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Echocardiographic measurement of left ventricular mass has provided a way of evaluating the undesirable effects of high blood pressure on the heart in the same way as for obesity, excess salt intake and blood hyperviscosity. Recently, the left ventricular mass was shown to correlate (r = 0.81) with the hemodynamic stimuli of blood pressure, stroke volume and left ventricular contractility. Prospective trials at Cornell and Framingham indicate that left ventricular mass is a powerful predictive factor of the risk of complications in hypertension. In the first of these trials, we demonstrated in a 5 year follow-up study of 140 men with uncomplicated hypertension that the incidence of death, myocardial infarction or angina requiring myocardial revascularisation, was four times greater in patients with increased left ventricular mass and that this association was independent of the blood pressure levels. Then, in a 10 year follow-up study of hypertensive patients of both sexes, we established that the left ventricular mass was the most powerful predictive factor of mortality and morbidity and that this was so marked (15% death rate in subjects with LVH vs 1% in subjects with normal left ventricular mass--p less than 0.00001--, cardiovascular accidents in 26% of subjects with LVH compared with 12% in subjects with normal left ventricular mass--p less than 0.0001) that only left ventricular mass and age were independant predictive factors of morbid events in multiple variable analysis. In the Framingham study, the frequency of coronary events in a 4 year follow-up period of healthy subjects from the original cohort (average age 69 years) was significantly related to the left ventricular mass and independent of other risk factors.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Relationship between left ventricular mass and prognosis of arterial hypertension]. 208 Aug 92

When one is faced with the problem of essential hypertension it is prudent to pay attention to lifestyle factors, especially alcohol, smoking and obesity. Modification of salt intake in the diet is a simple measure. Drug therapy will need to be long-term therapy and ease of treatment is important, which means that drugs given once a day or at most twice a day should be used. Diuretics and beta-blockers are inexpensive and well proven but have many side-effects. Newer agents may have fewer side-effects but are more expensive. The choice will be an individual one.
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PMID:Essential hypertension--investigations and management. 209 50

The relationships between nutrition and immune defence in man are poorly understood. The clinical situations of nutritional origin involving immune deficiency: protein energy malnutrition (marasmus and kwashiorkor), nutritional disorders in developed countries, anorexia, obesity, mineral salt and vitamin deficiencies, hypercholesterolemia and alcoholism are reviewed.
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PMID:Clinical status of nutritional origin involving immune deficiency. 212 54

Antihypertensive drugs have been of major benefit to people with moderate or severe hypertension and have contributed enormously to fundamental physiological knowledge. Antihypertensive therapy in milder hypertension reduces the incidence of stroke by 40% or more, may reduce myocardial infarction and prevents progression to more severe hypertension or heart failure but is being criticised as not cost-effective. Much of this criticism is based on deductions from inappropriate data. Nevertheless, it is likely that money is in some cases being wasted on the treatment of people who were not truly hypertensive in the first place. It is also likely that drug dosage is often unnecessarily high. Clearly it is vital that treatment is delivered as economically as possible. A reduction in the prevalence of hypertension would be the best way to reduce costs. Obesity and a high alcohol intake are associated with a higher blood pressure at any age. A high salt intake throughout life appears to be associated with a rise in blood pressure in the second half of life and may well be the main factor in hypertension. A radical rethinking of the method of pricing of medical care should be considered, so as to provide incentives to people to adopt life-style measures that lead to avoidance of hypertension (and other cardiovascular risk factors) or, in established hypertension, to a reduction in the need for medication.
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PMID:Managing hypertension: drugs, life-style manipulation or benign neglect? Medical, ethical and economic considerations. 175 Sep 10

