Headache in patients with mild to moderate hypertension is generally not associated with simultaneous blood pressure elevation.

OBJECTIVE: Although headache is regarded a symptom of hypertension, its relation to blood pressure, especially in mild and moderate hypertension, is not clear. Thus, the aim of the study was to investigate whether headache in patients with mild to moderate hypertension may be attributed to simultaneous elevations in blood pressure. DESIGN AND METHODS: Ambulatory blood pressure monitoring (ABPM) was performed in patients (mean age 48 +/- 10 years, n = 150, 92 men, 58 women) classified, according to their office blood pressure, as stage 1 -2 hypertensives (JNC VI). Headache periods were recorded in patients' diaries. RESULTS: Headaches were generally not directly associated with blood pressure elevations in the studied group of stage 1-2 hypertensive patients because (i) blood pressure values from headache periods were not significantly higher than those from headache-free periods; (ii) blood pressure values directly preceding the pain were not significantly different from values at the beginning of headache; and (iii) in the vast majority of hypertensives, their maximal blood pressure values were recorded during headache-free periods. Moreover, in some instances, patients who showed maximal ABPM values during headache had relatively high blood pressure, i.e. > or = 180/110 mmHg. CONCLUSIONS: Our results did not support the opinion that headache experienced by stage 1-2 hypertensives was generally caused by simultaneous elevation in blood pressure. The direct mechanisms of headache in hypertension, as well as the relation between increments in blood pressure above 180/110 mmHg and headache, need further investigations.

Heritability of plasma leptin levels: a twin study.

OBJECTIVE: To examine the influence of genetic factors on plasma leptin levels. SUBJECTS AND METHODS: We measured plasma leptin levels, body mass index and body fat distribution in healthy young female monozygotic (n = 19) and dizygotic (n = 14) twins. The twin zygosity was verified by determination of short tandem repeat and amplified fragment length polymorphism systems. The genetic analysis included analysis of variance-based and maximum likelihood-based methods. RESULTS: Plasma leptin levels were correlated significantly with body mass index (r = 0.59, P < 0.001), waist circumference (r = 0.54, P < 0.001) and hip circumference (r = 0.63, P < 0.001), but not with age (r = -0.17) or the waist:hip ratio (r = 0.02). The heritability estimates derived from intraclass correlations were significant for body mass index (P = 0.001), waist circumference (P = 0.004), hip circumference (P = 0.01) and plasma leptin levels (P = 0.005), but not for the waist:hip ratio (P = 0.22). In the maximum likelihood-based path analysis, heritability was estimated at 79% for body mass index and at 73% for plasma leptin levels. After adjustment for body mass index, the heritability estimate for leptin levels from the model-fitting approach was 55%. CONCLUSIONS: Genetic factors are major determinants of plasma leptin levels in humans and may account for as much as half of the variance in leptin levels.

No effect of genetic variation at the angiotensinogen locus on ambulatory blood pressure level in normotensive subjects.

The aim of the study was to evaluate the potential association between ambulatory blood pressure and the molecular variants T174M and M235T of the angiotensinogen gene in a random sample of young normotensive men (n = 145). The two point mutations were detected using restriction digests of a mispairing polymerase chain reaction product. Twenty-four-hour ambulatory blood pressure monitoring was performed with a SpaceLabs 90207 device. Ambulatory blood pressure levels did not vary according to T174M and M235T genotypes. When the subjects were grouped according to their blood pressure level (as indicated by tertiles of their 24-h ambulatory blood pressure), no significant differences in allele frequencies between the three groups were found. Our results indicate that the T174M and M235T molecular variants of the angiotensinogen gene have no major influence on ambulatory blood pressure in young normotensive subjects.

Genetic influences on insulinemia in normotensive twins.

