Contribution of Snacks and Physical Activities to Elevated Blood Pressure of Adolescent Girls in West Java, Indonesia

@#Introduction: The prevalence of hypertension in Indonesia has continued to increase over the last few years. An unhealthy diet and lack of physical activity can elevate blood pressure, particularly if an unhealthy lifestyle has been followed since adolescence. This study aimed to analyze the correlation between snack consumption and physical activity with blood pressure in adolescent girls. Methods: A cross-sectional study was conducted with 349 adolescent girls from seven Islamic boarding schools in West Java, Indonesia. Data on daily food and snack consumption were obtained by the 24-hour recall for 3 non-consecutive days. Blood pressure was measured using a digital blood pressure instrument, and the results were categorized by age, gender, and height. Linear regression analyses were performed to investigate determinants of blood pressure. Results: A total of 120 (34.4%) of the adolescent girls in the study had hypertension. A majority of girls had inadequate daily intake (energy, fat, carbohydrates, and sodium; only total protein intake met Indonesia’s recommended dietary allowance). Snacks were found to be high in protein, fat, and carbohydrates, with consumption levels above 15%. More than half (61.9%) of the subjects’ daily sodium intake came from snacks. Low-fat intake from snacks was associated with an increase in blood pressure in this study. Daily nutritional intake affecting blood pressure included sodium and total fat intake. Lack of physical activity in adolescent girls was not a risk factor for elevated blood pressure. Conclusion: Fat and sodium intake was associated with elevated blood pressure in adolescent girls.

The Association between Night Shift Work and Hypertension Among Workers at A Construction Company in Jakarta

@#Introduction: Night shift work, which can cause circadian misalignment, may be associated with increased blood pressure. The purpose of this research was to find out the prevalence of hypertension and the associated factors of hypertension among night shift and day shift workers at a construction company in Jakarta. Methods: The data used in this study was taken from records of general medical checkup which was held in August 2019. Data of 107 male workers (28 day shift workers, 79 night shift workers) were gathered. Results: The prevalence of hypertension in night shift workers (59.5%) was higher compared to that in the day shift workers (17.9%). Systolic blood pressures (SBPs) of the night shift workers (mean SBP = 137.58; SD = 15.05; CI 95% = 134.58-141.32) were significantly higher compared to day shift workers’ (mean SBP = 122.14, SD = 13.24; CI 95% = 117.01-127.07). Diastolic blood pressures (DBPs) of night shift workers (mean DBP = 84.90; SD = 10.59; CI 95% = 82.53-87.27) were also significantly higher than day shift workers’ (mean DBP = 76.54; SD = 10.85; CI 95% = 72.33-80.74). According to multiple logistic regression analysis, workers with night shifts (OR = 7.47; CI 95% = 2.48-22.51) and overweight (OR = 2.73; CI 95% = 1.04-7.18) were significantly associated with hypertension compared to day shift workers and normal weight workers, respectively, after adjusted by other covariates. Conclusion: Night shift workers faced higher risk of hypertension compared to day shift workers, particularly for those who were overweight.

Association between blood pressure and acute phase stroke case fatality rate: a prospective cohort study / Associação entre níveis de pressão arterial e letalidade na fase aguda do acidente vascular cerebral: estudo de coorte prospectivo

ABSTRACT Objective ed to investigate the association between blood pressure and acute phase stroke lethality in a Brazilian intensive care unit. Methods This was an observational, prospective cohort study of hemorrhagic and ischemic stroke intensive care patients. The primary outcome was all-cause mortality during the first seven days. Results There were 146 patients, aged 66 ± 13.4 years, 56% men, 89% Caucasian, 69% had ischemic stroke, and 80% were hypertensive. The median of the National Institutes of Health Stroke Scale score was 16. There were 101 ischemic stroke patients and 45 hemorrhagic stroke patients. In the ischemic stroke patients, logistic regression analysis identified low systolic blood pressure as an independent ominous prognostic factor and the optimal cut off was a mean of systolic blood pressure ≤ 131 mmHg during the first 48 hours from admission for prediction of death. No association was found for hemorrhagic stroke. Conclusions There was a negative association between systolic blood pressure and case fatality ratio of acute phase stroke in ischemic stroke intensive care patients.

