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CORK Bibliography: Blood Pressure and Hypertension

74 citations. January 2003 to present

Prepared: March 2008

Agirbasli M; Tanrikulu B; Arikan S; Izci E; Ozguven S; Besimoglu B et al. Trends in body mass index, blood pressure and parental smoking habits in middle socio-economic level Turkish adolescents. Journal of Human Hypertension 22(1): 12-17, 2008. (39 refs.)

Patterns of cardiovascular risk factors in populations are not static over time. We examined trends in body mass index (BMI), parental smoking and blood pressure over a 15-year period in Turkish children aged 15-17 years. Two cross-sectional studies were performed in secondary schools in Turkey in 1989-1990 and 2004-2005. Study participants were 673 children in 1989-1990 and 640 adolescents in 2004-2005. Main outcome measures were weight, height, BMI, presence and amount of parental smoking, systolic and diastolic blood pressure. Age and sex matched comparisons were performed to assess temporal trends in these measures. Children in 2004-2005 had increased weight, height, BMI and decreased systolic and diastolic blood pressure in all age groups compared with children in 1989-1990. According to the international criteria, 3.4% of children were obese and 15.8% were overweight in 2005, compared to 0.7% obese and 4.2% overweight in 1990 (P<0.001). However, a decrease was noted in blood pressure; 16% were classified as hypertensive in 1989-1990 versus 8% in 2004-2005 (P<0.001). The prevalence and amount of parental smoking also decreased over the last 15 years. We observed significant changes in BMI and blood pressure in Turkish children over the last 15 years. Temporal trends in these parameters may indicate a change in the pattern of cardiovascular disease in this population.

Appel LJ. Lifestyle modification as a means to prevent and treat high blood pressure. Journal of the American Society of Nephrology 14(7 Supplement 2): S99-S102, 2003. (17 refs.)

High BP is one of the most important and common risk factors for atherosclerotic cardiovascular disease and renal disease. The contemporary approach to the epidemic of elevated BP and its complications involves pharmacologic treatment of hypertensive individuals and "lifestyle modification," which is beneficial for both nonhypertensive and hypertensive persons. A substantial body of evidence strongly supports the concept that lifestyle modification can have powerful effects on BP. Increased physical activity, a reduced salt intake, weight loss, moderation of alcohol intake, increased potassium intake, and an overall healthy dietary pattern, termed the Dietary Approaches to Stop Hypertension (DASH) diet, effectively lower BP. The DASH diet emphasizes fruits, vegetables, and low-fat dairy products and is reduced in fat and cholesterol. Other dietary factors, such as a greater intake of protein or monounsaturated fatty acids, may also reduce BP but available evidence is inconsistent. The current challenge to health care providers, researchers, government officials, and the general public is developing and implementing effective clinical and public health strategies that lead to sustained lifestyle modification.

Beilin LJ; Puddey IB. Alcohol and hypertension: An update. Hypertension 47(6): 1035-1038, 2006. (33 refs.)

Given the social significance of alcohol worldwide it is not surprising that there is continuing strong interest in the relation between alcohol and hypertension. Recent research continues to address unresolved questions concerning the balance between the medical hazards and the cardiovascular benefits of alcohol, the possible significance of different types of beverage, the role of different drinking patterns for cardiovascular morbidity and mortality, and mechanisms underlying the pressor effects of ethanol. These issues all need to be considered in the context of social aspects of drinking and effects on noncardiovascular morbidity and mortality. Epidemiologic data relating the type or quantity of alcohol consumption to blood pressure or cardiovascular disease needs to be viewed with circumspection from a number of viewpoints. First, heavier drinkers or problems drinkers are far less likely to participate in surveys than others. Second, alcohol consumption past or present is notoriously underreported. Third, drinking patterns are difficult to quantify and often not reported at all. The type, quantity, and pattern of drinking are all highly correlated with socioeconomic and other lifestyle behaviors, many of which may not be measured or not measured accurately enough for adequate adjustments in statistical models. A relation between average weekly alcohol consumption, blood pressure level, and hypertension prevalence has been consistent worldwide and continues to be studied in different populations to evaluate its contribution in relation to other risk factors. The article covers patterns of drinking, beverage type and effects on hypertension subtypes; effects on large vessel structure and function; metabolic syndrome and diabetes; safe levels of drinking for hypertiesnive people. It then examines major studies discussing results that seemingly are significant and those that might well be spurious, such as the benefits of as little as one drink per day. It concludes with a quote from a landmark World Health Organization study on the burden of disease that "assessed the risks and benefits of alcohol by region and then globally and attributed 16% of all hypertensive disease to alcohol. To add to the controversy concerning "safe" levels of drinking, the Report's authors concluded that issues of bidirectional confounding in population studies had been underestimated in relation to alcohol and coronary heart disease and that any benefits of moderate alcohol consumption on coronary disease were likely to be outweighed by harmful effects (ie, there was "probably no free lunch").

Bulpitt CJ. How many alcoholic drinks might benefit an older person with hypertension? (review). Journal of Hypertension 23(11): 1947-1951, 2005. (29 refs.)

Lowering alcohol intake reduces blood pressure and hence cardiovascular risk. However, abstainers have an increase in cardiovascular risk and the advice to reduce intake to low levels may not be sound. This review examines the effects of lowering alcohol consumption in terms of blood pressure and coronary heart disease (CHD). The relationship between both CHD and stroke and alcohol consumption, and the benefits and disadvantages of alcohol consumption in the general population, are discussed. Where available, the results of large meta-analyses are reported. It is concluded that the hypertensive patient over the age of 60 who drinks over 16 drinks per week should be advised to reduce his or her alcohol intake but a daily drink may be advisable and the patient should not stop drinking entirely. It is not suggested that the non-drinker should start drinking, but most hypertensives are over the age of 60 when community studies suggest that drinking alcohol does more good than harm.

Corrao G; Bagnardi V; Zambon A; La Vecchia C. A meta-analysis of alcohol consumption and the risk of 15 diseases. Preventive Medicine 38(5): 613-619, 2004. (29 refs.)

Background. To compare the strength of evidence provided by the epidemiological literature on the association between alcohol consumption and the risk of 14 major alcohol-related neoplasms and non-neoplastic diseases, plus injuries.Methods. A search of the epidemiological literature from 1966 to 1998 was performed by several bibliographic databases. Meta-regression models were fitted considering fixed and random effect models and linear and nonlinear effects of alcohol intake. The effects of some characteristics of the studies, including an index of their quality, were considered.Results. Of the 561 initially reviewed studies, 156 were selected for meta-analysis because of their a priori defined higher quality, including a total of 116,702 subjects. Strong trends in risk were observed for cancers of the oral cavity, esophagus and larynx, hypertension, liver cirrhosis, chronic pancreatitis, and injuries and violence. Less strong direct relations were observed for cancers of the colon, rectum, liver, and breast. For all these conditions, significant increased risks were also found for ethanol intake of 25 g per day. Threshold values were observed for ischemic and hemorrhagic strokes. For coronary heart disease, a J-shaped relation was observed with a minimum relative risk of 0.80 at 20 g/day, a significant protective effect up to 72 g/day, and a significant increased risk at 89 g/day. No clear relation was observed for gastroduodenal ulcer. Conclusions. This meta-analysis shows no evidence of a threshold effect for both neoplasms and several non-neoplastic diseases. J-shaped relations were observed only for coronary heart disease.

Corwin EJ; McCoy CS; Whetzel CA; Ceballos RM; Klein LC. Risk indicators of metabolic syndrome in young adults: A preliminary investigation on the influence of tobacco smoke exposure and gender. Heart & Lung 35(2): 119-129, 2006. (89 refs.)

BACKGROUND: Metabolic syndrome is characterized by hypertension, dyslipidemia, insulin resistance, and obesity. Limited investigations have Studied early indicators of metabolic syndrome in healthy Young adults before diagnosis of disease. PURPOSE: The purpose of this investigation is to identify shifts in cardiovascular (CV), metabolic, and immune variables consistent with metabolic syndrome but occurring before development of the disorder, and to determine whether these variables are influenced by gender or cigarette smoking. METHODS: A pilot study of 41 subjects ages 18 to 39 years, with 20 smokers and 21 nonsmokers, was undertaken. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured to evaluate CV Status; cholesterol, body mass index, leptin, percent glycated albumin, and homocysteine were measured to evaluate metabolic status; C-reactive protein, interleukin-1 beta, and interleukin-10 were measured to evaluate immunologic status. Risk scores were assigned to each indicator, and total risk score was computed. RESULTS: Men had higher SBP (P < .001), DBP (P = .046), and body mass index (P = .01), whereas women had higher leptin (P = .002). Total risk scores in men were greater (P = .02). There was no effect of smoking on risk score, related to the increase in two risks for smokers (SBP, P = .04, DBP; P = .027) reciprocated by a decrease in another (percentage of glycated albumin; P = .02). CONCLUSION: Risk factors contributing to metabolic syndrome are present and highest in young men compared with women, whereas the effects of cigarette smoking on the syndrome are mixed. Early intervention to reduce modifiable risks may prevent full expression of disease.

Estruch R.; Sacanella E.; De la Sierra A.; Aguilera MT; Antunez E.; Nicolas JM; Fernandez-Sola J.; Coca A.; Urbano-Marquez A. Effects of alcohol withdrawal on 24 hour ambulatory blood pressure among alcohol-dependent patients. Alcoholism: Clinical and Experimental Research 27(12): 2002-2008, 2003. (48 refs.)

Background: Although epidemiologic studies have reported an association between alcohol intake and high blood pressure (BP), the results of intervention studies have shown inconsistent results. We embarked on a study to determine whether different subgroups of alcohol-dependent patients may be identified in relation to the effect of alcohol on BP. Methods: Fifty alcohol-dependent men (mean age, 41.4 years) received 0.4 g of ethanol per kilogram of body weight every 4 hr in 200 ml of orange juice during 24 hr and the same amount of orange juice without ethanol during another 24 hr. Twenty-four hour ambulatory BP monitoring was performed during ethanol and orange juice intakes, as was hormonal and biochemical analysis. Results: Thirty-five (75%) alcohol-dependent men were normotensive and 15 (30%) hypertensive. Eighteen (51%) normotensive and 12 (80%) hypertensive subjects showed a significant decrease in 24 hr mean BP after ethanol withdrawal (mean decrease of 8.4 mm Hg [95% confidence interval, -11.2 to -5.7] and 12.5 mm Hg [confidence interval, -16.2 to -8.8], respectively) and were considered as sensitive to alcohol. The remaining alcohol-dependent subjects were considered as resistant to alcohol. Normotensive subjects sensitive to ethanol showed a significantly greater left ventricular mass and a significantly lower ejection fraction than those normotensive patients whose BP did not change after ethanol withdrawal (both P < 0.01).Conclusions: More than three fourths of the hypertensive and more than half of the normotensive alcohol-dependent patients showed sensitivity to the pressor effects of ethanol. Impairment also was observed in heart function in normotensive patients sensitive to the pressor effects of ethanol.

