To provide updated, evidence-based recommendations for the management of hypertension in adults.
For lifestyle and pharmacological interventions, evidence from randomized, controlled trials and systematic reviews of trials was preferentially reviewed. Changes in cardiovascular morbidity and mortality were the primary outcomes of interest. For lifestyle interventions, blood pressure (BP) lowering was accepted as a primary outcome given the lack of long-term morbidity/mortality data in this field. For treatment of patients with kidney disease, the development of proteinuria or worsening of kidney function was also accepted as a clinically relevant primary outcome.
MEDLINE searches were conducted from November 2004 to October 2005 to update the 2005 recommendations. In addition, reference lists were scanned and experts were contacted to identify additional published studies. All relevant articles were reviewed and appraised independently by content and methodological experts using prespecified levels of evidence.
Lifestyle modifications to prevent and/or treat hypertension include the following: perform 30 min to 60 min of aerobic exercise four to seven days per week; maintain a healthy body weight (body mass index of 18.5 kg/m2 to 24.9 kg/m2) and waist circumference (less than 102 cm for men and less than 88 cm for women); limit alcohol consumption to no more than 14 standard drinks per week in men or nine standard drinks per week in women; follow a diet that is reduced in saturated fat and cholesterol and that emphasizes fruits, vegetables and low-fat dairy products; restrict salt intake; and consider stress management in selected individuals. Treatment thresholds and targets should take into account each individual's global atherosclerotic risk, target organ damage and comorbid conditions. BP should be lowered to less than 140/90 mmHg in all patients, and to less than 130/80 mmHg in those with diabetes mellitus or chronic kidney disease (regardless of the degree of proteinuria). Most adults with hypertension require more than one agent to achieve these target BPs. For adults without compelling indications for other agents, initial therapy should include thiazide diuretics. Other agents appropriate for first-line therapy for diastolic hypertension with or without systolic hypertension include beta-blockers (in those younger than 60 years), angiotensin-converting enzyme (ACE) inhibitors (in nonblack patients), long-acting calcium channel blockers or angiotensin receptor antagonists. Other agents for first-line therapy for isolated systolic hypertension include long-acting dihydropyridine calcium channel blockers or angiotensin receptor antagonists. Certain comorbid conditions provide compelling indications for first-line use of other agents: in patients with angina, recent myocardial infarction or heart failure, beta-blockers and ACE inhibitors are recommended as first-line therapy; in patients with diabetes mellitus, ACE inhibitors or angiotensin receptor antagonists (or in patients without albuminuria, thiazides or dihydropyridine calcium channel blockers) are appropriate first-line therapies; and in patients with nondiabetic chronic kidney disease, ACE inhibitors are recommended. All hypertensive patients should have their fasting lipids screened, and those with dyslipidemia should be treated using the thresholds, targets and agents recommended by the Canadian Hypertension Education Program Working Group on the management of dyslipidemia and the prevention of cardiovascular disease. Selected patients with hypertension, but without dyslipidemia, should also receive statin therapy and/or acetylsalicylic acid therapy.
All recommendations were graded according to strength of the evidence and voted on by the 45 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported here achieved at least 95% consensus. These guidelines will continue to be updated annually.
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The Food- Frequency Questionnaire (FFQ) is a dietary assessment tool frequently used in large-scale nutritional epidemiology studies. The goal of the present study is to validate a self-administered version of the Hawaii FFQ modified for use in the general adult population of Newfoundland and Labrador (NL).
Over a one year period, 195 randomly selected adults completed four 24-hour dietary recalls (24-HDRs) by telephone and one subsequent self-administered FFQ. Estimates of energy and nutrients derived from the 24-HDRs and FFQs were compared (protein, carbohydrate, fibre, fat, vitamin A, carotene, vitamin D, and calcium). Data were analyzed using the Pearson's correlation coefficients, cross-classification method, and Bland-Altman plots.
The mean nutrient intake values of the 24-HDRs were lower than those of the FFQs, except for protein in men. Sex and energy-adjusted de-attenuated Pearson correlation coefficients for each nutrient varied from 0.13 to 0.61. Except for protein in men, all correlations were statistically significant with p?
