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A working day evaluation of the dyslipidemia in a Spanish population (“JADE” study): a sub-analysis of the hypertensive patients.
AJH-APRIL 1999-VOL. i2, NO. 4, PART 2
POSTERS:
Epidemiology
K025
K026
A Working Day Evaluation of the Dyslipidemia in a Spanish Population ("JADE" study): A Sub-analysis of the hypertensive pstients.
OBESITY INFLUENCES THE URINARY SODIUM EXCRETION IN CHILDREN AND ADOLESCENTS .F,~g.~, Beatriz Cremades. Isabel Tort6, Concepci6n Rodriguez, Jose Tacons, Vicente Alvarez, Josep Redon*. Hospital General and Hospital Clinico*.University of Valencia. Spain. Previous studies have found that comparedto normal weight children, obesechildreuhadsignificantly higher amhulatoryBP valaes. Obiective. To study tile influence of obesity in urinary sodium excretion in children and adolescents. Subjects and methods. Seventhy-two obese (O) (defined by BMI) and 87 controls (C) matched by age and sex, were included. Ambulatory BP was assessed at the age of 3 to 16 years during a 24 hours period (Spacelabs 90207). At the time of monitoring, awake and sleep split urine samples were collected. Average ambulatorY BP and the urinary excretion rates for sodium and creatinine were calculated separately for awake and sleep periods defined by a mini-diary. The differences in urinary sodium excretion between 0 and C at the same ambulatory BP values were analyzed. Re~¢Its. At the same ambulatory BP values, the urinary sodium excretion expressed per minute and current weight was lower in O as compared to C (Figure).
J, Martinez-Gonzfilez, J.A. G6mez-C,-erique*, I. Femfindez-Arias, J. Espejo-Martinez Medical Div., Pfizer Spain; *Fandaci6n Jim6nez Diaz, Madrid Methods: This study was an epidemiological survey carried out across the Spanish Primary Care settings during 0 specific working day fOecember5% 1997). The physicians recorded data from patiems who visited the clinics that particular day having laboratory data including at least one hpid value. Almost 3,900 physicians participated in the study who recorded information from 10,641 patients. We mainly obtained data related to cardiovascnlar risk factors, CV treatments (more specifically lipid-lowering drugs and anti-hypertensives) as well as the therapeutic decision taken accordingto the latest clinical/lab data on the patients. Results: 73.6% of the subjects included in the study had a previous diagnosis of dyslipidemia. From this dyslipidemic population, 52% had hypertension, and interestingly, 64.6% showed during the visit to file clinic BP valueS > 140/90. In addition, 47% of the dyslipidemic subjects who showed BP > 140/90 had never been diagnosed as having hypertension. On the other hand, the percentage of patients treated with anti-hypertensive drugs and those who reached an appropriate control of the BP were as follows: DYSLIPIDEMIC PATIENTS (N=7,262) ALL (%) BP > 140)90 (%) ANTI-HYPERTENSIVES* 886 (12.2) 702 (79.2) Diuretics 388 (5.3) 257 (66.2) ~-Bloquers 904 (12.5) 688 (76.1) CCBs 1,609 (22.2) 1,311 (81.5) ACIs 106 (1.5) 87 (82.1) ARBs 94 (1.3) 72 (76.6) g-Bloquers *Multiple response Conclusions: According to these data, this particular population with a high cardiovascular risk profile did not show an adecuate control of the BP in spite of the use of different types of anti-hypertensive dmgs. Moreover, although the ACIs were the more frequently used drugs, they had the highest rate of patients above the recommended values of BP K e y Words: dyslipidemia, hypertension, anti-hypertensive drugs, cardiovascular risk factors.
3.5 °
== ~-~
3
3"
v~
~
2
T ,o, .L
Control
,~, .4.
'~' Obese
1"05
fis
1.5
45
i25
SBP (mmHg) Conclusions: Obese children may have a restricted ability to excrete sodium. This may predispose them to higher BP values and the development of hypertension later in life. Obesity, ambulatory BP, sodium excretion, children
K027
K028
THE ROLE OF 24.pIOUR BLOOD PRESSURE MONITORING IN PREDICTING THE DEVELOPMENT OF SUSTAINED HYPERTENSION AFTER ti MONTHS OF FOLLOW-UP. HOSPITALET STUDY. Hetmindez-del Rfty I~, Armario P*, Martin-Baranera M, Sanchez P, Almendros MC, Cooa A*(*), Pardell H*. Consorci de L'Hoapital de la Creu Roja de L'Hospitalet de Llobregat. (*)Hospital Clinic i Provincial. Universidad de Medicina. Barcelona.
