Hypertension: Kromhout D

Kromhout D. · Division of Public Health Research, National Institute of Public Health and Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands. · J Nutr Health Aging. · Pubmed #11458283 No free full text.

Abstract: In spite of the decreasing trend in age-adjusted cardiovascular disease mortality in Western European countries, an increase in the cardiovascular morbidity is expected because of the ageing of the population. Consequently the health care cost for these diseases will increase. This article focuses on the role of diet in the occurrence of cardiovascular diseases.Total and HDL cholesterol are major determinants of coronary heart disease. Saturated and trans fatty acids have a total and LDL cholesterol elevating effect and unsaturated fatty acids a lowering effect. N-3 polyunsaturated fatty acids seem to have a protective effect on coronary heart disease occurrence independent of cholesterol. Dietary antioxidants could be of importance because they may prevent oxidation of the atherogenic cholesterol rich LDL lipoproteins. There is however no convincing evidence that either vitamin E, carotenoids or vitamin C protect against coronary heart disease. Observational research has shown that flavonols, polyphenols with strong antioxidant properties present in plant foods, may protect against coronary heart disease. Blood pressure is a major determinant of coronary heart disease and stroke. Historically salt is viewed as the most important dietary determinant of blood pressure. Recent research shows that also a low-fat diet rich in potassium, calcium and magnesium lowers blood pressure substantially. This suggests a multifactorial influence of different nutrients on blood pressure. It can be concluded that a diet low in saturated and trans fatty acids and rich in plant foods in combination with regular fish consumption is associated with a low risk of cardiovascular mortality.

Giltay EJ, Zitman FG, Kromhout D. · Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands. · Am J Geriatr Psychiatry. · Pubmed #18626001 No free full text.

Abstract: Objectives: It is insufficiently known whether "classic" cardiovascular risk factors are associated with subsequent functional disability and mental well-being in elderly men. DESIGN: A population-based cohort study with 15 years of follow-up from 1985 onward. Setting: The Zutphen Study started as the Dutch contribution to the Seven Countries Study. PARTICIPANTS: Five hundred forty-five (59.2%) of 887 men (aged 64-84 years) who were free of preexisting cardiovascular disease and cancer. MEASUREMENTS: High cardiovascular risk was defined as having >/=2 "classic" risk factors: body mass index >/=30.0 kg/m(2), presently smoking, hypertension (systolic blood pressure >/=160 mm Hg, diastolic blood pressure >/=95 mm Hg, or antihypertensive medication), serum cholesterol >/=6.5 mmol/L, and diabetes mellitus. Self-rated health and dispositional optimism were assessed in 1985, 1990, 1995, and 2000. Disability and depressive symptoms (by the Zung self-rating depression scale) were assessed from 1990 onward. RESULTS: The high-risk (N = 230) versus low-risk group (N = 315) had higher multivariate adjusted risks of all-cause and cardiovascular mortality (hazard ratios: 1.43; confidence interval[CI]: 1.15, 1.76; and 1.61; CI: 1.20, 2.18, respectively). High-risk status was also associated with more functional disability at 5, 10, and 15 years (odds ratios of 2.00, 95% CI: 1.25-3.20; 2.51, 95% CI: 1.36-4.65; and 2.45, 95% CI: 0.91-6.61, respectively), adjusted for baseline age, self-rated health, and dispositional optimism. Risk status was not associated with self-rated health, dispositional optimism, or depressive symptoms at follow-up. CONCLUSION: Combined "classic" cardiovascular risk factors are not associated with impaired self-rated health or mental well-being in elderly men, but are predictive of functional disability.

van Gelder BM, Tijhuis M, Kalmijn S, Giampaoli S, Nissinen A, Kromhout D. · National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research, PO Box 1, Internal Postal Code 101, 3720 BA, Bilthoven, the Netherlands. · J Gerontol B Psychol Sci Soc Sci. · Pubmed #16855033 No free full text.

Abstract: We investigate the association between marital status and living situation (over 5 years) on 10-year subsequent cognitive decline. The study population consisted of 1,042 men aged 70-89 years in 1990, who participated in the longitudinal Finland, Italy, the Netherlands Elderly (known as FINE) Study. We measured cognition by using the Mini-Mental State Examination, and we assessed marital status (married vs unmarried) and living situation (living with others vs living alone) with a standardized questionnaire. We performed repeated measurement analyses and made adjustments for age, education, country, smoking, alcohol, chronic diseases, marital status or living situation, and baseline cognition. Men who lost a partner, who were unmarried, who started to live alone, or who lived alone during the 5-year period had at least a two times stronger subsequent cognitive decline compared with men who were married or who lived with someone in those years.

Schelleman H, Stricker BH, Verschuren WM, de Boer A, Kroon AA, de Leeuw PW, Kromhout D, Klungel OH. · Department of Epidemiology & Biostatistics, Erasmus MC, Rotterdam, The Netherlands. · Pharmacogenomics J. · Pubmed #16314886 No free full text.

