Relation of body mass and alcohol, nutrient, fiber, and caffeine intakes to blood pressure in the special intervention and usual care groups in the Multiple Risk Factor Intervention Trial

Dietary factors and hypertension risk in West Africa: a systematic review and meta-analysis of observational studies

BACKGROUND

Contrary to North America and Europe, the prevalence of hypertension is rising in West Africa. Although diet is implicated as a contributor to this trend, nutritional guidelines in West Africa are not tailored to address this concern. This study aimed to address this limitation by investigating dietary factors common to West Africa and evaluating their association with hypertension.

METHODS

PubMed, Scopus, Web of Science, and Medline were searched to identify studies that investigated diet and hypertension in West African adults. All meta-analyses used a generic inverse-variance random effects model, with subgroup analyses by age, BMI, and study location, and were performed in R.

RESULTS

Three thousand, two hundred ninety-eight studies were identified, of which 31 ( n  = 48 809 participants) satisfied inclusion criteria - all cross-sectional. Meta-analyses of the association between dietary factors and hypertension included dietary fat [odds ratio (OR) = 1.76; 95% confidence interval (95% CI) 1.44-2.14; P  < 0.0001], red meat (OR = 1.51; 95% CI: 1.04-2.18; P  = 0.03), junk-food (OR = 1.41; 95% CI: 1.19-1.67; P  < 0.0001), dietary salt (OR = 1.25; 95% CI: 1.12-1.40; P  < 0.0001), alcohol (OR = 1.17; 95% CI: 1.03-1.32; P  = 0.013), and 'fruits and vegetables' (OR = 0.80; 95% CI: 0.24-1.17; P  < 0.0001). Subgroup analyses suggested that 'fruit and vegetable' consumption is less protective in the elderly.

CONCLUSION

High consumption of dietary salt, red meat, dietary fat, junk food, and alcohol are associated with increased odds of hypertension, whereas high fruit and vegetable appear protective. This region-specific evidence will support the development of nutritional assessment tools for clinicians, patients, and researchers aiming to reduce hypertension in West Africa.

CYP17A1-ATP2B1 SNPs and Gene-Gene and Gene-Environment Interactions on Essential Hypertension

Background: The association between the CYP17A1 and ATP2B1 SNPs and essential hypertension (referred to as hypertension) is far from being consistent. In addition to the heterogeneity of hypertension resulting in inconsistent results, gene–gene and gene–environment interactions may play a major role in the pathogenesis of hypertension rather than a single gene or environmental factor.

Methods: A case–control study consisting of 1,652 individuals (hypertension, 816; control, 836) was conducted in Maonan ethnic minority of China. Genotyping of the four SNPs was performed by the next-generation sequencing technology.

Results: The frequencies of minor alleles and genotypes of four SNPs were different between the two groups (p < 0.001). According to genetic dominance model analysis, three (rs1004467, rs11191548, and rs17249754) SNPs and two haplotypes (CYP17A1 rs1004467G-rs11191548C and ATP2B1 rs1401982G-rs17249754A) were negatively correlated, whereas rs1401982 SNP and the other two haplotypes (CYP17A1 rs1004467A-rs11191548T and ATP2B1 rs1401982A-rs17249754G) were positively associated with hypertension risk (p ≤ 0.002 for all). Two best significant two-locus models were screened out by GMDR software involving SNP–environment (rs11191548 and BMI ≥ 24 kg/m²) and haplotype–environment (CYP17A1 rs1004467G-rs11191548C and BMI ≥ 24 kg/m²) interactions (p ≤ 0.01). The subjects carrying some genotypes increased the hypertension risk.

Conclusions: Our outcomes implied that the rs1004467, rs11191548, and rs17249754 SNPs and CYP17A1 rs1004467G-rs11191548C and ATP2B1 rs1401982G-rs17249754A haplotypes have protective effects, whereas the rs1401982 SNP and CYP17A1 rs1004467A-rs11191548T and ATP2B1 rs1401982A-rs17249754G haplotypes showed adverse effect on the prevalence of hypertension. Several SNP–environment interactions were also detected.

Association between animal source foods consumption and risk of hypertension: a cohort study

PURPOSE

This study assessed the association between animal source foods (ASF) consumption and hypertension, a recognised risk factor for cardiovascular disease. Adverse effects of red and processed meat (RPM) consumption and beneficial effects of the consumption of dairy products and other ASF have been discovered separately; however, the constrained nature of food intake has been typically ignored. We assessed the effects of substituting RPM and other ASF.

METHODS

We followed-up 5394 Chinese adults (age 18-60 years) at baseline using the China Health and Nutrition Survey from 2004 to 2011. Food consumption was assessed using individual-based consecutive 24-h recall and household-based food weighing approaches. Both traditional substitution analysis and substitution analysis based on compositional transformation were used to assess substitution effects.

RESULTS

In total, 1267 participants were newly diagnosed with hypertension during the median follow-up time of 6.81 years (range, 2.97-6.99 years). The traditional substitution analysis found that substituting eggs for RPM was associated with a lower risk of hypertension. The compositional transformation substitution analysis revealed that replacing RPM with any other ASF was associated with a lower risk of hypertension; it implemented substitutions of one or many ASF for RPM; it also revealed different substitution effects of RPM and dairy products, and substituting dairy products for RPM was associated with reduced hypertension risks.

CONCLUSION

The compositional transformation substitution analysis considers the constrained and relative nature of food consumption. It is a flexible approach to estimating substitution effects using different patterns to obtain personalised estimation effects and provide individualised dietary recommendations.

Association between abdominal aortic aneurysms and alcohol-related diseases

Heterogeneous associations exist between alcohol consumption and the initial presentation of cardiovascular diseases (CVDs). Studies regarding the association between abdominal aortic aneurysms (AAAs) and alcohol consumption are still limited and controversial. We hypothesize that patients with alcohol-related diseases are susceptible to AAA formation due to the presence of overlapping epidemiological factors and molecular mechanisms. We aimed to use a nationwide population-based retrospective cohort study to evaluate the association between alcohol-related diseases and AAA.The data were extracted from the National Health Insurance Research Database (NHIRD) in Taiwan. The study outcome assessed was the cumulative incidence of AAA in patients with alcohol-related diseases during a 14-year follow-up period.Our study included 22,878 patients who had alcohol-related diseases; these patients with alcohol-related diseases had a significantly higher cumulative risk of developing AAA 5 years after the index date than did the 91,512 patients without alcohol-related diseases. Patients with alcohol-related diseases also exhibited a significantly increased incidence of AAA compared with the incidence among patients without alcohol-related diseases, according to Cox regression analysis and Fine & Gray's competing risk model (adjusted hazard ratio = 2.379, 95% confidence interval = 1.653 -3.424, P < .001). In addition, male gender, older age, and chronic kidney disease were also associated with an increased risk of developing AAA. An interaction model showed that males with alcohol-related diseases had a 10.4-fold higher risk of AAA than did females without alcohol-related diseases.We observed an association between alcohol-related diseases and AAA even after adjusting for several comorbidities and medications in a nationwide population database.

Endothelial Function in Healthy Young Individuals Is Associated with Dietary Consumption of Saturated Fat

Background: A diet rich in fat, in particular saturated fat (SF), may be linked to cardiovascular disease development, possibly due to a detrimental effect of fat on endothelial function (EF).

Objective: We aimed to determine whether the habitual SF intake [as a ratio to total fat (the sum of saturated, polyunsaturated, and monounsaturated fat)] might influence endothelial function in young, overweight but otherwise healthy adults.

Design: Sixty-nine young adults (49 males, mean age: 23 ± 1 years, mean BMI: 29.1 ± 0.8 kg/m²) were classified into three tertiles according to their habitual SF intake consumption (low SF: <39%, medium SF 39.1–43.7%, and high SF: >43.7% of total fat). Endothelial function was assessed using digital amplitude tonometry.

