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THE AUTHORS EXAMINED THE PREVALENCE of clinically diagnosed hypertension among all American Indian and Alaska Native outpatients served in Indian Health Service (IHS) facilities in fiscal year 1992, and compared these rates with a similar analysis done in 1987. In this report they provided data on that analysis as well as on the association between hypertension and diabetes. The 1992 overall estimated age-adjusted prevalence of clinically diagnosed hypertension in adults older than age 15 was 10.4%, compared with 10.9% in 1987, a small but significant decrease. Considerable variation exists in hypertension prevalence rates in American Indian communities as analyzed by IHS service area. This report represents an attempt to use ambulatory patient care data to demonstrate a means for ongoing surveillance of a chronic disease for the entire service population of the IHS. This comprehensive data set represents approximately 60% of the entire U.S. American Indian and Alaska Native population. Based on the ongoing nature of this ambulatory patient care data system, this model for hypertension surveillance permits a unique opportunity for longitudinal evaluation of quality improvement efforts for the American Indian and Alaska Native populations served by the IHS.
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PMID:Clinical hypertension in Native Americans: a comparison of 1987 and 1992 rates from ambulatory care data. 889 69

THE HEART DISEASE MORTALITY RATES of the Chippewa and Menominee, who reside in the upper Midwest, are higher than the rates of most other tribes in the United States. Little is known, however, about the prevalence of hypertension, diabetes, and obesity among these communities. The Inter-Tribal Heart Project (ITHP) was designed to determine the prevalence of risk factors for heart disease and to implement community-based heart disease prevention programs. Age-stratified random samples of active users of the tribal-Indian Health Service (IHS) clinics, ages 25 and older, were drawn from three communities within the Bemidji Service Area. Between September 1992 and June 1994, 1396 people completed an extensive questionnaire and underwent a physical exam for heart disease risk factors. Preliminary data indicate mean blood pressure levels of 126 mmHg for systolic blood pressure (SBP) and 74.4 mmHg for diastolic blood pressure (DBP). Mean SBP and DBP were higher among men than women. Mean body mass index (BMI), which did not vary by gender, was 30.6 mmHg. The prevalence of hypertension was 33%; and diabetes, 33%. Men had a higher prevalence of hypertension than women, but there was little gender difference in the prevalence of diabetes. These preliminary data suggest that the prevalences of hypertension, diabetes, and obesity in these communities are higher than the recent estimates for the total United States. The next stage of the ITHP will focus on policies and programs to prevent and treat these conditions.
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PMID:Blood pressure, diabetes, and body mass index among Chippewa and Menominee Indians: the Inter-Tribal Heart Project Preliminary Data. 889 70

THE PIMA INDIANS HAVE THE WORLD'S HIGHEST reported incidence of diabetes. Since 1965, this population has participated in a longitudinal epidemiological study of diabetes and its complications. The examinations have included a medical history for diabetes and other major health problems. The focus of this study is the correlation between the prevalence of hypertension and glucose tolerance in this population. Of the 4315 adults ages 18 and older, 50% had normal glucose tolerance; 12%, impaired glucose tolerance (IGT); 8%, newly diagnosed diabetes; and 31%, previously diagnosed diabetes of a mean duration of 11 years. Age-sex adjusted prevalence of hypertension was 24% in those with normal glucose tolerance, 34% in those with IGT, and 40% in those with diabetes. Hypertension was more common in men than in women and was positively related to obesity. Of the 2667 children ages 6 to 17 years, 4% had IGT, and 1% had diabetes. Blood pressure was higher in boys than girls and was associated with older age and worse glucose tolerance. Longitudinal analyses of data from 188 children ages 5 to 9 years who had their follow-up exam at ages 18 to 24 revealed no relationship between insulin concentration and blood pressure in either sex. In this group mean blood pressure at followup was positively correlated with relative weight, mean blood pressure, and 2-hour post-load plasma glucose concentration at baseline. In a multiple regression model, relative weight was the strongest predictor of mean blood pressure at the follow-up exam.
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PMID:Hypertension in Pima Indians: prevalence and predictors. 889 71

THE ESTIMATED TWO MILLION American Indians and Alaska Natives, while sharing certain genetic traits, belong to groups with distinct social, cultural, political, and biomedical attributes. They share with certain other ethnic minorities high poverty rates, low educational attainment, increased susceptibility to certain diseases, and elevated mortality rates. Hypertension has been reported less frequently among American Indians compared to other U.S. groups, but is increasing in frequency, is strongly associated with obesity and diabetes, and is synergistically associated with diabetes in the etiology of end-stage renal disease. The first priority for dealing with hypertension among American Indians is to maximize efforts toward control. The Indian Health Service (IHS) provides such an opportunity, which is not as readily available to other minorities. In addition to controlling hypertension, areas of fruitful investigation include studies relating hypertension to acculturation, physiology of peripheral adrenergic vasoreceptors, salt and water metabolism, and prevention or amelioration of end-stage renal disease. Understanding some of these basic processes will prove valuable for American Indians and Alaska Natives as well as the entire population.
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PMID:American Indians and Alaska Natives--overview of the population. 889 74

