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Objective: Although prospective studies suggest light-to-moderate chronic alcohol intake protects against coronary artery disease in type 2 diabetic patients, the balance of effects on individual cardiovascular risk factors needs further assessment. We examined the effects of alcohol consumption on 24-h ambulatory blood pressure (BP) and heart rate (HR), high-density lipoprotein cholesterol, fibrinogen, C-reactive protein, homocysteine, and glycaemic control in well controlled type 2 diabetes., Methods: Twenty-four participants aged 49-66 year were randomized to a three-period crossover study with women drinking red wine 230  ml/day (∼24  g alcohol/day) and men drinking red wine 300  ml/day (∼31  g alcohol/day), or equivalent volumes of dealcoholized red wine (DRW) or water, each for 4 weeks. Ambulatory BP and HR were monitored every 30  min for 24  h at the end of each period. Home blood glucose monitoring was carried out twice weekly throughout., Results: Red wine increased awake SBP and DBP relative to water by 2.5 ± 1.2 /1.9 ± 0.7  mmHg (P = 0.033, P = 0.008, respectively), with a similar nonsignificant trend relative to DRW. Asleep DBP fell with red wine relative to DRW (2.0 ± 0.8  mmHg, P = 0.016) with a similar nonsignificant trend relative to water. Red wine increased 24-h, awake and asleep HR relative to water and DRW. Relative to DRW, red wine did not affect glycaemic control or any other cardiovascular risk factor., Conclusion: In well controlled type 2 diabetic individuals 24-31  g alcohol/day (∼2-3 standard drinks) raises awake BP and 24-h HR and lowers asleep BP but does not otherwise favourably or adversely modify cardiovascular risk factors.

Alcohol has been consistently demonstrated to elevate blood pressure (BP) in intervention studies in men. There are uncertainties, however, as to the nature of the relationship in women. We, therefore, determined in healthy premenopausal women the dose-dependent effects of alcohol on ambulatory BP. Twenty-four participants aged 25 to 49 years, with a mean alcohol intake of 202±94 g alcohol/wk and mean 24-hour systolic and diastolic BP of 110.2±8.9/68.9±5.7 mm Hg, were randomized to a 3-period cross-over study. Each evening they consumed higher volume red wine (lower level drinkers, 146 g alcohol/wk; higher level drinkers, 218 g alcohol/wk), lower volume red wine (lower level drinkers, 42 g alcohol/wk; higher level drinkers, 73 g alcohol/wk), or dealcoholized red wine, each for a period of 4 weeks. Higher volume red wine significantly increased 24 hours systolic and diastolic BP relative to dealcoholized red wine (by 2.0±0.6/1.2±0.4 mm Hg; P=0.001 and P=0.028, respectively). There were similar changes for higher volume red wine relative to lower volume red wine (by 1.6±0.6/1.4±0.4 mm Hg; P=0.014 and P=0.005, respectively). These effects were predominantly on awake rather than asleep BP. There was no significant difference in BP between lower volume red wine and dealcoholized red wine. We conclude that in healthy premenopausal women regular consumption of alcohol as 200 to 300 mL red wine/d (146-218 g alcohol/wk) elevates 24 hours systolic and diastolic BP. The magnitude of the increase in BP is similar to that previously reported in intervention studies in men., (© 2015 American Heart Association, Inc.)

Background: Metabolism of arachidonic acid by cytochrome P450 ω-hydroxylase leads to the formation of 20-hydroxyeicosatetraenoic acid (20-HETE) that regulates vascular function, sodium homeostasis and blood pressure (BP). Supplementation with n-3 fatty acids is known to alter arachidonic acid metabolism and reduce the formation of the lipid peroxidation products F2-isoprostanes, but the effect of n-3 fatty acids on 20-HETE has not been studied., Method: We previously reported a significant effect of n-3 fatty acids but not coenzyme Q10 (CoQ) to reduce BP in a double-blind, placebo-controlled intervention, wherein patients with chronic kidney disease (CKD) were randomized to n-3 fatty acids (4 g), CoQ (200 mg), both supplements or control (4 g olive oil), daily for 8 weeks. This study examined the effect of n-3 fatty acids on plasma and urinary 20-HETE in the same study, as well as plasma and urinary F2-isoprostanes, and relate these to changes in BP., Results: Seventy-four patients completed the 8-week intervention. n-3 fatty acids but not CoQ significantly reduced plasma 20-HETE (P = 0.001) and F2-isoprostanes (P < 0.001). In regression models adjusted for BP at baseline, postintervention plasma 20-HETE was a significant predictor of the fall in SBP (P < 0.0001) and DBP (P < 0.0001) after n-3 fatty acids., Conclusion: This is the first report that n-3 fatty acid supplementation reduces plasma 20-HETE in humans and that this associates with reduced BP. These results provide a plausible mechanism for the reduction in BP observed in patients with CKD following n-3 fatty acid supplementation.

Objective: Oxidative stress has been suggested to play a role in the development of diabetes, hypertension and vascular dysfunction. Vitamin E, a major lipid-soluble dietary antioxidant, has two major dietary forms, alpha-tocopherol and gamma-tocopherol. The potential importance of gamma-tocopherol has largely been overlooked. Our aim was to investigate the effect of alpha-tocopherol and gamma-tocopherol supplementation on 24-h ambulatory blood pressure (BP) and heart rate, vascular function and oxidative stress in individuals with type 2 diabetes., Method: Fifty-eight individuals with type 2 diabetes were randomized in a double-blind, placebo-controlled trial. Participants were randomized to a daily dose of 500 mg/day RRR-alpha-tocopherol, 500 mg/day mixed tocopherols (60% gamma-tocopherol) or placebo for 6 weeks. Primary endpoints were 24-h ambulatory BP and heart rate, endothelium-dependent and independent vasodilation and plasma and urinary F2-isoprostanes., Results: Treatment with alpha-tocopherol significantly increased systolic BP [7.0 (5.2, 8.8) mmHg, P < 0.0001], diastolic BP [5.3 (4.0, 6.5) mmHg, P < 0.0001], pulse pressure [1.8 (0.6, 3.0) mmHg, P < 0.005] and heart rate [2.0 (0.6, 3.3) bpm, P < 0.005] versus placebo. Treatment with mixed tocopherols significantly increased systolic BP [6.8 (4.9, 8.6) mmHg, P < 0.0001], diastolic BP [3.6 (2.3, 4.9) mmHg, P < 0.0001], pulse pressure [3.2 (2.0, 4.4) mmHg, P < 0.0001] and heart rate [1.8 (0.5, 3.2) bpm, P < 0.01] versus placebo. Treatment with alpha-tocopherol or mixed tocopherols significantly reduced plasma F2-isoprostanes versus placebo, but had no effect on urinary F2-isoprostanes. Endothelium-dependent and independent vasodilation was not affected by either treatment., Conclusion: In contrast to our initial hypothesis, treatment with either alpha- or mixed tocopherols significantly increased BP, pulse pressure and heart rate in individuals with type 2 diabetes.

Background: Compared with carbohydrate intake, dietary intake of plant protein can lower blood pressure in humans, but the effects of animal protein intake on blood pressure have yet to be investigated., Objective: We aimed to determine whether partial substitution of carbohydrate intake with animal protein intake from lean red meat changes blood pressure and other markers of cardiovascular disease risk in hypertensive persons., Design: Hypertensive persons (n = 60) were recruited to an 8-wk parallel-design study. The participants were randomly assigned either to maintain their usual diet (control group) or to partially replace energy intake from carbohydrate-rich foods with protein from lean red meat (protein group). Measurements were performed at baseline and at the end of the intervention., Results: Compared with the control group, the protein group had a significantly higher protein intake [x (95% CI) percent of energy: 5.3% (3.7%, 6.9%), P < 0.001] and a corresponding lower carbohydrate intake [-5.3% of energy (-7.9%, -2.7%), P < 0.001]. Body weight and intakes of fat, alcohol, and fiber were not significantly different between the groups. Compared with the control group, the clinic, 24-h, awake, and asleep systolic blood pressures were lower [-5.2 (-10.3, -0.1), -4.0 (-7.4, -0.6), -4.7 (-8.9, -0.5), and -4.7 (-10.3, -0.1) mm Hg, respectively, P < 0.05] and fasting plasma glucose concentrations were higher [0.33 mmol/L (0.09, 0.58 mmol/L), P = 0.008] in the protein group. These differences were independent of age, sex, and changes in weight, alcohol intake, or urinary sodium and potassium excretion. Diastolic blood pressure and heart rate, arterial compliance, blood lipids, and serum insulin were not significantly different between the groups., Conclusion: Within the context of other studies, these results suggest that modest substitution of carbohydrate-rich foods with protein-rich foods may lower blood pressure in hypertensive persons.

