Possible factors predisposing to peripheral vascular disease (PVD) in hypertensive subjects with Type 2 diabetes mellitus were studied. Details of age, sex, duration of diabetes, blood pressure, and smoking habit were recorded in 180 subjects of either White, West Indian Black or Asian ethnic origin. Glycosylated haemoglobin, fasting serum total cholesterol, total high density lipoprotein (HDL), HDL2, low density lipoprotein (LDL-cholesterol), and triglycerides were measured in all subjects. Peripheral vascular disease was defined as an ankle/brachial systolic pressure < 1.0 as measured by the Doppler technique. Multivariate analysis was performed and the following factors were identified as being strongly associated with the presence of PVD with a statistical significance of p < 0.001; LDL-cholesterol, total HDL-cholesterol, age, male sex, diet or oral hypoglycaemic therapy, diastolic blood pressure, and of p < 0.003; systolic blood pressure. When blood pressure was excluded from the analysis the other factors retained their predictive value. We conclude that hypertension and dyslipidaemia are important risk factors for peripheral vascular disease in Type 2 diabetes mellitus.

Blood Pressure↗

PubMed1992

Effectiveness of advice to reduce alcohol consumption in hypertensive patients.

The relation between alcohol consumption and blood pressure is well recognized, and advice to reduce alcohol plays an important part in the management of hypertensive patients. We have evaluated the effectiveness of this advice in a randomized, controlled, single-blind clinical study. After a 2-week run-in period, hypertensive men regularly consuming more than 20 units/wk (1 unit = 10 g) of alcohol were randomly assigned either to the "advice" or control group and were seen at 2-week intervals over an 8-week study period. The outcome measures were: reported alcohol consumption (1-week retrospective diary), markers of alcohol consumption (serum gamma-glutamyl transpeptidase, aspartate aminotransferase, uric acid, mean corpuscular volume), and blood pressure (sitting and standing). Over 18 months, 67 men who drank more than 20 units/wk of alcohol were seen. Twenty-six either were excluded, refused to participate, or dropped out due to nonattendance. Forty-one patients completed the study. After intervention, reported alcohol consumption fell from 60 units/wk to around 30 units/wk in the advice group, whereas it remained between 50 and 60 units/wk in the control group (analysis of variance [ANOVA] F = 7.1, p less than 0.05). This was accompanied by falls in gamma-glutamyl transpeptidase (20.9%) and aspartate aminotransferase (18.1%), but no significant changes were seen in the control group. Standing diastolic blood pressure fell significantly in the advice group (from 101.5 mm Hg to 96.3 mm Hg) compared with the control group (ANOVA F = 4.8, p less than 0.05). The results suggest that advice to reduce alcohol consumption is a useful form of treatment for hypertensive patients who drink excessively.

Adult↗

PubMed1990

The survival of malignant hypertension in blacks, whites and Asians in Britain.

Life table analysis was used to compare survival rates in 168 whites, 39 blacks and 26 Asians with malignant phase hypertension. Amongst men, survival until death or the requirement of chronic renal dialysis was significantly worse in blacks, who initially presented with higher blood pressures and more renal impairment. There were no differences in survival in women in the three ethnic groups. Malignant hypertension remains common in Britain and still carries a poor prognosis.

Asian People↗

PubMed1989

Sodium restriction and blood pressure in hypertensive type II diabetics: randomised blind controlled and crossover studies of moderate sodium restriction and sodium supplementation.

OBJECTIVE: To determine the effect of moderate dietary sodium restriction on the hypertension of non-insulin-dependent (type II) diabetes. DESIGN: Randomised parallel controlled study of moderate sodium restriction for three months compared with usual diabetic diet, followed by randomised double blind crossover trial of sustained release preparation of sodium for one month versus placebo for one month in patients continuing with sodium restriction. SETTING: Patients attending diabetic outpatient clinic of city hospital. PATIENTS: Thirty four patients with established type II diabetes complicated by mild hypertension (systolic blood pressure greater than 160 mm Hg or diastolic pressure greater than 95 mm Hg on three consecutive occasions). Patients already taking antihypertensive agents (but not diuretics) not barred from study provided that criteria for mild hypertension still met. Conditions precluding patients from study were diabetic or hypertensive nephropathy, cardiac failure, and pregnancy. INTERVENTIONS: After run in phase with recordings at seven weeks, three weeks, and time zero patients were allocated at random to receive moderate dietary sodium restriction for three months (n = 17) or to continue with usual diabetic diet. Subsequently nine patients in sodium restriction group continued with regimen for a further two months, during which they completed a randomised double blind crossover trial of sustained release preparation of sodium (Slow Sodium 80 mmol daily) for one month versus matching placebo for one month. END POINT: Reduction in blood pressure in type II diabetics with mild hypertension. MEASUREMENTS AND MAIN RESULTS: Supine and erect blood pressure, body weight, and 24 hour urinary sodium and potassium excretion measured monthly during parallel group and double blind crossover studies. After parallel group study sodium restriction group showed significant reduction in systolic blood pressure (supine 19.2 mm Hg, erect 21.4 mm Hg; p less than 0.001) and mean daily urinary sodium excretion (mean reduction 60 mmol/24 h). There were no appreciable changes in weight, diabetic control, or diastolic pressure. No significant changes occurred in controls. In double blind crossover study mean supine systolic blood pressure rose significantly (p less than 0.005) during sodium supplementation (to 171 mm Hg) compared with value after three months of sodium restriction alone (159.9 mm Hg) and after one month of placebo (161.8 mm Hg). CONCLUSIONS: Moderate dietary restriction of sodium has a definite hypotensive effect, which may be useful in mild hypertension of type II diabetes.

