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Biomedical subjects

C J Bulpitt

Publications and source records attributed to C J Bulpitt.

At least 199 records · Page 11Linked to original sources
PubMed1986

Fifteen year survival of patients presenting with hypertension to a hospital clinic.

The survival has been determined for the 404 patients who presented to the Hammersmith Hospital Hypertension Clinic during the years 1962 to 1966 and in whom the untreated blood pressure was known. The fifteen year survival ranged from 72% for young men aged 30-49 at presentation to 27% for men aged 60-69. Sixty-eight percent of the deaths were cardiovascular or renal, 33% of all deaths were from ischaemic heart disease (IHD), 17% from stroke and 3% from renal causes. Death from any cause was predicted with statistical significance by age, the presence of accelerated or malignant hypertension, impaired renal function, smoking at presentation and systolic blood pressure. Death was not predicted by hypokalaemia, hyperuricaemia (after adjusting for renal function) and obesity.

Adult↗
PubMed1986

Pharmaco-epidemiological considerations in patients with arthritis and vascular disease of the kidney.

Non-steroidal anti-inflammatory drugs (NSAIDs) may produce acute renal failure, papillary necrosis and interstitial nephritis. These adverse drug reactions are rare but have been reported in patients with congestive heart failure, cirrhosis, renal parenchymal disease, lupus nephritis and hypertension. All these conditions may be associated with hypovolaemia and an activated renin-angiotensin system, when renal blood flow and glomerular filtration depend on local renal prostaglandin biosynthesis. A severe impairment of renal function may occur when this synthesis is inhibited by NSAID treatment. It is possible that 1 in 100 of elderly patients have renal parenchymal disease, 1 in 100 arteriolar nephrosclerosis, 1 in 200 unilateral or bilateral renal artery stenosis and an unknown number suffer from atheroembolic renal disease. Fortunately, only a small proportion of 'at risk' patients given NSAIDs appear to develop renal failure. Perhaps bilateral renal disease or salt depletion are necessary factors? Whatever the explanation, NSAIDs should be used with caution in the elderly.

Adolescent↗
PubMed1985

Fibrinogen: a possible link between social class and coronary heart disease.

Mortality from coronary heart disease in civil servants in the lowest grade of employment has been found to be about three times that of men in the highest grade of employment. As part of an investigation of this finding several haemostatic variables were measured in a sample of 29 men in lower grades of employment and 45 men in higher grades. There was a significant difference in plasma fibrinogen concentrations between men in lower grades of employment and those in higher grades (mean 3.39 g/l v 2.95 g/l, respectively; p less than 0.01) but not in other haemostatic variables. Multiple regression analyses showed significant independent associations of fibrinogen concentration with smoking (p less than 0.05) and grade of employment (p less than 0.05). The size of the observed difference between the grades of employment was similar to that between those dying of coronary heart disease or surviving during longitudinal study; it may therefore be an important part of the mechanism underlying social class differences in coronary heart disease. The statistical relation between fibrinogen concentrations and other characteristics that may be concerned in the aetiology of coronary heart disease was examined. A summary measure of job stress was significantly related to fibrinogen concentration (p less than 0.01) and made a substantial contribution to explaining the differences between grades of employment. Behaviour type and a score of physical activity were not significantly related to fibrinogen concentration.

Adult↗
PubMed1985

Familial aggregation of blood pressure, anthropometric characteristics and urinary excretion of sodium and potassium--a population study in two Belgian towns.

Blood pressure and anthropometric characteristics were measured on two separate occasions and the urinary sodium and potassium excretion determined from one 24-hr urine collection in a random population sample (n = 612) of two Belgian towns. After adjusting for confounding factors familial aggregation of these measurements was studied by computing correlation coefficients for the various intrafamilial relationships. Spouses are genetically dissimilar and share a common home environment only from adulthood on. The spouse-spouse correlations for blood pressure, body weight, body mass index and urinary sodium were therefore not significant, whereas the close spouse-spouse correlation for height (r = 0.29) may be explained by assortive marriage. Sibs not only share a common home environment, but also part of their genetic material. Significant sib-sib correlations could therefore be demonstrated for diastolic blood pressure (r = 0.21), height (r = 0.32), body mass index (r = 0.24) and urinary sodium (r = 0.34). For systolic pressure the father-son (r = 0.33) and mother-daughter (r = 0.24) correlations were significant, whereas the other parent-offspring correlations for systolic and diastolic pressure were not statistically different from zero. The tendency of the correlation coefficients for body weight and body mass index to be higher in mother-offspring than in father-offspring pairs suggests a closer maternal role in the determination of calorie intake in offspring. The parent-offspring correlations for urinary sodium were only significant in father-daughter (r = 0.24) and mother-son (r = 0.21) pairs. The fact that potassium, in contrast to sodium, is rarely used as an artificial additive in food preparation may explain why the correlations for urinary potassium were relatively high in all relationship pairs, varying from 0.20 to 0.34.