Objective: Swimming is often recommended in the prevention and treatment of hypertension. Few studies have investigated the effect of swimming training on blood pressure (BP). Our objective was to evaluate 6 months of supervised moderate swimming or walking on BP in previously sedentary, normotensive, older women., Design: Women aged 50-70 years (n = 116) were randomly assigned to a supervised 6-month swimming or walking programme. They were further randomized to receive usual care or a behavioural intervention package., Methods: Exercise comprised 3 sessions/week with a warm-up, cool down, and 30-min of moderate intensity walking or swimming. BP was recorded for 20 min supine, and 5 min standing. Assessments were made at 0 and 6 months., Results: At baseline, mean supine BP (+/- SD) was 115.7 +/- 1.3/66.8 +/- 0.7 mmHg. Swimming improved swim distance by 78.1 m (29.3%) [95% confidence interval (CI); 66.7, 89.4] and walk time by 0.58 min (3.8%) (0.41, 0.74). Walking decreased walk time by 1.0 min (6.5%) (0.81, 1.19). After adjustment for initial BP, age, hypertension treatment status and change in weight, swimming increased supine and standing systolic BP relative to walking by 4.4 mmHg (1.2, 7.5) (P = 0.008) and 6.0 mmHg (2.6, 9.5) (P = 0.001), respectively. Supine and standing diastolic BP increased by 1.4 mmHg (-0.14, 3.0) (P = 0.07) and 1.8 mmHg (-0.02, 3.5) (P = 0.05), respectively., Conclusion: Relative to moderately paced walking, regular swimming significantly elevates BP in previously sedentary, normotensive, older women. This finding may have important implications for exercise prescription in older subjects.

A positive relationship between alcohol consumption and blood pressure (BP) is well-established but the relative effect of specific alcoholic beverages is controversial. This study aimed to determine whether red wine may improve vascular function and have less of an impact on blood pressure because of its high content of antioxidant vasodilator polyphenolic compounds. Healthy normotensive men entered a 4-period crossover study comparing in random order 4 weeks of control-abstinence with similar periods of daily consumption of red wine (375 mL; 39 grams alcohol), de-alcoholized red wine (375 mL), or beer (1125 mL; 41 grams alcohol). Ambulatory systolic BP and diastolic BP and heart rate (HR) were measured together with vascular function as assessed by flow-mediated dilatation (FMD) and glyceryl trinitrate-mediated (GTNMD) dilatation of the brachial artery. The systolic and diastolic BP and HR were not different between control-abstinence and de-alcoholized red wine. However, compared with control-abstinence, both red wine and beer increased awake systolic BP (2.9 and 1.9 mm Hg, respectively; P<0.05) and asleep HR (5.0 and 4.4 bpm; P<0.05). There were no specific effects of red wine, de-alcoholized red wine, or beer on FMD or GTNMD. Daily consumption of approximately 40 grams alcohol as either red wine or beer for 4 weeks results in similar increases in systolic BP and HR. De-alcoholized red wine did not lower BP, and neither red wine nor de-alcoholized red wine influenced vascular function, suggesting that red wine polyphenolics do not have a significant role in mitigating the blood pressure-elevating effects of alcohol in men.

Background: There is growing evidence that oxidative stress contributes to the pathogenesis of hypertension and endothelial dysfunction. Thus, dietary antioxidants may beneficially influence blood pressure (BP) and endothelial function by reducing oxidative stress., Objective: To determine if vitamin C and polyphenols, alone or in combination, can lower BP, improve endothelial function and reduce oxidative stress in hypertensive individuals., Design: A total of 69 treated hypertensive individuals with a mean 24-h ambulatory systolic blood pressure > or = 125 mmHg participated in a randomized, double-blind, placebo-controlled, factorial trial. Following a 3-week washout, participants received 500 mg/day vitamin C, 1000 mg/day grape-seed polyphenols, both vitamin C and polyphenols, or neither for 6 weeks. At baseline and post-intervention, 24-h ambulatory BP, ultrasound-assessed endothelium-dependent and -independent vasodilation of the brachial artery, and markers of oxidative damage, (plasma and urinary F2-isoprostanes, oxidized low-density lipoproteins and plasma tocopherols), were measured., Results: A significant interaction between grape-seed and vitamin C treatments for effects on BP was observed. Vitamin C alone reduced systolic BP versus placebo (-1.8 +/- 0.8 mmHg, P = 0.03), while polyphenols did not (-1.3 +/- 0.8 mmHg, P = 0.12). However, treatment with the combination of vitamin C and polyphenols increased systolic BP (4.8 +/- 0.9 mmHg versus placebo; 6.6 +/- 0.8 mmHg versus vitamin C; 6.1 +/- 0.9 mmHg versus polyphenols mmHg, each P < 0.0001) and diastolic BP (2.7 +/- 0.6 mmHg, P < 0.0001 versus placebo; 1.5 +/- 0.6 mmHg, P = 0.016 versus vitamin C; 3.2 +/- 0.7 mmHg, P < 0.0001 versus polyphenols). Endothelium-dependent and -independent vasodilation, and markers of oxidative damage were not significantly altered., Conclusion: Although the mechanism remains to be elucidated, these results suggest caution for hypertensive subjects taking supplements containing combinations of vitamin C and polyphenols.

Background: Effects of regular exposure to polyphenolic compounds found in tea, leading to improved endothelial function and blood pressure, may reduce cardiovascular disease risk. Controlled trials in humans have found that ingestion of tea can improve endothelial function, but also cause a rapid onset acute increase in blood pressure., Objective: To examine the acute effects of tea consumption on fasting and postprandial vascular function and blood pressure., Methods: Endothelium-dependent dilatation of the brachial artery, assessed using ultrasound and blood pressure were measured in 20 participants with a history of coronary artery disease. Measurements were performed at baseline and at 3.5 h (blood pressure) and 4 h (endothelial function) after drinking three cups of black tea or hot water (consumed at time = 0, 1.5 and 3 h) with and without a high-fat (50 g) meal: a total of four treatments administered in random order., Results: The high-fat meal did not impair endothelial function. In comparison to water alone, endothelium-dependent dilatation was increased by the meal with tea (1.7 (0.4, 3.0)%, P = 0.02), but was not significantly altered by the tea alone (0.7 (-0.6, 2.0)%, P = 0.32). Systolic blood pressure was significantly increased by tea alone in comparison to each of the other three groups: water alone (9.3 (4.5, 14.1) mmHg, P = 0.0003), meal with water (9.8 (5.0, 14.6) mmHg, P = 0.0001) and meal with tea (7.2 (2.4,12.0) mmHg, P = 0.004). Consumption of a meal negated the acute increase in systolic blood pressure found with tea in the fasting state., Conclusion: Consumption of food may alter the acute effects of tea on vascular function and blood pressure.

Background: Using data from a longitudinal study of young Australians, we applied recent international standards for overweight and obesity to examine associations with blood pressure (BP) and to determine the prevalence and degree of tracking of overweight and obesity. We also aimed to examine socioeconomic status in relation to these variables., Methods: BP, height, and weight were measured at 3-year intervals from age 9 to 18, and then at 25 years of age in a Western Australian cohort. At these stages, data were available for 1,036, 1,310, 618, 615 and 600 individuals, respectively., Results: We found 10% of 9-year-old males to be overweight or obese, while among 12-year-olds, 13% were overweight or obese; at age 15, and still at age 18, overweight or obesity was registered in 17% of this population and it rose to 42% among the 25-year-old young men. The percentage of overweight or obese females at these stages was initially 8, then 12 (at age 12), 11 (at age 15), 14 (at age 18) and finally 32. Overweight or obesity tracked to young adult life in 16% of those overweight or obese at 9, 24% at 12, 34% at 15 and 35% at 18 years. Systolic BP was significantly higher in the overweight or obese except in 12-year-olds. At the age of 25 years, 53% of men had high normal BP or were hypertensive., Conclusions: Increasing overweight or obesity in young Australians, consistent with international trends, has serious health implications. Overweight and obesity show tracking and are predictors of higher blood pressure, except in early adolescence.

