Sex differences in the pharmacological treatment of hypertension: a review of population-based studies

OBJECTIVE: To summarize all available literature on sex differences in the pharmacological treatment of hypertension with respect to the percentage of hypertensive patients treated pharmacologically and the selection of antihypertensive drugs. The influences of the calendar period, age, definition of hypertension, prevalence of hypertension and country on these sex differences were examined. DATA IDENTIFICATION: A secondary analysis of data from 46 population-based studies in 22 countries on the prevalence of pharmacologically treated hypertension was conducted to estimate sex ratios for the prevalence of drug treatment for hypertension. RESULT: Overall, women with hypertension were 1.33-fold [95% confidence interval (CI) 1.32-1.34] more likely to be treated pharmacologically for hypertension than were hypertensive men. With increasing age, the female: male ratio for pharmacological treatment of hypertension decreased from 2.26 (95% CI 1.56-3.27) at ages 20-29 years to 1.22 (95% CI 1.11-1.34) at ages 60-69 years. In all countries more women than men were treated for hypertension, with the biggest difference observed in the USSR (1983-1986), where about twice as many women as men were treated for hypertension. Women more frequently used diuretics, whereas men more often used beta-blockers, angiotensin converting enzyme inhibitors and calcium antagonists. CONCLUSIONS: Hypertensive women are more often treated for hypertension than hypertensive men and their pattern of use of antihypertensive drugs differs from that of men. Further research is required in order to explain sex differences in the treatment of hypertension with respect to the prevalence of pharmacological treatment of hypertension and choice of antihypertensive drugs, and to investigate the consequences of this difference for long-term outcomes.     

Trends in blood pressure levels and control of hypertension in Finland from 1982 to 1997

OBJECTIVE: To assess the trends in blood pressure levels and hypertension control in Finland from 1982 to 1997. DESIGN: Four independent cross-sectional population surveys conducted in 1982, 1987, 1992 and 1997. SETTING: From 1982 to 1997, the provinces of North Karelia and Kuopio in eastern Finland and the region of Turku-Loimaa in southwestern Finland were surveyed. From 1992 to 1997, the Helsinki-Vantaa region in southern Finland was surveyed. PARTICIPANTS: Men and women aged 25-64 years were selected randomly from the national population register. The total number of participants was 27 623. MAIN OUTCOME MEASURES: We assessed mean systolic and diastolic blood pressure, prevalence of hypertension (subjects with systolic blood pressure > or = 160 mmHg or diastolic blood pressure > or = 95 mmHg or current use of antihypertensive drug treatment) and antihypertensive drug treatment and quality of hypertension care among hypertensive persons. RESULTS: Mean systolic blood pressure and the prevalence of hypertension decreased significantly in all areas except among men in the Helsinki-Vantaa region. The fall in mean diastolic pressure was significant only in eastern Finland. The proportion of hypertensives who were unaware of their condition fell from 45.5 to 24.1% in men and from 27.2 to 15.7% in women. At the same time, the proportion of hypertensives with adequately controlled blood pressure (systolic pressure < 160 mmHg and diastolic pressure < 95 mmHg) increased from 9.4 to 23.5% in men and from 16.0 to 36.7% in women. CONCLUSION: Hypertension care in Finland has improved significantly during the last 15 years. However, the situation is still far from optimal. It is obvious that the biggest problem in hypertension care has shifted from detection to adequate treatment of high blood pressure.     

Reduced plasma volume and changes in vasoactive hormones in underweight pregnant women

The objective of this case-control study is to identify factors associated with the prevalence of minimal or mild endometriosis among infertile women. Cases (N = 329) were women diagnosed by laparoscopy with minimal or mild endometriosis and without any other factors explaining their infertility. Controls (N = 262) were women in whom the infertility remained unexplained after a diagnostic laparoscopy. Selected characteristics were documented by means of a face-to-face interview before the laparoscopy. The prevalence of minimal or mild endometriosis was higher in women age 25 years or older, in those who reported menarche at the age of 13 years [prevalence odds ratio (POR) = 1.63; 95% confidence interval (CI) = 1.02-2.60] or older (POR = 1.73; 95% CI = 1.07-2.78), menstrual cycles of 27 days or less (POR = 1.63; 95% CI = 1.02-2.60), or caffeine intake of 300 mg per day or more (POR = 1.33; 95% CI = 0.91-1.94). The prevalence of minimal or mild endometriosis was inversely related to body mass index. Parous women were less likely to have endometriosis (POR = 0.61; 95% CI = 0.39-0.96) than were nulliparous women. Education, duration of infertility, and smoking status were not related to the presence of endometriosis.     