Fan AZ; Russell M; Dorn J; Freudenheim JL; Nochajski T; Hovey K et al. Lifetime alcohol drinking pattern is related to the prevalence of metabolic syndrome. The Western New York Health Study (WNYHS). European Journal of Epidemiology 21(2): 129-138, 2006. (48 refs.)

The association of lifetime alcohol drinking pattern with the prevalence of the metabolic syndrome is largely unknown. Analyses were conducted on a population-based sample in a cross-sectional study (N = 2818, ages 35-79 years, 93% whites). Included were subjects who drank at least once a month for a period of at least six months during their lifetimes and were free of cardiovascular disease and cancer at the time of interview. Lifetime drinking measures included total years of drinking, total drinking days, volume (total drinks) and average intensity (#drinks/drinking day); frequency of intoxication and heavy drinking; and age drinking began and ended. Metabolic syndrome components included impaired fasting glucose (IFG), high triglycerides (HTG), low HDL cholesterol (LHDLC), abdominal obesity (ABO), and hypertension (HBP). Potential confounders examined were age, gender, race, family history of coronary heart disease or diabetes, years of education, lifetime and current cigarette smoking, current drinking status, physical activity, and dietary factors. Multiple logistic regressions indicated that average intensity was directly related to IFG, HTG, HBP, and metabolic syndrome overall (p for linear trend = 0.03, 0.04, 0.003, and 0.009, respectively) and to ABO in women only (p for trend = 0.0004). Prevalence ratios (95% CI) for the metabolic syndrome according to quartiles of intensity were 1.00 (lowest), 1.23 (0.91-1.67), 1.43 (1.06-1.91) and 1.60 (1.12-2.30). Total drinking days was inversely related to LHDLC (p for trend = 0.0002) and to ABO in women only (p for trend < 0.0001). It is concluded that lifetime drinking patterns are significantly related to the prevalence of the metabolic syndrome.

Fleming M; Brown R; Brown D. The efficacy of a brief alcohol intervention combined with %CDT feedback in patients being treated for type 2 diabetes and/or hypertension. Journal of Studies on Alcohol 65(5): 631-637, 2004. (42 refs.)

Objective: Alcohol biomarkers are being developed to improve a physician's ability to identify and intervene with patients with chronic medical problems adversely affected by heavy alcohol use. This article reports the findings of a brief intervention trial which included feedback to patients of their carbohydrate-deficient transferrin (CDT) test results. Method: A pilot study was conducted to test the efficacy of brief clinician advice to reduce alcohol use and improve health status in a sample of 151 patients being treated for Type 2 diabetes and hypertension. The intervention included informing patients of their CDT levels. The patients were randomized to a usual care or brief intervention group. Results: There were no significant differences at baseline between the two groups in alcohol use, CDT levels, addiction rates, age, gender, socioeconomic status or health status measures. Following brief intervention, significant differences were observed in the intervention group in alcohol use and CDT: The proportion of heavy drinkers at the 12-month follow-up compared with baseline decreased from 35.8% to 24.7% in the intervention group, with no change in the control group (p <.044). CDT levels decreased as well from 2.79% to 2.41% (16% change) in the control group and 3.05% to 2.35% (28% change) in the intervention group, with significantly more intervention-group patients reducing their CDT level by at least 25% (p <.006). Conclusions: The study provides new information suggesting brief intervention, combined with feedback on CDT levels, can reduce alcohol use and %CDT in a sample of primary care patients being treated for Type 2 diabetes and hypertension.

Fleming M; Mundt M. Carbohydrate-deficient transferrin: Validity of a new alcohol biomarker in a sample of patients with diabetes and hypertension. Journal of the American Board of Family Practice 17(4): 247-255, 2004. (44 refs.)

Objective: To test the reliability and validity of a new alcohol biomarker. Design: Cross-sectional with matched control. Alcohol use, symptoms of alcohol dependence, health status, current medications, carbohydrate-deficient transferrin (CDT) levels, and gamma-glutamyl transferase levels were assessed. Validity of the %CDT test was estimated using a drinking cutoff of 90 or more drinks in the previous 30 days. Participants: Sample (n = 799) included 89 patients with type 2 diabetes, 299 patients with hypertension, 209 patients with hypertension and type 2 diabetes, and 202 matched control subjects with neither diabetes nor hypertension. Results: Three hundred ninety-six women and 403 men ages 30 to 60 participated in the study. Six percent ( 45 of 799) reported drinking more than 14 drinks per week, 2% (n = 17) met criteria for alcohol abuse, and 3% (n = 23) met DSM-IV criteria for dependence. The overall sensitivity of the %CDT test was 61% with a specificity of 85%. A receiver operating characteristic curve was used to determine that the best fit was for persons who reported >90 drinks per month and a CDT level >2.5% with an area under the curve of 0.83. Test-retest reliability (R) was 0.94. Conclusions: %CDT levels are useful in detecting and/or confirming high-risk drinking in patients being treated for type 2 diabetes and hypertension.

Geleijnse JM; Kok FJ; Grobbee DE. Impact of dietary and lifestyle factors on the prevalence of hypertension in Western populations. European Journal of Public Health 14(3): 235-239, 2004. (38 refs.)

Background: Data on the impact of the many dietary and lifestyle factors on the prevalence of hypertension in Western societies are lacking. This study quantified the contributions of body weight, physical inactivity and dietary factors to the prevalence of hypertension in Finland, Italy, the Netherlands, United Kingdom (UK) and USA. Methods: Distributions of blood pressure (BP) and risk factors in Western populations were obtained from nationwide surveys. The effect of risk factors on BP was assessed by meta-regression analysis of randomized trials, published between 1966 and March 2001. Population attributable risk percentages (PAR%) for hypertension (i.e. systolic BP greater than or equal to140 mmHg) were computed for all risk factors in the five countries. Results: Being overweight made the largest contribution to hypertension, with PAR% between 11% (Italy) and 25% (USA). PAR% were 5-13% for physical inactivity, 9-17% for high sodium intake, 4-17% for low potassium intake and 4-8% for low magnesium intake. The impact of alcohol was small (2-3%) in all populations. PAR% varied among populations for inadequate intake of calcium (2-8%), magnesium (4-8%), coffee (0-9%) and fish fatty acids (3-16%). Conclusions: Diet and lifestyle have a substantial impact on hypertension in Western societies, with being overweight, physical inactivity, high sodium intake and low potassium intake being the main contributors. The relative significance of different risk factors varies among populations, which is important for preventative strategies.

Gorelick DA; Heishman SJ; Preston KL; Nelson RA; Moolchan ET; Huestis MA. The cannabinoid CB1 receptor antagonist rimonabant attenuates the hypotensive effect of smoked marijuana in male smokers. American Heart Journal 151(3): doi:10.1016/j.ahj.2005, 2006. (23 refs.)

Background: Animal studies suggest that cannabinoid CB1 receptors play a role in regulating blood pressure (BP). In human studies, activation of CB I receptors by cannabis or its active ingredient, Delta 9-tetrahydrocannabinol (THC), has modest and inconsistent effects on BP. Methods We evaluated this phenomenon in 63 male cannabis smokers (mean [SD] age 27.7 +/- 5.4 years, 70% African American, 10.3 +/- 5.9 years of lifetime cannabis use) by administering escalating oral doses (1, 3, 10, 30, 90 mg) of the selective CBI receptor antagonist rimonabant (or placebo) in a randomized, parallel-group, double-blind, placebocontrolled design. Subjects smoked an active (2.64% THC) or placebo marijuana cigarette 2 and 6 hours after rimonabont dosing. Blood pressure and symptoms were monitored for 90 minutes after smoking while subjects remained seated. Results Marijuana smoking alone (ie, after placebo rimonabant) had no consistent effect on BP, but 22% of subjects experienced symptomatic (dizziness, lightheadedness) hypotension, as did 20% to 33% of subjects who received pretreatment with rimonabant, 1, 3, or 10 mg. No subject receiving rimonabont, 30 or 90 mg, before marijuana smoking experienced symptomatic hypotension. The 7 subjects who experienced symptomatic hypotension had significantly higher mean (SD) peak plasma THC concentrations (181.6 +/- 80.2) than did the 33 subjects who did not (109.0 +/- 62.6). Rimonabont by itself had no effects on BP and did not alter THC pharmacokinetics. Conclusions: These findings indicate that CB1 receptors play a role in mediating effects of cannabis smoking on BP in humans.

Greenberg JA; Dunbar CC; Schnoll R; Kokolis R; Kokolis S; Kassotis J. Caffeinated beverage intake and the risk of heart disease mortality in the elderly: A prospective analysis. American Journal of Clinical Nutrition 85(2): 392-398, 2007. (33 refs.)

Background: Motivated by the possibility that caffeine could ameliorate the effect of postprandial hypotension on a high risk of coronary events and mortality in aging, we hypothesized that caffeinated beverage consumption decreases the risk of cardiovascular disease (CVD) mortality in the elderly. Objective: The objective of the study was to use prospective cohort study data to test whether the consumption of caffeinated beverages exhibits this protective effect. Design: Cox regression analyses were conducted for 426 CVD deaths that occurred during an 8.8-y follow-up in the prospective first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. The analysis involved 6594 participants aged 32-86 y with no history of CVD at baseline. Results: Participants aged >= 65 y with higher caffeinated beverage intake exhibited lower relative risk of CVD and heart disease mortality than did participants with lower caffeinated beverage intake. It was a dose-response protective effect: the relative risk (95% CI) for heart disease mortality was 1.00 (referent), 0.77 (0.54, 1.10), 0.68 (0.49, 0.94), and 0.47 (0.32, 0.69) for < 0.5, 0.5-2, 2-4, and >= 4 servings/d, respectively (P for trend = 0.003). A similar protective effect was found for caffeine intake in mg/d. The protective effective was found only in participants who were not severely hypertensive. No significant protective effect was found in participants aged < 65 y or in cerebrovascular disease mortality for those aged 65 y. Conclusion: Habitual intake of caffeinated beverages provided protection against the risk of heart disease mortality among elderly participants in this prospective epidemiologic analysis.

Guthrie SK; Ni LS; Zubieta JK; Teter CJ; Domino EF. Changes in craving for a cigarette and arterial nicotine plasma concentrations in abstinent smokers. (review). Progress in Neuro-Psychopharmacology & Biological Psychiatry 28(4): 617-623, 2004. (21 refs.)

