Blood pressure and lifestyle

[Guest guest]

Hi All, From email: apater@... PDFs are available on the below on blood

pressure and lifestyle.

Cheers, Al.

37. Age-specific relevance of usual blood pressure to vascular mortality,

Page 1389

Stanley S lin, D Wong and B Kannel

SummaryPlus | Full Text + Links | PDF (52 K)

38. Age-specific relevance of usual blood pressure to vascular mortality,

Pages 1389-1390

Albert Fournier and Michel Safar

SummaryPlus | Full Text + Links | PDF (60 K)

39. Age-specific relevance of usual blood pressure to vascular mortality,

Page 1390

Sid Port

SummaryPlus | Full Text + Links | PDF (50 K)

40. Age-specific relevance of usual blood pressure to vascular mortality,

Pages 1390-1391

Jennrich

SummaryPlus | Full Text + Links | PDF (58 K)

41. Age-specific relevance of usual blood pressure to vascular mortality, Page

1391

Peymané Adab, K K Cheng, C Q Jiang, W S Zhang and T H Lam

SummaryPlus | Full Text + Links | PDF (51 K)

42. Age-specific relevance of usual blood pressure to vascular mortality,

Pages 1391-1392

Prospective Studies Collaboration...

SummaryPlus | Full Text + Links | PDF (60 K)

43. In-vitro fertilisation and retinoblastoma, Page 1392

Annette C Moll, Saskia M Imhof, Antoinette Y N Schouten-van Meeteren

and Flora E van LeeuwenThe Lancet Volume 361, Issue 9366 , 19 April 2003, Pages

1391-1392

Correspondence

Age-specific relevance of usual blood pressure to

vascular mortality

Prospective Studies Collaboration, Lewington, e, Nawab

Qizilbash, Peto and Rory

Authors' reply

Sir––With 56000 vascular deaths between ages 40 and 89 years among one

million adults without

known vascular disease at baseline, the PSC shows that––at least down to

usual blood pressure

levels of 115/75 mm Hg––each difference of 20 mm Hg in usual SBP is

associated with about a

two-fold difference in age-specific mortality rates from stroke, ischaemic

heart disease, and other

vascular causes. For risk prediction from a single measurement, SBP is

slightly better than DBP,

their average (the mid blood pressure) is better than either, and the pulse

pressure is much worse

than either. Stanley lin and colleagues incorrectly state that the

latter findings were based on

univariate analyses, but at a given measured value of SBP, the measured

value of DBP was still very

significantly positively (as in mid blood pressure), rather than negatively

(as in pulse pressure),

related to both stroke and ischaemic heart disease mortality. The

associations of risk with mid blood

pressure (see http://image.thelancet.com/03cor2002webfigure.pdf), as

requested by Albert Fournier

and Michel Safar) confirm its relevance throughout middle and old age.

Sid Port suggests that " usual " blood pressure (ie, the long-term average)

could be confused with

" casual " blood pressure (ie, a single measurement), but the meaning of usual

blood pressure is

explained clearly in the PSC report. The smooth relations of stroke,

ischaemic heart disease, and

other vascular mortality with the usual blood pressure (figures 2, 4, and 6

in our main report) are

based on 61 contributing studies, some of which (such as the two that Sid

Port and Jennrich

selectively emphasise) had found irregular associations with all-cause

mortality that are refuted by

the overall evidence. As we discussed, analyses of the association of blood

pressure with the

aggregate of all causes of death may be less informative about causal

relations than are

cause-specific analyses. This can be illustrated by notional data (figure)

for a risk factor that is

associated with a doubling in the risk of vascular mortality between

quintiles but with no difference in

the risk of non-vascular mortality.

Figure. Notional association of a risk factor with vascular,

non-vascular, and all-cause mortality.

Based on a doubling in the number of vascular deaths between each

quintile of the risk factor (ie,

100, 200, 400, 800, 1600 deaths, respectively) but no difference in the

number of non-vascular

deaths (ie, 800 in each quintile), and with the overall percentages of

deaths due to vascular and

non-vascular causes (44% and 56%, respectively) similar to those in the

Prospective Studies

Collaboration.

