Uphill energy transfer in a chlorophyll d-dominating oxygenic photosynthetic prokaryote, Acaryochloris marina.

The steady-state fluorescence properties and uphill energy transfer were analyzed on intact cells of a chlorophyll (Chl) d-dominating photosynthetic prokaryote, Acaryochloris marina. Observed spectra revealed clear differences, depending on the cell pigments that had been sensitized; using these properties, it was possible to assign fluorescence components to specific Chl pigments. At 22 degrees C, the main emission at 724 nm came from photosystem (PS) II Chl d, which was also the source of one additional band at 704 nm. Chl a emissions were observed at 681 nm and 671 nm. This emission pattern essentially matched that observed at -196 degrees C, as the main emission of Chl d was located at 735 nm, and three minor bands were observed at 704 nm, 683 nm, and 667 nm, originating from Chl d, Chl a, and Chl a, respectively. These three minor bands, however, had not been sensitized by carotenoids, suggesting specific localization in PS II. At 22 degrees C, excitation of the red edge of the absorption band (which, at 736 nm, was 20 nm longer than the absorption maximum), resulted in fluorescence bands of Chl d at 724 nm and of Chl a at 682 nm, directly demonstrating an uphill energy transfer in this alga. This transfer is a critical factor for in vivo activity, due to an inversion of energy levels between antenna Chl d and the primary electron donor of Chl a in PS II.

Differences and similarities among circadian characteristics of plasma renin activity in healthy young women in Japan and the United States.

A circadian rhythm of plasma activity (PRA) was demonstrated for both Japanese and North American women, the latter mostly Caucasians of mixed ethnic origin. The results were based on blood samples withdrawn at 4-hour intervals during a 24-hour span (in March 1978) from 20 subjects from Fukuoka (average age 20.4 +/- 0.1 years) and 16 subjects from Minneapolis (average age 20.2 +/- 0.4 years). The rhythms in the two populations showed similarities in some characteristics and differences in others. The timing of high values, i.e., of acrophases, objectively assessed by curve-fitting (and of corresponding 95 per cent confidence limits) was at 07(36) (05(00), 10(16) and 06(32) (03(00), 10(00) for Japan and USA, respectively. As objective measures of the extent of predictable rhythmic change mean amplitudes, in nanograms per milliliter per hour (ng/ml/hour), were similar (0.31 and 0.32); a statistically significant difference (P less than 0.05) was found in mean amplitudes expressed as percentage of the rhythm-adjusted average. Mean rhythm-adjusted average values (mesors) were lower in women from Japan than in those from the United States: (1.64 +/- 0.14 and 2.39 +/- 0.23 ng/ml/hour, respectively; P less than 0.01). A statistically significant difference in dietary salt, indicated by differences between the Japanese and North American women in the urinary excretion of sodium and chloride (P less than 0.05), almost certainly contributed to these results.

Blood pressure 24-hour pattern in two industrialized countries (Italy and Japan) with a different culture in salt intake.

This study investigates the blood pressure (BP) 24-hour pattern in representative samples of 2 industrialized countries, Italy and Japan, showing different cultures in salt intake. BP was monitored by means of a noninvasive ambulatory device whose readings were analyzed by means of chronobiometric procedures. The results show that the 24-hour BP pattern is not substantially different in Italian and Japanese subjects. In particular, the expected lower BP in the Italians was not detected despite their lower salt intake. Because the 24-hour mean BP value was seen not to be proportional to salt intake, the hypothesis is formulated that maintenance of the pressure regimen within a given range of variability is a principle of human physiology. To comply with this rule the Japanese people are supposed to have ethnically developed a certain resistance to dietary salt for which their cardiovascular apparatus is protected (phyletic escape to dietary sodium excess).

Relationships of the systolic blood pressure response during exercise with insulin resistance, obesity, and endurance fitness in men with type 2 diabetes mellitus.

