Unsupervised hierarchical clustering identifies a metabolically challenged subgroup of hypertensive individuals.

The current classification of hypertension does not reflect the heterogeneity in characteristics or cardiovascular outcomes of hypertensive individuals. Our objective was to identify distinct phenotypes of hypertensive individuals with potentially different cardiovascular risk profiles using data-driven cluster analysis. We performed clustering, a procedure that identifies groups with similar characteristics, in 3726 individuals (mean age 59.4 years, 49% women) with grade 2 hypertension (blood pressure ≥160/100 mmHg or antihypertensive medication) selected from FINRISK 1997, 2002, and 2007 cohorts. We computed clusters based on eight factors associated with hypertension: mean arterial pressure, pulse pressure, non-high-density lipoprotein cholesterol, blood glucose, BMI, C-reactive protein, estimated glomerular filtration rate, and alcohol. After that, we used Cox regression models adjusted for age and sex to assess the relative risk of cardiovascular disease (CVD) outcomes between the clusters and a reference group of 11 020 individuals. We observed two comparable clusters in both men and women. The Metabolically Challenged (MC) cluster was characterized by high blood glucose (Z-score 4.4 ± 1.1 vs 0.2 ± 0.8, men; 3.5 ± 1.1 vs 0.0 ± 0.6, women) and elevated BMI (30.4 ± 4.1 vs 28.9 ± 4.3, men; 32.7 ± 4.9 vs 29.3 ± 5.5, women). Over a 10-year follow-up (1034 CVD events), MC had 1.6-fold (95% CI 1.1-2.4) CVD risk compared to non-MC and 2.5-fold (95% CI 1.7-3.7) CVD risk compared to the reference group (P ≤ .009 for both). Using unsupervised hierarchical clustering, we found two phenotypically distinct hypertension subgroups with different risks of CVD complications. This substratification could be used to design studies that explore the differential effects of antihypertensive therapies among subgroups of hypertensive individuals.

Home versus office blood pressure: longitudinal relations with left ventricular hypertrophy: the Finn-Home study.

OBJECTIVES: Electrocardiographically assessed left-ventricular hypertrophy (ECG-LVH) is a particularly high-risk phenomenon that is a part of every hypertensive patient's initial work-up. Several cross-sectional studies have demonstrated that home blood pressure (BP) has a stronger relation to LVH than office BP. However, longitudinal evidence on the association between home BP and target organ damage is scarce to nonexistent. METHODS: We studied in a sample of 615 community-dwelling participants (mean age at baseline 53.7 ±â€Š7.2, 58% women) whether change in home BP is more strongly associated with change in ECG-LVH than change in office BP over an 11-year follow-up. RESULTS: Pearson's correlation coefficients between changes in home/office SBP and changes in Sokolow-Lyon index, Cornell voltage, Cornell product and R wave amplitude in aVL were 0.21/0.18, 0.28/0.17, 0.25/0.16, and 0.32/0.20, respectively (asterisk indicates P < 0.05 for between-method difference in correlations with Steiger's z test). For change in home/office DBP and change in the aforementioned ECG-LVH indexes, the correlations were 0.12/0.12, 0.20/0.15, 0.16/0.12, and 0.28/0.19. Multivariable-adjusted regression modelling provided similar results. No clinically significant increase in correlations between home BP and ECG-LVH indexes occurred after the fourth day of home BP measurement. CONCLUSION: Our study demonstrates for the first time the superiority of home BP over office BP in the follow-up of left ventricular mass. The results of this and previous studies underline the importance of using out-of-office BP measurements as the primary method for assessing blood pressure levels.

White-coat and masked hypertension as risk factors for progression to sustained hypertension: the Finn-Home study.