Although the relationship between nicotine and changes in heart rate and blood pressure has been demonstrated, the relationship between nicotine and subjective effects such as decreased craving, relaxation, sickness, and decreased nervousness, is less well delineated. In this study, arterial nicotine levels were drawn in 21 smokers who smoked two average nicotine (AN) cigarettes and one low nicotine (LN) cigarette. Craving for a cigarette, relaxation, sickness, and decreased nervousness were rated on a visual analog scale (VAS) before and after smoking each cigarette. None of these subjective measures except craving for a cigarette was changed significantly by smoking. The change in craving was significantly correlated with the area under the plasma nicotine concentration versus time curve (r = -0.57, p = 0.01) calculated from the arterial nicotine samples drawn up to 20 min after the initiation of smoking the first AN cigarette. Although well-documented behavioral manipulations, such as smoking denicotinized cigarettes, reduce craving, increases in plasma arterial nicotine concentrations after smoking the first cigarette of the day also reduce craving. Both the psychology and pharmacology of nicotine/tobacco smoking are involved in craving reduction.

Hser YI; Gelberg L; Hoffman V; Grella CE; McCarthy W; Anglini MD. Health conditions among aging narcotics addicts: Medical examination results. Journal of Behavioral Medicine 27(6): 607-622, 2004. (68 refs.)

The study examined health conditions among an aging cohort of male narcotics addicts. This prospective cohort study (1964-1998) included interviews and medical testing for 108 surviving subjects who had been admitted to the California Civil Addiction Program during the years 1962 through 1964. Medical testing results were: 51.9% had high blood pressure, 22.4% showed hyperlipidemia, 13.3% had elevated levels of blood glucose, 33.6% had abnormal pulmonary function, half of the sample had abnormal liver function, and 94.2% tested positive for hepatitis C, 85.6% for hepatitis B, 3.8% for syphilis, and 27.3% for TB. The study empirically demonstrated poor health conditions and high morbidity among surviving narcotics addicts.

Ijzerman RG; Serne EH; van Weissenbruch MM; de Jongh RT; Stehouwer CDA. Cigarette smoking is associated with an acute impairment of microvascular function in humans. Clinical Science 104(3): 247-252, 2003. (104 refs.)

An effect on microvascular function has been proposed as a possible mechanism explaining the association of acute smoking with increased blood pressure and decreased insulin sensitivity. However, the effects of smoking on microvascular function have not been studied. We have investigated the acute effects of smoking on microvascular function in 12 healthy smokers. Before and after smoking a cigarette, we measured heart rate, blood pressure and capillary recruitment during peak reactive hyperaemia. We also measured endothelium-dependent and endothelium-independent vasodilatation of the skin microcirculation with iontophoresis of acetylcholine and sodium nitroprusside respectively combined with laser Doppler fluxmetry. To exclude non-specific changes, a control study with sham smoking was performed. The smoking and sham smoking studies were conducted in a randomized order. Compared with sham smoking, acute smoking caused increases in heart rate (smoking, 9.3+/-4.1 beats/min; sham, -1.3+/-3.0 beats/min; P < 0.001) and systolic blood pressure (smoking, 6.3+/-8.8 mmHg; sham, 0.8+/-4.4 mmHg; P < 0.05); decreases in absolute (smoking, -4.9+/-6.9 per mm(2); sham, 0.8+/-2.1 per mm 2; P = 0.01) and relative (smoking, -13.8+/-21.4%; sham, 1.9+/-6.9%; P = 0.02) capillary recruitment during peak reactive hyperaemia; and decreases in absolute [smoking, -62.4+/-47.7 perfusion units (PU); sham, -30.8+/-32.6 PU; P = 0.04] and relative (smoking, -147+/-163%; sham, 32+/-225%; P = 0.07) vasodilatation caused by acetylcholine. Absolute (smoking, -31.6+/-58.5 PU; sham, -8.4+/-44.0 PU; P = 0.3) and relative (smoking, -50.2+/-219.0%; sham, -17.1+/-139%; P = 0.7) vasodilatation caused by sodium nitroprusside were not affected. Thus acute smoking is associated with impaired capillary recruitment during peak reactive hyperaemia and impaired microvascular endothelium-dependent vasodilatation. These findings may explain the increased blood pressure and decreased insulin sensitivity that have been observed after acute smoking.

John U; Meyer C; Hanke M; Volzke H; Schumann A. Smoking status, obesity and hypertension in a general population sample: A cross-sectional study. QJM: Monthly Journal of the Association of Physicians 99(6): 407-415, 2006. (27 refs.)

Background: In some studies, hypertension is more common in never and former smokers than in current smokers. Aim: To examine the associations between hypertension and smoking status, when divided into subgroups by overweight and obesity. Design: Cross-sectional study. Methods: We used data from a national health survey with a probability sample of the national population of Germany aged 18 to 79 (n = 6903 with complete data). Smoking status data were collected via questionnaire. Obesity and overweight were assessed by body mass index, hypertension by blood pressure measurement and by participants' statements about anti hypertensive treatment. Analyses were adjusted for gender, age, history of coronary artery disease, serum cholesterol levels, alcohol drinking, exercise, and education. Results: Obese former smokers who were abstinent for 3 or more years had an adjusted odds ratio (OR) 3.6 (95% confidence interval, CI 2.3-5.7) for mild hypertension (>= 140 mmHg systolic or >= 90 mmHg diastolic blood pressure) and an adjusted OR 6.5 (95% CI 3.6-11.8) for moderate or severe hypertension (>= 160 mmHg systolic or >= 100 mmHg diastolic). Normal weight never or former smokers did not differ from normal weight current smokers smoking > 15 cigarettes/day with regard to likelihood of hypertension (normal weight never smokers, OR 1.1, 95% CI 0.8-1.5; normal weight former smokers, abstinent 3 or more years, OR 0.8, 95% CI 0.5-1.3). Discussion: In this nationally representative sample, never or former smoking was unrelated to hypertension among normal weight individuals.

Kawabe H; Saito I; Saruta T. Effects of nighttime alcohol intake on evening and next morning home blood pressure in Japanese normotensives. Clinical and Experimental Hypertension 29(1): 43-49, 2007. (15 refs.)

Home blood pressure (HBP) is usually measured in the morning and evening, but the evening HBP tends to be influenced by an individual's behavior pattern, such as bathing and drinking, which are often seen in the Japanese. In this study, in order to elucidate the influence of nighttime drinking on the evening and next morning HBP and heart rate (HR), HBP measurement was performed in Japanese normotensives under conditions in which the influence of bathing was minimized. Among 700 registered volunteers, 245 normotensives (189 male, 56 female, mean age; 35.8 +/- 0.5 years old) whose data consisted of a combination of drinking and non-drinking on workdays were selected. A semi-automatic device was lent to all participants, and they were asked to perform triplicate morning and evening measurements on seven consecutive days between October 16, 2002, and November 13, 2002. The differences in evening HBP and HR between the drinking and non-drinking days were calculated, as were the differences in the next morning HBP and HR. Only data of evening HBP measured at least 30 min after bathing were accepted. Evening SBP and DBP on drinking days were significantly lower (2.5 +/- 0.5 mmHg, 3.1 +/- 0.5 mmHg) than those on non-drinking days. On the other hand, evening HR on drinking days was significantly higher (7.7 +/- 0.8 b.p.m.) than that on non-drinking days. Although there was no difference in morning SBP after days with and without drinking, morning DBP the day after drinking was slightly (0.8 +/- 0.3 mmHg) but significantly lower than that the day after non-drinking. Morning HR the day after drinking was significantly higher (2.4 +/- 0.4 b.p.m.) than that after non-drinking. Because nighttime drinking influenced the evening HBP even in normotensives, it was suggested that morning HBP could give more stable values than evening HBP in Japanese people.

Kim MT; Han HR; Hill MN; Rose L; Roary M. Depression, substance use, adherence behaviors, and blood pressure in urban hypertensive black men. Annals of Behavioral Medicine 26(1): 24-31, 2003. (46 refs.)

Relationships between depression, alcohol and illicit drug use, adherence behaviors, and blood pressure (BP) were examined in 190 urban hypertensive Black men enrolled in an ongoing hypertension control clinical trial. More than one fourth (27.4%) of the sample scored greater than 16 on the Center for Epidemiological Studies-Depression Scale (CES-D), indicating a high risk of clinical depression. Depression was significantly associated with an increased likelihood of meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for alcohol abuse or dependence (odds ratio = 5.2; 95% confidence interval = 1.897-14.214). The level of depression was significantly correlated with poor medication (r = .301) and poor dietary compliance (r =. 164). Both alcohol intake and illicit drug use were significantly correlated with poor dietary compliance (r = .195 and. 185, respectively) and smoking (r = .190 and. 269, respectively). Although no direct relationship between depression and the level of BP was substantiated by multivariate analysis, findings of descriptive analyses revealed statistically significant associations among depression, substance use, poor adherence, and poor BP outcomes. Given the harsh environment in which a large number of young urban Black men live, the high prevalence of substance abuse might be an attempt to fight off depression. Further in-depth investigation is needed to identify the role of depression and BP control in urban young Blacks in order to construct effective interventions that address their unique needs.

Kim MT; Hill MN. Validity of self-report of illicit drug use in young hypertensive urban African American males. Addictive Behaviors 28(4): 795-802, 2003. (21 refs.)

Inaccurate self-reporting is the primary threat to the validity and utility of self-report in the research on illicit drug use. The purpose of this study was to estimate the sensitivity and specificity of self-report of drug use, using urine toxicity screening as a criterion variable, and to explore the individual characteristics associated with false reporting in a sample of urban African American males. Baseline data from urine tests and a questionnaire about self-report of illicit drug use were obtained from 290 hypertensive African American males enrolled in an ongoing hypertension clinical trial. Sensitivity and specificity of self-report were estimated, and multivariate logistic regression analysis was conducted to examine factors associated with true or false reporting of drug use. Result: The sensitivity and specificity of self-report were 0.87�0.019 and 0.63�0.02, respectively. Members of the underreporting group were more likely to be older, more educated, employed, living with family, and having experience with jail. Jail experience (OR, 2.0) and living with friends or family (OR, 1.7) were the two strongest predictors of false reporting. This study further confirms that social desirability and fear of the consequences of drug use are major contributing factors in underreporting of drug use.

Kim SH; Ensunsa JL; Zhu QY; Kim JS; Shin HS; Keen CL. An 18-month follow-up study on the influence of smoking on blood antioxidant status of teenage girls in comparison with adult male smokers in Korea. Nutrition 20(5): 437-444, 2004. (29 refs.)