Results: The three groups of individuals were comparable for total energy intake and calories from: fat, protein, and carbohydrates. There was no difference in anthropometric and hemodynamic variables among the groups. Those in the high SF group presented with impaired endothelial function [reactive hyperemia index (RHI): high SF: 1.60 ± 0.08 compared to 2.23 ± 0.16 in the medium SF and 2.12 ± 0.14 in the low SF group, P < 0.01]. Regression analysis, including gender, age, ethnicity, body mass index indicated that the ratio of SF to total fat was an independent predictor of the RHI (P < 0.05).

Conclusion: The habitual consumption of a diet high in SF in relation to polyunsaturated and monounsaturated fat was strongly associated with impaired endothelial function in young overweight adults, potentially contributing to increased risk of developing cardiovascular disease.

Weight Management in Primary Care

BACKGROUND

Obesity is one of the greatest public health challenges worldwide. It is not only a medical but also a philosophical, ecological, economic, sociocultural, and psychological problem as well as a severe consequence of our modern value definition to 'receive more and more'. Therefore, physicians are not able to treat obesity broadly and should not be used as tools to achieve certain weight goals.

METHODS

This article presents an outline of conservative obesity therapy. Using the key words 'obesity', 'diet', and 'exercise', a search was conducted in the PubMed and ScienceDirect databases for the period from 1995 to 2015.

RESULTS/CONCLUSION

The goal of obesity therapy is primarily the reduction of abdominal fat distribution. Only after achieving this main objective, weight loss reduction can be included by changes in eating and activity habits as well as further lifestyle modifications supplemented by weight-reducing medical, invasive, and/or surgical therapy measures in order to reduce obesity-associated comorbidities and to improve quality of life. A reduction of fat intake while avoiding unsaturated fatty acids, an optimization especially of the quality of carbohydrate and protein intake, an increase in physical activity (about 30-60 min per day) with individual adaption, and a personal, ongoing therapeutic leadership is necessary to reach the main goal, i.e. losing 5-15% of the initial weight.

Coffee and myocardial infarction: heterogeneity of an association in Portuguese men

BACKGROUND

Despite the amount of published studies on the subject, controversy still exists about the effect of coffee drinking on the occurrence of coronary heart disease. In general, epidemiological studies do not support the belief that it is a major risk factor.

DESIGN

A community-based case-control study was conducted.

METHODS

A random sample of men aged 40 years and over with no previous myocardial infarction was compared with patients with a first acute myocardial infarction (AMI). A structured questionnaire was used to collect information on sociodemographic characteristics, personal and family medical history and lifestyles. Dietary data were obtained by a food frequency questionnaire. Odds ratios were calculated by unconditional logistic regression. After exclusions, 290 cases and 364 controls were considered in the final analysis.

RESULTS

Coffee drinking is a widespread habit in this population, and most individuals did not change their habit throughout life. Most participants reported the consumption of moderate amounts of coffee (< 25% drank more than four cups a day) and espresso was by far the most commonly used brewing. The crude odds ratio for having ever drunk coffee regularly was 0.5 (95% confidence interval 0.3-1.1). However, there was a significant effect-measure modification by family history of AMI (P = 0.02).

CONCLUSIONS

The results suggest different susceptibility to coffee drinking, such that coffee drinking was positively although not significantly associated with an increased risk of AMI in men with a family history of AMI, whereas there was a significant inverse association with the occurrence of myocardial infarction among men with no family history of AMI.

An Update on Nutrients and Blood Pressure

Adverse blood pressure (BP) is a major independent risk factor for epidemic cardiovascular diseases affecting almost one-quarter of the adult population worldwide. Dietary intake is a major determinant in the development and progression of high BP. Lifestyle modifications, including recommended dietary guidelines, are advocated by the American Society of Hypertension, the International Society of Hypertension, the Japanese Society of Hypertension, and many other organisations for treating all hypertensive people, prior to initiating drug therapy and as an adjunct to medication in persons already on drug therapy. Lifestyle modification can also reduce high BP and prevent development of hypertension. This review synthesizes results from the International Study of Macro/Micronutrients and Blood Pressure (INTERMAP), a cross-sectional epidemiological study of 4,680 men and women aged 40-59 years from Japan, the People's Republic of China, the United Kingdom, and the United States, published over the past few years on cross cultural BP differences. INTERMAP has previously reported that intakes of vegetable protein, glutamic acid, total and insoluble fibre, total polyunsaturated fatty acid and linoleic acid, total n-3 fatty acid and linolenic acid, phosphorus, calcium, magnesium, and non-heme iron were inversely related to BP. Direct associations of sugars (fructose, glucose, and sucrose) and sugar-sweetened beverages (especially combined with high sodium intake), cholesterol, glycine, alanine, and oleic acid from animal sources with BP were also reported by the INTERMAP Study.

Total, insoluble and soluble dietary fibre intake in relation to blood pressure: the INTERMAP Study

Prospective cohort studies have shown inverse associations between fibre intake and CVD, possibly mediated by blood pressure (BP). However, little is known about the impact of types of fibre on BP. We examined cross-sectional associations with BP of total, insoluble and soluble fibre intakes. Data were used from the INTERnational study on MAcro/micronutrients and blood Pressure (INTERMAP) study, including 2195 men and women aged between 40 and 59 years from the USA. During four visits, eight BP, four 24 h dietary recalls and two 24 h urine samples were collected. Linear regression models adjusted for lifestyle and dietary confounders to estimate BP differences per 2 sd higher intakes of total and individual types of fibre were calculated. After multivariable adjustment, total fibre intake higher by 6·8 g/4184 kJ (6·8 g/1000 kcal) was associated with a 1·69 mmHg lower systolic blood pressure (SBP; 95% CI -2·97, -0·41) and attenuated to -1·01 mmHg (95% CI -2·35, 0·34) after adjustment for urinary K. Insoluble fibre intake higher by 4·6 g/4184 kJ (4·6 g/1000 kcal) was associated with a 1·81 mmHg lower SBP (95% CI -3·65, 0·04), additionally adjusted for soluble fibre and urinary K excretion, whereas soluble fibre was not associated with BP. Raw fruit was the main source of total and insoluble fibre, followed by whole grains and vegetables. In conclusion, higher intakes of fibre, especially insoluble, may contribute to lower BP, independent of nutrients associated with higher intakes of fibre-rich foods.

Self-reported knowledge and awareness about blood pressure and hypertension: a cross-sectional study of a random sample of men and women aged 60-74 years

Background

In general, it is assumed that patient education, by increasing knowledge, may change behavior and lifestyle and promote health. In this context, it is a surprise that knowledge and awareness about blood pressure and hypertension among elderly people is poor. We hypothesized that knowledge about blood pressure and hypertension would be better among individuals with self-reported hypertension compared with subjects without self-reported hypertension.

Methods

We mailed a questionnaire to a random sample of 1,000 subjects living in the municipality of Silkeborg, Denmark. The study sample was drawn from the Central Person Registry.

Results

The response rate was 72%. Of these, 43% of responders had self-reported hypertension. The people with self-reported hypertension were older, less educated, had higher self-reported blood cholesterol levels, had higher body weight, and more often had a family history of hypertension. More than 80% reported that overweight and obesity increases blood pressure. More than 60% reported that untreated hypertension may cause heart disease or stroke. More than half of the responders did not know their blood pressure, and only 21% knew that hypertension can occur without symptoms. Knowledge about hypertension was independent of self-reported hypertension status, but awareness about blood pressure was most prominent among those with self-reported hypertension.

Conclusion

General knowledge about blood pressure and hypertension was reasonable, but there is still room for improvement in elderly people’s knowledge and awareness of blood pressure.

Magnesium for alcohol withdrawal

BACKGROUND

Patients have been given magnesium to treat or prevent alcohol withdrawal syndrome (AWS). Evidence to support this practice is limited, and is often based on the controversial link between hypomagnesaemia and AWS.

