectively from their mother's first antenatal clinic assessment was used. Maternal age, body mass index, and smoking during pregnancy were all positively associated with offspring systolic blood pressure at 5 years of age. The systolic blood pressure of children whose mothers had smoked throughout pregnancy was on average 0.92 mm Hg (95% CI 0.17 to 1.68) greater than that of children whose mothers had never smoked, after full adjustment. Children who had been breast fed until at least 6 months had lower systolic blood pressure than those who were breast fed for a shorter duration. Paternal body mass index and child's weight, height, and body mass index were all positively associated with blood pressure at age 5. CONCLUSIONS: Because childhood blood pressure tracks into adulthood, interventions aimed at early life risk factors, such as quitting smoking during pregnancy, breast feeding, and prevention of obesity in all family members, may be important for reducing the population distribution of blood pressure and thus cardiovascular disease risk.

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Fat distribution, body mass index and blood pressure in 22,090 men and women in the Norfolk cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk) study.

Canoy D, Luben R, Welch A, Bingham S, Wareham N, Day N, Khaw KT.

Department of Public Health and Primary Care, University of Cambridge, Cambridge, MRC Dunn Human Nutrition Unit, Cambridge and MRC Epidemiology Unit, Cambridge, UK. dexter.canoy srl.cam.ac.uk

OBJECTIVE: To determine the relation between fat distribution and blood pressure, independent of body mass index. DESIGN: Cross-sectional, population-based study. PARTICIPANTS AND METHODS: Participants, 9936 men and 12,154 women aged 45-79 years, were recruited from general practices in Norfolk, United Kingdom for the European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk) study. Participants filled in a health and lifestyle questionnaire and their blood pressure and anthropometry were measured at a clinic. We mainly used waist-hip ratio (WHR) to assess body fat distribution. RESULTS: Systolic blood pressure (SBP) and diastolic blood pressure (DBP) increased linearly across the whole range of waist-hip ratio in both men and women. The relation was independent of age, body mass index (BMI) and other covariates. Separately, waist and hip circumferences were positively related to SBP and DBP. When adjusted for BMI, waist circumference was positively related to SBP (in women) and DBP (in both men and women), whereas hip circumference was inversely related to SBP (but not DBP) in both men and women. Stratifying by tertiles of waist and hip circumference, age- and BMI-adjusted SBP and DBP were highest among those with high waist and small hip circumference measures. CONCLUSION: Waist-hip ratio was independently related to blood pressure. Waist-hip ratio could reflect the separate and opposite relations of waist and hip circumferences on blood pressure. Characterizing patterns of fat distribution may have implications in the assessment and control of obesity-related blood pressure elevation.

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High altitude and blood pressure in children.

Arslan S, Arslan N, Soylu A, Akgun C, Tepebasili I, Turkmen M, Kavukcu S.

Department of Pediatrics, Yuzuncu Yil University, Faculty of Medicine, Van, Turkey.

We aimed to evaluate the blood pressure of children who had similar demographic characteristics but lived at different altitudes. Blood pressure of the children attending primary schools in Izmir (sea level: n = 425) and Van (altitude: 1725 m, n = 291) were measured by mercurial sphygmomanometer for this study. They were similar with respect to age, sex, weight, height, and BMI. Mean age of the children was 10.51 +/- 0.87 years (range: 9 to 12 years), and 358 (50 percent) of them were female. Mean systolic blood pressure was significantly higher in the children living in Van than in the children living in Izmir (104.72 +/- 11.2 vs. 97.96 +/- 25.5 mmHg, respectively, p < .001). Similarly mean diastolic blood pressure was significantly higher in the children living in Van than in the children living in Izmir (63.98 +/- 9.3 vs. 59.91 +/- 10.0 mmHg, respectively, p < .001). When blood pressure was evaluated with regard to height percentile, the number of children with a blood pressure over 90 percentile were 19 (4.5 percent) and 48 (16.5 percent) for systolic blood pressure, and 25 (5.9 percent) and 37 (12.7 percent) for diastolic blood pressure among the children living in Izmir and Van, respectively (p < .001). Systolic and diastolic blood pressures were found to increase in parallel to the increase in body mass index in children living in Van (r = 0.358, p < .001 and r = 0.235, p < .001, respectively). However, blood pressures were not correlated to body mass index in children living in Izmir. A difference of 1700 m in altitude was associated with higher systolic and diastolic blood pressure levels in children with similar demographic characteristics, and at this altitude, body mass index and blood pressure showed a positive correlation.