OBJECTIVES: To assess the risk of progression from white-coat hypertension (WCHT) and masked hypertension (MHT) to sustained hypertension (SHT) in a nationwide unselected population sample. METHODS: Both office and home blood pressure (BP), along with other cardiovascular risk factors, were measured in an unselected population sample of 944 participants in 2000 and 2011. We compared the risk of progression to SHT (office BP ≥140/90 mmHg and home BP ≥135/85 mmHg or start of treatment with antihypertensive medication) between 528 participants with normotension (office BP <140/90 mmHg and home BP <135/85 mmHg), 142 participants with WCHT (office BP ≥140/90 mmHg and home BP < 135/85 mmHg), and 63 participants with MHT (office BP < 140/90 mmHg and home BP ≥135/85 mmHg) at baseline. We used the χ test and a multivariable-adjusted log-binomial regression model to evaluate the association between baseline BP categories and incident SHT. RESULTS: During an 11-year follow-up, the rate of progression to SHT increased from normotension (18%) to WCHT (52%) and MHT (73%), P < 0.0001. Progression to SHT became more likely with an increasing baseline home BP category (Ptrend < 0.0001). The multivariable-adjusted relative risks (95% confidence interval) for developing SHT, as compared with normotension, were 2.8 (2.2-3.6, P < 0.0001) for WCHT and 3.8 (2.9-5.0, P < 0.0001) for MHT. CONCLUSIONS: Persons with WCHT and MHT have a three to four-fold risk for developing SHT than those with NT and could benefit from active follow-up and lifestyle counselling.

Adding a low-dose antihypertensive regimen would substantially improve the control of hypertension and reduce cardiovascular morbidity among uncomplicated hypertensive patients.

AIMS: To assess the utilization of antihypertensive drugs among uncomplicated hypertensive patients in Finland between 2000 and 2006 and to calculate the achievable reduction in cardiovascular morbidity, with intensified antihypertensive treatment. METHODS: From the databases of the Social Insurance Institution of Finland, 428,986 treated hypertensives without diabetes or cardiac disease (further named uncomplicated hypertensives) in 2000 and 591,206 in 2006, respectively, were identified. In addition, from the Health 2000 survey representing the whole Finnish adult population, 729 uncomplicated hypertensives were determined to assess their characteristics and control of hypertension. Applying Law's meta-analyses we calculated the reduction of blood pressure (BP) by intensifying the treatment with low-dose antihypertensive regimens for those with a BP ≥140/90 mmHg. RESULTS: The nationwide data suggests a relative overuse of beta-blockers. Combination antihypertensive treatment increased relatively 8%, while at least three drug combinations increased from 19.8% to 21.6% between 2000 and 2006. However, calculated prevalence of controlled BP (<140/90 mmHg) increased only from 30.3% to 33.9%. Addition of one half standard dose or one to two half standard doses for the treatment of the patients with a BP ≥140/90 mmHg would improve the control of hypertension from 33.9% to 47.8% and 67.3%, respectively. The intensified treatment would reduce strokes by 18% and 28%, and ischaemic heart disease events by 13% and 21%, respectively. CONCLUSIONS: Underutilization of preferred drugs and poor control of BP continues. Surprisingly small addition of the number of low-dose antihypertensive regimen is needed in order to substantially improve the control of hypertension and to decrease cardiovascular morbidity among uncomplicated hypertensive patients.

Estimating glomerular filtration rate in hypertensive subjects: comparison of the chronic kidney disease epidemiology collaboration (CKD-EPI) and modification of diet in renal disease (MDRD) study equations.

