Cardiac adaptation to increased systemic blood pressure in borderline hypertensive men

Two women, aged 28 and 32, presented with primary infertility and severe dysmenorrhea. The younger woman developed recalcitrant and recurrent firm vaginal, cervical and possibly endometrial lesions over a period of six years; the older patient had similar material in the cervix, endometrium and a fallopian tube. The lesions were composed of amorphous eosinophilic hyaline or necrotic material, shown by histochemical and immunoperoxidase stains to be partly fibrin. Pathologic examination showed that the lesions were similar to those of ligneous (pseudomembranous) conjunctivitis, a rare disease that may occasionally affect the lower female genital tract. However, neither patient had eye disease, and ligneous conjunctivitis has not previously been reported to involve the upper genital tract. Endometrial and tubal involvement could readily explain primary infertility and dysmenorrhea in these patients.     

Caffeine and behavioral stress effects on blood pressure in borderline hypertensive Caucasian men.

Caffeine in dietary amounts raises blood pressure (BP), and its use increases during work stress; however, caffeine combined with behavioral stress has not been tested in borderline hypertensive (BH) men. Accordingly, this study tested a psychomotor stressor plus caffeine (3.3 mg/kg, equivalent to 2–3 cups of coffee) using a double-blind, crossover design in 24 BH men (140/90 mmHg?≤?BP?160/95 mmHg) and 24 controls (BP?≤?135/85 mmHg). BH men had modestly larger BP increases to the task and showed a greater combined effect of caffeine plus the task (+15/+11 mmHg) than controls (+10/+6 mmHg). BH men maintained response to the stressor in the face of an exaggerated BP response to caffeine, suggesting that use of caffeine during behavioral stress may elevate BP in BH individuals to a clinically meaningful degree. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The influence of 5-week relaxation therapy on arterial blood pressure in patients with borderline hypertension

The present study was performed to evaluate the influence of 5-week relaxation therapy on office and ambulatory blood pressure in young borderline hypertensives. Thirty patients were studied. The office blood pressure decreased significantly after 5 weeks of relaxation therapy (P < 0.001 for both systolic and diastolic blood pressure). Ambulatory monitoring revealed only a slight decrease of 24-hour blood pressure (P = 0.02). Our results indicate limited efficacy of relaxation therapy in treatment of borderline hypertensives.     

Impact of caffeine and psychological stress on blood pressure in Black and White men.

Examined the effects of caffeine and psychological stress on systolic blood pressure (SBP) and heart rate (HR) in 40 healthy Black and White male college students (aged 18–35 yrs) who were regular coffee drinkers. Half the Ss had a positive family history of hypertension, and half did not. The effects of 250 mg of caffeine vs placebo (3 mg) in decaffeinated coffee were compared in a within-subject, double-blind, cross-over design. Results confirm previous findings (J. D. Lane and R. B. Williams; see record 1988-19531-001) with White men that a moderate dose of caffeine produced significant increases in SBP and little effect on HR and that the pressor effects of caffeine and stress combined additively (W. Greenberg and D. Shapiro; see record 1988-20603-001). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Elevated plasma catecholamines without alteration in cardiovascular responsiveness in young men with borderline hypertension

Plasma catecholamines and cardiovascular responses to upright posture, exogenous noradrenaline (NA), and isoproterenol (IP) were examined in 20 young men with borderline hypertension and in 10 age-matched normotensive volunteers. Resting plasma NA and adrenaline (Ad) levels were higher in the borderline hypertensive patients. Significant correlations were found among plasma NA and mean blood pressure (MBP) or heart rate (HR), and between plasma Ad and HR in all individuals in the supine position. The increases in plasma NA were similar between groups for orthostatic positions. Pressor response to exogenous NA and chronotropic response to exogenous IP were not augmented in borderline hypertensives. A negative correlation was found between plasma NA before infusion and the increases of MBP produced by NA or the increases of HR produced by IP in all the individuals. Our observations suggest that there is hyperactivity of the sympathoadrenal system without enhancement in cardiovascular reactivity to catecholamines in young men with borderline hypertension.     

