Biomedical subjects

Valerie Burke

Publications and source records attributed to Valerie Burke.

At least 19 recordsLinked to original sources

PubMed2007

The effect of vitamin E on blood pressure in individuals with type 2 diabetes: a randomized, double-blind, placebo-controlled trial.

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.

Antioxidants↗

PubMed2006

Chocolate craving among children: implications for disordered eating patterns.

The aim was to test the validity of a multidimensional model of chocolate craving among children, and to examine if the dimensions underlying the model predict consumption and eating disordered symptoms. Participants were 602 children (53% female) aged 11, 12, and 13 from 11 schools in Western Australia. Measures included the Orientation to Chocolate Questionnaire (OCQ) designed to assess three components of chocolate craving (approach, avoidance, and guilt), questions assessing body image dissatisfaction and dieting, and body mass index (BMI). Using structural equation modeling, results confirmed that chocolate craving among children is best conceptualized as a three-factor model (approach, avoidance, guilt). The underlying dimensions were differentially associated with self-reported chocolate consumption and indicators of disordered eating patterns. After controlling for BMI and gender, chocolate-related guilt was strongly associated with greater body dissatisfaction and dieting, and avoidance inclinations were also associated with dieting. Chocolate-related guilt was higher in girls than in boys. Results suggest that children experience chocolate craving as a multidimensional phenomenon reflecting some ambivalence. A gender difference in chocolate-related guilt appears to emerge in childhood, potentially contributing to a greater risk for girls to develop exaggerated concerns about body shape and weight.

Adolescent↗

PubMed2006

A lifestyle program for treated hypertensives improved health-related behaviors and cardiovascular risk factors, a randomized controlled trial.

OBJECTIVE: To assess effects of a cognitively based program on health-related behaviors and cardiovascular risk factors in overweight drug-treated hypertensives. STUDY DESIGN AND SETTING: In a clinical trials center, volunteers, recruited by advertisement, were randomized to usual care (N=118) or to a 4-month program (N=123) incorporating weight loss; a low-sodium diet, high in fruit, vegetables, and fish; and increased physical activity. Diet, physical activity, weight, blood lipids, glucose, and insulin were measured at 4 and 16 months. RESULTS: Ninety-eight usual care and 106 program participants completed the 4-month assessment; 90 and 102, respectively, completed follow-up. Using intention-to-treat analysis, relative to usual care, net changes with the program at 4 months were as follows: dietary fat (-2.6% energy; P<0.001); sodium (-290mg/d; P=0.004); energy (-313mJ/d; P=0.005); fish (+2.1 serves/wk; P<0.001); vegetables (+3.0 serves/wk; P<0.001); physical activity (+37min/wk; P=0.004); weight (-2.8kg; P<0.001); waist girth (-3.1cm; P<0.001); total cholesterol (-0.2mmol/L; P=0.017); and triacylglycerols (-0.12mmol/L; P=0.002). One year later, net changes included dietary fat (-2.2% energy; P<0.001); sodium (-150mg/d; P=0.029); fish (+2.0 serves/wk; P<0.001); vegetables (+4.3 serves/wk; P<0.001); weight (-2.5kg; P=0.001); waist girth (-3.1cm; P<0.001); high-density lipoprotein cholesterol (+0.03mmol/L; P=0.031). CONCLUSION: Improvements in behaviors and risk factors, several maintained long term, suggest the potential for long-term benefits in hypertensives.

Adult↗

PubMed2006

Small changes in thyroxine dosage do not produce measurable changes in hypothyroid symptoms, well-being, or quality of life: results of a double-blind, randomized clinical trial.