THE AUTHORS PRESENT DATA FROM 361, 662 MEN ages 35 to 57, screened from 1973 to 1976 for possible participation in the Multiple Risk Factor Intervention Trial (MRFIT). Volunteers identified themselves as "white," "black," "Oriental," "Spanish American," "American Indian," or "other." They also noted if they were taking medication for diabetes. A trained technician measured blood pressure after participants had rested for 5 minutes, using the fifth Korotkoff sound to define diastolic pressure and averaging the second and third of three readings. Differences among the groups included the following: blacks had consistently higher systolic and diastolic blood pressure (SBP and DBP) than other groups; Orientals had slightly lower pressure than other nonblack groups; American Indians had somewhat higher pressure than other nonblack groups at ages 35 to 44 but lower at ages 45 to 54; Hispanics in Miami and Davis, California, had significantly higher SBP and DBP than whites in the same area; Orientals in California had significantly higher DBP (but not SBP) than whites in California.
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PMID:Blood pressure in minorities screened for the Multiple Risk Factor Intervention Trial (MRFIT). 889 81

THE WORKSHOP ON THE EPIDEMIOLOGY OF HYPERTENSION in Hispanic Americans, Native Americans, and Asian/Pacific Islander Americans concluded with a panel discussion of the findings from a scientific perspective. Panel members presented their ideas for research direction on measuring and identifying more accurately the frequency, distribution, and determinants of hypertension in minority populations, evaluating mechanisms leading to hypertension, and identifying the implications for public health and medical practice. Several members stressed the need for additional data collections, using standardized methods. They stated that future studies, including longitudinal ones, should target specific ethnic populations and subpopulations and address the role of acculturation, assimilation, modernization, and socio-economic status. They also recommended comparative and collaborative studies among groups. They emphasized the importance of obesity and diabetes or impaired glucose tolerance as determinants of hypertension in all three populations, and suggested that there may be differences in the etiology and pathophysiology of hypertension among the groups, with visceral adiposity or insulin resistance syndrome being more important in Asian populations. The potential for identification of genes involved in blood pressure variation and hypertension risk may help understand the interaction of genes with the environment. Minority groups in the United States share the problem of high prevalence of high blood pressure and low rates of control. For this reason, the panel urged a new era of community-based, culturally sensitive prevention and control projects.
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PMID:NHLBI workshop panel discussion: a scientific perspective. 889 82

BLOOD PRESSURE REDUCTION AND CARDIOVASCULAR MORBIDITY AND MORTALITY: Several hypertension trials have shown that antihypertensive treatment can reduce the cardiovascular morbidity and mortality accompanying this condition. They have also shown, however, that the reduction does not entirely normalize the risk of hypertensive patients. STRATEGIES TO IMPROVE THE BENEFIT OF ANTIHYPERTENSIVE TREATMENT: Although some of the risk of the hypertensive patient may prove to be irreversible, pathophysiological and clinical evidence obtained in recent years suggests that some modifications to antihypertensive treatment strategies might increase the benefit. For example, greater use of drugs such as calcium antagonists and angiotensin converting enzyme (ACE) inhibitors as first-line agents might bring greater benefits, because some properties of these drugs which are additive to their blood pressure lowering effects, such as regression of cardiovascular structural changes, nephroprotection and delay of atherogenesis, may provide a degree of protection against target-organ damage. ONGOING CLINICAL TRIALS AND THE INTERNATIONAL NIFEDIPINE (GITS) GASTROINTESTINAL SYSTEM STUDY OF INTERVENTION AS A GOAL IN HYPERTENSIVE TREATMENT (INSIGHT): Several ongoing clinical trials are aimed at comparing the effects of calcium antagonists and ACE inhibitors versus beta-blockers and diuretics on cardiovascular morbidity and mortality. INSIGHT is particularly interesting because the effects of nifedipine GITS and a combined thiazide and potassium-sparing diuretic on cardiovascular morbidity and fatal events are being compared in patients with hypertension plus one or more additional risk factors, such as hypercholesterolemia, smoking, diabetes, left ventricular hypertrophy, etc. INSIGHT is therefore the first trial to address, in a prospective fashion, the prognostic influence of antihypertensive treatment in hypertensives with concomitant risk factors.
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PMID:Benefit versus risk of calcium antagonists in hypertensive patients with concomitant risk factors. 898 41