Intra-arterial blood pressure during exercise and left ventricular indices in normotension and borderline and mild hypertension

OBJECTIVE: To determine whether a sex-related difference in outcome is present among patients who undergo percutaneous transluminal coronary angioplasty (PTCA) for unstable angina. DESIGN: We retrospectively analyzed the results after PTCA was performed between January 1981 and June 1993 in a series of 2,073 men and 941 women with unstable angina and rest pain. RESULTS: The success rates of PTCA were similar for women and men (87.9% and 87.2%, respectively), as were the in-hospital mortality rates (4.1% and 3.2%, respectively) and the need for emergency coronary artery bypass operation (3.1% and 3.5%, respectively). Fewer women than men had Q-wave myocardial infarction (0.5% versus 1.6%; P = 0.02). During the follow-up period (mean, 4 years), no significant differences were noted between women and men in overall survival (81% and 85% at 6 years, respectively) or survival free of Q-wave myocardial infarction (81% and 83% at 6 years, respectively) with use of the Kaplan-Meier method. Women were less likely than men to have had coronary artery bypass grafting (19% versus 22% at 6 years; P = 0.02), and the occurrence of severe angina was higher in women than in men (52% versus 44% at 6 years; P = 0.001). A subgroup analysis of patients who had myocardial infarction within 7 days preceding PTCA showed a similar pattern of results. CONCLUSION: After PTCA performed for unstable angina and rest pain, survival rates were excellent in both women and men, and no difference was observed in subsequent myocardial infarction rates. During follow-up, however, women were more likely to have severe angina and were less likely to have had coronary artery bypass grafting. Concerns about possible sex-related complications should not dissuade physicians from performing PTCA when clinically indicated for unstable angina and rest pain.     

Influence of nighttime blood pressure on left atrial size in uncomplicated arterial systemic hypertension

Little information is available on the relationship between occupational exposure to inorganic arsenic in coal fly ash and urinary excretion of arsenic metabolites. This study ws undertaken in a coal-fired power plant in Slovakia during a routine maintenance outage. Arsenic was measured in the breathing zone of workers during 5 consecutive workdays, and urine samples were obtained for analysis of arsenic metabolites--inorganic arsenic (Asi), monomethylarsonic acid (MMA), and dimethylarsinic acid (DMA)--prior to the start of each shift. Results from a small number of cascade impactor air samples indicated that approximately 90% of total particle mass and arsenic was present in particle size fractions >/= 3.5 micron. The 8-hr time-weighted average (TWA) mean arsenic air concentration was 48.3 microg/m3 (range 0.17-375.2) and the mean sum of urinary arsenic (SigmaAs) metabolites was 16.9 microg As/g creatinine (range 2.6-50.8). For an 8-hr TWA of 10 microg/m3 arsenic from coal fly ash, the predicted mean concentration of the SigmaAs urinary metabolites was 13.2 microg As/G creatinine [95% confidence interval (CI), 10.1-16.3). Comparisons with previously published studies of exposure to arsenic trioxide vapors and dusts in copper smelters suggest that bioavailability of arsenic from airborne coal fly ash (as indicated by urinary excretion) is about one-third that seen in smelters and similar settings. Arsenic compound characteristics, matrix composition, and particle size distribution probably play major roles in determining actual uptake of airborne arsenic.     

Intra-arterial blood pressure and heart rate reactivity to behavioral stress in normotensive, borderline, and mild hypertensive men

Intra-arterial blood pressure (BP) stress reactivity was studied in newly detected, World Health Organization-classified (1978), age-matched normotensive (NT; n = 33), borderline hypertensive (BHT; n = 30), and hypertensive (HT; n = 32) men recruited through routine health examinations. They underwent a relaxation baseline followed by 8 standardized behavioral challenges. BHT and HT men displayed exaggerated BP reactivity compared with NT men, particularly on perceptual-motor and social tasks, and HT men showed higher reactivity than NT men in the cold pressor test. These results are the first to show reactivity differences between NT men and BHT or HT men in an intra-arterial experiment. Diastolic BP (DBP) discriminated the groups better than systolic BP (SBP) or heart rate (HR). The few differences in SBP compared with DBP among the groups combined with hardly any differences in HR indicate the predominance of vascular factors in middle-aged as opposed to younger men with borderline or mild hypertension.     

