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Cotter J.,Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk | Cotter J.,University of Minho | Cotter J.,PT Government Associate Laboratory | Cotter M.J.,Joao de Meira | And 5 more authors.
Journal of Hypertension | Year: 2013

Objective: The aim of the study was to evaluate the 24-h urinary sodium excretion in children of 10 - 12 years at a school in the north of Portugal and to examine the influence on salt intake and blood pressure of three different educational interventions for 6 months. Methods: Blood pressure (BP) and sodium excretion in 24-h urinary samples (UNa) validated with urinary creatinine were measured in 155 children 10 - 12 years old belonging to nine classes at baseline and after 6 months of three educational interventions in students from three classes each after parents consent was obtained. Interventions consisted in no additional action [control (CTR)], weekly lessons about the dangers of high salt intake [Theoretical (THEOR)] and both lessons and working practices in the school garden of planting, collection of herbs for salt substitution at home [practical (PRACT)]. Results: At baseline 139 students (76 girls and 63 boys) were eligible showing average 24-h UNa of 132±43 mmol/24 h (mean salt intake of 7.8±2.5 g per day) and BP of 118/62 (13/9)mmHg that did not correlate to each other. At the end of the study, versus baseline, BP decreased by 8.2/6.5mmHg in CTR (n=31), by 3.8/ 0.6mmHg in THEOR (n=43) and by 3.5/0.7mmHg in PRACT (n=53) and salt intake was reduced by 0.4±2.4 g per day in CTR, by 0.6±3.2 g per day in THEOR and by 1.1±2.5 g per day in PRACT. It was observed that salt intake variation was not independent of the group (CRT, THEOR and PRACT) (×2, 9.982, P=0.041). Salt intake was significantly reduced only in the PRACT group (1.1 g per day) and in the PRACT group the percentage of children who reduced salt intake by at least 1g per day from baseline to the end of the study was significantly higher (50.9%) than that of the other groups, THEOR, 48.8% and CTR, 32.2%. Conclusion: Our data indicates that children 10 - 12 years old have a high salt intake that is well above the proposed recommendations and that a strategy based on theoretical and practical education may achieve in some children an important reduction in daily salt intake which, if maintained over time, may assume important public health implications. These results suggest that in those children a more complete theoretical and practical intervention is more productive and efficient towards reduction of salt intake than single theoretical or no intervention. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Cunha P.G.,Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk | Cunha P.G.,University of Minho | Cunha P.G.,Icvs 3Bs Pt Government Assoct Laboratory | Cotter J.,Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk | And 11 more authors.
Journal of Hypertension | Year: 2015

Background: By contrast with other southern European people, north Portuguese population registers an especially high prevalence of hypertension and stroke incidence. We designed a cohort study to identify individuals presenting accelerated and premature arterial aging in the Portuguese population. Method: Pulse wave velocity (PWV) was measured in randomly sampled population dwellers aged 18-96 years from northern Portugal, and used as a marker of early vascular aging (EVA). Of the 3038 individuals enrolled, 2542 completed the evaluation. Results: Mean PWV value for the entire population was 8.4 m/s (men: 8.6 m/s; women: 8.2 m/s; P<0.02). The individuals were classified with EVA if their PWV was at least 97.5th percentile of z-score for mean PWV values adjusted for age (using normal European reference values as comparators). The overall prevalence of EVA was 12.5%; 26.1% of individuals below 30 years presented this feature and 40.2% of individuals in that same age strata were placed above the 90th percentile of PWV; and 18.7% of the population exhibited PWV values above 10 m/s, with male predominance (17.2% of men aged 40-49 years had PWV>10 m/s). Logistic regression models indicated gender differences concerning the risk of developing large artery damage, with women having the same odds of PWV above 10 m/s 10 years later than men. Conclusion: The population PWV values were higher than expected in a low cardiovascular risk area (Portugal). High prevalence rates of EVA and noteworthy large artery damage in young ages were found. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

Cunha P.G.,Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk | Cunha P.G.,University of Minho | Cunha P.G.,Bs Pt Govnmnt Asoct Laboratory | Cotter J.,Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk | And 6 more authors.
Journal of Human Hypertension | Year: 2015

Surveying the evolution of blood pressure (BP) levels and hypertension (HTN) prevalence is important. A stringent strategy was utilized in a population cohort study. The BP was measured at two visits at least 3 months apart, and the results were analyzed using the following two methods: the Surveillance method (three BP measurements were performed in one visit, and the results were compared with those published previously for the identical method) and the Clinical method (three measurements per visit for two visits, and the concordant results in both visits were used to determine the BP classification). A total of 2542 subjects completed the evaluation. Using the Clinical method, an average systolic/diastolic BP value of 129.8/76.8 mm Hg was obtained, and the prevalence of HTN was 31.6%. Of the hypertensive patients, 74.3% were aware of his/her condition; 69.1% were treated and 40.8% of those treated had adequate BP control. A total of 24.7% of subjects changed his/her BP classification between visits, and 13.7% misreported HTN. Using the Surveillance method, we determined that the average global SBP has been maintained, with HTN prevalence increasing in this region, drifting from reported trends nationally and worldwide. There has been improvement in the proportion of treated and controlled subjects; however, the Surveillance method overestimated the HTN prevalence and underestimated the proportion of treated and controlled subjects. The BP levels were higher than observed worldwide in high-cardiovascular (CV) risk countries as well as higher than the minimum risk exposure level for developing CV disease. © 2015 Macmillan Publishers Limited All rights reserved.

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