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Biomedical subjects

A E Fletcher

Publications and source records attributed to A E Fletcher.

At least 73 records · Page 4Linked to original sources
PubMed1994

Quality of life and the heart: evaluation of therapeutic alternatives.

The choice of criteria that should be used in cardiological disease in order to establish a meaningful measure of quality of life is influenced by the severity and nature of the disease, the expected benefits and adverse effects of treatment, and such considerations as the length of the study and availability of appropriate methods. Moreover, the selection of specific instrumentation should be made with a view to producing valid, repeatable results that allow sensitive assessment of the effects of treatment. The inclusion of a health index is one method of obtaining quality-of-life scores from patients who withdraw from a clinical trial or who die. Interpretation of quality-of-life results from clinical trials is not simple: for example, the effect of treatment must be distinguished from the benefit of trial inclusion; moreover, changes in quality-of-life scores should correspond to changes in the patients' own experiences of their daily lives. The measurement of quality of life, when the effect of treatment is being assessed, requires adequate control data. This usually necessitates a double-blind, randomised trial protocol. The quality of life of patients on long-term pharmacological treatment needs to be evaluated, and several groups of drugs commonly employed are discussed here. Transdermal nitrates for angina do impair quality of life if used continuously, by producing headaches and limiting social participation, while tolerance limits their efficacy.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1993

Smoking and blood pressure in the leg.

OBJECTIVES: To determine whether the calf:brachial ratio for systolic blood pressure is reduced in both current and ex-smokers of cigarettes. DESIGN: Cross-sectional study of the calf:brachial systolic blood pressure ratio and smoking history. SUBJECTS: Four hundred and ten male and 138 female civil servants aged 35-59 years working in the Department of the Environment Building, London. RESULTS: In men the systolic blood pressure ratio (Doppler calf:auscultatory brachial) decreased above the age of 50 years. However, different patterns were observed in those who had smoked at some time and those who had never smoked. In those who had never smoked the ratio in men aged 35-44 years was lower than that in men aged 55-59 years. In those who had smoked the average ratio rose from the age of 35-44 years to the age of 45-49 years and then fell to below the former value at the age of 55-59 years. There was a significant difference between lifelong non-smokers and current smokers at age 55-59 years. The pattern was similar in both male ex- and current smokers, and ex-smokers had results intermediate between those for current smokers and those who had never smoked. In women who had never smoked the ratio increased from the age of 35-44 years to the age of 50-59 years. In women aged 50-59 who currently smoke or used to smoke cigarettes the average ratio was close to that for women aged 35-44 years who had never smoked. CONCLUSIONS: The calf:brachial systolic blood pressure ratio is a simple measurement that may prove useful in detecting the early adverse effects of smoking on peripheral vascular disease. Lower ratios at older ages occurred in both current and ex-smokers, and the effects of smoking on peripheral arterial disease may not be easily reversible at older ages.

Adult↗
PubMed1993

The relationship between blood pressure and sodium and potassium excretion during the day and at night.

OBJECTIVE: The relationships between blood pressure and the urinary excretion rates of sodium and potassium during the day and at night were investigated. METHODS: A total of 160 participants (135 normotensive subjects and 25 untreated patients with essential hypertension) were examined using ambulatory blood pressure monitoring and timed urine collections during waking and sleeping hours. RESULTS: Blood pressure averaged 126/79 mmHg during waking hours and 107/62 mmHg during sleep. More sodium, potassium and aldosterone were excreted during the daytime, but the natriuretic substance kallikrein was excreted at a fixed rate throughout the 24 h. During waking hours there was poor correlation between blood pressure and urinary sodium and potassium excretion. By contrast, at night when the aldosterone: kallikrein ratio fell, the sodium and potassium excretion rates were positively correlated with blood pressure. CONCLUSIONS: Pressure natriuresis, not apparent during waking hours, may be unmasked at night when the balance between sodium-retaining and sodium-losing mechanisms favours natriuresis. Thus, the relationship between blood pressure and 24-h sodium excretion, usually considered to show the influence of salt intake on blood pressure, may also reflect pressure-induced natriuresis, if urine is more completely collected at night than during the day, and in circumstances favouring sodium retention during the day and sodium loss during sleep.

Adult↗
PubMed1993

Antihypertensive therapy in elderly patients with isolated systolic hypertension: third progress report of the Syst-Eur trial.

The Syst-Eur trial is a randomised, double-blind, placebo-controlled trial that examines the hypothesis that antihypertensive treatment can prevent or delay cardiovascular complications in elderly patients (> 60 years) with isolated systolic hypertension. On March, 1st 1993 a total of 1395 patients with a sitting systolic blood pressure on placebo averaging 160-219 mmHg and a diastolic blood pressure < 95 mmHg were randomised into this trial. The placebo and active treatment groups were similar at randomisation with respect to age (72 +/- 7 years, mean +/- SD), percentage of women (68%), percentage of patients with cardiovascular complications (30%) and sitting blood pressures (175 +/- 12/85 +/- 6 mmHg). The fall in sitting systolic and diastolic blood pressures from baseline to 2 years was significantly more pronounced (p < 0.001) in the actively treated (-22 +/- 18/-6 +/- 9 mmHg) as compared with the placebo treated Syst-Eur patients (-10 +/- 20/-1 +/- 9 mmHg). Active treatment consists of nitrendipine if necessary associated with a converting-enzyme inhibitor and a thiazide. Whether treatment with these antihypertensive agents results in a clinically meaningful reduction of cardiovascular morbidity and mortality is the subject of investigation in this trial.

Aged↗
PubMed1993

Cost-effectiveness of the treatment of hypertension.