Clinical Trials as Topic↗

PubMed1987

Standards for blood pressure measuring devices.

Explore the source record for details and available documents.

Anthropometry↗

PubMed1987

Lack of evidence of low ionized calcium levels in systemic hypertension.

An epidemiologic screening survey was conducted in 325 male industrial workers to investigate the relation between serum total and ionized calcium concentrations and blood pressure. No relation was found. Previous reports of lower serum ionized calcium levels in hypertensive patients may be related to methodologic deficiencies both in the selection of subjects and in ionized calcium measurement. These data do not support the concept that increased blood pressure levels are related to calcium deficiency or to abnormal plasma calcium homeostasis.

Adult↗

PubMed1986

Lack of difference between malignant and accelerated hypertension.

The clinical features and survival rates of 200 consecutive patients with malignant and accelerated hypertension admitted to a district hospital were investigated. Ninety five patients had bilateral haemorrhages and exudates and papilloedema (grade IV retinopathy) and 31 had bilateral haemorrhages and exudates with no papilloedema (grade III). A further 74 patients had bilateral retinopathy but failed to meet the criteria for grade IV or III and were investigated separately. No overall differences were found in survival when comparing the various grades of retinopathy. Cigarette smoking was significantly commoner only in grade IV patients compared with those with non-malignant hypertension matched for age, sex, and race. In patients with grade III retinopathy excess smoking was not statistically significant. In conclusion, the clinical features and survival rate showed that malignant and accelerated hypertension are one and the same disease.

Female↗

PubMed1986

An audit of nifedipine in a hypertension clinic.

The results of treating 235 hypertensive patients who had been prescribed nifedipine in a hypertension clinic were examined for factors affecting blood pressure response and the frequency of side-effects. Pretreatment systolic and diastolic blood pressure correlated significantly with the decrease in blood pressure but this effect was lost following statistical correction. No relation was found between response and age or race nor did any biochemical or haematological parameter predict the antihypertensive effect. Fifty-nine (25%) patients complained of side-effects which were dose related; the drug had to be discontinued in 30 patients (13%) but the remaining 29 continued at the same or reduced dosage. Small, but statistically significant, elevations were seen in serum albumin, alkaline phosphatase and bilirubin as well as a rise in average blood glucose levels. Although side-effects are fairly common nifedipine is an effective antihypertensive drug when given alone or in combination with other therapies.

Age Factors↗

PubMed1985

Similarity of blood pressure in blacks, whites and Asians in England: the Birmingham Factory Study.

Factory workers aged 16-64 years were screened for ethnic differences in blood pressure. The 78% response rate was evenly spread between whites (439 men; 164 women), black West Indians (173 men; 101 women) and Asians (172 men). Mean systolic and diastolic pressures by age decade in men were similar in all three groups, but there was a modest excess of both higher and lower blood pressures in blacks and Asians. Older black women had higher blood pressures than whites, but body mass indices were 2-5 kg/m2 greater. Multiple regression analysis revealed no significant effect of ethnic group on either systolic or diastolic blood pressure variance and that the higher pressures in black women were accounted for by differences in age and body mass index. The influence of body mass index was more marked on diastolic than systolic pressure. In men, alcohol intake and a family history of hypertension had small independent positive effects on systolic pressure. The lack of black/white difference in blood pressure differs from the United States results and may be due to the similarity in social class of participants. This should be confirmed in further population samples with larger numbers of black (and Asian) subjects.