OBJECTIVES: The influence of cigarette smoking on blood antioxidant status in teenage girls with a history of short-term smoking was followed over 18 mo. METHODS: Data obtained from female senior high school students (ages 14 to 18 y) in Korea were compared with data obtained from adult male smokers (ages 36 to 51 y) with a long history of smoking and living in the same geographic areas as the teenage subjects. A snicker was a person who had smoked at least three cigarettes a day for at least 1 y for teenagers (n = 35) or at least 10 cigarettes a day for at least 13 y for adults (n = 20). Serum, urine, and anthropometric data were obtained from teenagers every 6 mo over an 18-mo period. Samples were collected once from adults. Data were analyzed by Student's t test and Fisher's protected least significant difference test for comparing smokers and non-smokers and for analyzing period effects in each group. RESULTS: Serum nicotine and cotinine concentrations were higher in smokers than in non-smokers. Blood pressures were higher in teenage (at 0 and 12 mo) and adult smokers than in non-smokers. Extracellular superoxide dismutase activities and concentrations of serum vitamin C and folate were lower in smokers in the teenage (at 0, 12, or 18 mo) and adult groups. Serum ceruloplasmin activities and thiobarbituric acid-reactive substance production were not influenced by smoking. In adults, serum copper concentrations were higher in smokers than in non-smokers. This parameter for teenagers did not change consistently throughout the study. CONCLUSIONS: Similar to adults, cigarette smoking by teenagers has a negative effect on oxidant defense systems.

Klatsky AL. Alcohol and hypertension: Does it matter? Yes. Journal of Cardiovascular Risk 10(1): 21-24, 2003. (10 refs.)

Observational studies and clinical experiments solidly establish an empiric relationship between heavy drinking (greater than or equal to 3 standard drinks/day) and higher blood pressure. A biologic mechanism for this link remains unclear. It has been difficult to study the incidence of usual hypertension sequelae in alcohol-associated hypertension because of complex interactions of alcohol, hypertension and cardiovascular conditions. Even with these limitations, a causal association is the most likely explanation and control of alcohol intake is probably important in prevention and treatment of hypertension.

Klatsky AL; Gunderson EP; Kipp H; Udaltsova N; Friedman GD. Higher prevalence of systemic hypertension among moderate alcohol drinkers: An exploration of the role of underreporting. Journal of Studies on Alcohol 67(3): 421-428, 2006. (24 refs.)

Objective: Heavy alcohol drinking is associated with increased prevalence of systemic hypertension (HTN), but the relationship between moderate drinking and HTN remains unclear. We explored the possible role of underreporting among moderate drinkers. Method: In a cross-sectional analysis of 105,378 persons, we defined a subset among persons reporting three or fewer drinks per day that was likely to include a disproportionate number of underreporters. This subset included persons who, on another occasion, indicated intake of three or more drinks per day or who ever had a diagnosis of an alcohol-related condition; these persons are called "positive." Persons who never reported three or more drinks per day and who had no alcohol-related diagnosis were called "negative." Logistic regression models estimated the odds ratios (ORs) for prevalent HTN (140/90 mm Hg or greater) in the positive and negative subgroups, compared with lifelong abstainers as referent. All persons and four race-gender groups were studied, and they were controlled for age, education, smoking, and body mass index. We also studied the relationship of blood liver transaminase enzyme levels in the positive and negative subgroups at specific alcohol intake strata. Results: For persons reporting one to two drinks per day, the OR (95% confidence interval) of HTN was 1.32 (1.21-1.43) for positive persons and 1.16 (1.09-1.25) for negative persons. For those reporting less than one drink per day, the ORs were 0.97 (0.89-1.06) for positives and 0.92 (0.87-0.98) for negatives. For those reporting one to two drinks per day, positive/negative comparisons showed approximately a 75% increased prevalence of high liver transaminase enzymes. For those reporting less than one drink per day, the positive/negative difference was approximately 30%. Conclusion: In these data, increased prevalence of HTN among persons reporting one to two drinks per day appears to be partially due to underreporting of alcohol intake.

Klatsky AL; Koplik S; Gunderson E; Kipp H; Friedman GD. Sequelae of systemic hypertension in alcohol abstainers, light drinkers, and heavy drinkers. American Journal of Cardiology 98(8): 1063-1068, 2006. (29 refs.)

A link exists between alcohol intake and increased blood pressure (BP), with many studies showing increased hypertension prevalence in heavy drinkers. The harmful and beneficial effects of alcohol can, confound the study of the long-term risks of alcohol-related hypertension. We therefore studied cardiovascular sequelae separately in heavy drinkers, light drinkers, and abstainers among 127,212 subjects with BP and alcohol intake ascertained at 1978 to 1985 health examinations. Subsequent cardiovascular end points included mortality risk, hospitalization risk, and outpatient diagnosis of hypertension. Analyses were performed for all subjects and stratified by 5 alcohol-drinking categories (from never drinkers to >= 3 drinks/day). With < 120/80 mm Hg as the referent, Cox proportional hazards models were used to estimate relative risks and 95% confidence intervals for 3 higher BP categories (120 to 129/80 to 84, 130 to 139/85 to 89, and >= 140/90 mm Hg). The covariates were age, gender, race, body mass index, education, and smoking. The risk of all outcomes was progressively higher for increasing BP categories, with a similarly increased risk for abstainers, light drinkers, and heavy drinkers. The interaction tests for alcohol and BP were not statistically significant for the mortality and hospitalization outcomes. Interpretation was limited by an inability to separate subjects with increased BP from alcohol consumption from those with other etiologies. In conclusion, the data indicate that the risks of hypertension are similar regardless of the amount of alcohol consumption.

Kodavali L; Townsend RR. Alcohol and its relationship to blood pressure. Current Hypertension Reports 8(4): 338-344, 2006. (39 refs.)

Ethanol is a molecule of enduring research interest because its consumption has important social as well as medical implications. With excessive ethanol consumption, there is higher prevalence for hypertension, stroke, cardiomyopathy, and arrhythmias. A principal mechanism by which ethanol exerts these cardiovascular effects is through modulation of blood pressure. In this article, we focus on recent research that pursues information on the effects of alcohol on blood pressure in human subjects, regardless of whether they have hypertension or not. Known means by which alcohol exerts hemodynamic effects are briefly covered, and insights on novel biomediators, such as endothelin and gene-based mechanisms, are presented. Newer tools, such as the Alcohol Use Disorders Identification Test-Consumption Questions (AUDIT-C) survey and carbohydrate-deficient transferrin (CDT) serum test, are also covered. Reducing excessive alcohol intake can produce a reduction in blood pressure of up to 4 mm Hg, on average, which could substantially affect the rates of stroke and ischemic heart disease.

Lip GYH; Beevers DG. Alcohol and hypertension: Does it matter? (no!). Journal of Cardiovascular Risk 10(1): 11-14, 2003. (10 refs.)

Good evidence suggests that alcohol probably has a causal relationship to hypertension, although many possible confounding factors that may exaggerate or attenuate the relationship, if true. Alcohol can also adversely affect other systems, including the heart (arrhythmias, alcoholic cardiomyopathy, etc.), the liver (alcoholic hepatitis, cirrhosis, etc.) and the nervous system (peripheral neuropathy, etc.). Hypertension is very common and it is unlikely that all (or most) of hypertensives can identify alcohol as causative. Indeed, hypertension is likely to be multifactorial and many factors would confound the relationship, if any, between alcohol and hypertension.

Malinski MK; Sesso HD; Lopez-Jimenez F; Buring JE; Gaziano JM. Alcohol consumption and cardiovascular disease mortality in hypertensive men. Archives of Internal Medicine 164(6): 623-628, 2004. (41 refs.)

Background: Heavy alcohol drinking is associated with a dose-dependent increase in blood pressure, but data on the relation between alcohol consumption and mortality in hypertensive patients are sparse. Objective: To assess the relation between light to moderate alcohol consumption and total mortality from cardiovascular disease (CVD) among men with hypertension. Participants and Design: From the Physicians' Health Study enrollment cohort of 88 882 men who provided self-reported information on alcohol intake, we identified a group of 14 125 men with a history of current or past treatment for hypertension who were free of myocardial infarction, stroke, cancer, or liver disease at baseline. Main Outcome Measure: Comparison of total and CVD mortality among men with hypertension who had reported to be either nondrinkers or rare drinkers, or light to moderate drinkers. Results: During 75 710 person-years of follow-up, there were 1018 deaths, including 579 from CVD. Compared with individuals who rarely or never drank alcoholic beverages, those who reported monthly, weekly, and daily alcohol consumption, respectively, had multivariate adjusted relative risks (RRs) for CVD mortality of 0.83 (95% confidence interval [CI], 0.62-1.13), 0.61 (CI, 0.49-0.77), and 0.56 (CI, 0.44-0.71) (P<.001 for linear trend). In the same groups, RRs for total mortality were respectively 0.86 (CI, 0.67-1.10), 0.72 (CI, 0.60-0.86), and 0.73 (CI, 0.61-0.87) (P<.001 for linear trend). Among men with a systolic blood pressure of 140 mm Hg or higher or a diastolic blood pressure of 90 mm Hg or higher, the RRs for CVD mortality were, respectively, 1.00 (referent), 0.82 (CI, 0.56-1.21), 0.64 (CI, 0.48-0.85), and 0.56 (CI, 0.42-0.75) (P<.001 for linear trend). On the other hand, we found no significant association between moderate alcohol consumption and cancer mortality (P=.8 for linear trend). Conclusion: These results, which require confirmation in other large-scale studies, suggest that light to moderate alcohol consumption is associated with a reduction in risk of total and CVD mortality in hypertensive men.

Mathew RJ; Wilson WH; Davis R. Postural syncope after marijuana: A transcranial Doppler study of the hemodynamics. Pharmacology, Biochemistry and Behavior 75(2): 309-318, 2003. (75 refs.)

Twenty-nine volunteers participated in a randomized, double-blind, placebo-controlled study. Cerebral blood velocity (CBV), pulse rate, blood pressure (BP), skin perfusion (SP) on forehead and plasma Delta(9) tetrahydrocannabinol (THC) levels were quantified during reclining and standing for 10 min before and after THC infusions and marijuana smoking. Both THC and marijuana induced postural dizziness, with 28% reporting severe symptoms. Intoxication and dizziness peaked immediately after drug. The severe dizziness group showed the most marked postural drop in CBV and BP and showed a drop in pulse rate after an initial increase during standing. Postural dizziness was unrelated to plasma levels of THC and other indices.

Mort JR; Kruse HR. Timing of blood pressure measurement related to caffeine consumption. Annals of Pharmacotherapy 42(1): 105-110, 2008. (21 refs.)

