Obese children should be screened for hypercholesterolemia.

Screening only those with a positive family history misses many children with hypercholesterolemia. This study investigated whether sensitivity improved by adding obesity as a criterion when screening children for cholesterol. During a two-year period screenings were conducted on 506 inner-city subjects aged 5-19. Demographic, clinical, and dietary information was also recorded. Mean age of participants was 11 +/- 4 years; 52 percent were female, 53 percent black, 39 percent Hispanic, and 8 percent other. Mean cholesterol level was 4.14 mmol/l (160 mg/dl). In multivariate analysis obesity was an independent risk factor for hypercholesterolemia, F = 13.14, p < 0.001. The sensitivity of obesity as a screening tool for hypercholesterolemia was better than that for positive family history (42 vs. 24 percent, respectively). Combining the two improved the sensitivity to 49 percent. The authors recommend expanding the indications for screening children to include obesity, in addition to positive family history of hypercholesterolemia or premature cardiovascular disease.

The association between daily blood pressure and catecholamine variability in normotensive working women.

Using ambulatory blood pressure monitors and timed urine collection techniques, blood pressure and the rates of urinary catecholamine excretion were compared across the work, home, and sleep environments of 45 women who perceived their work environment as most stressful (work stressed) and 35 women who perceived their home environment as equally or more stressful (home stressed) on the day of monitoring. The work-stressed women had higher systolic pressure at work (121 vs. 115; p < 0.05). There were no significant differences in diastolic pressure or the absolute levels of the catecholamines between the groups. However, the percent changes in blood pressure and catecholamines from work or home to sleep were significantly correlated in the work-stressed but not the home-stressed women (r values from 0.25 to 0.45, p < 0.05). The work-stressed and home-stressed women differed in their proportional make-up of several demographic characteristics, including having children (percentage of home-stressed women with children > work-stressed) (p < 0.05), ethnicity (percent of black home-stressed > work-stressed) (p < 0.01), and family history of hypertension (percentage of work-stressed > home-stressed) (0.05 < p < 0.10). These differences, in part, may have determined the daily patterns of perceived stress in the two groups of women. Overall, these findings suggest that work stress and/or the sociodemographic characteristics that may influence the perception of work stress may drive a daylong sympathetic response that increases blood pressure in working women.

The role of behavioral factors in white coat and sustained hypertension.

Studies using ambulatory monitoring of blood pressure have indicated that patients with persistently elevated clinic pressures may be subdivided into two groups, those in whom ambulatory pressure is also elevated (persistent hypertension), and those in whom it is normal (white coat hypertension). The role of behavioral factors in contributing to these two types is discussed. Studies of white coat hypertension suggest that it is not characterized by any generalized physiological abnormality, and that target-organ damage is mild and the prognosis relatively benign. It may represent a conditioned response to the physician. Behavioral factors can significantly influence the diurnal profile of blood pressure, as shown by a comparison of ambulatory pressures recorded on working and non-working days, and in women who experience varying levels of occupational and domestic stress. The role of behavioral factors in the development of sustained hypertension (defined as an upward resetting of the diurnal profile), however, is much less clear. A cross-sectional study of normotensive and hypertensive men has shown that men employed in high-strain jobs are more likely to show a sustained elevation of blood pressure.

A validation study of the instromedix Baro-Graf QD home blood pressure monitor.

The purpose of this study was to assess the accuracy of the Instromedix Baro-Graf QD home blood pressure monitor. Forty subjects were divided among three blood pressure (BP) groups: low (BP less than 110/70, N = 11); medium (BP 110/70 to 140/90, N = 17) and high (BP greater than 140/90, N = 12). Five seated readings were taken per subject. We examined the differences between simultaneous auscultatory and machine readings and assessed the machine's accuracy using ANOVA and correlation analysis. The results show that the device, while highly accurate, tended to become less so as pressure increased. However, its accuracy was superior compared to most other devices we have tested, and because of features, such as a computer memory that stores events and blood pressure over time, this monitor will likely be a useful tool for clinical trials of long term blood pressure change.

The effect of work environments on blood pressure: evidence from seven New York organizations.

The prevalence of hypertension defined according to National Health and Nutrition Examination Survey II (NHANES II) criteria (140/90 mmHg and/or taking antihypertensive medication) was analyzed cross-sectionally at seven worksites in New York City (n = 4274; 2616 men and 1648 women), in order to assess whether exposure to different work environments and occupations contributes to blood pressure variation. The prevalence of hypertension across worksites was 26% among men and 12% among women. Blood pressure was significantly different across worksites even after controlling for known risk factors using analysis of covariance. Of the variation in systolic pressure, 34% was predicted significantly by eight variables; after adjusting for upper-arm circumference, age and body mass index, higher pressures were associated with worksite differences (9.0 mmHg), being male (7.2 mmHg), lacking a high-school education (4.3 mmHg), having a clerical occupation (2.9 mmHg) and being unmarried (1.8 mmHg). Similar results for diastolic pressure suggest that researchers should consider worksite and job characteristics as important predictors of blood pressure differences in working populations.