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Biomedical subjects

C J Bulpitt

Publications and source records attributed to C J Bulpitt.

At least 235 records · Page 13Linked to original sources
PubMed1980

Maternal hypertension and intrauterine fetal death in mid-pregnancy.

An analysis of the 156 pregnancies which terminated spontaneously between 16 and 27 weeks gestation, inclusive, indicated that in 41 patients where fetal death was the primary event, maternal arterial pressure was raised in early pregnancy when compared with matched groups of women whose pregnancies had a successful outcome. Blood pressure in the 14th week of pregnancy in women with fetal death was significantly higher than in women with other types of mid-trimester abortion. It is suggested that maternal hypertension predisposes to intrauterine fetal death in the mid-trimester of pregnancy as it does in the third trimester.

Abortion, Spontaneous↗
PubMed1980

How obstetricians in the United Kingdom manage preterm labour.

A questionnaire survey was conducted in order to establish how obstetricians in this country manage preterm labour. The results indicate that the majority of obstetricians would use beta sympathomimetic agents to inhibit premature labour; most would use corticosteroids in some circumstances to accelerate pulmonary surfactant production, while the use of prophylactic antibiotics seemed variable. The findings and implications of the survey are discussed.

Adrenergic beta-Agonists↗
PubMed1980

Long-term antihypertensive drug treatment and blood pressure control in three hospital hypertension clinics.

Prescribing patterns and blood pressure control have been studied in 1101 patients treated at three specialist hypertension clinics in Britain. Seventy-four per cent of the patients were already receiving treatment at the time they were referred by their general practitioners. Though the initial improvement in blood pressure control was satisfactory, there was often some deterioration of control over the long term. The pressure exceeded 140/90 mmHg in the majority of patients followed for a year or more. During 1971-5 diuretics remained first preference, with increasing use of beta-blockers and a distinct decline in the use of sympathetic neurone blockers both by hospital staff and referring practitioners. Multiple drug treatment was common, nearly half the patients requiring more than one antihypertensive drug. In newly treated patients the frequency of cessation of a particular class of drug because of side effects or lack of efficacy ranged from 6 per cent with diuretics to 57 per cent with adrenergic neurone blocking drugs. Long-term blood pressure control still presents many problems, and the results contrast with the more optimistic interpretations sometimes placed on short-term clinical trials of antihypertensive effect.

Antihypertensive Agents↗
PubMed1980

Factors influencing over and under-consumption of anti-hypertensive drugs.

Using a self-administered questionnaire, 817 patients attending two hypertension clinics were questioned about the number of tablets of different hypotensive drugs they took every day. The answers were compared with the number of tablets they should have been taking to determine the proportion who were not compliant with individual drug therapy. Ten per cent reported they were taking less than they should and seven per cent were taking more. Obsessionality was determined from a psychological questionnaire and non-compliant patients had a lower average score than compliant patients. Symptomatic side-effects associated with bethanidine appeared to induce non-compliance. Two symptoms were associated with failure to take the prescribed number of tablets, faintness on standing and a lessened interest in sex. This latest survey showed an improvement in compliance with most drugs compared with previous unpublished surveys conducted in 1971 to 1976. Once daily diuretic regimes were associated with better compliance than more complicated drug regimens.

Antihypertensive Agents↗
PubMed1979

Risk factors for death in treated hypertensive patients. Report from the D.H.S.S. Hypertension Care Computing Project.

A prospective study was performed to determine factors at presentation influencing survival in 2587 treated hypertensive patients who were followed for an average of 4 years. 86% had been referred to hospital clinics with hypertension and 14% were seen solely by their general practitioners. Of the 156 deaths, 81% were from cardiovascular causes. Independent risk factors for cardiovascular death were age, impairment of renal function, smoking habits, and systolic blood-pressure before treatment. Other independent factors of importance were proteinuria, history of myocardial infarction, and retinal changes of accelerated hypertension. Increased weight, serum cholesterol, and serum uric acid were not independent risk factors. Although these results agree substantially with data for normal populations, notable exceptions were impairment of renal function, which was very important in hypertensives, and raised serum cholesterol, which was not an independent risk factor in this hypertensive population.

Age Factors↗
PubMed1979

Comparison of black and white patients attending hypertension clinics in England.

Reports suggest that hypertension and death due to hypertensive disease are commoner among black than among white people. One hundred and thirty-five black patients attending hypertension clinics at three English hospitals were compared with age-, sex-, and clinicmatched white patients. The black women had higher blood pressures and weighed more than the white women, but there were no differences between the men. The black patients had not increased risk from family, obstetric, or smoking history. Proteinuria and nocturia were more common in black patients while urinary infections were less common. Heart size and left ventricular voltage were greater in black patients. Haemoglobin and plasma cholesterol and triglyceride concentrations were smaller and serum globulin concentration greater in black patients. No difference in response to treatment, attributable to race, was observed during the period of clinic attendance, which averaged 1.7 years. There was a slightly greater rate of default among black men during the first year of attendance.

Adult↗
PubMed1979

Biochemical and haematological changes induced by tienilic acid combined with propranolol in essential hypertension.

