Abstract-The purpose of this study was to determine if ambulatory blood pressure measurement predicted total and cardiovascular mortality over and beyond clinic blood pressure measurement and other cardiovascular risk factors; 5292 untreated hypertensive patients referred to a single blood pressure clinic who had clinic and ambulatory blood pressure measurement at baseline were followed up in a prospective study of mortality outcome. Multiple Cox regression was used to model time to total and cause-specific mortality for ambulatory blood pressure measurement while adjusting for clinic blood pressure measurement and other risk factors at baseline. There were 646 deaths (of which 389 were cardiovascular) during a median follow-up period of 8. Key Words: blood pressure Ⅲ blood pressure monitoring, ambulatory Ⅲ cardiovascular diseases Ⅲ hypertension Ⅲ mortality T he most commonly used technique of blood pressure measurement in clinical practice is the auscultatory method with a mercury sphygmomanometer and stethoscope. A metaanalysis of clinic blood pressure measurement (CBPM) in 1 million adults participating in 61 prospective studies showed that a 10-mm Hg higher usual systolic blood pressure (SBP) or 5-mm Hg higher usual diastolic blood pressure (DBP) would be associated with Ϸ40% higher risk of stroke death and Ϸ30% higher risk of death from ischemic heart disease and other vascular causes. 1 There are, however, numerous criticisms of CBPM, which include interobserver and intraobserver variability, and terminal digit preferences, 2,3 all of which may bias the accuracy of measurement. Moreover, CBPM cannot detect white-coat hypertension, the prevalence of which can be as high as 30%. 4 There is growing evidence from a number of small studies that ambulatory blood pressure measurement (ABPM) is a better predictor of outcome than CBPM, 5-13 but only one large Japanese population study has shown ABPM to be better predictor of cardiovascular mortality than CBPM. 8 Similarly, evidence is accumulating to demonstrate that nighttime pressure is superior to daytime pressure in predicting cardiovascular outcome. 7,14 -21 The objective of this study, therefore, was to determine the additional predictive value of ABPM over and above CBPM, and also to estimate the superiority of nighttime pressure over daytime pressure in a large Western population of untreated hypertensive patients from a single center followed-up for up to 20 years. Methods Study PopulationThe Blood Pressure Unit (formerly located at the Charitable Infirmary and now based at Beaumont Hospital in Dublin) has been in operation for 22 years. The majority of patients are referred to the Correspondence to Eoin O'Brien,

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ObjectiveWe investigated the association between body mass index (BMI) standard deviation score (SDS) and prenatal exposure to hexachlorobenzene, dichlorodiphenyldichloroethylene (DDE), dioxin-like compounds, and polychlorinated biphenyls (PCBs).MethodsIn this prospective birth cohort study, we assessed a random sample of mother–infant pairs (n = 138) living in Flanders, Belgium, with follow-up until the children were 3 years of age. We measured body mass index as standard deviation scores (BMI SDS) of children 1–3 years of age as well as pollutants measured in cord blood.ResultsDDE correlated with BMI SDS, with effect modification by maternal smoking and the child’s age. At 1 year, children of smoking mothers had higher BMI SDS than did children of nonsmoking mothers. At 3 years, this difference was reduced because of the faster rate of decline in BMI SDS in the former group. This relationship held except for children with high levels of DDE. DDE had a small effect on BMI SDS at 3 years of age in children of nonsmoking mothers (difference in BMI SDS for DDE concentrations between the 90th and 10th percentiles = 0.13). On the other hand, smoking enhanced the relation between DDE and BMI SDS at 3 years (difference in BMI SDS for DDE concentrations between the 90th and 10th percentiles = 0.76). Increasing concentrations of PCBs were associated with higher BMI SDS values at all ages (parameter estimate = 0.003 ± 0.001; p = 0.03).ConclusionIn this study we demonstrated that intrauterine exposure to DDE and PCBs is associated with BMI during early childhood. Future studies are warranted to confirm our findings and to assess possible mechanisms by which these pollutants could alter energy metabolism.

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ASCA is strongly associated with familial CD in Belgium, and 21% of healthy family members also display the marker. The association is much weaker in patients belonging to mixed families. ASCA is a stable marker and is not a secondary phenomenon due to increased intestinal permeability.

Polychlorinated aromatic hydrocarbons (PCAHs) have been described as endocrine disruptors in animals and in accidentally or occupationally exposed humans. In the present study we examined the effect of moderate exposure to PCAHs on sexual maturation. Two hundred adolescents (mean age, 17.4 years) who resided in two polluted suburbs and a rural control area in Flanders (Belgium) participated. We measured the serum concentration of polychlorinated biphenyl (PCB) congeners 138, 153, and 180 and dioxin-like compounds [chemically activated luciferase expression (CALUX) assay] as biomarkers of exposure. School physicians assessed the pubertal development of boys and girls and measured testicular volume. In one suburb near two waste incinerators, compared with the other suburb and the control area, fewer boys (p < 0.001) had reached the adult stages of genital development (62% vs. 92% and 100%, respectively) and pubic hair growth (48% vs. 77% and 100%). Also, in the same suburb, fewer girls (p = 0.04) had reached the adult stage of breast development (67% vs. 90% and 79%). In individual boys, a doubling of the serum concentration of PCB congener 138 increased the odds of not having matured into the adult stage of genital development by 3.5 (p = 0.04); similarly for PCB congener 153 in relation to male pubic hair growth, the odds ratio was 3.5 (p = 0.04). In girls, a doubling of the serum dioxin concentration increased the odds of not having reached the adult stage of breast development by 2.3 (p = 0.02). Left plus right testicular volume was lower in both polluted areas than in the control area (42.4 mL vs. 47.3 mL, p = 0.005) but was not related to the current exposure of the adolescents to PCAHs. Through endocrine disruption, environmental exposure to PCAHs may interfere with sexual maturation and in the long-run adversely affect human reproduction.

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