The aim of this study was to establish the contribution of genetic factors to the variance of plasma insulin concentration in healthy, normotensive twins. Seventeen pairs of monozygotic (MZ) and 17 pairs of dizygotic (DZ) twins were investigated. The test of genetic variance revealed a significantly larger within-pair variance of fasting plasma insulin (FPI) and a relative insulin resistance (RIR) in the DZ twins, in comparison with the MZ twins. Both FPI and RIR had a higher intraclass correlation coefficient in the MZ twins than in the DZ twins; the corresponding heritability estimates were 0.54 for FPI and 0.66 for RIR. Adjusting for age, gender, and body mass index did not affect heritability estimates for either FPI or RIR. Our data indicate that genetic factors are important determinants of insulinemia in normal subjects, independent of body mass index.

Awareness and treatment of arterial hypertension in Poland.

In order to find out the general public's opinion on blood pressure (BP) control in Poland a poll was conducted on a representative sample of 2080 randomly selected subjects. Overall 71% of the subjects were aware of their BP level. The awareness of BP level increased progressively with age and education level. Among those who were aware of their BP level, 21% had hypertension. Only 43% of hypertensives were treated on a regular basis. Cigarettes were smoked by 33% of the patients. Only 16% of the hypertensives used a low-salt diet, and only 31% tried to reduce animal fat in their diet. More than a half of the hypertensives did not adjust their lifestyle and daily habits to the disease. In conclusion, these results indicate that the prevention and treatment of hypertension in Poland should be urgently improved.

Have rapid socioeconomic changes influenced awareness of blood pressure in Poland?

The aim of our study was to evaluate changes in awareness of blood pressure during transition into a market economy in Poland. Thus, in 1994, we conducted a cross-sectional survey based on a questionnaire interview on a sample of 2080 men (M) and women (F) aged 18 years and over. The subjects were selected from a Polish population by stratified and cluster random sampling with quotas by the Center for Social Research in Sopot. They were asked if they were aware of blood pressure. The results were analysed according to age, sex, education level, income and place of living. In September 1997 we carried out the same investigation on a new group of 1664 adults. In addition to the questionnaire, the blood pressure (three recordings at home) measurements were completed. The interviewers were well-trained medical students. Awareness of blood pressure has declined (P < 0.001) from 71% in 1994 to 65.5% in 1997. The highest decrease in awareness of blood pressure was observed among less educated people, as well as among people living in smaller cities and villages. The overall prevalence of hypertension was 25.9% by 'older' WHO criteria (BP > or =160/95 mm Hg or taking antihypertensive medication) and 44.5% by JNC VI criteria (BP > or =140/90 mm Hg or taking antihypertensive medication). Forty-six percent of hypertensive subjects classified by JNC VI criteria were previously known to be hypertensives and 54% were newly detected (F: 39%, M: 69%). Low awareness of blood pressure in Poland is the crucial factor of insufficient detectability of hypertension. Decline of awareness of blood pressure being the most significant among people representing lower social status, emphasises the need for urgent preventive measures.

Arterial hypertension in Poland in 2002.

Arterial hypertension represents a serious medical, social and economic problem in Poland. Owing to a small number of studies concerning HT epidemiology in Poland and large differences in methodology, it is difficult to make an objective verification of the changes regarding principal parameters in our country within the last decade. Important programme for the assessment of the situation in our country is NATPOL PLUS, carried out in the year 2002 on a representative sample of 3051 adult Polish residents aged between 18 and 93 years, using the current diagnostic criteria for arterial hypertension (blood pressure readings obtained at three separate visits in cases of newly detected HT, different cuff sizes for different arm circumference, age range 18-93 years, rejection of first measurement during initial screening visit). Prevalence of HT in Poland is 29%, awareness-67%, and effectiveness of treatment-12%. This means that while HT affects about 8.4 million adult Poles, only 1 million of them get effective treatment. Moreover, as much as 8.7 million Poles have high normal blood pressure and they should apply active prevention. The awareness, detection and control of hypertension is much worse in men than in women. A series of NATPOL studies indicated over the period 1994-2002 a significant and rapid decrease in the awareness of one's own blood pressure among the adult Polish population, especially in small towns and villages, among less educated people, and in males.

The influence of exercise on albumin excretion rate in borderline hypertensives and in offspring of hypertensive parents.

