Hypertension: Blackburn H

Luepker RV, Arnett DK, Jacobs DR, Duval SJ, Folsom AR, Armstrong C, Blackburn H. · University of Minnesota, School of Public Health, Division of Epidemiology and Community Health, Minneapolis, Minn 55454-1015, USA. · Am J Med. · Pubmed #16431183 No free full text.

Abstract: OBJECTIVE: The study's objective was to determine population trends in blood pressure, hypertension prevalence, hypertension control, and stroke mortality. METHODS: We performed population-based surveys of 2906 to 5630 adults from 1980 to 1982, 1985 to 1987, 1990 to 1992, 1995 to 1997, and 2000 to 2002, and stroke mortality from 1980 to 2002, in the Minneapolis/St Paul, Minn metropolitan area (2.63 million population according to the 2000 census). Randomly selected resident adults aged 25 to 74 years (n = 21773) were each screened once. The main outcome measures were standardized measures of blood pressure, treatment and control of hypertension, and stroke mortality rates. RESULTS: The mean systolic blood pressure adjusted for age decreased in men (-1.5 mm Hg [95% confidence interval -0.3 to -2.7], P <.01) and women (-1.8 mm Hg [95% confidence interval -0.5 to -3.0], P <.001) from 1980 to 1982 and 2000 to 2002. The mean diastolic blood pressure was unchanged for men (0 mm Hg) and women (-0.4 mm Hg, not significant). The proportion of the population taking antihypertensive medications decreased in the 1990s but returned to 1980s levels from 2000 to 2002. The use of other methods to decrease blood pressure (diet, exercise, and weight loss) peaked in the 1990 to 1992 survey and then decreased. Proportions of hypertensive patients in the aware, treated, and/or controlled categories leveled in the 1980s and 1990s, but improved substantially from 1995 to 1997 and 2000 to 2002 with blood pressure controlled at the less than 140 and/or 90 mm Hg criteria in 44% of the men and 55% of the women. Population mortality trends for stroke paralleled those for hypertension control. CONCLUSIONS: Population data beginning in 1980 to 1982 from the Minnesota Heart Survey indicate a leveling in the detection and control of hypertension in the 1990s followed by improvement from 2000 to 2002.

Larsen CT, Blackburn H, Bruun NE, Jensen GB, Scharling H, Schnohr P. · Department of Cardiology, Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark. · Eur J Epidemiol. · Pubmed #15971501 No free full text.

Abstract: Information is limited on the co-existence and prognostic association of the ischemic electrocardiogram (ECG) and blood pressure. Prospectively collected data sets from 28,118 examinations in the Copenhagen City Heart Study were analyzed for cardiac morbidity and mortality for a 5.9-year follow-up. The prognosis of the ECG, independently of blood pressure, was examined. The Cox proportional hazard model was employed to evaluate the prognostic implications of ECG findings and relative risk was adjusted for age and multivariately adjusted for traditional cardiovascular risk factors. End-points were (1) fatal and non-fatal ischemic heart disease (IHD) events and (2) cardiovascular disease (CVD) mortality. During a total follow-up period of 166,471 person years (mean: 5.9 years) 1.481 IHD events were recorded and 1.051 CVD deaths. The relative risk of an ischemic ECG was independent of the blood pressure level. The multivariately adjusted relative risk for fatal and non-fatal IHD for the ischemic ECG was 1.70 (95% CI: 1.39-2.09, p < 0.001) in women, and 1.96 (95% CI: 1.67-2.30, p < 0.001) in men, and for CVD mortality 1.71 (95% CI: 1.34-2.17, p < 0.001) in women and 2.08 (95% CI: 1.74-2.49, p < 0.001) in men. An ECG with left ventricular hypertrophy (LVH) and ST-depression was the finding with the highest risk for future events. LVH by ECG voltage-only was associated with no statistically increased risk, except for men treated for arterial hypertension.

Blackburn H. · School of Public Health, University of Minnesota, Minneapolis 55454, USA. · Epidemiology. · Pubmed #12500060 No free full text.

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Arnett DK, McGovern PG, Jacobs DR, Shahar E, Duval S, Blackburn H, Luepker RV. · Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, MN 55454-1015, USA. · Am J Epidemiol. · Pubmed #12419765 links to  free full text

Abstract: The objective was to describe trends in cardiovascular risk factors between 1980-1982 and 1995-1997 in metropolitan Minneapolis-St. Paul, Minnesota. Four population-based surveys of 4,000-6,000 adults aged 25-74 years were conducted in 1980-1982, 1985-1987, 1990-1992, and 1995-1997 using consistent sampling strategies and protocols. The authors completed interviews and examinations to characterize cardiovascular risk factors. Blood samples were drawn and assayed for several analytes including total cholesterol. Although total cholesterol decreased 7-9 mg/dl during the 1980s, no further reduction was noted between 1990-1992 and 1995-1997. Hypercholesterolemia prevalence (total cholesterol of >240 mg/dl and/or use of lipid-lowering medication) fell between 1980-1982 and 1990-1992 but increased thereafter. Current cigarette smoking, systolic blood pressure, and hypertension prevalence decreased significantly between 1980-1982 and 1995-1997. Body mass index increased substantially across the four surveys. Although there was little change in the mean leisure-time physical activity, the proportion of the population not engaging in regular exercise increased between 1990-1992 and 1995-1997. Dietary fat decreased consistently from 1980-1982 to 1995-1997, while overall caloric intake rose 8% in women but not men. To conclude, the favorable trends in hypertension, cigarette smoking, and dietary fat consumption observed in Minneapolis-St. Paul from 1980-1982 to 1995-1997 were paralleled by less favorable recent trends in total cholesterol, hypercholesterolemia, adiposity, and physical activity.

Panagiotakos DB, Kromhout D, Menotti A, Chrysohoou C, Dontas A, Pitsavos C, Adachi H, Blackburn H, Nedeljkovic S, Nissinen A. · Department of Dietetics and Nutrition, Harokopio University, Athens, Greece. · Arch Intern Med. · Pubmed #16217005 links to  free full text

Abstract: BACKGROUND: Hypertension is a dominant characteristic in the prediction of cardiovascular diseases (CVDs). We aimed to evaluate the association of blood pressure measurements with CVD mortality among different populations of the world. METHODS: A total of 12 763 men, aged 40 to 59 years, from 7 countries (United States, Japan, Italy, Greece, former Yugoslavia, Finland, and the Netherlands) were surveyed from 1958 to 1964. Follow-up for vital status and causes of death was carried out over 25 years. RESULTS: All baseline blood pressure measurements were the best predictors of CVD mortality, compared with age, physical activity, total serum cholesterol level, body mass index or height, and smoking. Moreover, pulse pressure and diastolic and systolic blood pressures were the best predictors for CVD death, followed by mean and mid blood pressures. The age-adjusted hazard ratio per 10-mm Hg increase in pulse pressure varied among cohorts from 1.19 in the United States (P = .04) to 1.29 in southern Europe (P = .01). Differences among cohorts were not significant. In the pooled cohorts, pulse pressure measurements were also a significant predictor for coronary heart disease (hazard ratio per 10-mm Hg increase, 1.15; P = .04) as well as stroke death (hazard ratio per 10-mm Hg increase, 1.32; P = .01). CONCLUSIONS: Pulse pressure followed by diastolic and systolic blood pressures were the best predictors for CVD mortality among other blood pressures, as well as age, physical activity, total serum cholesterol level, anthropometric indexes, and smoking habits. No significant differences were observed among the different populations studied.