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CORK Bibliography: Blood Pressure and Hypertension

29 citations. January 2009 to present

Prepared: March 2011

Au BT; Blizzard L; Schmidt MD; Pham HL; Granger RH; Dwyer T. The association between smoking and hypertension in a population-based sample of Vietnamese men. Journal of Hypertension 28(2): 245-250, 2010. (38 refs.)

Objective: The association between tobacco smoking and blood pressure in epidemiological studies remains unclear despite experimental evidence that smoking elevates blood pressure. This study examined the association between smoking and hypertension in a population-based sample of Vietnamese men. Methods: The study utilized a population-based sample of men (n = 910) from a survey of risk factors of noncommunicable diseases in Vietnam. Measurements including behavioural risk factors, body composition, and blood pressure were performed according to internationally standardized protocols. Poisson regression was used to obtain prevalence ratios and 95% confidence intervals (CIs). All analyses were performed using complex survey methods. Results: There were significant trends of increasing prevalence of hypertension with increasing years (P = 0.05) and pack-years (P = 0.03) of smoking after adjusting for age, BMI, and alcohol intake. Relative to never-smokers, the risk of hypertension for those who had smoked for 30 years or more and those who had smoked 20 pack- years or more were 1.52 (95% CI 0.95-2.44) and 1.34 (95% CI 0.94-1.91), respectively. Overall, however, current smokers were not at higher risk of hypertension than never-smokers (prevalence ratio = 1.08, 95% CI 0.70-1.68), and ex-smokers were more likely to be hypertensive than either never-smokers (prevalence ratio = 1.81, 95% CI 1.07-3.06) or current smokers (prevalence ratio = 1.67, 95% CI 1.25-2.23), similarly adjusted. Conclusion: In this population-based sample, hypertension was associated with smoking in a dose-response manner when characterized as number of years of smoking and lifetime cigarette consumption, but was not associated with current smoking status.

Bakker R; Steegers EAP; Mackenbach JP; Hofman A; Jaddoe VWV. Maternal smoking and blood pressure in different trimesters of pregnancy: The Generation R Study. Journal of Hypertension 28(11): 2210-2218, 2010. (45 refs.)

Objective Smoking during pregnancy is a risk factor for various adverse birth outcomes but lowers the risk of preeclampsia. Cardiovascular adaptations might underlie these associations. We examined the associations of smoking in different trimesters of pregnancy with repeatedly measured blood pressure and the risks of preeclampsia and pregnancy-induced hypertension in a low-risk population-based cohort of 7106 pregnant women. Methods This study was embedded in a population-based prospective cohort study from early pregnancy onwards. Smoking and systolic and diastolic blood pressures were assessed by questionnaires and physical examinations in each trimester of pregnancy. Information about preeclampsia and pregnancy-induced hypertension was obtained from medical records. Results Compared to nonsmoking women, both first-trimester-only and continued smoking were associated with a steeper increase for systolic blood pressure and a lowest mid-pregnancy level and steeper increase thereafter for diastolic blood pressure throughout pregnancy. We did not find any significant associations in risk of preeclampsia for first-trimester-only smoking (odds ratio of 1.28, 95% confidence interval 0.74, 2.21) and continued smoking (odds ratio of 0.83, 95% confidence interval 0.50, 1.36), respectively. Conclusions Our results suggest that both first-trimester-only and continued smoking are associated with persistent maternal cardiovascular adaptations during pregnancy. Strategies for prevention of smoking during pregnancy should be focused on the preconception period. The effects of early and late-pregnancy smoking on the risk of preeclampsia should be further explored. Our results should be carefully interpreted to the general population of pregnant women.

Baldassarre D; Castelnuovo S; Frigerio B; Amato M; Werba JP; De Jong A et al. Effects of timing and extent of smoking, type of cigarettes, and concomitant risk Factors on the association between smoking and subclinical atherosclerosis. Stroke 40(6): 1991-1998, 2009. (31 refs.)

Background and Purpose-The purpose of this study was to evaluate the effects of timing and extent of smoking, type of cigarettes, and concomitant vascular risk factors (VRFs) on the association between smoking and carotid intima-media thickness (C-IMT) in a lipid clinic population. Methods-1804 patients (869 men, age 21 to 85 year) participated in the study. Smoking habits were recorded and C-IMTs were measured by B-mode ultrasound. The associations of C-IMT with smoking status (never, former, and current) and with the cigarettes' content of tar, nicotine, and carbon monoxide (alone or combined to define "light" or "regular" cigarettes) as well as the interactions between smoking status, gender, and VRFs were evaluated before and after adjustment for confounders. Results-C-IMT was highest in current smokers, lower in former, and lowest in never smokers. C-IMT of former and current smokers differed only after data adjustment for variables describing the extent and timing of smoking exposure. C-IMT was positively related to the number of pack-years (number of cigarettes smoked per day [cigarettes/d] multiplied by number of years smoked/20) in both former and current smokers. There were no differences in C-IMT between smokers of cigarettes with high or low nicotine, tar, or carbon monoxide content. Both diabetes and hypertension interacted positively with smoking in determining C-IMTs. Conclusions-In the present cross-sectional observational investigation, carried out in a cohort of patients attending a lipid clinic, consumption of light cigarettes does not reduce the atherogenic effect of smoking on C-IMT. The number of pack-years, cigarettes/d, and years of smoking are relevant covariates in evaluating the effects of smoking on vascular health. The presence of diabetes or hypertension strengthens the association between smoking and cardiovascular risk.

Britton KA; Gaziano JM; Sesso HD; Djousse L. Relation of alcohol consumption and coronary heart disease in hypertensive male physicians (from the Physicians' Health Study). American Journal of Cardiology 104(7): 932-935, 2009. (18 refs.)