Inverse associations between size at birth and blood pressure (BP) in later life are commonly statistically significant only after adjustment for current size, consistent with change in size as the determinant. Few studies have been prospective or have included a range of potential confounders. Using regression models, including maternal and demographic variables, we examined associations between size at birth and BP in Australian children followed from week 16 of gestation to the age of 8 years. BP measurements were available from 1417 children born after 37 weeks gestation without congenital abnormalities. In models adjusted only for sex, the birthweight (BW), birth length, ponderal index, head circumference, chest circumference, abdominal girth, mid-arm circumference, triceps skinfold, placental weight, or BW/placental weight ratio did not significantly predict SBP in 8-year-olds. With adjustment for current size, associations were inverse but not statistically significant (regression coefficients: BW, -1.11; 95% confidence limits [CL], -2.22, 0.01; birth length, -0.25; 95% CL, -0.52, 0.24) and remained nonsignificant after adjustment for confounders. Current weight, height, or body mass index significantly predicted SBP and DBP (P<0.001) with differences of 8/4 mm Hg between upper and lower quartiles; effects were similar in infants with lower and higher BW. These findings are consistent with postnatal change in size as the major determinant of BP in 8-year-olds and are important in the context of the worldwide "epidemic" of obesity in childhood as a likely precursor of increasing rates of hypertension in adults.

Lifestyle programmes delivered by academic nurse-counsellors in a primary care setting lowered blood pressure (BP) among at-risk patients. We examined whether the programmes could be successfully implemented by nurses employed in Australian general practices. In a randomised controlled trial, 212 of 591 eligible 20-75-year olds with hypertension, Type II diabetes or coronary disease from seven practices volunteered. Patients were randomised to: a 'Low' group with one face-to-face individual counselling session, then monthly telephone contacts for 1 year (n=69); a 'High' group with individual face-to-face counselling up to 1 h monthly for 1 year (n=74) or a control group receiving usual care only (n=69), and were evaluated at baseline and 12 and 18 months later; 164 individuals completed the study. Patients' usual doctors continued to prescribe in all groups. Changes in 24 h ambulatory BP did not differ significantly between groups at 12 months (Low, -2+/-2/1+/-1 mmHg; High, +4+/-2/1+/- 1 mmHg; usual care, +1+/-2/1+/-1 mmHg) or 18 months (-2+/-2/2+/-1 mmHg; -4+/-2/3+/-2 mmHg; -1+/-2/2+/- 1 mmHg, respectively). Antihypertensive drugs prescribed decreased by 12 months in 33% of the High, 5% of the Low and 13% of the control groups (P=0.008) and by 36, 7 and 16% at 18 months (P=0.018). After 18 months, targets for BP control were not met in about 60% of patients and almost 50% had clinic BP above 140/90 mmHg. Year-long interaction with nurse-counsellors may influence longer-term antihypertensive drug prescription, possibly by improving compliance. Suboptimal BP control suggests that continuing physician education on BP targets is needed.

Background: n-3 Fatty acids lower blood pressure, improve lipids, and benefit other cardiovascular disease risk factors. Effects on glycemia in patients with type 2 diabetes are uncertain., Objective: We determined whether purified eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have differential effects on glycemic control, including insulin sensitivity and stimulated insulin secretion; 24-h ambulatory blood pressure; and serum lipids in type 2 diabetic patients with treated hypertension., Design: In a double-blind, placebo-controlled trial of parallel design, 59 subjects were randomly assigned to consume 4 g EPA, DHA, or olive oil/d for 6 wk while continuing to consume their usual diet., Results: Thirty-nine men and 12 postmenopausal women with a mean (+/- SE) age of 61.2 +/- 1.2 y completed the study. In comparison with the change from baseline in fasting glucose in the olive oil group, fasting glucose in the EPA and DHA groups increased 1.40 +/- 0.29 mmol/L (P = 0.002) and 0.98 +/- 0.29 mmol/L (P = 0.002), respectively. Neither EPA nor DHA had significant effects on glycated hemoglobin, fasting insulin or C-peptide, insulin sensitivity or secretion, or blood pressure. Serum triacylglycerols in the EPA and DHA groups decreased 19% (P = 0.022) and 15% (P = 0.022), respectively. There were no significant changes in serum total, LDL, or HDL cholesterol, although HDL(2) cholesterol in the EPA and DHA groups increased 16% (P = 0.026) and 12% (P = 0.05), respectively. HDL(3) cholesterol decreased 11% (P = 0.026) with EPA supplementation., Conclusions: EPA and DHA had similar benefits on lipids but adverse effects on short-term glycemic control in hypertensive diabetic patients. The overall implications for cardiovascular disease require long-term evaluation.

Objective: Our objective was to assess effects of dietary supplementation with coenzyme Q10 (CoQ) on blood pressure and glycaemic control in subjects with type 2 diabetes, and to consider oxidative stress as a potential mechanism for any effects., Subjects and Design: Seventy-four subjects with uncomplicated type 2 diabetes and dyslipidaemia were involved in a randomised double blind placebo-controlled 2x2 factorial intervention., Setting: The study was performed at the University of Western Australia, Department of Medicine at Royal Perth Hospital, Australia., Interventions: Subjects were randomly assigned to receive an oral dose of 100 mg CoQ twice daily (200 mg/day), 200 mg fenofibrate each morning, both or neither for 12 weeks., Main Outcome Measures: We report an analysis and discussion of the effects of CoQ on blood pressure, on long-term glycaemic control measured by glycated haemoglobin (HbA(1c)), and on oxidative stress assessed by measurement of plasma F2-isoprostanes., Results: Fenofibrate did not alter blood pressure, HbA(1c), or plasma F2-isoprostanes. There was a 3-fold increase in plasma CoQ concentration (3.4+/-0.3 micro mol/l, P<0.001) as a result of CoQ supplementation. The main effect of CoQ was to significantly decrease systolic (-6.1+/-2.6 mmHg, P=0.021) and diastolic (-2.9+/-1.4 mmHg, P=0.048) blood pressure and HbA(1c) (-0.37+/-0.17%, P=0.032). Plasma F2-isoprostane concentrations were not altered by CoQ (0.14+/-0.15 nmol/l, P=0.345)., Conclusions: These results show that CoQ supplementation may improve blood pressure and long-term glycaemic control in subjects with type 2 diabetes, but these improvements were not associated with reduced oxidative stress, as assessed by F2-isoprostanes., Sponsorship: This study was supported by a grant from the NH&MRC, Australia.

Objectives: To evaluate the long-term effects of regular moderate or vigorous intensity exercise on blood pressure and blood lipids in previously sedentary older women., Design: Subjects were randomly assigned to either a supervised centre-based (CB) or a minimally supervised home-based (HB) exercise program, initially for 6 months. Within each program, subjects were further randomized to exercise either at moderate (40-55% heart rate reserve, HRres) or vigorous intensity (65-80% HRres). After 6 months, all groups continued a HB moderate or vigorous exercise program for another 12 months., Methods: Healthy, sedentary women (aged 40-65 years) (n = 126) were recruited from the community. Subjects exercised three times per week for 30 min. They were evaluated at baseline, 6, 12 and 18 months., Results: There was a significant fall of 2.81 mmHg in systolic blood pressure (P = 0.049) and 2.70 mmHg in diastolic blood pressure (P = 0.004) after correction for age and baseline values with moderate exercise, but not with vigorous-intensity exercise. When this analysis was repeated with the change in body mass included, the results were unchanged. After correction for potential confounding factors, there was a significant fall in total cholesterol and low density lipoprotein cholesterol with vigorous but not moderate exercise at 6 months (P < 0.05) but not at 18 months., Conclusions: In this largely normotensive population of older women, a moderate, but not vigorous exercise program, achieved sustained falls in resting systolic and diastolic blood pressure over 18 months. The study demonstrates that, in older women, moderate intensity exercise is well accepted, sustainable long-term and has the health benefit of reduced blood pressure.