The purpose of the present study was to investigate the relationships among the resting systolic (SBP) and diastolic blood pressure (DBP) or SBP response during exercise with insulin resistance evaluated by a homeostasis model (HOMA-IR), abdominal fat accumulation (visceral fat area [VFA], subcutaneous fat area [SFA]) by computed tomography (CT), and an estimation of the maximal oxygen uptake (V*O2max) in 63 Japanese middle-aged male patients with type 2 diabetes mellitus (type 2 DM). Body mass index (BMI) and waist-to-hip ratio (WHR) in type 2 DM subjects were significantly higher than in age-matched healthy male control subjects (n = 135) with normal glucose tolerance. Resting SBP (127.7 +/- 16.2 mm Hg v 119.4 +/- 13.0 mm Hg) and DBP (82.2 +/- 11.9mmHg v 76.8 +/- 9.4 mm Hg) levels, and the percentage of hypertension (20.6% v 1.5%) in type 2 DM subjects were significantly higher than in the control subjects (P <.05). According to a multiple regression analysis for resting blood pressure in type 2 DM, VFA was found to be an independent predictor of SBP, while V*O2max and HOMA-IR were independent predictors of DBP. In the controls, however, HOMA-IR was not found to be a significantly independent predictor for either resting SBP or resting DBP. Measurement of the SBP response during graded exercise using a ramp test was performed by an electrical braked cycle ergometer in 54 patients with type 2 DM only. The SBP was measured at 15-second intervals during exercise. The exercise intensity at the double product breaking point (DPBP), which strongly correlated with the exercise intensity at the lactate threshold, was used as an index for the SBP response to standardized exercise intensity. The SBP corresponding to exercise intensity at DPBP (SBP@DPBP) was evaluated as an index of the SBP response to standardized exercise intensity. The change in SBP (deltaSBP = SBP@DPBP - resting SBP) was significantly and positively associated with log area under the curve for glucose (log AUCPG) during a 75-g oral glucose tolerance test (OGTT). In addition, deltaSBP significantly and negatively correlated with the log area under the curve for insulin (log AUCIRI) and log AUCIRI/log AUCPG. Based on these results, insulin resistance was suggested to be independently associated with the resting DBP and SBP response to standardized exercise intensity in type 2 DM patients.

Relationship of urinary kallikrein excretion to renal water and sodium excretion.

The circadian rhythms of urine volume and urinary excretion of sodium, potassium, kallikrein, and aldosterone were analyzed by a multivariate method (cosinor method) in 20 healthy Japanese women on an ordinary diet. The relationship of urinary kallikrein and aldosterone excretion to urine volume and urinary sodium and potassium excretion was studied by assessing the correlation of the circadian rhythms. The acrophases in the circadian rhythms of urine volume (16:51) and urinary sodium excretion (16:55) appeared after the acrophase of urinary kallikrein excretion (15:28). There was a highly significant correlation between the circadian rhythm of urinary kallikrein excretion and the circadian rhythms of urine volume (r = 0.948) and urinary sodium excretion (r = 0.921). These results suggest that the renal kallikrein-kinin system participates in the regulation of renal water and sodium excretion in persons on an ordinary diet. A highly significant relationship between the acrophases in the circadian rhythms of urine volume and sodium excretion (r = 0.935) also suggests that water and sodium excretion may have a mutual influence on the kidneys. There were positive correlations between the circadian rhythms of potassium excretion and kallikrein excretion and potassium excretion and sodium excretion; and the latter relationship was relatively closer than the former. The acrophase in the circadian rhythm of aldosterone excretion did not correlate well with the acrophases of the other urine variables including sodium excretion.

Seasonal variation in 24-h blood pressure pattern of young normotensive women.

To investigate the seasonal variations in ambulatory blood pressure patterns, 24-h blood pressure was measured every 15 minutes noninvasively in ten young normotensive women. Urine was collected every 4 hours. The examinations were repeated in spring, summer, autumn, and winter in a standardized living environment. The 24-h average systolic and diastolic blood pressures did not differ significantly among the seasons. Similarly, there were no significant differences in the average values of either daytime or nighttime blood pressure. In contrast, the average pulse rate during nighttime was significantly higher in winter than in summer (64 +/- 2 beats/min vs. 59 +/- 2 beats/min, p < 0.05). The variabilities of either blood pressure or pulse rate did not change significantly among the seasons. The mesors and acrophases of both systolic and diastolic blood pressures, determined by a single cosinor method, were not significantly different among the seasons. On the other hand, the acrophase of pulse rate appeared significantly later in winter (16:19) compared with those in spring (14:54), summer (14:42), and autumn (14:21). Urine volume and urinary excretion of norepinephrine were significantly greater in winter than in summer. These results indicate that the 24-h pattern of blood pressure is reproducible and shows no seasonal difference in young normotensive women.