We investigated exercise induced urinary albumin excretion rate (UAE)(ex-UAE) in patients with borderline hypertension (BH) compared to normotensives with positive-PFH and negative-NFH family history of hypertension. The study population consisted of 20 young, non-obese males with BH defined according to WHO criteria and confirmed by 24 h ambulatory blood pressure (ABP) and 40 healthy matched normotensives (PFH = 20 and NFH = 20). Twenty-four hour UAE was assessed by day and night time urine collection. BH and normotensive subjects performed a 20 min ergometric graded exercise test. The relationship between 24 h UAE, 24 h ABP and 2-D-echocardiographic left ventricular mass index (LVMI) were examined. The three groups did not differ in 24 h UAE. Exercise induced a significant increase in UAE only in BH. Exercise induced UAE was greater in BH compared to normotensives: BH = 54.3(21-125), PFH = 37.6(13-62), NFH = 9.7(0-35)micrograms/min, data expressed as median (I quartile-III quartile). Pooled data from all three groups showed a positive correlation between ex-UAE and systolic BP (SBP) during night time (by multiple regression analysis). In conclusion, BH without other known cardiovascular risk factors, moderate dynamic exercise induced an excessive increase in UAE.

Renin-aldosterone regulation during upright posture in young men with mitral valve prolapse syndrome.

Previous studies have shown that symptom complex in patients with mitral valve prolapse syndrome (MVPS) may result from various forms of autonomic dysfunction. However, the interaction between adrenergic activity and renin release has not been studied. The purpose of this investigation was to assess changes in plasma renin activity (PRA) and plasma aldosterone in response to prolonged orthostatic stimulation in 19 young men with MVPS when compared to age- and sex-matched 20 control subjects. Heart rate was measured, and blood samples for PRA and aldosterone were obtained in the supine position and 90 min after assuming an upright position and slow walk. With posture the heart rate increase was greater in patients with MVPS in comparison with control subjects (19 +/- 9 vs. 12 +/- 8 beats per min, p < 0.05). Also an increase of PRA during upright activity was significantly greater in patients with MVPS (control 1.0 +/- 0.5 ng angiotensin I/mlxh, MVPS 1.8 +/- 1.7 ng angiotensin I/mlxh; p < 0.05). A significant correlation (r = 0.52, p < 0.05) was found between a rise of heart rate and PRA in patients with MVPS, but not in the control subjects. During prolonged upright activity aldosterone increased significantly in control subjects (at rest 74 +/- 41 pg/ml, with posture 98 +/- 68 pg/ml, p < 0.05) but did not change in patients with MVPS (at rest 64 +/- 29 pg/ml, with posture 67 +/- 26 pg/ml, NS).(ABSTRACT TRUNCATED AT 250 WORDS)

[Spectrum analysis of heart rate. A method of studying the role of the autonomic nervous system in the regulation of blood circulation]. / Analiza widma czestosci akcji serca. Metoda badania udzialu ukladu autonomicznego w regulacji krazenia.

Spectral analysis of heart rate variability has recently been shown to be a reliable noninvasive test for quantitative assessment of cardiovascular automatic regulatory responses. In 12 ambulant normotensive healthy young males (mean age 23 +/- 1 years) after a period of 10 min. for stabilisation, a continuous ecg recording (lead CM-5) for 8 min. was obtained in the supine and standing position, with a controlled respiration rate 15/min. Power spectrum of 512 point time series (R-R intervals) in both positions was calculated using a fast Fourier transform-based window periodogram method. Based upon results from the literature the power spectrum analysis was performed on two components: low frequency LF (0.05-0.15 Hz) and high frequency HF (0.15-0.50 Hz). Mean R-R interval decreased on standing position from 0.79 +/- 0.10 s to 0.59 +/- 0.11 s (p less than 0.001). The ratio HF/LF in supine was 0.63 +/- 0.70 and on standing position 2.54 +/- 0.73 (p less than 0.001). The relative LF component of the total HR power spectrum increased from 22.8% +/- 12.1% to 42.9 +/- 14.4% (p less than 0.001) after changing the position from supine to standing, and the relative HF component decreased from 56.3 +/- 22.4% to 25.5 +/- 16.2 (p less than 0.001). The total power was significantly lower when standing in comparison to supine position (681 +/- 519 s2, 1188 +/- 963 s2 respectively, p less than 0.05). Our results suggest that heart rate fluctuations in supine position in normal men are mainly vagally determined (HF power spectrum component).(ABSTRACT TRUNCATED AT 250 WORDS)