RESUMO Objetivo Investigar a associação entre pressão arterial e letalidade do acidente vascular cerebral (AVC) em uma unidade de terapia intensiva brasileira. Métodos estudo de coorte prospectivo de pacientes com AVC hemorrágico (AVC-H) ou isquêmico (AVC-I) internados em terapia intensiva. O desfecho primário foi a letalidade por todas as causas nos primeiros sete dias. Resultados Avaliados 146 pacientes, idade: 66 ± 13,4 anos, 56% homens, 89% brancos, 69% AVC-I e 80% hipertensos. A mediana do NIH foi de 16. Os pacientes com AVC-I foram 101 e 45 com AVC-H. Para AVC-I, a análise de regressão logística identificou baixa pressão arterial sistólica como um fator prognóstico negativo e o melhor corte foi uma média da pressão arterial sistólica nas primeiras 48 h de admissão ≤ 131 mmHg para a predição da morte. Para o AVC-H, nenhuma correlação foi encontrada. Conclusões houve associação negativa entre a pressão arterial sistólica e a letalidade do AVC-I em fase aguda em pacientes de terapia intensiva.

A imunidade na hipertensão arterial: o papel dos linfócitos eda resposta humoral / Immunity and hypertension: role of lymphocytes and humoral response

A hipertensão arterial é um dos maiores fatores de risco a eventos cérebro e cardiovasculares, com alta prevalência na população mundial. Diversos fatores podem conduzir à elevação da pressão arterial; no entanto, estudos recentes têm demonstrado o papel do sistema imune na modulação da pressão e no surgimento da hipertensão. Ainfiltração de células imunes nos rins provoca uma inflamação crônica que, por sua vez, altera o sistema de controle da pressão arterial. Além disso, outros estudos revelam que o sistema imune pode provocar mudanças no sistema nervoso central que podem alterar o controle da pressão arterial. Diferentes subtipos de linfócitos estão relacionados à modulação da pressão arterial, bem como à resposta humoral a antígenos que possuem a capacidade de alterar o endotélio. Aresposta autoimune também se apresenta como um possível fator causador da hipertensão. Este manuscrito teve por objetivo abordar os mecanismos pelos quais os linfócitos e as respostas humorais contribuem para a modulação da pressão arterial.

Hypertension is a major risk factors to stroke and acute coronary syndromes events with high prevalence in the world population. Several factors can lead to high blood pressure, however recently studies have shown the role of the immune system in the pressure modulation and in the occurrence of hypertension. The infiltration of immune cells in the kidney leads to a chronic inflammation which in turn changes the blood pressure. In addition, other studies have shown that the immune system activity central nervous system with changes in blood pressure control. Subtypes of lymphocytes are related to the modulation of blood pressure and the humoral immune response to antigens which have thecapacity to change the endothelium. The autoimmune response also appears as a possible causing factor of hypertension. This manuscript will address mechanisms by which lymphocytes and humoral responses contribute to the modulation of blood pressure.

The Prevalence Of Hypertension And Its Associated Risk Factors In Two Rural Communities In Penang, Malaysia

Background: Hypertension is estimated to cause 4.5% of the global disease burden. The prevalence of hypertension in Malaysia is 32.2%. Objective: To determine the prevalence of hypertension and its associated risk factors in two rural communities in Penang, Malaysia. Methods: This cross sectional study was conducted among all consenting residents aged 18 years and above from two villages in Penang. Besides the baseline demographic information, blood pressure was measured using a manual sphygmomanometer according to the American Heart Association Guidelines. Results: 50 out of 168 people were hypertensive, giving a prevalence rate of 29.8%. 50.0% of those found with hypertension were undiagnosed and 48.0% of those who were diagnosed with hypertension had uncontrolled blood pressure. Logistic regression analysis showed that age, history of alcohol consumption and BMI were found to be independently associated with hypertension. Conclusions: Age, education level, alcohol consumption and BMI are important risk factors associated with the prevalence of hypertension among the villagers. These risk factors are comparable to those reported in National Health and Morbidity Survery 2006 in Malaysia.

Prehypertension: what is the current status?

Cardiovascular disease (CVD) risk is a continuum across blood pressure. The term prehypertension was introduced because it is now recognized that blood pressure readings between what is deemed optimal and hypertension is associated with increased CVD risk. The prevalence of prehypertension is high and the progression to hypertension is also high. Prehypertension is also commonly associated with other CVD risk factors namely dyslipidaemia, dysgylcaemia and overweight/obesity. Eighty-five percent of prehypertensives have one other or more CVD risk factor compared to normotensives. A recent study has shown a reduction in the development of hypertension from prehypertension with the use of an angiotensin receptor blocker. Unfortunately to date, the impact of treatment of prehypertension on CVD outcome is still unknown except in those with high CVD risk like diabetes or established CVD. However this does not mean nothing can be done for those with prehypertension. The aim of managing prehypertension is to lower the BP, prevent progression to hypertension and to prevent BP related CVD deaths. Lifestyle changes can reduce BP and this by itself can lower CVD risk. Until more evidence about other modalities of treatment become available this is a sensible and cost-effective way to manage prehypertension.