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Concurrent treatment with an ACE inhibitor may amplify the utility of calcium supplementation for control of hypertension.

McCarty MF.

Pantox Laboratories, 4622 Santa Fe St., San Diego, CA 92109, USA. mmccarty nai-online.com

Although supplemental calcium typically lowers blood pressure in subjects with salt-sensitive, low-renin hypertension - presumably by down-regulating increased production of parathyroid hormone (PTH) and/or parathyroid hypertensive factor (PHF) - its impact on the blood pressure of unselected hypertensive or normotensive subjects, as assessed by meta-analyses, appears to be trivial at best. This suggests that calcium may actually raise blood pressure a bit in some patients with high-renin hypertension, a prediction that is borne out in rodent models of this disorder. There is limited clinical evidence that long-term calcium supplementation tends to raise plasma renin activity; this finding, if valid, could evidently rationalize the equivocal clinical impact of calcium on blood pressure. Salt restriction likewise boosts renin production, and this effect tends to most notable in subjects whose blood pressure fails to decline during low-salt diets. Two clinical groups have demonstrated that salt restriction has a larger and more consistently beneficial impact on the blood pressure of hypertensives when they concurrently are treated with ACE inhibitors - evidently because the physiological impact of the associated rise in renin is blunted. Analogous logic suggests that calcium supplementation may be more beneficial for hypertensives in the context of ACE inhibition or blockade of angiotensin II receptors; this supposition that can readily be tested clinically. The imminent availability of safe nutraceutical ACE inhibitors may make it more feasible for the general public to benefit from these therapeutic/preventive possibilities.

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Hoe 140 abolishes the blood pressure lowering effect of taurine in high fructose-fed rats.

Nandhini AT, Anuradha CV.

Department of Biochemistry, Faculty of Science, Annamalai University, Annamalainagar, Tamil Nadu, India.

High fructose feeding induces moderate increases in blood pressure of normal rats, associated with hyperinsulinemia, insulin resistance and impaired glucose tolerance. Increased vascular resistance, and sodium retention have been proposed to contribute to the blood pressure elevation in this model. Taurine, a sulphur-containing amino acid has been reported to have antihypertensive and antinatriuretic actions. In addition, taurine is shown to increase the excretion of nitrite and kinin availability and hence would be expected to improve the vascular tone. In the present study, the involvement of kinins in the blood pressure lowering effect of taurine was investigated by coadministration of Hoe 140, a kinin B(2) receptor antagonist along with taurine. The effects of taurine on plasma and urinary concentrations of sodium and tissue kallikrein activity were studied in high fructose-fed rats. Fructose-fed rats had elevated blood pressure and decreased levels of sodium in urine. Treatment with 2% taurine in drinking water prevented the blood pressure elevation and coadministration of Hoe 140 abolished this effect of taurine in high fructose-fed rats. The findings confirm the antinatriuretic action of taurine and also suggest a role for the kinins in the mechanism of taurine action in diet-induced hypertension.

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Birth weight is inversely correlated to adult systolic blood pressure and pulse pressure in type 1 diabetes.

Fagerudd J, Forsblom C, Pettersson-Fernholm K, Saraheimo M, Waden J, Ronnback M, Rosengard-Barlund M, Af Bjorkesten CG, Thorn L, Wessman M, Groop PH; Finn Diane Study Group.

Folkhalsan Institute of Genetics, Research Center, Helsinki, Finland.