[Effects of isometric exercise on left ventricular function assessed with polycardiography in patients with early type I diabetes]. / Wplyw wysilku izometrycznego na czynnosc lewej komory serca oceniana metoda polikardiograficzna u chorych z krótkotrwajaca cukrzyca typu I.

15 patients with controlled type 1 diabetes lasting up to 24 months underwent the study. The control group consisted of 22 healthy men. Noninvasive examinations were carried out at rest and during a 3-minute isometric exercise of a load equal to 30% maximal effort. Rest systolic and diastolic blood pressures (SBP and DBP) were almost the same in both groups. Also exercise peak SBP and DBP did not significantly differ in examined groups. Rest PEP/LVET ratio were significantly lower in diabetics (means = 0.313 vs means = 0.348 in the control group; p less than 0.002). Peak isometric exercise PEP/LVET ratio significantly increased to 0.333 in diabetics, comparing with its rest value, whereas significantly decreased to 0.333 in the control group. Results indicate increased resting left ventricular contractility in patients with early, type 1 diabetes and impairment of a left ventricular adaptation for the isometric exercise in comparison with the control group.

[Echocardiographic assessment of left ventricular function in patients with early type I diabetes]. / Echokardiograficzna ocena funkcji lewej komory serca u pacjentów z wczesna cukrzyca typu I.

M-mode, resting echocardiographic examination has been performed under 2-D control in 19 patients (mean age-26 years) with controlled, type 1 diabetes lasting up to 2 years (D group). The control group (C) consisted of 20 healthy men (average age-25 yrs). Greater cardiac index has been stated in D group (p less than 0.05). Left ventricular systolic function parameters such as: ejection fraction, percentage of fractional shortening and a mean rate of circumferential shortening indicate greater contractility in D patients. Left ventricular mass also has been significantly greater (p less than 0.04) and the total peripheral resistance significantly lowered (p less than 0.05) in the D group. Stated alterations in left ventricular function and structure are probably due to adaptation for increased peripheral flow.

[Autonomic regulation of the circulatory system in early type I diabetes]. / Odruchowa regulacja ukladu krazenia w krótkotrwajacej cukrzycy typu I.

In the group of 16 men with controlled, type I diabetes lasting up to 24 months, simple tests for assessment of autonomic regulation of the circulatory system such as a deep breathing test, Valsalva's manoeuvre and a tilt trial have been performed. Variations of systolic and diastolic blood pressures as well as heart rate have been studied. The control group consisted of 22 young, healthy men. Rest heart rate has been significantly increased prior the all tests but its alterations during deep breathing have been significantly decreased in diabetics (EM index mean = 1.44 vs 1.74 in the control group; p less than 0.01). Also Valsalva's index has been significantly increased in them (1.67 vs 1.42; p less than 0.02). Significant reduction of a delay index at the early tilt test period has been stated in diabetics (1.31 vs 1.57; p less than 0.01) as well as significant lowering of diastolic blood pressure in 1st and 5th minute of a tilt test. Performed tests indicate that even short duration of diabetes changes the autonomic regulation of the circulatory system due to inequality of para- and sympathetic system tones and/or the early autonomic neuropathy.

[Circadian rhythm of blood pressure and heart rate in hypertension with type 2 diabetes mellitus]. / Rytm dobowy cisnienia tetniczego i tetna w nadcisnieniu tetniczym i curkzycy typu 2.

