Accurate,reproducible measurement of blood pressure.

The diagnosis of mild hypertension and the treatment of hypertension require accurate measurement of blood pressure. Blood pressure readings are altered by various factors that influence the patient, the techniques used and the accuracy of the sphygmomanometer. The variability of readings can be reduced if informed patients prepare in advance by emptying their bladder and bowel, by avoiding over-the-counter vasoactive drugs the day of measurement and by avoiding exposure to cold, caffeine consumption, smoking and physical exertion within half an hour before measurement. The use of standardized techniques to measure blood pressure will help to avoid large systematic errors. Poor technique can account for differences in readings of more than 15 mm Hg and ultimately misdiagnosis. Most of the recommended procedures are simple and, when routinely incorporated into clinical practice, require little additional time. The equipment must be appropriate and in good condition. Physicians should have a suitable selection of cuff sizes readily available; the use of the correct cuff size is essential to minimize systematic errors in blood pressure measurement. Semiannual calibration of aneroid sphygmomanometers and annual inspection of mercury sphygmomanometers and blood pressure cuffs are recommended. We review the methods recommended for measuring blood pressure and discuss the factors known to produce large differences in blood pressure readings.     

Comparison of performance of various sphygmomanometers with intra-arterial blood-pressure readings.

Seven types of sphygmomanometer were used in random order on each of nine hypertensive patients and the readings compared with simultaneous intra-arterial blood-pressure recordings. All the devices gave significantly different values for systolic pressure, and only two measured diastolic pressure without significant error. Systolic pressure was consistently underestimated (range 31-7 mm Hg), and all but one instrument overestimated diastolic pressure (range 10-2 mm Hg). The variability of readings was least with the standard mercury sphygmomanometer and the random-zero machine, while with some of the more automated devices single readings were in error up to -68/33 mm Hg. The strong correlations found between intra-arterial and cuff systolic pressures with all devices tested and significant correlations for diastolic pressure with all but one device indicate that, with one possible exception, the sphygmomanometers would give accurate results where a change in blood pressure was the main concern.     

Biosorption of mercury by the inactivated cells of pseudomonas aeruginosa PU21 (Rip64)

Biomass of a mercury-resistant strain Pseudomonas aeruginosa PU21 (Rip64) and hydrogen-form cation exchange resin (AG 50W-X8) were investigated for their ability to adsorb mercury. The maximum adsorption capacity was approximately 180 mg Hg/g dry cell in deionized water and 400 mg Hg/g dry cell in sodium phosphate solution at pH 7.4, higher than the maximum mercury uptake capacity in the cation exchange resin (100 mg Hg/g dry resin in deionized water). The mercury selectivity of the biomass over sodium ions was evaluated when 50 mM and 150 mM of Na(+) were present. Biosorption of mercury was also examined in sodium phosphate solution andphosphate-buffered saline solution (pH 7.0), containing 50mM and 150 mM of Na(+), respectively. It was found that the presence of Na(+) did not severely affect the biosorption of Hg(2+), indicating a high mercury selectivity ofthe biomass over sodium ions. In contrast, the mercury uptake by the ion exchange resin was strongly inhibited by high sodium concentrations. The mercury biosorption was most favorable in sodium phosphate solution (pH 7.4), with a more than twofold increase in the maximum mercury uptake capacity. The pH was found to affect the adsorption of Hg(2+)bythe biomass and the optimal pH value was approximately 7.4. The adsorption of mercury on the biomass and the ion exchange resin appeared to follow theLangmuir or Freundlich adsorption isotherms. (c) 1994 John Wiley & Sons, Inc.     

An in situ study of rock bass (Ambloplites rupestris) physiology: effect of season and mercury contamination