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BACKGROUND: Dairy foods may play a role in the regulation of body weight. OBJECTIVE: We examined the association between changes in dairy product consumption and weight change over 9 y. DESIGN: The study was conducted in 19 352 Swedish women aged 40-55 y at baseline. Data on dietary intake, body weight, height, age, education, and parity were collected in 1987-1990 and 1997. The intake frequencies of whole milk and sour milk (3% fat), medium-fat milk (1.5% fat), low-fat milk and sour milk (or=1 serving/d; 3) constant, >or=1 serving/d; and 4) decreased from >or=1 serving/d to or=1 kg/y were calculated by using multivariable logistic regression analyses, with group 1 as the reference. RESULTS: Mean (+/-SD) body mass index (in kg/m2) at baseline was 23.7 +/- 3.5. The constant (>or=1 serving/d) intakes of whole milk and sour milk and of cheese were inversely associated with weight gain; ORs for group 3 were 0.85 (95% CI: 0.73, 0.99) and 0.70 (95% CI: 0.59, 0.84) respectively. No significant associations were seen for the other 3 intake groups. When stratified by BMI, the findings remained significant for cheese and, for normal-weight women only, for whole milk and sour milk. CONCLUSION: The association between the intake of dairy products and weight change differed according to type of dairy product and body mass status. The mechanism behind these findings warrants further investigation.
The aim of this paper was to investigate associations between the intake of dairy products and the development in caries (DMFS, decayed, missing and filled surfaces) among children/adolescents over a period of 3 and 6 years, and to investigate whether dairy intake protects against caries incidence. A total of 68.9% of the children were caries free at the age of 9 compared with 34.0% of the adolescents at the age of 15 (measured as DMFS = 0). A larger percentage of children/adolescents with a dairy intake above the mean were caries free compared with the group of children/adolescents with an intake below the mean (72.8 vs. 65.8% at age 9 and 41.1 vs. 30.7% at age 15). The results from the generalized estimation equation showed that dairy and milk intake, as well as intakes of components of dairy such as dairy calcium, whey and casein, was generally inversely associated with childhood/adolescent caries experience (measured as DMFS). With regard to caries incidence, the same inverse association was found for incidence over a period of 3 years and for incidence over 6 years, but the results were only statistically significant for the 3-year incidence and for the unadjusted models of the 6-year incidence. This study found that previous dairy intake, as well as milk intake or intake of dairy components, may be a predictor of future risk of caries measured by the DMFS count level. This relationship was inverse, meaning that a high intake of dairy products was associated with less future caries development. However, more studies on larger cohorts are needed to confirm these findings.
Very few studies have evaluated both parathyroid hormone (PTH) and 25-hydroxyvitamin D [25(OH)D] and their effects on bone mass in children.
We studied the associations of serum 25(OH)D and intact PTH (iPTH) with bone mineral content (BMC) and bone mineral density (BMD) at different bone sites and the relation between serum 25(OH)D and iPTH in early pubertal and prepubertal Finnish girls.
The subjects were 10-12-y-old girls (n = 193) at Tanner stage 1 or 2, who reported a mean (+/- SD) dietary calcium intake of 733 +/- 288 mg/d. 25(OH)D, iPTH, tartrate-resistant acid phosphatase 5b (TRAP 5b), urinary calcium excretion, BMC, areal BMD, and volumetric BMD were assessed by using different methods.
Thirty-two percent of the girls were vitamin D deficient [serum 25(OH)D
To assess usual calcium intake of urban high school students and to assess the association of social and demographic variables with calcium intake.
A self-administered survey instrument containing the following elements: a food frequency questionnaire (FFQ) developed to estimate calcium intake; questions to elicit demographic information; and scales to reflect taste enjoyment of dairy products, social reinforcement for consumption of milk, perceptions of others' opinions about milk, and behavioral modeling of milk consumption (ie, the frequency of observing friends' and family members' use of milk). The FFQ was shown to include major sources of calcium in diets of a pretest sample (n = 130).
Urban high schools in a metropolitan setting.
Students in one class per grade level in six high schools (approximately 900 students) were asked to participate. Of the 856 questionnaires completed, 785 were usable.
Total calcium intake, as estimated using the FFQ.
Descriptive statistics, t tests, one-way analysis of variance, correlation analysis, and stepwise multiple regression analysis were used to assess relationships of independent variables with calcium intake.
Mean estimated calcium intakes for male and female students were 1,146 +/- 41 mg/day (mean +/- standard error of the mean) and 815 +/- 26 mg/day (P girls); taste enjoyment of dairy products; number of meals and snacks per day; age; ethnicity (whites > Asians); behavioral modeling of milk consumption; perceptions of others' opinions, recommendations, and use of milk; and soft drink consumption (total adjusted R2 = .304). With the exception of age, these variables were positively associated with calcium intake. Regression equations developed for boys and girls separately revealed that different variables entered the equations.
