Acute stress promotes transient elevation of blood pressure, but there is no consistent evidence that this effect results in hypertension. In this systematic review of cohort and case-control studies ...that investigated the association between psychosocial stress and hypertension, we conducted a complete search up to February 2007 in MEDLINE, EMBASE, PSYCINFO and LILACS, through a search strategy that included eight terms to describe the exposure, six related to the design of the studies and one term for outcome. The quality was assessed by the Newcastle-Ottawa Quality Assessment Scale. The selection was done in duplicate by two teams of independent reviewers. Among 82 studies selected in the second phase, only 14 (10 cohort studies and 4 case-control studies), totalling 52,049 individuals, fulfilled the selection criteria. The average quality of the studies was 6.6+/-1.3 in a 9-point scale. Acute life events were associated with hypertension in one and were not associated in two studies. Five out of seven studies found a significant and positive association between measures of chronic stress and hypertension, with risk ratios ranging from 0.8 to 11.1. Three out of five studies reported high and significant risks of affective response to stress for hypertension, one a significant risk close to a unit and one reported absence of risk. Acute stress is probably not a risk factor for hypertension. Chronic stress and particularly the non-adaptive response to stress are more likely causes of sustained elevation of blood pressure. Studies with better quality are warranted.
Patients with hypertension usually report lower health-related quality of life (HRQoL), but it is unclear whether this is secondary to high blood pressure (BP) per se, drug treatment or awareness of ...disease. In a cross-sectional study using a multistage population-based sample, participants were interviewed and examined at home. Hypertension was defined by BP ≥140/90 mm Hg or use of BP-lowering drugs. HRQoL was assessed through the Short-Form Health Survey (SF-12) and presented as the physical component summary (PCS), mental component summary (MCS) and the SF-12 eight-domain scale. In total, 1858 individuals were evaluated, being 60.1% women, aged 52.5 ± 4.1 years old, and 39.9% men, aged 47.2 ± 9.1 years old. Prevalence of hypertension was 34.2% (95% CI 31.5-36.9). The PCS scores for hypertensive and normotensive participants were 49.4 (CI 48.6-50.2) and 51.06 (CI 50.4-51.7) (P=0.01), respectively, and the MCS scores were 49.1 (CI 47.9-50.3) and 50.5 (CI 49.6-51.2) (P=0.06), respectively. Participants with hypertension and not using BP drugs had higher HRQoL scores (PCS 49.6; MCS 51.9) than those using BP drugs either with uncontrolled (PCS 45.3; MCS 49.4) or controlled BP (PCS 46.2; MCS 47.7; P<0.05). We concluded that individuals with hypertension have worse quality of life, particularly when their BP is controlled by drugs. This perception may lead to lower rates of adherence to treatment.
To ascertain the most appropriate treatment for chronic, stable, coronary artery disease (CAD) in patients submitted to elective coronary angiography.
A total of 814 patients included in the ...prospective cohort study were referred for elective coronary angiography and were followed up on average for 6±1.9 years. Main outcomes were all-cause death, cardiovascular death, non-fatal myocardial infarction (MI) and stroke and late revascularization and their combinations as major adverse cardiac and cerebral events (MACCE): MACCE-1 included cardiovascular death, nonfatal MI, and stroke; MACCE-2 was MACCE-1 plus late revascularization. Survival curves and adjusted Cox proportional hazard models were used to explore the association between the type of treatment and outcomes.
All-cause death was lower in participants submitted to percutaneous coronary intervention (PCI) (0.41, 0.16-1.03, P=0.057) compared to medical treatment (MT). Coronary-artery bypass grafting (CABG) had an overall trend for poorer outcomes: cardiovascular death 2.53 (0.42-15.10), combined cardiovascular death, nonfatal MI, and stroke 2.15 (0.73-6.31) and these events plus late revascularization (2.17, 0.86-5.49). The corresponding numbers for PCI were 0.27 (0.05-1.43) for cardiovascular death, 0.77 (0.32-1.84) for combined cardiovascular death, nonfatal MI, and stroke and 2.35 (1.16-4.77) with the addition of late revascularization. These trends were not influenced by baseline blood pressure, left ventricular ejection fraction and previous MI. Patients with diabetes mellitus had a significantly higher risk of recurrent revascularization when submitted to PCI than CABG.