OBJECTIVE: To determine whether patients should wait 30 minutes after caffeine consumption to have their blood pressure measured. DATA SOURCES: Literature was obtained by searching MEDLINE (1980-September 2007), International Pharmaceutical Abstracts (1980-September 2007), and the Cochrane Database of Systematic Reviews (1994-September 2007). Search terms included caffeine and blood pressure. Literature was a so obtained from citations in relevant articles. STUDY SELECTION AND DATA EXTRACTION: Articles that examined caffeine's acute effect on blood pressure were reviewed, with additional focus on caffeine tolerance and hypertensive status. DATA SYNTHESIS: Caffeine appears to affect blood pressure through adenosine receptor inhibition and an increased release of select neurotransmitters. Caffeine levels peak 30-120 minutes after oral intake and caffeine's half-life is 3-6 hours. The effect of caffeine on blood pressure has been examined for decades, with variable results depending on factors such as population examined (eg, hypertensive status, physical stressors, age) and study design (eg, acute effects, chronic ingestion, retrospective epidemiologic review). Caffeine tolerance diminishes the acute effect of caffeine on blood pressure, and hypertensive individuals are more susceptible to blood pressure changes. Reviews of caffeine's acute effect on blood pressure indicate changes of 3-15 mm Hg systolic and 4-13 mm Hg diastolic. Typically, blood pressure changes occur within 30 minutes, peak in 1-2 hours, and may persist for more than 4 hours. CONCLUSIONS: Having a patient abstain from caffeine for 30 minutes prior to blood pressure monitoring is not adequate to avoid caffeine's potential effects. An alternative approach to blood pressure monitoring would be to ask the patient about recent caffeine consumption and interpret the blood pressure reading based on this information. In addition, healthcare practitioners should provide education regarding caffeine's effects.

Ohkuma H; Tabata H; Suzuki S; Islam MS. Risk factors for aneurysmal subarachnoid hemorrhage in Aomori, Japan. Stroke 34(1): 96-100, 2003. (42 refs.)

Background and Purpose: Japan is known to have an incidence of aneurysmal subarachnoid hemorrhage (SAH) as high as that in Finland, where SAH is especially common. However, the risk factors for SAH in Japan are unknown. The purpose of this study was to identify the risk factors and then examine their possible roles in cases of SAH in Japan. Methods: Case-control data were collected in the Aomori prefecture between June 2000 and May 2001 and in the Shimokita area between 1989 and 1998. A history of hypertension, cigarette smoking, alcohol consumption, hypercholesterolemia, and diabetes mellitus were examined as possible risk factors for SAH by using stepwise logistic regression analysis. Results: Stepwise logistic regression analysis showed that a history of hypertension and current smoking increased the risk of SAH and that a history of hypercholesterolemia decreased the risk of SAH. Alcohol consumption and a history of diabetes mellitus were excluded from the model, because their log-likelihood ratios were not significant. The adjusted odds ratios, obtained by forcing matching factors, were 2.29 for a history of hypertension (95% CI, 1.66 to 3.16), 3.12 for current smoking (95% CI, 2.05 to 4.77), and 0.41 for a history of hypercholesterolemia (95% CI, 0.24 to 0.71). The prevalence of hypertension in control subjects was 27% in men and 31% in women, whereas the prevalence of cigarette smoking in control subjects was 46% in men and 9% in women. Conclusions: Hypertension and cigarette smoking seem to be independent risk factors for SAH in Japan. The high prevalence of hypertension in both sexes and the high prevalence of cigarette smoking in men in the general population might contribute to the high incidence of SAH in Japan.

Okubo Y; Suwazono Y; Kobayashi E; Nogawa K. An association between smoking habits and blood pressure in normotensive Japanese men: A 5-year follow-up study. Drug and Alcohol Dependence 73(2): 167-174, 2004. (40 refs.)

Background: There are few studies on the effects of smoking on blood pressure (BP) that consider confounding factors such as age, obesity, lifestyle and blood chemistry. As such, we conducted a 5-year follow-up study to clarify the effects of smoking habits on blood pressure in normotensive Japanese men. Methods: The subjects were 2107 normotensive male steelworkers aged 40-54 years. They were classified using three indices: smoking habits in 1990, changes in smoking habits, and changes in amount of smoking. The associations between these indices and changes in blood pressure were evaluated using analysis of covariance (ANCOVA). As analyses, BMI, salt intake, physical activity, drinking habit, and results of blood chemistry in 1990 and their changes, age and blood pressure in 1990 were used as covariates. Results: The cumulative incidence of hypertension in smokers was lower than in non- and ex-smokers. The adjusted mean of change in blood pressure of smokers was significantly lower than in non- and ex-smokers. No significant difference between non-smokers and ex-smokers, or among groups of smokers who varied their amount of smoking was observed. Conclusion: Chronic smoking reduces changes in blood pressure and 5-year cumulative incidence of hypertension. However, no significant dose-dependent effect of smoking on changes in blood pressure was observed.

Palatini P; Dorigatti F; Santonastaso M; Cozzio S; Biasion T; Garavelli G et al. Association between coffee consumption and risk of hypertension. Annals of Medicine 39(7): 545-553, 2007. (44 refs.)

Background. The longitudinal relationship between coffee use and hypertension is not well known. Aim. We did a prospective study to investigate if there is a temporal relationship between coffee consumption and development of sustained hypertension. thod. We assessed 1107 white subjects with elevated blood pressure who were followed up for 6.4 years. Coffee intake and other life-style factors were ascertained from regularly administered questionnaires. Incident physician-diagnosed hypertension was the outcome measure. Results: During the follow-up, 561 subjects developed sustained hypertension, whereas 546 subjects did not meet the criteria for treatment. Coffee drinkers developed sustained hypertension more frequently than abstainers (53.1% versus 43.9%, P=0.007). The incidence of hypertension did not differ between moderate and heavy coffee drinkers. Kaplan-Meier analysis confirmed that sustained hypertension was developed more frequently by coffee drinkers compared with nondrinkers (P< 0.00 1). The adjusted relative risk of hypertension was greater in both categories of coffee drinking than in abstainers (hazard ratio, 95% confidence limit (CL)=1.24, 1.06-1.44). The risk of hypertension associated with coffee drinking increased gradually with increasing level of alcohol use (adjusted P for interaction= 0.005). Conclusions. In subjects screened for stage I hypertension a nonlinear association was found between coffee consumption and development of sustained hypertension.

Papadelis C; Kourtidou-Papadeli C; Vlachogiannis E; Skepastianos P; Bamidis P; Maglaveras N et al. Effects of mental workload and caffeine on catecholamines and blood pressure compared to performance variations. Brain and Cognition 51(1): 143-154, 2003. (36 refs.)

Caffeine is characterised as a central nervous system stimulant, also affecting metabolic and cardiovascular functions. A number of studies have demonstrated an effect of caffeine on the excretion of catecholamines and their metabolites. Urinary epinephrine and norepinephrine have been shown to increase after caffeine administration. Similar trends were observed in our study in adrenaline (ADR) and noradrenaline (NORADR) levels and additionally a dose dependant effect of caffeine. The effect of caffeine on cognitive performance, blood pressure, and catecholamines was tested under resting conditions and under mental workload. Each subject performed the test after oral administration of 1 cup and then 3 cups of coffee. Root mean square error (RMSE) for the tracking task was continuously monitored. Blood pressure was also recorded before and after each stage of the experiment. Catecholamines were collected and measured for three different conditions as: at rest, after mental stress alone, after one dose of caffeine under stress, and after triple dose of caffeine under stress. Comparison of the performance of each stage with the resting conditions revealed statistically significant differences between group of smokers/coffee drinkers compared with the other two groups of non-coffee drinkers/non-smokers and non-smokers/coffee drinkers. There was no statistically significant difference between the last two groups. There was an increase of urine adrenaline with 1 cup of coffee and statistically significant increase of urine noradrenaline. Both catecholamines were significantly increased with triple dose of caffeine. Mental workload increased catecholamines. There was a dose dependant effect of caffeine on catecholamines.

Papamichael C; Karatzi K; Karatzis E; Papaioannou TG; Katsichti P; Zampelas A et al. Combined acute effects of red wine consumption and cigarette smoking on haemodynamics of young smokers. Journal of Hypertension 24(7): 1287-1292, 2006. (30 refs.)

OBJECTIVE: Red wine seems to improve haemodynamic variables, while smoking provokes adverse effects. The haemodynamic effects of their combined use is unknown. The purpose of the present study was to examine the acute effects of red wine and its constituents, in combination with the smoking of one cigarette, on haemodynamic parameters, such as blood pressure and wave reflections, in a group of smokers. METHODS: Twenty smokers (12 males, eight females) participated in a double-blind, crossover study comprised of 3 study days. All subjects either smoked one cigarette, or smoked and drank 250 ml of red wine, or 250 ml of de-alcoholized red wine (containing the same type and similar concentration of antioxidants). Applanation tonometry and generalized transfer functions were used to estimate aortic pressure waveforms at baseline and 30, 60 and 90 min after each trial. The augmentation index (AIx) was used to express wave reflections. RESULTS: Smoking increased peripheral systolic blood pressure (P < 0.005) 30 min later, but simultaneous consumption of either type of red wine caused no such effect. Additionally, smoking caused no overall effect on AIx, while smoking and drinking either regular or de-alcoholized red wine reduced AIx (P < 0.001). The reduction of AIx after red wine consumption was significantly greater than the respective reduction after de-alcoholized red wine (P = 0.004). CONCLUSION: Antioxidant substances in red wine counteracted the smoking-induced increase in peripheral systolic blood pressure. Both alcohol and antioxidants in red wine decrease wave reflections in uncomplicated habitual smokers postprandially, indicating an additional favourable effect of red wine.

Puddey IB; Beilin LJ. Alcohol is bad for blood pressure. Clinical and Experimental Pharmacology & Physiology 33(9): 847-852, 2006. (63 refs.)

The regular consumption of alcohol elevates blood pressure, with global estimates that the attributable risk for hypertensive disease from alcohol is 16%. The increase in blood pressure is approximately 1 mmHg for each 10 g alcohol consumed and is largely reversible within 2-4 weeks of abstinence or a substantial reduction in alcohol intake. This increase in blood pressure occurs irrespective of the type of alcoholic beverage. In particular, the postulated effects of vasodilator flavonoid components of red wine to lessen or reverse alcohol-related hypertension have not been borne out in intervention studies. Heavy drinking, especially a binge pattern of drinking, is linked to a higher incidence of cerebral thrombosis, cerebral haemorrhage and coronary artery disease deaths, although a role for alcohol-related hypertension in the causal pathway is not well defined. In contrast, the light to moderate intake of alcohol has been consistently linked to a reduced risk of atherosclerotic vascular disease end-points. Such a protective effect may also extend to hypertensive subjects. However, the magnitude of any protective effect appears to have been exaggerated because of unmeasured confounders, especially diet, lifestyle and patterns of drinking. Furthermore, a decrease in overall mortality with drinking appears confined to older subjects and to populations with a high background cardiovascular risk profile. Any putative cardiovascular benefits from drinking need to be carefully considered against the effects of alcohol to elevate blood pressure, together with many other adverse health consequences from drinking. Maximum cardiovascular benefit occurs at relatively low levels of consumption (i.e. one to two standard drinks a day in men (10-20 g alcohol) and up to one a day in women (10 g alcohol). In hypertensive subjects, consumption beyond these levels would be unwise.

