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Biomedical subjects

J F Potter

Publications and source records attributed to J F Potter.

At least 19 recordsLinked to original sources
PubMed1992

General practitioners' management of hypertension in elderly patients.

OBJECTIVE: To assess general practitioners' attitudes to the diagnosis and management of hypertension in elderly patients. DESIGN: Postal questionnaire to all general practitioners in Leicestershire. RESULTS: 360 of 451 general practitioners (80%) responded. 81% (292) reported rechecking an initially high blood pressure on two or three occasions before starting treatment, 56% (202) measured sitting blood pressure only, and just 28% (100) took sitting and standing levels. 36% (128) had no upper age limit for starting anti-hypertensive treatment; of the 58% (206) who did, the median was 80 (range 70-99) years. Blood pressure levels reported for starting treatment in patients aged 70-79 years were 180 (150-240)/106 (90-120) mm Hg. 34% of general practitioners (121) would not treat isolated systolic hypertension. The most popular first line treatment for an elderly hypertensive patient was a thiazide diuretic; only 17% of general practitioners (61) initially tried non-pharmacological methods. 34% (122) would continue anti-hypertensive treatment unchanged in the period immediately after stroke. CONCLUSIONS: The variation among general practitioners in the criteria for the measurement, diagnosis, and treatment of hypertension in elderly patients emphasises the need for clear management guidelines in this age group.

Adrenergic beta-Antagonists↗
PubMed1992

A prospective evaluation of the cumulative illness rating scale.

Assessment of overall physical health is an important yet little studied problem in geriatric research. The Cumulative Illness Rating Scale (CIRS) was among the first instruments that attempted to summarize the overall severity of illness based on clinical information. This study evaluated the CIRS in a prospective longitudinal study of 181 elderly (mean age +/- SD = 79 +/- 7.4) subjects undergoing comprehensive geriatric assessment in an outpatient unit. The CIRS was found to correlate negatively with activities of daily living (r = -0.49, p = 0.0001), instrumental activities of daily living (r = -0.34, p = 0.0001), patient morale (r = -0.30, p = 0.0001), and positively with days in hospital (r = 0.21, p = 0.0075) and number of medications (r = 0.31, p = 0.0001). Mean CIRS scores for subjects who died during follow-up were significantly higher than the scores for survivors (p less than 0.01). In logistic regression, CIRS was a significant predictor of death, yet it did not improve that prediction over information contained in measures of activities of daily living. In separate logistic analyses, CIRS and age predicted acute care hospital days during follow-up, while ADL or IADL predicted the use of nursing home services. Although the CIRS appears to be a reliable method of summarizing medical information and to have some external validity, in its present form it does not provide additional prognostic information.

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PubMed1992

Thiamine status of elderly patients with cardiac failure.

This study compared the thiamine status of 37 elderly patients admitted with cardiac failure (CF) with that of 35 unselected elderly patients with other diagnoses (Non-CF), and with that of 41 apparently healthy elderly people. The thiamine pyrophosphate effect (TPPE) on erythrocyte transketolase activity was used to estimate thiamine status. The prevalence of thiamine deficiency (TPPE greater than 19%) on admission in the CF and Non-CF groups was 13% and 29%, respectively. The TPPE of the CF group was significantly lower than that of the Non-CF group, and was not significantly different from that of the elderly control group. The results indicate that thiamine deficiency is not common in an unselected group of elderly inpatients with cardiac failure, but a potential benefit of thiamine supplementation in such patients cannot be ruled out.

Adult↗
PubMed1992

Altered epithelial lining fluid parameters in old normal individuals.

Pneumonia is a leading cause of morbidity and death in older patients, and immunosenescence is believed to contribute to their susceptibility. In order to investigate whether age-related changes occur on the epithelial surfaces of the lung, bronchoscopy and bronchoalveolar lavage (BAL) were performed without complication in 19 young (27.7 +/- 4.2 yrs), 6 middle-aged (49.8 +/- 3.5 yrs), and 8 old (74.1 +/- 4.3 yrs) normal, nonsmoking subjects. BAL was performed by instilling and retrieving five 20 ml aliquots of normal saline into three sites. The returns from the first aliquots (the bronchial sample) were analyzed separately from the returns from the subsequent aliquots (the distal sample). Lavage fluid cellularity was characterized and IgA, IgG, and albumin were measured by ELISA. Lavage fluid returns were lower in the elderly group and correlated with spirometric parameters. Significantly elevated numbers of neutrophils were recovered by the bronchial sample fluid from the old group. In contrast, no consistent difference in macrophage recovery by either the bronchial or distal sample was noted. In both the bronchial and distal samples, IgG, but not IgA or albumin, was elevated in the group of old subjects. Alterations occurring in BAL fluid with aging may reflect changes in local host defenses.

