Cation consumption and blood pressure.
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Blood Pressure↗
Biomedical subjects
C J Bulpitt
Publications and source records attributed to C J Bulpitt.
North Hammersmith stroke prevention project.
The North Hammersmith stroke prevention project was designed to reduce the number of deaths from stroke in this health district by improving the detection of hypertensive patients and thereafter reducing the default rate from treatment. Starting in May 1979 general practitioners in the district were asked to register hypertensive patients over the age of 40 so that the proportion of such patients in each practice was known and could be compared with the average for all practices. This confidential information was fed back every year to the individual general practitioners so that they could assess their performance. Forty of 44 eligible general practitioners agreed to participate and 29 proceeded to register patients. Over a three year period 1006 patients were registered, representing 4.3% of the project population over the age of 40. Individual practice registration rates ranged from 1.1% to 9.1%. Sixty five per cent of the registered patients were women, 34% of all registrations were in the age group 60-69, 31% in the group 50-59, 12% in the group 40-49, and 23% in the group over 70. The average blood pressure before treatment was 190/111 mm Hg. After one and two years the patients were contacted or their notes examined to ensure that they still receiving treatment. Persistant default from treatment occurred in under 12% over the three year period.
Adult↗
Analgesia and satisfaction in childbirth (the Queen Charlotte's 1000 Mother Survey).
Maternal satisfaction with the experience of childbirth was investigated in 1000 women having a vaginal delivery of a live child. Effective pain relief did not ensure a satisfactory birth experience. Epidural block produced the most effective analgesia but there were more dissatisfied women among the epidural patients than among those who did not receive this analgesia (p less than 0.05). Bad experience scores were evaluated one year later and were clearly related to a forceps delivery and long labour, both of which were more common in the epidural group. The desirability of an "epidural on demand" service should be tested against an "epidural when necessary" service.
Analgesia↗
Effectiveness of pain relief in labour: survey of 1000 mothers.
The amount of pain that had been experienced by 1000 women during vaginal delivery of a live child was determined by interview within 48 hours of delivery. Patients had been offered a choice of analgesia, and 536 had received epidural analgesia: pain relief was greatest in this group, just over half having had a painless labour. The duration of pain was also reduced by a third in this group even though patients who had received an epidural block had tended to have longer labour and an incidence of assisted delivery of 51% compared with 6% in the remainder. Seventy-two per cent of the patients receiving an epidural had had as much pain as they had expected. A similar proportion (70%) was reported with simpler analgesic methods, suggesting that women may expect a certain amount of pain in labour and request further analgesic treatment when this is exceeded.
Adult↗
Blood pressure and heart rate in patients with ischaemic heart disease receiving nifedipine and propranolol.
A randomised controlled crossover trial was performed to assess the anti-anginal effects of nifedipine and propranolol separately and together. The effects of these treatments on blood pressure and heart rate were assessed at rest and after the cold pressor and mental arithmetic tests. Nifedipine and propranolol together produced the greatest reduction in supine and erect systolic and diastolic blood pressures. Propranolol (480 mg daily) lowered resting systolic/diastolic blood pressures by 7/6 mm Hg and nifedipine (60 mg daily) lowered it by 10/8 mm Hg, while in the erect position the hypotensive effect of these agents averaged 9/8 mm Hg. During the cold pressor test propranolol lowered the maximum pressure by an average of 11/6 mm Hg and nifedipine by 19/10 mm Hg. For the mental arithmetic test, the results were 7/2 mm Hg and 16/7 mm Hg respectively. Propranolol (480 mg daily)reduced supine and erect heart rate by 19 and 25 beats/minute respectively, while nifedipine did not alter heart rate significantly. The favourable haemodynamic responses to nifedipine suggest that it may be of value in the management of hypertension.
Adult↗
Hydralazine, antinuclear antibodies, and the lupus syndrome.
The incidence of patients with positive antinuclear antibody test results rose during three years of treatment with hydralazine. At the end of that period over half of the patients (both rapid and slow acetylators) had titres exceeding 1/20, but the rate of rise was faster in the slow acetylators than in the rapid. There was a significant relation between the cumulative dose of hydralazine and the proportion of patients found to have antinuclear factors. Fewer black patients had positive test results than white. Patients whose antinuclear antibody test results changed fron negative to positive during the study showed this change five to 26 months after beginning treatment. Some patients showed a substantial fall in antinuclear antibody titre even though hydralazine was continued. From these findings patients in whom test results for antinuclear antibody became positive during treatment with hydralazine need not have the drug stopped unless they have clinical features of the lupus syndrome.
Acetylation↗
Community care compared with hospital outpatient care for hypertensive patients.