Patients with confirmed CAD in elective coronary angiography do not have a better prognosis when submitted to CABG comparatively to medical treatment. Patients treated with PCI had a trend for the lower incidence of combined cardiovascular events, at the expense of additional revascularization procedures. Patients without significant CAD had a similar prognosis than CAD patients treated with medical therapy.
The risk that lowering blood pressure (BP) excessively increases the incidence of cardiovascular disease-the J-shaped phenomenon-has been a matter of concern endorsed by many experts, particularly in ...patients with coronary heart disease and diabetes. The results of the Action to Control Cardiovascular Risk in Type 2 Diabetes (ACCORD) trial strengthened the idea that it may be futile to lower BP more intensively in patients with diabetes. Nevertheless, there seems to be no direct J-shaped relation between BP-lowering treatment and outcome. Patients with normal or low BP and high or very high cardiovascular risk could have their BP reduced further by treatment. Placebo-controlled clinical trials of BP-lowering agents in patients with BP within normal values and concomitant cardiovascular disease demonstrated consistent reduction of recurrent and newer cardiovascular events. The use of BP agents in such conditions, as in patients with coronary artery disease, heart failure, diabetes and in patients recovered from a stroke has been endorsed by guidelines. Although is likely that there is a J-shaped relationship of BP with outcomes in cohort studies, clinical trials that tested more intensive versus standard goals and clinical trials done with patients with low BP demonstrated that the J-shaped phenomenon should not be a concern in the treatment of high BP.
Because studies have evidenced variations in nutrient intake, further investigation of the interaction between demographic characteristics and the seasons is necessary. We aimed to test the ...differences in food intake throughout the seasons and the interaction between the seasons and sex and age.
This study included 273 individuals. Food intake was evaluated with 24-hour dietary recalls, and the reported food items were sorted into food groups. We performed the test on the differences in intake of food groups throughout the seasons with repeated measures and on the interaction effect by using the Generalized Estimate Equation.
Intake of fruits and natural fruit juices and sweetened beverages was lower, whereas that of grains and derivatives was higher in the winter. The intake of leafy vegetables and fish and seafood was lower in the autumn. The consumption of coffee and eggs was higher in the spring. Intake of chocolate powder and sugar, salt and lean poultry was higher in the winter. The variation in consumption of grains and derivatives, eggs, fatty poultry and processed meat over the seasons was more likely to be modified by sex. Age interacted with the seasons for leafy vegetables, beans and lentils, lean beef, lean poultry, low fat milk and light yogurt, vegetable oil and unsalted margarine, chocolate powder and sugar and processed meat.
This study shows that food intake may change seasonally and that seasonal variation depends on sex and age, which might aggregate a specific co-variation component.
BACKGROUND
The prevalence of hypertension among elderly persons has been assessed in several circumscribed studies scattered across Brazil, and no representative data about this exist for the whole ...country. In this meta-analysis with a systematic review of the literature, we provide a summary estimate of hypertension among elderly persons in Brazil and present the trend in prevalence of the condition from 1980 to 2010.
METHODS
Population-based prevalence studies carried out between 1980 and 2010 were identified by two independent reviewers, without language restrictions, in electronic databases. For PubMed searches we used the following Mesh Terms: "Aged"Majr AND "Hypertension" AND "Prevalence" AND "Brazil." Elderly individuals were defined as being ≥ 60 or ≥ 65 years of age, depending on the cutoff age of the relevant study. Hypertension was defined as the use of antihypertensive medication or as a seated blood pressure ≥ 140/90mm Hg, in accord with the criteria of the Joint National Committee (JNC) on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure of the U.S. National Heart, Lung and Blood Institute. The prevalence of self-reported hypertension, assessed by household surveys and through telephone inquiries, was also evaluated. Prevalence estimates were calculated with a random-effects model.
