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In an investigation on hypertension risk factors, the entire school population was examined in Trecchina, a southern Italian village. The reported findings refer to those children examined together with at least one parent, for a total of 134 mother-child pairs and 128 father-child pairs. For these groups of children, fathers and mothers, systolic (SBP) and diastolic (DBP) blood pressure, weight (W), height (H) and triceps skinfold (TS) were detected and body mass index (BMI) was calculated in order to evaluate the prevalence of high blood pressure (BP) values and if overweight. Of 19.3% children, 26.9% fathers and 15.8% mothers showed high BP values; 28.9% of children, 14.0% of fathers and 19.3% of mothers were overweight. In children, the analysis of correlations, after adjustment for height, showed a significant association between BP and W, BMI and TS. Using multiple regression analysis, with BP as the dependent variable, SBP was significantly associated with BMI and age in mother and fathers. For DBP the only variable entered in the model was BMI for mothers and fathers. When controlling for the children's age, H, W and BMI of children were significantly related to H, W and BMI of mothers and fathers. These results confirm that overweight and a parental history of obesity are predictive and possibly causal factors for essential hypertension.
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PMID:Blood pressure and anthropometry in parents and children of a southern Italian village. 887 32

DESPITE THEIR HIGHER PREVALENCE of obesity and diabetes, Hispanics have lower or equal rates of hypertension than non-Hispanic whites (1-4). Healthy People 2000 objectives call for increasing the proportion of hypertensive men whose blood pressure is under control to at least 40%. In addition, the objectives recommend reducing the prevalence of overweight to 41% among hypertensive women, and to 35% among hypertensive men (5). The Hispanic Health and Nutrition Examination Survey (HHANES) collected data on Mexican Americans (MA), Cuban Americans (CA), and Puerto Ricans (PR) living in the continental United States. A trained physician measured systolic (SBP) and diastolic (DBP) blood pressure twice in one visit. Our findings provide data to assess baseline estimates for several Healthy People 2000 objectives among Hispanics. Based on criteria from The Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC-V), we found Hispanic women to have higher rates of awareness, treatment, and control of hypertension than men. Only 8% of MA and PR men and 9% of CA men who were hypertensive had their high blood pressure under control. The prevalence of overweight among hypertensive men ranged from 39% to 60%; and among hypertensive women, from 44% to 74%. Hispanic women with six or fewer years of education had higher prevalence of hypertension and other cardiovascular disease (CVD) risk factors. Future research should investigate the socioeconomic factors associated with the presence of these risk factors.
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PMID:Hypertension and other cardiovascular disease risk factors among Mexican Americans, Cuban Americans, and Puerto Ricans from the Hispanic Health and Nutrition Examination Survey. 889 61

Cigarette smoking has been reported to worsen high-density lipoprotein (HDL) cholesterol and other cardiac risk factors, yet no studies have examined this issue among rural African Americans. This study examines the association between cigarette smoking and cardiac risk factors among rural African Americans. A population-based sample of 403 African-American adults from two rural Virginia counties underwent total cholesterol (TC), HDL, systolic and diastolic blood pressure (SBP and DBP), body mass index (BMI), serum glucose, and glycosylated hemoglobin (GlyHb) measurements. Cross-sectional multivariate analyses were used to compare risk factors across categories of cigarette use. Age, BMI, alcohol consumption, and the use of antihypertensive medications were covariates in the analysis. Results indicated that female light smokers had significantly lower SBP and DBP, and lower HDL. Female heavy smokers had significantly lower HDL and BMI and significantly higher TC/HDL ratios. Male heavy smokers had significantly higher SBP. More than 33% of males and more than 50% of females were overweight, and increasing BMI was associated with significantly or nearly significantly worsening of all other risk factor levels. Both cigarette smoking and obesity adversely affect other cardiac risk factors. Novel approaches are needed to decrease both smoking and obesity in this difficult to reach population.
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PMID:Coronary heart disease risk factors and cigarette smoking among rural African Americans. 900 15

