Headache is not more frequent among patients with moderate to severe hypertension.

The association between hypertension and headache has been a contentious issue. Most studies have showed that mild hypertension and headache are not associated, but this may not be the case in patients with hypertension classified at more severe stages. We investigated the association between hypertension classified at moderate to severe stages and headache in a cross-sectional study conducted in the hypertension clinic of a tertiary care University hospital. In total, 1763 referred patients with a medical diagnosis of hypertension in most cases (95.7%) were evaluated by an extensive protocol questionnaire, detailed physical examination, laboratory examination, and had their blood pressure classified according to the VI Joint National Committee (JNC-VI) recommendation. Logistic regression models were used to explore the association between severity of hypertension and pulse pressure with the presence of headache, controlling for several potential confounders. The complaint of headache was referred by 903 (51.3% of whole sample), and a total of 378 patients (21.4%) were classified at the moderate to severe stage (stage III of the JNC-VI report). The diagnosis of moderate to severe hypertension was not associated with the complaint of headache (OR 1.02, 95% CI from 0.79 to 1.30). Pulse pressure and headache were inversely associated (OR 0.91, 95% CI from 0.86 to 0.97, for 10 mmHg). We concluded that headache and hypertension classified at moderate to severe stages were not associated in patients attending to a hypertension clinic. The novel finding of an inverse association between pulse pressure and headache should be addressed in further investigations.

The effects of two aerobic training intensities on ambulatory blood pressure in hypertensive patients: results of a randomized trial.

The effect of different intensities of aerobic exercise on blood pressure remains uncertain. The goal of this trial was to compare the effect of two different levels of aerobic physical training on 24-hour ambulatory blood pressure. In this double-blind parallel-group trial, 28 sedentary hypertensive patients (mean diastolic blood pressure of 90 to 104 mm Hg) were randomly assigned to 10 weeks of physical training at 20% (Group I) or 60% (Group II) of their maximal workload on a cycle ergometer (mean load of 32 and 85 watts, respectively). Maximal oxygen consumption was estimated by the time spent on a mechanical braked Monark bicycle (Monark, Sáo Paulo, Brazil). Indexes of physical fitness were determined by cycle ergometer tests before and after the experimental period. The principal outcome variable was mean 24-hour ambulatory blood pressure. Mean 24 hour systolic blood pressure fell from 137.2+/-14.9 to 135.2+/-12.7 mm Hg in Group I and from 144.4+/-13.3 to 138.6+/-12.9 in Group II (mean between group difference of -2.1 mm Hg, P = 0.479, adjusted for baseline blood pressure). Mean diastolic blood pressure fell from 9.21+/-10.0 to 89.3+/-7.7 mm Hg in Group I and from 93.3+/-5.8 to 90.6+/-6.8 mm Hg in Group II (mean adjusted difference of -0.06, P = 0.765). Nighttime blood pressure did not change in either group. Across all participants, a reduction in systolic blood pressure was significantly associated with improved physical fitness as manifest by increased physical work capacity at heart rate of 130 bpm (PWC130), increased systolic blood pressure at PWC130, and decreased maximum heart rate measured during the cycle ergometer test We conclude that aerobic training programs at 20% and 60% of the maximum work capacity have similar effects on ambulatory blood pressure.

Blood pressure effects of antihypertensive drugs and changes in lifestyle in a Brazilian hypertensive cohort.

BACKGROUND: The antihypertensive efficacy of drug therapy and of some nonpharmacologic recommendations has been demonstrated in controlled clinical trials, but not in a clinical setting. OBJECTIVE: To assess the antihypertensive effectiveness of drug therapy and of three nonpharmacologic recommendations (loss of weight, salt-intake restriction, and physical exercise). DESIGN: A prospectively planned cohort study. SETTING: A hospital-based hypertensive outpatient clinic. PATIENTS: We studied 637 patients (65.5% women) with systolic blood pressures above 140 mmHg or diastolic blood pressures above 90 mmHg, corresponding to 76% of 839 patients who were administered a prescription for hypertension and who returned for the first follow-up visit 3.5 months later on average. METHODS: The nonpharmacologic prescription consisted of salt-intake restriction for all, weight reduction for overweight patients, and practice of aerobic physical exercise for those for whom it was not contraindicated; 60% of the patients were treated with drugs according to standard recommendations. Patients treated with drugs were compared with untreated subjects; for the nonpharmacologic interventions, the groups were compared according to their reported compliances with the recommendations (at least some compliance versus none). The main outcome measures were variations in systolic and diastolic blood pressures between the baseline evaluation and the first follow-up visit and an improvement in prognosis, represented by a favorable change in the classification of the blood pressure (according to Joint National Committee V criteria). RESULTS: The cohort constituted predominantly low-income, middle-aged, overweight white women, with low-to-moderate hypertension of long duration. The group treated with drugs exhibited the greatest reduction in blood pressure, with clinical significance even discounting the losses in follow-up; the group of patients who reported compliance with the low-energy-intake diet also showed a consistent antihypertensive effect, which was still detectable on the occasion of the third follow-up visit 9 months after the first prescription; reported compliance with a low-sodium diet and practice of physical exercise were not associated with a reduction in blood pressure; among a subset of the patients, reported compliance with the salt-intake-restricted diet did not reduce the amount of sodium to the theoretical antihypertensive threshold. It was not possible to determine whether the lack of an antihypertensive effect of physical exercise for this cohort was secondary to a misreport of the extent of compliance or to an absence of effect of the intensity of training prescribed. The effects of drug therapy and compliance with a low-energy-intake diet were shown to be independent of other interventions or confounders. CONCLUSION: The antihypertensive effect of drugs demonstrated in well-controlled clinical trials is achievable in clinical practice. The recommendation to lose weight was the only nonpharmacologic intervention with a detectable antihypertensive effect in this cohort. The absence of effect of a low-sodium diet is probably secondary to the insufficient reduction in the amount of salt consumed. The lack of an antihypertensive effect of physical exercise could reflect either a misreported compliance or an absence of effect of the intensity of training recommended in this study.

Study of the usefulness of optic fundi examination of patients with hypertension in a clinical setting.

The purpose of this study was to evaluate the usefulness of direct opthalmoscopy by non-opthalmologists in patients with hypertension. In a cross-sectional survey, we analysed the association between optic fundi abnormalities, individually and according to the criteria of Keith and Wagener (KW), with blood pressure and duration of known hypertension in 400 non-diabetic hypertensive patients. The optic fundi abnormalities were more frequent in patients with diastolic blood pressure (DBP) > 105 mm Hg (P = 0.002), SBP > 180 mm Hg (P < 0.0001) and with a duration of known hypertension > 3 years (P = 0.002). The severity of hypertension did not vary in parallel with the KW classes I and II: 34.5% of patients classified as KW I had a diastolic pressure of > 105 mm Hg compared with only 25.3% of those classified as KW II. Class III abnormalities were infrequent (2.5% of the whole cohort). In a logistic regression model, diffuse arteriolar narrowing was associated with DBP (P = 0.002) and age (P < 0.001). Abnormalities of the arteriovenous crossings were associated with SBP (P = 0.001) and duration of disease (P = 0.008). The positive predictive value of any fundoscopic abnormality to estimate the severity of hypertension was 59% and the negative value was 60%. The results of this study demonstrate that optic fundi examination by internists and cardiologists does not give an accurate assessment of the severity of hypertension in most patients, and that the Keith-Wagener classification of retinopathy has a limited applicability.(ABSTRACT TRUNCATED AT 250 WORDS)