Alcohol has diverse effects on the cardiovascular system. Moderate drinking is associated with a decreased risk of cardiovascular disease, yet increasing amounts of alcohol consumption are known to increase blood pressure. These opposing effects have led to interest in the effect of moderate alcohol consumption on the risk of coronary heart disease (CHD) in patients with hypertension. To test the hypothesis that moderate alcohol consumption decreases the risk of myocardial infarction (MI) in patients with hypertension, we used data on 5,164 participants in the Physicians' Health Study who were apparently healthy and free of CHD at baseline. Incident MI was ascertained by annual follow-up questionnaires and validated through review of medical records. Cox proportional hazard model was used to compute multivariable-adjusted hazard ratios with corresponding 95% confidence intervals. From 1982 to 2008, 623 cases of MI occurred. Compared to subjects consuming <1 drink per week, hazard ratios for MI were 1.05 (95% confidence interval 0.85 to 1.28), 0.78 (95% confidence interval 0.64 to 0.97), and 0.57 (95% confidence interval 0.35 to 0.95) for alcohol consumption of I to 4, 5 to 7, and >8 drinks per week adjusted for age, body mass index, smoking, exercise, diabetes, multivitamin use, vegetable intake, breakfast cereal intake, and cholesterol, (p for trend <0.0022). Similar inferences could be made for the secondary outcomes of angina pectoris and any CHD (which included MI, angina pectoris, and previous revascularization). In conclusion, our data demonstrated an inverse relation between moderate alcohol consumption and CHD in hypertensive men.

Caban-Martinez AJ; Davila EP; Zhao W; Arheart K; Hooper MW; Byrne M et al. Disparities in hypertension control advice according to smoking status26. Preventive Medicine 51(3-4): 302-306, 2010. (26 refs.)

Objectives. Hypertension is the most common modifiable cardiovascular risk factor. Blood pressure (BP) reduction, particularly among smokers, is highly effective at preventing cardiovascular diseases. We examined the association between patient smoking status and hypertension management advice. Methods. Adults who participated in the 2007 Behavioral Risk Factor Surveillance System with self-reported hypertension were examined (n = 51,063). Multivariable logistic regression analysis controlling for age, gender, race/ethnicity, education, marital status, insurance status, body mass index, alcohol use, self-reported general health and survey design were conducted to examine the association between smoking status (never, former, or current) and receipt of hypertension control advice. Results. After controlling for potential confounders, being a current smoker was significantly associated with lower odds of receiving advice to lower salt intake (Adjusted Odds Ratio, AOR, 0.91 [95% confidence interval = 0.84-0.99]), exercise (AOR 0.89 [0.80-0.98]), and to take hypertensive medication (AOR 0.80 [0.66-0.98]) compared to never smokers. However, hypertensive smokers had greater odds of receiving advice to reduce alcohol consumption (AOR 1.23 [1.10-1.45]). Conclusions. Although healthcare providers are in an optimal position to provide patient education to improve BP control, hypertensive smokers may be less likely to receive important BP control lifestyle modification messages from their healthcare provider than non-smokers.

Farag NH; Whitsett TL; McKey BS; Wilson MF; Vincent AS; Everson-Rose SA et al. Caffeine and blood pressure response: Sex, age, and hormonal status. Journal of Women's Health 19(6): 1171-1176, 2010. (40 refs.)

Purpose: The pressor effect of caffeine has been established in young men and premenopausal women. The effect of caffeine on blood pressure (BP) remains unknown in postmenopausal women and in relation to hormone replacement therapy (HRT) use. Materials and Methods: In a randomized, 2-week cross-over design, we studied 165 healthy men and women in 6 groups: men and premenopausal women (35-49 yrs) vs. men and postmenopausal women (50-64 yrs), with postmenopausal women divided into those taking no hormone replacements (HR), estrogen alone, or estrogen and progesterone. Testing during one week of the study involved 6 days of caffeine maintenance at home (80 mg, 3x/day) followed by testing of responses to a challenge dose of caffeine (250 mg) in the laboratory. The other week involved ingesting placebos on maintenance and lab days. Resting BP responses to caffeine were measured at baseline and at 45 to 60 min following caffeine vs placebo ingestion, using automated monitors. Results: Ingestion of caffeine resulted in a significant increase in systolic BP in all 6 groups (4 +/- .6, p < 0.01). Diastolic BP significantly increased in response to caffeine in all (3 +/- .4, p < 0.04) but the group of older men (2 +/- 1.0, p = 0.1). The observed pressor responses to caffeine did not vary by age. Conclusions: Caffeine resulted in an increase in BP in healthy, normotensive, young and older men and women. This finding warrants the consideration of caffeine in the lifestyle interventions recommended for BP control across the age span.

Foerster M; Marques-Vidal P; Gmel G; Daeppen JB; Cornuz J; Hayoz D et al. Alcohol drinking and cardiovascular risk in a population with high mean alcohol consumption. American Journal of Cardiology 103(3): 361-368, 2009. (30 refs.)

Moderate alcohol consumption has been associated with lower coronary artery disease (CAD) risk. However, data on the CAD risk associated with high alcohol consumption are conflicting. The aim of this study was to examine the impact of heavier drinking on 10-year CAD risk in a population with high mean alcohol consumption. In a population-based study of 5,769 adults (aged 35 to 75 years) without cardiovascular disease in Switzerland, 1-week alcohol consumption was categorized as 0, 1 to 6, 7 to 13, 14 to 20, 21 to 27, 28 to 34, and >= 35 drinks/week or as nondrinkers. (0 drinks/week), moderate (1 to 13 drinks/week), high (14 to 34 drinks/week), and very high (>= 35 drinks/week). Blood pressure and lipids were measured, and 10-year CAD risk was calculated according to the Framingham risk score. Seventy-three percent (n = 4,214) of the participants consumed alcohol; 16% (n = 909) were high drinkers and 2% (n = 119) very high drinkers. In multivariate analysis, increasing alcohol consumption was associated with higher high-density lipoprotein cholesterol (from a mean +/- SE of 1.57 +/- 0.01 mmol/L in nondrinkers to 1.88 +/- 0.03 mmo/L in very high drinkers); triglycerides (1.17 +/- 1.01 to 1.32 +/- 1.05 mmol/L), and systolic and diastolic blood pressure (127.4 +/- 0.4 to 132.2 +/- 1.4 mm Hg and 78.7 +/- 0.3 to 81.7 +/- 0.9 mm Hg, respectively) (all p values for trend <0.001). Ten-year CAD risk increased from 4.31 +/- 0.10% to 4.90 +/- 0.37% (p = 0.03) with alcohol use, with a J-shaped relation. Increasing wine consumption was more related to high-density lipoprotein cholesterol levels, whereas beer and spirits were related to increased triglyceride levels. In conclusion, as measured by 10-year CAD risk, the protective effect of alcohol consumption disappears in very high drinkers, because the beneficial increase in high-density lipoprotein cholesterol is offset by the increases in blood pressure levels.