Adolescent↗

PubMed1985

Prevalence of hypertension in white, black and Asian diabetics in a district hospital diabetic clinic.

In a District General Hospital Diabetic Clinic 40.0% of a random sample of diabetics under the age of 65 years of age were hypertensive. Black patients (48.9%) had greater (p less than 0.05) prevalence of hypertension than Whites (37.5%) and Asians (35.4%). Hypertension was more prevalent in females (49.1%) than males (33.0%) (p less than 0.001) in each ethnic group except Asians, and patients not receiving insulin had greater prevalence (45.6%) than those on insulin (30.7%) (p less than 0.001), except black diabetics where the reverse was found. There was a positive relationship between age and systolic (p less than 0.00001) and diastolic blood pressure (p less than 0.00001) and a negative association between duration of diabetes and diastolic blood pressure (p less than 0.004) on multiple regression analysis but no relationship was noted between blood pressure and either weight or blood glucose. Forty-six percent of all hypertensives were receiving conventional anti-hypertensive drug therapy; 38.7% were normotensive with similar results in each ethnic group and between the sexes. Isolated systolic hypertension was the commonest form of hypertension (48.3%) with isolated diastolic hypertension (4.9%) the rarest. These findings were observed regardless of the ethnic group or gender. Although in the majority of cases hypertension was mild these data confirm the importance of routine blood pressure measurement in diabetic patients.

Cross-Sectional Studies↗

PubMed1984

Standardized methods for comparison of sphygmomanometers.

Medical research in general and equipment comparisons in particular suffer from a deficiency and disparity of statistical analysis. We studied four semi-automatic sphygmomanometers in comparison with the Hawksley random zero mercury manometer. The Astropulse 80 showed marked deviation from the standard machine in average blood pressure recorded and greater variation of readings. The Infrasonde M3010, Bosomat II and Infrasonde D4000 were similar to the standard machine. To help comparability in future studies we suggest the following guidelines; blood pressures to be taken under standard conditions, data to be shown as scatterplots, analysis of variance to be performed and regression analysis to be used only to give an approximate overall view. Finally, we urge the manufacturing companies to conduct such studies and include the results in their brochures.

Blood Pressure Determination↗

PubMed1983

Blood pressure in black, white and Asian factory workers in Birmingham.

A screening survey was conducted among factory workers, aged 15-64 years, in Birmingham, England to investigate ethnic differences in blood pressure. One-thousand and forty-nine subjects (784 men, 265 women) were screened, representing 79% of the eligible population. Mean systolic and diastolic blood pressures generally did not differ between men of black West Indian (n = 173), local white (n = 439) or Asian (n = 172) origin, when matched by 10-year age groups. Analysis of covariance using age as the covariate revealed that, overall, Asian men had significantly lower systolic but higher diastolic pressures than the other ethnic groups. The proportion of men arbitrarily defined as hypertensive (greater than or equal to 160 mmHg systolic or greater than or equal to 95 diastolic or blood pressures below this figure whilst receiving antihypertensive therapy) was 26% of West Indians, 22% of whites and 17% of Asians, but these were not significantly different when age was accounted for. Black West Indian women (n = 101) did have higher diastolic pressure than white women (n = 164), but this difference was dependent on body mass index. Overall, systolic pressures in women were not significantly different. These findings differ from those consistently reported from the United States.

Adolescent↗

PubMed1983

The Birmingham blood pressure school study.

Four-hundred and twenty-eight school leavers of 3 ethnic groups (white, black and Asian) were screened for blood pressure, resting pulse rate and general anthropometric characteristics. Asian pupils were both shorter and lighter than the other two groups whilst black males were heavier and taller. There was no significant difference in the mean systolic or diastolic blood pressure between the 3 groups, although the black pupils had a stronger family history of hypertension, particularly on the mother's side. These observations differ in some respects from other ethnic blood pressure studies and establish values for the local population.

Adolescent↗

PubMed1983

The ethnic prevalence of hypertension in a diabetic clinic.

Using the WHO criteria of hypertension, we have demonstrated that 40% of randomly selected diabetic clinic attenders under the age of 65 were hypertensive. Black diabetics had a significantly greater prevalence (P less than 0.001) of hypertension than either white or Asian diabetics. Hypertension was commoner in black and white females compared with males (P less than 0.001); in Asians this difference was not statistically significant. Systolic hypertension was the most common form in all ethnic groups. Only 38.7% of diabetics receiving antihypertensive therapy had normal blood pressure readings. Blood pressure measurement should therefore be routinely performed in all diabetic patients under the age of 65, particularly in females of all ethnic groups and in black males.

Adult↗