CONTEXT: In patients with primary hypothyroidism, anecdotal evidence suggests that well-being is optimized by fine adjustment of T(4) dosage, aiming for a serum TSH concentration in the lower reference range. This has not been tested in a clinical trial. OBJECTIVE: Our objective was to test whether adjustment of T(4) dosage aiming for a serum TSH concentration less than 2 mU/liter improves well-being compared with a serum TSH concentration in the upper reference range. DESIGN: We conducted a double-blind, randomized clinical trial with a crossover design. PARTICIPANTS: Fifty-six subjects (52 females) with primary hypothyroidism taking T(4) (>/=100 microg/d) with baseline serum TSH 0.1-4.8 mU/liter participated. INTERVENTIONS: Each subject received three T(4) doses (low, middle, and high in 25-microg increments) in random order. OUTCOME MEASURES: Outcome measures included visual analog scales assessing well-being (the primary endpoint) and hypothyroid symptoms, quality of life instruments (General Health Questionnaire 28, Short Form 36, and Thyroid Symptom Questionnaire), cognitive function tests, and treatment preference. RESULTS: Mean (+/- sem) serum TSH concentrations were 2.8 +/- 0.4, 1.0 +/- 0.2, and 0.3 +/- 0.1 mU/liter for the three treatments. There were no significant treatment effects on any of the instruments assessing well-being, symptoms, quality of life, or cognitive function and no significant treatment preference. CONCLUSIONS: Small changes in T(4) dosage do not produce measurable changes in hypothyroid symptoms, well-being, or quality of life, despite the expected changes in serum TSH and markers of thyroid hormone action. These data do not support the suggestion that the target TSH range for the treatment of primary hypothyroidism should differ from the general laboratory range.

Adult↗

PubMed2006

Dog ownership, health and physical activity: a critical review of the literature.

This review examines the association between dog ownership and adult physical activity levels. While there is evidence to suggest that dog ownership produces considerable health benefit and provides an important form of social support that encourages dog owners to walk, there is limited evidence on the physical environmental and policy-related factors that affect dog owners walking with their dog. With the high level of dog ownership in many industrialized countries, further exploration of the relationship between dog ownership and physical activity levels may be important for preventing declining levels of physical activity and the associated detrimental health effects.

Adult↗

PubMed2006

Is reversal of endothelial dysfunction by tea related to flavonoid metabolism?

Dietary flavonoids can improve endothelial function, but the response varies between individuals. Wide variability is also seen in flavonoid O-methylation, a major pathway of flavonoid metabolism. The O-methylation of flavonoids could alter activity, and thus influence any effect on endothelial function. The objective of the current analysis was to investigate whether variability in the endothelial function response to ingestion of tea, a rich source of flavonoids, is related to the degree of O-methylation of flavonoids. This relationship was investigated in two studies in which endothelium-dependent flow-mediated dilatation (FMD) of the brachial artery was assessed and urinary 4-O-methylgallic acid (4OMGA) excretion was used as a marker of the O-methylation of tea-derived flavonoids. In the first study, amongst participants consuming five cups of tea per day for 4 weeks, the degree of increase in 4OMGA excretion was inversely associated with the change in FMD responses (r -078, P=0.008). In the second study, there was a significant difference in the FMD responses to acute ingestion of three cups of tea between individuals with a low ( median) 4OMGA response (1.94 (sem 0.79) % and -0.25 (sem 0.53) %, respectively; P=0.03). That is, any improvement in FMD following ingestion of tea may be enhanced in individuals who O-methylate less of the absorbed flavonoids. The present results are consistent with the suggestion that differences in flavonoid metabolism may influence their effect on endothelial function. Thus, differences in flavonoid metabolism could be related to the level of benefit of dietary flavonoids on the risk of CVD.

Brachial Artery↗

PubMed2006

Partial substitution of carbohydrate intake with protein intake from lean red meat lowers blood pressure in hypertensive persons.

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.

Blood Glucose↗

PubMed2006

Lupin-enriched bread increases satiety and reduces energy intake acutely.