In population studies, higher blood pressure has been associated with lower intake of protein and, possibly, lower fiber consumption. In the present randomized controlled trial, we sought to determine whether dietary protein and fiber had additive effects on blood pressure reduction in hypertensives. Treated hypertensive patients changed for 4 weeks (familiarization) to a diet low in protein (12.5% energy) and fiber (15 g/d). Patients (n=41) were then randomized to 1 of 4 groups in an 8-week factorial study of parallel design in which they continued the low-protein, low-fiber diet alone or had supplements of soy protein to increase protein intake to 25% energy, of psyllium to provide an additional 12 g soluble fiber/d, or of both protein and fiber. The 24-hour ambulatory blood pressure was compared from the end of familiarization to the end of intervention. In the 36 subjects who provided complete data, protein and fiber had significant additive effects to lower 24-hour and awake systolic blood pressure. Relative to control subjects, the net reduction in 24-hour systolic blood pressure was 5.9 mm Hg with fiber and with protein. Findings were independent of age, gender, and change in weight, alcohol intake, or urinary sodium and potassium. Relative to reduced fiber and protein intake, dietary protein and soluble fiber supplements lower blood pressure additively in hypertensives. These findings have important implications for the prevention and management of hypertension, particularly in populations in which high blood pressure is prevalent in association with diets low in protein, fiber, or both.

Objective: Tracking of blood pressure (BP) from childhood occurs in populations but, for individuals, prediction of adult BP from childhood levels is poor. We examined factors that may influence tracking of BP to identify better predictors of higher BP in early adult life., Design: A prospective study of children recruited at the age of 9 years by random sampling of Perth metropolitan schools stratified by socio-economic status., Setting: Community based with re-surveys 3-yearly for 9 years., Participants: A total of 516 boys and 520 girls at 9 years; 680 boys and 630 girls at 12 years; 318 boys and 300 girls at 15 years; 330 men and 326 women at 18 years., Main Outcome Measures: Systolic (SBP) and diastolic (DBP) BP., Results: Persistence in the highest quartile for SBP between surveys was seen in 34-48% of subjects and in 37% between the ages of 9 and 18 years. The proportion increased to around 60% in those in the highest quartile for body mass index (BMI), to 70% in those in the highest quartile for change in BMI and to 60% if there was a family history of hypertension. In log-linear models, persistence in a quartile for SBP was significantly related to a family history of hypertension, previous SBP, BMI and change in BMI. Relationships were similar for DBP., Conclusions: Excessive weight gain in adolescence and a family history of hypertension substantially increase the risk of higher BP persisting into early adult life. Recognition of children at risk would allow early intervention emphasizing weight control with potential long-term benefits.

Objectives: The aim of this study was to determine whether pulse pressure is a risk factor for coronary artery disease using data from the MRC trial of treatment of mild hypertension, and whether the effect of anti-hypertensive drug therapy on pulse pressure may be a determinant of outcome in treated patients., Methods: Logistic regression and Cox regression analyses were used to compare systolic and diastolic blood pressure, pulse pressure and mean blood pressure as predictors of coronary events and stroke in the MRC Mild Hypertension Trial. The effects of anti-hypertensive drug treatment with bendrofluazide and propranolol on pulse pressure were assessed using 1-year follow-up data. Event rates in the placebo-treated group and responses to anti-hypertensive treatment were measured in quartiles of age-adjusted entry pulse pressure. A 'four-corners' analysis was performed, with subjects divided into the upper and lower halves of the distributions of systolic and diastolic blood pressure at entry., Results: Pulse pressure was a stronger predictor of coronary events than systolic, diastolic or mean blood pressure in males by logistic regression. Pulse pressure was similar to systolic pressure as a coronary event predictor on Cox regression. Stroke was predicted most strongly by mean blood pressure. Fatal and non-fatal coronary event rates increased progressively in ascending quartiles of age-adjusted pulse pressure, but there was also a strong correlation with systolic blood pressure. The values of partial logistic regression coefficients in models containing both systolic and diastolic blood pressure also supported a role for pulse pressure in predicting coronary events and for mean blood pressure in predicting stroke. Coronary risk, but not stroke, was inversely related to diastolic blood pressure in the four-corners analysis. In a Cox model, regressions of coronary event probability on systolic blood pressure at entry were significantly and inversely related to diastolic blood pressure categorized in quartiles. Bendrofluazide but not propranolol decreased pulse pressure significantly and was associated with a reduction in cardiovascular events overall, but no definite relationship between the effect of drugs on pulse pressure and specific responses to treatment was seen., Conclusion: Pulse pressure is a strong risk factor for coronary events in untreated hypertensive male subjects in the MRC Mild Hypertension Trial, whereas stroke is best predicted by mean blood pressure. Bendrofluazide and propranolol have different effects on pulse pressure which may be related to their relative efficacy in the treatment of hypertension, but this possibility requires further study in more suitable populations.

Animal studies suggest that the 2 major omega3 fatty acids found in fish, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), may have differential effects on blood pressure (BP) and heart rate (HR). The aim of this study was to determine whether there were significant differences in the effects of purified EPA or DHA on ambulatory BP and HR in humans. In a double-blind, placebo-controlled trial of parallel design, 59 overweight, mildly hyperlipidemic men were randomized to 4 g/d of purified EPA, DHA, or olive oil (placebo) capsules and continued their usual diets for 6 weeks. Fifty-six subjects completed the study. Only DHA reduced 24-hour and daytime (awake) ambulatory BP (P<0.05). Relative to the placebo group, 24-hour BP fell 5.8/3.3 (systolic/diastolic) mm Hg and daytime BP fell 3.5/2.0 mm Hg with DHA. DHA also significantly reduced 24-hour, daytime, and nighttime (asleep) ambulatory HRs (P=0. 001). Relative to the placebo group, DHA reduced 24-hour HR by 3. 5+/-0.8 bpm, daytime HR by 3.7+/-1.2 bpm, and nighttime HR by 2. 8+/-1.2. EPA had no significant effect on ambulatory BP or HR. Supplementation with EPA increased plasma phospholipid EPA from 1. 66+/-0.07% to 9.83+/-0.06% (P<0.0001) but did not change DHA levels. Purified DHA capsules increased plasma phospholipid DHA levels from 4.00+/-0.27% to 10.93+/-0.62% (P<0.0001) and led to a small, nonsignificant increase in EPA (1.52+/-0.12% to 2.26+/-0.16%). Purified DHA but not EPA reduced ambulatory BP and HR in mildly hyperlipidemic men. The results of this study suggest that DHA is the principal omega3 fatty acid in fish and fish oils that is responsible for their BP- and HR-lowering effects in humans. These results have important implications for human nutrition and the food industry.

1. Oscillometric devices for blood pressure (BP) measurement at the wrist are becoming more widely used in clinical practice. However, systematic comparisons with standard auscultatory BP measurement at the brachial artery are scarce. Therefore, we compared two such devices, the Boso-Mediwatch (Bosch & Sohn GmbH U. Co., Jungingen, Germany) and the Omron R3 (Omron Corp., Tokyo, Japan), with upper-arm auscultatory mercury sphygmomanometry. 2. In 20 normotensive subjects and 20 treated hypertensive subjects, the Boso-Mediwatch was applied to the left wrist by observer 1 and was compared with mercury sphygmomanometry of the right upper arm by observer 2. Each observer swapped sides and the procedure was repeated. The Boso-Mediwatch was then applied to the right wrist by observer 1 and was compared with mercury sphygmomanometry of the left upper arm by observer 2. Each observer once again swapped sides and the procedure was repeated. An identical protocol was followed for the Omron R3 in a further 20 treated hypertensive subjects and 20 normotensive subjects. 3. There were no significant differences between observers or left versus right arm for either oscillometric device or when measurements were performed by mercury sphygmomanometry. In normotensive subjects, the Boso-Mediwatch readings were higher than mercury sphygmomanometer readings, with mean differences (95% confidence intervals) of 3.9 (0.1, 7.6; P = 0.045) and 7.0 mmHg (4.7, 9.2; P < 0.001) for systolic and diastolic BP, respectively. In hypertensive subjects, the Boso-Mediwatch readings were lower for systolic BP (mean difference -6.0 mmHg (-11.6, -0.3; P = 0.04) but were higher for diastolic BP (mean difference 3.8 mmHg (1.4, 6.3; P < 0.01). 4. In normotensive subjects, the Omron R3 readings were higher, with mean differences of 3.2 (0.6, 5.8; P = 0.018) and 4.2 mmHg (1.6, 6.7; P = 0.003) for systolic and diastolic BP, respectively. In hypertensive subjects, the Omron R3 readings were lower for both systolic and diastolic BP (mean differences: -5.8 (-8.8, -2.8; P = 0.001) and -5.5 (-9.3, -1.6; P = 0.008), respectively). 5. For the Boso-Mediwatch, weighted least products analysis confirmed the presence of both fixed and proportional error for systolic BP but not for diastolic BP. For the Omron R3, fixed or proportional error was not detected for either systolic or diastolic BP. 6. These wrist oscillometric devices, although offering portability and convenience, give BP measurements that frequently differ substantially (by at least 5 mmHg) from readings simultaneously measured at the upper arm by a mercury sphygmomanometer. The magnitude and direction of differences detected are dependent on both the device used and the underlying level of BP.

