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Since 1969, we have investigated epidemiological studies of cerebro-cardiovascular diseases in the suburbs of Iwamizawa city in Hokkaido, the northernmost island of Japan. Cross-sectional surveys of 1,092 persons, equivalent to 90.3% of inhabitants over 40 years of age, revealed that the prevalence of hypertension amounted to 34%, and that the prevalence of abnormal ECG, CTR, fundi, albuminuria, glucosuria and overweight in the hypertensive group were significantly higher than in the normotensive group. After a 5-year cohort follow-up study concerning the incidence of strokes and heart attacks, age was found to be the highest risk factor in both incidents and hypertension was the second highest in cerebrovascular accidents, but not so high in heart attacks. In addition, we measured plasma renin activity (PRA) as a risk factor. On the basis of our observations, it is evident that the casual PRA of the rural Japanese population in Hokkaido, who usually excrete sodium more than 200 mEq per day, is valuable for our study. PRA was inversely proportional to systolic blood pressure in the normotensives and total group, but no correlation was found in the hypertensives alone. Observing 13 renin-determined accidents (8 strokes & 5 heart attacks) prospectively, incidence of strokes and heart attacks occurred more frequently in the high- and low-renin subgroups than in the normal-renin subgroup. Based on multivariate analysis, the following conclusion was drawn: systolic pressure, high renin, diastolic pressure and low renin, in this sequence, contribute largely toward the discrimination of cerebro-cardiovascular accident from no cerebro-cardiovascular accident. Thus it was suggested that the casual PRA was useful to predict the occurrence of vascular complications, in addition to the existence of hypertension. It has been said that the mortality rate of CVA in Hokkaido is less than the average of the rest of northern parts in Japan. By the vital statistics and our survey, it was clear that seasonal variation of the death rate from CVA and heart attack, which increases in the winter season, is weaker in Hokkaido than in Honshu. It is of interest to speculate that it is due to better-equipped heating in houses in Hokkaido than in other northern parts of Honshu.
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PMID:[Epidemiological survey of cerebro-cardiovascular diseases at Iwamizawa in Hokkaido (author's transl)]. 66 61

Sixteen middle-aged, normotensive, slightly overweight male patients with previous myocardial infarction were studied during Holter-checked silent myocardial ischaemia. As reference, stress and late 201-T1 scintigraphy served for comparison with Cardiolite-MIBI silent ischaemic perfusion scan, both carried out in planar mode. The circumferential profiles differed in 9 cases, on region of interest basis the segment number difference was 10, but the late distribution segment number was near to both ischaemic numbers. The quantitative scores were distinctive (ratio 133-128/103) indicating the silent ischaemia appeared in the peri-infarct area. The silent ischaemic MIBI and stress 201-T1 ischaemic score difference was reduced by means of repeated SPECT investigation. With gated radionuclide ventriculography there was -4.3% difference between the left ventricular ejection fractions, measured with first pass MIBI technique during silent ischaemia and afterwards in basal state. The impairment of the left ventricular function was reflected on the stroke pattern of our Holter-based radiocyclogram, as well. Taking the 43.7-48.0 = -4.3% "ischaemic shift" into consideration it was a close correlation (r = 0.90) between the two kinds of ejection fraction determination. The major rhythm failures (occurring during the 24 h Holter monitoring) decreased to a higher degree the left ventricular ejection fraction than silent ischaemia or silent ischaemia and minor rhythm failure together (38-42-50%).
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PMID:99-m technetium (Dupont Cardiolite) investigations in postinfarction patients with Holter-checked silent ischaemia. 181 59

Epidemiologic research indicates that glucose intolerance and hypertension are interrelated phenomena, each powerfully predisposing to atherosclerotic cardiovascular disease. Both diabetic and hypertensive patients have greater amounts of atherogenic risk factors, including dyslipidemia, hyperuricemia, elevated fibrinogen, and left ventricular hypertrophy. Diabetic persons have an increased prevalence of hypertension (50%), and glucose intolerance is more common in hypertension (15% to 18%). Both share a strong relationship to excess weight, but the excess of hypertension in diabetic persons occurs in both lean and obese subjects. Diabetes doubles the risk of hypertension associated with overweight. The risk of coronary disease, stroke, and peripheral arterial disease increases with increasing blood pressure to the same degree in diabetic persons as in nondiabetic persons, but at any level of blood pressure, diabetic persons have a doubled risk of these outcomes. Both diabetic and hypertensive patients are particularly prone to silent or unrecognized myocardial infarctions. Greater efforts at primary prevention of both hypertension and diabetes are clearly needed, including efforts at weight control, exercise, limitation of salt intake, and control of blood lipid levels. In either diabetic or hypertensive candidates for cardiovascular disease, optimization of the chances of avoiding sequelae requires a comprehensive multifactorial approach. Prevention requires more than normalization of either the blood sugar or blood pressure. Rational preventive measures must also include weight reduction, a fat-modified diet, cessation of smoking cigarettes, raising high-density lipoprotein, lowering low-density lipoprotein, and reduction of fibrinogen. Hypertension, obesity, insulin resistance, hyperinsulinemia, hypertriglyceridemia, and low high-density lipoprotein cholesterol tend to coexist.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The epidemiology of impaired glucose tolerance and hypertension. 200 55

