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Biomedical subjects

A E Fletcher

Publications and source records attributed to A E Fletcher.

At least 109 records · Page 6Linked to original sources
PubMed1990

Quality of life on antihypertensive therapy: a randomized double-blind controlled trial of captopril and atenolol.

A randomized double-blind study lasting 2 months was performed with either 25 mg captopril twice a day or 50 mg atenolol once a day in 125 patients with established diastolic hypertension (diastolic blood pressure greater than 95 mmHg) identified during a population screening programme of subjects aged less than 65 years. Quality of life was assessed from self-completed questionnaires. A significant fall in diastolic blood pressure occurred with both captopril (106.7 +/- 7.0 to 98.6 +/- 8.6 mmHg) and atenolol (107.4 +/- 7.5 to 98.2 +/- 8.1 mmHg) but there was no difference between the two drugs in the size of the fall. A measure of the number of symptomatic complaints, the symptom complaint rate, decreased with both drugs, by 1.3% for captopril and 3.1% for atenolol, but the difference between the drugs was not significant [1.8%; 95% confidence interval (Cl) - 1.3%, 4.9%]. There was a significant increase in the reporting of cough and runny nose in those on captopril compared with atenolol. A health index increased by 1.1% with captopril in comparison with no change on atenolol (difference 1.1%; 95% Cl - 2.0%, 4.2%). Psychological well-being was measured using the Symptom Rating Test. The improvement in total score was 1.4% with captopril and 2.3% with atenolol. The difference of 0.9% was not statistically significant (95% Cl - 1.2%, 3.0%).(ABSTRACT TRUNCATED AT 250 WORDS)

Affect↗
PubMed1990

Mortality associated with captopril and enalapril: a report from the DHSS Hypertension Care Computing Project.

In 1986, the Committee on Safety of Medicines published a report suggesting that enalapril may have an adverse effect on renal function. The prescription event monitoring scheme subsequently published figures on adverse drug reactions and mortality for patients treated with enalapril. They concluded that enalapril did not have an adverse effect on renal function and survival. Similar data were not available for captopril, as the drug was marketed before prescription event monitoring had been developed. In the Department of Health and Social Security (DHSS) Hypertension Care Computing Project (DHCCP), 368 hypertensive patients treated with captopril and 371 treated with enalapril were followed for an average of 3.1 and 1.6 years, respectively. Thirty-two patients died; none had renal failure as an underlying cause of death. The death rate was similar in both drug groups, at 17.5 (enalapril) and 24.0 (captopril) per 1000 patient-years. The present report shows that, for patients treated for high blood pressure, the relative risk of mortality with captopril compared with enalapril was 1.37, an insignificant difference (95% confidence interval 0.63, 2.98).

Acute Kidney Injury↗
PubMed1990

Blood lead concentration, renal function, and blood pressure in London civil servants.

Blood lead concentration was measured in 398 male and 133 female London civil servants not subject to industrial exposure to heavy metals. The relation between blood lead and serum creatinine concentrations and blood pressure were examined. Blood lead concentration ranged from 0.20 to 1.70 mumol/l with a geometric mean concentrations of 0.58 mumol/l in men and 0.46 mumol/l in women (p less than 0.001). In women blood lead concentration increased with age (r = +0.27; p = 0.002). In the two sexes blood lead concentration was positively correlated with the number of cigarettes smoked a day (men r = +0.17 and women r = +0.22; p less than or equal to 0.01), with the reported number of alcoholic beverages consumed a day (men r = +0.34 and women r = 0.23; p less than 0.01), and with serum gamma-glutamyltranspeptidase (men r = +0.23 and women r = +0.14; for men p less than 0.01). Blood lead concentration was not correlated with body weight, body mass index, and employment grade. In men 14% of the variance of blood lead concentration was explained by the significant and independent contributions of smoking and alcohol intake and in women 16% by age, smoking, and alcohol consumption. In men serum creatinine concentration tended to rise by 0.6 mumol/l (95% confidence interval from -0.2 to +1.36 mumol/l) for each 25% increment in blood lead concentration. In men and women the correlations between blood lead concentration and systolic and diastolic blood did not approach statistical significance. In conclusion, in subjects not exposed to heavy metals at work gender, age, smoking, and alcohol intake are determinants of blood lead concentration. At a low level of exposure, lead accumulation may slightly impair renal function, whereas blood pressure does not seem to be importantly influenced. Alternatively, a slight impairment of renal function may give rise to an increase in blood lead concentration.

Alcohol Drinking↗
PubMed1990

Should medical screening of the elderly population be promoted?