GENDER DIFFERENTIALS 1N BLOOD PRESSURE AND CARDIOVASCULAR DISEASE IN THE BARBADOS EYE STUDY. A. Hermis ~*, S-Y Wu 2, B. Nemesure2, X. Li2, M.C. Leskez and the Barbados Eye Study Group, University of West Indies and Ministry of Health, Barbados, W.I), University Medical Center, Stony Brook, N.Y. 2 The Barbados Eye Study commenced in 1988 and included 4709 participants or 84% of a simple random sample of the island's population, aged 40 to 84 years. Measurements included applanation tonometry, visual acuity and perimetry, blood pressure (BP) with a random zero sphygmomanometer, anthropometry (including weight, height and body circumfe~nces) performed by trained observers, as well as the assay of glycosylated hemoglobin. The median age of the cohort was 58 years, 57% being female, with 93% reporting their race as Black. Among Black participants, the prevalence of hypertension (defined as systolic B I l l 4 0 mmHg, diastolic BP_>90 mmHg, and/or antihypertensive treatment) was 55.4%, affecting 49.8% of men and 59.6% of women. Factors associated with hypertension were examined in logistic regression models and included age (OR 1.92; 95% Confidence Interval 1.79-2.06), diabetes (OR 1.72; 1.43-2.07), a family history of hypertension (OR 1.65; 1.43-2.07), high body mass index (OR 1.38; 1.271.49) and waist-hip ratio (OR 1.11; 1.04-1.18), low education (OR 1.24; 1.02-1.51), non-professional occupation (OR 1.22; 1,04-1.43) and female gender (OR 1.16; 1.00-1.34). Gender differentials were apparent in prevalent coronary heart disease, with 5.7% of women x~*~orting angina or myocardial infarction, in contrast to 3.5% of men. Specifically, angina symptoms were reported in 3.0% of women and 1.2% of men. Black Barbadian women were therefore found to be at increased risk of hypertension and associated cardiovascular complications, consistent with the documented gender differential in chronic disease burden frequently observed among westernised populations of African descent. Sponsored by Grant Number EY07625. Key Words: Black Barbadian, Hypertension, Gender, Cardiovascular Disease
Introduction: After the diagnosis of mild hypertension, a decrease of blood pressure (BP) in successive determinations has been reported. On this basis, both the WHO and the JNC recommend not to initiate a pharmacological treatment before month 3 or 6, depending on the presence of other cardiovascular risk factors Oblectlves:l.To assess the relationship between 24Jlour ambulatory blood p~'e~ure measurements and the development of sustained hypenension;2.To compare the proportion of patients with sustained hypertension after 6 months o1 follow-up between patients with white-coat hypertension (WCH) and patients with ambulatory hypertension (AH). Patients end n'm~od~: A 24-11ourambulatory blood pressure monitoring (ABPM) was ol~sinnd in 204 subjects out of 211 patients with mild hypertension included in the Hospitalst study. Following WHO guidelines, those patients were visited on month 1, 3 and 6 after being diagnosed. Sustained hypertension was defined as systolic SP -> 140 mmHg, diastolic BP2 90 mmHg, or both, or antihypertensive treatment after 6 months of follow-up Results: A 6-moflth follow-up was completed in 176 (86%) subjects (mean(standard deviation) of BP at physician's office: 144/(13)/91(8) mmHg) Thirty patients (17%) become normotensive Those who developed sustained hypertension had higher initial systolic and diastolic BP than those who become normotensive. The difference in the proportions of normoteoaive patients between WCH and AH was not statistically significant: 21%(n= 12) vs.15%(n=18). ABPM
Normotensives
Hypedensives
P
24 h
[
SBP/DBP * 125(9)/80(7) 132(tl)/83(9) 0,001/0,06 Systolic load ** 16(0-58) 26(0-91 ) 0,009 Diastolic load ** 21 (0-55) 22(0-95) ns I Total load ** 26(0-59) 37(1-97) 0,009 I Day SaP/DBP * 130(10)/84(7) 136(11 )/87(9) O,003/ns Systolic load ** 22(0-59) 33(0-98) 0,02 Diastolic load ** 29(0-73) 29(0-99) ns I Nignt SBP/DBP * 115(13)/69(8) 121(13)/72(10) 0,003Ins Systolic load ** 0(0-20) 0(0-93) 0,03 Diastolic load ** 0(0-281 0{0-931 ns * mean (standard deviation). ** median (minimum-maximum) Con©lustsn: Subjects who become normotensive after 6 months had both lower clinical and ambulatory systolic BP (24-h, day and night) than patients with sustained hypertension. The proportion of sustained hypertension after 6 months of follow-up was not statistically different between patients with WCH and patients
I
I
~Vords: Follow-up, ambulatory hypertension
blood pressure, sustained
hypertension,
white-coat
91A
POSTERS:
Epidemiology
K025
K026
A Working Day Evaluation of the Dyslipidemia in a Spanish Population ("JADE" study): A Sub-analysis of the hypertensive pstients.