Impact of ambulatory blood pressure on left ventricular diastolic dysfunction in uncomplicated arterial systemic hypertension

To determine the relations of 24-hour blood pressure (BP) and its different phases with left ventricular (LV) diastolic filling, 125 subjects (mean age 46 years) not taking cardiac drugs were studied by Doppler echocardiography and ambulatory BP recording. Subjects (excluding those with coronary artery or valvular heart disease, heart failure, or diabetes) were classified into 2 groups according to the level of Doppler-derived ratio of peak early to atrial velocity (E/A ratio): 59 had E/A >1 (normal diastole), 62 had E/A <1 (impaired diastole), and 4 had E/A = 1. Patients with E/A <1 were older and had higher LV mass indexed for height, average 24-hour BP, average nighttime BP, and lower day-night BP decrease, whereas average daytime BP did not differ significantly between the 2 groups. Negative correlations of E/A were found with age, heart rate, office, average 24-hour and average nighttime systolic and diastolic BP, and LV mass index. In a multivariate model that included potentially confounding factors, only age (standardized beta coefficient = -0.52, p<0.00001), nighttime BP (beta = -0.28, p<0.0001), and heart rate (beta = -0.22, p<0.001) were independent predictors of E/A in the pooled population. In conclusion, LV diastolic function is more closely related to ambulatory, rather than to clinic, BP measurements, and high average nocturnal diastolic BP is a powerful marker of LV filling impairment.     

Gender differences in the relationship between left ventricular size and ambulatory blood pressure in borderline hypertension. The HARVEST Study

AIM: To assess whether the are gender differences in cardiac adaptation to raised blood pressure levels in young subjects with borderline to mild hypertension. METHODS AND RESULTS: In 499 18-45-year-old stage I hypertensive subjects (377 men and 122 women) with a mean age of 33 +/- 9 years and office blood pressure of 146 +/- 11/ 94 +/- 6 mmHg, ambulatory blood pressure monitoring in duplicate, echocardiography and 24-h urinary catecholamines measurement were performed. RESULTS: The whole group was divided into quartiles of increasing daytime blood pressure and differences in left ventricular echocardiographic data were analysed in the two sexes separately. In men no left ventricular parameter differed across the quartiles, while in women left ventricular mass, posterior wall thickness and interventricular septum thickness showed a clear tendency to increase with increasing levels of systolic blood pressure. In multiple regression analysis, daytime systolic blood pressure explained only a small fraction of the variance in left ventricular parameters in men, while in women daytime systolic blood pressure was a main determinant of left ventricular mass and posterior wall and septal thicknesses. Body weight explained most of the variance in all dimensional parameters in men. In women weight was an important predictor of left ventricular mass and diameter, but was unrelated to left ventricular posterior wall and septal thicknesses. CONCLUSIONS: Daytime systolic blood pressure is the most important predictor of left ventricular mass and geometry in pre-menopausal women with stage I hypertension, while in men left ventricular dimensional indices are chiefly explained by body weight.     

The effect of caffeine on ambulatory blood pressure in hypertensive patients

Because the potential impact of habitual caffeine intake on blood pressure is a controversial issue, a study was carried out to explore the relationship between caffeine and various humoral factors that could account for a coffee-induced rise in blood pressure. Twenty-three hypertensive patients who refrained from caffeine for 2 to 3 weeks were given 250 mg oral caffeine powder dissolved in water. Blood pressure was recorded every 15 min by blood pressure monitor. Caffeine blood level, renin and endothelin were measured before and 1, 2, 3, and 6 h after caffeine intake. Urinary electrolytes and catecholamines were measured under caffeine influence (period I), and for the next 6 h (period II). A significant increase in systolic (P = .017) and diastolic blood pressure (P = .023) occurred in 13 subjects who were 58 +/- 10.4 years old. Nonresponders were younger (44.5 +/- 15.8 years). A statistically significant decrease in heart rate was seen during the first hour after caffeine intake in both responders (P = .008) and nonresponders (P = .004). Marked diuresis and natriuresis were observed during period I in both groups. Renin and endothelin levels were unchanged. Although chronic studies point to development of tolerance to long-term caffeine ingestion, acute studies like the one described are essential to obtain data on the immediate effects that can be of practical importance, especially in the elderly.     