OBJECTIVES

To assess the effects of magnesium for the prevention or treatment of AWS in hospitalised adults.

SEARCH METHODS

We searched the Cochrane Drugs and Alcohol Group Register of Controlled Trials (August 2012), PubMed (from 1966 to August 2012 ), EMBASE (from 1988 to August 2012), CINAHL (from 1982 to March 2010), Web of Science (1965 to August 2012). We also carried out Internet searches.

SELECTION CRITERIA

Randomised or quasi-randomised trials of magnesium for hospitalised adults with, or at risk for, acute alcohol withdrawal.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data with a standardised data extraction form, contacting the correspondence investigator if the necessary information was not available in the reports. Dichotomous outcomes were analysed by calculating the risk ratio (RR) for each trial, with the uncertainty in each result expressed with a 95% confidence interval (CI). Continuous outcomes were to be analysed by calculating the standardised mean difference (SMD) with 95% CI. For outcomes assessed by scales we compared and pooled the mean score differences from the end of treatment to baseline (post minus pre) in the experimental and control groups.

MAIN RESULTS

Four trials involving 317 people met the inclusion criteria. Three trials studied oral magnesium, with doses ranging from 12.5 mmol/day to 20 mmol/day. One trial studied parenteral magnesium (16.24 mEq q6h for 24 hours). Each trial demonstrated a high risk of bias in at least one domain. There was significant clinical and methodological variation between trials.We found no study that measured all of the identified primary outcomes and met the objectives of this review. Only one trial measured clinical symptoms of seizure, delirium tremens or components of the Clinical Institute Withdrawal Assessment for Alcohol (CIWA) score. A single outcome (handgrip strength) in three trials (113 people), was amenable to meta-analysis. There was no significant increase in handgrip strength in the magnesium group (SMD 0.04; 95% CI -0.22 to 0.30). No clinically important changes in adverse events were reported.

AUTHORS' CONCLUSIONS

There is insufficient evidence to determine whether magnesium is beneficial or harmful for the treatment or prevention of alcohol withdrawal syndrome.

Health-risk factors and the prevalence of hypertension: cross-sectional findings from a national cohort of 87,143 Thai Open University students

BACKGROUND

Thailand is undergoing a health-risk transition which increases chronic diseases, particularly hypertension, as a result of a rapid transition from a developing to a developed country. This study analyzes the effect of health-risk factors such as demography, socioeconomic status (SES) and body mass index (BMI) on the prevalence of hypertension.

METHODS

This was a cross-sectional analysis using data obtained in 2005 from 87,143 Sukhothai Thammathirat Open University (STOU) students participating in the Thai Cohort Study (mean age 30.5 years, 54.7% female). Adjusted odds ratios of the association between risk factors and hypertension were analysed across two age groups by sex, after controlling for the confounding factors such as SES and BMI.

RESULTS

The prevalence of hypertension in men was approximately twice as high as that in women (6.9% vs 2.6%). Hypertension was associated with ageing, a lower education attainment, a higher BMI and having underlying diseases in both sexes. In men, hypertension was associated with being single, having a high income, spending more time on screens (TV & PC), cigarette smoking and drinking alcohol. In women, it was directly correlated with instant and roasted or smoked food consumption.

CONCLUSIONS

Hypertension was highly associated with obesity and having underlying disease. The Thai health-risk transition is in a later stage. Thais should now be educated about the danger of high blood pressure and the protective power of a low fat and low salt diet, and a normal BMI. Cessation of smoking and moderation in alcohol intake should be promoted.

Drinking pattern and blood pressure among non-hypertensive current drinkers: findings from 1999-2004 National Health and Nutrition Examination Survey

CONTEXT AND OBJECTIVE

Epidemiological studies show the apparent link between excessive alcohol consumption and hypertension. However, the association between alcohol intake and blood pressure among non-hypertensive individuals is scarcely examined.

METHODS

This analysis included participants in the 1999-2004 National Health and Nutrition Examination Survey who were aged 20 to 84 years without a diagnosis of cardiovascular disease, hypertension or pregnancy, whose systolic/diastolic blood pressure (SBP/DBP) was lower than 140/90 mmHg, who were not on antihypertensive medication, and who consumed 12 drinks or more during the past 12 months (N = 3957). Average drinking volume (average alcohol intake per day), usual drinking quantity (drinks per day when drinking) and frequency of binge drinking were used to predict SBP/DBP. Covariates included age, gender, race/ethnicity, education level, smoking status, average physical activity level, and daily hours spent on TV/ video/computer.

RESULTS

Drinking volume was directly associated with higher SBP in a linear dependent manner (an increment of 10 g of alcohol per day increased average SBP by 1 mmHg among both men and women). Drinking above the US Dietary Guidelines (men more than two drinks and women more than one drink per drinking day) was associated with higher SBP. Binge drinking was associated with both higher SBP and higher DBP. Average intake greater than two drinks per day was particularly associated with higher DBP among women (P = 0.0003).

CONCLUSION

This analysis from a population-based survey indicates a direct association between higher alcohol consumption and a higher prevalence of prehypertension among non-hypertensive drinkers.

Evidence-based guideline of the German Nutrition Society: carbohydrate intake and prevention of nutrition-related diseases

The relative contribution of nutrition-related chronic diseases to the total disease burden of the society and the health care costs has risen continuously over the last decades. Thus, there is an urgent necessity to better exploit the potential of dietary prevention of diseases. Carbohydrates play a major role in human nutrition - next to fat, carbohydrates are the second biggest group of energy-yielding nutrients. Obesity, type 2 diabetes mellitus, dyslipoproteinaemia, hypertension, metabolic syndrome, coronary heart disease and cancer are wide-spread diseases, in which carbohydrates could have a pathophysiologic relevance. Correspondingly, modification of carbohydrate intake could have a preventive potential. In the present evidence-based guideline of the German Nutrition Society, the potential role of carbohydrates in the primary prevention of the named diseases was judged systematically. The major findings were: a high carbohydrate intake at the expense of total fat and saturated fatty acids reduces the concentrations of total, LDL and HDL cholesterol. A high carbohydrate consumption at the expense of polyunsaturated fatty acids increases total and LDL cholesterol, but reduces HDL cholesterol. Regardless of the type of fat being replaced, a high carbohydrate intake promotes an increase in the triglyceride concentration. Furthermore, a high consumption of sugar-sweetened beverages increases the risk of obesity and type 2 diabetes mellitus, whereas a high dietary fibre intake, mainly from whole-grain products, reduces the risk of obesity, type 2 diabetes mellitus, dyslipoproteinaemia, cardiovascular disease and colorectal cancer at varying evidence levels. The practical consequences for current dietary recommendations are presented.

Fiber, protein, and lupin-enriched foods: role for improving cardiovascular health

Cardiovascular diseases (CVD) are the leading cause of death globally (World Health Organisation, 2011). Many of the risk factors for CVD are modifiable, including overweight and obesity. Numerous strategies have been proposed to fight CVD, with a special focus being placed on dietary interventions for weight management. The literature suggests that two nutrients, fiber and protein, may play significant roles in weight control and hence cardiovascular health. Increasing both protein and fiber in the diet can be difficult because popular low-carbohydrate and high-protein diets tend to have considerably low-fiber intakes (Slavin, 2005). One approach to obtain both is to develop functional foods using unique ingredients. Lupin flour is a novel food ingredient derived from the endosperm of lupin. It contains 40-45% protein, 25-30% fiber, and negligible sugar and starch (Petterson and Crosbie, 1990). Research conducted to date reveals that lupin-enriched foods, which are naturally high in protein and fiber, may have a significant effect on CVD risk factors. This review explores whether there is a role for fiber-, protein-, and lupin-enriched foods in improving cardiovascular health.