Background: The flavonoid components of tea have been associated in epidemiological studies with a decreased risk of cardiovascular disease. Flavonoids have been shown to have antioxidant and vasodilator effects in vitro; we therefore postulated that drinking green or black tea attenuates the well-characterized acute pressor response to caffeine and lowers blood pressure during regular consumption., Objective: To determine whether green and black tea can attenuate the transient pressor effect of caffeine, or lower blood pressure during regular consumption., Methods: In the first study, the acute effects of four hot drinks - green tea and black tea (at a dose equivalent to four standard cups), water matched to the teas for caffeine content ('caffeine') and water - were assessed in 20 normotensive men using a Latin-Square designed study. Clinic blood pressure was measured before and 30 and 60 min after each drink had been ingested. In the second study, the effects on blood pressure of regular green and black tea ingestion were examined in 13 subjects with high-normal systolic blood pressure and mild systolic hypertension (systolic blood pressure in the range 130-150 mmHg) using a three-period crossover study. Five cups per day of green tea, black tea and caffeine (in hot water and matched to the teas) were consumed for 7 days each, in random order. Twenty-four hour ambulatory blood pressure was measured at the end of each seven-day intervention. Results are presented as means and 95% confidence intervals (CI)., Results: An acute pressor response to caffeine was observed. Relative to caffeine, there were further acute increases in systolic and diastolic blood pressure at 30 min among those drinking green tea [5.5 mmHg (95%CI -1.4 to 12.4) and 3.1 mmHg (95%CI -0.1 to 6.3), respectively] and black tea [10.7 mmHg (95%CI 4.0 to 17.4) and 5.1 mmHg (95%CI 1.8 to 8.4), respectively]. The changes in blood pressure at 60 min were not significant The effect on 24-h ambulatory systolic and diastolic blood pressure of regular drinking of green tea [increases of 1.7 mmHg (95%CI -1.6 to 5.0) and 0.9 mmHg (95%CI -1.3 to 3.1), respectively] or black tea [increase of 0.7 mmHg (95%CI -2.6 to 4.0) and decrease of 0.7 mmHg (95%CI -2.9 to 1.5), respectively] was not significant relative to caffeine., Conclusions: Contrary to our initial hypothesis, tea ingestion caused larger acute increases in blood pressure than caffeine alone. However, any acute effects of tea on blood pressure did not translate into significant alterations in ambulatory blood pressure during regular tea consumption.

This study assessed the effects of regular coffee drinking on 24-hour ambulatory blood pressure (ABP) in normotensive and hypertensive older men and women. Twenty-two normotensive and 26 hypertensive, nonsmoking men and women, with a mean age of 72.1 years (range, 54 to 89 years), took part in the study. After 2 weeks of a caffeine-free diet, subjects were randomized to continue with the caffeine-free diet and abstain from caffeine-containing drinks or drink instant coffee (5 cups per day, equivalent to 300 mg caffeine per day) in addition to the caffeine-free diet for a further 2 weeks. Change in systolic and diastolic blood pressures (SBP, DBP) determined by 24-hour ambulatory BP monitoring showed significant interactions between coffee drinking and hypertension status. In the hypertensive group, rise in mean 24-hour SBP was greater by 4.8 (SEM, 1.3) mm Hg (P=0.031) and increase in mean 24-hour DBP was higher by 3.0 (1.0) mm Hg (P=0.010) in coffee drinkers than in abstainers. There were no significant differences between abstainers and coffee drinkers in the normotensive group for 24-hour, daytime, or nighttime SBP or DBP. In older men and women with treated or untreated hypertension, ABP increased in coffee drinkers and decreased in abstainers. Restriction of coffee intake may be beneficial in older hypertensive individuals.

Vegetarian diets lower blood pressure (BP), but attempts to identify dietary components responsible have been unsuccessful. Isoflavonoids are commonly consumed as part of vegetarian diets. The objective of this study was to assess the effect of isoflavonoid supplementation on BP. Fifty-nine subjects with high-normal range systolic BP completed a randomized, double blind, placebo-controlled trial of two-way parallel design and 8 weeks duration. One tablet containing 55 mg of isoflavonoids, including 30 mg of genistein, 16 mg of biochanin A (a genistein precursor), 1 mg of daidzein, and 8 mg of formononetin (a daidzein precursor), or one placebo tablet, was taken daily with the evening meal. Significant increases in urinary excretion of genistein (5.22 mg/day, 95% CI: 3.72, 6.72) and daidzein (2.53 mg/day, 95% CI: 1.66, 3.40) were observed in the group taking the isoflavonoid supplement. There were no significant changes in isoflavonoid excretion in the placebo group. Clinic BP was measured at two visits, and ambulatory BP monitoring was performed over one 24-h period, at baseline and postintervention. There was no significant difference between groups, after adjustment for baseline values, in postintervention clinic supine BP (systolic 1.2 mm Hg, 95% CI: -2.3, 4.7; diastolic 0.6 mm Hg, 95% CI: -1.9, 2.5), clinic erect BP (systolic 1.7 mm Hg, 95% CI: -4.0, 8.4; diastolic 0.4 mm Hg, 95% CI: -2.4, 3.2), or 24-h ambulatory BP (systolic -1.4 mm Hg, 95% CI: -4.4, 1.6; diastolic -0.8 mm Hg, 95% CI: -2.3, 0.7). Adjustment for age, gender, and weight change did not alter the result. Therefore, these results do not support the hypothesis that isoflavonoids, and genistein in particular, are major contributors to the BP lowering effect of vegetarian diets.

Background: Sex both of parent and of child might influence associations between parental hypertension and blood pressure in offspring., Objective: To examine these associations., Design: A cohort of Australians was surveyed 3-yearly from age 9 to 18 years., Setting: A community-based sample., Participants: When they were aged 18 years, 630 of 1565 participants who had been selected randomly at the age of 9 years were re-surveyed., Main Outcome Measures: Systolic and diastolic blood pressures., Results: Paternal hypertension was reported by 18% of men and 15% of women and maternal hypertension by 15% of men and 14% of women. By the time they were aged 9 years, systolic blood pressure was significantly higher in sons [117.8 mmHg, 95% confidence interval (CI) 116A-119.2 versus 114.7 mmHg, CI 113.4-116.0] and daughters (118.2 mmHg, CI 116.9-119.5 versus 114.9 mmHg, CI 112.8-117.0) of hypertensive fathers than it was in sons and daughters of normotensive fathers. When they were aged 18 years, paternal hypertension predicted blood pressures in men and women independently of their weight at birth, fitness, alcohol consumption and weight for height for age. Systolic blood pressures increased more rapidly (by 0.6 mmHg/year) in men with hypertensive fathers., Conclusions: Systolic blood pressure in young adults differs in relation to parental hypertension according to the sex of the affected parent and the sex of the offspring. This could reflect unmeasured environmental variables or the action of sex-related genetic or intrauterine factors.

