Sympathetic tone and relation between sodium intake and blood pressure in the general population.
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Adult↗
Biomedical subjects
C J Bulpitt
Publications and source records attributed to C J Bulpitt.
The visual field in chronic simple glaucoma and ocular hypertension; its character, progress, relationship to the level of intraocular pressure and response to treatment.
Nine hundred and twenty-nine patients with chronic simple glaucoma or ocular hypertension were followed for one to thirteen years using the King's College Hospital glaucoma data base. The 30 degree visual field was divided into twelve clinical zones. The field sensitivity and its change as measured by the mean differential threshold both in these zones and overall was followed to determine the pattern and progress of field loss in eyes diagnosed initially as chronic simple glaucoma or ocular hypertension. The findings were related to other similar analyses in which the mean differential threshold in chronic glaucoma was found to correlate significantly with the initial intraocular pressure and its progress with the mean follow-up intraocular pressure under treatment. Inferences were drawn regarding the nature of chronic simple glaucoma and ocular hypertension and their management.
Adult↗
Assessment of postural hypotension in elderly patients.
Change in blood pressure on standing was measured in 23 geriatric inpatients during the morning. The fall in systolic blood pressure was found to be greatest 30 s after standing, at 9.3 +/- 3.3 (SEM) mmHg and had returned to the supine levels within 2 min. In contrast, the diastolic pressure rose to a maximum of 9.7 +/- 1.8 mmHg by 2 min. In 13 patients the measurements were repeated in the afternoon after lunch. The systolic blood pressure drop was significantly greater: 20.8 +/- 3.6 against 7.1 +/- 2.0 mmHg in the morning (p = 0.01). Standardization of the time after standing and time of day of measurement may allow more precise comparisons of different studies.
Aged↗
Mortality in patients who have their antihypertensive therapy changed.
Medical records were examined for 1935 patients who presented sequentially to a hypertension clinic between 1971 and 1981. Patients were classified according to whether they were on a beta-blocker, methyldopa, a potassium-losing diuretic, or whether they had discontinued any of these treatments. Age-standardized mortality rates were calculated and the relative risks of stopping compared with non-stopping were computed. Those stopping a beta-blocker had a significantly higher mortality in the following year than those who continued, both in men [relative risk (RR) = 5.91, 95% confidence interval (Cl) 2.78-12.56] and women (RR = 5.67, 95% Cl 1.75-18.41). Moreover, women also had a significantly higher mortality when stopping methyldopa, compared with those who continued on the drug (RR = 4.91, 95% Cl 1.82-13.20). However, analysis of data from the years following withdrawal indicated that a high RR was not limited to the first year after the withdrawal of beta-blockers, but was still apparent in the fourth year after stopping. This indicates that the high mortality was not an early function of withdrawal. The high initial RR of mortality in women stopping methyldopa was followed by a substantial decrease in risk over the later years of follow-up. The high mortality in patients stopping particular antihypertensive drugs was not explained by known cardiovascular risk factors.
Adrenergic beta-Antagonists↗
Joint pain and quality of life; results of a randomised trial.
1. Eight hundred and forty-six patients with pain in one or two joints of the hip, knee, ankle or wrist participated in a randomised double-blind trial to compare the efficacy, tolerability and effect on quality of life of diclofenac sodium slow release (DSR) 100 mg daily and a combination of dextropropoxyphene 180 mg and paracetamol 1.95 g daily (D&P). Health status or quality of life was measured using the Nottingham Health Profile (NHP) questionnaire. 2. Pain as measured by a visual analogue scale (VAS) showed 8% greater pain reduction with DSR as compared with D&P (P less than 0.05). Physical mobility as measured by the NHP improved by 13% more with DSR as compared with D&P (P less than 0.01). Energy, sleep, social isolation and emotional reactions did not differ significantly between the two treatment groups, but both treatment groups showed improvement during the trial. More D&P patients as compared with DSR patients reported problems with their job of work (P less than 0.05), and time lost from work (P less than 0.05). 3. Patients on D&P suffered an excess of tiredness or sleep disturbance (50 vs 21, P less than 0.01) whilst patients treated with DSR had an excess of abdominal or epigastric pain or indigestion (40 vs 18, P less than 0.01). 57 patients were withdrawn from DSR and 65 from D&P.
Acetaminophen↗
Treatment with calcium antagonists: pharmacokinetics and effects on blood pressure, vascular protection, and quality of life.
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Blood Pressure↗
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↗
The influence of menopause on blood pressure.