The Effect of Preoperative Pulmonary Arterial Pressure and Right Ventricular Function on the Changes in Right Ventricular Function after Mitral Valve Replacement / 대한마취과학회지

BACKGROUND: In patients with mitral valvular disease with pulmonary hypertension (PHT) accompanying right ventricular (RV) dysfunction, mitral valve replacement (MVR) improves RV function and other hemodynamic variables in long term follow-up. However, there are controversies in improvement of RV function in the immediate postoperative period. We compared the RV function immediately after a MVR with a pulmonary artery catheter (PAC) between patients with normal and decreased RV function with PHT preoperatively. METHODS: Twenty nine patients undergoing a MVR were included in the study. The patients (n = 14) with mean pulmonary arterial pressure (PAP) < or = 25 mmHg were assigned to group I and the patients (n = 15) with mean PAP 25 mmHg were assigned to group II. A PAC with rapid response-thermistors which enables us to determine right ventricular ejection fraction (RVEF) was inserted in all patients and hemodynamic variables were measured before and after cardiopulmonary bypass (CPB). RESULTS: After CPB, PAP, pulmonary vascular resistance index (PVRI), and RV end-diastolc volume (RVEDV) were significantly decreased and RVEF was significantly increased in group II compared with group I in which no hemodynamic variables were changed. CONCLUSIONS: A MVR decreased RV afterload and increased RV function more significantly in patients with preoperative PHT accompanying RV dysfunction than in patients with normal PAP preoperatively.

Paroxysmal Hypertension during Cardiopulmonary Bypass in a Patient with Pheochromocytoma Undergoing Coronary Artery Bypass Grafting / 대한마취과학회지

A 39 year old man suffering from pheochromocytoma and coronay artery obstruction diseases was scheduled for coronary artery bypass graft surgery before an adrenalectomy. General anesthesia was induced with fentanyl and midazolam and maintained with intermittent administration of fentanyl and low concentraion of isoflurane. At 5 minutes after commencement of cardiopulmonary bypass (CPB), the mean arterial pressure suddenly elevated to 150 mmHg. Sodium nitroprusside and labetalol were administered rapidly, however, mean arterial pressure could not be lowered below 100 mmHg. After release of aortic cross clamp, the electrocardiography showed tachycardia (150 beats/min) with wide QRS and systolic arterial pressure elevated to 180 mmHg. Antiarrhythmic drugs, inotropic and antiischemic drugs were administered. Thereafter tachycardia was disappeared and systolic arterial pressure was lowered below 150 mmHg. We observed the paroxysmal hypertension and tachycardia during CPB that is considered to be attributed to the presence of pheochromocytoma. Therefore we suggest that continuous thoracic epidural anesthesia and pulsatile perfusion during CPB could be helpful in a patient with pheochromocytoma undergoing coronary artery bypass grafting.

The Effect of Age on the Cardiovascular Responses Induced by High Concentration of Isoflurane / 대한마취과학회지

BACKGROUND: The inhalation of a high concentration of isoflurane transiently increases heart rate (HR) and blood pressure. The current study examined the effects of age on isoflurane-induced circulatory responses. METHODS: One hundred-ten patients were randomly allocated into one of four groups according to age: under 10 years (Group 1), 20 - 40 years (Group 2), 41 - 60 years (Group 3), and over 65 years (Group 4). In each group, the inspired concentration of isoflurane via mask was increased to 5.0 vol% abruptly. The target was to produce an end-tidal concentration of isoflurane (ETisof) of 2.6 vol% which was maintained until the end of the study by adjusting the vaporizer setting when necessary. HR, mean arterial pressure (MAP), ETisof, and end-tidal concentration of carbon dioxide were measured at baseline and every 30 seconds for 5 minutes after inhalation of isoflurane and for 2 minutes after intubation. RESULTS: HR and MAP significantly increased after inhalation of isoflurane in all four groups compared with the baseline. The time from administration of isoflurane to the maximal HR was less than that for MAP. However, there were no significant differences among the groups for ETisof at the maximal HR and MAP. In Groups 1 and 4, the times for maximal HR were shorter than in Groups 2 and 3. In aged patients (Group 4), the isoflurane-induced HR increase was less than in the other three groups. There were no significant differences among the groups in increases of MAP. CONCLUSIONS: The high concentration of isoflurane transiently increases HR and MAP during inhaled anesthesia induction. In aged patients, the increase in HR is less than in younger-aged patients.