The effects of 12-week psyllium fibre supplementation or healthy diet on blood pressure and arterial stiffness in overweight and obese individuals

Endothelial dysfunction and increased arterial stiffness occur early in the pathogenesis of the metabolic syndrome and they are both powerful independent predictors of cardiovascular risk. A high-fibre diet has been correlated with lower BMI and a lower incidence of hyperlipidaemia, CVD, hypertension and diabetes. The present randomised, parallel-design study compared the effects of fibre intake from a healthy diet v. fibre supplement diets on blood pressure (BP) and vascular function over 12 weeks. Overweight and obese adults were randomised to one of three groups: control (with placebo), fibre supplement (FIB) or healthy eating group with placebo (HLT). Systolic blood pressure (SBP) was lower in the FIB group compared with the control group at week 6, but not at week 12. However, SBP was lower in the HLT group compared with control group at week 12. At week 6, the FIB group presented lower diastolic blood pressure and augmentation index compared with the control group, but this result did not persist to the end of the study. The present study did not show any improvements in BP or vascular function in overweight and obese individuals with psyllium fibre supplementation over 12 weeks of intervention. However, a healthy diet provided the greatest improvements in BP in overweight and obese subjects. Further research with hypertensive individuals is necessary to elucidate whether increased fibre consumption in the form of psyllium supplementation may provide a safe and acceptable means to reduce BP, vascular function and the risk of developing CVD.

Tracking of blood pressure among adolescents and young adults in an urban slum of puducherry

Background:

Early diagnosis of hypertension (HT) is an important strategy in its control. Tracking of blood pressure (BP) has been found useful in identifying persons with potential HT, particularly in youngsters. A cohort of 756 subjects (with baseline information as a cross-sectional study in 2002) was followed up in 2006 to comment on the distribution of BP and its attributes.

Objectives:

To track BP distribution in a cohort of adolescents and young adults, and assess the persistence of high/low normotensives; to measure the incidence of HT and study the relationship of BP with age, sex, socioeconomic status, BMI, physical exercise, salt intake, smoking and alcohol consumption.

Materials and Methods:

The baseline study cohort (2002) of 756 subjects (19-24 years) in urban field area of Department of Preventive and Social Medicine, JIPMER, was followed up between May and November 2006 by house visits for measurement of sociodemographic variables, anthropometry, salt intake, physical activity and BP.

Results:

A total of 555 subjects from the 2002 cohort were contacted (73.4%), in that 54.5% subjects who were below 5^th percentile, 93.6% subjects between 5^th and 95^th percentiles and 72% of those above 95^th percentile previously persisted in the same cut-offs for systolic blood pressure (SBP). The corresponding figures for diastolic blood pressure (DBP) were 46.2, 92.2 and 74.1%, respectively. Shift from one cut-off to another was not significant for both SBP and DBP, proving the tracking phenomenon. Annual incidence of HT was 9.8/1000. Baseline BP was the significant predictor of current BP for the entire cohort; BMI and salt intake were significant predictors only in certain sections of the study cohort.

Conclusions:

Early diagnosis of hypertension even among adolescents/young adults is an important preventive measure, as tracking exists in the population.

Sugar-sweetened beverage, sugar intake of individuals, and their blood pressure: international study of macro/micronutrients and blood pressure

The obesity epidemic has focused attention on relationships of sugars and sugar-sweetened beverages (SSBs) to cardiovascular risk factors. Here we report cross-sectional associations of SSBs, diet beverages, and sugars with blood pressure (BP) for United Kingdom and US participants of the International Study of Macro/Micronutrients and Blood Pressure. Data collected include four 24-hour dietary recalls, two 24-hour urine collections, 8 BP readings, and questionnaire data for 2696 people ages 40 to 59 years of age from 10 US/United Kingdom population samples. Associations of SSBs, diet beverages, and sugars (fructose, glucose, and sucrose) with BP were assessed by multiple linear regression. SSB intake related directly to BP, with P values of 0.005 to <0.001 (systolic BP) and 0.14 to <0.001 (diastolic BP). SSB intake higher by 1 serving per day (355 mL/24 hours) was associated with systolic/diastolic BP differences of +1.6/+0.8 mm Hg (both P<0.001) and +1.1/+0.4 mm Hg (P<0.001/<0.05) with adjustment for weight and height. Diet beverage intake was inversely associated with BP (P 0.41 to 0.003). Fructose- and glucose-BP associations were direct, with significant sugar-sodium interactions: for individuals with above-median 24-hour urinary sodium excretion, fructose intake higher by 2 SD (5.6% kcal) was associated with systolic/diastolic BP differences of +3.4/+2.2 mm Hg (both P<0.001) and +2.5/+1.7 mm Hg (both P=0.002) with adjustment for weight and height. Observed independent, direct associations of SSB intake and BP are consistent with recent trial data. These findings, plus adverse nutrient intakes among SSB consumers, and greater sugar-BP differences for persons with higher sodium excretion lend support to recommendations that intake of SSBs, sugars, and salt be substantially reduced.

Dietary meat fats and burden of cardiovascular disease risk factors, in the elderly: a report from the MEDIS study

Dietary fats have long been associated with human health, and especially cardiovascular disease (CVD). Some observational studies have shown that reduction in dietary fats, and particularly cholesterol is associated with lower cardiovascular risk; however, other prospective studies or randomized controlled trials of dietary fat reduction or modification have shown varying results on CVD morbidity and mortality. In this work we evaluated the relationships between dietary fats and a cluster of CVD risk factors (i.e., diabetes, obesity, hypercholesterolemia, hypertension), among elderly individuals without known CVD. In particular, dietary and clinical data from 1486 elderly (aged 65 to 100 years) men and women living in Cyprus, Mitilini, Samothraki, Cephalonia, Crete, Lemnos, Syros, Naxos, Corfu and Zakynthos islands, and participated in the MEDIS study, were analysed. Data analysis revealed that 18.5% of males and 33.3% of females had three or four cardiovascular disease risk factors; the major source of fat was olive oil (mean intake for men and women 50.0 +/- 19.3 g/day and 46.0 +/- 16.8 g/day, p < 0.001). In addition it was observed that a 5% increase in energy adjusted fat intake from meat was associated with a 21% increase in the likelihood of having one additional CVD risk factor (95%CI 6%-39%); no significant associations were observed regarding the other types of fat consumed by the elderly participants. These findings may state a hypothesis that the consumption of fat only from meat or its products seems to increase the burden of CVD risk factors among CVD-free, elderly people.

The prevalence of hypertension, obesity and dyslipidemia in individuals of over 30 years of age belonging to minorities from the pasture area of Xinjiang

Background

The prevalence of population-wide hypertension, obesity and dyslipidemia has not been well studied in the pasture area of Xinjiang. The present epidemiological study was performed to determine the prevalence of hypertension, obesity and dyslipidemia in minority populations from the pasture area of Xinjiang and to discuss the potential risk factors for hypertension.

Methods

A population-based, cross-sectional study in the Xinjiang pasture area was performed which included 2251 participants aged over 30 years (90.33% participation rate) of whom 71.26% were Kazaks. Several risk factors were considered: hypertension (defined as systolic or diastolic blood pressure or both of at least 140/90 mmHg measured on one occasion or treatment for hypertension) overweight/obesity (body mass index ≥ 25 kg/m²) alcohol intake, smoking/tobacco use and dyslipidemia. Outcomes were prevalence of hypertension, obesity and dyslipidemia and the associated risk factors of hypertension detected by multivariate logistic regression analysis taking into account various metabolic and lifestyle characteristics.