Objective: To evaluate the effects of patterns of drinking (weekend versus daily drinking) on the pressor responses to alcohol in 55 male drinkers using clinic and 24 h ambulatory blood pressure monitoring., Design: A randomized, controlled cross-over trial., Methods: Recruitment required a regular alcohol intake of 210-500 ml absolute alcohol/week, with > 60% consumed as beer. Fourteen subjects were categorized as predominantly weekend drinkers, whereas the remaining 41 subjects regularly drank on a daily basis. After 4 weeks of familiarization, all subjects were randomly allocated to drinking low-alcohol beer (0.9% vol:vol) only or to maintain their usual drinking habits with provision of full-strength beer (5% vol:vol) for 4 weeks. They then switched back to their usual drinking habits or low-alcohol beer, respectively, for a further 4 weeks while maintaining their usual drinking pattern., Results: Baseline ambulatory systolic blood pressure in weekend but not in daily drinkers was 2.4 mmHg higher on Monday than it was on Thursday (P = 0.02). This Monday-Thursday difference was lost during intervention. When subjects switched from the high-alcohol to the low-alcohol period the falls in ambulatory systolic blood pressure in weekend (3.1 mmHg, P < 0.001) and daily drinkers (2.2 mmHg, P < 0.001) were similar. Most of the fall was evident during week 1 of the low-alcohol period for weekend drinkers but not until week 4 for daily drinkers., Conclusion: The pressor response to alcohol consumption is similar in magnitude in weekend and daily drinkers, present throughout a 24 h period and has a rapid onset/offset in weekend drinkers but is more sustained in daily drinkers.

Objective: To examine whether restriction of caloric intake and exercise of vigorous intensity can independently and additively influence clinic and ambulatory blood pressures in sedentary overweight men., Design: Sixty subjects aged 20-50 years were randomly allocated either to continue their normal caloric intake or to restrict it by 4186-6279 kl/day, with 15% provided by protein, 30% by fat and 55% by carbohydrate, for 16 weeks. Within each of these groups subjects were further randomly allocated either to a control light intensity programme of exercise or to a vigorous intensity programme of exercise for 30 min three times a week. The light exercise group performed stationary cycling against no resistance, flexibility exercises and slow walking. The vigorous intensity group cycled on an ergometer at 60-70% of maximum their workload., Results: Fifty-one subjects completed the study. Their maximal oxygen uptake was increased by approximately 24% with vigorous exercise but did not change with light exercise. Caloric intake restriction led to a significant loss of body mass of 9.5 kg (95% confidence interval 7.6-11.3), whereas vigorous exercise had no effect. Restriction of caloric intake reduced supine clinic systolic and diastolic blood pressures significantly by 5.6 (2.3-8.9) and 2.4 mmHg (0.4-4.2), respectively. Relative to the control light exercise group, exercise of vigorous intensity exercise had no significant effect on clinic blood pressure. In contrast, time series analysis revealed that both caloric intake restriction and vigorous exercise were associated with lower daytime ambulatory systolic blood pressure, the reduction in systolic blood pressure being sustained throughout the 24 h period when vigorous exercise and caloric intake restriction were combined., Conclusion: Compared with the effects of caloric intake restriction, the effects of a vigorous exercise programme on blood pressure are inconsistent, there being no influence on clinic blood pressure but a reduction in daytime ambulatory blood pressure. However, when combined with caloric intake restriction, regular vigorous exercise exhibits a synergistic effect in reducing ambulatory blood pressure throughout a 24 h period.

1. In a long-term study of the optimal approach to initiating and maintaining a regular exercise programme in previously sedentary older women (40-65 years), we have assessed determinants of change in resting blood pressure (BP) after 6 and 12 months. 2. Women (n = 126) were randomly assigned to either a centre-based or home-based exercise programme for an initial 6 months. The centre-based group attended supervised sessions three times per week, while the home-based group exercised unsupervised at home three times per week. Both groups were home-based during a second 6 months. Within each arm, subjects were further randomized to either exercise at moderate intensity (40-55% heart rate reserve; HRres) or at vigorous intensity (65-80% HRres). A nonintervention comparison group of 30 women was followed throughout. 3. At 6 months there was a fall in BP with moderate, but not vigorous intensity exercise (-2.7 mmHg; P = 0.025), an effect no longer significant at 12 months. 4. Change in BP was unrelated to improvements in fitness (VO2max), increases in lean tissue mass, number of exercise sessions completed or a composite measure of the total number of exercise sessions completed multiplied by the mean exercise intensity expressed as a percentage of heart rate reserve (%HRres). 5. Continuing participation in any regular exercise was a consistent predictor of change in BP, with those subjects still exercising in the 2 weeks before BP measurement having 1.9 mmHg lower BP at 6 months (P = 0.038) and 3.8 mmHg lower BP at 12 months (P = 0.016). 6. We conclude that the small effects of exercise on resting BP in these older women are predominantly related to continuing participation in lower intensity exercise, rather than to improvements in fitness or body composition.

1. A postprandial fall in blood pressure (BP) in older men and women increases the risks of falls and impaired cerebral perfusion. Postprandial hypotension has been suggested to be greater in hypertensive subjects, particularly in those on antihypertensive medication. 2. Caffeine, given as tablets or as strong coffee, may attenuate postprandial falls in BP in older subjects, but findings are not consistent. 3. In a randomized controlled intervention in 171 healthy non-smokers over the age of 50 years, we compared the effects of coffee-drinking with abstaining from caffeine in normotensives (NT), untreated hypertensives (UNHT) and subjects on drug treatment for hypertension (TRHT). Tea drinking was a third intervention used only in TRHT. 4. After adjustment for the effects of the initial value on changes in BP, there were no significant differences related to hypertension or to hypertensive agents in the magnitude of postprandial falls in BP. 5. After the intervention, changes in fasting supine and standing systolic BP and heart rate (HR) were not significantly different from controls in NT, UNHT and TRHT, but fasting supine and standing diastolic BP were significantly higher in coffee drinkers in the UNHT group. 6. In normotensive coffee drinkers there was a significant reduction in the postprandial fall in supine systolic BP of 4.1 mmHg (+/- s.e.m. 1.1) and in standing systolic BP of 5.2 +/- 1.6 mmHg. Among untreated hypertensives, abstainers showed a significant attenuation of the postprandial fall in supine, but not standing, systolic BP. Among treated hypertensives who were tea drinkers the postprandial fall decreased for supine systolic BP by 3.8 +/- 1.2 mmHg (P = 0.029) and for standing systolic BP by 5.2 +/- 2.1 mmHg. 7. Both tea and coffee were potentially beneficial in decreasing postprandial falls in systolic BP, but coffee drinking may increase fasting diastolic pressures in untreated hypertensives.

1. Changes in membrane fluidity have been proposed to contribute to the pathogenesis of ethanol-induced hypertension possibly through changes in membrane lipid patterns, but reports are inconsistent. 2. In a controlled trial we documented ethanol-induced changes in blood pressure and composition of membrane lipids in ethanol-fed rats. 3. Systolic blood pressure increased significantly in the ethanol-treated rats (9.3 mmHg, s.e.m. 2.9) compared with the control group (-1.3 mmHg, s.e.m. 2.6). Mean cholesterol content in red cell membranes did not differ significantly between ethanol-fed and control rats. Phospholipids of aorta, red cells and kidney showed a significant decrease in the polyunsaturated to saturated fatty acid ratio, while membrane phospholipids from the heart showed a significant increase in the polyunsaturated to saturated fatty acid ratio with ethanol treatment. 4. In univariate regression blood pressure was significantly negatively related to levels of arachidonic acid in the kidney (P = 0.0013) and to linoleic acid in the aorta (P = 0.0341) and red cells (P = 0.0289). Blood pressure was not significantly related to fatty acids in the heart nor to membrane cholesterol or phospholipids. 5. Differences in fatty acid composition of phospholipids between controls and ethanol-fed rats are consistent with altered membrane fluidity. Altered membrane function is a potential mechanism involved in ethanol-induced hypertension.

1. Evidence that vegetarian dietary patterns lower blood pressure (BP) comes from both population studies and randomized controlled trials in normotensive and hypertensive subjects. 2. The effect has been shown most clearly in those who keep to a strict lacto-ovo vegetarian diet characterized by a relatively low intake of saturated fat, a high polyunsaturated/saturated fat ratio, and a high intake of fruit, vegetables and other fibre containing products. Randomized controlled dietary trials suggest the effects are independent of dietary sodium, additive to that of calorie restriction, and not due to the absence of meat protein per se. Indeed, recent population studies suggest an inverse relationship between dietary protein and BP. 4. Dietary fats, fibre, potassium, magnesium and calcium do not independently seem to account for the effects. A possible role for complex carbohydrate in conjunction with the other dietary factors has yet to be fully explored.

