Hypertension, admission blood pressure and perioperative cardiovascular risk

We performed a retrospective case-control study to investigate hypertension and admission blood pressure as risk factors for postoperative cardiovascular death. We identified records of 76 patients who had died of a cardiovascular cause within 30 days of anaesthesia and elective surgery and 76 matched controls. From the records of each patient (case and control) we recorded the admission blood pressure and details of any history of hypertension. A pre-operative history of hypertension was strongly associated with perioperative cardiovascular death (p < 0.001 with one degree of freedom: odds ratio 4.14, 95% confidence intervals 1.63-11.69). There was no association between systolic or diastolic pressure at admission for operation and perioperative cardiovascular death. The mean admission systolic pressure of the cases was 145.5 mmHg (range 90-250 mmHg) and that of the controls was 146.5 mmHg (range 100-200 mmHg). The mean admission diastolic pressure of the cases was 83.2 mmHg (range 60-130 mmHg), and that of the controls was 84.5 mmHg (range 60-110 mmHg).     

Salt intake, urinary sodium, and hypercalciuria

Several studies have reported that high sodium (Na) intake increases not only urinary Na but also urinary calcium (Ca), suggesting that high Na intake could be involved in the pathogenesis of hypercalciuria. No research data are available on the relationship of Na intake to the prevalence of hypercalciuria within the general population. Moreover, it is not clear if Na intake relates only to urinary Ca or also to other indices of Ca homeostasis, including intestinal Ca absorption. In the present paper, two distinct studies addressed these points using 24-hour urinary Na as an index of salt intake in individuals on their habitual unrestricted free diet. Study 1 analyzed the relationship between 24-hour urinary Na and hypercalciuria (24-hour urinary Ca > or = 7.5 mmol in men, > or = 6.25 mmol in women) in a population sample of 203 men and women, aged 20-59 years. Study 2 analyzed the relationship between 24-hour urinary Na and intestinal strontium (Sr) absorption, used as an index of intestinal Ca absorption, urinary (24-hour and fasting) and plasma Ca, and plasma parathyroid hormone in 36 healthy men and women, aged 18-65 years. Within the population sample (study 1), 24-hour urinary Na was directly and significantly correlated with prevalence of hypercalciuria when controlling for gender, age, weight, and urinary creatinine: the relationship was continuous and linear for urinary Na ranging between 40 and 200 mmol/24 h. In the 36 volunteers (study 2), 24-hour urinary Na was related to 24-hour and fasting urinary Ca (p < 0.001) but not to intestinal Sr absorption: the relationship between 24-hour urinary Na and urinary Ca (both 24 h and fasting) was also significant, controlling for other variables. The results indicate that in adults on their habitual diet, urinary Na, which reflects dietary salt intake, correlates with the prevalence of hypercalciuria independently of intestinal Ca absorption and mainly via renal mechanisms.     

Salt sensitive blood pressure and the renin-angiotensin system in hypertension

The relationship between (excessive) use of sodium chloride and the blood pressure is still equivocal. Blood pressure responses to alterations in dietary salt consumption vary greatly between individuals, which has led to the concept of salt sensitivity. Although the mechanisms which determine the degree of salt sensitivity are not fully understood, the renin-angiotensin system seems to play a key role. A relative inability of this system to respond promptly to alterations in salt intake may underlie the development of salt sensitivity. By administering drugs which block the renin-angiotensin system to patients with essential hypertension, blood pressure is rendered more sensitive to the effects of salt restriction and (or) diuretic treatment.     

A study of the interactive effects of oral contraceptive use and dietary fat intake on blood pressure, cardiovascular reactivity and glucose tolerance in normotensive women

A morphometrical evaluation was made of the seasonal changes affecting the numbers of lymphocytes in the thymus, spleen and pronephros of wild brown trout, Salmo trutta, while the size of the thymus and the three thymic zones were also determined. Results reveal statistically significant changes throughout the year in the number of lymphocytes in the lymphoid organs studied. The spleen and pronephros have similar annual patterns of lymphocyte distribution with high numbers in two seasons, spring and autumn, and two periods of lymphoid involution in winter and summer. The highest numbers of thymocytes occur in trout caught in May and August, and the lowest in winter. In addition to normal lymphocytes, degenerated lymphoid cells that show pale cytoplasm devoid of cell organelles, also occurred in all the lymphoid organs. A negative correlation exists between the numbers of normal lymphocytes and that of degenerated lymphoid cells. The thymic size, as well as that of the subcapsular, inner and outer thymic zones, undergo very significant changes over the year. We discuss the relevance of cell proliferation, cell migration and in situ cell death for the circannual variations observed in the cell content of trout lymphoid organs, together with the possible causes.     