Selected physiological and biochemical variables were examined in rock bass, Ambloplites rupestris, which were collected on five different sampling dates from an area of chronic mercury contamination and a reference site on the South River, Virginia.The onset of spawning represented the most significant seasonal influence in the physiological profile of the fish, with elevations in hematocrit, hemoglobin, plasma protein, and plasma glucose. Sex-related differences in plasma calcium, liver glycogen and liver ascorbic acid were also unique to the period. Female rock bass had significantly higher levels of liver glutathione than did males on all but one of the sampling dates, although the cause of this difference is not clear.Rock bass from the mercury contaminated site had an average muscle mercury concentration of 1.37 mg Hg g^–1, and an average liver mercury concentration of 2.86 mg Hg g^–1. These levels were approximately an order of magnitude greater than those found in the tissues of the reference fish which averaged 0.165 and 0.101 mg Hg g^–1 in muscle and liver respectively. In July 1987, mercury concentrations in the liver of both reference and contaminated fish increased significantly, possibly the result of greater uptake of the metal through increased feeding or changes in the mercury level of selected prey items. Rock bass collected from the two sites in July also had significantly different levels of liver glutathione: reference fish exhibited an elevation and contaminated fish a depression. When fish from the two sampling stations received a 96-hr exposure to 150 µg HgCl₂ in the laboratory, both groups exhibited elevated liver mercury and decreased liver glutathione. Mercury levels in the gall bladders of the exposed fish were also elevated, suggesting that glutathione may have been lost through excretion with the metal in the bile.On the whole, physiological differences between the two groups of rock bass were limited, indicating that exposure to the mercury is not having a significant impact on the rock bass from the contaminated area. This is further supported by field examination of the fish and comparison of condition indices from rock bass previously taken from the same two stations.Those factors which significantly altered the physiology of the rock bass were unique to certain times of the year, indicating that the most appropriate sampling approach in future studies is one which examines a number of variables over a range of environmental conditions.     

Toxic effects of mercury on the hard clam,Meretrix lusoria,in various salinities

1. The 96-hr lc₅₀ values for juvenile hard clams, Meretrix lusoria, were 328, 392 and 194 μg/l Hg in 10, 20 and 30 ppt salinities at 25 ± 1°C, respectively; for adult hard clams 341 and 140 μg/l Hg in 20 and 30 ppt salinities, respectively.2. Acclimatizing the adult clams to low salinity of 10 ppt lessened the toxicity of mercury. However, juvenile animals appeared to be more sensitive to mercury poisoning after 96 hr exposure in 10 ppt salinity.3. All embryos exposed to 40 μg/l Hg and above died within 30 hr. In the control, 44% of hatched embryos had developed into D-stage larvae, while those exposed to 20 μg/l Hg were still in the trochophore stage. Most of the retarded larvae developed into abnormal forms within 30 hr at 28°C in 15 ppt salinity.4. In order to maintain water quality and protect natural resources, the recommended safe level of mercury is 0.046 (0.039–0.053) μg/l Hg, based on the estimated 30-hr EC₅₀ for the clam embryos, with an application factor of 0.01.     

Comparison of the inhibitory effects of mercuric chloride on cytosolic and mitochondrial hexokinase activities in rat brain, kidney and spleen

Hg2+ (10-20 microM), at concentrations comparable to mercury levels reportedly occurring in mercury neurotoxicity (Minamata disease), effectively inhibited both cytosolic (IC50 for Hg2+ = 4.1 microM) and mitochondrial (IC50 for Hg2+ = 1.4 microM) rat brain hexokinases. Kidney (IC50 for Hg2+ approximately equal to 3 microM) and spleen hexokinases were less susceptible to inhibition by Hg2+. IC50 values for Hg2+ in inhibiting cytosolic and mitochondrial spleen hexokinases were 8.9 and 3.1 microM, respectively. In both brain and spleen, mitochondrial hexokinases were more susceptible to inhibition by Hg2+ than cytosolic forms, suggesting that the microenvironment of the mitochondrial membranes may exert some modulatory effects on the properties of hexokinases. These results also suggest that inhibition of glucose utilization may be an important mechanism of tissue damage in mercury poisoning.     

Differential mercury volatilization by tobacco organs expressing a modified bacterial merA gene

INTRODUCTIONEnvironmental pollution is an increasing prob-lem both fOr developing and developed countries.Mercury, both in organic and ionic fOrm, is one of themost hazardous pollutants among the heavy met-als[l]and its accumuIation in human body results ininactivation of metabolic enzymes and structuralproteins[2, 3] giving rise to serious health problems(Minamatasyndrome).Usually mercury pollution is caused by indus-trial and agricultural activities, releasing mercuryinto air, water an…     

Hypertension—Indications,Goals and Potential Risks of Drug Therapy

Double-blind, placebo-controlled studies show that drug treatment of hypertension does not significantly reduce morbidity and mortality at diastolic pressures less than 105 mm of mercury. Nevertheless, most physicians start drug therapy at 90 to 104 mm of mercury. Few reports have dealt with the level to which blood pressure should be reduced. Available data, including reports from two large-scale studies, suggest that excessively low diastolic pressure due to drug therapy may cause an increase in deaths from coronary heart disease. Other studies suggest that reducing diastolic pressure below 100 mm of mercury does not enhance the prevention of complications of hypertension nor the reversal of pretreatment secondary change. Therefore, it is suggested that drug treatment of hypertension should be begun only if diastolic pressure is consistently 105 mm of mercury despite hygienic measures of treatment. A goal diastolic pressure of at least 100 mm of mercury is suggested.     