Reims HM; Kjeldsen SE; Brady WE; Dahlof B; Devereux RB; Julius S et al. Alcohol consumption and cardiovascular risk in hypertensives with left ventricular hypertrophy: The LIFE study. Journal of Human Hypertension 18(6): 381-389, 2004. (38 refs.)

The Losartan Intervention For End point reduction in hypertension (LIFE) study showed superiority of losartan over atenolol for reduction of composite risk of cardiovascular death, stroke, and myocardial infarction in hypertensives with left ventricular hypertrophy. We compared hazard ratios (HR) in 4287 and 685 participants who reported intakes of 1-7 and >8 drinks/week at baseline, respectively, with those in 4216 abstainers, adjusting for gender, age, smoking, exercise, and race. Within categories, clinical baseline characteristics, numbers randomized to losartan and atenolol, and blood pressure (BP) lowering were similar on the drug regimens. Overall BP control (<140/90 mmHg) at end of follow-up was similar in the categories. Composite end point rate was lower with 1-7 (24/1000 years; HR 0.87, P < 0.05) and >8 drinks/ week (26/1000 years; HR 0.80, NS) than in abstainers (27/1000 years). Myocardial infarction risk was reduced in both drinking categories (HR 0.76, P < 0.05 and HR 0.29, P < 0.001, respectively), while stroke risk tended to increase with >8 drinks/ week (HR 1.21, NS). Composite risk was significantly reduced with losartan compared to atenolol only in abstainers (HR 0.81 95% confidence interval, CI (0.68, 0.96), P < 0.05), while benefits for stroke risk reduction were similar among participants consuming 1-7 drinks/week (HR 0.73, P < 0.05) and abstainers (HR 0.72, P < 0.01). Despite different treatment benefits, alcohol-treatment interactions were nonsignificant. In conclusion, moderate alcohol consumption does not change the marked stroke risk reduction with losartan compared to atenolol in high-risk hypertensives. Alcohol reduces the risk of myocardial infarction, while the risk of stroke tends to increase with high intake.

Renaud SC; Gueguen R; Conard P; Lanzmann-Petithory D; Orgogozo JM; Henry O. Moderate wine drinkers have lower hypertension-related mortality: A prospective cohort study in French men. American Journal of Clinical Nutrition 80(3): 621-625, 2004. (23 refs.)

Background: For a given blood pressure, the risk of death from coronary artery disease is much higher in northern Europe and the United States than in Mediterranean countries. Objective: In this prospective cohort study, we tested the hypothesis that regular wine drinking reduces the hypertension-related risk of death. Design: We used data from 36,583 healthy middle-aged men who had normal results on an electrocardiogram and were not taking drugs for cardiovascular disease risk factors. The subjects underwent a comprehensive health appraisal at the Center for Preventive Medicine between 1 January 1978 and 31 December 1985. Mortality from all causes and from specific causes during a 13-21-y follow-up was recorded. Results: In a Cox model adjusted for 6 confounding variables, moderate wine drinkers (those who consumed <60 g alcohol/d and no beer) with systolic blood pressure (SBP) of 158, 139, or 116 mm Hg had significantly lower risks of death from all causes by 23%, 27%, and 37%, respectively, than did abstainers. Even for the highest quartile of blood pressure, moderate wine drinkers were protected from all-cause mortality. No significant reduction in all-cause mortality in relation to SBP was observed in other drinkers (those who consumed greater than or equal to60 g alcohol/d or who consumed beer and wine). Conclusion: A moderate intake of wine is associated with a lower risk of mortality from all causes in persons with hypertension.

Rhee MY; Na SH; Kim YK; Lee MM; Kim HY. Acute effects of cigarette smoking on arterial stiffness and blood pressure in male smokers with hypertension. American Journal of Hypertension 20(6): 637-641, 2007. (30 refs.)

Background: Although the acute increase of arterial stiffness and blood pressure (BP) after cigarette smoking in healthy smokers is considered a possible mechanism of increased cardiovascular risk, the acute effect of smoking on arterial stiffness in hypertensive smokers is unknown. We investigated the acute effects of cigarette smoking on arterial stiffness and BP in hypertensive male smokers. Methods: Heart rate (HR), brachial and ankle BP, and pulse-wave velocity (PWV) were measured in 22 hypertensive male smokers (HTs) and in 30 normotensive male smokers (NTs) before and 5, 10, and 15 min after smoking one cigarette (nicotine content, 0.9 mg). Results: Smoking induced acute increases of HR, brachial BP, and heart-femoral PWV (hfPWV) in NTs and HTs (P < .05). Ankle systolic BP and femoral-ankle PWV were acutely increased in HTs (P < .05), but not in NTs. In HTs, brachial systolic BP and hfPWV at 15 min were higher than at baseline (P < .05). An acute increase of hfPWV in the HTs was significant (P =.025) after adjustment for total cholesterol, time-dependent HR, and brachial mean arterial pressure, but acute changes of other PWVs lost statistical significance. Conclusions: Cigarette smoking acutely increases aortic stiffness and BP in male smokers with hypertension, and the effects persist longer than in male smokers without hypertension.

Roberts AT; de Jonge-Levitan L; Parker CC; Greenway FL. The effect of an herbal supplement containing black tea and caffeine on metabolic parameters in humans. Alternative Medicine Review 10(4): 321-325, 2005. (9 refs.)

OBJECTIVE: The objective of this study was to test an herbal supplement containing black tea (the fully oxidized form of Camellia sinensis) and caffeine for stimulation of thermogenesis. METHODS/MATERIALS: A double-blind, placebo-controlled, crossover study was conducted on 16 healthy, weight-stable, non-smoking subjects, ages 21-55 years, with body mass index (BMI) of 20-30 kg/m(2), and on no medications other than oral contraceptives or hormone replacement therapy. Subjects had no caffeine for 48 hours, no exercise for 24 hours, and no food for 12 hours before each visit. Area under the curve (AUC) for resting metabolic rate (RMR), respiratory quotient (RQ), blood pressure, pulse rate, and temperature were measured. At each visit RMR was measured at baseline and at one and two hours following oral administration of a supplement containing principally 600 mg black tea extract (60% polyphenols, 20% caffeine) and 442 mg guarana extract (36% caffeine) or matching placebo. RESULTS: The RMR and systolic blood pressure (SBP) AUCs increased significantly (p<0.02 and p<0.01, respectively) in the herbal supplement group compared to placebo. The AUC increase in RMR over the two-hour test period was 77.19 kcal/24 hr(2) +/- 120.10 kcal/24 hr(2) with an average rise of 52.38 +/- 29.52 kcal/24 hrs. The AUC rise in SBP over two hours was 10.3 mm Hg/hr +/- 14 mm Hg/hr. The average rise in SBP over two hours was 3.7 mm Hg +/- 4.4 mm Hg. DISCUSSION: The herbal supplement increased metabolic rate without changing substrate oxidation. The rise in SBP was consistent with the amount of caffeine the supplement contained.

Rogers PJ; Smith JE; Heatherley SV; Pleydell-Pearce CW. Time for tea: Mood, blood pressure and cognitive performance effects of caffeine and theanine administered alone and together. Psychopharmacology 195(4): 569-577, 2008. (62 refs.)

Rationale: Although both contain behaviourally significant concentrations of caffeine, tea is commonly perceived to be a less stimulating drink than coffee. At least part of the explanation for this may be that theanine, which is present in tea but not coffee, has relaxing effects. There is also some evidence that theanine affects cognitive performance, and it has been found to reduce blood pressure in hypertensive rats. Objectives To study the subjective, behavioural and blood pressure effects of theanine and caffeine administered alone and together, in doses relevant to the daily tea consumption of regular tea drinkers. Materials and methods In a randomised, double-blind, placebo-controlled study, healthy adult participants (n=48) received either 250-mg caffeine, 200-mg theanine, both or neither of these. They completed ratings of mood, including anxiety, and alertness, and had their blood pressure measured before and starting 40 min after drug administration. Anxiety was also assessed using a visual probe task. Results: Caffeine increased self-rated alertness and jitteriness and blood pressure. Theanine antagonised the effect of caffeine on blood pressure but did not significantly affect jitteriness, alertness or other aspects of mood. Theanine also slowed overall reaction time on the visual probe task. Conclusions: Theanine is a physiologically and behaviourally active compound and, while it is unclear how its effects might explain perceived differences between tea and coffee, evidence suggests that it may be useful for reducing raised blood pressure.

Saremi A; Hanson RL; Tulloch-Reid M; Williams DE; Knowler WC. Alcohol consumption predicts hypertension but not diabetes. Journal of Studies on Alcohol 65(2): 184-190, 2004. (23 refs.)

Objective: This study examines the associations between alcohol consumption, Type 2 diabetes and hypertension in a native American population. Method: Data were collected in a population-based cross-sectional and prospective study conducted on 3,789 individuals aged 20 years. Reported alcohol consumption was classified as never, occasional or <1 a day, 1-2 drinks a day, greater than or equal to3 drinks a day, and occasional heavy drinking. The prevalence and incidence of diabetes and hypertension by categories of alcohol intake were determined. Results: About 68% of men and 39% of women reported some degree of alcohol consumption. There was no association between alcohol consumption and prevalence or incidence of diabetes, but a positive, statistically significant association between blood pressure and alcohol consumption was found in both genders. After adjustment for age, body mass index (BMI) and diabetes in a proportional hazards model in men, moderate drinkers (occasional or <1 drink a day and 1-2 drinks a day combined) had 1.24 (95% confidence interval: 0.98-1.57) and occasional heavy drinkers had 1.49 (1.02-2.17) times the incidence of hypertension as nondrinkers. The corresponding estimates of hypertension incidence for women were 1.53 (1.29-1.83) for moderate drinking and 1.38 (0.81-2.36) for occasional heavy drinking. As only 1% of participants reported greater than or equal to3 drinks a day., this group was excluded from these analyses. Conclusions: Alcohol consumption did not affect the development of Type 2 diabetes, but it was associated with increased risk of hypertension, and this effect was independent of diabetes or BMI in both genders.

Savoca MR; Evans CD; Wilson ME; Harshfield GA; Ludwig DA. The association of caffeinated beverages with blood pressure in adolescents. Archives of Pediatrics & Adolescent Medicine 158(5): 473-477, 2004. (19 refs.)

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

Schutte AE; van Rooyen JM; Huisman HW; Kruger HS; de Ridder JH. Factor analysis of possible risks for hypertension in a black South African population. Journal of Human Hypertension 17(5): 339-348, 2003. (52 refs.)