Adolescent↗
PubMed1985

The symptoms of patients treated for Parkinson's disease.

One hundred and eighty-one patients with treated Parkinson's disease completed a self-administered questionnaire on symptoms, and their responses were compared with those of 263 control subjects randomly selected from a general practice population. Nine symptoms were reported by the patients with more than a fivefold excess when compared with the controls. These included jerking of the limbs, shaking of the hands, excessive salivation, poor mental concentration, grimacing, being frozen or rooted to the spot, and hallucinations. Compared with the general control population, the patients did not have an excess of stomach or limb pain, indigestion, headache, or any decrease of interest in sex. This observational survey, unlike a randomised controlled trial, could not ensure that the different treatment groups were comparable in important respects. However, certain associations were apparent; for example, patients receiving both a decarboxylase inhibitor and levodopa tended to report fewer attacks of being frozen to the spot, fewer problems with salivation, and a reduced frequency of defaecation. Patients receiving anticholinergic drugs reported an excess of dry mouth, faintness, and dyskinesia, and fewer hot flushes.

Adult↗
PubMed1985

Quality of life in hypertensive patients on different antihypertensive treatments: rationale for methods employed in a multicenter randomized controlled trial.

In measuring the quality of life and other such end points in a trial, it is widely recognized that poor methods and observer and subject bias may invalidate the results. The measurement of two aspects of the quality of life, activity and well-being, is attempted using methods which include valid, repeatable assessments that are also sensitive to the actions of pharmaceutical agents. Methods are described for use in a randomized controlled trial to measure three aspects of well-being: symptoms, activity, and psychological status. These methods are employed in a single-blind randomized trial of a combination of oxprenolol plus diuretic compared with captopril plus diuretic in 97 patients with mild to moderate hypertension. The patients are from West German centers involved in a multicenter European study. In 34 (35%) of the patients, well-being was assessed from a self-administered questionnaire, and in the remaining 63 patients the investigators interviewed the patients and asked the same questions. Data are presented at entry to the trial. The methods appeared to be successful at that stage and the results were comparable with those for similar studies in London. Activity, well-being, and psychological status were sufficiently correlated to suggest that the methods are valid estimates of certain aspects of the quality of life. However, two major problems remain. Less disability was reported when the questionnaires were completed by the investigators; and after randomization their nonblindness must raise doubts about the objectivity of interviewer-derived data. The results of the trial may have to be assessed solely from self-administered questionnaires.

Adult↗
PubMed1985

Angiotensin converting enzyme inhibitors and quality of life: the European trial.

Two prospective multi-centre randomized trials were initiated to compare the relative efficacy and influence on quality of life of captopril, alone or in combination with hydrochlorothiazide, against either methyldopa, alone or in combination with hydrochlorothiazide, or oxprenolol in combination with chlorothalidone. The complaint rate, activity index and psychiatric morbidity were evaluated as indices of quality of life. Captopril was associated with a significantly (P less than 0.05) greater reduction in complaint rate compared with methyldopa and a tendency for less symptoms of depression compared with oxprenolol (P = 0.06), the latter drug being associated with an increase in depression scores. The trends in quality of life indices in the captopril-treated patients would suggest the need for double-blind placebo-controlled trials to investigate these apparent benefits.

Adult↗
PubMed1985

Potassium supplementation fails to lower blood pressure in hypertensive patients receiving a potassium losing diuretic.