OBESITY INFLUENCES THE URINARY SODIUM EXCRETION IN CHILDREN AND ADOLESCENTS .F,~g.~, Beatriz Cremades. Isabel Tort6, Concepci6n Rodriguez, Jose Tacons, Vicente Alvarez, Josep Redon*. Hospital General and Hospital Clinico*.University of Valencia. Spain. Previous studies have found that comparedto normal weight children, obesechildreuhadsignificantly higher amhulatoryBP valaes. Obiective. To study tile influence of obesity in urinary sodium excretion in children and adolescents. Subjects and methods. Seventhy-two obese (O) (defined by BMI) and 87 controls (C) matched by age and sex, were included. Ambulatory BP was assessed at the age of 3 to 16 years during a 24 hours period (Spacelabs 90207). At the time of monitoring, awake and sleep split urine samples were collected. Average ambulatorY BP and the urinary excretion rates for sodium and creatinine were calculated separately for awake and sleep periods defined by a mini-diary. The differences in urinary sodium excretion between 0 and C at the same ambulatory BP values were analyzed. Re~¢Its. At the same ambulatory BP values, the urinary sodium excretion expressed per minute and current weight was lower in O as compared to C (Figure).
J, Martinez-Gonzfilez, J.A. G6mez-C,-erique*, I. Femfindez-Arias, J. Espejo-Martinez Medical Div., Pfizer Spain; *Fandaci6n Jim6nez Diaz, Madrid Methods: This study was an epidemiological survey carried out across the Spanish Primary Care settings during 0 specific working day fOecember5% 1997). The physicians recorded data from patiems who visited the clinics that particular day having laboratory data including at least one hpid value. Almost 3,900 physicians participated in the study who recorded information from 10,641 patients. We mainly obtained data related to cardiovascnlar risk factors, CV treatments (more specifically lipid-lowering drugs and anti-hypertensives) as well as the therapeutic decision taken accordingto the latest clinical/lab data on the patients. Results: 73.6% of the subjects included in the study had a previous diagnosis of dyslipidemia. From this dyslipidemic population, 52% had hypertension, and interestingly, 64.6% showed during the visit to file clinic BP valueS > 140/90. In addition, 47% of the dyslipidemic subjects who showed BP > 140/90 had never been diagnosed as having hypertension. On the other hand, the percentage of patients treated with anti-hypertensive drugs and those who reached an appropriate control of the BP were as follows: DYSLIPIDEMIC PATIENTS (N=7,262) ALL (%) BP > 140)90 (%) ANTI-HYPERTENSIVES* 886 (12.2) 702 (79.2) Diuretics 388 (5.3) 257 (66.2) ~-Bloquers 904 (12.5) 688 (76.1) CCBs 1,609 (22.2) 1,311 (81.5) ACIs 106 (1.5) 87 (82.1) ARBs 94 (1.3) 72 (76.6) g-Bloquers *Multiple response Conclusions: According to these data, this particular population with a high cardiovascular risk profile did not show an adecuate control of the BP in spite of the use of different types of anti-hypertensive dmgs. Moreover, although the ACIs were the more frequently used drugs, they had the highest rate of patients above the recommended values of BP K e y Words: dyslipidemia, hypertension, anti-hypertensive drugs, cardiovascular risk factors.
3.5 °
== ~-~
3
3"
v~
~
2
T ,o, .L
Control
,~, .4.
'~' Obese
1"05
fis
1.5
45
i25
SBP (mmHg) Conclusions: Obese children may have a restricted ability to excrete sodium. This may predispose them to higher BP values and the development of hypertension later in life. Obesity, ambulatory BP, sodium excretion, children
K027
K028
THE ROLE OF 24.pIOUR BLOOD PRESSURE MONITORING IN PREDICTING THE DEVELOPMENT OF SUSTAINED HYPERTENSION AFTER ti MONTHS OF FOLLOW-UP. HOSPITALET STUDY. Hetmindez-del Rfty I~, Armario P*, Martin-Baranera M, Sanchez P, Almendros MC, Cooa A*(*), Pardell H*. Consorci de L'Hoapital de la Creu Roja de L'Hospitalet de Llobregat. (*)Hospital Clinic i Provincial. Universidad de Medicina. Barcelona.