Little is known about hypertension in Haitians. We performed a pilot survey of ambulatory Haitian patients in a multispecialty clinic at a large public teaching hospital. Approximately 10% of the clinic population was of Haitian origin. Clinical data were collected on 88 consecutive Haitian patients. Of these 88, 77 (87.5%) were hypertensive (SBP > or = 140 or DBP > or = 90 mm Hg or taking antihypertensive medication). The characteristics of the hypertensive patients were: age 54.1 +/- 13.0 (s.d.) years; 27 men, 50 women; 12/64 (19%) smoked; 7/63 (11%) used alcohol. Diabetes was present in 21/77 (27%). In patients for whom height and weight were available, obesity was present in 52%. Using JNC V criteria, 18 (23%) had Stage 1, 16 (21%) Stage 2, 18 (23%) Stage 3, and 25 (33%) Stage 4 hypertension. Despite 63/77 (82%) being treated for hypertension, only 20 (26%) were controlled (< 140/< 90 mm Hg). Of those under treatment, 29 were taking one drug; 18 (two drugs); 12 (three drugs); and four (four drugs). Target organ damage was evident in 37 (48%), including coronary artery disease (8), CHF (6), chronic renal failure (15), stroke (9), and LVH by ECG (19). There was evidence of severe noncompliance in 32 (42%). We conclude that in this clinic sample, hypertension was highly prevalent and unusually severe in terms of blood pressure (BP) level, refractoriness to treatment, and target organ consequences. Further studies are indicated.
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PMID:Hypertension in Haitians: results of a pilot survey of a public teaching hospital multispecialty clinic. 900 4

We have investigated the possible involvement of endogenous corticosteroids in the maintenance of hypertension in aged lean and obese Zucker rats using the type II corticosteroid antagonist mifepristone. At 8 mo of age, the start of the study, obese Zuckers had been hypertensive for at least 2 mo (systolic blood pressure; 153 +/- 4 vs. 136 +/- 5 mmHg; n = 8-9; P < .05) and were hyperinsulinemic (756 +/- 98 vs. 193 +/- 61 microU x ml(-1)) and hypercorticosteronemic (524 +/- 83 vs. 260 +/- 97 ng x ml(-1)) compared to their lean littermates. There were no differences in plasma renin activity between lean and obese animals and plasma renin activity was unaffected by any treatment. Oral treatment of obese rats with mifepristone (40.0 mg x kg(-1) day(-1) for 9 days) resulted in a gradual reduction in SBP to lean levels by day 9. Mifepristone treatment did not affect plasma insulin or corticosterone levels but resulted in a significant reduction in plasma aldosterone concentration. Mifepristone was without significant effect on systolic blood pressure in lean rats. Oral treatment of lean rats with corticosterone-21-acetate (3.0 mg x kg(-1) day(-1) for 9 days) resulted in a rise in systolic blood pressure to levels similar to obese Zuckers after 9 days. Plasma insulin levels were unchanged but corticosterone immunoreactivity was significantly reduced. Plasma aldosterone levels were increased from 564 +/- 3 to 802 +/- 68 pg x ml(-1). Our data suggest that raised glucocorticoids and aldosterone may be factors contributing to hypertension in obesity.
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PMID:Effects of the glucocorticoid II receptor antagonist mifepristone on hypertension in the obese Zucker rat. 931 65

Changes in the activity of the sympathetic activity are often involved in the development of human insulin-resistance syndrome. However, the nature of changes in both the parasympathetic and orthosympathetic components are still controversial. We have recently developed an experimental model reproducing in dog this morbid triptyque (obesity, hypertension and hyperinsulinism), obtained by hypercaloric hyperlipidic diet. The aim of the present study was to characterize the changes in autonomic nervous system and spontaneous baroreflex in the initial period of obesity-hypertension syndrome. Ten male Beagle-Harrier dogs were used in this study. We investigated before and during 20 weeks after the beginning of the hypercaloric diet, plasma insulin, noradrenaline levels, spontaneous baroreflex efficiency (using the sequence method), arterial blood pressure, heart rate and their spectral analysis (fast Fourier Transformation) in both low (LF: 50-150 mHz, reflecting sympathetic activity) and high (HF: respiratory rate +/- 50 mHz, reflecting parasympathetic activity) frequency bands. Body weight (+20%), systolic (SBP: +23%) and diastolic (+16%) blood pressure and heart rate (+19%) increased during 6 weeks and then remained stable. Concomitantly, high frequency of HR (22.01 +/- 1.9 vs 14.15 +/- 1.04% at 7th week) and BF of systolic blood pressure (15.6 +/- 1.1 vs 19.2 +/- 1.2% at 4th week); p < 0.07, showed a rapid decrease in parasympathetic tone and a early increase in sympathetic activity. Nevertheless, in steady state of this syndrome, parasympathetic tone returned to initial values (18.43 +/- 3.25% at 20th week). Insulinemia significantly increased from the 4th week (14.2 +/- 0.9 vs 25.3 +/- 2.2 microUI/mL at 20th week), but noradrenaline remained not modify (400 +/- 85 vs 312 +/- 45 pg/mL at 20th week). Spontaneous baroreflex efficiency also decreased from the 2nd week (35.5 +/- 5.5 vs 16.7 +/- 4.9 mmHg/ms at 20th week). This study shows that an hyperlipidic hypercaloric diet induces a decrease in both parasympathetic tone and spontaneous baroreflex efficiency, which could be the physiopathological link between obesity, hypertension and hyperinsulinism.
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PMID:[Autonomic nervous system abnormalities in the initial phase of insulin resistance syndrome. Value of the study of variability of cardiac rate and blood pressure on a model of nutritional obesity]. 940 26