Plasma concentrations of angiotensin metabolites in young male normotensive and mild hypertensive subjects.

The plasma concentrations of angiotensin (Ang) I, Ang II, and their metabolites (Ang (3-8), (4-8), (5-8), and (3-4)) following in vitro ACE inhibitory activity were examined in young male normotensive (NT) (n = 7), and mild hypertensive (HT) volunteers (n = 6). There were no differences in supine plasma levels of Ang I, Ang II, and Ang (5-8) between the NT and HT groups: Ang I, 304 +/- 43 fmol/ml vs. 293 +/- 15 fmol/ml; Ang II, 32 +/- 6 fmol/ml vs. 43 +/- 10 fmol/ml; Ang (5-8), 176 +/- 22 fmol/ml vs. 133 +/- 32 fmol/ml. In addition, there were no significant differences between groups in any of these Ang levels when measured after standing for 60 min. However, the HT group showed significantly reduced supine and upright plasma Ang (3-8) and Ang (3-4) levels as compared to the NT group. In particular, the supine plasma level of Ang (3-4) (71 +/- 13 fmol/ml-plasma) in the HT group was significantly (1/3-fold) lower than that in the NT group (197 +/- 35 fmol/ml-plasma). An inverse correlation between the plasma level of Ang (3-4) and the upright systolic blood pressure (r = -0.627, p < 0.02, n = 13) was observed, indicating that the metabolism of Ang (3-4) might have been associated with the change in blood pressure.

Improvement of blood pressure control in a hypertension clinic: a 10-year follow-up study.

The objective of the study was to assess whether the publication of new guidelines, such as JNC VI 1997 and WHO/ISH 1999, and the development of new antihypertensive drugs have improved blood pressure (BP) control. A total of 150 patients (age 29-88, mean 66+/-11 years in 2001) who were followed at our hypertension clinic during 1991-2001 were retrospectively investigated. We compared the clinical characteristics of the patients in 2001 to those in 1991 and 1996, using the averaged BP determined at two occasions each year for our analysis. The average BP decreased during the 10 years between 1991 and 2001. When good BP control was defined as <140/90 mmHg, the rate of patients with good BP control increased from 31% in 1991 to 43% in 1996, and to 57% in 2001 (P<0.001 vs 1991). Both younger (< or =64 years) and older (> or =65 years) patients showed similar improvement during these 10 years. In 2001, satisfactory BP control (<130/85 mmHg) was achieved in 24% of younger patients, which was significantly higher than the achievement in 1991 (10%, P=0.02). This improvement occurred at the same time as an increase in the prescription of Ca antagonists and angiotensin II antagonist. The patients with improved BP control during these 10 years (n=50) showed lower body mass index (BMI) and serum total cholesterol levels in 2001 compared to persistently uncontrolled patients (n=54). Furthermore, the change in BMI during these 10 years was significantly less in the patients with improved BP control than in the persistently uncontrolled patients. In conclusion, BP control improved in the 10 years studied, and it seems to be attributable to the more frequent use of the newer drugs such as angiotensin II antagonists and Ca antagonists, to lifestyle modification and also to the growth in awareness of the importance of strict BP control.

Circadian rhythm of blood pressure and life style: a study of clinically healthy subjects living in rural and industrialized countries.

The aim of this study is to investigate how the blood pressure (BP) circadian rhythm (CR) is influenced by life style. Two groups of subjects were recruited from Nepal and Japan because of the extremely different occupational routines of these countries. The Nepalese represent a rural culture, while the Japanese reflect an industrialized civilization. Both the ethnic groups have in common a high dietary sodium intake. The BP monitoring was estimated according to chronobiological methods. Results provide evidence for a phase difference in BP CR which is coherent with the life style in the two groups. Furthermore, the estimates demonstrate that the Japanese show a higher level in daily BP which is related to the greater number of hours in which they are active. These findings may be taken into account for better deciphering of what is the role of life style on BP physiology in human beings.

Investigation of high salt intake in a Nepalese population with low blood pressure.