Evidence for cAMP-independent mechanisms mediating the effects of adrenomedullin, a new inotropic peptide

OBJECTIVE: To determine the relation of skeletal body build and obesity to blood pressure and the prevalence of hypertension. DESIGN: Cross-sectional data obtained from the baseline recruitment of the EPIC-Potsdam Study, which is part of the European Prospective Investigation into Cancer and Nutrition (EPIC). SUBJECTS: A total of 10,303 subjects (4387 men, aged 40-65 y and 5916 women, aged 35-65 y) were recruited between January 1995 and July 1996. MEASUREMENTS: Anthropometric measures included body mass index (BMI), waist-hip ratio (WHR) and metrik index (MIX) as a measure of body build that is derived from the relation of chest depth and breadth to body height. Systolic and diastolic blood pressure was obtained using automatic oscillometric devices. Hypertension was defined as blood pressure > or = 160/95 mmHg or current use of antihypertensive medication. Information on lifestyle factors were obtained by personal interview. STATISTICAL ANALYSIS: Logistic regression was used to define the association of categories of BMI, WHR, and MIX and the prevalence of hypertension. Odds ratios (ORs) of being hypertensive were estimated comparing the highest to the lowest quintile, adjusting for age, smoking status, alcohol intake level, educational attainment, physical activity categories, and each of the anthropometric variables. RESULTS: The simultaneously adjusted OR of being hypertensive, comparing the highest vs the lowest category, was for BMI 2.3 (95% confidence interval (CI) = 1.6-3.2) in men and 1.8 (95% CI = 1.4-2.5) in women, for WHR 1.8 (95% CI = 1.4-2.4) in men and 1.5 (95% CI = 1.2-2.0) in women, and for MIX (largest chest size vs lowest chest size relative to body height) 2.0 (95% CI = 1.4-2.8) in men and 2.2 (95% CI = 1.6-3.1) in women. CONCLUSION: In addition to measures of overall obesity (BMI) as well as central obesity (WHR), skeletal body build (MIX) was independently associated with the prevalence of hypertension. The biological mechanism relating MIX to hypertension, however, is still unclear and needs further exploration.     

Sex differences in the impact of coexistent diabetes on survival in patients with coronary heart disease

OBJECTIVE: To evaluate the sex difference in the impact of diabetes on survival in patients with coronary heart disease. RESEARCH DESIGN AND METHODS: Cohort study based on a sample from a hospital registry in Chicago, IL. A total of 974 consecutive patients (585 men and 389 women) with angiographically confirmed coronary artery disease were followed for 4.6 yr. RESULTS: At baseline, 160 men and 155 women had diabetes. The age-adjusted relative risk of death from all causes for patients with diabetes versus patients without diabetes was 0.93 (95% confidence interval 0.65-1.34) in men and 1.99 (95% CI 1.30-3.05) in women. For cardiac death, the corresponding relative risk was 1.00 (95% CI 0.64-1.56) and 1.96 (95% CI 1.19-3.24) in men and women, respectively. Baseline differences in age, hypertension, body mass index, number of diseased vessels, and ejection fraction did not fully explain the excess mortality risk in diabetic women. Excess risk was apparent in both cardiac and noncardiovascular categories. Among nondiabetic patients, the risk of death was significantly lower in women compared with men (multivariate-adjusted relative risk = 0.61, 95% CI 0.41-0.89). However, the mortality risk of diabetic women became similar to men as a whole (relative risk = 1.13, 95% CI 0.80-1.60). CONCLUSIONS: Diabetes confers a substantially higher risk of mortality in women than in men when it occurs in the presence of coronary heart disease.     

