The ambulatory blood pressure in normotensive and hypertensive subjects: results from an international database.

OBJECTIVE: To delineate more precisely an operational threshold for making clinical decisions based on ambulatory blood pressure (ABP) measurement by studying the ABP in subjects who were diagnosed as either normotensive or hypertensive by conventional blood pressure (CBP) measurement. SUBJECTS: Twenty-four research groups recruited 7069 subjects. Of these, 4577 were normotensive (systolic CBP < or = 140 mmHg and diastolic CBP < or = 90 mmHg) and 1773 were hypertensive (systolic CBP > or = 160 mmHg and/or diastolic CBP > or = 90 mmHg). Of the latter, 1324 had systolic and 1310 had diastolic hypertension. RESULTS: Ninety-five percent of the normotensive subjects had a 24-h ABP below (systolic and diastolic, respectively) 133 and 82 mmHg. Of the patients with systolic hypertension, 24% had a 24-h systolic ABP of < 133 mmHg. Similarly, 30% of those with diastolic hypertension had a 24-h diastolic ABP of < 82 mmHg. The probability that hypertensive patients had a 24-h ABP below these thresholds was higher in women than in men, increased with age and was 2- to 4-fold greater if the CBP of the patient had been measured at only one visit and if fewer than 3 CBP measurements had been averaged to establish the diagnosis of hypertension. By contrast, for each 10-mmHg increment in systolic CBP, this probability decreased by 54% for the 24-h systolic ABP and by 25% for the 24-h diastolic ABP, and for each 5 mmHg increment in diastolic CBP it increased by 6 and 9%, respectively. CONCLUSION: The ABP distributions of the normotensive subjects included in the present international database were not materially different from those in previous reports in the literature. One-fifth to more than one-third of the hypertensive patients had an ABP which was below the 95th centile of the ABP in normotensive subjects, but this proportion decreased if the hypertensive patients had shown a higher CBP upon repeated measurement. The prognostic implications of elevated CBP in the presence of normal ABP remain to be determined.

Ambulatory blood pressure in normotensive and hypertensive subjects: results from an international database.

OBJECTIVE: To delineate more precisely an operational threshold for making clinical decisions based on ambulatory blood pressure (ABP) measurement by studying the ABP in subjects who were diagnosed as either normotensive or hypertensive by conventional blood pressure (CBP) measurement. SUBJECTS: Twenty-four research groups recruited 7069 subjects. Of these, 4577 were normotensive (CBP < or = 140/90 mmHg), 719 were borderline hypertensive (systolic CBP 141-159 mmHg or diastolic CBP 91-94 mmHg) and 1773 were definitely hypertensive. Of the subjects in the last of these categories, 1324 had systolic hypertension (systolic CBP > or = 160 mmHg) and 1310 had diastolic hypertension (diastolic CBP > or = 95 mmHg). Combined systolic and diastolic hypertension was present in 861 subjects. Hypertension had been diagnosed from the mean of two to nine (median two) CBP measurements obtained at one to three (median two) visits. RESULTS: The 95th centiles of the ABP distributions in the normotensive subjects were (systolic and diastolic, respectively) 133 and 82 mmHg for 24-h ABP, 140 and 88 mmHg for daytime ABP and 125 and 76 mmHg for night-time ABP, respectively. Of the subjects with systolic hypertension, 24% had 24-h systolic ABP < 133 mmHg. Similarly, 30% of those with diastolic hypertension had 24-h diastolic ABP < 82 mmHg. The probability that hypertensive subjects had 24-h ABP below these thresholds tended to increase with age and was two- to fourfold greater if the CBP of the subject had been measured at only one visit and if fewer than three CBP measurements had been averaged for establishing the diagnosis of hypertension. By contrast, for each 10-mmHg increment in systolic CBP, this probability decreased by 54% for 24-h systolic ABP and by 26% for 24-h diastolic ABP, and for each 5-mmHg increment in diastolic CBP it decreased by 6 and 9%, respectively. In comparison with 24-h ABP, the overlap in the daytime and night-time ABP between normotensive and hypertensive subjects was of similar magnitude and was influenced by the same factors. CONCLUSIONS: The ABP distributions of the normotensive subjects included in the present international database were not materially different from those in previous reports in the literature. One-fifth to more than one-third of hypertensive subjects had an ABP which was below the 95th centile of the ABP of normotensive subjects, but this proportion decreased if the hypertensive subjects had shown a higher CBP upon repeated measurement. The prognostic implications of elevated CBP in the presence of normal ABP remain to be determined.