Hypertension is an important risk factor for cardiovascular complications of diabetes. Most of the studies performed in diabetics so far, however, have dealt with the assessment of blood pressure by traditional sphygmomanometry. In order to investigate the circadian pattern of blood pressure and heart rate in patients with different categories of glucose tolerance, we performed ambulatory blood pressure monitoring in 28 obese hypertensives without clinical nephropathy divided in two groups. Group A consisted of 14 hypertensive males with type 2 diabetes mellitus (mean age 49.7 +/- 7.1 years, mean duration of diabetes 4.0 +/- 2.9 years); group B consisted of 14 hypertensive males with normal glucose tolerance according to National Diabetes Data Group (mean age 47.2 +/- 7.1 years). There was no significant difference in casual blood pressure (151.4/104.8 in group A versus 148.5/104.2 mmHg in group B). Ambulatory blood pressure monitoring revealed significantly higher systolic blood pressure in group A during the day (162.2 +/- 12.1 vs 152.1 +/- 9.0 mmHg in group B, P < 0.05) and at night (141.0 +/- 13.2 vs 125.5 +/- 12.5 mmHg in group B, P < 0.005). That suggests that casual readings underestimate systolic blood pressure as a predictor for macrovascular events in type 2 diabetics. The decline in nocturnal heart rate was significantly lower in group A (11.2 +/- 5.2 min-1) in comparison to group B (16.9 +/- 7.0 min-1; P < 0.05) suggesting reduced parasympathetic tone at night in diabetic patients. We conclude that type 2 diabetes has significant influence on systolic blood pressure and heart rate 24-h profiles even in patients without diabetic nephropathy.

[Evaluation of mental status of patients with diabetes mellitus type 1 in relation to the duration of the illness]. / Ocena stanu psychicznego chorych na cukrzyce typu I z uwzglednieniem czasu trwania choroby.

Personality features of 38 men (mean age 31 +/- 7 years) with the diagnosis of the type I diabetes mellitus and 23 healthy subjects of similar age were assessed by MMPI. Diabetics in addition were examined by means the Potential Intelligence Test (TPI). MMPI profiles of three groups of the examines were significantly different and suggested that the circumstances of diabetes mellitus type I and the duration of the disease could be responsible for the changes in the mental state of the patients.

[The application of hemodynamic examination in psychiatry]. / Zastosowanie i perspektywy badan hemodynamiczynch w psychiatrii.

The authors discuss the most modern non-invasive methods for the examination of the circulatory system and consider the opportunity of their application in psychiatry. They refer to the results of their earlier studies on the some selected parameters of the circulatory system by means of radiocardiography i.e. Total Peripheral Resistance Index (TPRI), Heart Rate (HR), Arterial Blood Pressure (AP) and the Stroke Index (SI). It follows from the results that such examinations are appropriate mainly in patients with endogenous depression and may contribute to an increased safety factor in the treatment with tricyclic antidepressants. Among the methods which could contribute to the better evaluation of the state of the circulatory system (especially on contraction in the left ventricle of the heart and peripheral resistance) in depressive patients, phonocardiography, mechanocardiography and Doppler echo sounding cardiography are enumerated. Haemodynamic examinations turned out to be useful in predictions of the somatic tolerance of tricyclic antidepressants and to be helpful in understanding the reason for several complains involving the circulatory system in patients with endogenous depression. Two groups of patients: psychomotorically retarded and excited (with high intensity of anxiety) who differ from each other in the haemodynamic parameters are discriminated. This paper points out the necessity for the control of the circulatory system in these patients by means of modern non-invasive methods and is in agreement with the holistic attitude towards a patient.

[The influence of 5-week relaxation therapy on arterial blood pressure in patients with borderline hypertension]. / Wplyw 5-tygodniowej terapii relaksacyjnej na wysokosc cisnienia tetniczego u chorych na nadcisnienie tetnicze graniczne.

The present study was performed to evaluate the influence of 5-week relaxation therapy on office and ambulatory blood pressure in young borderline hypertensives. Thirty patients were studied. The office blood pressure decreased significantly after 5 weeks of relaxation therapy (P < 0.001 for both systolic and diastolic blood pressure). Ambulatory monitoring revealed only a slight decrease of 24-hour blood pressure (P = 0.02). Our results indicate limited efficacy of relaxation therapy in treatment of borderline hypertensives.

