Comparison of three DASH scoring paradigms and prevalent hypertension among older Hispanics.

Older Hispanics are less likely to be aware of their hypertension or adopt lifestyle modifications for hypertension control than non-Hispanic whites. Few reports exist Dietary Approaches to Stop Hypertension (DASH) accordance among Hispanics. This study was designed to: (1) assess accordance to a DASH pattern using three widely used DASH scoring paradigms; and (2) determine which DASH paradigm was most strongly associated with hypertension in 169 older Hispanics (mean age, 66 years and 73% female). Food frequency questionnaires were used to calculate DASH scores. Logistic regression modeling was performed for prevalent hypertension with the DASH scores, age, gender and acculturation. Using the Folsom et al. DASH scoring paradigm, 55% of adults were deemed DASH accordant compared with 17% using Fung et al. scores and 13% using the Toledo et al. Folsom et al. scores were predictive of prevalent hypertension (odds ratio=1.35, 95% confidence interval (1.04, 1.77) in this older Hispanic sample; the remaining two scoring systems were not associated with hypertension in this sample.

The accumulative effects of physical activity in hypertensive post-menopausal women.

BACKGROUND: Lifestyle modifications, such as physical activity, are recommended as first-line or adjunctive therapy for hypertension. However, controversy exists regarding the type, amount, and intensity of physical activity for optimal blood pressure lowering. DESIGN AND METHODS: This study evaluated the blood pressure changes in 18 post-menopausal, sedentary, untreated hypertensive women randomized to an individualized 8-week programme of intermittent moderate-intensity physical activity versus no change in physical activity. The physical activity group was asked to select activities (such as walking) to engage in physical activity for 10 min, three times a day, 5 days per week at an intensity of 50-60% heart rate reserve. RESULTS: Independent T-tests were used to compare the difference in resting blood pressure between groups. After 8 weeks, resting blood pressure was 8/5 mmHg lower in the physical activity group (systolic blood pressure, P= 0.006 and diastolic blood pressure, P = 0.059). The between group differences remained significant after adjustment for age, baseline blood pressure and previous use of antihypertensive drug therapy. CONCLUSION: These data show that hypertensive, post-menopausal women who engage in intermittent, moderate-intensity physical activity experience a reduction in blood pressure.

Variability in fibrinogen measurements: an obstacle to cardiovascular risk stratification.

The clinical utility of fibrinogen measurement has been limited by large intraindividual variability. Several approaches that have been shown to improve the repeatability of fibrinogen include acquisition of samples at the same time of day, standardized sample procurement techniques, and multiple replicate sampling. This study employed established pre-analytical and analytical techniques known to reduce fibrinogen variability, including the acquisition of three replicate samples, each analyzed in duplicate, to evaluate the impact of intraindividual variability in fibrinogen measurement at baseline and 3 months on cardiovascular risk in 60 healthy subjects. Classification accuracy was evaluated by the ability to categorize subjects into tertiles of fibrinogen. Only 55% (33/60) of the subjects were correctly assigned to the appropriate fibrinogen tertile. Fibrinogen measurements varied by more than 10% in 45% of subjects and by 5% in 80% of subjects. Intraindividual variability in fibrinogen measurement with a functional assay limits cardiovascular risk assessment even when three replicates are averaged.

Renin-angiotensin-aldosterone-kinin system influences on diabetic vascular disease and cardiomyopathy.

Diabetes mellitus is associated with an inordinately high risk of virtually all manifestations of cardiovascular-renal disease including atherosclerotic coronary and peripheral vascular disease, congestive heart failure, stroke, nephropathy, and cardiomyopathy unassociated with coronary heart disease. Abnormalities in the renin-angiotensin-aldosterone-kinin (RAAK) cascade have been implicated in the pathogenesis and clinical expression of these cardiovascular-renal sequelae. Thus, pharmacological modulation of the RAAK system is an attractive therapeutic target in diabetes mellitus. Indeed, emerging data from human clinical studies appear to confirm this thesis.

Therapeutic strategies for hypertension treatment in patients with selected cardiovascular diseases.

Patients with hypertension and concomitant cardiovascular (CVD) conditions are at high risk for developing deleterious CVD-related clinical sequelae. The selection of therapeutic strategies for hypertension management in patients with cardiovascular diseases is an important first step in normalizing blood pressure (BP) levels (<140/90 mmHg). The ultimate goal of BP normalization for this high-risk group of hypertensive patients is target-organ protection. This review will discuss the management of hypertension in patients with selected CVD conditions (congestive heart failure, coronary artery disease, renal insufficiency/end-stage renal disease) and will incorporate both nondrug and drug therapies. Nondrug therapy, including weight reduction, physical activity, restriction of dietary sodium and alcohol intake are effective strategies for lowering BP. If these measures are not adequate, then the addition of drug therapy is needed in order to provide gradual BP normalization. Drug regimens may include a single antihypertensive agent with up-titration of the dose, or a combination of antihypertensive agents at a lower dose of each agent. The availability of different classes of antihypertensive agents enables therapeutics strategies to be implemented in the management of hypertension that provide maximum target-organ protection for each entity of CVD. Thus, aggressive hypertension management is crucial for delaying/preventing target organ damage and subsequent CVD clinical events.