In Caucasian subjects, an insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene is associated with coronary artery disease (CAD) and fatal myocardial infarction. The underlying mechanism(s) of this association is not fully understood. Pima Indians have a low incidence of nonfatal and fatal CAD despite a high prevalence of diabetes. In Pima Indians, circulating ACE levels are related to ACE genotype, but the frequency of the D allele is significantly lower than in Caucasians. A lower frequency of the D allele may underlie a low risk of CAD in this population. We examined the relationship of the ACE genotype and plasma ACE level with electrocardiographic evidence of CAD (Tecumseh criteria), hypertension, and metabolic variables associated with insulin resistance in 305 (146 men and 159 women aged 47+/-9.0 years) Pima Indians characterized for the ACE I/D genotype. The distribution of ACE genotypes was unrelated to diabetes and obesity. Fasting plasma insulin, plasminogen activator inhibitor-1 (PAI-1) activity, plasma triglyceride concentrations, and systolic (SBP) and diastolic (DBP) blood pressure were not significantly different between the three ACE genotypes among nondiabetic and diabetic subjects. There was no significant association of ACE genotype with electrocardiographic evidence of CAD or with hypertension. Plasma ACE concentrations were not significantly different between nondiabetic and diabetic subjects (median, 77 [range, 21 to 1691 v 83 [7 to 238] IU/mL, P=NS). In all subjects, plasma ACE levels were associated weakly with plasma triglyceride (partial r=.20, P < .01) and total cholesterol (partial r=.13, P <.03) concentrations, but not with fasting plasma insulin or PAI-1 activity. In diabetic subjects, ACE levels were related to fasting plasma glucose concentrations (partial r=.15, P=.07). These findings would suggest that ACE gene I/D polymorphism is unlikely to be a major determinant of susceptibility to CAD in Pima Indians. Plasma ACE levels, but not ACE genotype, correlated with lipids, plasma glucose, and blood pressure, suggesting that elevated plasma ACE levels may contribute to the link between insulin resistance and CAD disease or may be a consequence of it.
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PMID:Angiotensin-1-converting enzyme (ACE) gene polymorphism, plasma ACE levels, and their association with the metabolic syndrome and electrocardiographic coronary artery disease in Pima Indians. 959 57

During a 12-week, multicenter study to evaluate the efficacy and safety of lisinopril and hydrochlorothiazide (HCTZ) for the treatment of obesity-related hypertension, ambulatory blood pressure (ABP) monitoring was performed both at baseline and at study completion in 124 patients. Patients were randomized to three groups: placebo, lisinopril (10, 20, or 40 mg/day), or HCTZ (12.5, 25, or 50 mg/day). All groups were matched with regard to sex, race, age, body mass index, and waist/hip ratio. The primary analysis of ABP data revealed that both lisinopril and HCTZ effectively lowered mean 24-h systolic (SBP) and diastolic (DBP) blood pressure compared with placebo, (mean change from baseline SBP/DBP: -12.0/-8.2, -10.6/-5.5, and -0.3/-0.5 mm Hg, respectively); however, lisinopril lowered DBP better than HCTZ (P < .05). Secondary analyses of groups revealed that men responded better to lisinopril than HCTZ (-11.9/-7.3 v -6.6/-3.5 mm Hg, respectively), whereas women responded well to both drugs. White patients responded better to lisinopril than HCTZ, whereas black patients showed a significant response to HCTZ only. Response to treatment was also influenced by patient classification of 24-h blood pressure profiles, ie, "dipper" or "nondipper." Overall, the majority of obese hypertensives were nondippers. Nondippers (n = 82) responded well to both drugs (-10.4/-6.9 v -12.5/-5.7 mm Hg, P < .05 v placebo), whereas dippers (n = 42) responded to lisinopril (-11.7/ -9.4 mm Hg, P < .05 v placebo and HCTZ), but not HCTZ (-5.6/-4.1 mm Hg, P = NS v placebo). Results of 24-h ABP data show that both lisinopril and HCTZ are effective therapies for obesity-related hypertension and that response to treatment is influenced by sex, race, and dipper/nondipper status.
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PMID:Nocturnal reduction of blood pressure and the antihypertensive response to a diuretic or angiotensin converting enzyme inhibitor in obese hypertensive patients. TROPHY Study Group. 971 82