Bioaccumulation and distribution of mercury in the hard clam,Meretrix lusoria (Bivalvia:Veneidae)

1. Total mercury concentration in whole soft parts of the hard clam, Meretrix lusoria, increased significantly with increasing exposure concentrations. It reached 4.247–7.084 and 9.956–13.643 μg T-Hg/g dry weight in 5 and 50 μg/l Hg mercury solution, respectively, against a background level of 1.824–0.577μg T-Hg/g dry weight.2. Bioconcentration factor was 4–6 times higher in 5 μg/l Hg than that of 50 μg/l Hg. An estimated biological half-life of 20.2 and 18.4 days in 5 and 50 μg/l Hg, respectively, were also obtained after 14 days uptake.3. Accumulation of mercury in tissues of the clams was greater in the gills and viscera than in the mantle, adductor, foot, or hemolymph.4. The amount of mercury present in the gills is related to be a linear relationship with the mercury content of viscera.     

Factors related to first dose hypotensive effect of captopril: prediction and treatment.

The blood pressure response to the first dose of captopril (6.25 mg, 12.5 mg, or 25 mg) was measured in 65 treated, severely hypertensive patients. Mean supine blood pressure was 187/108 mm Hg immediately before captopril was given. Twenty one patients experienced a fall in supine systolic pressure greater than 50 mm Hg, including five whose pressure fell more than 100 mm Hg and two whose pressure fell more than 150 mm Hg. Six patients developed symptoms of acute hypotension, including dizziness, stupor, dysphasia, and hemiparesis. Percentage reductions in blood pressure were greatest in those with secondary hypertension (p less than 0.05), high pretreatment blood pressure (p less than 0.05), and high concentrations of plasma renin and angiotensin II (p less than 0.01). No significant correlation was found between fall in blood pressure and serum sodium concentration, age, renal function, and the dose of captopril given. A severe first dose effect cannot be consistently predicted in individual patients who have received other antihypertensive drugs for severe hypertension. Such patients should have close medical supervision for at least three hours after the first dose of captopril.     

Tn1 generated mutants in the mercuric ion reductase of the Inc P plasmid, R702

Summary Physiological, biochemical and genetic aspects of resistance to inorganic mercury compounds were examined in a group of mercury sensitive derivatives generated in the Inc P plasmid, R702, by Tn1 insertion. Strains carrying each of these insertion mutations had no detectable mercuric ion reductase, were more sensitive to mercuric ion than a plasmidless strain, and exhibited inducible uptake of Hg²⁺. These characteristics indicate that the mutants are altered in the Hg(II) reductase. This hypothesis was supported by complementation and recombination analysis with known point and deletion mutations in the mer operon of the Inc FII plasmid, R100. Such experiments showed that the eight insertions studied had occurred in four distinct regions of the Hg(II) reductase structural gene (merA). Complementation data also demonstrated that the regulatory protein determined by the R702 plasmid has no effect on the expression of the micro-constitutive Hg(II) reductase activity expressed by merR mutants of R100.     

In vitro cultivation of Dipetalonema viteae third-stage larvae: effect of the gas phase

The effect of the gas phase on the in vitro growth and development of Dipetalonema viteae (Nematoda: Filarioidea) third-stage larvae obtained from the tick vector and 3 day infections of jirds was examined. Measurements of the oxygen (pO2) and carbon dioxide (pCO2) tensions and the pH in the medium were made for each gas phase. In cultures gassed with 5% carbon dioxide in nitrogen the pO2 was between 32 and 50 mm Hg, the pCO2 ranged from 25 to 40 mm Hg and the pH was between 7.2 and 7.4. This gas phase resulted in the best growth and development of third-stage larvae to the fourth-stage. Survival and development of larvae were decreased in cultures with oxygen tensions less than 20 mm Hg and greater than 50 mm Hg.     