Most of the variability in adolescents calcium intakes remained unexplained by the variables included in this study. Nevertheless, the results suggest that education programs focusing on taste enjoyment of dairy products and building on the influence of peers and family members may have a positive impact on calcium intake.
To report bone mineral density (BMD) in young, reportedly healthy Canadian women and to determine whether lifestyle factors that have been associated with bone health in older women are also associated with BMD in young women.
We recruited a convenience sample of 52 female undergraduate students in the Applied Human Nutrition program at the University of Guelph, Ontario, Canada. BMD was measured at the femoral neck, lumbar spine (L1 to L4), and whole body using a Discovery Wi (Hologic Inc.) dual-energy x-ray absorptiometer. Subjects completed a questionnaire to collect demographics, medical history, physical activity levels, and dietary habits; in addition, a subset of subjects (n = 31) completed a food frequency questionnaire to collect data on calcium and vitamin D intake. BMD data were examined using T- and Z-score classifications established by the World Health Organization (WHO); multiple regression analysis was used to predict BMD with biological and lifestyle variables.
Mean BMD measured at the femoral neck, lumbar spine, and whole body was 0.863 ± 0.11, 1.019 ± 0.09, and 1.085 ± 0.07 g/cm(2), respectively. Body mass and body mass index were significantly positively correlated with BMD at all 3 sites. Television watching, lactose intolerance, number of alcoholic drinks consumed per week, and age were used to develop a linear regression model to predict whole-body BMD (r(2) = 0.727, p
The purpose of this study was to evaluate the association between body size from birth to adulthood and bone mineral content (BMC) and bone mineral density (BMD) at the age of 31 years in a longitudinal study of the Northern Finland birth cohort for 1966. Data were collected at birth, 1, 14, and 31 years. This analysis was restricted to a subsample of individuals (n =1,099) for whom the BMC (g) and BMD measurements (g/cm(2)) were performed on the distal and ultradistal radius by dual-energy X-ray absorptiometry (DXA) at the age of 31 years. Determinants of low BMC and BMD were analyzed using multivariate logistic regression. Growth retardation at birth, being underweight (BMI
Lifestyle factors, such as diet, are believed to be involved in modifying bone health, although the results remain controversial, particularly in children and adolescents. The objective of the study was to identify associations between dietary factors and whole body bone measurements in 10-year-old children. The study was a cross-sectional analysis of a random sample of 105 healthy Danish children, aged 10 years (9.97+/-0.09). Whole body bone mineral content (BMC) and bone area (BA) were determined by dual-energy X-ray absorptiometry. The influence of diet (7 day food records) on BMC and BA were examined in bi- and multivariate analyses. The mean intakes of calcium, protein, phosphorus and sodium were 1226 mg, 78 g, 1523 mg and 3.3 g, respectively. In bivariate analyses, BMC and BA were strongly positively correlated with height (p
In Quebec, cancer is the principal cause of mortality. This epidemiologic research program includes two components. The first component takes place at the "Institut national de santé publique du Québec" and involves surveillance and evaluation of practices in oncology with the aim of providing the Quebec Ministry of Health with some of the evidence needed to determine its policies in cancer control. The second component takes place at the "Unité de recherche en santé des populations (URESP)" of Laval University and is devoted to studying the etiology and prevention of breast cancer. This paper focuses on this second research component which uses mammographic breast density as an intermediate biomarker to study the causes of breast cancer and strategies to prevent it. Breast cancer risk is much higher among women with very dense breasts than among those with little or no breast density. Recently, we were among the first to show that women with high vitamin D or calcium intakes have less breast density than those with low intakes, especially among premenopausal women. Furthermore, we have confirmed that breast density was increased among premenopausal women with high levels of IGF-I and low levels of IGFBP3 which is consistent with the observed effect of these molecules on breast cancer risk. Studies are now being conducted to assess whether breast density varies according to blood levels of vitamin D and of additional growth factors, as well as to genetic polymorphisms involved in the pathways of vitamin D, calcium and growth factors. The increase in vitamin D and calcium intakes may prove to be a safe and inexpensive approach to breast cancer prevention; this possibility should be carefully examined as quickly as possible.