The relation between BP and the factors influencing an increase in BP with age were investigated in the inhabitants of two representative hilly (Kotyang: 206 men and 212 women) and suburban (Bhadrakali: 265 and 244) villages in Nepal. BP for both sexes was statistically significantly higher in Bhadrakali than in Kotyang. Neither hypertension nor elevation of BP with age for men and very few women (1.4%) with hypertension were observed in Kotyang, while 10.9% of men and 4.9% of women were found to be hypertensive in Bhadrakali. Average urinary Na excretion was 183-221 mEq/day in both villages. Urinary Na/K ratio, percentage body fat (%Fat), total protein, total cholesterol and serum Ca were statistically significantly higher in Bhadrakali than in Kotyang, and maximal oxygen uptake and serum Mg were higher in Kotyang. In spite of high salt consumption, there was no increase in BP with age in Kotyang's males, suggesting that the BP may be influenced by physical activity, fat-free mass and nutrient consumption in addition to the high sodium intake, and that extremely high physical activity and very low %Fat could serve to mute the influence of high sodium intake.

Long-term prognosis of malignant hypertension; difference between underlying diseases such as essential hypertension and chronic glomerulonephritis.

A long-term prognosis was studied in 69 patients with malignant hypertension, followed for an average of 56 months. Overall survival rate was 90% for a 5-year period, although the prognosis was different between two major underlying diseases, namely the 5-year survival was 79% for 33 essential hypertension (EHT) and 100% for 26 chronic glomerulonephritis (CGN); the difference is significant (p less than 0.01). In contrast, the 5-year rate for renal survival, defined as the probability of surviving without hemodialysis, was 37% in all cases. However, there was significant difference in the renal survival between EHT (60% for a 5-year period) and CGN (4% for a 18-month period). Multivariate analyses of the Cox's proportional hazards model revealed that the long-term change in renal function was different between the two groups, namely more rapid deterioration in the CGN group. These results indicate that a long-term prognosis of malignant hypertension is influenced by the underlying diseases and hemodialysis besides antihypertensive treatment may increase survival in malignant hypertension associated with severely damaged renal function.

Circadian characteristics of urinary epinephrine and norepinephrine from healthy young women in Japan and U.S.A.

Clinically healthy diurnally active young adult women were studied during the same season (March) at the Universities of Kyushu (Fukuoka City, Japan) and of Minnesota (Minneapolis, U.S.A.), under comparable conditions, except that the habitual diets were not changed. The subjects (20 Japanese and 16 Americans of mixed Caucasian background) were studied over a single 24-hr span. Urine was collected at 4-hr intervals. A circadian rhythm in total urinary norepinephrine excretion showed similar characteristics in Japanese and Americans. In epinephrine excretion, the Japanese women showed a statistically significantly higher amplitude with higher peak values, but no statistically significant difference in the rhythm-adjusted mean. This intergroup difference is strictly time dependent; it does not come to the fore in urine samples covering the nocturnal rest span of the subjects.

A school refusal case with biological rhythm disturbance and melatonin therapy.

An 18-year-old male high school student with school refusal and circadian rhythm disturbance is reported. At 17 years of age, he was unable to attend school because of a reversal of the daily rhythm and a moderate depressive feeling. Other circadian rhythms, including deep body temperature (DBT), and plasma melatonin, cortisol and beta-endorphin, also showed quite different or abnormal curves compared with those in normal controls. He was treated with methyl B12 and melatonin, which normalized the circadian rhythm, i.e. it became entrained to a 24-h period, and the DBT and hormonal rhythms became closer to normal patterns. These results suggest that desynchronization of the biorhythms, particularly the circadian rhythm, may be one of the important causes of school refusal in Japan, and melatonin and methyl B12 might be useful for treatment of the condition.

The human blood pressure chronome: a biological gauge of aging.

OBJECTIVE: This study examines changes in the broad time structure (chronome) of blood pressure (BP) as a function of age. DESIGN: This is an observational study. SETTING: The study was conducted at the Chronobiology Laboratories of the University oi Minnesota, Minneapolis, Minnesota. PARTICIPANTS: Seventy-two individuals 12 to 106 years of age provided a 7-day record of BP measured indirectly with an ambulatory monitor, mostly at 15-60-minute intervals. MAIN OUTCOME MEASURES: Amplitudes in least squares spectra at frequencies of 1 to 7 cycles per week and 1 to 8 cycles per day were analyzed by linear regression as a function of age. A two-way analysis of variance for subjects classified in four age groups tested for any variance transposition from the circadian (about-daily) to the infradian (frequency lower than one cycle per day) and/or to the ultradian (frequency higher than one cycle per day) domain. RESULTS: The decreasing circadian BP amplitude with age is accompanied by an increase in infradian and ultradian prominence. The day-to-day variability in circadian characteristics also increases with age. CONCLUSION: A variance transposition from the circadian to the neighboring ultradian and infradian domains characterizes the elderly human BP chronome, as a new, technically implementable biological, rather than chronological, gauge of human aging.