Freiberg MS; Chang YF; Kraemer KL; Robinson JG; Adams-Campbell LL; Kuller LL. Alcohol consumption, hypertension, and total mortality among women. American Journal of Hypertension 22(11): 1212-1218, 2009. (37 refs.)

BACKGROUND: Moderate alcohol consumption is associated with a reduced risk of total mortality among Caucasian women. Whether moderate alcohol consumption is associated with a reduced risk of total mortality among African-American or hypertensive women is unclear. METHODS: We conducted a prospective study among 10,576 black and 105,610 white postmenopausal women from the Women's Health Initiative (WHI), without a history of cancer or cardiovascular disease, who completed the baseline examinations in 1994-1998. RESULTS: During the mean 8 years of follow-up, 5,608 women died. Moderate drinking (1 to <7 drinks/week) was associated with a lower risk of total mortality among Caucasians (hazard ratio (HR) = 0.81, 95% confidence interval (CI) = 0.72-0.91) and hypertensives (HR = 0.76, 95% CI = 0.65-0.87) as compared with lifetime abstention from alcohol. Among African-American moderate drinkers the risk of total mortality was HR = 0.94,95% CI = 0.67-1.3. Current drinking (<1 drink/month or greater) was associated with a lower risk of mortality among Caucasians, including hypertensives and non hypertensives, and hypertensive African Americans (HR = 0.74,95% CI = 0.54-0.99) but not among nonhypertensive African Americans (HR = 1.31,95% CI = 0.79-2.16). The stratified comparisons among African Americans were affected by the low prevalence of moderate drinking (14.6%) and the low mortality rate (37.5/10,000) among the nonhypertensive lifetime abstainers. CONCLUSION: Moderate drinking is associated with a lower risk of total mortality among Caucasian women. Current drinking is associated with a lower risk of total mortality among Caucasians, regardless of hypertensive status, and hypertensive but not nonhypertensive African-American women. The latter observation was affected by the low mortality rate among the African-American nonhypertensive lifetime abstainers.

Getahun W; Gedif T; Tesfaye F. Regular Khat (Catha edulis) chewing is associated with elevated diastolic blood pressure among adults in Butajira, Ethiopia: A comparative study. BMC Public Health 10: article 390, 2010. (33 refs.)

Background: Fresh leaves and buds of the Khat plant (Catha edulis) contain Cathinone, an amphetamine like alkaloid responsible for its pharmacological action. Chewing of Khat has been associated with a transient rise in blood pressure and heart rate in experimental studies. Few studies examined the effect of regular or frequent Khat chewing on blood pressure at the population level. This study was conducted to examine the association of regular Khat chewing with blood pressure among adults. Methods: We compared systolic and diastolic blood pressure of adults 35-65 years of age who reported regular chewing of Khat during the preceding five years to those who never chewed Khat during the same period. Study participants were recruited from purposively selected urban and rural villages of Butajira District in Ethiopia. The comparative groups, chewers (334) and non-chewers (330), were identified from among the general population through a house-to-house visit using a screening questionnaire. They were frequency-matched for sex and age within a five-year range. Data were collected through structured interviews and physical measurements including blood pressure, weight and height. Results: The prevalence of hypertension was significantly higher among Khat chewers (13.4%) than non-chewers (10.7%), odds ratio (OR) = 1.66 (95% confidence interval (CI) 1.05, 3.13). A considerably high proportion of chewers (29.9%) than non-chewers (20.6%) had sub-optimal diastolic blood pressure (> 80 mmHg). The mean (sd) diastolic blood pressure was significantly higher among Khat chewers [75.0 (11.6)] than non-chewers [72.9 (11.7)], P < 0.05. Similarly, Khat chewers had significantly higher mean (sd) heart rate [76.3 (11.5)] than non-chewers [73.9 (12.6)], P < 0.05. There was no significant difference in mean systolic blood pressure between the two groups. Conclusion: Regular chewing of Khat is associated with elevated mean diastolic blood pressure, which is consistent with the peripheral vasoconstrictor effect of Cathinone. Regular Khat chewing may have sustained effects on the cardiovascular system that can contribute to elevated blood pressure at the population level.

Ghiadoni L. Smoking and central blood pressure: A metabolic interaction? (editorial). American Journal of Hypertension 22(6): 585-585, 2009. (5 refs.)

Greenlund KJ; Daviglus ML; Croft JB. Differences in healthy lifestyle characteristics between adults with prehypertension and normal blood pressure. Journal of Hypertension 27(5): 955-962, 2009

Background: Identifying differences in modifiable lifestyle factors between persons with prehypertension and normal blood pressure (BP) can help improve prevention efforts. Methods Data from the 1999-2004 National Health and Nutrition Examination Survey were analyzed (in 2008) for persons aged at least 20 years (n = 11 194). Differences in five healthy lifestyle characteristics were examined by BP status (normal, prehypertension, and hypertension). Additionally, differences in lifestyle characteristics by sex, race/ethnicity, and education among those with prehypertension were analyzed. Results Overall, 32.8% of adults had a normal BMI 75.3% did not smoke, 31.3% were regularly physically active, 57.7% were moderate drinkers or nondrinkers, and 28.1% had a low sodium intake; only 2% had all five characteristics. Almost 40% had a normal BP and 30.3% were prehypertensive. Those with prehypertension were less likely to have a normal BMI than normotensive individuals [adjusted odds ratio (OR) = 0.63, 95% confidence interval (CI) = 0.56-0.70], to be regularlyactive (adjusted OR = 0.85, 95% CI = 0.74-0.98), and to moderately/not drink (adjusted OR = 0.88, 95% CI = 0.80-0.97). Those with prehypertension or hypertension were less likely to have at least three or four healthy lifestyle characteristics compared with those with normal BP. Among 3168 persons with prehypertension, some sex, race/ethnic, and education level differences in the prevalence of healthy lifestyles were observed. Conclusion: Differences in healthy lifestyle factors were observed by BP status, but the prevalence of healthy lifestyle factors is suboptimal among the population as a whole.

