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Biomedical subjects

C J Bulpitt

Publications and source records attributed to C J Bulpitt.

At least 181 records · Page 10Linked to original sources
PubMed1988

Pulse rate and twenty-four hour urinary sodium content interact to determine blood pressure levels of male London civil servants.

Blood pressures, pulse rates and 24-h urinary electrolyte content were measured in 371 male and 125 female randomly selected civil servants. The male and female subjects were divided into nine subgroups each, by tertiles of sodium (Na) excretion and tertiles of pulse rate. Those in the subgroup with highest values for both variables had the highest mean systolic and diastolic blood pressure (adjusted to age 50 years and a body mass index of 25 kg/m2) among the male and female groups, and those in the subgroup with lowest values for both variables had the lowest systolic pressure among the male and female groups and the lowest diastolic pressure of the female groups. Both systolic and diastolic blood pressure were significantly related to an interaction term between urinary Na excretion and pulse rate among males (P less than 0.02, P less than 0.03 respectively). These data support the hypothesis that psychological stress (assessed by pulse) and dietary sodium (assessed by sodium excretion) may interact to determine levels of blood pressure.

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

Responders and non-responders to antihypertensive treatment.

Responders to antihypertensive treatment have been defined as any patient with a fall in mean arterial pressure, however small; any patient with a fall in mean arterial pressure of 5%, 10% or greater; and any patient achieving a goal blood pressure, usually a diastolic pressure less than 90 mm Hg. Non-responders are normally defined as those who do not fit into the category of a responder. Blood pressure, however, varies considerably during follow-up, and diastolic pressure has a within-subject standard deviation of 8 mm Hg. Blood pressure varies according to environmental factors such as temperature, diet and stress, and tends to drift downwards during follow-up as the patient becomes accustomed to having blood pressure taken, to the place of measurement and to the observer. In a statistical sense, responders may be defined as the 2.5% with a fall in DBP greater than 16 mm Hg, yet in clinical studies of a low sodium diet reports have indicated that 50% have experienced an increase in pressure and 50% a fall (responders). Although the characteristics of those with a fall in pressure are of interest and should be compared with those who do not respond, a 50:50 division is unlikely to help. Methods of identifying true responders and non-responders are discussed in this brief review, along with the errors that may arise from a misclassification and problems of conducting further trials of treatment on the non-responders.

Antihypertensive Agents↗
PubMed1988

Responders to antihypertensive treatment: how may they be identified?

The identification of responders to antihypertensive treatment is valuable as an aid to management, in determining the characteristics of a responder and as a measure of treatment efficacy. This paper discusses the various methods of identifying a responder and the factors influencing response, including the placebo factor and regression to the mean. Response is also discussed in terms of fall in systolic and diastolic pressure. Antihypertensive drugs that have a greater effect on systolic pressure rather than on diastolic pressure are identified, for example methyldopa; and drugs with more equal effects on systolic and diastolic pressure, such as verapamil, are also identified. If it is proven that isolated systolic hypertension requires active treatment it is important to identify those drugs with a greater effect on systolic pressure.

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↗
PubMed1988

The relationship between a low treated blood pressure and IHD mortality: a report from the DHSS Hypertension Care Computing Project (DHCCP).

The suggestion that treating blood pressure to below a certain level may increase IHD mortality is controversial. We investigated the influence of treated blood pressure on mortality in the DHSS Hypertension Care Computer Project. Mortality was examined by quintiles of treated diastolic blood pressure (DBP) in 2,145 patients treated for a minimum period of one year and subsequently followed for an average of four years. One hundred and seventy five patients died; 71 from IHD. In men and women all cause mortality increased with level of treated DBP. In men IHD mortality showed a U-shaped distribution with an age-adjusted rate of 15.2 per 1,000 person years in the lowest fifth (DBP less than 86 mmHg) comparable to that of 15.6 per 1,000 in the upper (DBP greater than or equal to 103 mmHg). A similar pattern could not be established in women due to very few IHD deaths. IHD mortality was further examined separately for men by prior history of IHD. An increase in IHD deaths in the lowest fifth of treated blood pressure was found for men both with and without a history of IHD. No similar pattern of IHD mortality was obtained for untreated DBP or treated systolic pressure. However, we cannot exclude the possibility that the risk of low treated DBP is secondary to ischaemic heart disease.

Age Factors↗
PubMed1987

Prognosis in adult asthma: a national study.

Although one million people consult their general practitioners for asthma each year, data on the prognosis of this disease are scarce, particularly in adults. Mortality was studied among 2547 adult asthmatics attending a national sample of 60 general practices between 1970 and 1976; they were compared with a matched group of non-asthmatic patients. Mortality from all causes was significantly raised in the asthmatic cohort (189 deaths v 112 among controls; relative risk 1.61, 95% confidence interval 1.3 to 2.0), especially in women (92 v 42 deaths; relative risk 2.2 (1.5 to 3.1)), and in the oldest age group (55-59 years). In both sexes the predominant cause of excess mortality was respiratory disease, particularly asthma (25 v 0 deaths) and chronic obstructive airways disease (37 v 4 deaths; relative risk 8.8 (2.8 to 23)). Overall, 94% of the asthmatic cohort survived the mean follow up period of eight years compared with 96% of the controls. In contrast to previous findings, the risk of death due to malignant neoplasms was not significantly reduced overall (34 v 36 deaths), though the risk was significantly reduced among those aged under 45 years (2 v 10 deaths; relative risk 0.2 (0.02 to 0.9)) and there was a significant trend of lowering of relative risk with younger age (p less than 0.01).

Adult↗
PubMed1987

Evaluation of quality of life in clinical trials of cardiovascular disease.