BACKGROUND: The Modification of Diet in Renal Disease (MDRD) Study equation is the most commonly used formula for estimation of glomerular filtration rate (eGFR). Recently, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) developed a new equation to provide a more accurate estimate of GFR among individuals with normal or mildly reduced renal function. AIM: To compare the MDRD and CKD-EPI equations in hypertensive population treated in general practice. METHODS: The MDRD and CKD-EPI equations were applied to a cohort of 994 hypertensive subjects aged 45-70 years without cardiovascular or renal disease or previously known diabetes. RESULTS: The prevalence of CKD stage 3 (eGFR 30-59 mL/min per 1.73 m(2)) was 6.7% (95% CI 5.3-8.5) (67/994) according to the MDRD formula and 3.7% (95% CI 2.6-5.1) (37/994) according to the CKD-EPI formula. Of the 67 subjects classified as having CKD stage 3 according to the MDRD equation, 30 (44.8%) were reclassified as 'no-CKD' by the CKD-EPI equation. These subjects were mostly women 26/30 (87.7%). CONCLUSION: Using the CKD-EPI equation leads to lower prevalence estimates for CKD than the MDRD equation in a hypertensive population treated in general practice.

Cardiopulmonary involvement in Fabry's disease.

BACKGROUND: Fabry's disease is an X-linked lysosomal storage disease caused by deficiency of alpha-galactosidase A enzyme activity. Decreased enzyme activity leads to accumulation of glycosphingolipid in different tissues, including endothelial and smooth-muscle cells and cardiomyocytes. OBJECTIVES: There is controversial data on cardiopulmonary involvement in Fabry's disease, because many reports are based on small and selected populations with Fabry's disease. Furthermore, the aetiology of cardiopulmonary symptoms in Fabry's disease is poorly understood. METHODS: We studied cardiopulmonary involvement in seventeen patients with Fabry's disease (20-65 years, 6 men) using ECG, bicycle stress, cardiac magnetic resonance imaging, spirometry, diffusing capacity and pulmonary high-resolution computed tomography (HRCT) tests. Cardiopulmonary symptoms were compared to observed parameters in cardiopulmonary tests. RESULTS: Left ventricular hypertrophy (LVH) and reduced exercise capacity are the most apparent cardiac changes in both genders with Fabry's disease. ECG parameters were normal when excluding changes related to LVH. Spirometry showed mild reduction in vital capacity and forced expiratory volume in one second (FEV I), and mean values in diffusing capacity tests were within normal limits. Generally, only slight morphological pulmonary changes were detected using pulmonary HRCT, and they were not associated with changes in pulmonary function. The self-reported amount of pulmonary symptoms associated only with lower ejection fraction (P < 0.001) and longer QRS-duration (P = 0.04) of all measured cardiopulmonary parameters, whereas cardiac symptoms have no statistically significant association with any of these parameters. CONCLUSION: LVH and reduced exercise capacity are the most apparent cardiopulmonary changes in Fabry's disease but they have only a minor association to cardiopulmonary symptoms.Therefore, routine cardiopulmonary evaluation in Fabry's disease using echocardiography is maybe enough when integrated to counselling for aerobic exercise training.

The assessment of total cardiovascular risk in hypertensive subjects in primary care.

BACKGROUND: Recently published guidelines emphasize that detection of any subclinical target organ damage in hypertensive subjects should be regarded as a sign of high cardiovascular risk. AIM: To assess the ability of conventional multivariable cardiovascular disease risk prediction tools and high-sensitivity C-reactive protein (hs-CRP) to identify hypertensive subjects with target organ damage. METHODS: Ankle-brachial index (ABI), estimated glomerular filtration rate (eGFR), electrocardiographically determined left ventricular hypertrophy (ECG-LVH), and base-line variables were measured in hypertensive subjects aged 45-70 years without established cardiovascular or renal disease or known diabetes. RESULTS: Of the 495 subjects, 123 (24.8% (95% CI 21.1-28.9)) had ABI <1.00, 81 (16.4% (95% CI 13.2-19.9)) had ECG-LVH, and 41 (8.3% (95% CI 6.0-11.1)) had eGFR <60 mL/min/1.73 m(2). In patients with SCORE <5% or Framingham risk <20%, any sign of target organ damage was found in 46% and 49% of patients, respectively. CONCLUSION: Assessment of ECG-LVH, ABI, and eGFR reclassifies a significant number of hypertensive patients to the high-risk category as compared to SCORE and Framingham risk prediction tools only.