Halanych JH; Safford MM; Kertesz SG; Pletcher MJ; Kim YI; Person SD et al. Alcohol consumption in young adults and incident hypertension: 20-year follow-up from the Coronary Artery Risk Development in Young Adults Study. American Journal of Epidemiology 171(5): 532-539, 2010. (37 refs.)

The relation between alcohol consumption and incident hypertension is unclear, and most observational studies have not accounted for socioeconomic factors. This study examined the association between alcohol consumption in a diverse group of young adults and incident hypertension over 20 years. Participants (n = 4,711) were from the Coronary Artery Risk Development in Young Adults Study cohort, recruited in 1985 (aged 18-30 years) from Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; and Oakland, California. The 20-year incidence of hypertension for never, former, light, moderate, and at-risk drinkers was 25.1%, 31.8%, 20.9%, 22.2%, and 18.8%, respectively (P < 0.001). Race, gender, age, family history of hypertension, body mass index, income, education, and difficulty paying for basics and medical care were associated with hypertension. Adjustment using Cox proportional hazard models revealed no association between baseline alcohol consumption and incident hypertension, except among European-American women in whom any current alcohol consumption was associated with lower risk of incident hypertension. The lack of association between alcohol and hypertension in the majority of this socioeconomically diverse cohort is not definitive. Future studies should include social factors, such as income and education, and consider additional characteristics that may modify or confound associations between alcohol and blood pressure.

Kadonaga Y; Dochi M; Sakata K; Oishi M; Tanaka K; Morimoto H et al. Longitudinal evaluation of the effect of smoking initiation on body weight, blood pressure, and blood biochemistry. Preventive Medicine 48(6): 567-571, 2009. (17 refs.)

Objective. To evaluate the effect of smoking initiation on annual changes in body weight, blood pressure, and blood biochemistry. Methods. This study analyzed the results of annual health examinations from 1991 to 2005 in male Japanese workers. Subjects who started smoking (n = 214) initially responded as non-smokers in a self-administered questionnaire (baseline year) and then answered consistently as snickers for 3 subsequent years. Out of 2547 non-smokers, we selected 1589 controls who had data available for at least four successive years. The time course of physiological and laboratory data was analyzed using a linear mixed model. Results. A significant temporal decrease from baseline in body mass index (first year, -0.1 kg/m(2)) diastolic blood pressure (second year, - 1.5 mm Hg) and gamma-glutamyl transpeptidase (second year, -3.5 IU/L) was observed for subjects who started smoking. An opposite pattern was observed in non-smokers. On average, those who started smoking had significantly lower body mass index (first year, - 0.2 kg/m(2); second year, -0.2 kg/m(2)), systolic blood pressure (second year, -2.1 mm Hg), diastolic blood pressure (second year, -2.0 mm Hg), and gamma-glutamyl transpeptidase (second year, -4.5 IU/L) than non-smokers. Conclusion. In this study, smoking initiation did not yield clinically significant long-term benefits with respect to physiological or biochemical outcomes. These results are important because few studies have tracked these types of changes longitudinally from initiation through 3 years of follow-up.

Montasser ME; Shimmin LC; Hanis CL; Boerwinkle E; Hixson JE. Gene by smoking interaction in hypertension: identification of a major quantitative trait locus on chromosome 15q for systolic blood pressure in Mexican-Americans. Journal of Hypertension 27(3): 491-501, 2009. (45 refs.)

Objective: Our objective was to investigate the influence of gene by smoking (GxS) interaction on hypertension and blood pressure (BP) using genome-wide linkage analysis in Mexican-Americans, followed by single nucleotide polymorphism (SNP) fine mapping of candidate genes in the linked chromosomal region. Methods: We used nonparametric methods to test for linkage of microsatellites with hypertension and BP measures in smokers, nonsmokers, and the combined group. To begin fine mapping of a major quantitative trait locus (QTL) for systolic blood pressure (SBP) on chromosome 15q that showed strong evidence for GxS interaction, we genotyped 55 SNPs in nine candidate genes for association studies using two population-based statistical methods. Results: The strongest evidence for GxS interaction (P=0.0004) was found for SBP on chromosome 15q,where a major QTL (LOD=3.36) was identified only in nonsmokers. Follow-up studies identified three SNPs in three genes (ANPEP, IGF1R, and SLCO3A1) that showed associations with SBP only in nonsmokers, cumulatively accounting for a 7 mmHg increase in SBP. However, conditional linkage analyses that accounted for phenotypic effects of these SNPs only slightly reduced the original LOD score. Conclusion: The detection of a major QTL on chromosome 15q for SBP in nonsmokers indicates the presence of loci that influence BP via GxS interactions. However, identification of the genes that underlie such QTL effects remains a challenge. Although we found three candidate genes that showed significant associations with SBP in nonsmokers, further studies are required to identify the gene(s) that underlie the chromosome 15q QTL that influences SBP via GxS interactions.

Moss DR; Lucht LA; Kip KE; Reis SE. Acute physiologic effects of secondhand smoke exposure in children. Nicotine & Tobacco Research 12(7): 708-714, 2010. (27 refs.)

We investigated the hypothesis that exhaled carbon monoxide (eCO), heart rate (HR), and blood pressure (BP) would increase acutely in exposed but not in unexposed children. In a nonrandomized controlled design, parent-child dyads were assigned to groups based on exposure: child subjects, 7-18 years of age, exposed to smoking daily in the home (exposed) or with no household exposure (unexposed control). HR, BP, and eCO were measured before and after exposure to a parent smoking 1 cigarette (exposed) or a time-lapse equivalent (control). The primary analysis compared mean acute changes in physiological measures following intervention or control procedure. Forty-one dyads were enrolled. At baseline, no differences in child gender, race, ethnicity, HR, BP, lipids, or fasting glucose were noted between exposure groups. Following experimental or control procedures, the median change in eCO was similar between groups (-0.1 ppm exposed vs. 0.0 ppm unexposed, p = .27). Acute hemodynamic changes were also similar between exposed and unexposed children, respectively: (HR change 4.2 vs. 2.6 beats per minute, p = .62; systolic blood pressure change 0.08 vs. 0.41 mm Hg, p = .91; diastolic blood pressure 0.08 vs. 2.27 mm Hg, p = .37). This is the first study to report on acute physiologic changes of secondhand smoke exposure in children in a naturalistic setting. A single acute dose of passive smoke exposure in children did not alter the physiologic variables of HR or BP. Further in-home study using continuous monitoring is needed. Demonstration of acute effects may serve as clinical feedback to motivate parents to quit smoking.