Prospective study of calcium channel blocker use, cardiovascular disease, and total mortality among hypertensive women: the Nurses' Health Study

BACKGROUND: In several observational studies, patients prescribed calcium channel blockers had higher risks of cardiovascular diseases and mortality than those prescribed other antihypertensive medications. We explored these associations in the Nurses' Health Study. METHODS AND RESULTS: A total of 14 617 women who reported hypertension and regular use of diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, or a combination in 1988 were included in the analyses. Cardiovascular events and deaths were ascertained through May 1, 1994. We documented 234 cases of myocardial infarction. Calcium channel blocker monodrug users had an age-adjusted relative risk (RR) of myocardial infarction of 2.36 (95% CI, 1.43 to 3.91) compared with those prescribed thiazide diuretics. Women prescribed calcium channel blockers had a higher prevalence of ischemic heart disease. After adjustment for these and other coronary risk factors, the RR was 1.64 (95% CI, 0.97 to 2.77). Comparing the use of any calcium channel blocker (monodrug and multidrug users) with that of any other antihypertensive agent, the adjusted RR was 1.42 (95% CI, 1.01 to 2.01). An association between calcium channel blocker use and myocardial infarction was apparent among women who had ever smoked cigarettes (covariate-adjusted RR, 1.81; 95% CI, 1.20 to 2.72) but not among never-smokers (RR, 0.94; 95% CI, 0.48 to 1.84). CONCLUSIONS: In analyses adjusted only for age, we found a significant elevation in RR of total myocardial infarction among women who used calcium channel blockers compared with those who did not. After adjustment for comorbidity and other covariates, the RR was reduced. Whether the remaining observed elevated risk is real, or a result of residual confounding by indication, or chance, or a combination of the above cannot be evaluated with certainty on the basis of these observational data.     

Calcium intake and the incidence of forearm and hip fractures among men

High calcium intakes are thought to be associated with strong bones and lower risk of fractures. However, findings from epidemiologic studies have not been consistent. In addition, the vast majority of such studies were conducted among women, leading to a relative lack of data concerning men. The objective of this study therefore was to investigate the relation between adult calcium intake and risk of fractures among men in the Health Professionals Follow-up Study (HPFS). During 331,234 person-years of follow-up over an 8-y period, 201 forearm and 56 hip fractures due to low or moderate trauma were reported among 43,063 men 40-75 y of age in 1986 when they first completed a questionnaire about diet and lifestyle factors. After controlling for age, smoking status, body mass index (BMI), physical activity, alcohol consumption and total energy intake, the relative risk (RR) of forearm fractures for men in the highest quintile of calcium intake (from foods plus supplements) compared with those in the lowest quintile was 0.98 [95% confidence interval (CI) = 0.59-1.61; P for trend = 0.78]; for hip fractures, the comparable RR was 1.19 (95% CI = 0.42-3.35; P for trend = 0.58). Relative risks for consuming >2.5 glasses (600 mL) of milk per day compared with one (240 mL) or fewer per week were 1.06 (95% CI = 0.69-1.62; P for trend = 0.82) for forearm fractures and 0.97 (95% CI = 0.39-2.42; P for trend = 0.56) for hip fractures. In conclusion, these results do not support a relation between calcium intake and the incidence of forearm or hip fractures in men.     

Dipyridamole stress echocardiography for risk stratification in hypertensive patients with chest pain

BACKGROUND: The noninvasive prognostic assessment of coronary artery disease (CAD) in hypertensive patients represents an unresolved task to date. In this study, we investigated the value of dipyridamole stress echocardiography in risk stratification of hypertensive patients with chest pain and unknown CAD. METHODS AND RESULTS: Dipyridamole stress echocardiography was performed in 257 hypertensives (110 men; age, 63+/-9 years) complaining of chest pain and without a history of CAD. No major complications occurred. Four tests were interrupted prematurely because of side effects, with 98. 4% feasibility of test. A positive echocardiographic response was found in 72 patients (27 during the low-dose [0.56 mg/kg]). During the follow-up (32+/-18 months), 27 cardiac events occurred: 3 deaths, 8 infarctions, and 16 cases of unstable angina. Moreover, 27 patients underwent coronary revascularization. At multivariate analysis, the positive echocardiographic result (OR, 5.5; 95% CI, 1.4 to 16.6) was the only predictor of hard cardiac events (death, infarction). Considering spontaneous cardiac events (death, infarction, and unstable angina) as end points, the positive echocardiographic result (OR, 4.2; 95% CI, 1.8 to 9.6) and family history of CAD (OR, 4.2; 95% CI, 1.5 to 6. 9) were independently associated with prognosis. The 3-year survival rates for the negative and the positive populations were, respectively, 97% and 87% (P=0.0019) considering hard cardiac events and 96% and 74% (P=0.0000) considering spontaneous cardiac events. CONCLUSIONS: Dipyridamole stress echocardiography is safe, highly feasible, and effective in risk stratification of hypertensives with chest pain and unknown CAD. At present, it represents an attractive option for prognostic assessment of this clinically defined population.     