Results

The prevalence of hypertension, overweight/obesity and dyslipidemia in all participants from the pasture area of Xinjiang was 51.9%, 47.9% and 49.2% respectively. Independently, the prevalence and awareness of hypertension was 52.6% and 15.3% among Kazaks (n = 1604), 54.6% and 14.1% among Uygurs (n = 418), 39.5% and 16.1% among Mongolians (n = 81) and 43.9% and 18.2% among non-Xinjiang-born Han immigrants (n = 148). The prevalence of overweight/obesity in Kazaks, Uygurs, Mongolians and Han immigrants was 46.7%, 48.9%, 62.5% and 50.3%, respectively. The prevalence of dyslipidemia in the four ethnic groups mentioned was 53.5%, 34.8%, 49.3% and 47.3%, respectively. The mean blood pressure in all participants was 136/86 mmHg (pre-hypertensive), the mean BMI was 24.7 kg/m². Based on multiple logistic regression analysis, the significant risk factors for hypertension were age [1.07(1.06-1.09), P < 0.0001], overweight/obesity [overweight: 1.61(1.22-2.13), p = 0.0007; obesity: 1.95 (1.33-2.87), p = 0.0007], hypercholesterolemia [1.30(1.15-1.47), p < 0.0001] and an alcohol intake of over 30 g/day [2.22(1.43-3.45), p = 0.0004].

Conclusions

The considerably high prevalence of hypertension, overweight/obesity and dyslipidemia among the minority population aged over 30 from the pasture area of Xinjiang calls for effective preventive measures. Age, increased body mass index, hypercholesterolemia and ≥30 g/d alcohol intake can be counted as risk factors for hypertension, but further genetic or environmental clarification would be desirable to explain the unusually high prevalence of the conditions mentioned above.

Different Effect of Psyllium and Guar Dietary Supplementation on Blood Pressure Control in Hypertensive Overweight Patients: A Six-Month, Randomized Clinical Trial

In the setting of a six-month, open-label clinical trial, 141 consecutively enrolled, hypertensive, overweight patients were randomized to the oral ingestion of psyllium powder or guar gum 3.5 gr t.i.d., to be taken 20 min before the main two meals, or to standard diet. Both fibers improved significantly BMI, FPG, FPI, HOMA Index, HbA1c, LDL-C, and ApoB. Psyllium supplementation only exerted a significant improvement in plasma TG concentration, in SBP and DBP. In our study, six-month supplementation with psyllium fiber, but not with guar fiber nor standard diet, appears to significantly reduce both SBP and DBP in hypertensive overweight subjects.

Dietary starch intake of individuals and their blood pressure: the International Study of Macronutrients and Micronutrients and Blood Pressure

OBJECTIVE

Data from the Multiple Risk Factor Intervention Trial show an independent direct association between starch intake and blood pressure in American men at higher risk of coronary heart disease. Cross-sectional data from the International Study of Macronutrients and Micronutrients and Blood Pressure (INTERMAP) were used to assess relations of dietary starch intake to blood pressure in men and women from four countries.

METHODS

Data include 83 nutrients from four multipass 24-h dietary recalls and two timed 24-h urine collections; eight blood pressure readings; and questionnaire data, for 4680 participants aged 40-59 years from 17 population samples in Japan, People's Republic of China, United Kingdom, and United States of America.

RESULTS

In multiple linear regression analyses--adjusted for urinary sodium, urinary potassium, consumption of alcohol, cholesterol, saturated fatty acids, polyunsaturated fatty acids, calcium, and other variables--starch intake higher by two standard deviations (14.1% kJ) was associated with systolic/diastolic blood pressure differences of -1.0/-0.9 mmHg (P = 0.09, P < 0.05). Results were similar with additional control for fiber, magnesium, or phosphorus; reduced to -0.5/-0.7 mmHg (P = 0.47, P = 0.13) with separate adjustment for vegetable protein. Findings were similar for men analyzed separately, for American men, and for American men at higher coronary heart disease risk.

CONCLUSION

Our findings indicate that--if any--relations of starch intake to blood pressure are modestly inverse. Current dietary guidelines for hypertension prevention and control remain relevant.

Association of BMI and nutritional habits with hypertension in the adult population of Croatia

Objective

The purpose of the present study was to investigate the distribution of hypertension, its nutritional and other determinants and their association in Croatia.

Design

Population-based, cross-sectional study.

Setting

Croatia.

Subjects

Representative random sample of 9070 adults (18 years and older) from all Croatian regions, selected using multistage sampling.

Results

Overall prevalence of hypertension (arterial blood pressure ≥140/90 mmHg) in Croatia was 45·5 %, of which 40 % were newly diagnosed hypertensives. There was no difference in the percentage of hypertensives between the continental and Mediterranean parts of Croatia. Newly diagnosed hypertension was found to be positively associated with increased BMI, age and alcohol consumption in the total sample and with moderate consumption of coffee in women, as well as inversely associated with regular consumption of fruits and vegetables in the total sample and high consumption of coffee in the total sample and in men. No association with newly diagnosed hypertension was recorded for use of animal fat, consumption of whole milk, smoked meat products, for adding salt, smoking and leisure-time physical activity.

Conclusions

Hypertension is a major public health problem in both continental and Mediterranean parts of Croatia. Maintenance of normal body mass, its reduction if already increased, and regular consumption of fruits and vegetables are proposed as priorities for primary prevention of hypertension in Croatia.

Relationship of dietary linoleic acid to blood pressure. The International Study of Macro-Micronutrients and Blood Pressure Study [corrected]

Findings from observational and interventional studies on the relationship of dietary linoleic acid, the main dietary polyunsaturated fatty acid, with blood pressure have been inconsistent. The International Study of Macro-Micronutrients and Blood Pressure is an international cross-sectional epidemiological study of 4680 men and women ages 40 to 59 years from 17 population samples in China, Japan, United Kingdom, and United States. We report associations of linoleic acid intake of individuals with their blood pressure. Nutrient intake data were based on 4 in-depth multipass 24-hour dietary recalls per person and 2 timed 24-hour urine collections per person. Systolic and diastolic blood pressures were measured 8 times at 4 visits. With several models to control for possible confounders (dietary or other), linear regression analyses showed a nonsignificant inverse relationship of linoleic acid intake (percent kilocalories) to systolic and diastolic blood pressure for all of the participants. When analyzed for 2238 "nonintervened" individuals (not on a special diet, not consuming nutritional supplements, no diagnosed cardiovascular disease or diabetes, and not taking medication for high blood pressure, cardiovascular disease, or diabetes), the relationship was stronger. With adjustment for 14 variables, estimated systolic/diastolic blood pressure differences with 2-SD higher linoleic acid intake (3.77% kcal) were -1.42/-0.91 mm Hg (P<0.05 for both) for nonintervened participants. For total polyunsaturated fatty acid intake, blood pressure differences were -1.42/-0.98 mm Hg (P<0.05 for both) with 2 SD higher intake (4.04% kcal). Dietary linoleic acid intake may contribute to prevention and control of adverse blood pressure levels in general populations.

The relationship between dietary protein intake and blood pressure: results from the PREMIER study

Observational and clinical studies suggest that high protein intake, particularly protein from plant sources, might reduce blood pressure (BP). To examine the association of dietary protein with BP, we analysed data from PREMIER, an 18-month clinical trial (n=810) that examined the effects of two multi-component lifestyle modifications on BP. We examined the association of protein intake with BP, and in particular the independent relationship of plant and animal protein with BP. Multivariable linear regression analyses were performed with both cross-sectional and longitudinal data. Dietary plant protein was inversely associated with both systolic and diastolic BP in cross-sectional analyses at the 6-month follow-up (P=0.0045 and 0.0096, respectively). Fruit and vegetable intake was also inversely associated with both systolic and diastolic BP cross-sectionally at 6 months (P=0.0003 and 0.0157, respectively). In longitudinal analyses, a high intake of plant protein at 6 months was marginally associated with a reduction of both systolic and diastolic BP from baseline to 6 months only (P=0.0797 and 0.0866, respectively), independent of change in body weight and waist circumference. Furthermore, increased intake of plant protein, and fruits and vegetables was significantly associated with a lower risk of hypertension at 6 but not at 18 months. Results of this study indicate that plant protein had a beneficial effect on BP and was associated with a lower risk of hypertension at 6 months. Our data, in conjunction with other research, suggest that an increased intake of plant protein may be useful as a means to prevent and treat hypertension.