Nakashita M; Ohkubo T; Hara A; Metoki H; Kikuya M; Hirose T et al. Influence of alcohol intake on circadian blood pressure variation in Japanese men: The Ohasama Study. American Journal of Hypertension 22(11): 1171-1176, 2009. (24 refs.)

BACKGROUND Both a large habitual alcohol intake and a pattern of circadian blood pressure (BP) variation characterized by a high morning/daytime BP have been reported to be risk factors for cerebral hemorrhage. Therefore, the association between these two factors was examined. METHODS A total of 194 men in the general population of Ohasama underwent ambulatory BP measurement, completed a lifestyle questionnaire, and were classified into three categories according to current alcohol consumption: nondrinkers, light drinkers, and heavy drinkers. Two-hour moving averages of BP (2h-BP) were used to compare BP variation during a 24-h period among the drinking categories. 2h-BP Dif (defined as 2h-BP 2 h after waking minus 2h-BP 2 h before waking) and the percentage decline in nocturnal BP were also assessed as indicators of circadian BP variation. Multivariate analysis was conducted after adjustment for possible confounding factors including daily salt intake. RESULTS Analysis of 2h-BP revealed that BP variation in drinkers had specific characteristics: a rapid BP increase before waking and higher morning BP levels (P = 0.0001). 2h-BP Dif was significantly higher in heavy drinkers than in nondrinkers (P = 0.04), while there was no significant association between drinking status and the magnitude of the nocturnal BP decline. CONCLUSION Habitual alcohol intake was associated with a higher 2h-BP Dif.

Ohira T; Tanigawa T; Tabata M; Imano H; Kitamura A; Kiyama M et al. Effects of habitual alcohol intake on ambulatory blood pressure, heart rate, and its variability among Japanese men. Hypertension 53(1): 13-U29, 2009. (29 refs.)

We sought to examine effects of habitual alcohol intake on ambulatory blood pressure (BP), heart rate (HR), and HR variability among Japanese men. Subjects were 539 men aged 35 to 65 years from rural and urban communities. Ambulatory BP and HR were monitored with an automated, portable, noninvasive multibiomedical recorder. Power spectral analysis of the RR intervals on the ECG was performed every 5 minutes. Compared with nondrinkers, moderate drinkers (alcohol intake 23 to 45 g/d) and heavy drinkers (alcohol intake >= 46 g/d) showed higher age- and field-adjusted mean values of systolic and diastolic BPs during the morning and while awake, but there were no differences in BPs over 24-hour periods and while asleep among the alcohol intake categories. Alcohol intake was positively associated with mean values of sleep-morning differences and daytime variability in BPs, HRs while awake and asleep, and low frequency: high frequency ratio while asleep. The results were virtually unchanged after adjustment for body mass index, smoking, and diabetes mellitus. Compared with the nondrinkers, age- and field-adjusted odds ratios of the morning BP surge (excess elevation of BP in the morning: morning systolic BP minus sleep systolic BP >= 37 mm Hg) for light (alcohol intake 0 to 22 g/d), moderate, and heavy drinkers were 0.96 (95% CI: 0.34 to 2.78), 1.68 (95% CI: 0.64 to 4.38), and 2.73 (95% CI: 1.12 to 6.67), respectively. Habitual alcohol intake was associated with increased BP in the morning, HR while awake and asleep, and sympathetic activity while asleep, which may explain some of the mechanisms of the relationship between heavy alcohol intake and risk of cardiovascular diseases.

Pierdomenico SD. Passive smoking and masked hypertension. (editorial). American Journal of Hypertension 22(8): 819-819, 2009. (6 refs.)

Steptoe A; McMunn A. Health behaviour patterns in relation to hypertension: the English Longitudinal Study of Ageing. Journal of Hypertension 27(2): 224-230, 2009. (42 refs.)

Objective: Clinical guidelines emphasize that hypertensive individuals should be encouraged to maintain healthy lifestyles with respect to smoking, physical activity, alcohol consumption and diet. We assessed health behaviours in a large sample of older hypertensive individuals, and tested whether medication for hypertension leads to compensatory increases in cardiovascular risk behaviours. Methods: Analysis of wave 1 of the English Longitudinal Study of Ageing, involving 5231 men and 6292 women aged at least 50 years. We analysed the prevalence of smoking, heavy drinking, sedentary behaviour and vigorous physical activity in relation to self-reported hypertension, controlling for age, sex, socioeconomic status, comorbidity (coronary heart disease, diabetes, arthritis), impairments of mobility, activities of daily living and depression. Results: The prevalence of self-reported hypertension was 37.8%, and 77% of hypertensive participants were prescribed medication. Hypertensive participants were less likely to smoke than normotensive ones (14.8 vs. 19.7%), with reduced odds of smoking [odds ratio (OR) 0.72, 95% confidence intervals (CI) 0.56-0.83] after adjusting for covariates. Hypertensive individuals were more likely to be heavy drinkers (OR 1.34, CI 1.10-1.62), to be sedentary (OR 1.14, CI 1.02-1.27), and not engage in vigorous physical activity (OR 0.84, CI 0.75-0.94). There was no evidence for risk compensation in medicated hypertensive individuals compared with unmedicated ones. Conclusion Smoking rates are low among hypertensive individuals, but the patterns of alcohol consumption and physical activity are suboptimal. Compensatory increases in risky behaviours appear not to be present in medicated individuals. There is considerable scope for advice and counselling to older hypertensive individuals to improve patterns of health behaviour.

Sull JW; Yi SW; Nam CM; Choi K; Ohrr H. Binge drinking and hypertension on cardiovascular disease mortality in Korean men and women: A Kangwha cohort study. Stroke 41(10): 2157-2162, 2010. (21 refs.)