The dissociation of arterial hypertension and lupus glomerulonephritis in systemic lupus erythematosus.

In spite of several articles questioning the general opinion that arterial hypertension in patients with systemic lupus erythematosus (SLE) is only the consequence of lupus glomerulonephritis (LGN), this still remains the usual pathophysiologic explanation. The purpose of this study was to explore the correlations between hypertension and LGN and to assess the importance of hypertension control for the prognosis of patients. A retrospective analysis of 173 patients with SLE over a period of 14 years was performed. For most of the patients, data were available from regular follow-up visits over an average of 6 years. Our results show a dissociation of hypertension and LGN and an association of hypertension and renal dysfunction. Severe hypertensive renal vascular lesions correlated well with a decrease of renal function. Successful treatment of hypertension is therefore essential in order to prevent deterioration of renal function in patients with LGN.

Short report: low-level lead exposure does not increase the blood pressure in the general population. Cadmibel Study Group.

OBJECTIVE: Long-term exposure to high concentrations of lead may adversely affect several organ systems, but the possible influence of low-level lead exposure on blood pressure remains debatable. The present study examined this relationship in a cross-sectional population survey. METHODS: Blood pressure and lead exposure were measured in 1648 subjects (827 males, 821 females; mean age 45 years), drawn at random from the general population, but not being treated for hypertension. RESULTS: Systolic/diastolic blood pressure averaged 131/77 mmHg in the males and 124/74 mmHg in the females. Blood lead was higher in males than in females (0.5 versus 0.3 mumol/l), but the opposite was observed for zinc protoporphyrin (1.0 versus 1.1 micrograms/g haemoglobin). After adjustment for significant covariates (age, body mass index, pulse rate, serum creatinine and serum calcium, and for contraceptive pill intake and menopause in females), systolic pressure was negatively correlated with blood lead in males; the partial correlations with blood lead were not significant for systolic pressure in females nor for diastolic pressure in either sex. Neither males nor females showed a significant relationship between blood pressure and lead exposure assessed from the zinc protoporphyrin level in blood. CONCLUSIONS: This study does not support the hypothesis that exposure to lead is associated with increased blood pressure in the population at large.

Hypertension control and management in Slovenia, Yugoslavia.

Data were collected from 413 questionnaires sent to general practitioners throughout Slovenia, accounting for half the physicians in this discipline. BP was measured most commonly in the sitting position (72%), mostly on the left arm. Most respondents (93%) used only one cuff size. Correction of BP readings according to the patient's arm circumference was used by 63% of the respondents. Seventy-eight percent of the general practitioners recorded phase V of the Korotkoff sounds for diastolic BP. BP was measured more than once at each examination by 55%. BP measurements were performed by nurses in 27% of cases. Mercury sphygmomanometers were used by 87%. Manometers were calibrated once a year by 73%. Complete diagnostic procedures for the definition of hypertension were conducted in approximately 50% of patients, predominantly in severe cases. Drug treatment was commenced in the range of 'mild hypertension' usually by 93% of the general practitioners. It was started at BP values of 165/99 mmHg and higher. In patients with other risk factors, it was instituted even earlier. General measures (non-drug therapy) were advised by only 30%. Beta-blockers were usually prescribed to younger patients as drug of choice (74%), and diuretic agents to the elderly (48%). General practitioners' sources of new information about hypertension were mainly medical literature, pharmaceutical industry information, and professional meetings. Prevalence of hypertensive BP values in the responding general practitioners themselves was 8%.