Gender and age differences in lifestyle factors related to hypertension in middle-aged civil service employees

Cardiovascular dysfunctions and sympathovagal imbalance in hypertension and prehypertension: physiological perspectives

Hypertension (HTN) and prehypertension (pre-HTN) have been identified as independent risk factors for adverse cardiovascular events. Recently, increased psychosocial stress and work stress have contributed to the increased prevalence of HTN and pre-HTN, in addition to the contribution of obesity, diabetes, poor food habits and physical inactivity. Irrespective of the etiology, sympathetic overactivity has been recognized as the main pathophysiologic mechanism in the genesis of HTN and pre-HTN. Sympathovagal imbalance owing to sympathetic overactivity and vagal withdrawal is reported to be the basis of many clinical disorders. However, the role played by vagal withdrawal has been under-reported. In this review, we have analyzed the pathophysiologic involvement of sympathovagal imbalance in the development of HTN and pre-HTN, and the link of sympathovagal imbalance to cardiovascular dysfunctions. We have emphasized that adaptation to a healthier lifestyle will help improve sympathovagal homeostasis and prevent the occurrence of HTN and pre-HTN.

Characteristics of hypertension-related factors in female home caregivers in Japan-comparison with general community non-caregivers

AIMS AND OBJECTIVES

To examine the characteristics of hypertension-related factors in female family caregivers in Japan who provide care in the home, in comparison with general community non-caregivers.

BACKGROUND

Hypertension is more frequently encountered in female caregivers than in non-caregivers. Lifestyle factors including sleep and eating habits differ in Japanese female caregivers and the general population. Therefore, hypertension-related factors in caregivers may also differ from those in the general population.

DESIGN

A cross-sectional study.

METHODS

The subjects were 150 female caregivers (aged 62·4, SD 12·2 years) who provided home care for persons with physical impairments and/or dementia and 154 female controls (aged 62·7, SD 2·2 years) who did not provide home care. Persons with a history of ischaemic heart disease or cerebral stroke were excluded. Subjects were examined using a self-reporting questionnaire that included a food frequency questionnaire and the tri-axial coping scale. Urine examinations and blood pressure measurements were also done. Logistic regression analysis was conducted for each group with the same variables as explanatory variables.

RESULTS

Hypertension was present in 46·7% of caregivers and 34·4% of controls (p<0·05). Menopause was a factor related to hypertension in both the caregivers and controls. In the caregiver group, hypertension was associated with the estimated 24-h Na excretion in urine and the carbohydrate-energy ratio for nutriti. BMI was associated with hypertension in the control group, but not in the caregiver group.

CONCLUSIONS

Hypertension was associated with nutritional factors, such as greater Na excretion in urine and higher carbohydrate energy ratio, in Japanese female caregivers and with obesity in non-caregivers.

RELEVANCE TO CLINICAL PRACTICE

To prevent hypertension, it is necessary to carefully monitor salt intake and nutritional balance in female caregivers in Japan.

Incidence of metabolic syndrome according to combinations of lifestyle factors among middle-aged Japanese male workers

OBJECTIVE

To examine a combination of healthy lifestyles on the risk of metabolic syndrome (MetS) to inform future interventions.

METHODS

A total of 1897 men aged 35-60 years participated in an annual health check-up in 2002 and 2005. MetS was defined by AHA/NCEP criteria. Logistic regression analyses were used to estimate age- and BMI-adjusted odds ratios (ORs) of MetS incidence for each healthy lifestyle (regular physical activity, adherence to healthy eating behaviors, not current smoking, and maintaining a stable weight since one's mid-twenties), separately (Model 1) and simultaneously (Model 2). A points system was developed to derive 3-year risk of MetS incidence by assigning a specific point to each healthy lifestyle.

RESULTS

MetS developed in 285 (15.0%) subjects after the follow-up. The ORs of MetS for each healthy lifestyle ranged from 0.42 to 0.64 (Model 2). Three-year risk of MetS incidence was predicted to differ from 1% to 60% according to the individual point total of the points system. The population-attributable fraction of MetS in subjects whose point total was not in the highest quartile was 71%.

CONCLUSION

Adherence to healthy lifestyles was associated with a lower risk of MetS among apparently healthy middle-aged Japanese male workers.

