During a survey of young subjects not receiving treatment for hypertension in Tecumseh, Michigan, clinic and self-monitored blood pressures taken at home (14 readings in 7 days) were obtained in 737 subjects (387 men, 350 women, average age 31.5 years). Hypertension in the clinic was diagnosed if the clinic blood pressure exceeded 140 mm Hg systolic or 90 mm Hg diastolic. In the absence of firm criteria for what constitutes hypertension at home, subjects whose average home blood pressure was in the upper decile of the whole population were considered to have hypertension at home. By these criteria, 7.1% of the whole population had "white coat" hypertension (i.e., high clinic but not elevated home readings). The prevalence of "sustained" hypertension (i.e., high readings in the clinic and at home) was 5.1%. Subjects with white coat and sustained borderline hypertension in Tecumseh were very similar. Both groups showed, at previous examinations (at ages 5, 8, 21, and 23 years), significantly higher blood pressure readings than the normotensive subjects. As young adults (average age 333 years), the parents of both hypertensive groups had significantly higher blood pressure readings than the parents of normotensive subjects. Both hypertensive groups had faster heart rates, higher systemic vascular resistance, and higher minimal forearm vascular resistance. Both hypertensive groups were more overweight, had higher plasma triglycerides, insulin, and insulin/glucose ratios than normotensive subjects. The white coat hypertensive group also had lower values of high density lipoprotein than the normotensive group. White coat hypertension is a frequent condition. In regards to excessive risk of hypertension (past blood pressures, parental blood pressures, weight, and heart rate), excessive risk for atherosclerosis (triglycerides and insulin), and hemodynamic parameters (vascular resistance and minimal forearm resistance), the white coat and sustained hypertensive groups are similarly different from the normotensive group. These findings do not support the accepted practice of using home blood pressure determination to distinguish groups of borderline hypertensive subjects with a lesser or greater clinical problem. (Hypertension 1990;16:617-623) T he clinical usefulness of ambulatory blood pressure monitoring rests on the original report of Sokolow et al 1 on patients with moderately severe hypertension. They found a strong correlation between cardiovascular morbidity and the average ambulatory blood pressure, whereas the correlation with the casual clinic blood pressure and morbidity was weaker. This finding in moderate sustained hypertension has been extrapolated to much milder forms of hypertension. It is assumed that patients with borderline blood pressure elevation who have "white coat" hypertension (i.e., show high office readings but normal values outside of the physician's office) have a less serious problem. We advocated the technique of home blood pressure readings by self-determination 2 -4 as a simple, reproduci...

In Kibera, an informal settlement in Nairobi, Kenya, major development efforts are underway – namely, the Kenya Slum Upgrading Programme (Kibera Pilot), the Nairobi Railway Relocation Action Plan, and the National Youth Service-led Kibera Slum Upgrade Initiative. This paper assesses how such interventions affect the social contract and social cohesion, and hence the resilience of Kibera residents. We examine the extent to which different types of slum upgrading efforts address risks in Kibera, particularly around conflict and flooding. Our findings show that these interventions can reduce conflict, crime, insecurity and flood risks, and subsequently strengthen resilience in highly dense and complex urban environments, if they do three things: first, include processes that build the social contract (such as meaningful consultation of residents and social accountability mechanisms); second, build bridging social capital between ethnic groups and avoid reducing bonding capital within groups; and third, integrate different sectoral interventions.

No abstract

Background Left ventricular hypertrophy (LVH) defined by either ECG or echocardiographic criteria is a risk factor for cardiovascular morbidity and mortality. A number of determinants of LVH have been described in previous studies, principally male sex, hypertension, obesity, and aortic valvular stenosis. We examined the distribution of LV mass (LVM) in a population of 18-to 42-year-old normotensive men and

The Nef protein of HIV-1 is capable of performing at least two functions: reduction of cell-surface expression of CD4, the viral receptor, and enhancement of HIV-1 infectivity. Here we report the results of assays of CD4 downregulation by nef point mutants. Areas of high charge density and highly conserved sequence motifs were targeted. In general, mutations in the carboxyl-terminal half of the protein had more deleterious effects than did those in the amino-terminal half. A single mutant nef allele was identified which encoded a stable protein but was completely inactive. Two mutant Nef proteins exhibited temperature-sensitive phenotypes in assays of CD4 downregulation.