BACKGROUND: Protein and fiber may be important determinants of satiety. Lupin kernel flour is a novel food ingredient that is rich in protein and fiber. OBJECTIVE: The objective was to investigate the effects of lupin kernel flour-enriched bread (LB) on satiety and energy intake in humans. DESIGN: Two randomized controlled crossover trials were performed to compare the acute effects of LB with those of white bread (WB). In study 1, the subjects (n = 16) completed 4 treatments 1 wk apart: WB breakfast (as toast) and WB lunch (as sandwiches), WB breakfast and LB lunch, LB breakfast and WB lunch, and LB breakfast and LB lunch. Energy intake at all breakfast meals was matched (1655 kJ), and ad libitum energy intake at lunch, 3 h after breakfast, was measured. In study 2, the subjects (n = 17) completed 2 treatments 1 wk apart: WB breakfast and LB breakfast (each 1655 kJ). Blood samples were taken at baseline and at regular intervals for 3 h after breakfast. RESULTS: In study 1, the LB breakfast resulted in significantly higher self-reported satiety (P < 0.001) and lower energy intake (kJ) at lunch (-488; 95% CI: -798, -178) than did the WB breakfast. The LB lunch resulted in a significantly lower within-meal energy intake (kJ) at lunch (-1028; 95% CI: -1338, -727) than did the WB lunch. In study 2, compared with the WB breakfast, the LB breakfast significantly altered the 3-h postmeal plasma ghrelin response (P = 0.04) and resulted in significantly lower mean 3-h plasma ghrelin concentrations (P = 0.009). CONCLUSION: A novel food enriched in protein and fiber derived from lupin kernel flour significantly influences energy intake acutely.

Area Under Curve↗

PubMed2006

Blood pressure rise with swimming versus walking in older women: the Sedentary Women Exercise Adherence Trial 2 (SWEAT 2).

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.

Aged↗

PubMed2006

Obesity in childhood and cardiovascular risk.

1. Childhood obesity is increasing worldwide and is associated with an increase in cardiovascular risk factors in childhood. 2. In children, obesity is associated with hypertension, impaired vascular function, dyslipidaemia, atheroma, the metabolic syndrome, type 2 diabetes, systemic inflammation and oxidative stress. Greater risk is associated with clustering of risk factors. 3. Obesity tracks from childhood to adult life and predicts adverse levels of risk and an increase in cardiovascular end-points. 4. Adults who were obese as children have higher rates of obesity and its sequelae: greater intima-media thickness, left ventricular hypertrophy and atherosclerosis. There is greater all-cause and cardiovascular mortality, as well as a greater risk of stroke, in long-term follow-up of obese children. 5. Genetic and environmental factors contribute to familial aggregation of obesity, with parental obesity as a strong predictor of obesity in children. However, clustering of adverse health-related behaviours is seen in such families. 6. Adverse behaviours (smoking, poor dietary choices, less physical activity and greater alcohol intake) also cluster in individuals, suggesting the need for multimodal interventions. 7. Recognition of families at risk offers opportunities for prevention of obesity in children and decreasing risk in parents.

Cardiovascular Diseases↗

PubMed2005

Impaired skin blood flow response to environmental heating in chronic heart failure.

AIMS: We examined the thermoregulatory response to heat exposure in patients with chronic heart failure. METHODS AND RESULTS: Skin blood flow (SkBF) was measured in HF subjects and matched controls. Cutaneous vascular conductance (CVC) was calculated from laser-Doppler SkBF and blood pressure. To assess the nitric oxide contribution to thermoregulatory responses, subcutaneous microdialysis membranes were placed beneath the laser-Doppler probes to infuse N(G)-nitro-l-arginine methyl ester (l-NAME), or Ringer's solution. Core (T(C)) and skin temperatures (five sites, T(Sk)) were continuously recorded. Subjects were studied during normothermia then at 38 degrees C, 50%RH within a climate chamber. T(C) and T(Sk) did not differ between HF and controls during normothermia and heating induced similar increases in both groups. During heating, CVC rose in both groups, but significantly less so in HF (HF 43.9+/-7.8 vs. controls 58.0+/-7.5% CVC(max), P<0.05). l-NAME attenuated SkBF responses in the control (58.0+/-7.5 vs. 34.6+/-5.1% CVC(max), P<0.001) and HF subjects (43.9+/-7.8 vs. 27.0+/-2.2% CVC(max), P<0.005), with a larger effect evident in the controls (P<0.05). CONCLUSION: HF patients exhibit impaired thermoregulatory responses to heat exposure. Lower SkBF in HF, which defends blood pressure during heat exposure, also predisposes these subjects to heat intolerance.