Three hundred and seventy-six patients with treated diastolic blood pressures of less than 105 mm Hg and no history of accelerated hypertension or renal failure were selected from among those attending the Hammersmith Hospital hypertension clinic. Their average lying treated blood pressure was 146 mm Hg systolic and 90 mm Hg diastolic and average age 56 years; 18% were black, 6% Asian, and 76% white. The patients were mostly having multiple treatment, 90% receiving a diuretic, 35% methyldopa, 33% propranolol, 18% atenolol, 9% hydrallazine, and 7% bethanidine. They were randomly allocated to either two years of further hospital outpatient care or referred back to their general practitioners. During the two years 19 (10%) of the 187 patients followed up in hospital defaulted and three had their treatment discontinued. Twelve (6%) of the 189 followed up by their general practitioners defaulted from follow-up and nine had their treatment discontinued. At the end of the trial the average lying blood pressure was 148 mm Hg systolic and 88 mm Hg diastolic in the hospital group and 149 mm Hg systolic and 90 mm Hg diastolic in the general practice group. The change in blood pressure was calculated for each individual and showed an average fall of 1.6 mm Hg in standing diastolic pressure in the hospital group and a rise of 1.4 mm Hg in the general practice group (p less than 0.05). The 90% confidence limits for a difference in standing diastolic pressure between the groups were 1 and 5 mm Hg with the pressure lower in the hospital group. General practice care was not quite as effective in controlling blood pressure as continued specialist supervision over two years in this selected group of treated outpatients with mild or moderate hypertension, but these results show that the discharge back to general practitioners of patients who are well controlled after hospital treatment is a sensible policy.
Adult↗
Prognosis of treated hypertension 1951-1981.
1 The 5 year survival of hypertensive patients in several studies was reviewed to demonstrate the adverse effects of increasing age, being male, having a higher untreated blood pressure of severe retinal changes. 2 The decrease in survival with increase in diastolic blood pressure was not linear, mortality being relatively constant below 90 mmHg. 3 The adverse effect of severe retinal changes was independent of the untreated blood pressure. 4 In patients selected with mild hypertension, 5 year survival can exceed 97% even when untreated. 5 Owing to the lack of suitable data we cannot conclude that treatment was more effective in prolonging life in the 1970s than in previous decades. 6 In the United States non-white patients with hypertension fared worse than white patients. 7 The serum cholesterol was not positively related to mortality in treated hypertension patients. 8 Treated hypertensive patients who smoked had at least a two-fold increase in mortality over those who did not. 9 Treated patients under the age of 50 years had a four-fold increase in mortality compared with the general population. This was greater than any excess mortality observed in the elderly.
Actuarial Analysis↗
A randomised controlled trial of the effects of screening for ulcer-type dyspepsia.
One hundred and ninety-nine male London office workers with dyspeptic symptoms elicited by a self-administered questionnaire were randomly allocated to intervention and control groups to assess the potential benefits of screening. The members of the intervention group were interviewed and examined, and those men who were considered to have a possible or probable peptic ulcer received a barium meal examination (53%). At the clinical interview the intervention group were advised against both smoking and drinking alcohol. Eighteen months later both groups were recalled for interview and examination and their sickness absence in the intervening period was assessed. The intervention group did not alter their cigarette consumption but did reduce their alcohol intake by an average of 10%. The control group increased their alcohol intake by 20%. Both groups tended to improve symptomatically, and there were no differences in symptoms between the groups at the end of the study. Sickness absence was not affected by the intervention. It is concluded that screening for ulcer-type dyspepsia is not justifiable in male London office workers.
Adult↗
Influence of liver disease and environmental factors on hepatic monooxygenase activity in vitro.
The effects of liver disease and environmental factors on hepatic microsomal cytochrome P-450 content, NADPH-cytochrome c reductase (reductase) activity and aryl hydrocarbon hydroxylase (AHH) activity have been simultaneously investigated in 70 patients undergoing diagnostic liver biopsy. The activity of reductase was not significantly affected by the presence of liver disease or any of the environmental factors studied. Cytochrome P-450 content decreased with increasing severity of liver disease whereas AHH activity was only significantly reduced in biopsies showing hepatocellular destruction. None of the parameters of monooxygenase activity varied significantly with the age or sex of the patients. Alcohol excess was associated with decreased cytochrome P-450 content and AHH activity and this effect was independent of the histological status of the biopsy. Both high caffeine intake and cigarette smoking increased AHH activity in the absence of any change in cytochrome P-450 content. There was a positive correlation between the number of meat meals eaten per week and cytochrome P-450 content. Chronic treatment with enzyme-inducing anticonvulsants appeared to increase both cytochrome P-450 content and AHH activity. Despite differential effects of liver disease and environmental influences on cytochrome P-450 content and AHH activity there was a highly significant correlation between the two parameters. The results of the present study correlate well with the known effects of disease and environment on drug metabolism in vivo.
Adolescent↗
Blood pressure and plasma sodium and potassium.
