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CORK Bibliography: Blood Pressure and Hypertension

44 citations. January 2006 to present

Prepared: March 2010

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.

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

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

Brion MJA; Leary SD; Lawlor DA; Smith GD; Ness AR. Modifiable maternal exposures and offspring blood pressure: A review of epidemiological studies of maternal age, diet, and smoking. (review). Pediatric Research 63(6): 593-598, 2008. (67 refs.)

Prenatal programming of adult disease is well established in animals. In humans the impact of common in utero exposures on long-term offspring health is less clear. We reviewed epidemiology studies of modifiable maternal exposures and offspring blood pressure (BP). Three maternal exposures were identified for review and meta-analyzed where possible: smoking during pregnancy, diet, and age at childbirth. Meta-analysis suggested there was a modest association between higher offspring BP and prenatal exposure to smoke (confounder-adjusted beta=0.62 mm Hg, 95% confidence interval: 0.19-1.05, I-2=16.4%). However, the level of confounder adjustment varied between studies, which in some studies attenuated the association to the null. There was no strong evidence that any component of maternal diet during pregnancy (maternal protein, energy, calcium, and various other nutrients) influences offspring BP. The results of studies of maternal age varied and there was strong evidence of heterogeneity in the pooled analysis. The association with maternal age, if present, was modest (confounder-adjusted beta=0.09 mm Hg/y, 95% confidence interval: -0.03 to 0.21, I-2=89.8%). In sum, there is little empirical evidence that the maternal exposures reviewed program offspring BP. Other components of offspring health may be more susceptible to effects of programming in utero.

Djousse L; Gaziano JM. Alcohol consumption and heart failure in hypertensive US male physicians. American Journal of Cardiology 102(5): 593-597, 2008. (28 refs.)

Although alcohol drinking increases blood pressure and heavy drinking has been associated with alcoholic cardiomyopathy, little is known about the association between light to moderate drinking and risk of heart failure (HF) in hypertensive subjects. Thus, the association between light to moderate drinking and incident HF in 5,153 hypertensive male physicians who were free of stroke, myocardial infarction, or major cancers at baseline was prospectively examined. Alcohol consumption was self-reported and classified as < 1, 1 to 4, 5 to 7, and >= 8 drinks/week. HF was ascertained using follow-up questionnaires and validated using Framingham criteria. Average age was 58 years, and about 70% of subjects consumed 1 to 7 drinks/week. A total of 478 incident HF cases occurred in this cohort during follow-up. Compared with subjects consuming < 1 drink/week, hazard ratios for HF were 0.89 (95% confidence interval [CI] 0.70 to 1.12), 0.72 (95% CI 0.57 to 0.91), and 0.38 (95% CI 0.20 to 0.72) for alcohol consumption of 1 to 4, 5 to 7, and >= 8 drinks/week after adjustment for age, body mass index, smoking, randomization group, use of multivitamins, vegetable consumption, breakfast cereal, exercise, and history of atrial fibrillation, respectively (p for trend < 0.001). Similar results were obtained for subjects with HF with and without antecedent myocardial infarction and those without diabetes mellitus. In conclusion, our data suggested that light to moderate alcohol consumption was associated with a lower risk of HF in hypertensive male physicians.

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

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

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

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.

Hsu TL; Bau JG; Wang WK; Li SP; Wang YYL. Similarity between coffee effects and Qi-stimulating events. Journal of Alternative and Complementary Medicine 14(9): 1145-1150, 2008. (23 refs.)

Aims: Previously, we found that qi-stimulating events exerted similar frequency-specific effects on the blood pressure pulse spectrum. Because coffee and qi induce similar stimulatory psychological responses, we aimed to determine whether they would induce similar pulse effects. Such a relationship would suggest a close linkage between the physiologic mechanisms underlying the psychostimulatory responses and vascular effects of coffee and qi. Therefore, the profound investigations into the mechanisms underlying the effects of coffee on the central nervous system and the vascular system may help to elucidate the underlying physiology mechanisms of qi. Methods: Each test subject took three rounds of 150 mL coffee (0.1 g/kg, 0.05 g/kg, 0.05 g/kg) in a 30-minute interval. The subject's pulses were recorded at the end of each round. The changes in the test subject's pulse spectrum between before and after coffee consumption were compared with changes induced by a water placebo. Results: Both coffee and qi caused the intensities of the third, sixth, and ninth harmonics of the pressure pulse spectrum to be relative peaks to their neighboring harmonics. Conclusion: Our results suggest that the coffee effect may be considered a qi-stimulating event, and there is a common physiologic factor determining the psychostimulatory responses of qi and coffee as well as their effects on the cardiovascular system, which results in a specific frequency pattern in the blood pulse spectrum. Adenosine, which is the main physiologic compound affected by coffee, might also be the key factor affected by qi.