The proportion of individuals with obesity-induced hypertension among total hypertensives in a general Japanese population: NIPPON DATA80, 90

The increased prevalence of obesity in Japan may contribute to the high prevalence of hypertension in Japan. In the present study, we calculated the odds ratio for hypertension in obesity (body mass index (BMI) >or= 25.0 kg/m(2)) using data from independent nationwide surveys conducted in 1980 and 1990. We estimated the percentage of hypertensives whose condition was due to obesity among total hypertensives in the general Japanese population. In the 1980 survey, 18.8% of 4,623 male participants were obese and 50.4% were hypertensive, whereas 22.6% of 5,893 female participants were obese and 41.1% were hypertensive. For both sexes, obese participants had a higher odds ratio for hypertension than non-obese participants (BMI < 25.0 kg/m(2)), and there was a significant dose-response relationship between BMI and the odds ratio for hypertension. Among all hypertensives, the percentage whose hypertension was due to obesity in 1980 and 1990 was 11.4% (95% confidence interval (CI): 4.7-17.7%) and 15.3% (95% CI: 6.8-23.1%) for men and 19.3% (95% CI: 12.1-25.9%) and 22.3% (95% CI: 14.6-29.3%) for women, respectively. Approximately 80-90% of individuals with obesity-induced hypertension were in the 25.0 <or= BMI < 30.0 kg/m(2) category for both sexes in each year. In conclusion, we found that obesity-induced hypertension as a proportion of total hypertension increased between 1980 and 1990 for both sexes. Obesity now is playing a more important role in the high prevalence of hypertension in Japan than it was before.

Sleep status and blood pressure in a healthy normotensive female population

Sleeplessness can be linked to hypertension and its consequent complications such as cardiovascular disease. We investigated the cross-sectional relationship between blood pressure (BP) and self-reported sleep status among 227 healthy normotensive Japanese females (mean age: 47.0 years) in a clinical setting. Multiple logistic regression analysis for the highest quartile of diastolic BP (DBP) showed the body mass index (BMI) (odds ratio=1.26 [95% confidence interval=1.12-1.41]) and sleep status (sometimes lack: 2.19 [1.00-4.79], poor: 2.82 [1.17-6.80]) as significantly associated factors. The same analysis for systolic BP or pulse pressure showed that both age and BMI were significant factors and sleep status was not associated. A poorer sleep status may contribute to elevated DBP in healthy normotensive females.

Determinants of blood pressure response to quinapril in black and white hypertensive patients: the Quinapril Titration Interval Management Evaluation trial

Race has been considered an important factor in determining blood pressure response to treatment and selection of antihypertensive drug therapy. Data collected during a clinical trial that evaluated rapidity of medication up-titration with blood pressure response to monotherapy with the angiotensin-converting enzyme (ACE) inhibitor quinapril were used to characterize response in 533 black and 2046 white participants. Our objectives were to examine the influence of race and other factors on blood pressure response and to assess the degree to which nonrace factors account for apparent racial differences in response. Average systolic and diastolic blood pressure responses (baseline minus follow-up) to treatment were assessed with treatment groups combined. Crude systolic and diastolic blood pressure responses averaged 4.7 and 2.4 mm Hg less, respectively, in black compared with white participants; however, the response distributions largely overlapped. In multivariate linear regression models adjusted for study design variables and measured participant characteristics, the racial difference in systolic response was reduced by 51% to 2.3 mm Hg, and diastolic response by 21% to 1.9 mm Hg. In these models, participant characteristics, including age, gender, body size, and pretreatment blood pressure severity, significantly predicted either attenuated or enhanced blood pressure response to treatment. Our findings demonstrate that a large source of variability of blood pressure response to treatment is within, not between, racial groups, and that factors that vary at the level of the individual contribute to apparent racial differences in response to treatment.

Reproducibility and validity of a simple checklist-type questionnaire for food intake and dietary behavior

BACKGROUND

A simple, reliable, and valid food questionnaire is needed in clinical dietary assessments, community health education, and multi-purpose epidemiologic studies to obtain a crude measure of dietary intake.

METHODS

To assess the validity and reproducibility of a simple 4-point scale food intake and behavior checklist, it was compared to two 3-day weighed dietary records. The FBC was administered to 47 students of a dietician course and their parents (n = 94) over a 9-month interval to assess the reproducibility. The mean intakes of selected food groups assessed by the two dietary records completed between food intake and behavior checklists were compared to the responses to the food intake and behavior checklist to assess its validity.

RESULTS

The kappa statistics for reproducibility ranged from 0.25 for confectionaries to 0.63 for a preference for fatty foods (median, 0.39). There was a reasonable level of correlation between the dietary record and the food intake and behavior checklist in the intake of eggs, milk, and fruits (r = 0.53, 0.56, and 0.50, respectively). There was a weaker but still significant correlation in the intake of vegetables, and alcohol (r = 0.31 and 0.45, respectively). No significant correlation was observed in the intake of meat, fish, confectionaries, and soft drinks. However, those who reported consuming mainly fish rather than meat were found to eat significantly less meat and animal fat. Similarly, those who did not prefer fatty foods consumed significantly less meat, animal fat, and polyunsaturated fatty acids.

CONCLUSIONS

This simple food checklist was useful in collecting data on egg, milk, and fruit consumption. Assessing intake frequency of vegetables, meat or fish with the FBC may be useful in screening high- or low-intake individuals.