1. Two thousand, three hundred and twenty-eight men and 1496 women between the ages of 35 and 64 years were screened for hypertension and their plasma sodium and potassium concentrations measured. Those on antihypertensive or diuretic treatment were excluded from further analysis. 2. After adjusting for age, body mass index and other variables, plasma potassium was negatively associated with both systolic and diastolic pressure in men and women. A decrease in plasma potassium of 1 mmol/l was associated with an increase in systolic pressure in women of 7 mmHg (P less than 0.001) and diastolic pressure of 4 mmHg (P less than 0.001). In men the corresponding increases were 4 mmHg (P less than 0.01) and 2 mmHg (P less than 0.05). 3. After adjusting for the other variables as above, plasma sodium was positively related to systolic blood pressure but not to diastolic pressure. An increase in plasma sodium of 1 mmol/l was associated with an increase in systolic pressure of 1 mmHg in both men (P less than 0.01) and women (P less than 0.05).
Adult↗
Atopy and wheeze in children according to parental atopy and family size.
The relationship between atopy and wheeze was examined in children, together with the possible influence on these conditions of parental atopy and family size. Children with a repeated history of wheezing were selected from an urban general practice population. The children, their first degree relatives, and a control group were examined for atopic status, atopy being defined as more than one positive immediate skin prick test response. The prevalence of wheeze in boys was 15.5%, in girls 7.6%, and of atopy in boys 19.7% and in girls 8.1%. Of 110 atopic children 70% had no atopic parent, 27% had one atopic parent, and in 3% both parents were atopic. The presence of parental atopy was associated with an increased prevalence of wheeze in boys but not in girls, 12.0% of boys having a history of wheezing if neither parent was atopic and 27.5% if either or both parents were atopic (p less than 0.05). The presence of parental atopy was associated with an increased prevalence of atopy in girls but not in boys, 6.1% of girls having atopy if neither parent was atopic and 18.9% if either or both parents were atopic (p less than 0.01). There was a strong association between atopy and wheeze for both sexes and no statistically significant difference in the prevalence of atopy or wheeze in children whether they were from two, three, or four child families.
Adolescent↗
Sodium excess or potassium lack as a cause of hypertension: a discussion paper.
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Animals↗
Millions of mild hypertensives.
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Humans↗
Environmental factors affecting paracetamol metabolism in London factory and office workers.
A Paracetamol elimination was measured, using serial saliva samples, in 114 London factory and office workers, 76 Whites and 38 Asian immigrants. 2. Use of social drugs such as alcohol, tobacco and the oral contraceptive varied considerably within the sample, being appreciably greater in White subjects. 3. Paracetamol clearance was 21% slower in Asians than in Whites and half-life 18% longer. The total range of clearance was 1.86--6.78 ml min-1 kg-1. 4. Clearance was slower in women than in men, increased with increasing alcohol intake and cigarett consumption, and was more rapid in those women using the oral contraceptive. The effects of alcohol and the oral contraceptive were also found in White subjects alone. 5 The variables found to correlate independently with paracetamol clearance accounted for only 27% of the total sample variance, however, and are unlikely to be the major determinants of paracetamol elimination in man.
Acetaminophen↗
Antipyrene clearance in Indian villagers.
1 Antipyrine clearance has been measured using saliva samples in 50 Maharashtrans from a village to the north of Bombay. 2 All subjects were very lean and were also anaemic probably as a result of hookworm infestation. 3 Antipyrine clearance was 36% faster than in White Londoners studied previously and more than twice as fast as in Asian immigrants living in London. 4 Clearance was 25% faster in men than in women but volume of distribution was also greater in men and mean half-lives did not differ significantly between the sexes. 5 There was a negative correlation between antipyrine clearance and haemoglobin concentration. 6 The study has identified geographic differences in antipyrine metabolism which could be clinically important. The role of anaemia merits further study.
Adult↗
Comparison of labetalol and propranolol in hypertension.
1 Labetalol has been compared with propranolol in a double-blind, double-dummy study of 24 patients with mild or moderate essential hypertension. 2 Two patients were unable to tolerate propranolol and five labetalol, because of symptom side effects; this difference was not significant (P greater than 0.1). 3 On a self-administered questionnaire, labetalol was associated with a greater number of side effects per patient than propranolol, but no individual side effect was significantly more common with either drug. 4 There was no difference in the number of spontaneously reported side effects between the two drugs. 5 Both drugs impaired pulmonary function, but propranolol caused a greater reduction than labetalol after 8 weeks of treatment. 6 We conclude that labetalol and propranolol are similarly effective and acceptable to the patient.
Adult↗
An audit of prescribing in an obstetric service.
An audit of drug prescribing was carried out in an obstetric service. Sixty-five different drugs were prescribed in 976 separate prescriptions. Nitrazepam and paracetamol accounted for 75 per cent of all prescriptions. Many of the prescriptions were incomplete. In 83 per cent of cases the drugs prescribed were not referred to in the patients' case notes, suggesting that their prescription did not form part of a therapeutic plan for the patient.
Drug Prescriptions↗