Background: Programs to improve cardiovascular health in schoolchildren need careful scientific evaluation., Method: In a randomized controlled trial of nutrition and fitness programs over a period of about 9 months, 1,147 10- to 12-year-olds from 30 schools were allocated to one of five health programs: fitness, fitness + school nutrition, school-based nutrition, school + home nutrition, home-based nutrition, or a control group. Nutrient intake, fitness, anthropometry, blood pressure, and blood cholesterol were measured before and after intervention., Results: Fitness increased and diastolic blood pressure and triceps skinfolds decreased significantly for girls in the fitness groups. Baseline consumption of sugar, fat, and fiber was outside national guidelines; blood cholesterol exceeded recommendations in one-third of children. In girls, fat intake decreased significantly in the two home nutrition groups and fiber intake increased in the school + home nutrition and fitness groups. Boys in the fitness, fitness + school nutrition, and school + home nutrition group reduced sugar intake. Change in sugar intake correlated negatively with change in fat intake in both boys and girls., Conclusions: Teacher-implemented health packages are feasible with minimal training but programs should differ between boys and girls. Fitness programs were more successful than nutrition education particularly in girls. Clearer nutrition messages should prevent reciprocal changes in sugar and fat. For girls, the 3 mm Hg reduction of diastolic blood pressure, less obesity, and increased fitness could translate into a substantial reduction in cardiovascular risk in adult life.

This study was conducted to compare the effects of omega 3 fatty acids, taken as fish or fish-oil supplements in the setting of a high- or low-fat dietary background, on blood pressure and heart rate in men with moderate cardiovascular risks. One hundred twenty men were randomly allocated to five high-fat (40% of daily energy) and two low-fat (30% of energy) groups to undertaken a 12-week dietary intervention period involving fish, fish oil, or a combination of these. Sodium intake was restricted to less than 90 mmol/d. The five high-fat groups were assigned to take either 6 or 12 fish-oil capsules daily, fish or a combination of fish oil and fish, or placebo capsules. The two low-fat groups took either fish or placebo capsules. Fish meals were devised to provide 1.3 g of eicosapentaenoic acid daily, equivalent to that contained in 6 fish-oil capsules. Subjects were instructed to eat a selection of fish that provided an average of 3.65 g/d (range, 3.2 to 4.1 g/d) of total omega 3 fatty acids. Subjects were seen at regular intervals during the baseline and dietary intervention periods for measurement of weight, blood pressure, heart rate, dietary compliance, urinary electrolyte excretion, platelet phospholipid fatty acids, blood glucose, and insulin concentration. There was a greater fall in both systolic and diastolic blood pressures in subjects allocated fish or fish oil, particularly in the low-fat groups, compared with control subjects. However, there was no significant group effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Objective: To assess the mechanisms of the blood pressure-lowering effect of a vegetarian diet in the early and later stages of dietary intervention., Design: After 2 weeks without intervention (baseline), 20 normotensive men were matched for age and body mass index and randomly allocated to an omnivorous (control) or a lacto-ovovegetarian diet for 6 weeks in a parallel trial., Methods: Ambulatory blood pressures were recorded between 0800 and 1700 h on alternate days during the first week of intervention, twice in the second week and weekly thereafter. Blood samples collected after a standard breakfast were analysed for plasma noradrenaline, adrenaline, atrial natriuretic peptide (ANP), renin, aldosterone, glucose and insulin. Factor and multiple regression analyses were used to assess the association among neurohormonal factors, blood pressures and diet. Results were analysed for the first week of the diet and for the entire 6 weeks., Results: Ambulatory blood pressures at work were lower on the vegetarian diet than in the controls. This blood pressure decrease was associated with a factor representing lower plasma catecholamine and renin activity levels throughout the study, and a factor representing reduced plasma glucose and insulin levels in week 1 of intervention only. Plasma ANP levels were significantly higher during week 1 of the vegetarian diet., Conclusions: A blood pressure lowering effect of a vegetarian diet during normal working activity was shown. Using factors derived from the biochemical variables, results were in keeping with the hypothesis that these effects may be mediated by reduced sympatho-adrenal activity consequent to altered glucose and insulin handling. An early increase in plasma ANP may contribute to the blood pressure reduction.

Objectives: To determine the effects of a vegetarian diet on daytime ambulatory (Accutracker) blood pressures and heart rates, and to relate these to the estimated peak in plasma glucose to determine whether low-glycaemic-index diets reduce sympathetic activity in response to differences in postprandial glucose and insulin., Design: The subjects were matched for age and body mass index and randomly assigned to one of two parallel diet groups., Setting: Clinical., Participants: Twenty-one normotensive non-vegetarian male hospital workers volunteered for the study and 20 completed it., Intervention: After 2 weeks of baseline measurement the subjects followed an omnivorous or a lacto-ovovegetarian diet for 6 weeks., Main Outcome Measures: Daytime ambulatory blood pressures and heart rate, and postbreakfast catecholamines, insulin and glucose., Results: Ambulatory systolic blood pressure and heart rates were lower in the vegetarian group during the working day. The preprandial rise in diastolic pressure was attenuated on the vegetarian diet. There were no differences in plasma catecholamine, glucose or insulin levels sampled after breakfast on the two dietary regimes., Conclusions: The blood pressure-lowering effect of a lacto-ovovegetarian diet, which occurs throughout the working day, is associated with lower heart rates, suggesting a central nervous or cardiac mechanism. The possibility that the lower glycaemic index of a lacto-ovovegetarian diet has some effect needs to be investigated further in relation to major meal-times and studied in both normotensive and hypertensive subjects.

The association between certain lifestyle and personality characteristics and blood pressure in the elderly was assessed in a cross-sectional study of 843 independent living 60-87 year old volunteers. They comprised 338 women and 505 men of whom 35 and 30% respectively were being treated with antihypertensive drugs. Among untreated volunteers, 28% of women and 28% of men had systolic blood pressure greater than 160 or diastolic blood pressure greater than 95. Isolated systolic hypertension was found in 20% of untreated women and 14% of untreated men. Lifestyle factors and personality characteristics associated with blood pressure were similar to those described in younger adult populations, although there were some differences related to gender and whether subjects were being treated for hypertension. Stepwise multiple regression showed that higher blood pressure was associated with greater body mass index (BMI), alcohol intake and coffee drinking and measures of irritability. Increased physical activity, and high values for measures of suspicion and extraversion were negatively related to blood pressure. Age was positively related to systolic, but not to diastolic blood pressure. The presence of hypertension was significantly associated with self-reports of raised cholesterol, diabetes or angina, as well as past history of heart failure, heart attack or stroke. Thus, in this elderly free-living population blood pressures are still significantly associated with behavioural characteristics which could be further investigated as an alternative or adjunct to antihypertensive therapy.

Background:Features of the metabolic syndrome comprise a major risk for cardiovascular disease and will increase in prevalence with rising childhood obesity. We sought to identify early life influences on development of obesity, hypertension and dyslipidemia in children.Methods and results:Cluster analysis was used on a subset of a longitudinal Australian birth cohort who had blood samples at age 8 (n=406). A quarter of these 8-year-olds fell into a cluster with higher body mass index, blood pressure (BP), more adverse lipid profile and a trend to higher serum glucose resembling adult metabolic syndrome. There was a U-shaped relationship between percentage of expected birth weight (PEBW) and likelihood of being in the high-risk cluster. The high-risk cluster had elevated BP and weight as early as 1 and 3 years old. Increased likelihood of the high-risk cluster group occurred with greatest weight gain from 1 to 8 years old (odds ratio (OR)=1.4, 95% confidence interval (CI)=1.3–1.5/kg) and if mothers smoked during pregnancy (OR=1.82, CI=1.05–3.2). Risk was lower if children were breast fed for 4 months (OR=0.6, 95% CI=0.37–0.97). Newborns in the upper two quintiles for PEBW born to mothers who smoked throughout pregnancy were at greatest risk (OR=14.0, 95% CI=3.8–51.1) compared to the nadir PEBW quintile of non-smokers.Conclusion:A U-shaped relationship between birth weight and several components of the metabolic syndrome was confirmed in a contemporary, well-nourished Western population of full-term newborns, but post-natal weight gain was the dominant factor associated with the high-risk cluster. There was a prominence of higher as well as lowest birth weights in those at risk. Future health programs should focus on both pre- and post-natal factors (reducing excess childhood weight gain and smoking during pregnancy), and possibly the greatest benefits may arise from targeting the heaviest, as well as lightest newborns, especially with a history of maternal smoking during pregnancy.International Journal of Obesity (2007) 31, 236–244. doi:10.1038/sj.ijo.0803394; published online 23 May 2006 [ABSTRACT FROM AUTHOR]