Meat intake and the risk of hypertension in middle-aged and older women

BACKGROUND

Although previous studies have suggested that high intake of meat, particularly red meat, may contribute to the development of hypertension, data on the prospective associations between meat intake and risk of hypertension are still limited.

OBJECTIVE

We investigated the association of total red meat, types of red meat and poultry intake at baseline with the incidence of hypertension in a prospective cohort of 28 766 female US health professionals aged > or = 45 years.

PATIENTS AND METHODS

Baseline red meat and poultry intake were assessed from semiquantitative food frequency questionnaires. Incident cases of hypertension (n = 8693) were identified from annual follow-up questionnaires during 10 years of follow-up.

RESULTS

After adjusting for known hypertension risk factors, the relative risk and 95% confidence interval (CI) of incident hypertension were 1.00 (reference), 1.05 (0.97-1.13), 1.05 (0.97-1.13), 1.05 (0.97-1.14) and 1.13 (1.04-1.23), respectively, across increasing quintiles of baseline total red meat intake (P for trend = 0.008). Using functional cutpoints, women who consumed > 0 to < 0.5, 0.5 to < 1.0, 1.0 to < 1.5 and > or = 1.5 servings/day of total red meat had multivariable relative risks (95% CI) of hypertension of 1.24 (1.08-1.43), 1.25 (1.08-1.44), 1.32 (1.13-1.53) and 1.35 (1.14-1.59) compared to those who consumed no red meat (P for trend = 0.008). By contrast, multivariable relative risks of incident hypertension across increasing quintiles of poultry intake were 1.00, 1.03, 1.03, 1.08 and 1.03 (P for trend = 0.37).

CONCLUSIONS

Red meat intake was positively associated, whereas poultry intake was unassociated, with the risk of hypertension in middle-aged and older women.

Dietary salt restriction and blood pressure in clinical trials

Dietary salt has long been recognized as a major factor affecting blood pressure such that sodium intake is a component of lifestyle modification guidelines for control of high blood pressure. These recommendations are based on results from epidemiologic observational studies and clinical trials of various sodium diets among normotensives and hypertensives. Nonetheless, results from the different studies vary such that specific recommendations regarding sodium intake are difficult to interpret. The results from several recent major trials indicated greater associations of blood pressure and sodium intake than earlier studies as well as meta-analyses of numerous clinical trials. The studies of sodium intake and blood pressures are complicated by measurements of intake, salt sensitivity, hypertension treatment, effects of sodium independent of blood pressure, and length of interventions. Limitations in the methodology of different studies have reduced the value of the results to provide specific and reliable sodium intake levels essential for clinical and lifestyle guidelines.

To drink or not to drink? That is the question

Numerous studies have used a J-shaped or U-shaped curve to describe the relationship between alcohol use and total mortality. The nadir of the curves based on recent meta-analysis suggested optimal benefit at approximately half a drink per day. Fewer than 4 drinks per day in men and fewer than 2 per day in women appeared to confer benefit. Reductions in cardiovascular death and nonfatal myocardial infarction were also associated with light to moderate alcohol intake. Although some studies suggested that wine had an advantage over other types of alcoholic beverages, other studies suggested that the type of drink was not important. Heavy drinking was associated with an increase in mortality, hypertension, alcoholic cardiomyopathy, cancer, and cerebrovascular events, including cerebrovascular hemorrhage. Paradoxically, light-to-moderate alcohol use actually reduced the development of heart failure and did not appear to exacerbate it in most patients who had underlying heart failure. Numerous mechanisms have been proposed to explain the benefit that light-to-moderate alcohol intake has on the heart, including an increase of high-density lipoprotein cholesterol, reduction in plasma viscosity and fibrinogen concentration, increase in fibrinolysis, decrease in platelet aggregation, improvement in endothelial function, reduction of inflammation, and promotion of antioxidant effects. Controversy exists on whether alcohol has a direct cardioprotective effect on ischemic myocardium. Studies from our laboratory do not support the concept that alcohol has a direct cardioprotective effect on ischemic/reperfused myocardium. Perhaps the time has come for a prospectively randomized trial to determine whether 1 drink per day (or perhaps 1 drink every other day) reduces mortality and major cardiovascular events.

Coffee consumption and the incidence of antihypertensive drug treatment in Finnish men and women

BACKGROUND

Only 2 prospective studies have previously investigated the association between coffee consumption and incident hypertension, and the findings are equivocal.

OBJECTIVE

The objective was to determine the relation between coffee consumption and the incidence of antihypertensive drug treatment.

DESIGN

We prospectively followed 24 710 Finnish subjects aged 25-64 y without a history of antihypertensive drug treatment, coronary heart disease, or stroke at baseline. Daily coffee consumption was assessed by questionnaires.

RESULTS

During a mean follow-up period of 13.2 y, 2505 participants started antihypertensive drug treatment. The multivariate-adjusted (age, sex, study year, education, leisure-time physical activity, smoking, body mass index, high total cholesterol, history of diabetes, and alcohol, tea, fruit, vegetable, sausage, and bread consumption) hazard ratios for antihypertensive drug treatment associated with the amount of coffee consumed daily (0-1, 2-3, 4-5, 6-7, or >or=8 cups) were 1.00, 1.29 (95% CI: 1.09, 1.54), 1.26 (95% CI: 1.06, 1.49), 1.24 (95% CI: 1.04, 1.48), and 1.14 (95% CI: 0.94, 1.37) (P for trend = 0.024), respectively. This trend became marginally significant after additional adjustment for baseline systolic blood pressure (P for trend = 0.077).

CONCLUSIONS

The results indicate that coffee drinking seems to increase the risk of antihypertensive drug treatment, and this risk was higher in subjects with low-to-moderate coffee intakes; however, there was no significantly increased trend in drinkers of approximately 1 cup (100 mL)/d or >or=8 cups/d.

Alcohol consumption and blood pressure in the adult US population: assessment of gender-related effects

OBJECTIVE

Our objective was to assess the gender-related effects of alcohol consumption on blood pressure (BP) in a representative sample of the adult US population.

METHODS

We examined data from the National Health and Nutrition Examination Survey 1999-2000. The effects of various risk factors for hypertension on BP were examined with analysis of covariance statistics.

RESULTS

Of the 5448 adults over 20 years of age, 2650 (48.7%) reported the intake of one or more drinks per day over the past year. In this population, the mean +/- SEM age was 46.9 +/- 0.34 years, the body mass index was 24.8 kg/m, 1257 (47.4%) were women, systolic BP was 124.3 +/- 0.44 mmHg and diastolic BP was 72.7 +/- 0.27 mmHg. Hypertension was reported in 21.1%, diabetes in 5.1% and cigarette smoking in 39.7%. A significant effect on systolic BP was shown with age (P < 0.01), body mass index (P < 0.01), race (P = 0.01), gender (P < 0.01) and diabetes (P < 0.01). The interaction with gender and alcohol drinking level was significant (P = 0.02). Post-hoc analysis localized the source of this effect. There was a significant increase in systolic BP between one and three and between one and four, but not between one and two, drinks per day in men. This effect was not observed in women.

CONCLUSION

Consistent with previous reports, our study suggests that alcohol intake up to two drinks per day has no effect on BP. There was a gender-related effect of alcohol intake in excess of two drinks per day on BP, with increased BP observed only in men but not in women.