Abstract: Despite the availability of effective antihypertensive drugs, there is a large variation in response to these drugs. This study investigates whether polymorphisms in the angiotensin converting enzyme (I/D), angiotensinogen (M235T), alpha-adducin (G460W), angiotensin II type 1 receptor (1166A/C), or G protein beta(3)-subunit (825C/T) gene modify the mean difference in blood pressure levels among diuretics, beta-blockers, or ACE-inhibitors users. Data were used from the Doetinchem Cohort Study, and blood pressure data were collected from GPs (1987-1997). A marginal generalized linear model (GEE) was used to assess the gene-drug interaction on the mean difference in systolic/diastolic blood pressure. In total, 625 hypertensive individuals were included with a total of 5262 measurements of blood pressure. Only the interaction between diuretic use and the GNB3 825C/T polymorphism was significant (C allele versus TT systolic blood pressure (SBP): 4.33 mmHg [95% CI: 0.14-8.54]). Thus, the mean SBP level among diuretic users may be modified by the GNB3 825C/T polymorphism.

Menotti A, Lanti M, Kafatos A, Nissinen A, Dontas A, Nedeljkovic S, Kromhout D, Anonymous00342. · Association for Cardiac Research--Associazione per la Ricerca Cardiologica--Rome, Italy. · J Hypertens. · Pubmed #15311095 No free full text.

Abstract: OBJECTIVE: The first objective was to study the long-term association of a casual measurement of systolic blood pressure (SBP) with cardiovascular deaths (CVD) and all causes of death (ALL) occurring during 35 years of follow-up in different population samples of men aged 40-59 years in five European countries. The second objective was to study the predictive power of early change in SBP levels (years 0-10) in relation to late fatal events (years 10-35). DESIGN, SETTING AND PARTICIPANTS: A single measurement of SBP was considered in cohorts in Finland, The Netherlands, Italy, Serbia and Greece for a total of 6507 men. Three partitioned proportional hazards models were solved, one for each independent and subsequent time block of 10 years, after excluding data from the first 5 years, to predict the risk of cardiovascular disease deaths of atherosclerotic origin (CVD) and all cause mortality (ALL). Independently, the predictive power of SBP changes (Delta-SBP) occurred during the first 10 years of follow-up was explored as a possible additional risk factor in relation to CVD and ALL deaths occurring between year 10 and year 35 of follow-up. RESULTS: Partitioned hazard scores derived from the three partitioned functions were cumulated. The resulting curves showed a continuous and significant association of baseline SBP with CVD and ALL deaths during three decades, although the strength of association declined significantly from the first to the third decade. The relative risk for 20 mmHg of SBP (and its 95% confidence intervals) in predicting CVD deaths was 1.65 (1.54-1.77) for the first 10-year block; 1.33 (1.24-1.42) for the second block; and 1.22 (1.13-1.31) for the last 10-year block. The corresponding levels of ALL deaths were 1.41 (1.34-1.49), 1.26 (1.19-1.32) and 1.11 (1.05-1.17). Changes in SBP during 10 years (Delta-SBP) added predictive power to baseline measurements in a direct and significant way, with a relative risk for a change of 10 mmHg of 1.14 (1.10-1.17) for CVD deaths and 1.11 (1.09-1.13) for ALL deaths. CONCLUSION: A single measurement of systolic blood pressure in middle-aged men maintains a strong relationship with fatal CVD and ALL deaths during the next 35 years, although for late events the strength of the association definitely declines. Changes in systolic blood pressure levels during the first 10 years of follow-up add predictive power, while baseline measurements retain their predictive power.

Schelleman H, Klungel OH, Kromhout D, de Boer A, Stricker BH, Verschuren WM. · Department of Epidemiology & Biostatistics, Erasmus MC, Rotterdam, The Netherlands. · J Hum Hypertens. · Pubmed #15103311 No free full text.

Abstract: The objective of this study was to determine the prevalence, treatment, and control of hypertension, and the determinants of undertreatment in the Dutch population. The study design was cross-sectional. A population-based survey on cardiovascular disease risk factors in the Netherlands from 1996 to 2002 was the setting of the study. A total of 10 820 men and women, aged 30-59 years, were included in the study. The main outcome measures of the study were: Prevalence of hypertension, treatment, and control of hypertension and determinants of undertreatment of hypertension. Hypertension was defined as: systolic blood pressure (SBP) > or =140 mmHg and/or diastolic blood pressure (DBP) > or =90 mmHg, and/or the use of antihypertensive medication. Treated and controlled hypertension was defined as SBP <140 mmHg and DBP <90 mmHg. Multivariate logistic regression was used to assess the determinants of undertreatment. The prevalence of hypertension in men was 21.4% and in women 14.9%, and 17.9% of the hypertensive men and 38.5% of the hypertensive women were receiving antihypertensive medication. Of the untreated hypertensives, 21.9% of the men and 13.6% of the women were eligible for treatment with antihypertensive medication according to Dutch guidelines. Female gender and the use of cholesterol-lowering medication were associated with an increased chance of being treated. Subjects who were physically active, on a low salt diet, and current smokers had an increased chance of being untreated. Taking cholesterol-lowering medication and no asthma or allergy were factors associated with better control of blood pressure. In conclusion, a considerable proportion of hypertensives were untreated and uncontrolled. Therefore, the detection and control of hypertension in the Netherlands needs to improve. Several groups of hypertensives were identified that need additional care and attention.