Positive change in the utilization of antihypertensive and lipid-lowering drugs among adult CHD patients in Finland: results from a large national database between 2000 and 2006.

AIM: To assess the changes in the utilization of antihypertensive, and lipid-lowering drugs among all adult Finnish coronary heart disease (CHD) patients between 2000 and 2006, and to evaluate the treatment and control of hypertension and dyslipidemia in a population-based sample of CHD patients. METHODS: From the databases of the Social Insurance Institution of Finland, 192,440 CHD patients aged 30 years or more in 2000 and 206,394 in 2006, respectively, were identified. Changes in the utilization of antihypertensive and lipid-lowering drugs were determined. In addition, from the Health 2000 Survey representing the whole Finnish population aged 30 years or more, 527 CHD patients were identified, to assess their characteristics and control of hypertension and dyslipidemia. RESULTS: Between the fall of 2000 and spring of 2001, 75% of the CHD patients were classified as hypertensives and 85% of these used antihypertensive medication. From 2000 to 2006, the utilization of lipid-lowering, and antihypertensive drugs increased from 33 to 52% and from 74 to 78%, respectively. Moreover, combination antihypertensive medication increased from 37 to 48%. Amidst the patients using antihypertensive drugs, the use of renin-angiotensin system blockers increased from 27 to 46% because of more than a three-fold increase in the use of angiotensin receptor blockers. CONCLUSION: Utilization of antihypertensive agents (especially angiotensin receptor blockers) and lipid-lowering drugs has increased remarkably by the end of 2006. However, the treatments are still far from optimal.

Positive change in the utilization of antihypertensive and lipid-lowering drugs among adult diabetics in Finland. Results from large national database between 2000 and 2006.

OBJECTIVES: To assess changes in the utilization of antihypertensive and lipid-lowering drugs among all adult Finnish diabetics between 2000 and 2006, and to evaluate the treatment and control of hypertension and dyslipidemia in a population-based sample of diabetic patients. METHODS: From the databases of the Social Insurance Institution of Finland, 143 366 diabetic patients aged 30 years or over in 2000-2001 and 187,099 in 2006-2007, respectively, were identified, and changes in the prevalence of antihypertensive and lipid-lowering drugs were determined. In addition, from the Health 2000 Survey representing the whole Finnish population aged 30 years or over, 388 diabetic patients were identified, to assess their characteristics and control of hypertension and dyslipidemia. RESULTS: Between the fall of 2000 and spring of 2001, 83% of the diabetics were classified as hypertensives. Sixty-nine percent of them used antihypertensive medication. From 2000 to 2006, utilization of lipid-lowering drugs increased by 111%, and combination antihypertensive medication, by 31%, for patients with diabetes. Among those using antihypertensive drugs, the use of angiotensin receptor blockers increased by 196%, and the use of either an angiotensin receptor blocker or an angiotensin-converting enzyme inhibitor, by 31%, respectively. Of the treated hypertensive diabetic patients in 2000-2001, only 14% had the blood pressure below 130/80 mmHg, and only 17% of the diabetics using lipid-lowering drugs had the serum low-density lipoprotein-cholesterol value less than 2.5 mmol/l. CONCLUSION: Our findings indicate that the control of hypertension and dyslipidemia among adult diabetics in the beginning of the decade was poor. On the contrary, utilization of antihypertensive agents (especially angiotensin receptor blockers) and lipid-lowering drugs has increased remarkably by the end of 2006. Still, the treatments are far from optimal.

Home blood pressure has a stronger association with arterial stiffness than clinic blood pressure: the Finn-Home Study.