Blood Pressure in a Scottish Town

As part of a general health screening survey in the Burgh of Renfrew blood pressure was measured in 3,001 subjects (78·8% of those eligible) aged 45 to 64. In 468 (15·6%) diastolic blood pressure was 100 mm Hg or more. A year later the mean blood pressure for those of the population re-examined showed no change, there being an equal number of subjects with increased and decreased pressures. The prognostic significance of those showing the larger fluctuations remains to be determined through medical-record linkage.Examination of the general practitioners'' medical records of 422 of the 468 subjects with diastolic blood pressure of 100 mm Hg or more showed that 255 had no previous documented hypertension. Of the remainder 73 were receiving antihypertensive therapy. Examination of the records of subjects whose blood pressure was under 100 mm Hg showed that 55 were receiving antihypertensive treatment and that another 113 had previously been recorded as having a diastolic blood pressure of 100 mm Hg or more by their general practitioner. Altogether at least 636 (21·2%) of those who were examined had been considered at some time to have evidence of hypertension.The prevalence of undetected hypertension in the general population has important implications for the resources of the National Health Service if current trials show benefit to the health of the community from treating “mild” as well as “moderate” hypertension.     

Studies on the binding of mercury in tissue homogenates

1. This paper describes an attempt to learn more about the binding of Hg(2+) to tissues at pharmacological concentrations of this metal. Other methods were not applicable to such low concentrations of mercury. 2. The method involved equilibrium dialysis of Hg(2+) against 1% homogenates of rat kidney or liver in the presence of penicillamine. Two classes of mercury-binding sites were observed, one class having a chemical affinity for mercury 100-fold greater than the other class. The binding capacities of the class of higher and lower affinity were respectively 1.0x10(-7) and 30x10(-7)mole of mercury/g. wet wt. of tissue. The same classes of binding sites were found in both liver and kidney homogenates. 3. The binding sites of both classes reacted with only one valency of Hg(2+), the other valency forming a bond with penicillamine. Thus the total binding capacities of both classes are equivalent to 50% of the total reactive protein-bound thiol groups in the homogenate. 4. The results eliminate three possible mechanisms for the preferential accumulation of mercury by kidney. They support the idea that the permeability changes in kidney cells resulting in diuresis are similar to the permeability changes produced on the membranes of other mammalian cell species by mercury.     

Early influences on blood pressure: a study of children aged 5-7 years.

OBJECTIVE--To examine factors that influence blood pressure in children. DESIGN--Cross sectional study of children aged 5.0-7.0 years who had blood pressure measurements and for whom parental questionnaires were completed. SETTING--School based survey. SUBJECTS--3591 Children aged 5.0-7.5 years selected by stratified random sampling of primary schools in nine British towns (response rate 72%); 3591 were examined and their parental questionnaires were completed. Data were complete for birth rank in 3559, maternal age in 3542, maternal history of hypertension in 3524, and paternal history in 2633. RESULTS--Birth weight was inversely related to mean systolic blood pressure but only when standardised for current weight (weight standardised regression coefficient -1.83 mm Hg/kg (95% confidence interval -1.31 to -2.35). Mean diastolic pressure was similarly related to birth weight. Maternal age, birth rank, and a parental history of hypertension were all related to blood pressure. After standardisation for current weight a 10 year increase in maternal age was associated with a 1.0 mm Hg (0.4 to 1.6) rise in systolic pressure; first born children had systolic blood pressure on average 2.53 mm Hg (0.81 to 4.25) higher than those whose birth rank was greater than or equal to 4; and a maternal history of hypertension was associated with a systolic pressure on average 0.96 mm Hg (0.41 to 1.51) higher than in those with no such history. The effects described were largely independent of one another and of age and social class. The relation for birth rank was, however, closely related to that for family size. CONCLUSIONS--Influences acting in early life may be important determinants of blood pressure in the first decade. The relation between birth weight and blood pressure may reflect the rate of weight gain in infancy. The reasons for the relation with birth rank and maternal age are unknown; if confirmed they imply that delayed motherhood and smaller family size may be associated with higher blood pressure in offspring.     

Effects of methylmercury and mercuric chloride on preimplantation mouse embryos in vivo

This report compares the effects of methylmercuric chloride (MMC) and mercuric chloride (MC) on the development of mouse preimplantation embryos in vivo. Female mice were injected with a single intravenous dose of 0.5-20.0 mg Hg/kg MMC or 0.5-2.5 mg Hg/kg MC on day 0 of gestation. The embryos were recovered by flushing excised oviduct and uterus on day 3.5 of pregnancy, and were examined for abnormalities. In the groups treated with doses of 0.5 and 1.0 mg Hg/kg of both compounds, the rates of abnormal embryos were not significantly different from that in the control group. The 50% effective dose of MMC was twice as great as that of MC. With increasing dose, the difference became more obvious; the 80% effective doses differed by a factor of ten. The body weight of dams decreased in terms of the dose of mercury in MC-treated groups, but did not vary in MMC-treated groups. The sensitive developmental stage for mercury toxicities could not be determined clearly, although the high sensitivity was reported in the blastocyst stage in vitro. The embryos treated in vivo were less sensitive than those reported in vitro.     