Thirty-three patients with hypertension receiving drug treatment that included a potassium losing diuretic were randomly allocated to 64 mmol of potassium (14 patients) or to no additional potassium supplementation (19 patients). Potassium was administered as slow release potassium chloride. After 3 months, blood pressure fell by 5/1 mm Hg in the patients who received the supplements and by 7/4 mm Hg in those who did not receive them. The falls in pressure were not significantly different and the 90% confidence limits for the effect of supplementation on diastolic pressure were: a fall of 2 mm Hg and a rise of 11 mm Hg, thus excluding an important hypotensive effect in these patients. Conversely, plasma creatinine fell by 11% in the supplement group compared with a 6% rise in the control group (P less than 0.05). Potassium supplementation, either by pharmacological preparations or by dietary manipulation, may prove to be desirable in patients on a potassium losing diuretic but should not be expected to lower blood pressure in such patients.

Benzothiadiazines↗
PubMed1985

Malignant hypertension in general practice.

A diagnosis of malignant hypertension was recorded for 165 patients in the national morbidity study between 1970 and 1973. Three patients with benign hypertension were selected as age- and sex-matched controls for each case. The general practitioners in the study were asked to complete a further questionnaire about the patients and 66% of the practices agreed to take part. Information about the retinal findings for the patients was requested and less than half of those in the national morbidity study proved to have a strict diagnosis of accelerated or malignant hypertension although they were originally recorded as patients with malignant hypertension. Of those patients originally classified as having benign hypertension 5% had the retinal appearance of accelerated or malignant hypertension.Patients had been diagnosed as having hypertension for a mean of more than five years prior to entry into the national morbidity study and the survival of patients with both benign and accelerated or malignant hypertension was good. Thirtyfour per cent of those with confirmed benign hypertension and 62% of those with definite accelerated or malignant hypertension died in the follow-up period which was on average 10 years from entry into the national morbidity study.The survival of patients registered with doctors who did not collaborate and of patients whose clinical details were missing was similar to the survival of patients for whom full details were provided.Blood pressure control was only fair with a mean of 172/101 mmHg for the group with benign hypertension and 177/107 mmHg for the group with accelerated or malignant hypertension. Blood pressure control was the poorest for those who died from a stroke. A high proportion (78%) of deaths in association with accelerated or malignant hypertension were from cardiovascular or renal causes.

Aged↗
PubMed1984

Combined oral and nasal beclomethasone diproprionate in children with atopic eczema: a randomised controlled trial.

In a double blind, placebo controlled, crossover trial in 26 children with severe atopic eczema those receiving four weeks' treatment with combined oral plus nasal beclomethasone diproprionate improved significantly more than those receiving placebo. No adverse effects were observed, but 24 hour urinary cortisol excretion was slightly reduced. This combination may provide effective treatment in refractory atopic eczema with relatively little of the danger associated with systemic administration of prednisolone and other traditional corticosteroids.

Administration, Intranasal↗
PubMed1984

Role of nifedipine in the treatment of resistant hypertension. Comparison with hydralazine in hospital outpatients.

In a double-blind, randomized crossover study, the daily administration of 30 to 90 mg of nifedipine lowered blood pressure in a dose-related fashion in 14 patients already taking a beta receptor blocker and diuretic. The duration of the hypotensive response to 20 mg of nifedipine in capsule form, giving as a "step-three" drug to five of these patients, was six to eight hours. A survey of 122 patients with resistant hypertension treated long-term with nifedipine and a control group of 102 similar patients treated with hydralazine revealed that nifedipine at an average dose of 40 mg daily caused a fall in blood pressure similar to that achieved with hydralazine in a dose of 86 mg daily. The side effect profile of both drugs was also similar. Nifedipine may be a useful alternative to existing step-three antihypertensive drugs.

Double-Blind Method↗
PubMed1984

The consumers' attitude to obstetric care.

Questionnaires were sent to 1000 mothers, 1 year after childbirth, to elicit opinions about various aspects of obstetric care in labour and effects on child bonding. Questionnaires were returned by 632 women. Some attitudes were in broad agreement with the views of natural childbirth groups but more were in agreement with the established medical view. The majority of women did not consider that medical care was excessive and 63% found fetal monitoring reassuring. Questions on mother and child bonding showed that only few mothers (19%) though that this was influenced by events during labour and delivery. Having pain in labour was seen as an essential part of the emotional experience of childbirth by 45% of the respondents. This attitude and others were correlated with certain psychological traits, marital status and race. Before changes are made in obstetric practices in response to 'consumer' pressure, the opinions of recently delivered mothers ought to be taken into account.

Attitude to Health↗
PubMed1984

Urinary cadmium and lead concentrations and their relation to blood pressure in a population with low exposure.