The risk factors vascular disease, smoking, alcohol, a diet high in saturated fat and cholesterol, sedentary life style, obesity, glucose intolerance and diabetes, high salt intake, oral contraceptives, left ventricular disease, hyperlipidemia, hyperfibrinogenemia, and uricemia are discussed in terms of evidence for added risk to hypertensive patients. Most of these risk factors have been extensively studied as contributors to the vascular diseases of the heart, brain and peripheral circulation, but not specifically in hypertensive people. For example, there is definite evidence that women with high blood pressure are at risk for coronary heart disease, and that oral contraceptives may raise blood pressure, but there are not large studies examining the level of risk for vascular disease for hypertensive women who take the pill. Similarly, the vascular risks to women who smoke and use orals are known to be multiplied, but one can only assume that hypertensive women smokers who contemplate using the pill would be at even higher risk. An exception is exercise, which has been shown to be as effective as drug therapy in lowering blood pressure and other cardiac risk factors. Generally many of these risk factors interact in a logarithmic, rather than additive manner. Furthermore, these risk factors tend to occur together more frequently in the same patient with high blood pressure more than they do in the normotensive population. High blood pressure is itself an independent risk factor for vascular disease, in proportion to its height, for all ages and sexes, whether systolic or diastolic, labile or fixed, and the threat is further aggravated by surges in blood pressure throughout the person's daily activities. In pharmacologic management of hypertension, it is important to ensure that the drug chosen does not aggravate other risk factors, such as hyperglycemia, cardiac arrhythmias or mobilization of uric acid.
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PMID:Management of vascular risk factors in the hypertensive patient. 214 91

The three forms of origin of the atherosclerotic plaque of adults, that is, the fatty streaks, gelatinous elevations, and microthrombi, all occur in arteries of normal infants and children. Some of these may become arrested or regress, but many progress to the prominent lesions that precipitate various clinical catastrophies. The aim of modern medicine is to modify or eliminate many of the factors known to advance the atherosclerotic process and thus decrease the incidence of this disease, which ranks highest on the list of causes of morbidity and mortality in the Western world. Of these factors, some may be controlled by dietary means (low salt; low total fat and cholesterol; appropriate ratios of saturated to mono- and polyunsaturated fatty acids; high content of complex carbohydrates and fiber); controlling hypertension, diabetes, and obesity; abstaining from cigarette smoking; and vigorous physical activities. Because patterns of life-style are determined in childhood and adolescence, and because it is only during that period of life that measures to prevent progression of atherosclerosis may be predictably effective, it becomes increasingly apparent that atherosclerosis is, indeed, a pediatric problem.
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PMID:The genesis of atherosclerosis in pediatric age-group. 217 19

Obesity is known to be associated with diabetes, hypertension and hyperlipidemia in the majority of the patients. There could be inaccuracy in measuring the blood pressure in obesity, therefore a cuff of sufficient size is important in blood pressure measurement. All parameters of obesity have been found to have a correlation with hypertension and it has been suggested that change in weight would cause a change in blood pressure. A weight reduction of 12 kg results in a blood pressure fall of 21/13 mm Hg. Such changes in blood pressures have been noted in untreated hypertensives. A few studies have negated the role of change in weight to have any influence on hypertension. Obesity causes a higher cardiac output and higher blood volume leading to hypertension. There may be increased intracellular sodium and reduced sodium-potassium-ATPase activity in obesity which causes increased sodium loading in hypertension. Abnormalities related to the insulin-carbohydrate metabolism and the renin-angiotensin aldosteron system have also been demonstrated in obese patients. Weight reduction also causes reduced dietary salt intake and diminished sympathetic activity. The benefits of weight reduction appear to be directly related to the amount of weight lost.
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PMID:Effect of obesity and weight reduction in hypertension. 218 Feb 41