The effects of hypercortisolemia and ACTH on the metabolism of cortisol in congenital adrenal hyperplasia, Cushing's syndrome, and exogenous ACTH and cortisol administration were investigated by analysis of the respective urinary tetrahydro-metabolites of cortisol (THF and aTHF) and cortisone (THE) by capillary gas chromatography. The results for the patients with congenital adrenal hyperplasia establish that ACTH hypersecretion in the absence of an associated marked elevation of plasma cortisol does not cause inhibition of the 11beta-OHSD enzyme. In contrast elevated plasma cortisol levels (adrenal adenoma or intravenous cortisol administration) in the presence of suppressed ACTH secretion leads to significant inhibition of the peripheral conversion of cortisol to cortisone. The latter results are equivalent to the mode of cortisol metabolism noted during clinical states of ACTH hypersecretion and hypercortisolemia (Cushing's disease, ectopic ACTH syndrome and ACTH administration). The overall findings provide convincing evidence that ACTH hypersecretion is not associated with specific in vivo inhibition of 11beta-OHSD enzyme activity.
Exp Clin Endocrinol Diabetes 1998
PMID:Effect of hypercortisolism and ACTH on the metabolism of cortisol. 951 61

ALTERATIONS OF THE ENDOTHELIUM: Because of its anatomic position between circulating blood and smooth muscle cells, the vascular endothelium is a prime target for cardiovascular diseases such as hypertension, hypercholesterolemia, diabetes or ischemia. The morphological changes occurring in the endothelium have been known for many years, but it was only recently that the functional alterations have been described. IMPACT OF NO: Under physiological conditions, the vascular endothelium plays a protective role by secreting relaxation factors. In the disease state, the synthesis and release of NO may be reduced or even abolished. The exact significance of endothelium-dependent vasodilatation disorders remains a topic of research, but the properties of NO strongly suggest it is involved in several diseases. For some diseases it is still a question as to whether the observed anomalies are the cause or the consequence of the underlying disease. DISEASE-SPECIFIC CHANGES: NO is known to be reduced in atherosclerosis, either because of less synthesis or accelerated degradation. In different experimental modules of hypertension, the baseline level of NO release appears to be decreased. Conversely, NO release can be normal, reduced or increased in diabetes. In heart failure, there appears to be not only a permanent alteration in NO secretion, but also an increase in factors stimulating vascular contraction, contributing to an altered capacity for vascular adaptation in these patients.
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PMID:[Nitric oxide (NO), vascular protection factor. NO related cardiovascular diseases]. 976 31

AIM OF THE STUDY: Heart failure is the final clinical presentation of a variety of cardiovascular diseases, such as coronary artery disease, hypertensive, toxic, and inflammatory heart disease. However, the cellular mechanisms responsible for the progressive deterioration of myocardial function observed in heart failure remain unclear and may result from cell death (programmed or not) and from an increase in number of nuclei and in the degree of their ploidy. METHODS: We examined thirty-eight explanted hearts obtained during transplantation for DNA content in the myocytic population. All thirty-eight patients had severe chronic heart failure: 23 had idiopathic dilated cardiomyopathy, and 15 had ischemic cardiomyopathy. Ten hearts of people whose death was not due to primary heart disease or as a consequence of major risk factors of coronary artery disease, including hypertension, diabetes, obesity, or severe atherosclerosis, were used as controls. DNA content in the myocytic population was evaluated using Image Cytometry. RESULTS: The DNA content per nucleus and per myocyte in cardiomyopathic hearts are characterized by: a) a decrease of the diploid DNA content of myocytic nuclei; b) an increase of DNA ploidies higher than 4c; c) a decrease in mononucleated myocytes; d) an increase in binucleated and multinucleated myocytes. The changes are more prominent in dilated cardiomyopathy. e) The total ploidy index, used to calculate the total DNA content, is related to heart weight and ventricular weight. CONCLUSIONS: Ischemic and dilated cardiomyopathies result in reduction of ventricular mass-to-chamber volume ratio and in discrete foci of myocyte cell death, leading to an elevation in systolic and diastolic stress on the remaining viable cells. Therefore mechanical stimuli generated by global and local loading abnormalities associated with end-stage failure may contribute to activate genes implicated in cell proliferation. Observations in this investigation are consistent with recent results documenting that in the presence of overload conditions the myocytes may retain their capacity to proliferate throughout life and this growth reserve mechanism may become operative in response to severe myocardial dysfuntion and overt failure. Polyploidization and multinucleation are prominent phenomena in the end-stage of ischemic and dilated cardiomyopathy in humans.
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PMID:DNA Content in End-Stage Heart Failure. 1035 69


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