To date only a small number of studies have investigated the pattern of associations within a set of hypertension risks. The objective of this study was therefore to examine the interrelation of main hypertension risks in an African population by using factor analysis in order to detect underlying risk patterns. Subjects aged 16-70 years (N=963) were recruited from 37 randomly selected sites throughout the North West Province during 1996-1998. Exclusion criteria were pregnancy, lactation, casual visitors, drunkenness and treatment for chronic diseases, such as hypertension. Subjects with blood pressures exceeding 140/90 mmHg were classified as hypertensive. Children aged 10-15 years were also recruited from 30 randomly selected schools during 2000-2001 (N=694). Children were classified as hypertensive when an average systolic or diastolic blood pressure greater than or equal to the 90th percentile for age and sex was encountered, while correcting for height. The following hypertension risks were measured: urbanisation, obesity, plasma fibrinogen, lipids, insulin, serum gamma glutamyl-transferase, dietary intake, smoking and alcohol consumption. From 23 risks the factor analysis disclosed five factors that explained 56.2% of the variance in the male and 43.5% of the variance in the female group: an urban malnutritional phenomenon, the metabolic syndrome X, a hypercholesterolaemic and obesity complex, an alcoholic hypertriglyceridaemia, and central and peripheral cardiovascular hypertensive effects. In conclusion, South Africans migrating from rural to urban areas adapt to a new lifestyle with numerous risks, resulting in conditions like malnutrition, the metabolic syndrome X, dyslipidaemia, alcoholism, obesity and increased peripheral vascular resistance. For successful prevention of hypertension in a population in transition, a whole risk pattern should be corrected, rather than an individual risk by implementing lifestyle modification programmes.

Shankaran S; Das A; Bauer CR; Bada H; Lester B; Wright L et al. Fetal origin of childhood disease: Intrauterine growth restriction in term infants and risk for hypertension at 6 years of age. Archives of Pediatrics & Adolescent Medicine 160(9): 977-981, 2006. (36 refs.)

Objective: To examine the association between intrauterine growth restriction (IUGR) status at birth among full-term infants, exposure to substance use during pregnancy, and risk of hypertension at 6 years of age. Design: Prospective evaluation of high-risk children. Setting: Four centers of the National Institute of Child Health and Human Development Neonatal Research Network. Participants: One thousand three hundred eighty-eight infants (600 cocaine exposed, 781 nonexposed, and 7 indeterminate, matched by gestational age, race, and sex), were enrolled at these sites. Nine hundred fifty children (415 exposed, 535 nonexposed) were followed up for 6 years. Intervention: Right arm blood pressure was measured using the Dinamap portable adult/pediatric monitor with appropriate cuff size. Main Outcome Measure: Blood pressure levels. Hypertension was defined as either systolic or diastolic blood pressure higher than the 95th percentile for sex, age, and height. Results: Eight hundred ninety-one children had blood pressure data at 6 years of age: 516 were born at full term; 144 (28%) of the 516 children had a diagnosis of IUGR at birth. At 6 years of age, 93 (19%) of 516 children had hypertension. Of 144 children with IUGR, 35 (24%) had hypertension as compared with 58 (16%) of 372 children without IUGR (P <.05). Twenty percent of cocaine-exposed children had hypertension as compared with 16% of nonexposed children (P=.20). Intrauterine growth restriction status at birth was significantly associated with hypertension (relative risk, 1.8 [95% confidence interval, 1.2-2.7]) when multivariable Poisson regression analysis was performed adjusting for site; maternal race, education, and tobacco, marijuana, alcohol, and cocaine use during pregnancy; and child's current body mass index (calculated as weight in kilograms divided by height in meters squared). Conclusion: In term infants, IUGR is linked to risk of hypertension in early childhood, which may be a marker for adult cardiovascular disease.

Soardo G; Donnini D; Varutti R; Milocco C; Basan L; Esposito W et al. Effects of alcohol withdrawal on blood pressure in hypertensive heavy drinkers. Journal of Hypertension 24(8): 1493-1498, 2006. (37 refs.)

Background: Epidemiological investigations have demonstrated a close association between heavy alcohol consumption and hypertension. The mechanisms of this association, however, remain elusive. We studied the effects of alcohol withdrawal on blood pressure, hormonal parameters, and circulating markers of endothelial activity. Methods: In 14 hypertensive heavy alcohol consumers (> 200 g/day) who agreed to participate in a hospital withdrawal programme we monitored, for 30 days, blood pressure, plasma levels of renin, aldosterone, cortisol, endothelin, and plasminogen activator inhibitor 1 (PAI-1), and urinary levels of catecholamines. Patients in the withdrawal group were compared with eight hypertensive heavy drinkers who refused to participate in the programme and maintained regular alcohol consumption and 11 normotensive teetotalers. Results: By the third day after withdrawal, blood pressure was significantly decreased and the normalization of levels was obtained in 13 of 14 patients by the end of the study. Alcohol withdrawal significantly decreased plasma aldosterone and cortisol levels, but did not affect levels of active renin and fractionated urinary catecholamines. At baseline, plasma endothelin and PAI-1 levels were significantly higher in alcoholic individuals than in teetotalers, and after the cessation of alcohol intake decreased progressively, reaching levels different from baseline within 1 week. A significant correlation was found between changes in endothelin and PAI-1, and blood pressure variations during alcohol abstinence that remained significant only for endothelin with the multivariate approach. Conclusion: Hypertension is rapidly reversible in the majority of heavy drinkers after the withdrawal of alcohol consumption. In these patients, hypertension is associated with an increased release of endothelial factors that might contribute to the increase in blood pressure.

Steffens AA; Moreira LB; Fuchs SC; Wiehe M; Gus M; Fuchs FD. Incidence of hypertension by alcohol consumption: Is it modified by race? Journal of Hypertension 24(8): 1489-1492, 2006. (27 refs.)

Objective To investigate the influence of race, binge drinking and alcohol addiction on the association between consumption of alcoholic beverages and incidence of hypertension. Methods In a population-based cohort study, 1089 adults were interviewed and had blood pressure and anthropometric measurements carried out at home. Their alcohol consumption was ascertained by an amount frequency questionnaire. Binge drinking was defined as consumption of five or more drinks on one occasion for men or four drinks for women, and abuse of alcohol as consumption of 30 g/day or more in men or 15 g/day or more in women. Incident cases of hypertension were characterized by blood pressure >= 140/90 mmHg or use of hypertension medication. Results Among 589 normotensive individuals in the baseline visit, 127 incident cases of hypertension were identified, after a follow-up of 5.6 +/- 1.1 years. Binge drinking and alcohol dependency were not associated with the incidence of hypertension. Adjusted (age, education) risk ratios for the incidence of hypertension (95% confidence interval) were significant only for non-white abusers of ethanol: 11.8 (1.6 -86.9). Systolic blood pressure of black abusers increased by 16.1 +/- 3.5 mmHg, in comparison with 4.9 +/- 1.5 mmHg among white abusers (P = 0.004). Conclusion Individuals with an African ancestry, who consumed larger amounts of ethanol, are at higher risk of developing hypertension. This risk is not explained by a binge drinking pattern or addiction to alcohol.

Tsioufis C; Dimitriadis K; Vasiliadou C; Taxiarchou E; Vezali E; Tsiamis E et al. Heavy coffee consumption in conjunction with smoking is accompanied by increased inflammatory processes and impaired thrombosis/fibrinolysis system in essential hypertensive subjects. Journal of Human Hypertension 20(6): 470-472, 2006. (12 refs.)

The effect of coffee on the cardiovascular system still remains controversial although it is one of the most popular beverages consumed worldwide in large amounts. However, the available data regarding the effect of caffeine intake on atherosclerotic inflammatory and thrombotic mechanisms are rather scarce.

Uiterwaal CSPM; Verschuren WMM; Bueno-De-Mesquita HB; Ocke M; Geleijnse JM; Boshuizen HC et al. Coffee intake and incidence of hypertension. American Journal of Clinical Nutrition 85(3): 718-723, 2007. (34 refs.)

Background: The long-term longitudinal evidence for a relation between coffee intake and hypertension is relatively scarce. Objective: The objective was to assess whether coffee intake is associated with the incidence of hypertension. Design: This study was conducted on a cohort of 2985 men and 3383 women who had a baseline visit and follow-up visits after 6 and 11 y. Baseline coffee intake was ascertained with questionnaires and categorized into 0, > 0-3, > 3-6, and > 6 cups/d. Hypertension was defined as a mean systolic blood pressure (SBP) >= 140 mm Hg over both follow-up measurements, a mean diastolic blood pressure (DBP) >= 90 mm Hg over both follow-up measurements, or the use of antihypertensive medication at any follow-up measurement. Results: Coffee abstainers at baseline had a lower risk of hypertension than did those with a coffee intake of > 0-3 cups/d [odds ratio (OR): 0.54; 95% CI: 0.31, 0.92]. Women who drank > 6 cups/d had a lower risk than did women who drank > 0-3 cups/d (OR: 0.67; 95% CI: 0.46, 0.98). Subjects aged >= 39 y at baseline had 0.35 mm Hg (95% CI: -0.59, -0.11 mm Hg) lower SBP per cup intake/d and 0.11 mm Hg lower DBP (95% CI: -0.26, 0.03 mm Hg) than did those aged < 39 y at baseline, although the difference in DBP was not statistically significant. Conclusions: Coffee abstinence is associated with a lower hypertension risk than is low coffee consumption. An inverse U-shaped relation between coffee intake and risk of hypertension was observed in the women.

Wakabayashi I; Masuda H. Influence of drinking alcohol on atherosclerotic risk in alcohol flushers and non-flushers of oriental patients with type 2 diabetes mellitus. Alcohol and Alcoholism 41(6): 672-677, 2006. (36 refs.)

Aims: Facial flushing caused by alcohol drinking is a typical symptom of high sensitivity to alcohol in orientals. We investigated whether drinking alcohol influences atherosclerotic risk factors in alcohol flushers and non-flushers in patients with diabetes mellitus. Methods: A cross-sectional study was performed using 225 subjects with type 2 diabetes. Sensitivity to alcohol was surveyed by a questionnaire on facial flushing. Subjects were divided into three groups by average amount of alcohol drinking (non-drinkers; light drinkers: < 140 g/week; heavy drinkers: 140 g/week or more). Results: Systolic blood pressure and blood HDL cholesterol were significantly higher in heavy drinkers than in non-drinkers. There were no significant differences in body mass index, blood pressure, blood total cholesterol, HDL cholesterol, uric acid, fibrinogen and sialic acid levels in flushers and non-flushers. In alcohol flushers, diastolic blood pressure and HDL cholesterol in heavy drinkers were significantly higher than those in non-drinkers, and systolic blood pressure was significantly higher in heavy drinkers than in non-drinkers and light drinkers. On the other hand, blood pressure and HDL cholesterol in non-flushers were not significantly different among non-, light and heavy drinkers. Serum total cholesterol was not significantly different among the three drinking groups both in flushers and non-flushers. Conclusions: Blood pressure and HDL cholesterol are more prone to be affected by drinking in flushers than in non-flushers, suggesting that alcohol sensitivity evaluated by flushing response due to drinking alcohol should be taken into account when the effects of alcohol drinking on atherosclerotic risk factors are considered in oriental patients with type 2 diabetes mellitus.