There was significant heterogeneity between studies of the overall strength

of the relations of

mortality from stroke and ischaemic heart disease with usual blood pressure

(both p<0·0001), but

little evidence that the outlying results importantly biased the estimated

associations. For example,

for deaths at ages 40–89 years, each 20 mm Hg lower usual SBP is associated

with a hazard ratio

of 0·50 for stroke and 0·57 for ischaemic heart disease. After excluding the

studies contributing

most to the heterogeneity (with p for heterogeneity >0·1 among the remaining

studies), each 20 mm

Hg lower usual SBP is associated with a hazard ratio of 0·49 for stroke and

0·54 for ischaemic

heart disease.

Randomised trials have shown that lowering blood pressure can reduce

vascular disease risk within

just a few years, and the PSC meta-analysis of observational studies

provides complementary

evidence of the even greater differences in risk that are likely to be

produced by more prolonged

differences in blood pressure. For example, a 10 mm Hg lower usual SBP or 5

mm Hg lower usual

DBP (as typically seen in randomised trials of blood-pressure-lowering

therapy) would, in the long

term, be associated with about a 40% lower risk of stroke death and a 30%

lower risk of death

from ischaemic heart disease or other vascular causes throughout middle age

(and with only slightly

smaller proportional differences at older ages).

Effects of Comprehensive Lifestyle Modification on Blood Pressure Control:

Main Results of the PREMIER Clinical Trial

Writing Group of the PREMIER Collaborative Research Group

JAMA 2003;289 2083-2093

ABSTRACT

Context Weight loss, sodium reduction, increased physical activity, and

limited alcohol

intake are established recommendations that reduce blood pressure (BP). The

Dietary

Approaches to Stop Hypertension (DASH) diet also lowers BP. To date, no

trial has

evaluated the effects of simultaneously implementing these lifestyle

recommendations.

Objective To determine the effect on BP of 2 multicomponent, behavioral

interventions.

Design, Setting, and Participants Randomized trial with enrollment at 4

clinical centers

(January 2000-June 2001) among 810 adults (mean [sD] age, 50 [8.9] years;

62% women;

34% African American) with above-optimal BP, including stage 1 hypertension

(120-159 mm

Hg systolic and 80-95 mm Hg diastolic), and who were not taking

antihypertensive

medications.

Intervention Participants were randomized to one of 3 intervention groups:

(1) " established, " a behavioral

intervention that implemented established recommendations (n = 268); (2)

" established plus DASH, " which also

implemented the DASH diet (n = 269); and (3) an " advice only " comparison

group (n = 273).

Main Outcome Measures Blood pressure measurement and hypertension status at

6 months.

Results Both behavioral interventions significantly reduced weight,

improved fitness, and lowered sodium

intake. The established plus DASH intervention also increased fruit,

vegetable, and dairy intake. Across the

groups, gradients in BP and hypertensive status were evident. After

subtracting change in advice only, the

mean net reduction in systolic BP was 3.7 mm Hg (P<.001) in the established

group and 4.3 mm Hg (P<.001) in

the established plus DASH group; the systolic BP difference between the

established and established plus DASH

groups was 0.6 mm Hg (P = .43). Compared with the baseline hypertension

prevalence of 38%, the prevalence

at 6 months was 26% in the advice only group, 17% in the established group

(P = .01 compared with the advice

only group), and 12% in the established plus DASH group (P<.001 compared

with the advice only group; P = .12

compared with the established group). The prevalence of optimal BP (<120 mm

Hg systolic and <80 mm Hg

diastolic) was 19% in the advice only group, 30% in the established group (P

= .005 compared with the advice

only group), and 35% in the established plus DASH group (P<.001 compared

with the advice only group; P = .24

compared with the established group).

Conclusion Individuals with above-optimal BP, including stage 1

hypertension, can make multiple lifestyle

changes that lower BP and reduce their cardiovascular disease risk.

]Weight decreased 1.1% in usual advice, 4.9 with Dash + usual advice and 5.8

with both.]