OBJECTIVE:: To examine predictors of body mass index (BMI) at the age of 8?y in a prospective study of Australian children. DESIGN:: Longitudinal survey of a cohort of Australian children followed from the 16th week of gestation to 8?y. SUBJECTS:: In total, 741 boys and 689 girls who attended the survey as 8?y olds. MEASUREMENTS:: Weight and height, blood pressure measured by automated oscillometry, fasting blood lipids and glucose. Questionnaire assessment of activity and diet. RESULTS:: Proportions of overweight including obesity in boys and girls were, respectively, 22 and 25%at 1?y, 14 and 14%at 3?y, 13 and 18%at 5?y and 15 and 20%at 8?y. At the age of 1, 3, 6 and 8?y, children with overweight including obesity showed significantly more adverse cardiovascular risk factors. Blood pressure (BP) was significantly higher by 2/3?mmHg (systolic/diastolic) at 1?y, 3/2?mmHg at 3?y, 4/2?mmHg at 5?y and 6/2?mmHg at 8?y; HDL was significantly lower (P=0.002) by 8%and triglycerides were significantly higher by 27%(P<0.001). In multivariate regression, BMI at the age of 8?y was significantly predicted positively by birth weight, mother's BMI and hours spent in watching television at the time of the survey of 6?y olds. Mothers being ex-smokers or non smokers and children being‘slightly active’and‘active’negatively predicted BMI in 8?y olds. In a subset of 298 children with information about fathers, paternal BMI was an additional independent predictor. Maternal or paternal overweight including obesity each independently increased risk of overweight including obesity at the age of 8?y three-fold. A food factor with consumption of cereals and breads as the major components derived from a Food Frequency Questionnaire in a subset of 340 children was also an independent negative predictor of BMI in multivariate models. CONCLUSION:: The increasing rate of overweight including obesity, particularly in girls, is associated with an increase in cardiovascular risk factors very early in life. Improvement of health-related behaviours within the family and a focus on promotion of activity in children should be priorities in achieving weight control.International Journal of Obesity (2005) 29, 15-23. doi:10.1038/sj.ijo.0802750 Published online 17 August 2004 [ABSTRACT FROM AUTHOR]

Health-related behaviours affecting diet, weight control and physical activity are important for long-term cardiovascular health but behaviour change is difficult to initiate and even more difficult to maintain. We have developed a health promotion program, in which social support has a key role, to encourage a prudent diet, weight control and physical activity. Behaviour change is based on evaluating initial behaviour, weighing up costs and benefits, assessing barriers to change and goal-setting. We first evaluated the program in couples beginning to live together, a group chosen because of the risk of weight gain and decreased physical activity after marriage, readiness to change behaviour at that time in the life course and the opportunity to use partner's support in achieving behaviour change. In an initial short-term study with 39 couples, intake of fat and take-away foods decreased and consumption of fruit, vegetables and reduced fat foods increased. Physical activity increased and there was a 6% fall in blood cholesterol. Further evaluation in 137 couples included assessment after 12 months. A decrease in fat intake and increase in physical activity and fitness seen at the end of the program persisted 1 year later. Lower cholesterol and a trend to lower weight gain and lower blood pressure were also maintained after 12 months. We have modified the program aiming for weight loss, improved dietary habits and increased physical activity in overweight treated hypertensives, supported by their partners. Decreased intake of energy, total and saturated fat, and weight loss seen at the end of the 16 week program was significantly greater in the intervention group than with usual care. Blood pressure fell in the program group at the end of intervention and, in men, withdrawal of antihypertensive drugs was significantly associated with the intervention. Weight loss and a decrease in waist circumference were maintained in the program group up to 16 months after... [ABSTRACT FROM AUTHOR]

Background -- Inverse associations between protein intake and blood pressure are reported in many population studies. In a randomised controlled trial we have previously shown that increased plant protein intake, in comparison to carbohydrate, can lower blood pressure, but effects of animal protein have yet to be investigated. Objective -- To determine if increased animal protein intake in the form of lean red meat, with a concomitant reduction in carbohydrate intake, alters blood pressure in hypertensive individuals. Design -- Hypertensive individuals (n=60) were recruited to a parallel-designed study of 8 weeks duration. Participants were randomized to maintain their usual diet (control) or increase net protein intake from lean red meat, replacing energy from carbohydrate-rich foods. Clinic and 24 hour ambulatory blood pressures were measured at baseline and at the end of intervention. Outcomes -- Relative to control, there was an increase in protein intake (5.3 (95%CI:3.7, 6.9) % of energy, P<0.001) and a corresponding decrease in carbohydrate intake (-5.3 (-7.9, -2.7) % of energy, P <0.001). Intakes of fat, alcohol and fibre were unchanged. There was a net reduction in clinic, 24 hour, awake and asleep systolic blood pressure with protein (-5.2 (-10.3, -0.1) mm Hg, -4.0 (-7.4, -0.6) mm Hg, -4.7 (-8.9, -0.5) mm Hg and -4.7 (-10.3, -0.1), respectively, P < 0.05). These differences were independent of age, gender, weight change, alcohol intake, and urinary sodium and potassium excretion. Diastolic blood pressure was not significantly altered. Conclusion -- The results suggest that modest replacement of carbohydrate-rich foods with protein in the form of lean red meat can lower blood pressure in hypertensive individuals. [ABSTRACT FROM AUTHOR]

Objective: Weight gain may follow altered eating habits and decreased physical activity in couples beginning to live together. Mutual support and willingness to accept changes in lifestyle at this stage may facilitate positive responses to health promotion. We aimed to compare the effects of a diet and physical activity program in couples using a randomized controlled trial.Study design and setting: Couples were randomized to a control group or to one of two intervention groups in whom the program was either delivered mainly by mail or with a combination of mail-outs and interactive group sessions.Results: Diets, physical fitness, and blood cholesterol improved up to 12 months after beginning the 4-month program, mainly in the interactive group. In that group, at the end of the program, the estimated cost was $445.30 ($111.33/month) per participant per unit change in outcome variables, only $0.03 per participant per month more than the group receiving the program mainly by mail. One year after beginning the program, costs per participant per month were $38.37 in the interactive group and $38.22 in the group receiving the program mainly by mail-out.Conclusion: The changes observed in cardiovascular risk factors could translate to a substantial cost-savings relating to health. [Copyright &y& Elsevier]

Background -- Oxidative stress may contribute to the pathogenesis of hypertension and endothelial dysfunction via increased production of free radicals in the arterial wall. Objective -- To investigate the effect of water-soluble antioxidants, vitamin C and polyphenols, on blood pressure (BP), endothelial function and oxidative stress in hypertensive individuals. Methods -- 69 treated hypertensive individuals with a mean 24hr ambulatory systolic BP ≥125 mmHg were involved in a randomised, double blind, placebo-controlled factorial trial. Following a 3-week washout, participants received either 500 mg/d vitamin C, 1000 mg/d grape-seed polyphenols, both vitamin C and polyphenols, or neither, for 6-weeks. At baseline and post-intervention, 24hr ambulatory BP, ultrasound assessed endothelium dependent and independent vasodilation of the brachial artery, and markers of oxidative damage, including plasma and urinary isoprostanes, oxidised low density lipoproteins and plasma tocopherols, were measured. Results -- A significant interaction was observed, therefore results could not be analysed for main effects. In comparison to placebo, vitamin C lowered systolic BP (-1.8±0.8 mmHg, p=0.03), polyphenols did not significantly alter BP, but the combination of vitamin C and polyphenols significantly increased systolic (4.8±0.9 mmHg, p<0.0001), and diastolic (2.7±0.6 mmHg, p<0.0001) BP. Endothelium-dependent and independent vasodilation, and markers of oxidative damage were not significantly altered. Conclusion -- The combination of vitamin C and polyphenols significantly increased BP, but the mechanism remains to be elucidated. [ABSTRACT FROM AUTHOR]