Views of hypertension among young African Americans who vary in their risk of developing hypertension.

OBJECTIVES: To describe beliefs about hypertension and health education of young African American adults varying in their hypertension risk status. DESIGN: Fifty-eight African American young adults (17-20 years) were selected based on low and high risk criteria for hypertension assessed in earlier investigations of hemodynamic responses to stress. The sample included 15 high risk males, 13 low risk males, 14 high risk females, and 16 low risk females who were interviewed indepth about their hypertension beliefs and health education experiences. Variable-based matrices identified participants with similar responses. RESULTS: Overall, participants had a limited understanding of hypertension. For example, they linked the condition to eating a diet high in pork and fat and having a positive family history of hypertension with little acknowledgement of weight, smoking, race and sex as key contributors to hypertension onset. Distinctions were found between risk categories and along sex lines. Most high risk participants believed stress could cause hypertension. High risk females believed that they were at risk for developing hypertension but lacked prevention strategies. High risk males were generally uninformed about risk or prevention. More low risk females believed in prevention compared to few low risk males. Participants reported little formal health education about hypertension and recommended that hypertension education be improved through more effective and relevant approaches in high school health education classes. CONCLUSIONS: These findings support the need for comprehensive and revitalized hypertension prevention programs for young African Americans. Participant views varied with hypertension risk status and gender suggesting that targeted educational efforts should reflect these differences.

A 4-day sodium-controlled diet reduces variability of overnight sodium excretion in free-living normotensive adolescents.

The present analysis examined changes in the variability of overnight sodium excretion in 84 free-living adolescents (ages 15 to 19 years) on a 4-day sodium-controlled diet in which foods provided were selected by adolescents from an extensive list of menu items. The only selection criterion imposed was that foods selected for each day contain 4,000+/-200 mg sodium. Adolescents collected overnight urine samples. Repeated measures analysis of variance tested the effect of diet day on overnight sodium excretion, overnight urinary sodium concentration, and overnight urinary volume. Variance ratio test evaluated changes in overnight sodium excretion variance across days. Day 4 overnight sodium excretion was statistically lower than days 1 to 3 (1.84 vs 6.54, 5.94, and 5.52 mEq/h [1.84 vs 6.54, 5.94, and 5.52 mmol/h]). Day 4 overnight urinary sodium concentration was lower than days 1 to 3 (32.16 vs 119.64, 109.61, and 111.32 mEq/L [32.16 vs 119.64, 109.61, and 111.32 mmol/L]). The variance of overnight sodium excretion from day 1 to day 4 was reduced 10-fold from 20.1 mEq/h (20.1 mmol/h) to 1.90 mEq/h (1.90 mmol/h). Daily overnight urine volumes remained constant, averaging 451.7 mL/day. The dietary protocol successfully reduced the variability of sodium intake as estimated by overnight sodium excretion in free-living adolescents. The protocol could be expanded to include baseline values, additional days of sodium control, and varying levels of dietary sodium intake.

Association of ambulatory blood pressure and dietary caffeine in adolescents.

BACKGROUND: Although relatively little is known about the responsible factors, there is an increased prevalence of essential hypertension in youth. Our previous research using casual blood pressure (BP) suggests a role for caffeine intake. The objective of this study was to assess the association between caffeine intake and ambulatory BP patterns among adolescents and to replicate our previous findings that compared caffeine intake to BP values obtained at a single time point. METHODS: Eighty-two African-American and non-Hispanic white adolescents (15 to 19 years old) with normal systolic BP selected foods and beverages for a 4-day sodium-controlled diet. Subjects were stratified into three groups based on the amount of caffeine in these foods. Ambulatory BP measures (24-h) were recorded during 1 day of the 4-day diet. The effects of ethnicity, caffeine, and the interaction of ethnicity and caffeine on BP were assessed for daytime and nighttime hours controlling for gender and body mass index. RESULTS: The level of dietary caffeine was positively associated with daytime systolic BP (F(2,76) = 3.1, P = .05, partial R(2) = 0.07) and daytime diastolic BP (F = 3.53(2,76), P = .03, partial R(2) = 0.07). Caffeine's effect on systolic BP was most pronounced for African-American subjects. These results replicated our earlier findings. There was no association between caffeine intake and nighttime BP. CONCLUSIONS: This investigation replicates and extends our previous findings that caffeine consumption impacts the BP of adolescents, during the daytime when sympathetic nervous system responses dominate BP control. Controlled studies that examine the pressor effects of caffeine intake at levels typical of the dietary patterns of today's adolescents are needed.

The association of caffeinated beverages with blood pressure in adolescents.

OBJECTIVE: To assess the association between the consumption of caffeinated beverages and blood pressure in African American and white adolescents. DESIGN: This study was part of ongoing research examining stress-induced hemodynamic responses in adolescents. African American and white adolescents (n = 159) selected foods and beverages for a 3-day sodium-controlled diet. Caffeine in these foods was used to stratify participants into 3 categories (0-50 mg/d, >50-100 mg/d, and >100 mg/d). Before menu selection, blood pressure readings were obtained. STATISTICAL ANALYSIS: A general linear model (multiple regression with both categorical and continuous variables) was developed to assess the effects of race, category of caffeine intake, and interaction of race and caffeine intake on systolic and diastolic blood pressure controlling for sex and body mass index (calculated as weight in kilograms divided by height in meters squared). RESULTS: The association between systolic blood pressure and caffeine category varied by race (P =.001). African Americans consuming more than 100 mg/d of caffeine had higher systolic blood pressure readings than the groups consuming 0 to 50 mg/d (mean difference, 6.0 mm Hg; 95% confidence interval [CI], 2.3 to 9.7) or more than 50 to 100 mg/d (mean difference, 7.1 mm Hg; 95% CI, 3.4 to 10.7). The effect on diastolic blood pressure was less pronounced (P =.08). The diastolic blood pressure of the group consuming more than 100 mg/d was 3.7 mm Hg (95% CI, 0.41 to 7.0) higher than the group consuming more than 50 to 100 mg/d and was not statistically different from the group consuming 0 to 50 mg/d (mean difference, 2.4 mm Hg; 95% CI, -0.9 to 5.8). There was no evidence that the association between diastolic blood pressure and caffeine intake varied by race (P =.80). CONCLUSIONS: For adolescents, especially African American adolescents, caffeine intake may increase blood pressure and thereby increase the risk of hypertension. Alternatively, caffeinated drink consumption may be a marker for dietary and lifestyle practices that together influence blood pressure. Additional research is needed owing to rising rates of adolescent hypertension and soft drink consumption.