Adult↗
PubMed1992

Potassium supplementation reduces clinic and ambulatory blood pressure in elderly hypertensive patients.

OBJECTIVES: To determine the effects of potassium chloride 60 mmol/day supplementation on clinic and 24-h ambulatory blood pressure values in elderly untreated hypertensive patients. DESIGN: A double-blind randomized placebo-controlled crossover study lasting 8 weeks, following a 4-week run-in period. SETTING: Outpatient clinic in a district general hospital. PATIENTS: Eighteen untreated elderly hypertensive patients (mean age 75 years, range 66-79) with a systolic blood pressure of > or = 160 mmHg and/or a diastolic blood pressure of > or = 95 mmHg were recruited from the clinics of local general practitioners and from the current hospital outpatient department. Patients had not received any antihypertensive medication for at least 4 weeks before entry into the study. INTERVENTIONS: Before entry into the study, the daily dietary electrolyte intake of each individual was established and this was maintained during the run-in and intervention periods. Following a 4-week run-in period patients received potassium supplements or matching placebo, each for 4 weeks. MAIN OUTCOME MEASURES: The within-patient changes in clinic and 24-h ambulatory blood pressures at the end of each intervention period. RESULTS: After 4 weeks potassium supplementation compared with placebo there was a significant fall in supine clinic blood pressure, standing and 24-h ambulatory systolic blood pressure. There was no significant change in clinic standing diastolic blood pressure, 24-h ambulatory diastolic blood pressure or pulse rate. Plasma renin activity increased and body weight fell after potassium supplementation. Twenty-four-hour urinary potassium rose significantly, whereas urinary sodium excretion was unchanged. CONCLUSIONS: A 60-mmol daily supplement of potassium chloride reduces clinic and 24-h ambulatory blood pressure in elderly hypertensive patients.

Aged↗
PubMed1992

Factors delaying hospital admission after stroke in Leicestershire.

BACKGROUND AND PURPOSE: Use of thrombolysis and acute treatments for cerebral infarction may require that acute stroke be treated as a medical emergency. To assess the factors influencing the time to admission in acute stroke, we conducted a prospective study of all such patients admitted to the hospitals in Leicester, UK, over a 12-month period. METHODS: Factors assessed were age, sex, time of stroke onset, stroke severity, home circumstances, and routes of admission. Initial between-group comparisons were made with the Mann-Whitney U test. The individual contribution of each of these variables was assessed with multiple linear regression analysis. RESULTS: An accurate time of stroke onset was identified in 374 (70%) of 535 registered patients (median age 77 [range, 29-98] years; 332 men, 203 women). Median time from onset to admission was 6 hours, with 25% of the patients arriving in less than 2.5 hours and 75% in less than 11.5 hours. Multiple regression confirmed that only admission through the bed allocation bureau (p less than 0.001), living alone (p less than 0.001), and nocturnal onset (p = 0.003) prolonged delay time. Despite patients over 70 years of age taking a median of 7 hours from onset to admission compared with 4 hours for those under age 70 (p less than 0.001), the effect of age appeared to be dependent on these three factors. Age, sex, level of consciousness, rural domicile, and place of admission did not influence the delay time independently. CONCLUSIONS: We have identified some of the factors affecting the hospital admission delay time for stroke. With the possible advent of effective early treatments for stroke, these factors will need to be addressed.

Adult↗
PubMed1991

Erythrocyte sodium, potassium and sodium fluxes with cell and subject ageing.

In young subjects erythrocyte sodium was lower in females than in males. In males juvenile erythrocyte sodium decreased with subject age whereas in females aged erythrocyte sodium increased with subject age. Therefore, the difference in erythrocyte sodium between young male and female subjects was not observed in the elderly. These differences in erythrocyte sodium appeared to be mainly due to differences in the sodium pump rate constant. In juvenile cells from young subjects the sodium pump rate constant was related to the ouabain sensitive sodium flux rate, but not in elderly subjects, suggesting disturbed control of cell sodium in the latter group. Juvenile erythrocytes had a higher potassium content in elderly than young subjects but this was mainly in the 'frail' hospitalised elderly and it decreased more rapidly with cell ageing. This could indicate more active erythrocytes entering the blood in elderly subjects and then ageing more rapidly. Differences between young and elderly subjects in erythrocyte sodium, potassium and sodium pump rate constant were more marked in the 'frail' hospitalised elderly.

Adult↗
PubMed1991

Effects of carbohydrate type on postprandial blood pressure, neuroendocrine and gastrointestinal hormone changes in the elderly.