For many decades there has been adequate information for the elimination of acute dietary deficiency diseases. Scurvy, beri-beri, and pellagra, once serious scourges, are now seen only rarely. The severe forms of protein-energy malnutrition, kwashiorkor and marasmus, have also decreased greatly. Nonetheless, mild to moderate forms of protein-energy deficiency, exacerbated by infection, continue to impair growth and development in a majority of the low-income pre-school age populations of most developing countries. Deficiencies of iron, iodine, and vitamin A are still widespread in developing countries. Fortunately, the success of the WHO/UNICEF "Child Survival and Development Revolution" in persuading most developing countries to introduce expanded programs of immunization, growth monitoring, and appropriate feeding of young children, control of diarrheal disease, and specific campaigns against avitaminosis A, iodine deficiency disorders, and the functional consequences of iron deficiency, will accelerate the decline of acute deficiency diseases in the developing world. Diets are changing among the more affluent in these countries, however, and it is time for them to stress dietary goals for the health of rich and poor alike. For the first time there is enough information regarding dietary risk factors for chronic disease to provide an opportunity in the 1990s to accelerate the dietary changes that have already brought significant health benefits to some populations in North America and Europe. The changes, which include a lower dietary intake of fat, particularly saturated fat, less salt, and more green and yellow vegetable and whole grain cereals, can be expected to influence favorably morbidity from cardiovascular diseases and some kinds of cancer. For maximum benefit, these measures need to be combined with the avoidance of obesity, reasonable physical activity, abstention from, or moderate use of, alcohol, and avoidance of tobacco in any form. Since there is already considerable momentum toward these changes in North America and some European countries, the 1990s are likely to see substantial further progress in the reduction of chronic diseases known to be influenced by diet.
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PMID:Nutrition: prospects for the 1990s. 219 71

The overall prevalence of salt sensitivity was studied in 75 men stratified by diagnosis (hypertensive v normotensive) and race (black v white). All were studied in a crossover design employing a 200 mEq and 10 mEq Na/day. High salt led to a decrease in diastolic pressure for all groups (P less than .002). For systolic pressure, there was no salt effect on blood pressure across the whole group; however amongst the hypertensives, particularly the black hypertensives, high salt led to increases in systolic pressure (P less than .022). Obese patients were more likely to increase their systolic pressure in response to salt loading (P less than .05). The patients whose pressure increased on high salt were those who manifested less of a decrease in plasma levels of norepinephrine and renin in response to salt loading (both P less than .05). Systolic salt sensitivity was predicted with high statistical power (R = 0.689, P less than .00001) by a multiple regression equation employing: race; diagnosis; the change in renin and norepinephrine levels with diet; and the change in BP sensitivity to infused norepinephrine across the two diets. In view of the findings of increased norepinephrine, renin and diastolic pressure on low salt and in view of the particular physiological and epidemiological setting associated with systolic salt sensitivity, one wonders about the advisability of across-the-board recommendations of low salt diets for all hypertensive patients.
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PMID:Prediction of salt sensitivity. 219 63

The lessons learned from developing countries which are applicable equally to developed countries include the recognition that poverty and social justice are an integral part of a health strategy, that disease prevention involved active participation of the population, that better cost effective measures are desirable, and that individual and community involvement need to be encouraged. Prior to 1940, health care strategy involved the doctor as the locus of care for curing disease. Thereafter, through the agenda of the WHO, there was a shift towards emphasis on community health, environmental sanitation, health education, and prevention; the goal was health for all. The 1978 WHO meeting in Alma-Ata set goals for the year 2000 as 1) health care users being actively involved in caring for themselves, 2) the implementation of cost effective strategies, 3) expanding the health team to other disciplines, and 4) achieving equity in services provided and outcomes. Primary health care approaches have successfully reduced infant and child mortality through immunization, clean water and sanitation efforts, breast feeding, household involvement in treatment of diarrhea, and monitoring growth and nutrition. The lesson to be learned from developed countries is that prevention is more cost effective than illness management, particularly with the availability of new expensive technologies. Education and other primary prevention efforts can be successful in reducing smoking, auto fatalities, environmental contamination, and AIDS. Health in the US: 50-100 years ago was similar to that in developing countries today, and the shift from infectious disease to chronic disease was not smooth. Countries like Mexico are already straining under the difficulties of both disease patterns, while Brazil's public resources spent on illness treatment have jumped from 36% in 1965 to 85% in 1982, or 6% of the GNP. This could easily expand to the US figure of 12% due to similar problems with injuries, heart and cerebrovascular disease, cancer, dietary patterns of high salt and fat intake inadequate exercise and obesity, and environmental risks.
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PMID:Prevention in developing countries. 223 Oct 55


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