de Bree A, Verschuren WM, Blom HJ, Nadeau M, Trijbels FJ, Kromhout D. · Department of Chronic Disease Epidemiology (pb 101), National Institute of Public Health and the Environment (RIVM), PO Box 1, NL-3720 BA Bilthoven, The Netherlands. · Atherosclerosis. · Pubmed #12535751 No free full text.

Abstract: The results of prospective studies on the relations between the plasma concentration of total homocysteine (tHcy) and B-vitamins, on the one hand, and coronary heart disease (CHD) mortality, on the other hand, are inconclusive and scarce considering the relation with B-vitamins. We prospectively determined these relations in a case-cohort study. The full-cohort existed in approximately 36,000 Dutch adults aged 20-59 years at baseline. The statistical analyses were done with a random sample from the cohort (n=630) complemented with all subjects who died of CHD (n=102) during a mean follow-up of 10.3 years. All subjects reported the absence of cardiovascular diseases (CVDs) at baseline. The plasma concentrations of tHcy, folate, PLP, and vitamin B12 were determined in samples obtained at baseline. Men with a tHcy concentration in the highest tertile (T3) compared with men in the lowest tertile (T1) had a relative risk (RR) of 1.14 for CHD (95% confidence interval (CI): 0.50, 2.61) after adjusting for age, study center, hypertension, HDL and total cholesterol, smoking, and creatinine. For women, this RR was 2.04 (95% CI: 0.48, 8.62). For each 5 micromol/l increase in tHcy, the RR of CHD was 1.03 (95% CI: 0.83-1.29) for men and women combined. In women only, high folate levels were associated with a statistically significant protection of fatal CHD (T3 versus T1; RR: 0.22, 95% CI: 0.06, 0.87). Plasma PLP (B6) and vitamin B12 concentrations were not associated with CHD risk. We conclude that elevated tHcy concentrations do not seem to be a risk factor for CHD mortality in these relatively young healthy Dutch subjects free of baseline CVD. Higher folate concentrations may be protective of CHD, but this needs confirmation.

Houterman S, Verschuren WM, Kromhout D. · Department of Chronic Diseases Epidemiology, National Institute of Public Health and the Environment, Bilthoven, the Netherlands. · Epidemiology. · Pubmed #12500042 No free full text.

Abstract: BACKGROUND: To study the impact of smoking and blood pressure conditional on serum total cholesterol levels, we investigated the 20-year mortality risk associated with high systolic blood pressure (> or =140 mmHg) and smoking, at low (<5.2 mmol/Liter), medium (5.2-6.49mmol/Liter), and high (> or =6.5 mmol/Liter) serum total cholesterol levels. METHODS: The study population comprised a cohort of 50,000 men and women age 30-54 years, examined between 1974 and 1980, in five Dutch towns. The duration of follow-up averaged 20 years. Age-adjusted relative risks (RRs) for mortality from coronary heart disease (CHD), cardiovascular diseases (CVD) and all causes were estimated, for six risk profiles (based on levels of total cholesterol, systolic blood pressure and smoking), using Cox proportional hazards analysis. RESULTS: Given a low cholesterol level, smoking had a larger impact than elevated blood pressure on CHD, CVD and all-cause mortality. The combination of elevated blood pressure and smoking among persons with low cholesterol was associated with RRs of 3.0 for CHD, 6.0 for CVD and 4.1 for all-cause mortality in men, and 2.3, 3.6 and 2.6, respectively, in women. Among persons with high cholesterol, the combination of high blood pressure and smoking was associated with RRs of 9.7 for CHD, 13.9 for CVD and 5.7 for all-cause mortality in men, and 15.9, 9.3 and 4.3, respectively, in women. For each risk profile, the absolute number of CHD, CVD and total deaths was larger in men than in women. CONCLUSIONS: The results demonstrate the potential power of a multifactorial approach to risk factor reduction in the prevention of cardiovascular diseases and all-cause mortality.

Van den Hoogen P, Seidell J, Nagelkerke N, Menotti A, Kromhout D. · No affiliation provided · Eur Heart J. · Pubmed #11686671 links to  free full text

This publication has no abstract.

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.