This article reviews the history of screening in the elderly, the conditions that should be considered, whether or not screening in the elderly is of benefit, whether we should look for disability or diseases and where screening should take place. Thirteen conditions are discussed: hearing loss and anaemia in some detail. Both disability and precise diagnostic criteria are considered. The place where screening is best carried out depends on the mobility of the subject and the nature of the particular screening tests selected for the 13 conditions. The desirability of screening was assessed on the following criteria: prevalence of the condition, severity of the problem, acceptability by the patient of the screening test, false positive rate, consequences of making a false positive diagnosis, the false negative rate and the consequences of this error, the effect of treatment, the cost of the screening test and the burden on the health services produced by the screening test. The criteria were scored 1-5 on a scale defined for each assessment, with higher scores favouring screening. We provide evidence that screening may be worthwhile for: need for chiropody, varicose veins/ulcer, hearing loss, obesity, visual impairment, hypothyroidism, hypertension, anaemia and diabetes mellitus. However, the assessments discussed in this paper need to be tested prospectively in randomised controlled trials.

Aged↗
PubMed1990

Drug treatment and quality of life in the elderly.

The QL of patients on long-term pharmacologic treatment needs to be evaluated, especially in the elderly. This article discusses how this should be done and gives the results of studies on three groups of drugs commonly taken by elderly patients. Diuretic treatment does not appear to grossly impair QL, transdermal nitrates for angina do impair QL if used continuously, and tolerance limits their efficacy. Antihypertensive drugs appear to vary widely in their effects on QL. Drugs such as ACE inhibitors, verapamil, and atenolol appear preferable to the older drugs such as methyldopa and the beta-blocker propranolol, which have a central action.

Aged↗
PubMed1989

Effects of calcitonin gene-related peptide on cyclic AMP formation in chicken, rat, and mouse bone cells.

Mixed bone cell cultures obtained by sequential collagenase-trypsin digestion of newborn chick, rat, and mouse calvaria responded to calcitonin gene-related peptide (CGRP) with a dose-dependent increase in cyclic AMP formation. The amplitude of response to CGRP in each species was less than that to parathyroid hormone (PTH). The CGRP effect was not the result of an action as a weak calcitonin agonist, since in most instances a calcitonin effect was not observed. Only in early digests of mouse calvarial cells were consistent stimulatory effects of calcitonin on cyclic AMP noted, and these were always considerably less in amplitude than those to CGRP. It is concluded that chick, rat, and mouse bones contain cells in osteoblast-rich populations that respond specifically to CGRP with a rise in cyclic AMP.

Animals↗
PubMed1989

Antihypertensive drugs and quality of life in the elderly.

In this article, the issues involved in the measurement of quality of life (QL) in clinical trials of anti-hypertensive drugs in the elderly are discussed. The specific choice of areas of QL to measure will be influenced by such factors as the length of the trial and the expected adverse effects or benefits of treatment. In measuring QL one should use methods that are valid, repeatable, and sensitive to change. With the elderly, interviewer-administered methods are preferable to self-administered ones, as subjects in poor health or with reading problems should be included. Interpretation of the results from the pilot trial of the Systolic Hypertension in the Elderly Program (SHEP) are discussed.

Aging↗
PubMed1989

The effects of verapamil and propranolol on quality of life in hypertension.

Quality of life was evaluated in a four-month randomised double-blind trial of verapamil compared with propranolol in the treatment of hypertension in 94 patients in the UK. Scores on a health status index, measuring activity and perceived health, increased in verapamil patients compared to a decrease in propranolol patients (P = 0.01). Measures of psychiatric morbidity also tended to improve with verapamil and deteriorate with propranolol. Propranolol patients reported more symptoms overall compared with verapamil (P less than 0.05). The prevalence of certain symptoms--headaches, weak limbs and slower walking pace, increased significantly with propranolol compared with verapamil, but constipation was more common in verapamil patients (P less than 0.05). After four months, diastolic blood pressure averaged 86.2 mmHg with verapamil and 90.3 mmHg with propranolol (P = 0.02). However, this difference in final blood pressure did not explain the more favourable quality of life scores with verapamil, and the data suggest that health-related well-being is higher with this drug.

Adult↗
PubMed1988

Importance of well-being to hypertensive patients.

Well-being may be adversely affected in hypertensive patients by the disease process and its complications, other concomitant diseases, especially depression and anxiety, and the treatment prescribed. The adverse consequences of both pharmacologic and nonpharmacologic treatment are discussed, with emphasis on the psychologic consequences of such treatment. The wider impact of side effects on the daily lives of patients is discussed--the quality-of-life approach. Areas considered include work performance and leisure activities. The problem of interpreting any changes in quality-of-life measures is considered.

Antihypertensive Agents↗
PubMed1988

The effect of withdrawing antihypertensive therapy: a review.

In this report the effects of withdrawing antihypertensive medication are reviewed from case reports and randomized trials. Success, defined as the proportion of patients remaining normotensive after withdrawal of medication varied from 15% to over 50%. Factors that predicted the return of high blood pressure after withdrawal, however, included high level of pre-treated blood pressure, marked obesity, short duration of treatment and left ventricular hypertrophy (LVH). Male patients also tended to be more likely to return to having high blood pressure than female patients. In community studies, it is predicted that many subjects will not be suitable candidates for withdrawal or treatment in view of their high blood pressures (both treated and pre-treated), obesity, and also their unwillingness to stop therapy.

