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Biomedical subjects

J Coope

Publications and source records attributed to J Coope.

At least 19 recordsLinked to original sources
PubMed1994

The Hypertension in the Very Elderly Trial (HYVET). Rationale, methodology and comparison with previous trials.

The Hypertension in the Very Elderly Trial (HYVET) is a multicentre, open, randomised, controlled trial. The aim of this trial is to investigate the effect of active treatment on stroke incidence in hypertensive patients over the age of 80 years. Secondary end-points include total cardiovascular mortality and morbidity. Entry criteria include a sustained sitting systolic blood pressure of 160 to 219mm Hg plus a sustained sitting diastolic pressure of 95 to 109mm Hg. Also required is a standing systolic blood pressure of at least 140mm Hg. Patients must give their informed consent, and be free of congestive heart failure requiring treatment, gout, renal failure or a recent cerebral haemorrhage. Patients are to be randomised to 3 groups-(i) no treatment; (ii) treatment with a diuretic [bendroflumethiazide (bendrofluazide)]; or (iii) treatment with an angiotensin converting enzyme (ACE) inhibitor (lisinopril). Starting dosage for bendroflumethiazide and lisinopril is 2.5 mg/day. In order to achieve goal sitting systolic and diastolic blood pressures (< 150/80 mm Hg), a doubling of the dosage is allowed. Furthermore, slow release diltiazem (120 mg/day increasing to 240 mg/day if required) may be added to the medication of the actively treated groups. These drugs have been chosen as inexpensive and appropriate representatives of their therapeutic classes. 700 patients in each group (a total of 2100) will be sufficient to detect a 40% difference in cerebrovascular events between no treatment and active treatment (alpha = 0.01, 1-beta = 0.90). These numbers will also detect a difference in total mortality of 25% and in cardiovascular mortality of 35%. The pilot phase of the trial has been started with support from the British Heart Foundation. Centres which are interested in taking part should contact C.J. Bulpitt or any of the other authors.

Aged↗
PubMed1992

Can we improve compliance with long-term HRT?

In order to increase awareness of strategies to prevent osteoporosis and heart disease we designed a clinic offering education and screening to all women aged 40-60 years on our practice list of 8600 patients, starting in January 1988. Screening and supervision of HRT users occurred at a weekly clinic run by the doctor and nurse. Audit in August 1991 showed that there were 260 present users of HRT (20%) of our population of 1322 women aged 40-60 years. Seventy-eight percent had taken HRT for over a year and 15% for more than 5 years. Ex-users totalled 117, of whom 52% had taken HRT for over a year and 14% for over 5 years. Examination of the clinic registers and responses to postal questionnaires showed that 681 (51.5%) of patients attended the health education clinic. Of the clinic attenders, 25% took HRT compared with 10.8% of non-attenders. Compliance with long-term therapy measured by audit of repeat prescriptions varied between 84% and 92% over a period of 5 years. Reasons for stopping treatment were anxiety over possible side-effects, especially breast cancer and dislike of bleeding.

Adult↗
PubMed1990

Menopause clinics.

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Clinical Protocols↗
PubMed1990

Primary protection with beta-blockers in the treatment of hypertension.

The treatment of hypertension has been associated with a reduction of stroke by nearly a half but with little or no effect on the incidence of heart attack. Hypotheses to account for this discrepancy include the short duration of the trials, the differential effects on initial subsets according to age, sex and smoking status, the adverse effects of antihypertensive agents, the excessive lowering hypothesis and the common causal link hypothesis. Each of these hypotheses is examined in this paper.

Adrenergic beta-Antagonists↗
PubMed1990

A clinic for the prevention of osteoporosis in general practice.

A clinic for women aged 40-60 years, offering screening and education about diet and hormone use and other measures for the prevention of osteoporosis, was organized in a group practice. Out of 582 eligible women contacted from the age-sex register, 252 (43%) attended the clinic. A year after the start of the clinic postal questionnaires were sent to all attenders and non-attenders to ascertain smoking habit, hormone use, calcium intake and social class. The use of hormone replacement therapy by the clinic attenders increased from a baseline of 15% to 45% but this had decreased to 38% one year later. Attending women were of higher social class and had slightly higher calcium intake than non-attenders. Although the use of hormone replacement therapy for prevention of osteoporosis is controversial, the risks and benefits were explained carefully to the women and the clinic provided a valuable opportunity for screening for weight problems, high blood pressure, menstrual problems and for health education about diet for the woman and her family.

Adult↗
PubMed1990

Hypertension: the cause of the J-curve.

Many studies have established that mortality from heart attacks is related to diastolic blood pressure in a J-curve with increased mortality at low as well as high pressures. This has been observed in untreated as well as treated patients and a similar phenomenon has been found in large population studies. Two hypotheses to account for this curve have been advanced. The direct causation hypothesis attributes the increased mortality at low pressures to low coronary perfusion. The reverse causation hypothesis attributes the curve to a subgroup of patients with low blood pressures as a result of pre-existing disease. This controversy is still unresolved and needs a prospective trial to decide the issue.

Blood Pressure↗
PubMed1989

A greater role for systolic pressure?

The large intervention trials on the treatment of hypertension have been based on the diastolic component of blood pressure. Recent work indicates that elevation of the systolic pressure is just as powerful in predicting stroke and heart attacks. The incidence of systolic-only hypertension in the elderly is between 5 and 20 per cent. How to approach the management of these patients is the subject of current research in the United States.

Age Factors↗
PubMed1988

The prognostic significance of blood pressure in the elderly.

Whilst recruiting for the Randomised Trial of the Treatment of Hypertension in Elderly Patients in Primary Care, 10,732 people aged 60-79 years of age (4,736 males and 5,996 females) were screened for hypertension. This constituted 78% of those eligible on the practice lists in this age range. These patients were followed up for a mean period of 2.6 years (range 0.1-11.2 years). All those leaving the practices were registered with the National Health Service Central Registry to ensure completeness of death ascertainment. 1,009 deaths were analysed and standardised mortality ratios computed for all deaths, stroke, coronary artery disease and all cardiovascular causes. Hypertensive patients included in the control group of the trial were also matched with patients found to be normotensive and their mortalities compared. Both high and low levels of SBP were associated with increased mortality producing a U-shaped curve for all deaths and J-shaped curves for cardiovascular causes. With increasing age the higher mortality associated with lower SBP became more pronounced. Similar effects were evident for DBP but in women high DBP was less dangerous than in men. Although the relative impact of hypertension declines with advancing age, the absolute impact is maintained up to the age of eighty.

Age Factors↗