Ambulatory blood pressure in hypertension with particular reference to the kidney

OBJECTIVE: To study the relationship between individual health beliefs and risk factors for coronary heart disease. DESIGN: Health beliefs indices, formed by factorial analysis of ratings of statements on health related matters in a questionnaire, were related to risk factors for coronary heart disease, assessed with physical examinations and self reports of medical history and habits. SETTING: An urban primary care district in Malm?, Sweden. SUBJECTS: A random sample of middle-aged men, invited to a health check-up. RESULTS: The participation rate was 453/705 (64%). "Perceived threat to health caused by illness" was positively related to previous information on high blood pressure, high plasma cholesterol, and/or diabetes (p = 0.01). In a model of logistic regression, adjusted for age, cohabitation, and previous medical history, health belief index on "threat to health" was related to low exercise habits (RR = 1.06, CI 1.01, 1.12). "Perceived control over illness" was related to high alcohol consumption (RR = 0.86, CI 0.75, 0.97), smoking (RR = 0.89, CI 0.79, 0.99), and high diastolic blood pressure (RR = 0.84, CI 0.75, 0.95). CONCLUSION: This cross-sectional study demonstrates relations between health beliefs, previous health-related experiences, and risk behaviour. To explore the causality of the former, longitudinal studies of changes in health beliefs after medical information are required.     

Left ventricular diastolic function in young men with high normal blood pressure

OBJECTIVE: Abnormalities in left ventricular (LV) diastolic filling have been reported in hypertensive patients. This study was designed to compare LV diastolic filling between individuals with high normal blood pressure (HNBP) and optimal blood pressure (OBP). SUBJECTS AND DESIGN: From a survey of 219 young male individuals (age 21 +/- 0.1 years), two groups were selected according to their BP (group A: systolic BP [SBP] 120 mmHg and diastolic BP [DBP] 80 mmHg, n = 23 and group B: SBP 130 to 139 mmHg and/or DBP 85 to 89 mmHg, n = 21). Subjects habits, anthropometric characteristics, LV structure and systolic and diastolic function were compared. RESULTS: No differences were detected between the two groups in habits, systolic function or early diastole. LV mass index (LVMI) was higher in group B (103.6 +/- 4.58 g/m2 versus 90.49 +/- 3.27 g/m2 in group A, P < 0.05), though the values were not high enough to indicate LV hypertrophy. The pattern of LV late filling was different between the two groups. The peak late diastolic flow velocity (A) was 0.45 +/- 0.02 m/s in group B and 0.52 +/- 0.03 m/s in group A (P < 0.05). The early peak velocity (E):A ratio was 1.82 +/- 0.08 in group A and 1.59 +/- 0.08 in group B (P < 0.05). The early filling fraction also demonstrated a significant shift to more prominent late diastolic filling in group B (0.68 +/- 0.01% versus 0.73 +/- 0.01% in group A, P < 0.05). This pattern in LV filling did not correlate to inheritance, age, sex, heart rate, habits or body mass index. CONCLUSIONS: This shift in filling pattern to a late flow in young men with HNBP seemed to be an early indicator of an increased dependence of LV filling on atrial contraction and may reflect an impairment in LV relaxation.     

Relationship of blood pressure, heart rate and behavioral mood state to norepinephrine kinetics in younger and older men following caffeine ingestion