Pathophysiology in malignant hypertension: with special reference to the renin-angiotensin system.

Pathophysiology of malignant hypertension, of which underlying disease was essential hypertension (EHT) in 33 cases and chronic glomerulonephritis (CGN) in 26 cases, was studied with reference to the renin-angiotensin system. Plasma renin activity (PRA) was significantly higher in the EHT than in the CGN group, and angiotensin II antagonist [Sar1, Ile8]angiotensin II (AIIA) induced a significant lowering of blood pressure only in the former group. PRA was linearly correlated with both pretreatment mean blood pressure (MBP, r = 0.474, n = 29, p less than 0.01) and serum creatinine (r = 0.540, n = 29, p less than 0.01) in the EHT group but not in CGN patients, although there was an inverse correlation between PRA and serum sodium in both groups. Multiple regression analysis revealed that PRA was independently related to MBP, serum creatinine, and serum sodium in the EHT group, but not in the CGN group. These results suggest that the renin-angiotensin system plays a significant role in elevating blood pressure and deteriorating renal function in malignant hypertension derived from EHT, but it is less important in CGN related hypertension.

Relationship between total serum cholesterol level and nutritional and physical status in Nepalese rural people.

To investigate the nutritional condition in a hilly village (Kotyang) and a suburban village (Bhadrakali) in Nepal and to clarify the possible cause of the difference in total serum cholesterol level between the two groups of villagers habitually eating low fat diets, we carried out a nutrition survey using the 24-h recall method and blood sampling in 403 subjects (204 men and 199 women) in the hilly village and 466 (244 men and 222 women) in the suburban village. Total serum cholesterol was statistically significantly lower in the hilly villagers than in the suburban villagers for both sexes, but HDL-cholesterol was not. In both villages, 82% of the total energy was taken from carbohydrate, 7-8% from fat and 10% from protein. Energy, protein, fiber, potassium, magnesium, monounsaturated fatty acid, polyunsaturated fatty acid, and vitamin A in the hilly villagers were significantly higher than those in the suburban villagers. Total serum cholesterol was significantly associated with age and body fat percentage, suggesting that total serum cholesterol level was not directly associated with total fat intake in these Nepalese people.

Age-related changes in blood pressure twenty-four-hour pattern in normotensive subjects of two populations.

OBJECTIVES: This study investigates the systolic (S) and diastolic (D) blood pressure (BP) 24-h pattern in normotensive healthy subjects belonging to two populations characterized respectively by a "non-salt culture" (Italian subjects) and a "salt culture" (Japanese subjects) in their dietary salt intake (4-6 g/day in Italians vs 10-12 g/day in Japanese). The comparison was performed by taking into consideration the within-day variability (WDV) and circadian rhythmicity (CR) of BP with respect to age. MATERIALS AND METHODS: Subjects investigated were 862 normotensive healthy subjects (308 Italians and 554 Japanese), stratified by age from 16 to 75 years, who volunteered for a noninvasive BP monitoring in an ordinary day of their life. The SBP and DBP time series were analyzed via conventional parametric statistics as well as chronobiological procedures. RESULTS: The biometric estimates demonstrate that BP changes in its WDV and CR as a function of age in both populations. Despite the difference in their habitual salt intake, the age-related changes in BP WDV and CR result to be almost comparable at the cross-sectional contrasts, giving origin to age-related trends for SBP and DBP which are significantly parallel. CONCLUSIONS: The comparability of BP WDV and CR in the two populations with a substantial difference in salt intake suggests that the normotensive status in human races is realized despite the difference in their habitual salt intake. This implies the ancestral development of mechanism(s) of adaptation to the possible "sodium luxus consumption". Although the adaptive mechanisms which provide a normotensive regimen under different conditions of sodium intake are almost unexplored, the racial adaptation to dietary salt constitutes, however, the initial condition for the cause-effect nexus between dietary salt intake and hypertension in human populations.