Previous studies have demonstrated that blood pressure falls postprandially in fit elderly subjects, the greatest changes occurring after meals with a high carbohydrate content. To evaluate the influence of the type of carbohydrate on postprandial blood pressure, the effects of equivalent energy content (2.4 MJ) high complex (starch) and high simple (monosaccharide) carbohydrate meals were studied in seven healthy elderly subjects. Blood pressure, heart rate, autonomic function, plasma catecholamines, insulin and neurotensin levels were measured pre- and postprandially. Greater falls in supine and erect systolic blood pressure occurred after the high simple than the high complex carbohydrate meal (p less than 0.05). No differences were found in supine or erect diastolic blood pressure, heart rate or in any of the biochemical parameters measured between the meal types. It is concluded that a simple carbohydrate meal results in a greater postprandial fall in blood pressure than an equivalent energy complex carbohydrate meal in the elderly, although the mechanisms for these changes are unknown.

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PubMed1991

The effect of caffeine on postprandial hypotension in the elderly.

In a double-blind, randomized trial the effects of caffeinated and decaffeinated drinks on postprandial hemodynamic and neurohumoral changes were studied in seven fit, elderly subjects after a standard 2.4MJ meal. There was a significant difference in supine postprandial systolic blood pressure between the placebo and caffeine phases (P less than 0.01); at 60 minutes, supine systolic blood pressure had fallen 14 mmHg [95% confidence interval (CI)-7 to-21 mmHg, p less than 0.01) after placebo, but was unchanged after caffeine (+9 mmHg, CI 0 to 18 mmHg, NS]. Similar differences between placebo and caffeine were seen in erect systolic and diastolic blood pressure (P less than 0.01), although orthostatic tolerance was maintained throughout each study period. Postprandial plasma noradrenaline levels were higher (P less than 0.02) and the increase greater (P less than 0.02) after caffeine than after placebo. Caffeine administered at the end of a standard test meal prevents the postprandial fall in blood pressure in fit, elderly subjects. The clinical relevance of this finding has yet to be determined, but it may offer a simple remedy for patients with symptomatic postprandial hypotension.

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PubMed1991

Low Body Mass Index in demented outpatients.

In order to determine the association between dementia and low body weight in outpatients, Body Mass Index (BMI) was evaluated prospectively in 346 frail elderly outpatients presenting for comprehensive geriatric assessment. Patients were categorized into four groups (cognitively intact, dementia of the Alzheimer's type (DAT), other dementia, and patients with depressive symptoms). Patients were assessed for severity of dementia by the Clinical Dementia Rating scale. Differences between groups for various clinical parameters were evaluated using an analysis of variance and Duncan's Multiple Range Test. Patients with dementia, regardless of etiologic type or severity, and patients with depressive symptoms had BMI's greater than or equal to 10% lower than the cognitively intact patients. BMI was positively correlated with Instrumental Activities of Daily Living (IADL) but not Activities of Daily Living (ADL) or Mini-Mental State Exam (MMSE) score. Low BMI was not associated with increased physical illness. In fact, in the subset of patients with DAT, lower BMI correlated with significantly lesser amounts of comorbid physical illness. Finally, compared to cognitively intact outpatients, patients with DAT appeared to be physically healthier despite their having a lower BMI. These results suggest an association between dementia and low BMI. On the other hand, the presence of comorbid physical illness, a common focus of evaluation in these patients, was not more common in those patients with lower BMI's.

Aged↗
PubMed1991

Factors determining the acute pressor response to alcohol.

The pressor response to acute alcohol loading is variable and the factors influencing it are unknown. Data from 34 standardized alcohol loading studies were analysed to try to identify any factor(s) that might predict the pressor response to oral alcohol. The maximum blood pressure rise following an acute alcohol load was assessed for each subject over a 4 hour period. Age, weight, recent alcohol intake, baseline blood pressure, pulse rate and serum gamma glutamyl transferase levels were entered, as the independent variables, into a multiple linear regression analysis with the maximum blood pressure response as the dependent variable. Alcohol consumption in the week prior to the study predicted the systolic blood pressure pressor response to acute alcohol loading. None of the independent variables entered had any predictive value for diastolic or mean arterial blood pressure response.

Adult↗
PubMed1991

Possible impairment of the sympathetic nervous system response to postprandial hypotension in elderly hypertensive patients.

In a randomised, single-blind, cross-over study, the effects of a high carbohydrate meal or 'no meal' on BP, pulse rate, blood glucose, plasma insulin and catecholamine levels were assessed in eight fit, untreated, elderly hypertensive subjects. A significantly greater fall in supine (P = 0.006) and erect (P = 0.03) systolic blood pressure (SBP) occurred post-meal compared with the no meal phase. The maximum postprandial fall in supine SBP (-24 mmHg, 95% CI -16 to -32 mmHg) occurred at 60 minutes and was associated with a significant rise in supine pulse rate. No overall difference in diastolic BP was seen between the two phases and orthostatic control of BP was maintained. Blood glucose and plasma insulin levels rose after the meal but plasma noradrenaline levels were unchanged during both phases. Thus in these elderly hypertensive subjects the postprandial fall in SBP was not associated with an overall increase in sympathetic nervous system (SNS) activity (as gauged by plasma noradrenaline levels), unlike the findings previously reported in normotensive elderly and young subjects. These changes in BP and the possible impairment of the SNS response to postprandial hypotension should be considered when assessing the BP control, particularly after therapeutic intervention, in elderly hypertensive patients.