Protein intake and blood pressure in cardiovascular disease

Raised blood pressure (BP) is a major cause of CHD and the leading cause of stroke. Although BP rises with age in most populations, there are remote populations around the world where BP does not rise with age and where the high prevalence of high BP and frank hypertension seen in the UK and other Western countries in the older age-groups is not found. However, when such populations migrate to urban settings, their BPs rise, indicating that the population-wide BP problem is largely environmental in origin. Thus, a substantial body of evidence has accumulated on the importance of dietary factors in BP (Na and alcohol intakes (direct relationship) and K intake (inverse relationship)) as well as body weight (direct relationship). More recently, attention has shifted to other dietary factors that might affect BP. Data from studies of vegetarians (who tend to have lower BP than meat-eating populations) as well as clinical data on the adverse effects of protein intake in patients with renal insufficiency led to the view in Western countries that dietary (animal or total) protein had an adverse effect on BP. By contrast, studies in Japan and China suggested that dietary protein might be protective of high BP and stroke. Recent epidemiological studies have found inverse associations between dietary protein intake and BP, consistent with this view, and supported by some evidence from animal studies. Recent controlled clinical trials of soyabean supplementation have also suggested a BP-lowering effect of protein intake. Results of further large-scale epidemiological studies of protein and BP are awaited.

Vegetable protein and fiber from cereal are inversely associated with the risk of hypertension in a Spanish cohort

BACKGROUND

Some cross-sectional studies suggest that fiber and protein intake can be associated with lower levels of blood pressure, but results from prospective cohorts are scarce and none has been conducted outside the U.S.

METHODS

The SUN cohort followed-up prospectively 5880 Spanish men and women older than 20 years of age, all university graduates. Dietary information was gathered at baseline with a previously validated semiquantitative food frequency questionnaire. New cases of medically diagnosed hypertension (HT) were identified through responses to a mailed questionnaire after at least 2 years from recruitment.

RESULTS

One hundred and eighty new cases of HT were ascertained after a median follow-up of 28 months. After adjustment for potential confounders and several dietary factors, participants in the highest quintile of vegetable protein intake had a lower risk of incident HT compared with those in the lowest quintile [hazard ratio (HR) = 0.5, 95% confidence interval (CI) 0.2-0.9, p for trend = 0.06]. Similarly, fiber from cereals was inversely associated with a lower risk of HT (HR comparing fifth vs. first quintile = 0.6, 95% CI 0.3-1.0, p for trend = 0.05). Risk reduction was more important among men and obese and older individuals. Total or animal protein and total fiber as well as fiber from other sources different from cereal were not associated with the risk of HT.

CONCLUSIONS

In this Mediterranean cohort, dietary intake of vegetable protein and fiber from cereals was associated with a lower risk of HT when other nutrients were also taken into consideration.

Effects of dietary saturated, monounsaturated, and n-3 fatty acids on blood pressure in healthy subjects

BACKGROUND

The quantity and quality of fats consumed in the diet influence the risk of cardiovascular disease (CVD). Although the effect of diet on plasma lipids and lipoproteins is well documented, less information exists on the role of fats on blood pressure (BP).

OBJECTIVE

The objective was to evaluate the effects of different types of dietary fat on BP in healthy subjects.

DESIGN

Healthy subjects (n = 162) were randomly assigned for 3 mo to follow 1 of 2 isoenergetic diets: 1 rich in monounsaturated fatty acids (MUFA diet) and the other rich in saturated fatty acids (SFA diet). Each group was further randomly assigned to receive supplementation with fish oil (3.6 g n-3 fatty acids/d) or placebo.

RESULTS

Systolic BP (SBP) and diastolic BP (DBP) decreased with the MUFA diet [-2.2% (P = 0.009) and -3.8% (P = 0.0001), respectively] but did not change with the SFA diet [-1.0% (P = 0.2084) and -1.1% (P = 0.2116)]. The MUFA diet caused a significantly lower DBP than did the SFA diet (P = 0.0475). Interestingly, the favorable effects of MUFA on DBP disappeared at a total fat intake above the median (>37% of energy). The addition of n-3 fatty acids influenced neither SBP nor DBP.

CONCLUSIONS

Changing the proportions of dietary fat by decreasing SFAs and increasing MUFAs decreased diastolic BP. Interestingly, the beneficial effect on BP induced by fat quality was negated by the consumption of a high total fat intake. The addition of n-3 fatty acids to the diet had no significant effect on BP.

Association between protein intake and blood pressure: the INTERMAP Study

BACKGROUND

Findings from epidemiological studies suggest an inverse relationship between individuals' protein intake and their blood pressure.

METHODS

Cross-sectional epidemiological study of 4680 persons, aged 40 to 59 years, from 4 countries. Systolic and diastolic blood pressure was measured 8 times at 4 visits. Dietary intake based on 24-hour dietary recalls was recorded 4 times. Information on dietary supplements was noted. Two 24-hour urine samples were obtained per person.

RESULTS

There was a significant inverse relationship between vegetable protein intake and blood pressure. After adjusting for confounders, blood pressure differences associated with higher vegetable protein intake of 2.8% kilocalories were -2.14 mm Hg systolic and -1.35 mm Hg diastolic (P<.001 for both); after further adjustment for height and weight, these differences were -1.11 mm Hg systolic (P<.01) and -0.71 mm Hg diastolic (P<.05). For animal protein intake, significant positive blood pressure differences did not persist after adjusting for height and weight. For total protein intake (which had a significant interaction with sex), there was no significant association with blood pressure in women, nor in men after adjusting for dietary confounders. There were significant differences in the amino acid content of the diets of persons with high vegetable and low animal protein intake vs the diets of persons with low vegetable and high animal protein intake.

CONCLUSIONS

Vegetable protein intake was inversely related to blood pressure. This finding is consistent with recommendations that a diet high in vegetable products be part of healthy lifestyle for prevention of high blood pressure and related diseases.

Different edible oil beneficial effects (canola oil, fish oil, palm oil, olive oil, and soybean oil) on spontaneously hypertensive rat glomerular enlargement and glomeruli number

We have tested the different edible oil effects on the blood pressure (BP) control and the following glomerular protection. Six groups of 12-week-old male spontaneously hypertensive rats (SHR) (n = 5), have received different edible oils (fish, canola, palm, olive, and soybean) or a placebo by gavage for 13 weeks. Renal cortex was analyzed through light microscopy and stereology. Usual BP increase, glomerulosclerosis, glomerular enlargement, and glomeruli loss in SHR has been prevented (fish, canola and palm oils) or attenuated (olive and soybean oils) by these oil long-term administration. The most favorable effect has been seen in the fish oil administration (source of n-3 polyunsaturated fatty acids, PUFA, eicosapentaenoic and docosahexaenoic acids), followed by both canola and palm oils (source of n-3 PUFA plus n-9 monounsaturated, MUFA, and saturated fatty acid, respectively), and finally both olive and soybean oils (source of n-9 MUFA and n-6 PUFA, respectively).

Trends in risk factor control in Germany 1984–1998: high blood pressure and total cholesterol

BACKGROUND

Diagnosis and treatment of the two primary cardiovascular risk factors, hypertension and hypercholesterolaemia, are well established. Nevertheless, according to earlier analyses of representative health questionnaire and examination surveys in 1984, 1988 and 1991, control of risk factors in the sense of normalized values through drug therapy did not improve to any relevant degree in former West Germany. The National Health Survey of 1998 now allows the reconsideration of the hypothesis that medical treatment has been improving and lead to a reduction of risk factor values measured in the population.

METHODS

Datasets of independent cross-sectional studies in 1984, 1988, 1991 and 1998 with net random sample sizes between 3,458 and 5,335 were analysed for actual (persons with elevated values and persons successfully treated) and population (persons with elevated values) prevalence, awareness of the risk factors under question, treatment coverage (risk factor aware and treated) and effectiveness (risk factor aware, treated and normalized), and the resulting parameters of controlled (successfully treated persons among actual prevalence) and uncontrolled prevalence (persons with elevated values among actual prevalence), respectively. Thresholds chosen were blood pressure values >or=160/95 mmHg for hypertension and values >or=250 mg/dl for hypercholesterolaemia. Regarding medication, the answer of 'one to two times weekly' or more was considered to indicate a relevant drug intake.