Hyperinsulinemia and impaired insulin action are familial and predictive of Type 2 diabetes onset. Since high levels of insulin are characteristic of our general (venezuelan)hispanic population, the purpose of this investigation was to identify early metabolic defects in a group of healthy first degree relatives of Type 2 diabetic patients. We studied 46 (29 women and 17 men; ages ranging 18-66 y) first degree relatives of Type 2 diabetic patients comparing them with 22 (12 women and 10 men; ages ranging 22-60 y) subjects who had no family history of diabetes. All subjects underwent resting blood pressure and anthropometric measurements; a 75 g oral glucose tolerance test with determination of glucose and insulin and a fasting lipid profile. The relatives of Type 2 diabetic patients had higher tricipital (TC) and subscapular (SC) skinfolds, and elevated DBP in relation to the control group. The skinfolds elevation was more evident in women, while in men the elevation in DBP predominates. None of the relatives had glucose intolerance, however, the glucose-stimulated insulin response was elevated at all points in men as well as in women. No difference was observed in the HOMA values for IR and beta cell function, or in the delta I30/delta G30 ratio. The lipid profile showed a marked elevation in TG levels in men as well as in women, with low HDL-C values in men. No other lipid abnormalities were observed. Correlation analysis revealed strong association between BMI and WHR with skinfolds and several parameters of the carbohydrate metabolism in women, but not in men. IR in women was possitively associated with skinfolds, SBP and lipid parameters and beta cell function with VLDL-C. Adult relatives of Type 2 diabetic venezuelan patients from hispanic origin had, early in their lives, several parameters of the metabolic syndrome as hyperinsulinemia, obesity, dyslipidemia and high blood pressure. These alterations were more prominent in women, group in which the association among BMI, WHR and IR were statistically significant respect to SBP, DBP, basal insulin, insulin/glucose ratio, TG and HDL-C.
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PMID:Women relatives of Hispanic patients with type 2 diabetes are more prone to exhibit metabolic disturbances. 1039 Sep 51

The higher rates of type 2 diabetes mellitus, hypertension, and many others factors of the insulin resistant syndrome (IRS) often seen in African Americans compared to whites do not seem to be explained by differences in central obesity. Reasons for this may be due, in part, to the validity of the commonly used anthropometric surrogate of central adiposity. Recent findings have shown that waist circumference is a better surrogate of total body and visceral adipose tissue and is better correlated with CVD than the traditionally used anthropometric indexes of the body mass index or waist/hip ratios. In this study, waist circumference was employed to determine the association between central adiposity and components of the insulin resistance syndrome in blacks (N=1963) and whites (N=4894) from the US national population-based samples. Sex-specific correlation coefficients were used to estimate the association between waist circumference and factors of the IRS. Multiple linear regression analyses were used to determine racial differences in waist circumference and the independent association of waist circumference to some known factors of IRS adjusting for age, BMI, alcohol use, and smoking. Waist circumference was positively correlated with plasma glucose, DBP, SBP, LDL cholesterol, fasting insulin, serum triglyceride, total cholesterol and total cholesterol/HDL ratio in black and white men and women (P<0.01). In both biracial groups, waist circumference was significantly associated with increases in glucose, DBP, LDL cholesterol, total cholesterol, triglyceride and fasting insulin levels controlling for age, BMI, and behavioral risk factors, such as alcohol use and smoking (P<0.05). Our data shows that central adiposity assessed with waist girth did not wholly explain the higher prevalence of IRS components often seen among blacks. The results of this study reinforce the need to encourage the use of waist measure as a public health tool in screening for CVD risks.
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PMID:The relation of central adiposity to components of the insulin resistance syndrome in a biracial US population sample. 1042 Oct 84


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