OBJECTIVE: To examine age-related differences in blood pressure, heart rate, behavioral mood state and norepinephrine kinetics after caffeine ingestion in younger and older men. DESIGN: Placebo-controlled, double-blind study. SETTING: General Clinical Research Center, University of Vermont. SUBJECTS: 10 older (O) (65-80 y) and 10 younger (Y) (19-26 y) healthy men who were moderate consumers of caffeine (Y= 126+/-30 mg/d; O = 160 44 mg/d:NS; mean +/- s.e.m.). INTERVENTION: All volunteers were characterized for fasting plasma glucose, insulin and caffeine levels, body composition, anthropometry, physical activity, and energy intake. Before and after placebo and caffeine ingestion (5 mg/kg fat-free mass) test days, the following variables were measured in all subjects: heart rate, blood pressure, mood state, and norepinephrine concentrations (NEconc), appearance (NEapp) and clearance (NEcl). MAIN OUTCOME MEASURES: Systolic and diastolic blood pressure, heart rate, mood state, and norepinephrine kinetic responses to placebo and caffeine ingestion. RESULTS: Following caffeine ingestion, plasma caffeine levels were similar in Y and O men. Systolic (SBP) and diastolic (DBP) blood pressure increased significantly (P < 0.01) from baseline by 9% (130+/-6 vs 142+/-6 mmHg) and 3% (75+/-3 vs 77+/-3 mmHg), respectively, in O men following caffeine ingestion, but remained unchanged in Y men. Self-reported feelings of tension (P < 0.05) and anger (P = 0.06) decreased in O men, while anger tended to increase in Y men (P < 0.06) following caffeine ingestion. Heart rates in both groups were unaltered following caffeine ingestion. No differences were noted at baseline between O and Y men for NEconc, NEapp and NEcl. After caffeine ingestion, NEconc were significantly greater in O than Y men, whereas NEapp and NEcl rates did not differ from baseline in either group. Blood pressure and subjective mood state effects of caffeine were not related to changes in norepinephrine kinetics. CONCLUSION: Age may play a role in augmenting blood pressure response and reducing subjective feelings of anger and tension following caffeine ingestion, suggesting that the elderly are more reactive to the pressor and less sensitive to the subjective effects of the drug. These effects do not appear to be mediated by changes in sympathetic nervous system activity.     

Preferential changes in hepatosplanchnic hemodynamics in patients with borderline hypertension

The purpose of this study was to gather data from first-year medical students prior to their taking gross anatomy and again at the end of the course to determine if changes occur regarding death anxiety and detached concern toward patients. Chi-square and t-tests were used to assess statistical significance. From the 84 students for whom we had data both prior to and after gross anatomy, only the sociodemographic variable of sex was consistently related to the two dependent variables. Women reported more death anxiety prior to and after the gross anatomy course and were more likely to disagree with the need for detached concern.     

Adrenoceptors on blood cells in patients with primary hypertension: correlation with blood pressure and related variables

OBJECTIVE: Alterations in platelet alpha 2-adrenoceptor and mononuclear leucocyte beta 2-adrenoceptor characteristics in primary hypertension have been extensively studied. The results of the reports have not been consistent, possibly because of the small number of subjects in most of the studies. We therefore studied the blood-cell adrenoceptor characteristics in a relatively large group of primary hypertensive and normotensive subjects. DESIGN: Platelet alpha 2-adrenoceptor characteristics were compared in 65 hypertensive and 51 normotensive subjects. Mononuclear leucocyte beta 2-adrenoceptor characteristics were compared in 72 hypertensives and 67 normotensives. Untreated hypertensive subjects were selected from the outpatient clinic and the normotensive controls were recruited by a newspaper announcement. METHODS: Platelets and mononuclear leucocytes were isolated from blood samples obtained after at least 10 min supine rest. The alpha 2- and beta 2-adrenoceptor characteristics were determined with [3H]-rauwolscine and [125I]-(-1)cyanopindolol, respectively. Correlations between the adrenoceptor characteristics and clinical parameters of the subjects were studied. RESULTS: No differences in alpha 2- or beta 2-adrenoceptor densities were observed between the two groups. However, a significantly lower equilibrium dissociation constant for [3H]-rauwolscine was observed in the hypertensive group. The correlations between the adrenoceptor characteristics and clinical parameters were weak and mostly not statistically significant. The results were compared with the most relevant studies in the literature. CONCLUSIONS: From our study and the literature, we conclude that blood-cell adrenoceptor characteristics are unchanged in primary hypertension.     

Inhibited power motivation and high blood pressure in men.

Examined the suppressed anger hypothesis, as related to the origins of essential hypertension, by using need for power (n Power) relative to need for affiliation (n Affiliation) as the measure of the disposition to be assertive or angry and by using activity inhibition as the measure of the tendency toward self-control. In 3 samples (127 German men, 235 male college freshmen, and 78 male college juniors) higher n Power than n Affiliation and high activity inhibition—the inhibited power motive syndrome—were associated with higher blood pressures than other motive combinations. In a longitudinal study it was found that the inhibited power motive syndrome, as measured in male Ss in their early 30s, significantly predicted elevated blood pressures and signs of hypertensive pathology appearing 20 yrs later. The personality predisposition predicted later elevated diastolic blood pressures, even when the possible contribution of an earlier physiological predisposition was controlled by a multiple regression analysis. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)