Blood pressure levels in the 41 populations of the WHO MONICA Project

In the early to mid 1980s, the WHO MONICA Project conducted cardiovascular risk factor surveys in 41 study populations in 22 countries. Study populations aged 35-64 years comprised 32,422 men and 32,554 women. Blood pressures (BP) and body mass index (BMI) were measured according to a standard protocol. Participants were asked about antihypertensive medication. In men, the average age-standardized BPs ranged among the populations from 124 to 148 mm Hg for systolic (SBP) and from 75 to 93 mm Hg for diastolic (DBP). The corresponding values in women were 118-145 mm Hg for SBP and 74-90 mm Hg for DBP. In all populations, women had lower SBP than men in the age group 35-44. However, SBP in women rose more steeply with age so that in 34 of 41 populations women had higher SBP than men in the age group 55-64. The proportion of participants with untreated major elevation of BP ranged from 4.5% to 33.7% in men and from 1.9% to 22.3% in women. The proportions of participants receiving antihypertensive medication were 4.3-17.7% for men and 6.0-22.0% for women. These proportions were not correlated with the prevalence of untreated hypertensives. Age-adjusted BMI was associated with SBP and accounted for 14% of the SBP variance in men and 32% in women. We found a large difference in SBP among the MONICA study populations and conclude that the results represent a valid estimate of the public health problem posed by elevated BP. We also have shown that almost universally the problem of elevated BP is more prevalent in women than in men, especially in the older age groups.     

Comments on a meta-analysis of the relation between dietary calcium intake and blood pressure

The role of dietary calcium in the etiology of hypertension is controversial. In 1995, Cappuccio et al. (American Journal of Epidemiology,1995;142:935-45) examined this issue in a meta-analysis of observational studies published between 1983 and 1993. The author of the present paper reviewed the original studies underlying this meta-analysis and discovered that data from one study had been inappropriately extracted and converted, leading to an understatement of the calcium-blood pressure relation by a factor of about 30. This review also raised questions about the extraction and conversion of data from several other studies and about the statistical methods used. The author repeated the meta-analyses and discovered an unadjusted regression slope between dietary calcium and systolic blood pressure of -0.34 mmHg/100 mg per day (95% confidence interval (CI) -0.46 to -0.22) for men, -0.15 mmHg/100 mg per day (95% CI -0.19 to -0.11) for women, and -0.39 mmHg/100 mg per day (95% CI -0.47 to -0.31) for men and women. For diastolic blood pressure, the pooled regression slope for men was -0.22 mmHg/100 mg per day (95% CI -0.32 to -0.13), while for women it was -0.051 mmHg/100 mg per day (95% CI -0.090 to -0.012); for men and women it was -0.35 mmHg/100 mg per day (95% CI -0.67 to -0.02). These slopes are still modest but are larger than those reported in the original analysis. However, since all of these analyses were based on zero-order correlations or regressions, extreme caution must be exercised in interpreting the results.     

