© 2004 American Thoracic Society
Nose and Blood PressureTo the Editor:We were able to replicate and extend the findings of Kony and colleagues (1) who reported an association between rhinitis and elevated systolic blood pressure (BP) in men. We will briefly describe our analysis, discuss a mechanism (sleep-disordered breathing [SDB]) that Kony and colleagues speculated might be involved in their reported association, and address the issue of acute congestion versus seasonal/chronic rhinitis. Our data are from the Wisconsin Sleep Cohort, an epidemiologic study of the natural history of polysomnographically assessed SDB in adults. Our methods for measuring BP, SDB, and other variables are described elsewhere (2, 3). Participants were asked two questions concerning nasal congestion and rhinitis: (1) did the participant have acute nasal congestion at the time of laboratory study?; and (2) did the participant have frequent nasal stuffiness due to participant-specified causes including seasonal or perennial allergic rhinitis, illness, or anatomic factors? Using multiple linear regression models, we examined cross-sectional associations between congestion/rhinitis and BP. Analogous to the approach of Kony and colleagues, we adjusted for age, body mass index, hypercholesterolemia, smoking, and medications used for respiratory conditions that have potential pressor effects. We further adjusted for SDB (snoring and the apnea–hypopnea index) to address Kony and coworkers' speculation that SDB might be a mechanism by which rhinitis affects BP. We obtained the following results:
We find this last result surprising because, as Kony and colleagues pointed out, positive associations between congestion and SDB, as well as between SDB and BP, have been reported (3, 4). Our findings suggest that if the rhinitis–BP association is causal, mechanisms other than SDB may be primarily responsible.
Department of Population Health Sciences University of Wisconsin-Madison Madison, Wisconsin REFERENCES
To the Editor: In a population-based study of 330 French adults, Kony and colleagues (1) found that men with rhinitis had higher systolic blood pressure and greater frequency of hypertension than men without rhinitis. Using data from 9,134 individuals sampled from the Danish general population (2), however, we were not able to confirm these results. In our analysis, after adjusting for the same four potential confounders as in the study by Kony and colleagues (1), systolic blood pressure was 140 ± 1.7 mm Hg (mean ± SEM) in men with rhinitis (n = 390) versus 141 ± 1.4 mm Hg in men without rhinitis (n = 3,569). Furthermore, the odds ratio for hypertension in men with rhinitis versus those without rhinitis was not increased after adjustment for age, body mass index, hypercholesterolemia, and smoking status (odds ratio: 0.81; 95% confidence interval: 0.64–1.03). Finally, when analyses were performed in men without self-reported asthma alone, or after stratification for smoking habits, the nonsignificant reduction in systolic blood pressure remained, in contrast to the data reported by Kony and colleagues (1). Similar results were observed among women. In our study, rhinitis was based on an affirmative answer to the question "Does food, medicine, grass, animals, etc. give you hay fever?," whereas blood pressure was measured in the sitting position using similar methods as in the study by Kony and colleagues (3). Hypertension was diagnosed if systolic blood pressure was 140 mm Hg or more, diastolic blood pressure was 90 mm Hg or more, or if participants took antihypertensive medication. In conclusion, the association between rhinitis and systolic blood pressure in men does not apply to the Danish population. Thus, it can be questioned whether men with rhinitis should have regular blood pressure checks as previously suggested (1).
a Department of Clinical Biochemistry Herlev and Copenhagen University Hospitals Copenhagen, Denmark FOOTNOTES Grant support: Supported by the Danish Lung Association and the Danish Heart Foundation. REFERENCES
From the Authors: We appreciate that researchers investigated the association between rhinitis and blood pressure that we found as part of the European Community Respiratory Health Survey follow-up (ECRHS-II) (1). Using data from an epidemiologic study of the natural history of polysomnographically assessed sleep-disordered breathing in the United States (2), Peppard and colleagues confirmed our results, whereas Dahl and associates, using data from a Danish population-based sample (3), did not. The consistency of the results of Peppard and coworkers with ours is striking and greatly reinforces the confidence in our results. Like us, they did not find any relation between rhinitis and blood pressure in women, whereas they did find a difference of systolic blood pressure between men with and men without rhinitis, a difference similar to that observed in our study. Dahl and colleagues did not confirm this result. We believe that neither the differences in population characteristics nor the way blood pressure was measured can explain the difference of results. Rather, the difference in the definition of rhinitis is, to our mind, of capital importance. The epidemiologic definition of rhinitis that we used (to have nasal allergies, including hay fever) was used in several other population-based studies (4, 5) and validated by different ways: (1) it is referenced in the recommendations from "Allergic Rhinitis and its Impact on Asthma" and the World Health Organization (6); (2) most of the subjects that reported rhinitis also answered "yes" to at least one of three other questions from our questionnaire defining seasonal/perennial rhinitis; (3) the subjects of our study were all examined for the first time 10 years ago: there was a strong association between the self-reported rhinitis of the first and second examinations (p < 0.0001); (4) atopy was strongly associated with self-reported rhinitis (4). Furthermore, the question used by Dahl and colleagues, "Does food, medicine, grass, animals, etc., ... give you hay fever?," might define a very heterogeneous group: subjects with occasional symptoms and subjects with seasonal or chronic symptoms. Besides, we wondered whether the term "hay fever" was adequate when related to causes like food or medicine, and whether "nasal allergy" was more appropriate. We believe that it is of great interest to perform further studies to confirm the association between rhinitis and blood pressure.
INSERM U408 Epidémiologie des Maladies Respiratoires Faculté de Médecine Xavier Bichat Paris, France REFERENCES
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