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

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

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.

Kennedy MD; Galloway AV; Dickau LJ; Hudson MK. The cumulative effect of coffee and a mental stress task on heart rate, blood pressure, and mental alertness is similar in caffeine-naive and caffeine-habituated females. Nutrition Research 28(9): 609-614, 2008. (19 refs.)

Most North American workers drink coffee throughout their workday, although the cumulative effect of job stress and coffee is not well known. Research has shown that coffee affects the cardiovascular system and mental alertness primarily through the active ingredient caffeine; however, the dose of caffeine used in these studies is greater than a normal cup of coffee. In addition, these changes have been mostly determined in male caffeine-habituated consumers. Therefore, this study examined the effect of a normal cup of coffee on the cardiovascular and mental alertness response both before and after a mental stress task in 10 caffeine-naive (23 +/- 5.0 years) and 10 caffeine-habituated (25 6 years) females. Blood pressure, heart rate, and mental alertness were taken at baseline (before coffee), 50 minutes after finishing coffee and immediately after a 9-minute mental stress task. The volume of coffee ingested for a 15-minute period was 350 mL (12 oz), which is equivalent to 140 mg of caffeine. The combined effect of coffee and mental stress significantly decreased diastolic blood pressure (Delta 18 mm Hg) and increased heart rate (Delta 6 beats per minute) and mental alertness (Delta 67.3%) in caffeine-naive and caffeine-habituated females, whereas systolic blood pressure (Delta 10.3 mm Hg) only increased in the caffeine-naive participants. Our results indicate that a normal cup of coffee can effect changes in blood pressure and mental alertness and that mental stress may alter the magnitude of change; however, the transient increase in systolic blood pressure after drinking coffee in caffeine-naive participants requires further investigation.

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.

Lee PN. Circulatory disease and smokeless tobacco in Western populations: A review of the evidence. International Journal of Epidemiology 36(4): 789-804, 2007. (79 refs.)

Background: Use of oral snuff or 'snus' has risen in Sweden. Sales of snuff in the US have also risen, overtaking sales of chewing tobacco. There is some evidence that nicotine contributes to circulatory disease (CID) from smoking. We therefore reviewed the evidence relating smokeless tobacco (ST) to CID and related risk factors. Methods: Publications that described relevant cohort, case-control and cross-sectional studies were identified from in-house files, a Medline search in December 2005 and reference lists. Relative risks (RRs) and odds ratios (ORs) for ischaemic heart disease, stroke and all CID for ST use, stratified by smoking habit, were estimated and combined by meta-analysis to provide an overall RR estimate. For diabetes, increased blood pressure, and other risk factors, evidence was qualitatively reviewed, with results from clinical studies also considered. Results: ST use in non-smokers was associated with an increased risk of heart disease (RR 1.12, 95% CI 0.99-1.27, n=8), stroke (1.42, 1.29-1.57, n=5) and CID (1.25, 1.14-1.37, n = 3). The increases mainly derived from two large US studies. The Swedish studies provided little evidence of an increase for heart disease (1.06, 0.83-1.37, n=5) or stroke (1.17, 0.80-1.70, n=2), although the estimates by country are not notably heterogeneous, even for stroke (P = 0.29). No close-response was evident. No increase was seen in former users of ST, or in ST users who also smoked. No clear relationship to diabetes was seen. In the US, an acute blood pressure rise following ST use was consistently reported, and isolated reports linked specific risk factors to ST. In Sweden, though one study reported that snuff acutely increased blood pressure, and two linked snuff to Raynaud-type symptoms, the overall evidence for an effect was inconclusive. Swedish studies generally showed no chronic effect of snuff on blood pressure or various risk factors. Conclusions Any CID risk from ST appears to be substantially less than from smoking, and no clear risk from Swedish snuff is seen. However, the overall evidence is limited.

Lenoir H; Lacombe JM; Dufouil C; Ducimetiere P; Hanon O; Ritchie K et al. Relationship between blood pressure and depression in the elderly. The Three-City Study. Journal of Hypertension 26(9): 1765-1772, 2008. (50 refs.)