An increased sympathetic drive combined with decreased parasympathetic inhibition is found in patients with borderline hypertension, who characteristically have rapid heart rates, high cardiac output and relatively normal vascular resistance (hyperkinetic state). In established hypertension, cardiac output is normal, vascular resistance is elevated and signs of increased sympathetic drive are absent. Apparently hemodynamics and sympathetic drive change during hypertension. The mechanism of the hemodynamic transition in the course of hypertension is well understood. Cardiac output returns from elevated to normal values as beta-adrenergic receptors down-regulate and stroke volume decreases (due to decreased cardiac compliance). The high blood pressure induces vascular hypertrophy, which in turn leads to increased vascular resistance. The mechanism of the change of sympathetic tone from elevated in borderline hypertension to apparently normal in established hypertension can best be explained within the conceptual framework of the "blood-pressure-seeking" properties of the brain. In hypertension, the central nervous system seeks to maintain systemic blood pressure at the higher level. As hypertension advances and vascular hypertrophy develops, arterioles become hyperresponsive to vasoconstriction. At this point, less sympathetic drive is needed to maintain pressure-elevating vasoconstriction, and the central sympathetic drive is down-regulated. The etiology of increased sympathetic drive in hypertension remains unresolved. Subjects with increased sympathetic drive are also usually overweight and have elevated levels of insulin, cholesterol and triglycerides, as well as decreased high-density lipoproteins. Future research must focus on the link between coronary risk factors and sympathetic overactivity in hypertension.
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PMID:Autonomic nervous system dysregulation in human hypertension. 202 Nov 14

Basic haemodynamic parameters - blood volume (BV), cardiac output (CO), stroke volume (SV), and total peripheral resistance (TPR) were studied in two groups of overweight patients with mild and moderate hypertension. Each group consisted of 15 subjects. The patients of the first group were kept on low caloric diet (1000-1100 cal per day). Patients of the second-control-group were treated with propranolol (120 mg per day). The duration of each study was 24 weeks. Blood pressure fell due to body weight reduction. BV, CO and SV decreased without changes in TPR. In the control group treated with propranolol in which the body weight did not change a fall in blood pressure, cardiac output, and stroke volume was seen without changes in blood volume and total peripheral resistance values.
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PMID:[Selected hemodynamic parameters in overweight patients with mild and moderate hypertension treated with low caloric diet]. 205 19

Several studies have shown a significant association of obesity with cardiovascular morbidity and mortality. The present study was carried out to investigate central and systemic haemodynamics in overweight and moderate obese, but otherwise healthy subjects, and in a lean control group to determine whether obesity can influence left ventricular performance per se. In this study an attempt has been made to eliminate misleading factors, such as diabetes, lipid abnormalities and hypertension. A total of 67 subjects, 44 with overweight or moderate obesity and 23 lean healthy subjects, were included. Patients were divided into three groups according to BMI levels and Garrow's criteria as follows: lean control group (BMI less than 25 kg/m2); overweight (BMI from 25 to 30 kg/m2); moderate obese (BMI greater than 30 less than 40 kg/m2). Overweight and moderate obese subjects were further subgrouped according to duration of obesity (DO) in subgroup A (DO less than 98 months) and in subgroup B (DO greater than 98 months). Haemodynamic assessment was performed using first pass radionuclide angiocardiography. When compared with lean subjects, overweight and moderate obese subjects were characterized by a significant increase in cardiac output (CO), stroke volume (SV), end diastolic volume (EDV), end systolic volume (ESV), total blood volume (TBV) and total plasma volume (TPV) and by a significant decrease in left ventricular ejection fraction (EF); some of these changes appeared to be related to the degree of obesity. In overweight and moderate obese subjects, total peripheral resistance (TPR) was lower than in lean controls, but this difference was not significant.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effect of obesity on left ventricular function studied by radionuclide angiocardiography. 207 19