Systemic lupus erythematosus with pulmonary hypertension--normalization of pulmonary artery pressure by long-term administration of beraprost sodium

OBJECTIVE: To determine the predictive value of angina pectoris diagnosed by Rose questionnaire for cardiovascular disease among treated hypertensives. METHODS: The cardiovascular experience of 4093 patients who had no history of cardiovascular disease and had been administered the Rose questionnaire for angina in a worksite treatment program was evaluated. RESULTS: Among 2659 men and 1434 women of similar age (53 versus 54 years), the race distribution was 44 versus 31% whites, 27 versus 41% blacks and 29 versus 28% Hispanics. Overall, the prevalence of angina by Rose questionnaire in women (15%) was twice that in men (7%) in all three races, with Hispanics having the highest (20 versus 10%) prevalence. Those with angina (Rose-plus) and those without (Rose-minus) had similar initial and final blood pressures. In 4.0 years of average follow-up study, the crude incidence rates (per 1000 person-years) of the recorded 120 myocardial infarctions and 35 strokes did not differ significantly between Rose-plus and Rose-minus patients, except for myocardial infarction in Hispanic men (20.5 versus 5.9). When myocardial infarction incidence was adjusted for age within each sex-race subgroup, only Rose-plus Hispanic men had a significantly greater relative risk with Rose-minus as referent (relative risk 3.13, 95% confidence interval 1.31-7.50). Overall, in the Cox proportional hazards regression model, angina by Rose questionnaire was not predictive of myocardial infarction after accounting for other recognized risk factors. CONCLUSIONS: The present data suggest that the Rose questionnaire as a diagnostic tool for angina is not predictive of subsequent clinical events among treated hypertensive patients.     

Evaluation of the automatic quantification of left ventricular function using ECG gated 99mTc-MIBI myocardial SPECT

OBJECTIVE: To compare temporal changes in body mass index (BMI) (kg/m2) and prevalence of obesity (BMI > 25 and > 30 kg/m2) among adult Kuwaitis between two periods 14 y apart. DESIGN: Comparison of two independent cross-sectional samples of Kuwaitis studied in 1980-1981 and 1993-1994. SUBJECTS: 2067 (896 men and 1171 women) and 3435 (1730 men and 1705 women) adult Kuwaitis (aged > or = 18 y), drawn from primary health care (PHC) clinics and studied for nutritional assessment and for prevalence of obesity in 1980-1981 and 1993-1994, respectively. MEASUREMENTS: BMI, which is the weight in kilograms divided by the height in meters squared (kg/m2), was based on measured weight and height. Obesity was defined as BMI > 25 kg/m2 (grade 1) and BMI > 30 kg/m2) (grade 2). RESULTS: Mean BMI increased significantly (P < 0.001) by 10.0% and 6.2% (2.5 and 1.7 kg/m2) among men and women, respectively. Prevalence of obesity (BMI > 25 and > 30 kg/m2) increased by 20.6% and 15.4% and by 13.7% and 8.4% among men and women, respectively. After controlling for sociodemographic differences between the two study periods, BMI was 2.0 and 1.6 kg/m2 higher in 1993-1994 than in 1980-1981 among men and women respectively. The risk of obesity (BMI > 25 and > 30 kg/m2) also increased among both genders between the two periods (OR = 2.1, 95% CI 1.7-2.7 and OR = 1.9, 95% CI 1.5-2.4, for men and OR = 2.2, 95% CI 1.6-3.0 and OR = 1.4, 95% CI 2.2 CI-1.0-1.9, for women). CONCLUSION: BMI and prevalence of obesity increased among Kuwaitis between 1980-1981 and 1993 and 1994 probably due to the effects of modernization, affluence, increased food consumption and the concomitant changes to sedentary lifestyles. The rate of temporal changes in BMI and obesity were higher, by comparison, in Kuwait than in selected other countries.     

Norepinephrine in urine and plasma following provocative maneuvers in normal and hypertensive subjects

Urinary norepinephrine (UNE) excretion rate and venous plasma norepinephrine (PNE) concentrations were studied in 266 normotensive and 107 essential hypertensive men and women under conditions of volume expansion with 2 liters of intravenous normal saline over 4 hours, and volume contraction with a 10 mEq sodium diet and 120 mg oral furosemide. The UNE excretion rate was correlated with age in normal women only. In men, and in hypertensives of both sexes, the relationship appeared to be biphasic. The PNE concentration was not correlated with age in the hypertensive subjects. Insufficient numbers of older subjects were available to exclude absolutely such a relationship among normals. The UNE and PNE were influenced by volume expansion and contraction in both normals and hypertensives; however, normals exhibited a correlation between UNE and blood pressure as well as consistent correlations between UNE and PNE, neither of which were observed in the hypertensives. Hypertensive women generally had greater UNE and PNE values than normal women or hypertensive men. Hypertensive women may have altered sympathetic activity.     

