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A model designed as primary hypertension prevention for children ranking high in blood pressure, selected from a total population, was applied to a semirural, biracial community. A Dietary/Exercise Alteration Program Trial (ADAPT), in combination with low-dose medication, was tested on 48 children aged 8-18 years who were randomly selected from 100 children consistently in the upper blood pressure decile. The interactive model a) focuses on a major public health problem that is measurable and modifiable, b) outlines a preventive approach to involve children and parents in establishing healthy life styles, and c) converts community limitations into resources. The comprehensive program was developed to support eating and exercise modifications accepted for hypertension treatment without placing children in a sick role. Sodium reduction, weight control, and regular exercise are the life-style changes promoted. Indicators for evaluating development and implementation of ADAPT are presented. The commitment to written pledges, ie, making simple behavioral changes, had a significant inverse association with post-treatment sodium and energy intakes in regression models that included the child's curriculum and physical activity class attendance. ADAPT represents an initial approach for developing primary preventive treatment of early essential hypertension in a pediatric population.

The association of heart-related mortality with tissue cadmium and lead in a study of autopsies performed on persons who resided in a soft-water, leached-soil area of North Carolina was examined. Liver cadmium concentrations and aortic lead level were indices of these elements. Both cadmium and lead levels had statistically significant correlations with cause of death (heart-related disease vs. non-heart-related disease, excluding cancer). Although cause of death was significantly associated with age, the association with cadmium and lead persisted after statistical adjustment for the effect of age. The combined effects of cadmium and lead provided sufficient information in an additive model to predict cause of death correctly for 80% of the cases, with age contributing insignificantly. These findings indicate the intimate relation of these two trace metals with increased risk of heart-related mortality, even in light of known conventional causes of such deaths.