Objective: To examine the relationship between blood pressure and depression in a large sample of noninstitutionalized elderly people. Methods: Cross-sectional community-based study in 9294 participants aged 65 years and over, living at home, in three French cities ( Bordeaux, Dijon and Montpellier). Participants were categorized as depressive, based on three different markers of depression. Multiple linear regression analyses of the relation between depression and mean systolic and diastolic blood pressure values were conducted, taking into account potential confounders like age, sex, education, smoking, alcohol consumption, body mass index and history of cardiovascular events. Results: Our working sample had a mean age (SD) of 73.7 (5.0) years, and included 60.7% of women. Overall, 31% of participants met the criteria for depression, 77.5% had hypertension, and 49.5% were on antihypertensive drugs. Analyses showed lower systolic and diastolic blood pressure values in depressive individuals compared with nondepressive ones, in both men ( systolic blood pressure 148.2 versus 151.8mmHg, P < 0.002; diastolic blood pressure 83.0 versus 84.7mmHg, P=0.003) and women ( systolic blood pressure 141.7 versus 144.7mmHg, P < 0.0001; diastolic blood pressure 80.7 versus 81.4mmHg, P < 0.02). These associations were independent of age and of use of antihypertensive or psychotropic agents. Conclusion: In a large sample of elderly individuals from the general population, depressive individuals had lower blood pressure values than nondepressive ones, independent of medications and of history of cardiovascular events.

Lynch WJ; Kalayasiri R; Sughondhabirom A; Pittman B; Coric V; Morgan PT et al. Subjective responses and cardiovascular effects of self-administered cocaine in cocaine-abusing men and women. Addiction Biology 13(3/4): 403-410, 2008. (18 refs.)

This study aimed to examine sex differences in cocaine self-administration and cocaine-induced subjective and cardiovascular measures. The research was based on secondary analysis of data collected in our human laboratory in which subjects self-administered cocaine infusions (8, 16 and 32 mg/70 kg) over a 2-hour period under a fixed ratio 1, 5 minute time out schedule in three test sessions. Subjects were 10 women and 21 men with a history of either cocaine abuse or dependence who were not currently seeking treatment. Women and men self-administered similar amounts of cocaine. None of the subjective effects measures showed a significant main effect of sex during the cocaine self-administration session. Significant interactions were observed for subjective ratings of 'high' (sex x time) and 'stimulated' (sex x time x dose), with women reporting lower ratings over time/doses than men. Relative to men, cocaine produced dose- and time-dependent increases in feelings of hunger (i.e., reduced appetite suppression) in women. Systolic and diastolic blood pressures showed different patterns of change in men and women, with women showing less robust cocaine-induced increases than men. Taken together, these findings suggest that women and men may differ in their subjective and cardiovascular responses to self-administered cocaine. Further research that prospectively controls for hormonal influences upon these measures is needed.

Manios ED; Koroboki EA; Tsivgoulis GK; Spengos KM; Spiliopoulou IK; Brodie FG et al. Factors influencing white-coat effect. American Journal of Hypertension 21(2): 153-158, 2008. (32 refs.)

Background: The transient blood pressure (BP) rise during clinical visits is usually referred to as white-coat effect (WCE). The aim of the present study was to investigate factors that may influence the WCE. Methods: A total of 2004 subjects underwent office BP measurements and 24-h ambulatory BP monitoring (ABPM) on the same day. The WCE was estimated as the difference between office and average daytime ambulatory BP (ABP). According to the office and daytime BP values, the study population was divided into normotensives (NTs), white-coat hypertensives (WCHs), masked hypertensives (MHTs), and sustained hypertensives (SHTs). Statistical analyses were performed using one-way analysis of variance and multiple linear regression models. Results: The mean systolic and diastolic WCE was 9 +/- 16 and 7 +/- 12 mm Hg, respectively. In the entire group of patients, multiple linear regression models revealed independent determinants of systolic WCE in the following rank order: office systolic BP (SBP) (beta = 0.727; P< 0.001), female gender (beta = 0.166; P < 0.001), daytime SBP variability (beta=0.128; P< 0.001), age (beta =0.039, P=0.020), and smoking (beta=0.031, P= 0.048). A 1.0mm Hg increase in daytime SBP variability correlated with an increment of 0.589 mm Hg (95% confidence intervals, 0.437-0.741) in the systolic WCE. The regression analyses for diastolic WCE revealed the same factors as independent determinants. A 1.0 mm Hg increase in daytime diastolic BP (DBP) variability was independently associated with an increment of 0.418 mm Hg (95% confidence intervals, 0.121-0.715) in the diastolic WCE. CONCLUSIONS: Factors such as gender, age, smoking, office BPV and daytime BPV may exert an important influence on the magnitude of the WCE.