Background and Purpose-The purpose of this study was to examine combined effects of hypertension and binge drinking on the risk of mortality from cardiovascular disease in Koreans. Methods-This study followed a cohort of 6100 residents in Kangwha County, aged >= 55 years as of March 1985, for cardiovascular mortality for 20.8 years up to December 31, 2005. We calculated hazard ratios (HRs) for cardiovascular mortality by blood pressure and binge drinking habits using the Cox proportional hazard model. Binge drinkers and heavy binge drinkers were defined as having >= 6 drinks on 1 occasion and >= 12 drinks on 1 occasion. Results-After adjusting for total alcohol consumption, male heavy binge drinkers with Grade 3 hypertension had a 12-fold increased risk of cardiovascular mortality (HR, 12.7; 95% CI, 3.47 to 46.5), whereas male binge drinkers with Grade 3 hypertension had a 4-fold increased risk of cardiovascular mortality (HR, 4.41; 95% CI, 1.38 to 14.1) when compared with nondrinkers with normal blood pressure. However, in considering separate effects of heavy binge drinking and hypertension on the risk of cardiovascular mortality, HRs were rather low (HR of heavy binge drinkers, 1.88, 1.10 to 3.20; HR of hypertensives, 2.00, 1.70 to 2.35) compared with nondrinkers with normal blood pressure. Conclusions-Binge drinkers and heavy binge drinkers with Grade 3 hypertension showed a marked increase in cardiovascular mortality risk. Even after adjusting for total alcohol consumption, the former revealed 4.41 and the latter indicated 12.7 of HR for the risk of cardiovascular mortality.

Suwazono Y; Dochi M; Oishi M; Tanaka K; Morimoto H; Sakata K. Longitudinal effect of smoking cessation on physical and laboratory findings. American Journal of Preventive Medicine 38(2): 192-200, 2010. (26 refs.)

Background: Detailed information on the expected physiologic changes after smoking cessation is practically useful to encourage people to stop smoking. Furthermore, weight increase after cessation may affect such physiologic changes. Purpose: This article aims to evaluate the effect of smoking cessation on annual changes in body weight, blood pressure, and blood biochemistry Methods: This Study analyzed the results of annual health examinations from 1991 to 2005 in male Japanese workers in 2009. Subjects classified as stopping smoking (n=445) responded initially as smokers in a self-administered questionnaire (baseline year) and then answered consistently as nonsmokers for 3 subsequent years of the 2672 smokers identified in the study, 2403 subjects who had data available for at least 4 successive years were selected as controls The time course of physiologic and laboratory data was analyzed using a linear mixed model. Results: Data adjusted for age, type of job schedule, drinking and physical activity showed that subjects who stopped smoking had significantly greater increases in weight, BMI, systolic and diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, and Uric acid and a greater decrease in hemoglobin in the 3 years following smoking cessation than continuing smokers additional adjustment for change in BMI from baseline negated the significant deterioration in systolic and diastolic blood pressure and total cholesterol that occurred following smoking cessation. Conclusions: Increase in body weight, blood pressure, and blood biochemistry can continue for at least 3 years after smoking cessation This study also indicated that these increases were related to the weight increase that occurred after smoking cessation.

Vandrey R; Umbricht A; Strain EC. Increased blood pressure after abrupt cessation of daily cannabis use. Journal of Addiction Medicine 5(1): 16-20, 2011. (26 refs.)

Objective: Cannabis is the most widely used illicit drug. Acute cannabis administration increases blood pressure (BP) and heart rate and tolerance develops to these effects with heavy use. A valid and reliable withdrawal syndrome occurs in most daily users, but few studies have assessed the cardiovascular effects of withdrawal. The objective of this report is to describe unexpected changes in cardiovascular function during brief periods of supervised cannabis use and abstinence in daily cannabis users. Methods: A within-subjects ABAC crossover study in which inpatient volunteers smoked cannabis ad libitum (A), and abstained from cannabis (B/C). Vital signs were obtained 3 times daily during 11 inpatient days for 13 daily cannabis users (11 men, 8 African American). Results: BP increased significantly during periods of cannabis abstinence compared with periods of cannabis use. The magnitude of increase was substantial in a subset (N = 6) of participants, with mean increases of up to 22.8 mm Hg systolic and 12.3 mm Hg diastolic BP observed. A main effect of heart rate was not observed. Secondary analysis limited to morning assessments suggested that resting heart rate increased during abstinence, but the magnitude of this effect was not clinically significant. Conclusions: Abrupt cessation of heavy cannabis use may cause clinically significant increases in BP in a subset of users. BP should be monitored among those attempting to reduce or quit frequent cannabis use, particularly those with preexisting hypertension. The time course of this effect is currently unknown and requires further study.

Virdis A; Giannarelli C; Neves MF; Taddei S; Ghiadoni L. Cigarette smoking and hypertension. (review). Current Pharmaceutical Design 16(23): 2518-2525, 2010. (99 refs.)

Cigarette smoking is a powerful cardiovascular risk factor and smoking cessation is the single most effective lifestyle measure for the prevention of a large number of cardiovascular diseases. Impairment of endothelial function, arterial stiffness, inflammation, lipid modification as well as an alteration of antithrombotic and prothrombotic factors are smoking-related major determinants of initiation, and acceleration of the atherothrombotic process, leading to cardiovascular events. Cigarette smoking acutely exerts an hypertensive effect, mainly through the stimulation of the sympathetic nervous system. As concern the impact of chronic smoking on blood pressure, available data do not put clearly in evidence a direct causal relationship between these two cardiovascular risk factors, a concept supported by the evidence that no lower blood pressure values have been observed after chronic smoking cessation. Nevertheless, smoking, affecting arterial stiffness and wave reflection might have greater detrimental effect on central blood pressure, which is more closely related to target organ damage than brachial blood pressure. Hypertensive smokers are more likely to develop severe forms of hypertension, including malignant and renovascular hypertension, an effect likely due to an accelerated atherosclerosis.

Wakabayashi I. Impact of body weight on the relationship between alcohol intake and blood pressure. Alcohol and Alcoholism 44(2): 204-210, 2009. (22 refs.)