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PubMed1990

Blood pressure, heart rate and neuroendocrine responses to a high carbohydrate and a high fat meal in healthy young subjects.

1. The responses of blood pressure, heart rate, autonomic function and plasma insulin to a high carbohydrate and a high fat meal of equivalent energy value were studied in nine young volunteers. 2. Neither meal produced a significant change in supine or erect blood pressure. The high carbohydrate meal, however, resulted in an overall rise in both supine (6 beats/min) and erect (6 beats/min; P less than 0.05) heart rate, no such changes being seen after the high fat meal. 3. Plasma noradrenaline levels increased by a maximum of 126% at 90 min (0.98 to 2.22 nmol/l) after the high carbohydrate meal but were virtually unchanged after the high fat meal (P less than 0.01). Parasympathetic function showed no between-meal differences. Plasma insulin and glucose levels were significantly higher after the high carbohydrate meal than after the high fat meal. No postprandial difference in packed cell volume was found between meal types. 4. We conclude that, in young subjects, the postprandial blood pressure after a high carbohydrate meal is maintained by an increase in heart rate associated with increased sympathetic nervous system activity. These changes are at variance with the blood pressure and heart rate responses seen in the elderly after a high carbohydrate meal. A high fat meal has no significant cardiovascular or neuroendocrine effects in the young or old. The nutrient composition of meals has to be taken into account when studying the postprandial cardiovascular and neuroendocrine responses in the young.

Adult↗
PubMed1990

Potassium supplementation in the treatment of idiopathic postural hypotension.

We studied the effects of potassium supplementation (60 mmol/day) and matching placebo on the postural blood-pressure fall in ten elderly patients with symptomatic idiopathic postural hypotension in a double-blind, randomized cross-over trial. There was a significant decrease in the orthostatic fall in systolic blood pressure (SBP 33 +/- 5 mmHg to 16 +/- 9 mmHg, p less than 0.01) and in supine SBP (162 +/- 7 to 150 +/- 7 mmHg, p less than 0.01) between placebo and potassium phases. Supine diastolic and erect blood pressures were unchanged, though pulse rate showed a greater orthostatic increase (7 +/- 3 beats/min to 14 +/- 2 beats/min, p less than 0.05) following potassium therapy. No significant changes were seen in intracellular electrolytes, plasma renin activity, aldosterone levels or body weight. Seven patients reported symptomatic improvement with potassium, but none during the placebo phase. Potassium therapy was well tolerated and may be a successful and safe method of treating idiopathic postural hypotension.

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PubMed1990

Benefits of anti-hypertensive therapy in the elderly.

Hypertension is common in the elderly, up to half of the population over the age of 65 years can be so classified. Raised systolic and diastolic blood pressure levels increase the risk of cardiovascular morbidity and mortality in those aged up to 80 years. Recent intervention studies have shown that antihypertensive treatment reduces death from stroke and myocardial infarction, without producing intolerable side-effects. The benefits of treating isolated systolic hypertension and hypertension following stroke are, as yet, unproven. The therapeutic goals for treating hypertension in the elderly should be to lower blood pressure while keeping adverse reactions to a minimum and thereby not impairing the patient's quality of life. Non-pharmacological methods should be tried initially before resorting to drug therapy. Both thiazide diuretics and beta-adrenoceptor antagonists are of proven value as first line hypotensive agents in the elderly. Drug therapy should be tailored to the individual patient and increased slowly to reduce the incidence of side-effects.

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PubMed1990

The effect of age on the relative potency of midazolam and diazepam for sedation in upper gastrointestinal endoscopy.

Diazepam and midazolam are considered safe and effective sedative agents for diagnostic procedures. However, there have been recent reports of deaths in older patients receiving midazolam for sedation. We examined the relative potency of diazepam compared with midazolam as a function of age in two large groups of patients receiving intravenous benzodiazepines for upper gastrointestinal endoscopy. While midazolam and diazepam are approximately equivalent before age 60, after age 60 the relative potency of midazolam compared with diazepam increases markedly. The rapid decline in dose necessary to sedate older patients with midazolam may explain deaths occurring in older patients who have received this drug. Until this problem receives definitive study, we advise that diazepam be preferred over midazolam for intravenous sedation in patients over 60.

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