Dietary restriction together with ongoing power-orientated training provide best results in the therapy and prevention of obesity. Diet can reduce the resting metabolic rate by up to 20% within 14 days. Physical activity stimulates the resting metabolic rate and counteracts this energy saving effect, but is especially important for maintaining a steady state after weight reduction. Exercise reduces the risk factors accompanying obesity by favorable adaptation of the sympathoadrenergic system to physical activity. This can be seen in the effects on heart rate, stroke volume, blood pressure, as well as glycogenolytic and lipolytic activities. Body fat especially in the abdominal area, which is particularly connected with atherogenic risk, is diminished. Weight reduction is accompanied by a decrease of the cardioprotective cholesterol fraction. Diets high in unsaturated fatty acids combined with a staying power training have a synergistic effect: they reduce a decrease of HDL. It is difficult to demonstrate risk factors connected with overweight children. However, from the preventive medicine point of view it is advisable to start with therapeutic measures during childhood. In an out-patient pilot project we surveyed 18 obese children aged 9 to 13 years. The therapy plan consisted of dietary restriction (1200 kcal/d), an exercise program performed 3 times a week, and psychological assistance. All children of 12 to 13 years arrived at an overweight level less than 20%, the younger ones displayed a lower weight reduction effect. All 18 improved their aerobic capacity. In the 1st months of treatment, HDL-cholesterol decreased slightly, but increased above pre-treatment level, later on. We did not see any vitamin deficiencies during the therapeutic regimen.
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PMID:[Prevention and therapy of obesity with diet and sports, an ambulatory therapy program for overweight children]. 219 99

Central fat distribution may be more closely associated with stroke risk than relative weight or body mass index, although both are associated with hypertension. Some of this association may reflect the fact that central obesity reflects adult weight gain, which may be more relevant to stroke risk than weight in old age. Three attributes associated with central obesity, hypertension and stroke risk deserve further exploration as a possible explanatory variables for the central obesity-stroke risk association. They are cigarette smoking, heavy alcohol intake and diabetes. Prevention of smoking and excess alcohol intake would be consistent with general public health guidelines and might be more relevant to stroke prevention than caloric reduction and management of general overweight.
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PMID:Obesity, hypertension and stroke. 220 49

We surveyed phenylpropanolamine (PPA) use and overuse among 309 diet center clients. Fifty-one percent of all subjects surveyed reported using PPA drugs: 44 percent used cold medicines and 16 percent used diet aids. Twenty-two percent of diet aid users and 7 percent of cold medicine users reported that they deliberately used more than the dosage recommended to improve efficacy. Among diet aid users, 59 percent also regularly consumed caffeine. Despite package warnings, individuals who had been told by their doctors that they were hypertensive used PPA products as often as normotensive individuals. PPA, the fifth most frequently used drug in the USA, is contained in over-the-counter (OTC) diet aids as well as OTC and prescription cold medicines. Severe adverse drug reactions (ADRs) including hypertensive crisis, stroke and death have been attributed to PPA products. Clinical studies have shown that using greater than recommended doses of PPA and using PPA in combination with caffeine may increase the risk of ADRs. Overweight patients may be particularly at risk for ADRs to PPA because they are likely to be hypertensive and to use diet aids. We recommend informing diet center clients of the potential dangers of consuming PPA products, especially more than the recommended dose, in the presence of hypertension, and when other sympathomimetic drugs are being taken.
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PMID:Phenylpropanolamine and caffeine use among diet center clients. 222 92

A large proportion of hypertensive men and women in Europe and North America are overweight. In obesity, the expanded blood volume increases cardiopulmonary volume, cardiac filling, left ventricular preload, stroke volume and, thereby, left ventricular work. Given enough exposure time, it is probable that all obese persons in the Western hemisphere would become hypertensive unless they succumb to competing causes of death. A postulated causal role of obesity in hypertension is based on epidemiological observations. In prospective studies weight gainers in adolescence are more often hypertensive than weight stable individuals. In the lower socio-economic strata of industrialized countries there is a higher prevalence of obesity and hypertension. Persons with high body weight show the greatest rise of BP with age. More relevant demonstration of a causal relationship is weight reduction in hypertensive patients. The evidence from a variety of sources, a) risk factor reduction and enhanced BP reduction in the Hypertension Detection and Follow-up Program patients on antihypertensive medication who experienced modest weight loss, b) clinical observations of formerly obese hypertensives who can forego BP lowering drugs, and c) the reversibility of haemodynamic change found in many overweight hypertensive patients after losing 10 kg, strongly suggests that the impact of obesity on hypertension is considerable.
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PMID:Obesity and hypertension: epidemiological aspects of the relationship. 225 90


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