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

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

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.

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

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

Notarius CF; Morris BL; Floras JS. Caffeine attenuates early post-exercise hypotension in middle-aged subjects. American Journal of Hypertension 19(2): 184-188, 2006. (30 refs.)

Background: Sustained hypotension after an acute dynamic exercise bout is due primarily to peripheral vasodilation. We tested the hypothesis that adenosine-mediated vasodilation contributes to hypotension after exercise, by determining the effect of blocking its actions with caffeine. Methods: Fourteen healthy middle-aged subjects (mean age = 51 +/- 3 years), cycled to peak effort on 2 study days, after a randomized double-blind intravenous infusion of caffeine (4 mg/kg) selective for adenosine receptor blockade, or vehicle. Both studies were performed after 72 h of caffeine abstinence. Results: Infusion achieved 52.0 +/- 6.1 mu mol/L caffeine in plasma. Significant reductions in mean and diastolic blood pressure (BP) were elicited by prior exercise on the vehicle day (from 93 +/- 2 to 85 +/- 2 mm Hg v from 79 +/- 2 to 73 +/- 3 mm Hg, respectively; both P <.05), but not after caffeine infusion. Systolic and mean BP, 10 min after exercise, were higher on the caffeine than on the vehicle day (by 9 +/- 3 and 6 +/- 2 mm Hg, respectively; P <.05), as was heart rate (HR) (100 +/- 5 v 93 +/- 4 beats/min; P <.05). Conclusions: These data suggest that endogenous adenosine contributes to early hypotension after exercise in healthy middle-aged subjects and underscore the importance of caffeine abstinence if BP or HR immediately after exercise is used to infer cardiovascular risk.

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

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

Onat A; Hergenc G; Dursunoglu D; Ordu S; Can G; Bulur S et al. Associations of alcohol consumption with blood pressure, lipoproteins, and subclinical inflammation among Turks. Alcohol 42(7): 593-601, 2008. (33 refs.)

Gender-related impact of alcohol consumption on blood pressure (BP), serum lipoprotein profile, and C-reactive protein (CRP) concentrations was evaluated prospectively. Alcohol drinking status was assessed as abstainers and categories of light, moderate, and heavy (daily >40 ml ethanol) intake. Mean age of the 3,443 men and women who were followed up for a mean of 7.4 years was 47.6 +/- 12 years. In each multivariable linear or logistic regression analysis, alcohol drinking status was adjusted for age, sex, smoking status, and physical activity. Among men. drinking was significantly associated positively with low-density lipo protein (LDL) cholesterol, apolipoprotein (apo) B, systolic and diastolic BR and with CRP in a log-linear manner exhibiting features of a threshold at heavy drinking. With respect to response of serum triglycerides to light-to-moderate drinking, whereas men exhibited a significant increase, women exhibited a decline (P < .05). Lower BPs (P < .03) and CRP levels (P = .032) were observed in female drinkers than abstainers and, as distinct from men, no increases in LDL cholesterol and apoB were noted. Heavy drinking tended to protect the sexes against the risk of developing low high-density lipoprotein cholesterol levels in prospective multi adjusted analyses. Sex modulates response of cardiometabolic risk variables to moderate alcohol consumption among Turks. Only women respond with lower triglycerides and CRP, whereas men show a log-linear positive association of drinking categories with BP, LDL cholesterol, apoB, and CRP.

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.

Reddy JG; Ebbert JO; Klesges LM; Enders FTB; Klesges RC; Lanctot JQ et al. The relationship between caffeine and blood pressure in preadolescent African American girls. Ethnicity & Disease 18(3): 283-288, 2008. (45 refs.)