The Effects of Phenylephrine and Norepinephrine on Systemic and Pulmonary Hemodynamics in Patients with Pulmonary Hypertension / 대한마취과학회지

BACKGROUND: It is difficult to choose the appropriate drug when hypotension develops in patients with pulmonary hypertension (PH). There is no known drug to increase the systemic blood pressure (BP) without an increase of pulmonary arterial pressure (PAP). We observed the effects of phenylephrine (PE) and norepinehrine (NE) on systemic and pulmonary hemodynamics when hypotension was treated in patients with PH. METHODS: Patients with PH (mean PAP > or = 25 mmHg, n = 28) were studied. When hypotension occurred (systolic BP < or = 100 mmHg, T1) after the induction of anesthesia, PE or NE was randomly infused to raise the systolic BP above 130 mmHg (T2) and 150 mmHg (T3). Hemodynamic variables were measured at T1, T2 and T3, and the ratio (RBP) of mean PAP to mean BP was calculated. The measurements were performed before skin incision to avoid the effects of surgical stimulation. RESULTS: NE increased BP concomitantly with relatively small increase of PAP, meaning a decrease of RBP (P < 0.05) without any other changes of hemodynamic variables in all patients. However, PE could not raise BP above 130 mmHg in one third of patients, and decreased the cardiac index without a significant decrease of RBP. CONCLUSIONS: NE increased BP and decreased RBP without tachycardia or any other hemodynamic disturbances. NE is considered to be a proper and safe drug to raise BP when hypotension occurs in patients with PH.

The Effects of a Combination of Fentanyl and Esmolol on Hemodynamic Responses after Endotracheal Intubation in Hypertensive Patients / 대한마취과학회지

BACKGROUND: To prevent hypertension and tachycardia after endotracheal intubation, esmolol and low-dose fentanyl have been used and it was reported that the combination of them was more effective than either in normotensive patients. However there have been few studies in this regard using hypertensive patients. Therefore, the author evaluated the effects of a combination of esmolol and low-dose fentanyl on hemodynamic responses after laryngoscopy and endotracheal intubation in hypertensive patients. METHODS: Thirty hypertensive patients were premedicated with midazolam and glycopyrrolate. Fentanyl 2 microgram/kg and esmolol 1 mg/kg were injected before induction of anesthesia. Thiopental sodium 3 5 mg/kg and succinylcholine 1 mg/kg were used for the induction of anesthesia. Endotracheal intubation was performed at 5 minutes after fentanyl injection. Thereafter 50% nitrous oxide in oxygen and 2 vol% enflurane were inhaled. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP) and heart rate (HR) were measured before fentanyl injection (base), before intubation, and at 1, 3 and 5 minutes after intubation. RESULTS: At 1 minute after intubation, SBP and MAP did not change significantly, but DBP increased slightly compared to base (P 170 mmHg) developed in 2 patients at 1 minute after intubation, and hypotension (SBP 100 bpm) developed in 2 patents at 1 minute after intubation and bradycardia (HR< 50 bpm) in 1 patient at 5 minutes after intubation. CONCLUSIONS: In treated hypertensive patients, the use of a combination of fentanyl 2 microgram/kg and esmolol 1 mg/kg is a useful method to attenuate hypertension and tachycardia after endotracheal intubation.

Clinical Effects of Addition of Clonidine to Ldegrees Cal Anesthetics in Hypertensive Patients Undergoing Senile Cataract Surgery / 대한마취과학회지

BACKGROUND: Although the effect of clonidine, an alpha2 adrenoreceptor agonist, is well established, there is no study to evaluate the effects of addition of clonidine to ldegrees Cal anesthetics in elderly hypertensive patients. The aim of this study is to evaluate the effects of addition of clonidine to ldegrees Cal anesthetics in elderly hypertensive patients undergoing senile cataract surgery. METHODS: Forty elderly hypertensive patients who scheduled for elective senile cataract surgery were divided into two groups. The control group (n=20) received oral diazepam 0.1 mg/kg 60 min before surgery and the clonidine group (n=20) did not received premedication. A mixture of 2% liddegrees Caine and 0.5% bupivacaine with normal saline 0.7 ml (control group) or clonidine 100 ug (clonidine group) was used as a ldegrees Cal anesthetics. Perioperative blood pressure, heart rate, sedation score, and intradegrees Cular pressure were measured. RESULTS: After anesthesia, there was a significant fall in blood pressure and intradegrees Cular pressure in clonidine group, and increase in sedation score in clonidine group than control group. There was no difference in the perioperative heart rate between the two groups. CONCLUSIONS: The above results show that addition of clonidine to ldegrees Cal anesthetics in elderly hypertensive patients undergoing senile cataract surgery produced reduction in blood pressure, intradegrees Cular pressure and produced intraoperative sedation.