Salt intake in young children

Among adult Finns salt intake is about twice as high as the recommended levels and almost five-fold greater than the physiological requirement. Information as to salt intake in children has hitherto been sparse. Daily sodium intake among 1-5-year-olds was investigated in this study, and the foodstuffs from which it was derived were identified. In all age groups, sodium intake was at least two-fold greater than the Nordic recommendations, and among five-year-olds it exceeded the recommended intake for adults. Approximately half of the sodium intake was found to have derived from salt used in cooking. Levels of sodium derived by children from dairy, meat and grain products were also relatively high. Sodium intake in children after infancy merits greater attention than previously accorded it, as permanent eating habits and taste preferences are already formed at this age, and reasonable limits for salt intake should therefore be established during childhood.     

Nutrient intake and blood pressure in the Dietary Intervention Study in Children

Delineating the role that diet plays in blood pressure levels in children is important for guiding dietary recommendations for the prevention of hypertension. The purpose of this study was to investigate relationships between dietary nutrients and blood pressure in children. Data were analyzed from 662 participants in the Dietary Intervention Study in Children who had elevated low-density lipoprotein cholesterol and were aged 8 to 11 years at baseline. Three 24-hour dietary recalls, systolic pressure, diastolic pressure, height, and weight were obtained at baseline, 1 year, and 3 years. Nutrients analyzed were the micronutrients calcium, magnesium, and potassium; the macronutrients protein, carbohydrates, total fat, saturated fat, polyunsaturated fat, and monounsaturated fat; dietary cholesterol; and total dietary fiber. Baseline and 3-year longitudinal relationships were examined through multivariate models on diastolic and systolic pressures separately, controlling for height, weight, sex, and total caloric intake. The following associations were found in longitudinal analyses: analyzing each nutrient separately, for systolic pressure, inverse associations with calcium (P < .05); magnesium, potassium, and protein (all P < .01); and fiber (P < .05), and direct associations with total fat and monounsaturated fat (both P < .05); for diastolic pressure, inverse associations with calcium (P < .01); magnesium and potassium (both P < .05), protein (P < .01); and carbohydrates and fiber (both P < .05), and direct associations with polyunsaturated fat (P < .01) and monounsaturated fat (P < .05). Analyzing all nutrients simultaneously, for systolic pressure, direct association with total fat (P < .01); for diastolic pressure, inverse associations with calcium (P < .01) and fiber (P < .05), and direct association with total and monounsaturated fats (both P < .05). Results from this sample of children with elevated low-density lipoprotein cholesterol indicate that dietary calcium, fiber, and fat may be important determinants of blood pressure level in children.     

Ambulatory blood pressure, nocturnal blood pressure reduction and plasma catecholamines

OBJECTIVE AND DESIGN: Controversial data have been reported on plasma catecholamines in hypertensives. Aims of this study were to find whether 24-hour ambulatory blood pressure was correlated with circulating catecholamines and to investigate whether nocturnal blood pressure reduction was associated with baseline plasma catecholamines. Samples for catecholamine determination were obtained in 34 consecutive male subjects after a 30-minute rest and before ambulatory blood pressure monitoring. RESULTS: Hypertensive patients (n = 22; 24-hour blood pressure: 145 +/- 14/94 +/- 6 mm Hg) showed similar norepinephrine and epinephrine levels when compared with normotensives (n = 12; 24-hour blood pressure: 124 +/- 6/81 +/- 6 mm Hg), and higher dopamine values (hypertensives: 64.6 +/- 58; normotensives: 26.2 +/- 31 pg/ml; p < 0.05). A positive correlation was observed between dopamine and diastolic nocturnal blood pressure (p < 0.05) while a negative correlation was found between dopamine and nocturnal diastolic blood pressure reduction (p < 0.025). No significant relationship was observed between both norepinephrine and epinephrine, and 24-hour blood pressures. CONCLUSIONS: Since previous reports have documented malfunctioning of dopaminergic system in hypertension, the higher levels of circulating plasma dopamine found in hypertensive patients in the present study may account for a peripheral compensatory increase. The correlation between dopamine and nocturnal blood pressure fall seems to indicate that the impairment of dopaminergic system may influence the 24-hour blood pressure profile, affecting the nocturnal blood pressure reduction.     

A comparative study of blood pressure and sodium intake in Belgium and in Korea

A comparative blood pressure and sodium excretion were higher in Korea than in Belgium. By multiple regression and covariance analysis an independent positive association between sodium and blood pressure and a negative correlation between potassium and blood pressure were found in some population subgroups and in the total population studied in Korea. In Belgium a positive association between sodium and blood pressure was found when higher powers of age, height, weight and sodium were included in the analysis. The independent influence of sodium on blood pressure was relatively small, amounting to about 2 mm Hg of pressure rise for an increase in 24-h excretion of 100 mmol of sodium.     