Free protein S deficiency is a risk factor for venous thrombosis

A recent study suggests that protein S deficiency is not a risk factor for venous thrombosis. Since this unexpected finding would have important clinical implications if confirmed, we performed a case-control study with the aim to determine the prevalence of protein S deficiency in patients with thrombosis and in healthy individuals taken from the general population and the relative risk of thrombosis in protein S-deficient patients. Free protein S concentration was measured in 327 consecutive patients with at least one venous thrombotic episode and in 317 age- and sex-matched control individuals. Different normal reference ranges were obtained and adopted for men and women. Protein S deficiency was found in 3.1% (95% CI: 1.5-5.2) of patients and in 1.3% of controls (95% CI: 0.3-2.8). Ten patients and 4 control subjects had protein S deficiency, which determined a relative risk of thrombosis (sex- and age-adjusted odds ratio) of 2.4 (95% CI: 0.8-7.9). When men and women were analyzed separately, the risk was 5.0 (95% CI: 0.6-43.6) and 1.6 (95% CI: 0.4-6.7) respectively. PS-deficient men had more thrombotic episodes than women and later in life. Multivariate analysis established that sex was an independent determinant of the number of episodes, as was age, while PS deficiency was not. However sex and PS deficiency status were both determinants of age at first thrombotic episode.     

Long-term cost and life-expectancy consequences of hypertension

OBJECTIVE: To estimate hypertension's long-term cost and impact on life expectancy. DESIGN: A 19-year individual follow-up study. Subjects were categorized according to their baseline (1972) diastolic blood pressure (DBP) level into three groups: normotensive (DBP < 95 mmHg), mildly hypertensive (DBP 95-104 mmHg), and severely hypertensive (DBP > 104 mmHg). By using their social security identification numbers, we linked the subjects to a set of national registers covering hospital admissions, use of major drugs, absence due to sickness, disability pensions, and deaths. SUBJECTS: A random population sample of 10 284 men and women aged 25-59 years from the provinces of Kuopio and North Karelia in eastern Finland. MAIN OUTCOME MEASURES: The numbers of years of life and years of work lost, the cost of drugs and hospitalization, and the value of productivity lost due to disability and premature mortality. RESULTS: The difference in life expectancy between normotensive and severely hypertensive men was 2.7 years, of which 2.0 years was due to cardiovascular disease (CVD). Among women the corresponding differences were 2.0 and 1.5 years. Severely hypertensive men lost 2.6 years of work more than did normotensive men, of which 1.7 years was due to CVD. Among women the differences were 2.2 and 1.3 years. The mean undiscounted total costs (USA dollars at 1992 prices) were $132 500 among normotensive, $146 500 among mildly hypertensive, and $219 300 among severely hypertensive men, of which CVD accounted for 28, 39, and 43%, respectively. More than 90% of the total costs were indirect productivity losses. Among women the total costs were lower for all DBP categories, as were the shares of CVD-related costs. The proportional increase in costs on going from the lowest to the highest DBP category was, however, somewhat larger among women. CONCLUSIONS: On the population level, severe hypertension leads to considerable losses in terms of years of life lost, years of work lost, and costs. However, the overall impact of mild hypertension is much more limited.     

Prevalence, knowledge, treatment and control of arterial hypertension in Oporto, Portugal

The aim of this study was to assess the prevalence, awareness, treatment and control of hypertension among subjects above the age of 39 years living in the urban area of Oporto, Portugal. One hundred and seventy seven individuals from the community were selected by random digit dialing. Each subject was asked about his/her personal history of hypertension, antihypertensive treatment and had his/her blood pressure measured. The prevalence of hypertension was 57.1%, defined by systolic blood pressure (SBP) > or = 140 mm Hg and/or diastolic blood pressure (DBP) > or = 90 mm Hg and/or administration of current the antihypertensive medication. If the values defining hypertension were SBP > or = 160 mm Hg, and DBP > or = 95 mm Hg the prevalence would be 37.9%. The overall prevalence of hypertension was higher in females, but a slightly higher non significant value was found in males in the fifth and sixth decades. Among hypertensives, 62.7% were aware of their condition, 56.7% were treated, 84.2% of hypertensives treated were controlled (SBP < 160 mm Hg and DBP < 95 mm Hg) and 44.7% were very well controlled (SBP < 140 mm Hg and DBP < 90 mm Hg). The question "Are you hypertensive?" had a sensitivity of 62.7%, a specificity of 83.6% and an accuracy of 75.7%. In the preliminary results of this study of an urban population with a high prevalence of hypertension, the awareness of hypertension is similar to that described in the United States of America twenty years ago, the percentage of hypertensives treated is similar to the American percentage fifteen years ago and the percentage of hypertensives treated and controlled is close to the current American percentage.     