Aims: The reduction of habitual alcohol drinking is recommended for the prevention of hypertension. Daily or weekly alcohol consumption, which is used for evaluation of the effects of alcohol drinking on blood pressure, is usually not corrected by body weight. In this study, the influence of body weight on the relationship between alcohol intake and blood pressure was investigated. Methods: The subjects (27,005 healthy men at ages of 35-54 years) were divided into four groups by average daily ethanol intake [non-, light (< 15 g per day), moderate (>= 15 and < 30 g per day) and heavy (>= 30 g per day) drinkers]. The subjects were also divided into four quartile groups by body weight. Results: Alcohol intake and the percentage of drinkers were not different in the four quartile groups of body weight. In the first and second quartiles of body weight, systolic and diastolic blood pressures were significantly higher in moderate and heavy drinkers than in non-drinkers, while systolic and diastolic blood pressures in the fourth quartile of body weight were significantly higher in heavy drinkers than in non-drinkers but were not significantly different in moderate drinkers and non-drinkers. The differences in systolic or diastolic blood pressure between non-drinkers and moderate drinkers and between non-drinkers and heavy drinkers became greater as body weight decreased. These results were not altered when age and smoking history were adjusted. Conclusions: The results suggest that body weight modifies the relationship between alcohol consumption and blood pressure and thus should be taken into account when effects of alcohol on blood pressure are considered.

Wakabayashi I; Araki Y. Associations of alcohol consumption with blood pressure and serum lipids in Japanese female smokers and nonsmokers. Gender Medicine 6(1): 290-299, 2009. (32 refs.)

Background: Alcohol intake and smoking have been reported to influence atherosclerotic progression. Objective: The purpose of this study was to determine whether the associations of alcohol intake with blood pressure (BP) and serum lipid concentrations are modified by smoking in Japanese women. Methods: Eligible subjects were healthy female Japanese workers aged 35 to <55 years who had received periodic health examinations at workplaces in Yamagata Prefecture in Japan. Subjects were classified as smokers or nonsmokers and subclassified into 3 subgroups based on average daily reported alcohol intake: nondrinkers, light drinkers (<15 g/d), and heavy drinkers (>= 15 g/d). The means of each variable (systolic and diastolic BP [SBP and DBP, respectively] and serum concentrations of total cholesterol [TC], low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and triglycerides) were compared among the 2 groups of smoking history and 3 subgroups of alcohol intake after adjusting for age and body mass index. Results: A total of 16,805 healthy women were enrolled (14,695 nonsmokers, 2110 smokers). In smokers, SBP was significantly higher in heavy drinkers than in nondrinkers, and DBP was significantly higher in light drinkers and heavy drinkers than in nondrinkers (all, P < 0.01). In nonsmokers, SBP was not significantly higher in light drinkers and heavy drinkers versus nondrinkers, and the difference in DBP between heavy drinkers and nondrinkers was significant (P < 0.01), but that between light drinkers and nondrinkers was not. In smokers but not in nonsmokers, serum TC concentration was significantly lower in heavy drinkers than in nondrinkers. In smokers and nonsmokers, LDL-C was significantly lower in light and heavy drinkers than in nondrinkers (all, P < 0.01), and serum HDL-C was significantly higher in light and heavy drinkers than in nondrinkers (all, P < 0.01). The differences in mean LDL-C between light and heavy drinkers versus nondrinkers were numerically greater in smokers than in nonsmokers. Conclusion: In this sample of women in Japan, serum LDL-C concentration was significantly lower in drinkers than in nondrinkers, and smoking might increase this association between alcohol intake and lowered LDL-C.

Wakabayashi I; Araki Y. Influences of gender and age on relationships between alcohol drinking and atherosclerotic risk factors. Alcoholism: Clinical and Experimental Research 34(2, Supplement 1): S54-S60, 2010. (14 refs.)

Background. Alcohol drinking affects atherosclerotic progression mainly through blood pressure and lipid metabolism. The purpose of the present study was to clarify whether effects of alcohol drinking on atherosclerotic risk factors differ by gender and age. Methods. The database of periodic health check-ups for local district workers was used. The subjects were divided into 3 groups according to mean ethanol consumption per day (nondrinkers; light drinkers, less than 30 g per day; moderate-to-heavy drinkers, 30 g or more per day). The mean levels of each atherosclerosis-related variable in the 3 groups were compared. Results. The mean level of body mass index (BMI) was slightly but significantly lower in drinkers than in nondrinkers in the thirties, forties, and fifties age groups in men and in the twenties, thirties, forties, and fifties age groups in women, while this tendency was not found in the sixties age groups of men and women. In men, mean blood pressure was higher in moderate-to-heavy drinkers than in nondrinkers in all age groups and was higher in light drinkers than in nondrinkers only in the age groups after 40 years. Mean blood pressure of women was higher in the moderate-to-heavy drinker group than in the nondrinker group and this difference became higher with advance of age. In women, mean blood pressure was not affected by light drinking in any of the age groups except for the fifties age group. In men, serum total cholesterol was higher in drinkers than in nondrinkers in the twenties age group but was lower in drinkers than in nondrinkers at thirties or older. Serum total cholesterol in women was lower in drinkers than in nondrinkers in the age groups from twenties to forties but tended to be higher in drinkers than in nondrinkers in the sixties age group. Serum HDL cholesterol increased with advance of age from thirties to sixties in men, while it decreased with advance of age from twenties to sixties in women. Serum HDL cholesterol was higher in drinkers than in nondrinkers in all age groups of men and women, and atherogenic index, calculated by using serum total cholesterol and HDL cholesterol concentrations, was lower in drinkers than in nondrinkers in all age groups of men and women. Conclusions. Both in men and women, blood pressure and HDL cholesterol were strongly affected by alcohol drinking: the elevating effect of alcohol drinking on blood pressure was more prominent in the elderly than in the young, while the elevating effect of alcohol drinking on serum HDL cholesterol was not influenced by age. Relationships of drinking with total cholesterol and BMI vary by age and gender.

Weston BW; Krishnaswami S; Gray MT; Coly G; Kotchen JM; Grim CE et al. Cocaine use in inner city African American research volunteers. Journal of Addiction Medicine 3(2): 83-88, 2009. (24 refs.)

