Arline McDonald

Nutritional Therapy for High Blood Pressure: Final Report of a Four-Year Randomized Controlled Trial— The Hypertension Control Program

A four-year trial assessed whether less severe hypertensives could discontinue antihypertensive drug therapy, using nutritional means to control blood pressure. Randomization was to three groups: group 1--discontinue drug therapy and reduce overweight, excess salt, and alcohol; group 2--discontinue drug therapy, with no nutritional program; or group 3--continue drug therapy, with no nutritional program. In groups 1 and 2 patients resumed drug therapy if pressure rose to hypertensive levels. Loss of at least 4.5 kg (10 + lb) was maintained by 30% of group 1, with a group mean loss of 1.8 kg (4 lb); sodium intake fell 36% and modest alcohol intake reduction was reported. At four years, 39% in group 1 remained normotensive without drug therapy, compared with 5% in group 2. Study findings demonstrated that nutritional therapy may substitute for drugs in a sizable proportion of hypertensives or, if drugs are still needed, can lessen some unwanted biochemical effects of drug treatment.

Separate and Joint Effects of Marine Oil and Simvastatin in Patients With Combined Hyperlipidemia

Marine oil plus simvastatin is an effective therapy for improving serum triglycerides, non-high-density lipoprotein cholesterol, and high-density lipoprotein cholesterol in patients with combined hyperlipidemia. Concurrent administration does not attenuate the individual effects of either marine oil or simvastatin on the serum lipid profile.

A comparison of two methods to ascertain dietary intake: The cardia study

Data on dietary intake were collected in the Coronary Artery Risk Development in Young Adults (CARDIA) Study at the baseline examination in 1985-86 and again at the second examination 2 years later. At baseline, a diet history questionnaire developed for the CARDIA study was used; at the second exam the NCI (Block) food frequency questionnaire was used. The purpose of the present report is to compare the estimated nutrient intakes obtained with the two instruments; to compare correlations of nutrient intakes obtained at the two exams with those observed for other lifestyle and physiological variables also measured 2 years apart; and to assess ability to test hypotheses relating 2-year changes in risk factors to between-exam differences in reported nutrient intakes. Mean levels of reported intake were generally greater for both blacks and whites on the CARDIA diet history than on the Block food frequency. Rank order correlations of reported nutrient intakes between the two questionnaires indicated greater consistency between instruments for whites (rs ranging between 0.35 and 0.52) than for blacks (rs ranging between 0.29 and 0.45). Correlations over time for nutrients were smaller than those observed for body size measures and lipid levels but were similar in magnitude to those for blood pressure, physical activity, and life events. At both exams, total caloric intake was positively associated with physical activity (range of rs for CARDIA were 0.07 for white women to 0.23 for black men, the range of rs for Block were 0.06 for women to 0.11 for white men). Using data from the two examinations, 2-year changes in total plasma cholesterol were significantly related to 2 year changes in Keys scores. The results of this comparison are useful in that they show similarities and differences between two instruments developed to gather dietary intake data. The study also illustrates the need to monitor young adults during a time when rapid changes occur in many lifestyle and physiologic factors.

Clinical utility of endurance measures for evaluation of treatment in patients with mucopolysaccharidosis VI (Maroteaux-Lamy syndrome).

Increased functional capacity of major organ systems improves the quality of life and contributes to reductions in the morbidity associated with chronic debilitating diseases. Routine endurance tests can be used to gauge the progression of disease and the impact of therapeutic modalities in disorders with multiple organ system involvement such as with Mucopolysaccharidosis type VI (MPS VI). MPS VI is a progressive disorder affecting multiple organs and tissues due to the deficient activity of N-acetylgalactosamine-4-sulfatase leading to the accumulation of glycosaminoglycan (GAG) dermatan sulfate. Since 2005, enzyme replacement therapy (ERT) with human recombinant N-acetylgalactosamine-4-sulfatase (galsulfase) has been an available treatment option for MPS VI. These patients are routinely evaluated for extent of disability, disease progression and the impact of ERT. Evaluations are made by a combination of urinary GAG measurement and submaximal intensity endurance tests such as the 3-minute stair climb (3-MSC), and the 6- and 12-minute walk tests (6-MWT and 12-MWT). This review highlights the clinical validity of endurance measures as inexpensive diagnostic tools for diseases affecting multiple organ systems and evaluating the impact of therapeutic modalities, such as ERT for MPS VI.

Soluble fiber and hypertension.

Hypertension is the most prevalent cardiovascular disorder in the United States. As many as 50 million people in this country have had elevated blood pressure diagnosed.1–3 Elevated blood pressure has been linked to an increased incidence of stroke and coronary heart disease.4,5 Treatment of elevated blood pressure decreases the associated mortality and morbidity, and control of hypertension has contributed substantially to a 57% decline in mortality from stroke and 50% in that from coronary heart disease from 1972 to 1990.1 A reduction in average population diastolic blood pressure of 5 mmHg would be expected to reduce the incidence of stroke by about one-third, resulting in the prevention of 100,000 strokes in the U.S. each year.6

Sodium-lithium countertransport and systolic blood pressure response to exercise

This study examined the relationship between erythrocyte sodium-stimulated lithium countertransport (Na-Li CT) and systolic blood pressure (SBP) response to exercise in 22 white normotensive men (mean age 40.6 years) completing a submaximal (85% of target heart rate) graded exercise tolerance test. These men were assessed to be at risk of hypertension on the basis of a high normal diastolic blood pressure (DBP; 80-89 mmHg), being overweight and having a rapid resting pulse rate. Na-Li CT was positively and significantly associated with the maximal SBP reached during exercise (P less than 0.01) and the lowest SBP achieved during post-exercise supine rest (P less than 0.01). The relationship with resting blood pressure was not significant. Standing DBP was the only resting blood pressure measurement significantly associated with Na-Li CT (P less than 0.05). We found an association between Na-Li CT, a membrane sodium transport system associated with blood pressure and hypertension, and the maximal SBP reached during exercise, a blood pressure measurement predictive of future hypertension, in people with normotensive resting blood pressure. This suggests that altered membrane sodium transport may occur before the establishment of hypertension, and supports the possibility that Na-Li CT may be a risk factor for this disease.

The effect of dietary sucrose on blood pressure in spontaneously hypertensive rats

Abstract The current study examined the effects of long-term isocaloric substitution of dietary sucrose for cornstarch in semisynthetic diets containing 60% carbohydrate (w/w) on blood pressure in spontaneously hypertensive rats (SHR). Four diets were initiated when the SHR were 8–9 weeks of age. A total of 32 SHR were placed on normal (0.08%) sodium diets (0.2% NaCl), and 32 SHR were placed on high (0.80%) sodium diets (2.0% NaCl). Each sodium group was further subdivided into two groups, one ingesting 60% sucrose (w/w); the other, 0% sucrose (60% cornstarch, w/w). Blood pressure and weight were measured at 1–2 month intervals for 17 weeks. No differences were noted in blood pressure between animals ingesting 0% sucrose and those ingesting 60% sucrose in either sodium group. The results indicate that long-term isocaloric substitution of sucrose for cornstarch beginning at 8–9 weeks of age in SHR does not affect the development of hypertension at either normal or high sodium levels.