Subclavian Steal Syndrome Found Incidentally during Emergence: Difference in Blood Pressures between Both Arms: A case report / 대한마취과학회지

Subclavian steal syndrome is understood to be an occlusion or stenosis of the subclavian artery proximal to the origin of the vertebral artery with a retrograde flow of blood through the ipsilateral vertebral artery. It is characterized most prominently and most consistently by unequal blood pressures of both arms. In this case, we found incidentally unequal arm pressures during emergence. After the surgery, the 95% stenosis of left anterior descending coronary artery and total occlusion of subclavian artery was proved angiographically. This patient had the risk factors of atherosclerosis such as male, DM, hypertension, smoking and hyperlipidemia. In conclusion, pressures should be taken from both arms during initial visit, when the patient has the risk factors of atherosclerosis.

A Study on the Predictors of Hypertension in the Immediate Postoperative Period / 대한마취과학회지

BACKGROUND: Hypertension in the immediate postoperative period, if sufficiently high, can cause left heart failure, arrhythmia, myocardial infarction, and cerebral hemorrhage. The causes of postoperative hypertension are hypertension history, pain, hypoxia, emergence excitement, reaction to endotracheal tube, hypothermia, excess fluid administration, hypercarbia, etc. To know the predictable factors for the postoperative hypertension the authors tried to investigate perioperative patient care of the postoperative hypertensive cases. METHODS: One hundred twenty surgical patients in both sexes between the age of 40~60 were sampled randomly and devided into two groups. The normotensive (N) group included the patients with postoperative blood pressure below 140/90 mmHg and the hypertensive (H) group, above 140/90 mmHg. The incidence of hypertension history, hypertension on admission, hypertension on ward, change of systolic blood pressure above 20% during surgery, intra or postoperative use of antihypertensives or inotropic agents were compared between the groups. RESULTS: The incidence of history of hypertension was higher in H group (20%) than N group (6.7%). Hypertension on admission was higher in H group (43.3%) than N group (23.3%). Systolic blood pressure change above 20% was only in H group (6.7%). Use of antihypertensive was more frequent in H group (33.3%) than N group (3.3%) and use of inotropic agents was only in N group (8.3%). The blood pressure at ward, preinduction, and after induction were higher in H group. Within the group the blood pressure between preinduction and after induction has no difference. CONCLUSION: Immediate postoperative hypertension can be expected in case of history of hypertenion, hypertension on admission (above 140/90 mmHg), change of systolic blood pressure above 20%, use of antihypertensive during operation, and hypertension just before induction.

Approximate Entropy of Hypertension: Effect of Anesthesia / 대한마취과학회지

BACKGROUND: Recently, measurement of heart rate variability and the nonlinear complexity of heart rate dynamics have been used as indicators of cardiovascular health. Hypertensive patients showed alternation of cardiovascular homeostasis. We designed this study to evaluate the effect of anesthesia in hypertensive patients with approximate entropy (ApEn), representing the nonlinear complexity. METHODS: With informed consent, none premedicated normotensive (n=18) and hypertensive patients (n=18) were included in this study. ECG data were collected from 10 minutes before induction to 15 minutes after induction. Collected ECG data were stored into computer binary files. We calculated ApEn from the collected ECG data. RESULTS: Before induction, ApEn of hypertensive patients was significantly lower than that of normotensive patients (p<0.05). During induction and maintenance of anesthesia, there was no difference of ApEn between the two groups. ApEn of normotensive patients during induction and maintenance of anesthesia was significantly lower than that of pre-induction (p<0.05). ApEn during maintenance of anesthesia was lower than that of induction of anesthesia (p<0.05). ApEn of hypertensive group during maintenace of anesthesia was significantly lower than that of pre-induction of anesthesia (p<0.05). CONCLUSIONS: As the ApEn of hypertensive patients is lower than that of normotensive patients during pre-inducton period, the heart rate dynamics of hypertensive patients is more regular normotensive patients. The anesthesia is deepened, the heart rate dynamics of the both group is more regular. During the maintenance of anesthesia, the regularity of the heart rate dynamics that not different in both group from the results.