GENDER DIFFERENTIALS 1N BLOOD PRESSURE AND CARDIOVASCULAR DISEASE IN THE BARBADOS EYE STUDY. A. Hermis ~*, S-Y Wu 2, B. Nemesure2, X. Li2, M.C. Leskez and the Barbados Eye Study Group, University of West Indies and Ministry of Health, Barbados, W.I), University Medical Center, Stony Brook, N.Y. 2 The Barbados Eye Study commenced in 1988 and included 4709 participants or 84% of a simple random sample of the island's population, aged 40 to 84 years. Measurements included applanation tonometry, visual acuity and perimetry, blood pressure (BP) with a random zero sphygmomanometer, anthropometry (including weight, height and body circumfe~nces) performed by trained observers, as well as the assay of glycosylated hemoglobin. The median age of the cohort was 58 years, 57% being female, with 93% reporting their race as Black. Among Black participants, the prevalence of hypertension (defined as systolic B I l l 4 0 mmHg, diastolic BP_>90 mmHg, and/or antihypertensive treatment) was 55.4%, affecting 49.8% of men and 59.6% of women. Factors associated with hypertension were examined in logistic regression models and included age (OR 1.92; 95% Confidence Interval 1.79-2.06), diabetes (OR 1.72; 1.43-2.07), a family history of hypertension (OR 1.65; 1.43-2.07), high body mass index (OR 1.38; 1.271.49) and waist-hip ratio (OR 1.11; 1.04-1.18), low education (OR 1.24; 1.02-1.51), non-professional occupation (OR 1.22; 1,04-1.43) and female gender (OR 1.16; 1.00-1.34). Gender differentials were apparent in prevalent coronary heart disease, with 5.7% of women x~*~orting angina or myocardial infarction, in contrast to 3.5% of men. Specifically, angina symptoms were reported in 3.0% of women and 1.2% of men. Black Barbadian women were therefore found to be at increased risk of hypertension and associated cardiovascular complications, consistent with the documented gender differential in chronic disease burden frequently observed among westernised populations of African descent. Sponsored by Grant Number EY07625. Key Words: Black Barbadian, Hypertension, Gender, Cardiovascular Disease
Introduction: After the diagnosis of mild hypertension, a decrease of blood pressure (BP) in successive determinations has been reported. On this basis, both the WHO and the JNC recommend not to initiate a pharmacological treatment before month 3 or 6, depending on the presence of other cardiovascular risk factors Oblectlves:l.To assess the relationship between 24Jlour ambulatory blood p~'e~ure measurements and the development of sustained hypenension;2.To compare the proportion of patients with sustained hypertension after 6 months o1 follow-up between patients with white-coat hypertension (WCH) and patients with ambulatory hypertension (AH). Patients end n'm~od~: A 24-11ourambulatory blood pressure monitoring (ABPM) was ol~sinnd in 204 subjects out of 211 patients with mild hypertension included in the Hospitalst study. Following WHO guidelines, those patients were visited on month 1, 3 and 6 after being diagnosed. Sustained hypertension was defined as systolic SP -> 140 mmHg, diastolic BP2 90 mmHg, or both, or antihypertensive treatment after 6 months of follow-up Results: A 6-moflth follow-up was completed in 176 (86%) subjects (mean(standard deviation) of BP at physician's office: 144/(13)/91(8) mmHg) Thirty patients (17%) become normotensive Those who developed sustained hypertension had higher initial systolic and diastolic BP than those who become normotensive. The difference in the proportions of normoteoaive patients between WCH and AH was not statistically significant: 21%(n= 12) vs.15%(n=18). ABPM
Normotensives
Hypedensives
P
24 h
[
SBP/DBP * 125(9)/80(7) 132(tl)/83(9) 0,001/0,06 Systolic load ** 16(0-58) 26(0-91 ) 0,009 Diastolic load ** 21 (0-55) 22(0-95) ns I Total load ** 26(0-59) 37(1-97) 0,009 I Day SaP/DBP * 130(10)/84(7) 136(11 )/87(9) O,003/ns Systolic load ** 22(0-59) 33(0-98) 0,02 Diastolic load ** 29(0-73) 29(0-99) ns I Nignt SBP/DBP * 115(13)/69(8) 121(13)/72(10) 0,003Ins Systolic load ** 0(0-20) 0(0-93) 0,03 Diastolic load ** 0(0-281 0{0-931 ns * mean (standard deviation). ** median (minimum-maximum) Con©lustsn: Subjects who become normotensive after 6 months had both lower clinical and ambulatory systolic BP (24-h, day and night) than patients with sustained hypertension. The proportion of sustained hypertension after 6 months of follow-up was not statistically different between patients with WCH and patients
I
I
~Vords: Follow-up, ambulatory hypertension
blood pressure, sustained
hypertension,
white-coat
91A