Objectives: To determine the prevalence of cocaine use and associated risk factors in African Americans volunteering as research subjects for a hypertension study. Methods: African Americans recruited from Milwaukee's inner city received $25 for completing a blood pressure screening protocol with the potential to participate in an additional protocol for $200, contingent on a negative drug test for cocaine. This study is based on the characteristics of the participants who completed the drug screen for cocaine. The significance of differences in the frequencies of categorical variables between users and nonusers was determined by X-2 analysis or Fisher exact test. Results: Of 389 drug-tested participants, 35% tested positive for cocaine. Cocaine Positive volunteers were slightly older (P = 0.02), had a lower body mass index (P = 0.001), a smaller waist circumference (P = 0.005), and lower serum cholesterol levels (P = 0.04). Those testing positive were more likely to be tobacco smokers (P < 0.0001), unemployed (P 0.001), and alcohol users (P < 0.0001), but less likely to use prescription medications (P = 0.01). Income and education did not differ between cocaine positive and negative subjects. Individuals employed full-time were less likely to test positive than the unemployed, whereas part-time employees were intermediate (P = 0.0003). Although those testing positive were slightly less likely to have a living mother (P = 0.07), there was no association with living fathers. Cigarette smokers were almost five times more likely to test positive for cocaine than nonsmokers (OR 4.88, 95% CI 2.73-8.71). Additional predictors of positive tests were alcohol consumption (OR 1.90, 95% CI 1.18-3.19), a reported history of substance abuse (OR 1.83, 95% CI 1.05-3.19), and a family history that included one or more deceased siblings (OR 1.82, 95% CI 1.03-3.21). Conclusions: A high prevalence of substance use was detected among inner city African Americans offered financial incentives for participating in a general medical research protocol. This information may be relevant for designing future clinical trials and drug use intervention programs.

Yarlioglues M; Kaya MG; Ardic I; Calapkorur B; Dogdu O; Akpek M et al. Acute effects of passive smoking on blood pressure and heart rate in healthy females. Blood Pressure Monitoring 15(5): 251-256, 2010. (30 refs.)

Objects Carbon monoxide (CO) is suspected of playing a major role in cigarette smoke-induced cardiovascular diseases. Hypertension is one of the common chronic cardiovascular diseases that lead to heart attacks, strokes, chronic heart failure, and chronic renal failure. We aimed to investigate the immediate effects of passive smoking on blood pressure and heart rate during and after exposure in healthy females. In addition, we examined that whether carboxyhemoglobin (COHb) levels were correlated with heart rate and blood pressure measurements. Methods Thirty healthy nonsmoker female volunteers (mean age: 26 +/- 5 years) were prospectively enrolled in the study. Systolic and diastolic blood pressure and heart rate were obtained at baseline, 5th, 10th, 15th, 30th minute of exposure and at 5th, 15th, and 30th minute after exposure. Blood samples for measuring COHb were taken at baseline and after spending 30 min in the smoking room from all volunteers. Difference between baseline and second measurements of COHb were described as DCOHb. Results Mean COHb level was significantly higher at the end of exposure when compared with baseline values (COHb 0.5 +/- 0.1 vs. 1.8 +/- 0.4%, P < 0.05). Heart rate and systolic blood pressure measurements at 15th and 30th minute of exposure were higher than at baseline and 5th minute of exposure (88 +/- 3.2 and 90 +/- 3.7 vs. 76 +/- 3.9 and 78 +/- 4.5 beats/min, P < 0.05; 135 +/- 1.1 and 136 +/- 4.0 vs. 113 +/- 5.7 and 115 +/- 3.5 mmHg, P < 0.05). They elevated significantly at the same time interval. Diastolic blood pressure was significantly increased at 30th minute of exposure when compared with earlier measurements (90 +/- 5.1 vs. 74 +/- 2.2, 72 +/- 3.2 vs. 71 +/- 4.5 mmHg, P < 0.05). Heart rate and systolic blood pressure decreased notably at 15th minute and returned to baseline values at 30th minute after exposure (80 +/- 1.2 and 76 +/- 3.2 vs. 88 +/- 4.5 beats/min, P < 0.05; 120 +/- 4.4 and 115 +/- 1.9 vs. 135 +/- 2.2 mmHg, P < 0.05). Diastolic blood pressure decreased significantly at 30th minute and returned to baseline values at 60th minute after exposure (75 +/- 3.6 and 70 +/- 2.5 vs. 89 +/- 4.3 mmHg, P < 0.05). Heart rate and diastolic blood pressure measurements were moderately correlated and systolic blood pressure measurements were closely correlated with DCOHb values at the end of the exposure. Conclusion Our results suggested that passive smoking has remarkable acute effect on heart rate and blood pressure in young healthy females. Beside this, we found that DCOHb level is closely correlated with systolic blood pressure and moderately correlated with heart rate and diastolic blood pressure measurements.

Zhang WS; Jiang CQ; Cheng KK; Adab P; Thomas GN; Liu B et al. Alcohol sensitivity, alcohol use and hypertension in an older Chinese population: The Guangzhou Biobank Cohort Study. (review). Hypertension Research 32(9): 741-747, 2009. (40 refs.)

Although the J-shaped association between alcohol consumption and blood pressure ( BP) is well known, the effect of alcohol sensitivity on this relationship is less clear. We studied the association of alcohol sensitivity and alcohol use with BP and hypertension. This cross-sectional analysis included 19,335 older participants from the Guangzhou Biobank Cohort Study recruited from 2003 to 2006, using clinically measured BP and self-reported alcohol use and alcohol sensitivity. Alcohol use was rare in women, in whom light-to-moderate drinkers (<140 g ethanol per week) without alcohol sensitivity had lower systolic and diastolic BPs (mean difference 5.3 (95% CI 3.8-6.9) mmHg and 1.9 (1.1-2.7) mmHg, respectively) and a reduced risk of hypertension (0.62 (0.53-0.72)) relative to never drinkers. Similarly, excessive drinkers (>= 140 g ethanol per week) without alcohol sensitivity had a significantly higher systolic and diastolic BP and risk of hypertension than did nondrinkers ( mean difference 5.1 (2.8-7.4) mmHg, 2.7 (1.5-4.0) mmHg and 34% (8-66%), respectively, for men). These differences were even greater for men with alcohol sensitivity ( mean differences 12.0 (8.9-15.2) mmHg, 6.2 (4.5-7.9) mmHg and 95% CI (46-159%), respectively). Alcohol sensitivity and alcohol use were both associated with elevated BP and risk of hypertension in an older Chinese population. Alcohol sensitivity may aggravate the effect of drinking on BP. Limiting alcohol use to two drinks per day for men and one drink a day for women may be suitable for East Asians. Reduction of alcohol consumption should be an important public health target.