We Anesthetized a Patient with Unexpected Pheochromocytoma, Diagnosed during Operation: 1 case report / 대한마취과학회지

Pheochromocytoma is a tumor which secretes catecholamine and produces remarkable hemodynamic changes during the perioperative period. It is reported that in cases where a patient with undiagnosed pheochromocytoma is operated on, the mortality rate can reach 25% to 50%. The subject in this study was a 55-year-old female patient who was diagnosed having a retroperitoneal mass which looked like a neurogenic tumor. During the manipulation, serious hypertension and tachycardia were developed. The authors at that time suspected a pheochromocytoma, interrupted the operation, and after insertion of arterial line and sodium nitroprusside infusion, the rest of the operation was restarted. After the extirpation of the tumor, as the patient suffered serious hypotension, the concentration of the inhalation agent was reduced, ephedrine was injected, the proper amount of fluid and blood were administered, and, as a result, the operation was carried out safely, and postoperative course was unremarkable.

Comparison of Hemodynamic Effects between Dobutamine and Amrinone in the Patients with Pulmonary Hypertension / 대한마취과학회지

BACKGROUND: Dobutamine and amrinone, phosphodiesterase-III inhibitor, are known to have both inotropic and vasodilatory properties. We evaluated the effects of both drugs on systemic and pulmonary hemodynamics in patients with pulmonary hypertension (PH). METHODS: With Institutional Review Board approval, 45 patients whose mean pulmonary arterial pressure was greater than 30 mmHg were studied. After sternotomy under the steady state of anesthesia and controlled ventilation (30 mmHg < PaCO2 < 40 mmHg), patients recieved one of following drugs for 30minutes (min); dobutamine 5.0ug/kg/min (Group I), low dose amrinone (loading dose 1.0 mg/kg, followed by infusion 7.5 g/kg/min, Group II) or high dose amrinone (loading dose 2.0 mg/kg, followed by infusion 10 g/kg/min, Group III). Hemodynamic variables were measured at 10 min and 30 min after start of infusion. RESULTS: Dobutamine didn't decrease pulmonary arterial pressure (PAP) and cause no hemodynamic change while low and high dose amrinone reduced PAP and especcially decrease of PAP in low dose amrinone group was statistically significnat. High dose amrinone increased cardiac index (CI) and decreased both systemic vascular resistance index (SVRI) and central venous pressure (CVP) more significantly than control value. CONCLUSIONS: In patients with chronic right ventricular failure associated with PH, amrinone may decrease the PAP and improve cardiac performance more effectively than dobutamin does. Increment of dosage of amrinone may not result in significant reduction of PAP.

The Relationship between Periadmission Blood Pressure and Periinduction Blood Pressure / 대한마취과학회지

BACKGROUND: There has been a study reporting those cases with elevated blood pressure (BP) above 140/90 mmHg on admission and normotension on ward showed more increase in mean arterial pressure(MAP) and pressure-pulse product than the normotensive or hypertensive patients in both situations. But the mean ages of the groups were different each other. This study was done to see if the same results would come without age differences. METHODS: One hundred and sixty-two patients between the age of 45 and 64 were divided into three groups. The patients with BP below 140/90 mmHg on admission and on ward were included in group 1(N=66) and those with BP above 140/90 mmHg on admission and below 140/90 mmHg on ward, in group 2(N=42) and those with BP above 140/90 mmHg in both situations were included in group 3(N=54). Preiinduction BP, PR, the changes of BP, PR during operation, incidence of hypertension at post-anesthesia room(PAR), and the number of cases who needed the use of inotropics or antihypertensives perioperatively were checked. RESULTS: As for the increase of BP just before induction the group 2 showed the greatest, group 1 was the next, and group 3 showed the least compared to ward value. Just after induction group 1 showed the greatest, group 2 the next, and group 3 the least amount increase. As for the increase of preinduction pressure-pulse product(PPP) group 2 showed the greatest, group 3 the next, and group 1 the least compared to ward value. Just after induction group 1 showed the greatest, group 2 the next,and group 3 the least amount increase. CONCLUSIONS: Intensive anesthetic care is needed also at periinduction period for the patients who showed hypertensive BP on admission and normotension on ward thereafter.