Nitric oxide synthase inhibition with N omega-nitro-L-arginine methyl ester affects blood pressure and cardiovascular structure in the genetically hypertensive rat strain

We examined an 18-year-old female and an 18-year-old male with mild mental retardation who suffered from the oscillatory form of sporadic essential myoclonus from an age of 3 years. Although the generalized oscillatory myoclonus resembled severe essential tremor, surface electromyography revealed small myoclonic jerks with frequencies of 6-8 Hz. As concomitant symptoms, the female case exhibited overanxious irritability from early childhood and generalized epileptic seizures occurred from the age of 4 years. In the male case, an obsessive-compulsive disorder and photosensitive convulsive seizures were persistently noted from early childhood. All their symptoms had been stable for at least the last 10 years. Thus, although non-progressive tremulous movements are rare in early childhood, sporadic essential myoclonus is causative. In contrast to hereditary essential myoclonus, sporadic essential myoclonus is considered to be more heterogeneous, especially in the various associated symptoms.     

Insulin as a vascular and sympathoexcitatory hormone: implications for blood pressure regulation, insulin sensitivity, and cardiovascular morbidity

The past several years have witnessed a major surge of interest in the cardiovascular actions of insulin. This interest has stemmed on the one hand from epidemiological studies that demonstrated an association between obesity, insulin resistance, and hypertension, leading to the so-called insulin hypothesis of hypertension. On the other hand, this interest has been stimulated by experimental evidence suggesting that the vascular actions of insulin may play a role in its main action, namely the promotion of glucose uptake in skeletal muscle tissue. Two tenets have emerged about how insulin may exert its cardiovascular actions. First, it is now firmly established that acute insulin administration stimulates sympathetic nerve activity in both animals and humans. Second, there is increasing evidence that insulin stimulates muscle blood flow, an effect that appears to be mediated at least in part by an endothelium-dependent mechanism. This review summarizes the current understanding and gaps in knowledge on cardiovascular actions of insulin in humans and pathophysiological consequences of derangements of such actions.     

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.     

Dietary magnesium intake and blood pressure: a qualitative overview of the observational studies

Published reports of 30 separate sets of analyses from 29 observational studies relating dietary intake of magnesium to blood pressure (BP) were identified through a comprehensive search using MEDLINE and BIDS-EMBASE. Three studies were prospective, 24 cross-sectional (25 reports), of which four also contained a longitudinal component, and two were obtained from baseline data in a trial. Various dietary methodologies were used: 24-h dietary recall (n = 12), food-frequency questionnaire (8), food record (7), and duplicate diet (2). Twelve reports compared magnesium intake or BP level between subgroups. Seven showed a negative association between magnesium intake and BP level, and five reported no association. From 18 of the 30 sets of analyses either a regression estimate or a Pearson correlation coefficient was reported. Many reports also allowed identification of subgroups by sex, age and race. Ninety population samples and subgroups could thus be identified from the 30 reports. All 11 Pearson-r correlation coefficients reported for systolic BP (SBP) (three significant, P < 0.05) and 10 (out of 12) Pearson-r correlation coefficients reported for diastolic BP (DBP) (four significant) were negative. Seven reports (13 subgroups for SBP, 11 subgroups for DBP) gave partial regression coefficients after adjustment; 10 (seven significant) and eight (six significant) were negative for SBP and DBP, respectively. For 13 subgroups in five papers, Pearson-r correlation coefficients were reported after adjustment for confounding factors. Eight (out of 13) showed a negative relationship for SBP and DBP. This review points to a negative association between dietary magnesium intake and BP. A systematic quantitative overview is needed to reconcile the inconsistencies of the results of individual studies and to quantify the size of such relationship.     

Effects of varying sodium intake on blood pressure and renin-angiotensin system in subtotally nephrectomized rats

In rats in which the renal mass had been reduced by 70 per cent, the effects of varying sodium intake on blood pressure, serum electrolytes, renin-angiotensin system, and some other parameters that were modified simultaneously were studied. Within 4 weeks, a high sodium diet (750 mEa. per kilogram) resulted in marked hypertension, whereas a standard sodium diet (150 mEq. per kilogram) elevated the blood pressure only slightly. A low sodium diet (less than 0.2 mEq. per kilogram) prevented the rise in blood pressure. In the hypertensive group, the hematocrit values were markedly decreased, indicating the expansion of extracellular and intravascular spaces. The compensatory renal hypertrophy was accelerated by the high sodium diet and retarded during restriction. During low sodium intake, the serum concentration of sodium was diminished and that of potassium elevated. During the high sodium diet, the sodium concentration was unchanged, but the potassium concentration was decreased. Subtotal nephrectomy diminished the plasma angiotensin II concentration, and the renin content of the kidney remnant was lower than that of the kidneys from control animals. Sodium restriction stimulated the renin angiotensin system markedly, whereas high sodium intake suppressed it. After subtotal nephrectomy, elevation of blood pressure, renal hypertrophy, and suppression of the renin-angiotensin system are closely related to sodium intake.     