Background: While high caffeine consumption has been shown to be associated with increased blood pressure in controlled experiments, the relationship between caffeine consumption and blood pressure in preadolescent (ages 6-11 years) and adolescent (ages 12-19 years) children has not been well studied. The primary objective of this study was to assess the cross-sectional relationship between caffeine intake and blood pressure in 8- to 10-year-old African American girls who eat an unrestricted diet. Methods: Demographic, 24-hour dietary recall, and blood pressure data collected at baseline from 303 African American girls aged 8-10 years in the Girls Health Enrichment Multisite Studies (GEMS) cohort were analyzed by using linear and multiple regression models. Results: Dietary caffeine intake was not associated with either systolic or diastolic blood pressure (P= .33 and P = .36, respectively). However, consistent with the literature, height and body mass index were each positively and independently associated with systolic blood pressure (both P<.0001). Height and amount of sodium intake were positively associated with diastolic blood pressure (P = .01 and P = .02, respectively). Conclusions: Dietary caffeine intake in low amounts is not associated with elevated blood pressure in 8- to 10-year-old African American girls who eat an unrestricted diet.

Reddy JG; Ebbert JO; Klesges LM; Enders FTB; Klesges RC; Lanctot JQ et al. The relationship between caffeine and blood pressure in preadolescent African American girls. Ethnicity & Disease 18(3): 283-288, 2008. (45 refs.)

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.

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.

Sprigg N; Willmot MR; Gray LJ; Sunderland A; Pomeroy V; Walker M; Bath PMW. Amphetamine increases blood pressure and heart rate but has no effect on motor recovery or cerebral haemodynamics in ischaemic stroke: a randomized controlled trial (ISRCTN 36285333). Journal of Human Hypertension 21(8): 616-624, 2007. (47 refs.)

Amphetamine enhances recovery after experimental ischaemia and has shown promise in small clinical trials when combined with motor or sensory stimulation. Amphetamine, a sympathomimetic, might have haemodynamic effects in stroke patients, although limited data have been published. Subjects were recruited 3-30 days post-ischaemic stroke into a phase II randomized (1: 1), double-blind, placebo-controlled trial. Subjects received dexamphetamine (5 mg initially, then 10 mg for 10 subsequent doses with 3- or 4-day separations) or placebo in addition to inpatient physiotherapy. Recovery was assessed by motor scales (Fugl-Meyer (FM)), and functional scales (Barthel index (BI) and modified Rankin score (mRS)). Peripheral blood pressure (BP), central haemodynamics and middle cerebral artery blood flow velocity were assessed before, and 90 min after, the first two doses. Thirty-three subjects were recruited, aged 33-88 (mean 71) years, males 52%, 4-30 (median 15) days post stroke to inclusion. Sixteen patients were randomized to placebo and seventeen to amphetamine. Amphetamine did not improve motor function at 90 days; mean (s.d.) FM 37.6 (27.6) vs control 35.2 (27.8) (P = 0.81). Functional outcome (BI, mRS) did not differ between treatment groups. Peripheral and central systolic BP, and heart rate (HR), were 11.2 mm Hg (P = 0.03), 9.5 mm Hg (P = 0.04) and 7 beats per minute (P = 0.02) higher, respectively, with amphetamine, compared with control. A nonsignificant reduction in myocardial perfusion (BUI) was seen with amphetamine. Other cardiac and cerebral haemodynamics were unaffected. Amphetamine did not improve motor impairment or function after ischaemic stroke but did significantly increase BP and HR without altering cerebral haemodynamics.

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.

Stewart SH; Latham PK; Miller PM; Randall P; Anton RF. Blood pressure reduction during treatment for alcohol dependence: Results from the Combining Medications and Behavioral Interventions for Alcoholism (COMBINE) study. Addiction 103(10): 1622-1628, 2008. (29 refs.)

Aims: Heavy drinking is associated with hypertension. This study evaluated blood pressure changes occurring during treatment for alcohol dependence. Participants Subjects included 1383 people participating in the Combining Medications and Behavioral Interventions for Alcoholism (COMBINE) study, a large multi-center treatment study for alcohol dependence. Measurements: Methods appropriate for repeated-measures data were used to assess the relationship of percentage of drinking days (PDD) to systolic and diastolic blood pressure over a 16-week treatment period. Modification of these associations by demographic and other variables was assessed. Findings Blood pressure reduction was evident only in people who were above the median blood pressure at baseline. In this group, systolic blood pressure decreased by an average of 12 mmHg and diastolic blood pressure decreased by an average of 8 mmHg. Blood pressure reduction occurred during the first month of treatment. This effect was similar regardless of age, sex, body mass index, reported history of hypertension and use of anti-hypertensive medications. An observed association between blood pressure and PDD in Caucasians was not evident in African Americans due largely to their lower pre-treatment blood pressure. Conclusions: Reduction in alcohol consumption has a potent anti-hypertensive effect in alcoholics with higher blood pressure. For hypertensive, alcohol-dependent people, treatment for alcoholism should be considered a major component of anti-hypertensive therapy.