OBJECTIVES: Most of the earlier studies assessing the determinants of pulse wave velocity (PWV) have been conducted with conventional clinic blood pressure (BP) measurements. The aim of this study was to assess whether PWV is more strongly associated with home-measured BP than clinic BP. Other risk factors associated with PWV were also investigated. METHODS: The study population was an unselected sample of 237 adults aged 45-74 years. The study participants underwent the measurement of PWV, clinic BP (mean of two measurements using a mercury sphygmomanometer) and home BP (mean of 14 duplicate measurements during 1 week using a validated, automatic device). Fasting blood samples for serum lipids and glucose were drawn. RESULTS: Pearson's correlation coefficients for PWV and home/clinic BP differed significantly in favour of home measurement for systolic BP (0.65 vs. 0.50, P < 0.001), diastolic BP (0.51 vs. 0.37, P < 0.001) and pulse pressure (0.62 vs. 0.40, P < 0.001). In a linear regression model (R(2) = 0.60, P < 0.001), home systolic BP (P < 0.001), age (P < 0.001) and diabetes (P < 0.001) were independently associated with increased PWV. The association between home BP and PWV increased only slightly with the number of home measurements. CONCLUSION: Home BP is one of the most important factors affecting arterial stiffness, a strong predictor of cardiovascular risk. Home-measured BP is more strongly associated with PWV than is clinic BP, even for a low number of measurements. These data support the application of home BP measurement in clinical practice, as it seems to produce values that represent true BP better than clinic BP.

Ankle-brachial index is lower in hypertensive than in normotensive individuals in a cardiovascular risk population.

BACKGROUND: Hypertension is an established risk factor for peripheral arterial disease (PAD), but the prevalence of this condition in hypertensive patients without comorbidities is unknown. METHODS: In this study, we assess the prevalence and factors associated with PAD, and the usefulness of ankle-brachial index (ABI) in evaluating cardiovascular risk in hypertensive patients without cardiovascular or renal disease or previously known diabetes mellitus. We measured ABI in 972 nonclaudicant patients with hypertension, newly diagnosed glucose disorders, metabolic syndrome, obesity or a 10-year risk of cardiovascular disease death of 5% or more according to the Systematic Coronary Risk Evaluation System. RESULTS: The prevalence of PAD (defined as ABI < or =0.90) and borderline PAD (defined as ABI 0.91-1.00) in hypertensive patients was 7.3% (39/532) and 23.7% (126/532), respectively. In a multivariate model, hypertension remained an independent factor associated with PAD (adjusted odds ratio 3.20; 95% confidence interval 1.56-6.58). There was no association between PAD and metabolic risk factors. SBP and pulse pressure increased linearly across subgroups of ABI (normal 0.91-1.00 and < or =0.90) in hypertensive patients (P < 0.001). CONCLUSION: Subclinical PAD is common in hypertensive patients even without comorbidities. The measurement of ABI is an efficient method to identify patients with increased cardiovascular risk and worth performing to hypertensive patients, particularly those with pulse pressure above 65 mmHg. Uniform criterions of defining PAD and borderline PAD would aid physicians in clinical decision-making.

Echocardiography in Fabry disease: diagnostic value of endocardial border binary appearance.

BACKGROUND AND AIM: It has been reported that the endocardium in Fabry disease has a binary appearance on transthoracic echocardiography. It has been suggested that this sign could be used with good accuracy to differentiate Fabry disease from hypertrophic cardiomyopathy and even as a first filter to screen for suspected Fabry disease. METHODS: Therefore, we performed a blinded echocardiography in a non-selected population of patients with Fabry disease and matched controls. We included 23 echocardiographic studies of Fabry patients. RESULTS: Two of the Fabry patients had binary appearance of the endocardium. One of them had left ventricular hypertrophy (LVH) and the other had a normal left ventricular mass. Binary appearance of the endocardium was detected in four of the controls, and one of them had LVH. Subgroup analysis of patients who had LVH indicated a sensitivity of 12.5% and a specificity of 66.7% for binary appearance of the endocardium to detect Fabry disease as the underlying cause of LVH. Overall, binary appearance of the endocardium had a sensitivity and a specificity of 15.4 and 73.3%, respectively, to distinguish patients with Fabry disease from controls in our population. CONCLUSIONS: Binary appearance of the endocardium is not feasible for screening Fabry disease by echocardiography.