RESULTS

For hypertension the population prevalence (population 30-69 years old) increased significantly (P < 0.0001) from 19.6% to 24.0% between 1984 and 1998, whereas the actual prevalence rose less steeply but still significantly (P < 0.0002) from 32.5% to 34.4%. For hypercholesterolaemia the population prevalence stagnated at 37.0% (1998), whereas the actual prevalence was 47.5% in 1998 (39.1% in 1984; P < 0.0001). For hypertension treatment, coverage improved from 45.4% to 63.0%, but treatment effectiveness decreased from 51.7% to 41.3%, both trends being highly significant. For hypercholesterolaemia, awareness increased from 18.3% to 57.6%, but treatment coverage decreased from 33.5% to 15.5%, whereas treatment effectiveness improved from 23.8% to 47.7%, all trends being highly significant (P < 0.0001).

CONCLUSIONS

The results do not support the hypothesis that medical care for the large population at cardiovascular risk in (Western) Germany was adequate and successful in the 1980s and 1990s.

Alcohol consumption and hypertension

Hypertension is a major independent risk factor for cardiovascular disease. In alcohol-consuming populations, the amount of alcohol consumption has significant impact on blood pressure values, the prevalence of hypertension, and cardiovascular as well as all-cause mortality. In this review, we focus on the connection between alcohol consumption and hypertension, and discuss the consequences on cardiovascular risk.

Lifestyle and dietary modification for prevention of heart failure

This article discusses the factors that contribute most to systolic and diastolic heart failure (HF): ischemic heart disease, hypertension,obesity, diabetes, and nephropathy. Diabetes often follows the insulin resistance syndrome in which obesity and hypertension are combined with dyslipidemia, and obesity is likely causal. Diabetes and hypertension are common causes of nephropathy, which in turn is a common precursor to HF. Insulin resistance, obesity,dyslipidemia, diabetes, and hypertension are risk factors for atherosclerotic coronary disease and left ventricular ischemia. Each is also a risk factor for diastolic dysfunction.

Dietary fat, insulin sensitivity and the metabolic syndrome

Insulin resistance is the pathogenetic link underlying the different metabolic abnormalities clustering in the metabolic syndrome. It can be induced by different environmental factors, including dietary habits. Consumption of energy-dense/high fat diets is strongly and positively associated with overweight that, in turn, deteriorates insulin sensitivity, particularly when the excess of body fat is located in abdominal region. Nevertheless the link between fat intake and overweight is not limited to the high-energy content of fatty foods; the ability to oxidize dietary fat is impaired in some individuals genetically predisposed to obesity. Insulin sensitivity is also affected by the quality of dietary fat, independently of its effects on body weight. Epidemiological evidence and intervention studies clearly show that in humans saturated fat significantly worsen insulin-resistance, while monounsaturated and polyunsaturated fatty acids improve it through modifications in the composition of cell membranes which reflect at least in part dietary fat composition. A recent multicenter study (KANWU) has shown that shifting from a diet rich in saturated fatty acids to one rich in monounsaturated fat improves insulin sensitivity in healthy people while a moderate alpha-3 fatty acids supplementation does not affect insulin sensitivity. There are also other features of the metabolic syndrome that are influenced by different types of fat, particularly blood pressure and plasma lipid levels. Most studies show that alpha-3 fatty acids reduce blood pressure in hypertensive but not in normotensive subjects while shifting from saturated to monounsaturated fat intake reduces diastolic blood pressure. In relation to lipid abnormalities alpha-3 fatty acids reduce plasma triglyceride levels but in parallel, increase LDL cholesterol. Substitution of unsaturated fat for saturated fat not only reduces LDL cholesterol but contributes also to reduce plasma triglycerides in insulin resistant individuals. In conclusion, there is evidence available in humans indicating that dietary fat quality influences insulin sensitivity and associated metabolic abnormalities. Therefore, prevention of the metabolic syndrome has to be targeted: (1) to correct overweight by reducing the energy density of the habitual diet (i.e., fat intake) and (2) to improve insulin sensitivity and associated metabolic abnormalities through a reduction of dietary saturated fat, partially replaced, when appropriate, by monounsaturated and polyunsaturated fats.

Blood pressure response to caffeine shows incomplete tolerance after short-term regular consumption

Caffeine acutely raises blood pressure (BP). The clinical significance of this effect depends on whether BP responses persist in persons who consume caffeine on a daily basis. Accordingly, the ability of caffeine to raise BP after 5 days of regular daily intake was tested in a randomized controlled trial. Individual differences in tolerance formation were then examined. Men (n=49) and women (n=48) completed a double-blind, crossover trial conducted over 4 weeks. During each week, subjects abstained for 5 days from dietary caffeine and instead used capsules totaling 0 mg, 300 mg, and 600 mg of caffeine per day in 3 divided doses. On day 6, in the laboratory, they used capsules with either 0 mg or 250 mg of caffeine at 9:00 am and 1:00 pm. Systolic/diastolic BP increases as a result of 250 mg of caffeine remained significant (P<0.006/0.001) at all levels of previous daily consumption. Individual difference comparisons found that although half the subjects had complete loss of systolic and diastolic BP responses to the challenge doses, the other half showed no loss in BP response, even after using 600 mg of caffeine per day for the previous 5 days (F >7.90, P <0.001). The sexes did not differ in degree of tolerance formation. Daily caffeine consumption failed to eliminate the BP response to repeated challenge doses of caffeine in half of the healthy adults who were tested. Caffeine may therefore cause persistent BP effects in persons who are regular consumers, even when daily intake is at moderately high levels.

INTERMAP: the dietary data--process and quality control

The aim of this report is to describe INTERMAP standardized procedures for assessing dietary intake of 4680 individuals from 17 population samples in China, Japan, UK and USA: Based on a common Protocol and Manuals of Operations, standardized collection by centrally trained certified staff of four 24 h dietary recalls, two timed 24-h urines, two 7-day histories of daily alcohol intake per participant; tape recording of all dietary interviews, and use of multiple methods for ongoing quality control of dietary data collection and processing (local, national, and international); one central laboratory for urine analyses; review, update, expansion of available databases for four countries to produce comparable data on 76 nutrients for all reported foods; use of these databases at international coordinating centres to compute nutrient composition. Chinese participants reported 2257 foods; Japanese, 2931; and UK, 3963. In US, use was made of 17,000 food items in the online automated Nutrition Data System. Average time/recall ranged from 22 min for China to 31 min for UK. Among indicators of dietary data quality, coding error rates (from recoding 10% random samples of recalls) were 2.3% for China, 1.4% for Japan, and UK; an analogous US procedure (re-entry of recalls into computer from tape recordings) also yielded low discrepancy rates. Average scores on assessment of taped dietary interviews were high, 40.4 (Japan) to 45.3 (China) (highest possible score: 48); correlations between urinary and dietary nutrient values--similar for men and women--were, for all 4680 participants, 0.51 for total protein, range across countries 0.40-0.52; 0.55 for potassium, range 0.30-0.58; 0.42 for sodium, range 0.33-0.46. The updated dietary databases are valuable international resources. Dietary quality control procedures yielded data generally indicative of high quality performance in the four countries. These procedures were time consuming. Ongoing recoding of random samples of recalls is deemed essential. Use of tape recorded dietary interviews contributed to quality control, despite feasibility problems, deemed remediable by protocol modification. For quality assessment, use of correlation data on dietary and urinary nutrient values yielded meaningful findings, including evidence of special difficulties in assessing sodium intake by dietary methods.