RESULTS
On the basis of the screening process, we selected 16 studies for meta-analysis, comprising 13,978 individuals. The prevalence of hypertension for the period from 1980 to 2010, according to the JNC criteria, was 68.0% (95% CI, 65.1%-69.4%). In the 2000s, the prevalence of hypertension according to the same criteria was 68.9% (95% CI, 64.1%-73.3%), whereas the self-reported prevalence based on household surveys was 49.0% (95% CI, 46.8%-51.2%) and the prevalence based on telephone surveys was 53.8% (95% CI, 44.8%-62.6%).
CONCLUSIONS
The prevalence of hypertension is high among elderly persons in Brazil, and there is considerable underestimation of the prevalence of the disease through self-reported estimates.
Oxidation by hydroxyl radical (OH) and ozonolysis are the two major pathways of daytime biogenic volatile organic compound (BVOC) oxidation and secondary organic aerosol (SOA) formation. In this ...study, we investigated the particle formation of several common monoterpenes (α-pinene, β-pinene and limonene) by OH-dominated oxidation, which has seldom been investigated. OH oxidation experiments were carried out in the SAPHIR (Simulation of Atmospheric PHotochemistry In a large Reaction) chamber in Jülich, Germany, at low NOx (0.01 ~ 1 ppbV) and low ozone (O3) concentration (< 20 ppbV). OH concentration and total OH reactivity (kOH) were measured directly, and through this the overall reaction rate of total organics with OH in each reaction system was quantified. Multi-generation reaction process, particle growth, new particle formation (NPF), particle yield and chemical composition were analyzed and compared with that of monoterpene ozonolysis. Multi-generation products were found to be important in OH-dominated SOA formation. The relative role of functionalization and fragmentation in the reaction process of OH oxidation was analyzed by examining the particle mass and the particle size as a function of OH dose. We developed a novel method which quantitatively links particle growth to the reaction rate of OH with total organics in a reaction system. This method was also used to analyze the evolution of functionalization and fragmentation of organics in the particle formation by OH oxidation. It shows that functionalization of organics was dominant in the beginning of the reaction (within two lifetimes of the monoterpene) and fragmentation started to play an important role after that. We compared particle formation from OH oxidation with that from pure ozonolysis. In individual experiments, growth rates of the particle size did not necessarily correlate with the reaction rate of monoterpene with OH and O3. Comparing the size growth rates at the similar reaction rates of monoterpene with OH or O3 indicates that, generally, OH oxidation and ozonolysis had similar efficiency in particle growth. The SOA yield of α-pinene and limonene by ozonolysis was higher than that of OH oxidation. Aerosol mass spectrometry (AMS) shows SOA elemental composition from OH oxidation follows a slope shallower than −1 in the O / C vs. H / C diagram, also known as Van Krevelen diagram, indicating that oxidation proceeds without significant loss of hydrogen. SOA from OH oxidation had higher H / C ratios than SOA from ozonolysis. In ozonolysis, a process with significant hydrogen loss seemed to play an important role in SOA formation.
High systolic blood pressure (SBP) variability has been associated with higher risk for target-organ damage. In a cross-sectional study done in a tertiary outpatient hypertension clinic, we compared ...short-term SBP variability among controlled and uncontrolled hypertensive patients and evaluated the association between higher levels of SBP variability and diastolic function and left ventricular hypertrophy (LVH). Patients were evaluated by 24-h ambulatory blood pressure monitoring and transthoracic Doppler echocardiogram. Blood pressure (BP) variability was evaluated by the time-rate index and high variability corresponded to index values in the top quartile of distribution. Echocardiographic parameters were compared in patients with and without higher BP variability within controlled and uncontrolled office BP (⩽140/90 mm Hg). The analyses included 447 patients with 58±12 years of age, 67% were women, 68% white, 43% current or previous smokers and 32% with diabetes mellitus. Among the whole sample, 137 patients had controlled and 310 uncontrolled BP. The 75th percentile cutoff points for the time-rate index were 0.502 mm Hg min(-1) and 0.576 mm Hg min(-1) for participants with controlled and uncontrolled BP, respectively. After adjustment for confounders, the time-rate index did not differ between controlled and uncontrolled patients. BP variability was not associated with LVH or diastolic function in controlled and uncontrolled BP after adjustment for 24-h SBP and age. Patients with controlled and uncontrolled BP had similar SBP variability assessed by time-rate index, which was not associated with LVH or diastolic function. These findings should be confirmed in studies with larger sample size.