The 24 hour urinary excretion of cadmium (U-Cd) and lead (U-Pb), and the excretion of beta-2- microglobulins and retinol binding protein concentration in spot urines, were determined in a random 4% sample of the population of a small Belgian town. Blood pressure and body weight were measured on two separate occasions. U-Cd averaged 2.4 nmol/24 h in 46 youths, increased with age, and was significantly higher in 57 adult men as compared with 59 women (9.3 v 7.2 nmol/24 h; p less than 0.01). U-Pb averaged 28 nmol/24 h in youths and similarly increased with age: adult men excreted more lead than women (64 v 40.0 nmol/24 h; p less than 0.001). Among men, manual workers excreted more cadmium (12.6 v 7.5 nmol/24 h; p less than 0.05) but a similar amount of lead (62 v 61 nmol/24 h) compared with office workers. After adjusting for sex and age, U-Cd and U-Pb were not related to body weight and cigarette consumption. In simple regression analysis, U-Cd was positively correlated with both systolic (r = +0.30; p less than 0.05) and diastolic (r = +0.38; p less than 0.01) blood pressure in women. After adjusting for other contributing variables, however, a weak but negative relation became apparent between systolic pressure and U-Cd in women (t = -2.21; p = 0.033) and between diastolic pressure and U-Cd in men (t = -2.04; p = 0.047). In women urinary beta-2-microglobulin was related to diastolic pressure (r-0.44; p<0.01) and after adjusting for age to both systolic (t=2.75; p=0.009) and diastolic (t=-3.07; p=0.004) pressure. In none of the sex-age groups did U-Pb and retinol binding protein contribute to the blood pressure variability.

Adolescent↗
PubMed1984

Is low salt dietary advice a useful therapy in hypertensive patients with poorly controlled blood pressure?

In order to decide whether or not to advise a low Na trial routinely in a hypertension clinic, a randomised controlled 'management' trial was conducted to assess dietary compliance, well-being and changes in antihypertensive medication as a result of such a diet. Sixty-five out-patients on drug treatment for hypertension but with diastolic blood pressures greater than 95 mm Hg on two successive occasions were randomly allocated either to an index group on a 1 g Na (44 mmol) daily diet or to a reference group. Dietary advice was given in detail and repeated as necessary to ensure there was no misunderstanding. After three months 28% of the index group still added salt to their cooking and 13% sometimes added salt at the table. The difference between the groups in 24-hour Na excretion averaged 59 mmol at the end of the trial but 55% of the index group had a 24-hour Na excretion greater than 80 mmol. The average blood pressure at the end of the trial was only a 4 mm Hg systolic and 3 mm Hg diastolic lower in the index group. However, this modest benefit was achieved without any obvious deterioration in the quality of the lives of the patients on the low Na diet. The index group enjoyed their food as much as before and tended to require less drug treatment. On the debit side the index group complained more of transient unsteadiness (p less than 0.05) suggestive of postural hypotension. Low salt dietary advice is only marginally effective in patients poorly controlled on drug treatment. Non-compliance limits the usefulness of the advice.

Antihypertensive Agents↗
PubMed1984

Contraceptive pill use, urinary sodium and blood pressure. A population study in two Belgian towns.

The relationship between contraceptive pill use, urinary sodium and blood pressure was investigated in a random sample of the premenopausal female inhabitants of 2 small Belgian towns. Systolic and diastolic pressure tended to be higher in 58 present pill users (126 +/- 11/75 +/- 9 mm Hg: mean +/- standard deviation) than in 110 women not currently taking the contraceptive pill (123 +/- 11/74 +/- 8 mm Hg). Their urinary sodium excretion averaged 149 +/- 47 and 143 +/- 57 mEq/24 h, respectively. Systolic pressure was positively associated with 24-hour urinary sodium in pill users (r = +0.41; p less than 0.01) and in those not on the pill (r = +0.19; p less than 0.05). This association was independent of age and persisted after adjusting for body weight and pulse rate in pill users, but was no longer apparent in the others when body weight, pulse rate, and age were taken into account. Thus, pill use was associated with an elevation of arterial pressure. In subjects taking the pill a positive association was observed between the urinary sodium excretion and systolic pressure. It is therefore possible that the systolic pressure of pill users becomes responsive to their usual sodium intake.

Adult↗