Antihypertensive Agents↗
PubMed1988

Treated blood pressure, rather than pretreatment, predicts survival in hypertensive patients. A report from the DHSS Hypertension Care Computing Project (DHCCP).

A group of hypertensive patients (n = 2855) with an untreated diastolic blood pressure greater than or equal to 90 mmHg were followed in the Department of Health and Social Security (DHSS) Hypertension Care Computing Project (DHCCP) for periods of up to 10 years. During this period 191 of these patients died. Survival was assessed in relation to pretreatment blood pressure levels and blood pressure achieved during treatment. The blood pressure during treatment was a useful predictor of mortality, but the pretreatment pressure was not. After adjusting for age, mortality was particularly related to the height of the systolic and diastolic blood pressure during the second and third years of treatment. In men, age-standardized 5-year mortality was greater than 10% in those with a first year treated systolic pressure greater than 150 mmHg or a diastolic pressure greater than 95 mmHg. In women, age standardized 5-year mortality was greater than 5% with the same levels of treated blood pressure. The longest survival occurred with the lowest bands of treated pressure, i.e. systolic pressure less than 140 and diastolic pressure less than 90 mmHg; the 5-year mortality being less than 7% in men and less than 3% in women. Treated systolic and diastolic pressures were useful in predicting death from ischaemic heart disease (IHD).

Blood Pressure↗
PubMed1988

Measurement of quality of life in clinical trials of therapy.

This article discusses some of the issues involved in the use of quality of life methods to evaluate treatment, primarily in trials of cardiovascular disease. The choice of aspects to measure is influenced by the severity and nature of the disease, the expected benefits and adverse effects of treatment and pragmatic considerations such as the length of the trial, and availability of the methods. The choice of specific instruments should take account of good measurement criteria such as validity and reliability, and, most importantly, sensitivity to the effects of treatment. The advantages and disadvantages of interviewer and self-completed questionnaires are discussed. The choice of respondent is primarily the patient. In some circumstances it may be appropriate to also include family members, either for their views on the patient, or for an assessment of their own quality of life as this may also be disrupted. Withdrawals are a major problem in the analysis of all trial results. The inclusion of a Health Index is one method of obtaining quality of life scores from patients who withdraw or die. The interpretation of quality of life results from trials is not simple, for example, the benefit of trial inclusion needs to be distinguished from the effect of treatment. Moreover, changes in quality of life scores should correspond to changes in the patients' own experiences of their daily lives.

Clinical Trials as Topic↗
PubMed1988

Effect of treatment on the quality of life in hypertension and congestive heart failure.

The objective in the treatment of hypertension is to preserve the quality of life. Most patients with hypertension do not have any impairment to their quality of life and the objective of treatment is to preserve this well-being. The results of trials in Europe and in the USA are discussed in this communication. At entry to the European trials, younger men appeared to have a better quality of life than older hypertensive men but older hypertensive women appeared, in some respects, to have a better quality of life than younger women. Following treatment the younger patients, aged less than 60 years, appeared to improve most with captopril and did not improve with methyldopa. However, in contrast, the elderly patients appeared to improve with both methyldopa and captopril. A large American trial confirmed that in white working men with hypertension the quality of life was best with treatment with captopril, least good with methyldopa and intermediate with propranolol. With congestive heart failure there are very few studies on the quality of life that can be discussed. However, Lipkin and Poole-Wilson did review the changes in exercise capacity with different drugs employed for the treatment of congestive heart failure. They assessed 16 trials that included the New York Heart Association Classification as an outcome. The reviewers did not consider that the inotropic agents improved exercise capacity. They considered that some of the trials supported a benefit from vasodilator treatment and that the four trials which assessed angiotensin-converting enzyme inhibitor therapy all showed an improvement in exercise capacity.(ABSTRACT TRUNCATED AT 250 WORDS)

Antihypertensive Agents↗
PubMed1988

Measurement of the quality of life in congestive heart failure--influence of drug therapy.

In cardiovascular diseases such as hypertension, drug therapy may improve survival and the drug of choice is the one that interferes least with health-related well-being, otherwise known as the quality of life. However, in angina, and possibly congestive heart failure, a drug may improve well-being but not survival. In this instance, the measurement of the quality of life is the endpoint in any therapeutic intervention. When selecting dimensions of quality of life and the methods to measure these dimensions, the key issue is the detection of a response to treatment during the trial. The sensitivity of a variety of methods appropriate to hypertension, angina, and congestive heart failure are considered. Overall, the quality of life should be assessed by double-blind, randomized, controlled trials, with a health index included to take account of any mortality and morbidity that occurs during the trial. Validity and repeatability of measures are most important, both within populations and across cultures. Observer bias must be avoided.

Heart Failure↗