Blood Flow Velocity↗

PubMed2005

Red wine and beer elevate blood pressure in normotensive men.

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.

Adult↗

PubMed2005

The 6-minute walk test does not reliably detect changes in functional capacity of patients awaiting cardiac transplantation.

BACKGROUND: Peak oxygen consumption (Vo(2)peak) is a strong independent predictor of prognosis in patients with severe chronic heart failure (CHF) and is used to guide optimal timing of transplantation. However, its assessment is relatively expensive and time-consuming and requires sophisticated equipment and highly trained personnel. The purpose of this study was to determine whether changes in 6-minute walk test (6WT) distance, a simple, inexpensive potential alternative measure of functional capacity, can predict changes in Vo(2)peak in patients with severe CHF. METHODS: Sixteen subjects (ejection fraction 23+/-2%, Vo(2)peak 16.2+/-1.1 ml kg (-1)min(-1)) underwent repeated 6WT and Vo(2)peak assessments that included familiarization and 4 serial measures, 6 weeks apart (baseline and at Weeks 6, 12 and 18). Analysis compared baseline performance with each subsequent testing occasion. RESULTS: At baseline, mean (+/-SE) VO(2)peak was 16.3+/-1.1 ml kg(-1) min(-1) and 6WT distance was 458+/-21 m. 6WT and Vo(2)peak were strongly correlated at all timepoints (average r=0.82; all p<0.05). However, mixed model analysis, assessing the capacity of the changes seen in 6WT to predict changes in Vo(2)peak, showed no statistical significance (F=0.11; p=0.74). CONCLUSIONS: The 6WT is commonly used to assess functional capacity in patients with heart failure. This study demonstrates that, despite a strong cross-sectional correlation with Vo(2)peak, changes in the 6WT are not a reliable predictor of changes in Vo(2)peak within patients. Therefore, the 6WT has limited utility as a serial measure to assess changes in the clinical status of patients with severe heart failure.

Australia↗

PubMed2005

Breastfeeding and overweight: longitudinal analysis in an Australian birth cohort.

OBJECTIVE: To examine adiposity in relation to breastfeeding using longitudinal analysis in an Australian birth cohort. STUDY DESIGN: Repeated surveys from 16 weeks gestation to 8 years in a cohort (N = 2087) recruited through antenatal clinics. Overweight was defined by National Center for Health Statistics 95th percentiles for weight-for-length at 1 year and body mass index (BMI) at 3, 6, and 8 years. Overweight was examined using Generalized Estimating Equations with results summarized as OR. BMI Z scores were analyzed in mixed models. RESULTS: At 1 year, infants breastfed >12 months were the leanest group (mean Z score -0.16, 95% CL -0.28, -0.04; not breastfed 0.16, 95% CL 0.02, 0.29; breastfed < or = 4 months 0.31, 95% CL 0.22, 0.40; 5-8 months 0.17, 95% CL 0.06, 0.27; 9-12 months 0.11, 95% CL 0.01, 0.22). From 1 to 8 years, children breastfed < or = 4 months had the greatest risk of overweight (OR 1.29, 95% CL 0.89, 1.97) and the highest prevalence of maternal obesity, smoking, and lower education. CONCLUSIONS: Infants breastfed >12 months were leaner at 1 year but not at 8 years. Breastfeeding < or = 4 months was associated with greatest risk of overweight and adverse maternal lifestyle. Familial factors may modify associations between breastfeeding and adiposity beyond infancy.

Body Mass Index↗

PubMed2005

Acute effects of tea on fasting and postprandial vascular function and blood pressure in humans.

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.

Aged↗

PubMed2005

The combination of vitamin C and grape-seed polyphenols increases blood pressure: a randomized, double-blind, placebo-controlled trial.

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.

Antioxidants↗

PubMed2005

Effects of a lifestyle programme on ambulatory blood pressure and drug dosage in treated hypertensive patients: a randomized controlled trial.