Effects of glibenclamide on blood pressure and cardiovascular responsiveness in non-insulin dependent diabetes mellitus

1. The incubation of mouse isolated diaphragm with guanidine for 60 min produced ultrastructural changes in the neuromuscular junction, the intramuscular fascicles of the phrenic nerve and the skeletal muscle fibers. 2. The main morphological characteristics of both the end terminals and the nerve fibers were a swollen appearance and an electron-lucent axoplasm. In addition, the mitochondria in these regions were markedly swollen and showed a rarefaction of their cristae as well as a "washed aspect" of their matrix. Occasional periaxonal vacuoles were present in the myelinated axons. There was a reduction in the number of synaptic vesicles, which was accentuated by the enlarged areas of the majority of the terminals. 3. Muscle cells underwent a range of morphological alterations in the myofibrils and mitochondria. The most drastic type of necrosis affecting these cells was complete dissolution of the myofibrils, which resulted in an apparently "empty" cell with only the sarcolemma and a few mitochondria remaining intact. 4. Tetrodotoxin was unable to provide total protection against these guanidine-induced changes. 5. We conclude that the ultrastructural effects evoked by guanidine may be associated with modifications in the permeability of the axolemmal and sarcolemmal membranes as a result of changes in ionic conductance. Such ionic disturbances also interfere with the metabolism of mitochondria and the sarcoplasmic reticulum and may account for the well-known inhibitory effect of guanidine on K+ channels and consequently on Ca2+ and Na+ conductances. 6. It is also suggested that the guanidine-induced alterations in the presynaptic and postsynaptic sites could have independent mechanisms of action.     

Associations between blood pressure and dietary intake and urinary excretion of electrolytes in a Chinese population

OBJECTIVE: The effect of age on energy expenditure was studied. DESIGN: Case-control study. SETTING: Respiration chamber at the University of Maastricht. SUBJECTS: Thirteen young men (27 +/- 4 years) and ten elderly men (74 +/- 5 years), were recruited with advertisements in local media. METHODS: In a 36 h experiment, 24 h energy expenditure (EE), sleeping metabolic rate (SMR), diet-induced thermogenesis (DIT) and energy expenditure of physical activity (EEact) were measured while subjects performed an activity protocol in a respiration chamber under strictly controlled conditions. RESULTS: SMR as a function of fat-free mass (FFM) was not different between both age groups. 24 h EE during a standardized activity protocol was significantly higher for the young men (young men: 12.85 +/- 1.53 MJ/d; elderly men: 10.90 +/- 1.12 MJ/d; P = 0.011). The DIT expressed as MJ/d was significantly higher for the young subjects but similar when expressed as percentage of energy intake (young men: 13.10 +/- 5.44%; elderly men: 9.88 +/- 3.86%). The resulting figure for EEact (24 h EE--SME--DIT) was the same for young and elderly men (young men: 3.11 +/- 0.71 MJ/d; elderly men: 3.05 +/- 0.64 MJ/d). CONCLUSION: The results indicate that mean energy costs for low intensity daily activities (some daily household activities and a bench stepping exercise) were the same for young and elderly men.     

Influence of salt intake, ANG II synthesis and SFO lesion on thirst and blood pressure during sodium depletion. Subfornical organ

Water intake was elevated in sodium-depleted rats during a daytime salt appetite test, but other rats drank a similar amount of water when saline was not available for drinking during the test. This water intake stimulated by sodium depletion was blocked by an inhibition of angiotensin (ANG) II synthesis with a high dose of captopril (100 mg/kg, sc). Captopril did not reduce water intake by causing hypotensive shock or uremia, because water and saline intakes were increased rather than decreased after a low dose of captopril (5 mg/kg) that also reduced blood pressure and elevated blood urea nitrogen. The water intake, but not salt appetite, induced by sodium depletion was greatly reduced by a lesion of the subfornical organ (SFO) in one-bottle tests, and this was not clearly related to any effects of the lesion on blood pressure. A physiological role for ANG II in water intake induced by sodium depletion has recently been disputed, but the simplest explanation for the data remains that elevated levels of circulating ANG II bind to receptors in the SFO to generate daytime water drinking during sodium depletion.