A slight reduction in saturated fat intake, along with the use of extra-virgin olive oil, markedly lowers daily antihypertensive dosage requirement, possibly through enhanced nitric oxide levels stimulated by polyphenols.

Ambulatory blood pressure monitoring allows a better understanding of blood pressure fluctuations over 24 h than simple clinic measurements. In this way the diagnosis of "white coat" versus "sustained" hypertension and that of "dipper" (patient with blood pressure fall during nighttime > 10% of daytime levels) versus "nondipper" status were made possible. This pilot study has been undertaken to investigate whether patients with recently discovered, never-treated, mild, sustained hypertension have cardiovascular abnormalities according to their dipper/nondipper status. Patients with long-standing (n = 123) and newly discovered (n = 56) sustained hypertension were classified according to their nighttime blood pressure fall, and compared with normotensive controls. Ambulatory blood pressure monitoring was performed noninvasively. Parameters of left ventricular structure, cardiac systolic and diastolic function, and carotid anatomy were determined noninvasively by echographic methods. Significant increases in parameters of cardiac structure as well as abnormalities in diastolic function were observed in patients with long-standing hypertension, regardless of their dipper status. In the group with newly discovered hypertension, left atrium (3.4+/-0.3, 3.7+/-0.5, 3.2+/-0.4 cm in dippers, nondippers, and controls, respectively), end-diastolic diameter index (2.9+/-0.3, 3.0+/-0.2, 2.8+/-0.2 cm/m), and atrial filling fraction (0.50+/-0.07, 0.52+/-0.05, 0.42+/-0.04) were significantly altered only in the nondipper subgroup, in comparison with controls. Significant changes in cardiac structure and diastolic function were observed in nondipper patients with recently discovered hypertension, who, at variance with dippers, show changes similar to those in patients with long-standing hypertension. Hypertensives with the observed abnormalities may benefit from active antihypertensive treatment, which appears, therefore, justified even in an early phase of mild hypertension, in terms of potential reduction of end-organ complications as well as cost-effectiveness.

Objective: This study is aimed at investigating the in¯uence of body size, body fat and sexual maturation on blood pressure (BP) in adolescents. Design: A cross-sectional study. Setting: A suburban student population of Southern Italy. Subjects: One hundred ninety students attending the ®rst and second year of a secondary school. Five were excluded because they were affected by major diseases. The remaining were 98 M and 87 F (mean age for either group 12.0 AE 0.8 y). Methods: Blood pressure was measured by a mercury sphygmomanometer, body weight by a platform beamscale, other measurements included height, biceps, triceps, subscapular and suprailiac skinfolds by a caliper; sexual maturation was evaluated according to Tanner. Results: Body size was greater than in Tanner's population: in particular body weight (but not height) in our sample markedly exceeded that of the children of the same age in Tanner's population. Boys had higher systolic blood pressure (SBP) than girls (BP 109a64 AE 12a10 vs 103a63 AE 11a8 mmHg, P`0.02 for SBP), while heart rate and waistahip ratio were lower.During puberty Ð evaluated on the basis of pubic hair growth Ð BP in girls was higher than in the prepubertal phase (107a66 AE 9a7 vs 99a61 AE 10a7, P`0.01). Pubertal boys showed a reduced percent of body fat (calculated from four skinfold measurements) in comparison to prepubertal ones (21.0% AE 4.5 vs 24.5% AE 7.1, P`0.01). In linear correlation analysis, height, BW, BMI and lean body mass were found to be signi®cantly associated with SBP in both sexes and to diastolic blood pressure (DBP) in girls. Percent body fat was correlated with SBP in boys, while sexual maturation was associated to SBP and DBP in girls only.Multiple regression analysis indicated a signi®cant contribution of body size to BP variability, particularly in the girls. Sexual maturation was excluded from the ®nal regression equations when height, BW or lean body mass were present. Conclusions: These data indicate that body weight in these adolescents is greater that in Tanner's population of the same age and sex. Body size appears to be a major determinant of BP, whereas sexual maturation seems to in¯uence BP levels mainly through body growth. The in¯uence of percent body fat on BP setting seems to be of limited importance.

These results indicate that in addition to the degenerative changes of the common carotid wall, the diameter of the carotid artery and the relation to parietal stress show an early impairment in patients with uncomplicated hypertension.

A close relationship between abnormalities of the lipid metabolism and arterial hypertension has been observed in several epidemiological studies. The aim of the present study was to investigate whether serum cholesterol might affect blood pressure (BP) levels at rest, during ambulatory monitoring or during sympathetic stimulation-independently of other variables such as body weight or serum insulin-thus influencing the outcome of hypertensive complications. Seventy-three patients with sustained newly-discovered and nevertreated hypertension were divided into tertiles according to their serum cholesterol levels and their resting BP, 24-h BP and BP during isometric exercise (handgrip) were compared. Cardiac mass and carotid wall thickness were measured by echographic technique. The results were that tertiles were similar for body weight, blood glucose and serum insulin, but dif-