Gas Exchange of Algae: II. Effects of Oxygen, Helium, and Argon on the Photosynthesis of Chlorella pyrenoidosa

Changes in the oxygen partial pressure of air over the range of 8 to 258 mm of Hg did not adversely affect the photosynthetic capacity of Chlorella pyrenoidosa. Gas exchange and growth measurements remained constant for 3-week periods and were similar to air controls (oxygen pressure of 160 mm of Hg). Oxygen partial pressures of 532 and 745 mm of Hg had an adverse effect on algal metabolism. Carbon dioxide consumption was 24% lower in the gas mixture containing oxygen at a pressure 532 mm of Hg than in the air control, and the growth rate was slightly reduced. Oxygen at a partial pressure of 745 mm of Hg decreased the photosynthetic rate 39% and the growth rate 37% over the corresponding rates in air. The lowered metabolic rates remained constant during 14 days of measurements, and the effect was reversible after this time. Substitution of helium or argon for the nitrogen in air had no effect on oxygen production, carbon dioxide consumption, or growth rate for 3-week periods. All measurements were made at a total pressure of 760 mm of Hg, and all gas mixtures were enriched with 2% carbon dioxide. Thus, the physiological functioning and reliability of a photosynthetic gas exchanger should not be adversely affected by: (i) oxygen partial pressures ranging from 8 to 258 mm of Hg; (ii) the use of pure oxygen at reduced total pressure (155 to 258 mm of Hg) unless pressure per se affects photosynthesis, or (iii) the inclusion of helium or argon in the gas environment (up to a partial pressure of 595 mm of Hg).     

Defects in sphygmomanometers: an important source of error in blood pressure recording.

Almost half the sphygmomanometers in a teaching hospital group had defects in the control valve which interfered with accurate blood-pressure reading. Ward staff should be taught to check sphygmomanometers regularly and replace control valves; time consumption and cost are low. The cuffs in general use in these hospitals, and of the standard size sold in Britain, had rubber bags which did not encircle the arm of more than half the patients on whom they were used. This deficiency causes over-reading of blood pressure in obese people. The size of error is uncertain but it should be avoided by adopting a cuff with a longer bag.     

Dynamics of oxygen tension in the brain and subcutaneous adipose tissue of newborn rats during anoxia and reoxygenation

The oxygen tension (pO2) in the brain and subcutaneous tissue of newborn rats was studied during anoxia and reoxygenation with hyperoxic gas mixtures. The level of pO2 in both tissues during anoxia fell from 10-30 mm Hg to 0 mm Hg. When newborn rats were reoxygenated with 50% or 100% O2, the oxygen tension in the brain and subcutaneous first increased and then decreased in spite of the hyperoxic inhalation. The decrease of pO2 in the subcutaneous during hyperoxia was more pronounced than that in the brain. Data obtained are discussed.     

Assessment of Total and Organic Mercury Levels in Blue Sharks (Prionace glauca) from the South and Southeastern Brazilian Coast

Mercury occurrence was evaluated in samples of edible muscle tissue of 27 blue sharks (Prionace glauca) caught in the Atlantic Ocean, adjacent to the south and southeastern Brazilian coast, indicating a slight increase in comparison with previous data obtained for the same studied area and being higher than those fish caught at different sites of the Atlantic Ocean. Total Hg concentrations ranged from 0.46 to 2.40 mg kg^?1 with the organic Hg fraction ranging between 0.44 and 2.37 mg kg^?1. A negative correlation between total Hg concentration in muscle tissue and blue shark size was obtained, and 40 % of samples analyzed had Hg concentrations higher than 1.0 mg kg^?1 Hg, the maximum concentration permitted in Brazilian predator fish. Data obtained showed that total Hg can be used as a reliable predictor of organic Hg in blue shark muscle because 95 to 98 % of the total Hg measured was found to be organic mercury. The wide range of Hg concentrations obtained for our set of samples can be explained by the heterogeneity of sampled population and the large size of the studied area. Given the adverse toxicological effects of Hg on animals and humans, a regular monitoring program of Hg contamination in Brazilian marine ecosystem can be recommended.