The chemical and physical properties of secondary organic aerosol (SOA) formed by the photochemical degradation of biogenic and anthropogenic volatile organic compounds (VOC) are as yet still poorly ...constrained. The evolution of the complex refractive index (RI) of SOA, formed from purely biogenic VOC and mixtures of biogenic and anthropogenic VOC, was studied over a diurnal cycle in the SAPHIR photochemical outdoor chamber in Jülich, Germany. The correlation of RI with SOA chemical and physical properties such as oxidation level and volatility was examined. The RI was retrieved by a newly developed broadband cavity-enhanced spectrometer for aerosol optical extinction measurements in the UV spectral region (360 to 420 nm). Chemical composition and volatility of the particles were monitored by a high-resolution time-of-flight aerosol mass spectrometer, and a volatility tandem differential mobility analyzer. SOA was formed by ozonolysis of either (i) a mixture of biogenic VOC (α-pinene and limonene), (ii) biogenic VOC mixture with subsequent addition of an anthropogenic VOC (p-xylene-d10), or (iii) a mixture of biogenic and anthropogenic VOC. The SOA aged by ozone/OH reactions up to 29.5 h was found to be non-absorbing in all cases. The SOA with p-xylene-d10 showed an increase of the scattering component of the RI correlated with an increase of the O / C ratio and with an increase in the SOA density. There was a greater increase in the scattering component of the RI when the SOA was produced from the mixture of biogenic VOCs and anthropogenic VOC than from the sequential addition of the VOCs after approximately the same ageing time. The increase of the scattering component was inversely correlated with the SOA volatility. Two RI retrievals determined for the pure biogenic SOA showed a constant RI for up to 5 h of ageing. Mass spectral characterization shows the three types of the SOA formed in this study have a significant amount of semivolatile components. The influence of anthropogenic VOCs on the oxygenated organic aerosol as well as the atmospheric implications are discussed.
ABSTRACT—A close relationship between alcohol consumption and hypertension has been established, but it is unclear whether there is a threshold level for this association. In addition, it has ...infrequently been studied in longitudinal studies and in black people. In a cohort study, 8334 of the Atherosclerosis Risk in Communities (ARIC) Study participants, aged 45 to 64 years at baseline, who were free of hypertension and coronary heart disease had their blood pressures ascertained after 6 years of follow-up. Alcohol consumption was assessed by dietary interview. The type of alcoholic beverage predominantly consumed was defined by the source of the largest amount of ethanol consumed. Incident hypertension was defined as a systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg or use of antihypertensive medication. There was an increased risk of hypertension in those who consumed large amounts of ethanol (≥210 g per week) compared with those who did not consume alcohol over the 6 years of follow-up. The adjusted odds ratios (95% confidence interval) were 1.2 (0.85 to 1.67) for white men, 2.02 (1.08 to 3.79) for white women, and 2.31 (1.11 to 4.86) for black men. Only 4 black women reported drinking >210 g ethanol per week. At low to moderate levels of alcohol consumption (1 to 209 g per week), the adjusted odds ratios (95% confidence interval) were 0.88 (0.71 to 1.08) in white men, 0.89 (0.73 to 1.09) in white women, 1.71 (1.11 to 2.64) in black men, and 0.88 (0.59 to 1.33) in black women. Systolic and diastolic blood pressures were higher in black men who consumed low to moderate amounts of alcohol compared with the nonconsumers but not in the 3 other race-gender strata. Models with polynomial terms of alcohol exposure suggested a nonlinear association in white and black men. Higher levels of consumption of all types of alcoholic beverages were associated with a higher risk of hypertension for all race-gender strata. The consumption of alcohol in amounts ≥210 g per week is an independent risk factor for hypertension in free-living North American populations. The consumption of low to moderate amounts of alcohol also appears to be associated with a higher risk of hypertension in black men.
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