Waist circumference home measurement--a device to find out patients in cardiovascular risk.

BACKGROUND: New strategies are needed to prevent the global epidemic of diabetes and subsequent rise in cardiovascular diseases. We describe a community-based, two-stage screening strategy using home waist circumference measurement and a risk factor questionnaire as a primary screening tool. METHODS: We mailed a tape for measurement of waist and a risk factor questionnaire to every inhabitant aged 45-70 years living in the rural town of Harjavalta in Finland. Thereafter we performed an oral glucose tolerance test, anthropometric variables and blood pressure of subjects having at least one risk factor for type 2 diabetes or cardiovascular disease. People with previously known diabetes or vascular disease were excluded. RESULTS: Seventy-three percent (2085/2856) of the invited inhabitants participated, and 84% of the respondents had at least one pre-specified risk factor. Waist circumference >or=80 cm in women and >or=94 cm in men (n = 1168), positive metabolic syndrome criteria of the International Diabetes Federation (n = 681) or the Finnish Diabetes Risk Score questionnaire >or=12 points (n = 697) identified 95, 92 and 63% of the new cases of type 2 diabetes and 84, 75 or 62% of pre-diabetes, respectively. CONCLUSION: The International Diabetes Federation criteria for elevated waist circumference are very sensitive but lack specificity in diagnosing glucose disorders. The criteria for metabolic syndrome and the Finnish Diabetes Risk Score questionnaire are more efficient tools for the selection of patients for further risk stratification in general practise.

Comparison of agreement between clinic and home-measured blood pressure in the Finnish population: the Finn-HOME Study.

BACKGROUND: The purpose of this study was to assess the agreement, mean difference, and the detection and control rates of hypertension, between home and clinic blood pressure (BP) measurement in the Finnish population. Variation in home BP during the measurements was also examined. METHODS: We studied a representative sample of the adult population (2051 45-74-year-old individuals) in Finland. Subjects included in the study underwent a clinical interview and measurement of clinic and home BP. Thresholds for elevated clinic and home BP were 140/90 and 135/85 mmHg. RESULTS: The mean difference between home and clinic BP, which increased with BP, was 7.7/3.4 mmHg. Overall agreement in diagnosis was only 75.2% (kappa coefficient 0.50). As compared with home BP, clinic BP overestimated the prevalence of hypertension (48.8 versus 42.5%, P < 0.001) and non-significantly underestimated the control of hypertension (28.7 versus 32.8%, P = 0.11). Evening home BP was 4.1/0.4 mmHg higher than morning BP among untreated subjects, but this difference was non-existent or reversed (0.5/-1.4 mmHg) among treated hypertensive individuals. Home BP decreased with an increasing number of measurements. CONCLUSIONS: The agreement between home and clinic BP in diagnosing hypertension according to the current guidelines is moderate at best, and the difference between home and clinic BP becomes larger at higher levels of BP. Because of the noticeable differences between these two methods, and the better prognostic accuracy of home BP, we endorse the use of home measurements in clinical practice.

A comparison of home measurement and ambulatory monitoring of blood pressure in the adjustment of antihypertensive treatment.