OBJECTIVE: To assess effects of multifactorial lifestyle modification on antihypertensive drug needs in treated hypertensive individuals. DESIGN: Randomized controlled trial. SETTING: Research studies unit. PARTICIPANTS: Overweight hypertensive patients, receiving one or two antihypertensive drugs, were recruited by advertising, and allocated randomly to a usual care group (controls; n = 118) or a lifestyle modification group (programme group; n = 123). INTERVENTION: A 4-month programme of weight loss, a low-sodium 'Dietary Approaches to Stop Hypertension'-type diet with added fish, physical activity and moderation of alcohol intake. After 4 months, if mean 24-h ambulatory blood pressure (ABP) was less than 135/85 mmHg, antihypertensive drugs were withdrawn over 4 weeks and long-term home blood pressure monitoring was begun. MAIN OUTCOME MEASURES: Antihypertensive drug requirements, ABP, weight, waist girth at 4 months and 1-year follow-up. RESULTS: Ninety control group and 102 programme group participants completed the study. Mean 24-h ABP changed after 4 months by -1.0/-0.3 +/- 0.5/0.4 mmHg in controls and -4.1/-2.1 +/- 0.7/0.5 mmHg with the lifestyle programme (P < 0.01). At follow-up, changes in the two groups were not significantly different (4.1/1.3 +/- 1.1/1.0 mmHg in controls; 2.5/-0.1 +/- 1.1/0.8 mmHg in the programme group; P = 0.73). At 4 months, drug withdrawal differed significantly between the groups (P = 0.038) in men (control 44%; programme 66%) but not in women (65 and 64%, respectively; P = 0.964). At follow-up, sex-related differences were not significant, and 41% in the control group and 43% in the programme group maintained drug-withdrawal status. With the programme, net weight loss was 3.3 kg (P < 0.001) at 4 months and 3.0 kg (P < 0.001) at follow-up; respective net decreases in waist girth were 3.3 cm (P < 0.001) and 3.5 cm (P < 0.001). CONCLUSIONS: A 4-month multifactorial lifestyle modification in patients with treated hypertension reduced blood pressure in the short-term. Decreased central obesity persisted 1 year later and could reduce overall cardiovascular risk.

Antihypertensive Agents↗

PubMed2005

Polycystic ovarian syndrome: marked differences between endocrinologists and gynaecologists in diagnosis and management.

BACKGROUND: Women with polycystic ovarian syndrome (PCOS) commonly consult endocrinologists or gynaecologists and it is not known whether these specialty groups differ in their approach to management. OBJECTIVE: To compare the investigation, diagnosis and treatment practices of endocrinologists and gynaecologists who treat PCOS. DESIGN AND SETTING: A mailed questionnaire containing a hypothetical patient's case history with varying presentations--oligomenorrhoea, hirsutism, infertility and obesity--was sent to Australian clinical endocrinologists and gynaecologists in teaching hospitals and private practice. RESULTS: Evaluable responses were obtained from 138 endocrinologists and 172 gynaecologists. The two specialty groups differed in their choice of essential diagnostic criteria and investigations. Endocrinologists regarded androgenization (81%) and menstrual irregularity (70%) as essential diagnostic criteria, whereas gynaecologists required polycystic ovaries (61%), androgenization (59%), menstrual irregularity (47%) and an elevated LH/FSH ratio (47%) (all P-values < 0.001). In investigation, gynaecologists were more likely to request ovarian ultrasound (91%vs. 44%, P < 0.001) and endocrinologists more likely to measure adrenal androgens (80%vs. 58%, P < 0.001) and lipids (67%vs. 34%, P < 0.001). Gynaecologists were less likely to assess glucose homeostasis but more likely to use a glucose tolerance test to do so. Diet and exercise were chosen by most respondents as first-line treatment for all presentations. However, endocrinologists were more likely to use insulin sensitizers, particularly metformin, for these indications. In particular, for infertility, endocrinologists favoured metformin treatment whereas gynaecologists recommended clomiphene. CONCLUSIONS: There is a lack of consensus between endocrinologists and gynaecologists in the definition, diagnosis and treatment of PCOS. As a consequence, women may receive a different diagnosis or treatment depending on the type of specialist consulted.

Australia↗