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

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

Tobe SW; Soberman H; Kiss A; Perkins N; Baker B. The effect of alcohol and gender on ambulatory blood pressure: Results from the Baseline Double Exposure study. American Journal of Hypertension 19(2): 136-139, 2006. (12 refs.)

Background: Research has demonstrated that psychosocial and lifestyle factors are associated with sustained increases in blood pressure (BP). Methods: Using post-hoc analyses from the Baseline Double Exposure cohort study, alcohol consumption and gender were examined as to their association with ambulatory BP (ABP) in participants with normal or elevated and untreated BP. Results: The current study included 248 subjects, 135 (54.4%) of whom were women, with a mean age (+/- SD) of 50.8 +/- 6.6 years. The main effects model, which included BMI, multiple regression analysis with 24 h systolic BP as the dependent variable found that alcohol consumption (P =.033), male gender (P =.004), and age (P =.039) were significant variables associated with higher systolic BP, whereas exercise (P =.037) was associated with lower systolic BP. From the regression analysis, the independent effect of alcohol consumption ( ! 10 drinks per week) on systolic BP was 4.4 mm Hg for all subjects during 24 h and 7.1 mm Hg during spousal contact, whereas in women with this degree of alcohol consumption the effect on systolic BP was 8.4 mm Hg during 24 h and 11.4 mm Hg during spousal contact. When the interaction term of gender by drinking status was added to the same regression model, the term was not significant for systolic BP during 24 h, but was significant during spousal contact time (P =.047). Conclusions: The current study demonstrates an association between alcohol with higher systolic BP, more pronounced in women than men, particularly during spousal contact time. This is the first time that the interaction of alcohol and gender with ABP has been demonstrated.

Wakabayashi I. Blood HDL cholesterol levels influence association of alcohol intake with blood pressure in young men but not in middle-aged men. Alcoholism: Clinical and Experimental Research 31(9): 1552-1557, 2007. (21 refs.)

Background: Both blood pressure and HDL cholesterol are affected by alcohol drinking. However, it has not been determined whether association of alcohol drinking with blood pressure varies depending on blood HDL level. Methods: The subjects were male workers aged 20 to 29 year and 50 to 59 year (n = 21,301), representing young and middle ages, respectively, who had received periodic health checkup examinations. The subjects were divided into tertile groups by serum HDL level, and they were further divided into 3 subgroups based on the average daily alcohol intake [nondrinkers, light drinkers (< 30 g of ethanol per day) and heavy drinkers (30 g or more of ethanol per day)]. Blood pressure and incidence of high blood pressure were compared among the 3 alcohol subgroups in each age and HDL group. Results: In the lowest HDL tertile of 20 to 29-year-old subjects, systolic and diastolic blood pressure and incidences of high systolic and diastolic blood pressure were not significantly different among the 3 alcohol subgroups. In the middle and highest HDL tertiles of the twenties age group, systolic and diastolic blood pressure was significantly higher in heavy drinkers than in nondrinkers, and incidences of high systolic and diastolic blood pressure were significantly higher in drinkers than in nondrinkers. On the other hand, in all HDL tertile groups of 50 to 59-year-old subjects, blood pressure was significantly higher in light drinkers and heavy drinkers than in nondrinkers, and incidences of high systolic and diastolic blood pressure were significantly higher in drinkers than in nondrinkers. Conclusions: The results suggest that blood pressure of middle-aged men is elevated by alcohol drinking independently of blood HDL level and is more sensitive to drinking than is blood pressure of young men.

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

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

Wakabayashi I. Influence of gender on the association of alcohol drinking with blood pressure. American Journal of Hypertension 21(12): 1310-1317, 2008. (39 refs.)