There is an increasing interest in the use of quality of life methods to assess the benefits of treatment in cardiovascular disease. When selecting dimensions of quality of life and the instruments to measure these dimensions, the key issue is the detection of a response to treatment during the trial. The sensitivity of a variety of instruments appropriate to hypertension, angina and congestive heart failure is reviewed. Quality of life should be assessed in double blind randomized controlled trials. A Health Index must be included to take into account any mortality and morbidity occurring during the trial. Data are presented on the measurement of quality of life in patients taking placebo prior to entering trials of antihypertensive treatment. The variation with age, sex and nationality is discussed. Also reported are the results arising from observer bias in a single-blind trial.

Angina Pectoris↗
PubMed1987

The contribution of a moderate intake of alcohol to the presence of hypertension.

The relationship between blood pressure and alcohol intake was examined in 2434 male and 1608 female London civil servants. These subjects had been selected from 24,000 office workers on the basis of responses to a health questionnaire. The men had an average blood pressure of 134/80 mmHg and consumed a mean of 62 g alcohol/week as beer, 28 g/week as wine or fortified wine and 18 g/week as spirits (a total of 11.8 drinks/week). The women had an average blood pressure of 133/79 mmHg and consumed 7 g alcohol/week as beer, 25 g/week as wine and 11 g/week as spirits (a total of 4.4 drinks/week). Twenty-five per cent of men and 24% of women had a casual diastolic pressure equal to or greater than 90 mmHg and were considered to have diastolic hypertension on the one occasion. There was no increase in either systolic or diastolic pressure in men until total alcohol intake exceeded 50 drinks/week. However, 1% of all men had hypertension associated with drinking alcohol and in those with hypertension, alcohol may have been the cause in between 4 and 9%. Defining 'hypertension' as a diastolic blood pressure of 90 mmHg or above on one occasion, 12-14% of people drinking more than 50 drinks of alcohol per week had hypertension associated with this intake of alcohol, and similarly, of those with both 'hypertension' and this level of intake, 36% could attribute their high blood pressure to their alcohol consumption.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

The effects of antihypertensive therapy on the quality of life.

We conducted a multicenter randomized double-blind clinical trial among 626 men with mild to moderate hypertension to determine the effects of captopril, methyldopa, and propranolol on their quality of life. Hydrochlorothiazide was added if needed to control blood pressure. After a 24-week treatment period, all three groups had similar blood-pressure control, although fewer patients taking propranolol required hydrochlorothiazide. Patients taking captopril alone or in combination with a diuretic were least likely to withdraw from treatment because of adverse effects (8 percent vs. 20 percent for methyldopa and 13 percent for propranolol). The treatment groups were similar in scores for sleep dysfunction, visual memory, and social participation. However, patients taking captopril, as compared with patients taking methyldopa, scored significantly higher (P less than 0.05 to less than 0.01) on measures of general well-being, had fewer side effects, and had better scores for work performance, visual-motor functioning, and measures of life satisfaction. Patients taking propranolol also reported better work performance than patients taking methyldopa. Patients taking captopril reported fewer side effects and less sexual dysfunction than those taking propranolol and had greater improvement (P less than 0.05 to less than 0.01) on measures of general well-being. Our findings show that antihypertensive agents have different effects on the quality of life and that these can be meaningfully assessed with available psychosocial measures.

Adult↗
PubMed1986

The relationship between both sodium and potassium intake and blood pressure in London Civil Servants. A report from the Whitehall Department of Environment Study.

The relationship was examined in 459 male London Civil Servants between the casual lying systolic and diastolic (phase V) blood pressures measured in the clinic, and 24-hr urinary sodium and potassium excretion collected an average of 6 weeks later. Systolic and diastolic pressures, after adjusting for age and weight, were both negatively associated with the 24 hr potassium excretion (r = -0.17 [p less than 0.001, 95% confidence limits -0.07, -0.27) and r = -0.11 (p less than 0.05, 95% CL 0.00, -0.21) for systolic and diastolic pressure respectively]. Adjusted systolic but not diastolic pressure was also negatively associated with plasma potassium estimated at the time of blood pressure measurement (r = -0.15, p less than 0.001, 95% CL -0.06, -0.24). In 159 female London Civil Servants both systolic and diastolic pressures were negatively correlated with plasma potassium. However, there was no evidence for a negative relationship between urinary potassium excretion and blood pressure in women. Urinary sodium excretion was not related to blood pressure either in men or women. Blood pressure was also measured by the subjects at home over a one week period during which time the urine collection was made. There was no evidence for an association between blood pressure measured at home 6 weeks after the time of drawing blood, and plasma sodium. On the other hand, in men, the negative relationship between blood pressure and urinary potassium excretion was consistent and independent of the time and place of measuring blood pressure. This is consistent with a true effect of diet, a low potassium intake being associated with an increased blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

The survival of treated hypertensive patients and their causes of death: a report from the DHSS hypertensive care computing project (DHCCP).

A prospective study has been carried out to determine the causes of death and risk factors for survival in 4994 patients referred with a diagnosis of hypertension to hospital specialist clinics and 457 patients treated by their general practitioners for this condition. At the time of entering the prospective study, 69% of the patients were already being treated for hypertension. Four hundred and eleven patients have died, and their causes of death and death rates have been compared with the rates for the population of England and Wales. Ischaemic heart disease accounted for over one-third of the deaths and stroke for one-fifth. The death rates for these conditions were two to five times those expected for men and women aged 50-59 years and up to twice the rate expected for the age group 60-69 years. Survival in these selected patients was impaired by the following independent risk indicators: cigarette smoking, previous history of myocardial infarction or stroke, diagnosis of angina, impaired renal function and raised blood sugar. The following factors were not independent positive risk factors: smoking a pipe or cigars, obesity, a low plasma potassium and an elevated serum uric acid.

Adolescent↗