In the general population, there is an inverse relationship between birth weight and adult systolic blood pressure. Because blood pressure in diabetic patients at least in part seems to be regulated by different mechanisms than in nondiabetic subjects, it is not known whether a similar correlation exists in diabetic individuals. Therefore, we obtained data on birth weight from original birth certificates in 1543 type 1 diabetic patients. Blood pressure was measured auscultatorily on a single occasion. In the 1225 patients born at term (after 37 weeks of gestation), the age- and sex-adjusted regression coefficients between systolic blood pressure and birth weight was -1.90 mm Hg/kg (95% confidence interval [CI], -3.71 to -0.09). The finding remained unchanged after adjustment for body mass index, current smoking, duration of diabetes, social class, antihypertensive therapy, glomerular filtration rate, glycemic control, and elevated albuminuria. The regression coefficient between birth weight and pulse pressure was of a similar magnitude. The age-adjusted regression coefficient between systolic blood pressure and birth weight seemed stronger in females (-3.34 mm Hg/kg; 95% CI, -6.06 to -0.62) than in males (-0.42 mm Hg/kg; 95% CI, -2.80 to 1.95), although this difference was not statistically significant. As a new finding, we report an inverse relationship between weight at birth and systolic blood pressure and pulse pressure in adult type 1 diabetic patients. Given the deleterious effects of elevated arterial blood pressure in diabetes, the impact of intrauterine growth retardation on the development of end-organ damage needs to be clarified.

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Increased plasma 8-isoprostane levels in hypertensive subjects: the Tsurugaya Project.

Hozawa A, Ebihara S, Ohmori K, Kuriyama S, Ugajin T, Koizumi Y, Suzuki Y, Matsui T, Arai H, Tsubono Y, Sasaki H, Tsuji I.

Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine and Pharmaceutical Science, Sendai, Japan. hozawa mail.tohoku.ac.jp

To examine the relationship between 8-isoprostane and blood pressure, we measured plasma 8-isoprostane concentration and home blood pressure levels in an elderly Japanese population. Our study population comprised 569 subjects aged 70 years and over who were not receiving antihypertensive medication. On the basis of their blood pressure values, the participants were classified into three groups: normotensive (home blood pressure <135/85 mmHg), hypertensive (home blood pressure 135/85-160/90 mmHg), and severely hypertensive (home blood pressure > or =160/90 mmHg). The mean plasma 8-isoprostane level in the severely hypertensive group (21.1+/-5.2 pg/ml) was significantly higher than that in the normotensive (20.2+/-4.9 pg/ml) or hypertensive (19.7+/-5.1 pg/ml) group, and this result was unchanged when we adjusted for possible confounding factors such as age, sex, use of vitamin A, C or E supplements, smoking status, drinking status, body mass index, use of non-steroidal anti-inflammatory drugs, history of diabetes, hypercholesterolemia, home heart rate and serum creatinine level. Thus, the level of plasma 8-isoprostane appears to be elevated in older subjects with severe hypertension.

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Role of manidipine in the management of patients with hypertension.

Tikhonoff V, Mazza A, Casiglia E, Pessina AC.

University of Padova, Department of Clinical and Experimental Medicine, Via Giustiniani No. 2, I-35128 Padova, Italy. valerie.tikhonoff unipd.it.

Manidipine is a third-generation dihydropyridine calcium antagonist, which causes systemic vasodilation by inhibiting the voltage-dependent calcium inward currents in smooth muscle cells. In clinical studies, manidipine has been shown to significantly lower office and 24-h blood pressure compared with placebo in patients with essential hypertension. The resulting reduction in blood pressure is maintained over 24 h, with preservation of the circadian blood pressure pattern; its blood pressure-lowering capacity appears to be similar to that of other calcium antagonists. In elderly patients with mild-to-moderate essential hypertension, manidipine is able to significantly decrease blood pressure compared with placebo for up to 3 years of treatment. The drug also significantly lowers blood pressure in patients with hypertension and concomitant Type 2 diabetes mellitus or renal impairment, and is devoid of adverse metabolic effects. It is well-tolerated with few untoward adverse effects related to vasodilation. In particular, manidipine appears to have less potential for pedal edema than other calcium channel blockers.

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