Cost-effectiveness and cost-utility analyses are defined and examples given of their use in a trial comparing the use of propranolol with verapamil. Eight other analyses are considered that look at the cost-effectiveness of anti-hypertensive treatment in general and at comparisons of such treatments. The analyses are examined to see if conclusions are made for different ages and both sexes; whether compliance with treatment is considered, and whether discounting, the cost of treating side effects and the effects of cholesterol were considered. The methods of estimating life years gained are examined and, if epidemiological data were employed, the fraction of benefit (FOB) assumed. The levels of blood pressure are examined together with the methods of estimating the quality of life adjusted years of survival (QALYS) in cost-utility analyses. It is concluded that large trials are required in which both survival on different treatments is measured together with costs and the quality of life of the individual patients. Cost-effectiveness and cost-utility is more favourable in men than women and in the elderly. There is no agreement as to which drug group has the most advantageous cost-utility.

Antihypertensive Agents↗
PubMed1993

Cognitive function in hypertension: a community based study.

Cognitive function was investigated in a random sample of subjects on the general practitioners' registry of hypertensive patients in an inner city area and matched with normotensive controls. The response rate was 66% giving 90 matched pairs, average age 63 yrs, with 47% men. There was no difference in educational background or measures of reading ability between the two groups. Cognitive function tests showed a consistent trend of poorer performance in hypertensives, with significant differences in Verbal Learning (immediate recall and retention). Age was inversely related to cognitive function, but no additional deterioration with increasing age was shown in hypertensives.

Adult↗
PubMed1992

Survival of hypertensive subjects identified on screening: results for sustained and unsustained diastolic hypertension.

Casual readings of blood pressure predict mortality and may reflect either the risk of sustained hypertension, additional components of 'white coat' hypertension or variable blood pressure. This study investigated mortality in 442 men and 360 women with a diastolic pressure (Phase IV) of 90 mmHg and over, unsustained on two subsequent monthly visits, followed for an average of 11 years and compared with a matched control cohort with an initial diastolic pressure (DBP) of less than 90 mmHg. Subjects were identified between 1975 and 1979 by screening 28,257 subjects aged 18-65 years on the lists of general practitioners in seven practices in the United Kingdom. Additionally, 912 men and 844 women with sustained hypertension (DBP > 90 mmHg on at least two out of three occasions) were identified and matched with normotensive controls. In men with sustained hypertension the relative risk (RR) for death from circulatory disease was 1.76, P < 0.01, 95% confidence interval 1.21, 2.58 and in women 1.85, P < 0.05, 95% confidence interval 1.06, 3.24 respectively, while in men with unsustained hypertension the RR = 1.52, P = 0.2, 95% confidence interval 0.81, 2.84. Few circulatory deaths occurred in women with transient hypertension or their controls (five and seven respectively). Despite the screening programme and further treatment, newly discovered subjects with sustained hypertension, both men and women, remain at high risk of cardiovascular mortality. The 95% confidence interval for men with transient hypertension does not exclude a similar adverse effect.

Adolescent↗
PubMed1992

Relation between treated blood pressure and death from ischaemic heart disease at different ages: a report from the Department of Health Hypertension Care Computing Project.

OBJECTIVE: To determine the relation between mortality from ischaemic heart disease (IHD) and treated blood pressure at different ages. DESIGN: Prospectively, 6216 patients were studied for a mean of 107 months. SETTING: Of the total patients, 95% were followed in five hospital-based hypertension clinics and the remainder in four group general practices. PATIENTS: Respectively, 2250 and 2126 hypertensive men and women aged < 60 years and 822 and 1018 aged > or = 60 years. MAIN OUTCOME MEASURES: Mortality (any mention on the death certificate) from IHD. RESULTS: Four hundred and sixty-seven patients died with IHD mentioned on the death certificate. The relation between both diastolic blood pressure (DBP) and systolic blood pressure (SBP) during the first 3-12 months of treatment and subsequent IHD mortality was examined. Under the age of 60 years the relative hazard rate (RHR) for death from IHD tended to increase with DBP in both men and women. Above the age of 60 years there was no important or significant relation between IHD mortality and treated DBP. For SBP there was no reduction in the positive relation between IHD mortality and blood pressure in the older age groups. The RHR for SBP ranged between 1.008 and 1.021 in men and women over and under the age of 60 years. CONCLUSIONS: The positive relation between DBP and IHD mortality decreased with increasing age and, in women aged > or = 60 years, even inverted, partly explaining the negative relation reported between DBP and total mortality in the very old.

Adolescent↗
PubMed1992

Quality of life in hypertensives treated with atenolol or captopril: a double-blind crossover trial.

AIM: To compare the effects of captopril and atenolol on quality of life of hypertensive patients. METHODS: In a randomly allocated double-blind crossover trial with two 6-week treatment periods captopril at 25 mg twice a day or atenolol at 50 mg once a day were administered to 265 hypertensive patients (mean age 56 years; 55% men). Of these, 65% were newly treated hypertensives and 35% were previously uncontrolled on a diuretic alone. A seated diastolic blood pressure of 95-115 mmHg was required after a 3-week placebo run-in period. Any previous diuretic therapy was changed to hydrochlorothiazide (25 mg once a day) and the dose was kept constant throughout the trial. Newly diagnosed patients did not take a diuretic at any time. Quality of life was assessed from self-completed questionnaires measuring psychological well-being, symptomatic side effects of treatment, and activity and perceived well-being (a health index). A relative's perception of the patients' mood was also obtained where possible. RESULTS: Twelve patients withdrew on atenolol and 10 on captopril. No differences between the drugs were observed in quality of life measures, and 95% confidence intervals suggested that important differences were excluded. CONCLUSION: We conclude that at the doses used in this trial there were no important differences between captopril and atenolol in their effects on quality of life.

Adult↗