BACKGROUND: The purpose of this study was to compare home and ambulatory blood pressure (BP) in the adjustment of antihypertensive treatment. METHODS: After a 4-week washout period, patients whose untreated daytime diastolic ambulatory BP averaged > or = 85 mm Hg were randomized to be treated according to their ambulatory or home BP. Antihypertensive treatment was adjusted at 6-week intervals according to the mean daytime ambulatory diastolic BP or the mean home diastolic BP, depending on the patient's randomization group. If the diastolic BP stayed above 80 mm Hg, the physician blinded to randomization intensified hypertensive treatment. RESULTS: Ninety-eight patients completed the study. During the 24-week follow-up period both systolic and diastolic BP decreased significantly within both groups (P < .001). At the end of the study, the systolic/diastolic differences between ambulatory (n = 46) and home (n = 52) BP groups in home, daytime ambulatory, night-time ambulatory, and 24-h ambulatory BP changes averaged 2.6/2.6 mm Hg, 0.6/1.7 mm Hg, 1.0/1.4 mm Hg, and 0.6/1.5 mm Hg, respectively (P range .06 to .75) A nonsignificant trend to more intensive drug therapy in the ambulatory BP group and a nonsignificant trend to larger share of patients reaching (57.7% v 43.5%, P = .16) the target pressure in the home BP group was observed due to the 3.8 mm Hg difference in ambulatory and home diastolic BP at randomization. CONCLUSIONS: The adjustment of antihypertensive treatment based on either ambulatory or home BP measurement led to good BP control. No significant between-group differences in BP changes were seen at the end of the study. Additional research is needed to provide more conclusive results.

Prevalence and determinants of isolated clinic hypertension in the Finnish population: the Finn-HOME study.

BACKGROUND: Previous studies performed in selected hypertensive subjects have reported several possible determinants of isolated clinic hypertension (ICH). The purpose of this study was to assess the prevalence and determinants of ICH in a randomly selected nationwide population. METHODS: We studied a representative sample of the general adult population (1440 45-74-year-old subjects) in Finland not treated for hypertension. The subjects were drawn from the participants of a multidisciplinary epidemiological survey, the Health 2000 Study. Subjects included in the study underwent a clinical interview, determination of serum lipids and glucose, measurement of clinic and home blood pressure (BP), and psychometric tests for psychological distress, hypochondriasis, depression, and alexithymia. The diagnosis of ICH was based on a clinic BP of 140/90 mmHg or greater and a home BP less than 135/85 mmHg. RESULTS: The prevalence of ICH in the untreated Finnish adult population was 15.6 and 37.5% among untreated clinic hypertensive individuals. In a multivariate logistic regression analysis, ICH was associated with mildly elevated systolic and diastolic BP, lower body mass index (BMI), and non-smoking status. Subjects with ICH represent an intermediate group between the normotensive and sustained hypertensive individuals where cardiovascular risk is concerned (age, BP, diabetes prevalence, lipid profile, and BMI). CONCLUSION: ICH is a common phenomenon in the general population. Non-smoking individuals with mildly elevated BP and low BMI have a higher risk of ICH. Physicians should disassociate the diagnosis of ICH from any psychosocial disorders, but should remember that patients with ICH have an increased risk of cardiovascular disease.

Ramipril Enhances Autonomic Control in Essential Hypertension: A Study Employing Spectral Analysis of Heart Rate Variation.

We estimated the effect of an angiotensin-converting enzyme inhibitor, ramipril, on the sympathetic and parasympathetic input to the sinoatrial node of hypertensive patients using spectral and time domain analysis of heart rate variation (HRV). The heart rate of patients with essential hypertension was recorded during spontaneous breathing at rest and during controlled deep breathing. The periodic HRV was quantified at low-frequency (0.025--0.075 Hz), mid-frequency (0.075--0.125 Hz) and high-frequency (0.15--0.40 Hz) bands. Ramipril changed the balance of autonomic nervous system assessed by spectra: the parasympathetic tone increased (p < 0.05) and the sympathetic tone decreased (p < 0.01). There was an inverse correlation between the decrease in diastolic blood pressure and increase in the mid-frequency HRV, which is connoted with resetting of the baroreceptor reflex by ramipril. Thus, ramipril treatment was associated with improved autonomic control of the circulatory system.