Hypertension is a major cause of disease burden in all racial and ethnic groups and in both developing and developed regions and countries. Much of the racial and ethnic disparity in cardiovascular outcomes can be attributed to the excess burden of hypertension. Racial and ethnic differences in blood pressure occur because of biology and sociology. Causes of racial differences in blood pressure likely begin early in life and reflect the complex relationship of these gene and environment interactions. Hypertension treatment and control remain less than optimal worldwide, and awareness is still a problem in many racial and ethnic groups. Instituting lifestyle changes for the primary prevention and treatment of hypertension among the general population would decrease prevalence and be effective in eliminating many racial and ethnic differences. This review highlights racial and ethnic differences in the prevalence and incidence of hypertension and identifies contributing factors associated with these differences.

Dark chocolate and other cocoa products are popular in the population as a whole, but their overall health benefit remains controversial. Observations from the Kuna Indian population have shown an impressive cardiovascular health benefit from cocoa. For various reasons, this benefit has not been as robust as in other populations. Additionally, several mechanisms have been proposed that might confer cocoa's possible health benefit, but no consensus has been reached on cocoa's physiologic role in promoting cardiovascular health. Flavanols, as well as theobromine, may contribute to enhancements in endothelial function and subsequent improvements in various contributors to cardiovascular disease (CVD) including hypertension, platelet aggregation and adhesion, insulin resistance, and hypercholesterolemia. While the benefits of cocoa may be altered at the various stages of growth, development, and production, it appears that for many people “healthy” dark chocolate may, indeed, provide a pleasurable role in CVD risk reduction. The objectives of this review are to discuss the associations of cocoa with decreased blood pressure and improved CVD risk, to describe the possible mechanisms for these potential benefits, and to highlight considerations for the use of cocoa as a dietary supplement.

J Clin Hypertens (Greenwich). 2012; 14:467–471. ©2012 Wiley Periodicals, Inc. Dietary supplements (DSs) are used extensively in the general population and many are promoted for the natural treatment and management of hypertension. Patients with hypertension often choose to use these products either in addition to or instead of pharmacologic antihypertensive agents. Because of the frequent use of DS, both consumers and health care providers should be aware of the considerable issues surrounding these products and factors influencing both efficacy and safety. In this review of the many DSs promoted for the management of hypertension, 4 products with evidence of possible benefits (coenzyme Q10, fish oil, garlic, vitamin C) and 4 that were consistently associated with increasing blood pressure were found (ephedra, Siberian ginseng, bitter orange, licorice). The goals and objectives of this review are to discuss the regulation of DS, evaluate the efficacy of particular DS in the treatment of hypertension, and highlight DS that may potentially increase blood pressure.

The authors assessed the process of blood pressure (BP) measurement and level of adherence to recommended procedures at representative sites throughout a large academic health sciences center. A casual observer assessed the setting and observed the process, noting the equipment, technique, and BP recorded by site personnel. A trained observer then repeated the patient's BP measurement following American Heart Association recommendations. Significant biases were observed between measurements by site personnel and the trained observer. Site personnel reported on average an increased systolic BP (SBP) of 5.66 mm Hg (95% confidence interval [CI], 3.09-8.23; P<.001) and a decreased diastolic BP (DBP) of )2.96 mm Hg (95% CI, )5.05 to )0.87; P=.005). Overall, 41% of patients had a !10-mm Hg difference in SBP between measurements. Similarly, 54% had differences of !5 mm Hg in DBP between measurements. Inaccurate BP measurement and poor technique may lead to misclassification, misdiagnosis, and inappropriate medical decisions. Concordance of measured SBP between our site personnel and trained observer was less than optimal. Several areas for improvement were identified. Routine calibration and use of system-wide standardized equipment, establishment of BP measurement protocols, and periodic technique and equipment recertification can be addressed in future quality initiatives. J Clin Hypertens (Greenwich). 2012;14:222-227. Ó2012 Wiley Periodicals, Inc.Blood pressure (BP) measurement is perhaps the most commonly performed procedure in the clinical encounter and one of the most important measurements in clinical medicine.1 Despite clear guidelines on appropriate techniques for BP measurement, 2,3 these recommendations rarely are followed by health care providers or personnel.1 There are numerous factors that influence accuracy of BP readings including those related to the patient, observer, instruments, and technique.2-4 Adequate rest time, diurnal variation, clinic atmosphere, pain, anxiety, smoking, and conversation all can have a significant impact on BP readings.4 Factors directly related to the observer include training, end-digit preference, and impaired hearing.2,3,5 Instrument accuracy, background noise, clothing interference, inappropriate cuff size and placement, posture, and inflation-deflation rate can influence BP measurements. Lack of repeated measurements further compounds the obtainment of an accurate reading.3 These multiple sources of potential error encountered in daily clinical practice emphasize the possibility for inaccurate results that can influence patient management. Accurate measurement of BP is essential in staging hypertension, ascertaining BP-related risk, and guiding management. Health care providers and personnel should be keenly aware of the need to carefully follow standardized procedures in order to achieve accurate and reproducible BPs. Despite education, clinic personnel who are aware of guidelines often do not follow them to the degree necessary to produce repeatable measures, and it h...