[The influence of 5-week relaxation therapy on psychological state of patients with borderline hypertension]. / Ocena wplywu 5-tygodniowej terapii relaksacyjnej na stan psychiczny chorych na nadcisnienie tetnicze graniczne.

The aim of the present was to evaluate the influence of 5-week relaxation therapy on psychic state of patients with borderline hypertension. The study group consisted of 30 hypertensives. We observed significant changes in anxiety scale, defensiveness, self-confidence, intraception, nurturance, affiliation, heterosexuality, change and succorance scales. In conclusion, 5-week relaxation changes significantly psychological status of patients with borderline hypertension.

[Clinical analysis of 10 cases of primary hyperaldosteronism]. / Analiza kliniczna 10 przypadków pierwotnego hiperaldosteronizmu.

The problems of diagnosis of primary hyperaldosteronism are described calling attention to a significant advance in the methods of localization diagnosis owing to the introduction of computed tomography of the adrenals.

Regression of left ventricular hypertrophy in hypertensive patients after 1 year of treatment with rilmenidine: a double-blind, randomized, controlled (versus nifedipine) study.

OBJECTIVE: To assess the effect of 1-year treatment with rilmenidine, an oxazoline compound that exerts its antihypertensive effects through binding to imidazoline receptors in the brainstem, on left ventricular hypertrophy (LVH) secondary to essential, mild-to-moderate hypertension [supine diastolic blood pressure (DBP)95-115 mmHg]. METHODS: We performed a double-blind, randomized, controlled (versus slow-release nifedipine) trial. Adjustment of treatment took place every month (M) between inclusion (MO) and an evaluation after 6 months (M6), then during M9 and after 1 year (M12) to achieve supine DBP values < or = 90 mmHg. Patients were dropped from our study if they had DBP> 95mmHg during two consecutive visits or DBP>115 mmHg on one occasion. The daily dosage of rilmenidine was 1 mg, and could be increased to 2 mg/day. The daily dosage of slow-release nifedipine was started from the beginning at the maximum dosage of 40 mg/day, so that there was no true adjustment of treatment despite the allocation of patients to a different unit in the case of DBP> 95 mmHg. The primary criterion was the change in left ventricular mass index (LVMI, g/m2), assessed by echocardiography, between MO and M12 for patients who completed the trial. RESULTS: After a 1-month placebo run-in period, 76 patients were selected and 73 were included (35 treated with rilmenidine and 38 treated with nifedipine). Fifteen patients withdrew from the study and two completed the study with a major deviation from protocol, leaving 56 patients (24 treated with rilmenidine and 32 treated with nifedipine) for a per-protocol analysis. Baseline demographic characteristics and history of arterial hypertension for the rilmenidine and nifedipine groups were similar, for included patients and for those taken into account for the per-protocol analysis. Between MO and M12, DBP in members of the per-protocol population was adequately controlled for those in the rilmenidine group (102.7+/-4.6 versus 88.5+/-7.1 mmHg, respectively) and for those in the nifedipine group (102.7+/-5.1 versus 85.6+/-79 mmHg, respectively). During MO, LVMI of patients in the rilmenidine group (176.9+/-41.3 g/m2) was slightly higher than that of patients in the nifedipine group (172.6+/-35.1 g/m2). During M12, LVMI was observed to have decreased both for patients in the rilmenidine group (to 154.8+/-40.2 g/m2, a decrease of 22.1+/-23.3 g/m2, P< 0.001) and for those in the nifedipine group (to 145.6+/-36.4 g/m2, a decrease of 26.9+/-29.5 g/m2, P< 0.001) but the difference between these two groups was not significant (P= 0.5). CONCLUSION: One-year treatment with a daily dosage of 1 or 2 mg rilmenidine achieves a significant reduction of left ventricular mass, which is not statistically different than that occurring with a daily dosage of 40 mg of slow-release nifedipine.