BACKGROUND: The purpose of this study was to determine whether gender influences the association of alcohol drinking with blood pressure. METHODS: The subjects (43,810 healthy men and women at ages of 35-54 years) were divided into five groups by average daily ethanol intake (non-, very light (<10 g per day), light (>= 10 g and <20 g per day), moderate (>= 20g and <30g per day), and heavy (>= 30g per day) drinkers). The means of each variable after adjustment for age, body weight, and history of smoking were compared among the groups. RESULTS: Systolic blood pressure of men was significantly higher in moderate and heavy drinkers than in nondrinkers, and systolic blood pressure of women was significantly higher in heavy drinkers but not in moderate drinkers than in nondrinkers. Diastolic blood pressure of men and women was significantly higher in light, moderate and heavy drinkers than in nondrinkers. The differences in systolic and diastolic blood pressure between drinkers and nondrinkers were greater in men than in women. Both in men and women, serum HDL cholesterol was significantly higher in all four drinker groups than in the nondrinker group, and the difference between drinkers and nondrinkers was greater in women than in men. The above findings were not altered when age-and alcohol intake-matched groups of subjects were used. CONCLUSIONS: The results suggest that blood pressure is more prone to be elevated by alcohol drinking in men than in women.

Wakabayashi I. Modification of the association of alcohol drinking with blood pressure by cigarette smoking. Blood Pressure 17(2): 87-93, 2008. (27 refs.)

The purpose of this study was to investigate whether the association of alcohol drinking with blood pressure was modified by cigarette smoking. The subjects were healthy male workers aged 40-59 years and were divided into three different groups by average daily consumption of alcohol (non-drinkers; light drinkers, less than 30 g ethanol per day; heavy drinkers, 30 g or more ethanol per day) and cigarettes (non-smokers; light smokers, less than 20 cigarettes per day; heavy smokers, 20 cigarettes or more per day). The mean levels of both systolic and diastolic blood pressures were significantly lower in the light and heavy smoker groups than in the non- smoker group. In the light and heavy smoker groups, systolic blood pressure was higher in the light drinker subgroup than in the non- drinker subgroup, while there was no significant difference between systolic blood pressures in the non- and light drinker subgroups of non- smokers. In the non-, light and heavy smoker groups, systolic and diastolic blood pressures were significantly higher in the heavy drinker subgroup than in the non- drinker subgroup, and these differences tended to be greater in light and heavy smokers than in non- smokers. The above differences in the relationships of alcohol drinking with blood pressure in non-, light and heavy smokers were also observed when age and body mass index were adjusted and when alcohol intake-matched groups were used. These results suggest that the association of alcohol drinking with blood pressure is stronger in smokers than in non- smokers, independently of age, body mass index and alcohol intake.

Wakabayashi I. Relationships among alcohol drinking, blood pressure and serum cholesterol in healthy young women. Clinica Chimica Acta 388(1-2): 192-195, 2008. (22 refs.)

Background: Habitual alcohol drinking affects both blood pressure and serum lipids. I investigated the relationships among alcohol drinking, blood pressure and atherogenic index defined by serum total and HDL cholesterol levels in young women. Methods: The subjects were young (20-39 y) healthy female workers (n=7887) receiving annual health checkups. Blood pressure was compared in subjects divided into groups according to average daily alcohol consumption (non-drinkers; light drinkers, < 15 g/day ethanol; moderate-to-heavy drinkers, >= 15 g/day ethanol) and in subjects divided into tertile groups of atherogenic index calculated as (total cholesterol - HDL cholesterol)/HDL cholesterol. Results: When overall subjects were analyzed, systolic and diastolic blood pressure in light and moderate-to-heavy drinkers was not significantly different from that in non-drinkers. Total cholesterol levels and atherogenic index were significantly lower and HDL cholesterol was significantly higher in the light and moderate-to-heavy drinker groups than in the non-drinker group. Atherogenic index and HDL cholesterol were also significantly lower and higher, respectively, in the moderate-to-heavy drinker group than in the light drinker group. In the lowest tertile group of atherogenic index, systolic and diastolic blood pressure after adjustment for age, body mass index, smoking history and atherogenic index was significantly higher in the moderate-to-heavy drinker groups than in the non-drinker group, while systolic and diastolic blood pressure was not different among the 3 alcohol consumption groups in the highest tertile group of atherogenic index. In non-, light and moderate-to-heavy drinker groups, systolic and diastolic blood pressure was significantly higher in the highest tertile group of atherogenic index than in the lowest and middle tertile groups. Conclusion: Habitual alcohol drinking is related to blood pressure in young women with low atherogenic index but not in those with high atherogenic index, while blood pressure is associated with atherogenic index independently of alcohol drinking.

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

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

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

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

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.

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.

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

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