Waring WS; Goudsmit J; Marwick J; Webb DJ; Maxwell SRJ. Acute caffeine intake influences central more than peripheral blood pressure in young adults. American Journal of Hypertension 16(11( Part 1)): 919-924, 2003. (31 refs.)

Background: The aim of this study was to characterize the acute effects of caffeine on peripheral and central blood pressure (BP) in healthy individuals, using validated noninvasive techniques. Methods: In a randomized double-blind study, 300 mg caffeine or matching placebo was administered orally to 20 healthy adults and hemodynamic responses were observed. Central BP and augmentation index (AIx) were determined by pulse wave analysis; cardiac index (CI) was estimated by transthoracic bioimpedance; and heart rate variability (HRV) given by power spectral analysis of pulse interval. Pressure amplification (peripheral to central pulse pressure ratio) and systemic vascular resistance index were also calculated. Results: Caffeine administration increased central systolic and diastolic BP by 7 +/- 3 (P < .01) and 3 +/- 2 turn Hg (P < .05), respectively (mean +/- SEM) at 45 min, but had no effect on peripheral BP. Caffeine caused AN to increase by 7 2 and 0 +/- 1%, respectively (P < .05), and pressure amplification to decrease by 1.0 +/- 0.1 v 0.2 +/- 0.2 (P < .001) placebo at 45 min. Conclusions: Acute caffeine intake significantly increases central BP and large artery waveform transmission and diminishes pressure amplification in healthy adults. Therefore, the effects of caffeine on BP may be significantly underestimated by measurement of BP at the brachial artery.

Wong DR; Willett WC; Rimm EB. Smoking, hypertension, alcohol consumption, and risk of abdominal aortic aneurysm in men. American Journal of Epidemiology 165(7): 838-845, 2007. (40 refs.)

Despite the known protective association between moderate alcohol consumption and ischemic heart disease, little is known about the effects of alcohol consumption on abdominal aortic aneurysms (AAA). The authors analyzed prospective, biennially updated data for a cohort of 39,352 US men from 1986 to 2002. The association of incident AAA diagnosis with alcohol consumption in grams per day was assessed at baseline and by using alcohol consumption data updated every 4 years, controlling for previously reported cardiovascular risk factors. During 576,374 person-years of follow-up, 376 newly diagnosed cases of AAA were demonstrated. After adjustment for other risk factors for AAA, including smoking, hypertension, and body mass index, alcohol consumption at baseline was independently associated with AAA diagnosis (p for trend = 0.03), with a maximum hazard ratio of 1.21 (95% confidence interval: 0.78, 1.87) for >= 30.0 g (approximately >= 2 standard drinks) of daily alcohol consumption. This association was stronger when the updated alcohol consumption data were assessed rather than simply baseline exposure (p for trend = 0.02); the hazard ratio for the highest level of intake (>= 30.0 g/day) was 1.65 (95% confidence interval: 1.03, 2.64). Small numbers limited analyses by beverage type, but liquor demonstrated the strongest positive association with AAA.

Writing Group of the PREMIER Collaborative Research Group. Effects of comprehensive lifestyle modification on blood pressure control: Main results of the PREMIER clinical trial. Journal of the American Medical Association 289(16): 2083-2093, 2003. (36 refs.)

Weight loss, sodium reduction, increased physical activity, and limited alcohol intake are established recommendations that reduce blood pressure (BP). The Dietary Approaches to Stop Hypertension (DASH) diet also lowers BP. This study evaluated the effects of simultaneously implementing these lifestyle recommendations. The participants were 810 adults (mean age, 50 years; 62% women; 34% African American) at four clinical centers with above-optimal BP who were not taking antihypertensive medications. Participants were randomized to one of three interventions: (1) "established" recommendations (n = 268); (2) "established+DASH diet (n = 269);" and (3) an "advice-only" comparison group (n = 273). Outcome measures were BP and hypertension status at 6 months. Both interventions significantly reduced weight, improved fitness, and lowered sodium intake. Established+DASH also increased fruit, vegetable, and dairy intake. After subtracting change in advice-only, the mean net reduction in systolic BP was 3.7 mm Hg in the established group and 4.3 mm Hg in the established+DASH group; the systolic BP difference between the established and established-plus-DASH groups was 0.6 mm Hg. Compared with the baseline hypertension prevalence of 38%, the prevalence at 6 months was 26% in the advice-only group, 17% in the established group, and 12% in the established+DASH group. Thus individuals with above-optimal BP, including stage 1 hypertension, can make multiple lifestyle changes that lower BP and reduce their cardiovascular disease risk.

Xiao DL; Huang XH; Yang SM; Zhang LB. Direct effects of nicotine on contractility of the uterine artery in pregnancy. Journal of Pharmacology and Experimental Therapeutics 322(1): 180-185, 2007. (43 refs.)

Recent studies indicate that smoking/ nicotine increases maternal blood pressure and decrease in uterine blood flow in pregnancy. However, the mechanisms are not fully understood. The present study was designed to test the hypothesis that nicotine exposure decreases endothelium- dependent relaxation and increases vascular contractility of the uterine artery in pregnancy. Uterine arteries were isolated from near- term ( similar to 140 days gestation) pregnant ewes. Arteries were subjected to acute ( 20 min) or chronic ( 48 h) nicotine treatment, and agonist- induced contractions and relaxations were measured in tissue bath. Endothelial eNOS was detected by immunohistochemistry in situ in arteries and by Western blotting in isolated endothelial cells. Chronic nicotine treatment produced a concentration-dependent increase in alpha(1)-adrenoceptor agonist phenylephrine- induced contractions. In contrast, the acute treatment showed no effect. Inhibition of eNOS with N-G-nitro-L-arginine (L-NNA) significantly increased phenylephrine- induced contractions, which was abolished in uterine arteries after chronic nicotine treatment. In the presence of L-NNA, there was no significant difference in phenylephrine- induced contractions between control and nicotine- treated vessels. Chronic, but not acute, nicotine treatment significantly attenuated the calcium ionophore A23187- induced relaxations. Unlike A23187, the endothelium-independent relaxation mediated by sodium nitroprusside was not affected by nicotine. Endothelial eNOS protein levels and the phosphorylation levels of eNOSSer1179 were significantly decreased in nicotine- treated uterine arteries. The results suggest that nicotine impairs uterine vascular function in pregnancy, which may lead to an increased vascular resistance and a decrease in uterine blood flow.

Yin RX; Li H; Wu JZ; Lin WX; Yang DZ; Pan SL et al. Effects of alcohol consumption and other lifestyle behaviors on blood pressure for the middle-aged and elderly in the Guangxi Hei Yi Zhuang and Han populations. Alcohol 41(8): 541-550, 2007. (43 refs.)

Han is the largest group and Zhuang is the largest minority among the 56 ethnic groups in China. Geographically and linguistically, Zhuang can be classified into 43 ethnic subgroups, in which Hei Yi Zhuang is proved to be the most conservative subgroup. Little is known about the relationship between alcohol consumption and blood pressure levels in this population. Therefore, the present study was undertaken to compare the effects of alcohol consumption and other lifestyle behaviors on blood pressure levels for the middle-aged and elderly in the Guangxi Hei Yi Zhuang and Han populations. A total of 657 subjects of Hei Yi Zhuang aged 40 and older were surveyed by a stratified randomized cluster sampling. Information on demography, diet, and other lifestyle factors was collected by standard questionnaires. Anthropornetric parameters and serum lipid levels were also obtained in all subjects. The results were compared with those in 520 participants of Han Chinese from the same region. The levels of systolic blood pressure and pulse pressure in Hei Yi Zhuang were higher than those in Han (P <.01-.001). Hypertension was positively correlated with sex (male), age, physical activity, alcohol consumption, serum triglyceride levels, and total energy, total fat, and salt intakes, and negatively associated with educational level in Hei Yi Zhuang (P <.05-.001), whereas positively correlated with sex (male), age, physical activity, alcohol consumption, body mass index, waist circumference, serum total cholesterol levels, and total energy, total fat, and salt intakes, and negatively associated with educational level in Han (P <.05-.001). The difference in blood pressure levels between the two ethnic groups might result from different dietary habit, lifestyle, sodium intake, educational level, physical activity, and even genetic factors.

Yugar-Toledo JC; Tanus-Santos JE; Sabha M; Sousa MG; Cittadino M; Tacito LHB et al. Uncontrolled hypertension, uncompensated type II diabetes, and smoking have different patterns of vascular dysfunction. Chest 125(3): 823-830, 2004. (50 refs.)

Study objectives: We evaluated the vascular reactivity in healthy subjects, heavy smokers, uncompensated type II diabetics, and patients with uncontrolled essential hypertension. Plasma nitrite/nitrate, cyclic 3',5'-guanosine monophosphate (cGMP), and thromboxane (TX)-B-2 levels were measured. Participants: One hundred participants were classified into four groups: normal control subjects (n = 25), heavy smokers (n = 25), uncompensated type II diabetics (n = 25), and patients with uncontrolled essential hypertension (n = 25).Interventions: The brachial artery diameter was measured by a high-resolution ultrasound technique before and after reactive hyperemia and glyceryl trinitrate (GTN), 0.4 mg, administration. Plasma nitrite/nitrate, cGMP, and TX-B-2 levels were also measured. Results: Heavy smokers, uncompensated type II diabetics, and uncontrolled hypertensive patients showed impaired endothelium-dependent, nitric oxide (NO) flow-mediated vasodilatation (8.0 +/- 2.5%, 5.8 +/- 2.7%, and 7.2 +/- 3.3%, respectively [mean +/- SD]) when compared to the control subjects (12.6 +/- 3.6%; p < 0.01). Smokers had a normal endothelium-independent function induced by NO donor (GTN) [25.0 +/- 7.3% vs 25.3 +/- 8.5% for control subjects]. Uncompensated type II diabetics and patients with uncontrolled hypertension had impaired endothelium-independent responses (17.7 +/- 7.1% and 16.8 +/- 6.9%, respectively, vs 25.3 +/- 8.5 for normal control subjects; p < 0.05). Plasma levels of cGMP and TX-B-2 were not significantly different in the four groups, but nitrite/nitrate concentrations were increased in diabetics compared to the control subjects (266 +/- 47 mumol/L vs 98 +/- 18 mumol/L, p < 0.05). Conclusion: Both uncontrolled hypertension and type II diabetes mellitus, but not smoking, are associated with impaired vascular smooth-muscle reactivity induced by NO donors. However, only uncompensated type II diabetics showed an increase in plasma nitrite/nitrate levels, suggesting an association with excessive production and/or inactivation of NO.