The association between menopause and systolic and diastolic blood pressure was explored in a random sample of 278 pre- and 184 post-menopausal women. In 64 subjects menopause had been surgically induced. Post-menopausal women had a higher systolic, diastolic and pulse pressure than pre-menopausal subjects (P less than 0.001). Hypertension, defined as being on antihypertensive medication, regardless of BP, or as having a pressure greater than or equal to 140/90 mmHg, was more frequently observed following menopause (40 vs 10%; P less than 0.001). After stratification by age and body mass index, the odds of having hypertension for pre- as compared with post-menopausal women were 2.2 (95% confidence interval from 1.1 to 4.4; P = 0.03). After adjustment of BP for significant covariates, such as body mass index, pulse rate and contraceptive pill intake, the slope of SBP on age was 0.5 mmHg/year (P less than 0.05) steeper in women with natural and surgical menopause than in pre-menopausal subjects. The relation of DBP with age showed a similar slope among pre- and post-menopausal subjects, but in women with natural and surgical menopause taken together, the regression line was shifted upward by an average of 2.3 mmHg (P = 0.03). The relationships of DBP with body mass index and with the urinary sodium: potassium ratio were also 0.2 mmHg/kg/m2 and 0.8 mmHg/unit steeper (P less than 0.05) in post- than in pre-menopausal subjects. In conclusion, in the present cross-sectional study menopause was accompanied by a steeper rise of SBP with age, and by an increase in the absolute level of DBP, which was independent of age.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
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↗
Visit frequency for essential hypertension: observed associations.
Data from the British Department of Health and Social Services Hypertension Care Computing Project were analyzed to study determinants of visit frequency in hypertension management. The 457 patients from five general practices made 7974 visits between 1971 and 1985 resulting in 7391 intervals on which evaluation could be based. The mean interval between visits was 113 days (SD = 110 days) with a median interval of 91 days. Visit interval was influenced by level of blood pressure and length of time in follow-up. For diastolic pressures less than 104 mmHg the mean visit interval was 4 months, contrasting with 2 months for diastolic pressures greater than 130 mmHg. Visit intervals became longer with increasing length of time in follow-up, independent of level of blood pressure. Shorter intervals reflected initial management and getting the blood pressure reduced; longer intervals may reflect patients' failure to keep scheduled appointments. Between practices, mean visit intervals ranged from 99 to 193 days (median 72 to 164 days). These differences were reduced after adjustment for length of time the patients had been in follow-up. Patient age, sex, body mass index, and the presence of angina pectoris were not associated with visit interval. The analyses illustrate how process and outcome may be linked in ambulatory care practice as a means of determining rational guidelines for optimal utilization of health services.
Adult↗
The effects of anti-hypertensive drugs on sexual function in men and women: a report from the DHSS Hypertension Care Computing Project (DHCCP).
One thousand, two hundred and eighty-five men and 1,080 women being followed in the DHSS Hypertension Care Computing Project answered the questions on sexual activity included in a self-administered questionnaire. In men, both impotence and sexual inactivity were increased in patients receiving hydralazine. No gross excess of these complaints could be determined in patients receiving either beta-adrenoceptor blocking drugs or methyldopa, nor was failure of ejaculation increased with these drugs. The survey could not exclude any deterioration in sexual function occurring uniformly across all treatment groups. However, the rates of complaint were similar in men taking a diuretic alone, a beta-adrenoceptor blocking drug alone and those taking the combination of these two drug groups. In women with hypertension, frequency of sexual intercourse and the achievement of orgasm was not associated with the giving of hydralazine, beta-adrenoceptor blocking drugs or methyldopa.
Adult↗
Quality of life on angina therapy.
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Administration, Cutaneous↗
Meta-analysis.
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Clinical Trials as Topic↗
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↗
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↗
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↗
Salt intake and blood pressure in the general population: a controlled intervention trial in two towns.
A controlled trial was conducted in two Belgian towns to investigate the feasibility and effects of a reduction in salt consumption at the community level. The low-sodium intervention in one town was mainly directed at women and implemented through mass media techniques, while the control town was merely observed. Cross-sectional random sampling at baseline and 5 years later was employed, the participation rate being similar (67%) in the two towns. During the study a total of 2211 subjects were examined. In adult women (greater than or equal to 20 years) in the intervention town the 24-h urinary excretion of sodium (UVNa) decreased by 25 mmol/24 h (P less than 0.001) and this reduction differed (P = 0.01) from the concurrent trend in UVNa in the control town (+8 mmol/24 h). However, both systolic (SBP, -7.5 versus -7.9 mmHg) and diastolic (DBP, -2.3 versus -3.0 mmHg) pressures declined to a similar extent in the women from the two towns. In adult men in the intervention town, decreases were observed in UVNa (-12 mmol/24 h) and in SBP (-5.6 mmHg) and DBP (-2.4 mmHg), but these trends were not significantly different from the concurrent changes in the control town (-14 mmol/24 h, -4.9 and +0.2 mmHg, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