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Biomedical subjects

V M Hawthorne

Publications and source records attributed to V M Hawthorne.

At least 19 recordsLinked to original sources

Blood-pressure screening and supervision in general practice.

Since April 1975 all men aged 35-69 years registered with four general practices in west central Scotland have had their blood pressure checked whenever they visit the surgery. Although the practice locations range from rural to city centre and observers comprise receptionists, nurses, and doctors, a standard procedure has been adopted for the examination, recording, follow-up, and management of high blood pressure. The results confirm that raised blood pressure is common and often goes undetected. Even when hypertension is known, casual blood pressure readings often exceed accepted normal levels. The findings also show that a population may be routinely examined through normal contact with the family doctor, and that this can provide a convenient, acceptable, and effective means of detecting and reducing raised blood pressure.

Adult

Excess smoking in malignant-phase hypertension.

The smoking habits of 82 patients with malignant-phase hypertension were compared with those of subjects in three control groups matched for age and sex. Sixty-seven (82%) of the patients with malignant-phase hypertension were smokers compared with 41 (50%) and 71 (43%) of the patients in two control groups with non-malignant hypertension, and 43 people (52%) in a general population survey. The excess of smokers in the malignant-phase group was significant for men and women, together and separately, for cigarette smoking alone, and for all forms of smoking. There were no significant differences between the control groups. The chance of a hypertensive patient who smoked having the malignant phase was five times that of a hypertensive patient who did not. Twelve patients in the malignant-phase group had never smoked. All were alive three and a half years on average after presentation (range 11 months to seven years). Twenty-four (36%) of the smokers with malignant-phase hypertension died during the same period. The mortality rate was significantly higher among patients with renal failure, as was the prevalence of smoking. Eighteen patients with malignant-phase hypertension had a serum creatinine concentration higher than 250 mumol/l (2.8 mg/100 ml); 17 were smokers and one an ex-smoker. Eleven of these 18 patients died.It is concluded that hypertensive patients who smoke are much more likely to develop the malignant phase than those who do not, and that once the condition has developed it follows a particularly lethal course in smokers.

Age Factors

Screening for mild hypertension: costs and benefits.

It is important to understand the full implications of introducing a new screening and treatment programme into the National Health Service. In this paper, we calculate, for mild hypertension, the cost of community-based screening and the cost of case-finding in general practice. We show that case-finding in general practice is both less expensive and more efficient. We calculate the cost of running a programme in general practice for five years and divide that cost by an estimate of the number of deaths that might be prevented as a result of introducing such a programme. This calculation give a minimum cost for extending a life by the programme.

Adult

Smoking and health: the association between smoking behaviour, total mortality, and cardiorespiratory disease in west central Scotland.

The relationship of smoking to total mortality and to the prevalence of cardiorespiratory symptoms has been studied in three prospective surveys in west central Scotland in which 18 786 people attended a multiphasic screening examination. The prevalence of respiratory symptoms, and to a lesser extent cardiovascular symptoms, increased with the number of cigarettes smoked, with inhalation, and with a younger age of starting to smoke. A lower prevalence of respiratory symptoms in both sexes was observed in smokers of filter cigarettes than in smokers of plain cigarettes, and in those who smoked cigarettes with lower tar levels, irrespective of whether these were filtered or plain. In general, the relationships found between smoking and mortality were similar to those reported by other workers. Current cigarette smokers had a death rate from all causes which was twice that of those who had never smoked. No difference was found between the mortality rates of smokers of plain and filter cigarettes.

Age Factors

Blood pressure measurement at screening and in general practice.

As part of an epidemiological study of hypertension, an analysis was made of the general practitioner records of all attenders at a screening survey. A blood pressure recording, made before screening, was found in 37-9 per cent of cases. The pressures obtained correlated well with those obtained by the screening unit, though the practitioners' readings tended to be lower. Further cases of hypertension were found, not diagnosed by the screening unit; the estimate made of the prevalence of hypertension at the survey could be corrected by inclusion of these cases. Chest pain, headaches, lightheadedness, and dizziness were common reasons for blood pressure measurement in general practice, but these symptoms were not associated with a rise in the blood pressure; symptoms were not helpful in the diagnosis of hypertension. Some form of screening programme is necessary to detect cases of hypertension. This could be carried out by general practitioners.

Blood Pressure Determination

Blood-cadmium in hypertensives and normotensives.

70 hypertensive patients and 70 controls matched for age and sex were investigated for a possible relationship between blood-cadmium and hypertension. No significant differences between the two groups were detected, although the blood-cadmium level was significantly higher in smokers as compared to non-smokers. These data do not support the hypothesis that cadmium is involved in the development of hypertension in man.

Antihypertensive Agents

Blood-lead and hypertension.

Blood and tap-water lead levels were examined in 135 hypertensives and 135 age and sex matched normotensives. Among male hypertensives there was a significant excess of cases with high blood-lead levels and a similar but statistically non-significant trend was found amongst female hypertensives. A positive correlation was found between blood-lead and tap-water lead. It is concluded that in the West of Scotland high blood-pressure is associated with high blood-lead levels, which might explain the high prevalence of cardiovascular disease in the area.

Blood Pressure

Lipoprotein levels in apparently healthy men and women in the west of Scotland.

Lipoprotein typing was undertaken in apparently healthy women (419) and men (103) in whom measurements of fasting total cholesterol, triglycerides, and cholesterol content of the major lipoprotein fractions were made. In the female group (30 to 59 years) there was a significant rise in total cholesterol, low density lipoprotein (LDL) cholesterol, and triglycerides with age. Using total cholesterol and triglyceride levels for classification, type II hyperlipoproteinaemia was present in 1 per cent and type IV in 6-7 per cent. When LDL cholesterol levels were also considered, type II occurred in 9-8 per cent ( 8-4% type IIA and 1-4% type IIB). In the male group ( 40 to 59 years) there was no increase in cholesterol or triglyceride levels with age: II per cent had type IV hyperlipoproteinaemia and none had a type II abnormality. When LDL cholesterol levels were also considered, type II occurred in 3 per cent ( 2% type IIA and 1% IIB). The apparent increase in LDL cholesterol frequency of type IIA abnormality in women could be merely the consequence of arbitrary selection of upper limits of normality for LDL cholesterol, but may signify improved detection of a high risk group.

Adult