Relation of calcium, vitamin D, and dairy food intake to ischemic heart disease mortality among postmenopausal women

To investigate whether greater intakes of calcium, vitamin D, or milk products may protect against ischemic heart disease mortality, the authors analyzed data from a prospective cohort study of 34,486 postmenopausal Iowa women 55-69 years old and without a history of ischemic heart disease who completed a dietary questionnaire in 1986. Through 1994, 387 deaths due to ischemic heart disease were documented (International Classification of Diseases, Ninth Revision, codes 410-414, 429.2). The multivariate-adjusted relative risks for the highest versus the lowest quartiles of total calcium, vitamin D, and milk product intakes were as follows: 0.67 (95% confidence interval (CI) 0.47-0.94; p for trend = 0.09) for calcium, 1.41 (95% CI 0.93-2.15; p for trend = 0.12) for vitamin D, and 0.94 (95% CI 0.66-1.35; p for trend = 0.68) for milk products. The relative risk was 0.63 (95% CI 0.40-0.98) for high dietary calcium but no supplemental calcium intake and 0.66 (95% CI 0.36-1.23) for high supplemental calcium but low dietary calcium intake. These results suggest that a higher intake of calcium, but not of vitamin D or milk products, is associated with reduced ischemic heart disease mortality in postmenopausal women, and reduced risk may be achievable whether the higher intake of calcium is attained by diet, supplements, or both.     

Antihypertensive treatment in the elderly

Drug treatment with beta-blockers and diuretics in hypertensive men and women aged 70 and above confers highly significant and clinically relevant reductions in cardiovascular (especially stroke) morbidity and mortality. This satisfactory effect is not impaired by a low tolerability of the drugs used. Furthermore, treatment of elderly hypertensives with beta-receptor blockers and/or diuretics is cost-effective. In STOP-Hypertension the cost-effectiveness ratios were low and of the same magnitude for both men and women. The clinical implication of this is that blood pressure lowering therapy should be considered in elderly hypertensives, at least up until they are 80 years old. It should also be remembered that elderly patients often have other diseases than hypertension and that the drug treatment should be adjusted accordingly, e.g. by using a calcium antagonist or an ACE inhibitor, when indicated.     

Assessment of trans-fatty acid intake with a food frequency questionnaire and validation with adipose tissue levels of trans-fatty acids

Past studies of the association of trans-fatty acid intake with coronary heart disease have been hindered by the lack of a database on the trans-fatty acid content of various foods. The authors used new data from the US Department of Agriculture to estimate trans-fatty acid intake using a self-administered food frequency questionnaire (FFQ), and they assessed the validity of the FFQ by comparing the dietary estimates with trans-fatty acid concentrations in adipose tissue. The 1996 study included 27 women and 24 men aged 51-78 years. The mean consumption of total trans-fatty acids estimated from the FFQ was 2.24 g per day and 5% of total dietary fat. The mean concentration of total trans-fatty acids in buttock adipose tissue was 4.7% of total fatty acids. Pearson correlations between total dietary intake of trans-fatty acids and total trans-fatty acid levels in adipose tissue were 0.67 (95% confidence interval (CI) 0.36-0.84) among men and 0.58 (95% CI 0.26-0.79) among women. After adjustment for energy intake, age, and body mass index, the correlation coefficients were 0.76 (95% CI 0.51-0.89) among men and 0.52 (95% CI 0.17-0.75) among women. The FFQ validated in this study is an important new tool for assessing usual intake of trans-fatty acids.