[Relationship of dietary intake of sodium, potassium, calcium and magnesium to blood pressure].

Dietary intake of sodium (Na), potassium (K), calcium (Ca) and magnesium (Mg) from measured food intake, and urinary Na and K excretions estimated by analyzing the second voided morning urine were analyzed for correlations to each other and to blood pressure in 57 males and 90 females (average age of 53 years). Significant positive correlations were found between systolic blood pressure and urinary Na/K ratio, dietary Ca/Mg ratio and body mass index after adjustment for age. Diastolic blood pressure was also positively correlated to these variables. By multiple regression analysis, the coefficients for age and urinary Na/K and dietary Ca/Mg ratios were all statistically significantly associated with systolic and diastolic blood pressure. Dietary Ca/Mg ratio was negatively correlated with rice, beans and fish intake, and urinary K excretion positively correlated with fish and green vegetable intakes by the same analysis. These data suggest that the dietary Ca/Mg ratio--but not magnesium singly--as well as aging and urinary Na/K ratio were among important factors related to blood pressure.

[Prediction of 24-hour urinary creatinine excretion from age, body weight and height of an individual and its application].

Equations to predict 24-hour urinary creatinine excretion (UcrV) from age, body weight (W) and body height (H) were developed based on the data for UcrV determined by collecting 24-hour urine for 3-5 days in 256 male and 231 female clinically healthy subjects, aged from 20 to 84 years. By regression analysis a regression equation was developed. Multiple regression analysis revealed that age, W and H contributed most to the measured value of UcrV. The regression equations to predict UcrV from age, W and H were as follows: Predicted value of UcrV (PRCr) = -12.63 x Age + 15.12 x W + 7.39 x H - 79.90 (male: mg/day) PRCr = -4.72 x Age + 8.58 x W + 5.09 x H - 74.50 (female: mg/day) The multiple correlation coefficients were 0.87 for males and 0.73 for females, respectively. The difference between PRCr and measured UcrV (residual) was +0.81 +/- 154 (SD) mg/day on the average. An analysis of residuals by means of plotting of standardized residuals and predicted standardized dependent variables showed no remarkable deviations in both sexes, suggesting that these equations are applicable to the prediction of UcrV. These equations were applied to 38 Japanese men and women who were asked to collect 24-hour urine for 14 days on average, and also to 47 foreigners (American, Nepalese and Italian). The average residual in the former was +27 +/- 87 mg/day and that in the latter -3 +/- 85 mg/day, suggesting that these equations can be applied not only to the Japanese but also to the foreigners as a useful index in predicting 24-hour urinary creatinine excretion.

Impact of antihypertensive medication adherence on blood pressure control in hypertension: the COMFORT study.

BACKGROUND: It has not been fully elucidated whether antihypertensive medication adherence affects blood pressure (BP) control in hypertension cases. AIM: To investigate the association of adherence to antihypertensive drug regimens and BP control using data from the Combination Pill of Losartan Potassium and Hydrochlorothiazide for Improvement of Medication Compliance Trial (COMFORT) study. DESIGN: An observational analysis from a randomized controlled trial. METHODS: A total of 203 hypertensive subjects were randomly assigned to a daily regimen of a combination pill (losartan 50 mg/hydrochlorothiazide 12.5 mg) or two pills, an angiotensin II receptor blocker and a thiazide diuretic. Medication adherence calculated based on pill counts and BPs was evaluated at 1, 3 and 6 months after randomization. RESULTS: The subjects were divided into three groups according to their adherence, i.e. relatively low-adherence (<90%; n = 19), moderate-adherence (90-99%; n = 71) and high-adherence (100%; n = 113) groups. Clinical characteristics of the subjects including BP, sex, randomized treatments and past medical history did not differ significantly among the three groups. Achieved follow-up BPs over the 6-month treatment period, which were adjusted for age, sex, baseline BP and randomized treatment, were significantly higher in the low-adherence group (135/78 mmHg) compared with the high-adherence (130/74 mmHg; P = 0.02/0.02) and the moderate-adherence (128/74 mmHg; P = 0.003/0.02) groups. CONCLUSION: Low adherence to an antihypertensive-drug regimen was associated with poor BP control.