Sixteen patients with moderate essential hypertension completed a double-blind crossover trial with four treatment periods each of 6 weeks. They received in random order: placebo; tienilic acid 250 mg/day; propranolol 80 mg twice daily; and tienilic acid 250 mg/day combined with propranolol 80 mg twice daily. Average blood-pressure in the lying position was 22.6/13.1 kPa (169/98 mm Hg) on placebo; 21.0/12.5 (157/94) on tienilic aicd; 21.2/12.0 (159/90) on propranolol, and 18.9/11.5 (142/86) on tienilic acid combined with propranolol. The effects of tienilic acid and propranolol on blood-pressure were additive and there were no statistically significant interactions. Tienilic acid significantly reduced serum-urate from 0.33 to 0.18 mmol/l and induced hypokalaemia which was corrected by propranolol. Basophil count and haemoglobin were lower after tienilic acid treatment than they had been at the start of the study.

Adult↗
PubMed1979

Environmental factors affecting antipyrine metabolism in London factory and office workers.

1 Measurements of antipyrine clearance in saliva have been made in 128 London factory and office workers. 2 Mean antipyrine clearance in 56 Asian immigrants was 40% slower than in 72 White subjects. 3 Although dietary differences existed between the two groups, analysis of their effect independently of race was impossible since all but one of the vegetarians were Asian and the non-vegetarians were nearly all White. 4 In the White subjects, use of the oral contraceptive reduced clearance by 38% in women, while cigarette smoking increase clearance by 38% in men.

Adolescent↗
PubMed1979

Atenolol and chlorthalidone in combination for hypertension.

1 The hypotensive effect of single daily dosing with atenolol 100 mg and chlorthalidone 25 mg given alone or in combination has been assessed in a double-blind, crossover, placebo controlled trial in fifteen hypertensive patients. 2 Average lying blood pressures were: Placebo 155.4/103.9 mm Hg, atenolol 134.6/85.8 mm Hg, chlorthalidone 139.5/90.1 mm Hg, combination 127.7/82.5 mm Hg. 3 The effect of the combination therapy in reducing lying diastolic pressure compared with placebo (a fall of 21.4 mm Hg) was significantly less than the 31.9 mm Hg fall predicted from the sum of the individual effects (P = 0.01). 4 Observations on blood pressure at rest and under mental, isometric and bicycle ergometer stress were made pre-dose and post-dose for a 12 h period at the end of the last treatment period. 5 Lying blood pressure declined from the zero hour (pre-dose) reading on all treatments to a low at 15.00--18.00 h and then rose again. 6 The rise in systolic blood pressure after isometric exercise and mental stress was of a similar magnitude with all four treatment regimes. 7 Atenolol, alone and in combination with chlorthalidone, reduced the blood pressure and the pulse rate increase on exercise 2 h post-dose when compared with readings 24 h post-dose. 8 Once daily dosing with a combination of atenolol and chlorthalidone produced a fall in supine blood pressure over a 24 h period but the effect on exercise induced changes was not uniform over this period.

Adolescent↗
PubMed1979

Contribution of environmental factors to variability in human drug metabolism.

Drug metabolism in 96 London factory and office workers has been studied after simultaneous single doses of antipyrine (phenazone) and paracetamol (acetaminophen). Metabolic clearance of both drugs was significantly greater in subjects eating meat more than once a week than in those who ate meat less frequently. The precise contribution of diet could not be clearly defined since 90% of "meat-eaters" were European while all except one of the "vegetarians" were Asian. Clearance of both drugs increased with both alcohol and cigarette consumption. Regular intake of coffee and/or tea had a similar effect but, in the case of paracetamol, this did not attain statistical significance. Antipyrine clearance was lower among women who took the oral contraceptive pill than among those who did not, while paracetamol clearance was not significantly different. These findings may have implications for the use of drugs which are administered regularly in order to achieve steady-state plasma and tissue concentrations.

Adolescent↗
PubMed1979

Propranolol and tienilic acid in essential hypertension.

Sixteen patients with moderately severe essential hypertension completed a double-blind crossover trial with four treatment periods each lasting for six weeks. They received in random order, placebo; tienilic acid 250 mg/day; propranolol 80 mg b.d.; and tienilic acid 250 mg/day and propranolol 80 mg b.d. in combination. Mean blood pressure in the lying position was 169/98 mmHg on placebo, 157/94 mmHg on tienilic acid, 159/90 mmHg on propranolol and 142/86 mmHg on the combination of tienilic acid and propranolol. The effects of tienilic acid and propranolol on blood pressure were additive and there was no evidence of any interaction. The onset of the hypotensive effect of tienilic acid was gradual while the effect of propranolol was maximal within 2 weeks of the start of treatment. Tienilic acid produced a significant reduction in serum urate from 0.33 mmol/l to 0.18 mmol/l. The combination of tienilic acid and propranolol in the doses used in the trial was effective and acceptable in the reduction of raised blood pressure.

Adult↗
PubMed1978

Factors influencing the incidence of neonatal jaundice.

A retrospective study of 12 461 single births confirmed an association between maternal oxytocin infusion and neonatal jaundice. The effect of oxytocin on jaundice was independent of gestational age at birth, sex, race, epidural anaesthesia, method of delivery, and birth weight, each of which was significantly associated with neonatal jaundice. The effect of oxytocin was, however, small, producing a calculated mean increase in peak plasma bilirubin concentration of 8.6 mumol/1 (0.5 mg/100 ml); this excess was independent of sex and less than the effect of the baby being born one week earlier.

Bilirubin↗
PubMed1978

How obstetricians manage hypertension in pregnancy.

One thousand and ninety-three obstetricians answered a questionnaire on the management of pregnant women with pre-existing hypertension and pre-eclampsia. They reported that they frequently used antihypertensive drugs (most often methyldopa and diuretics) in severe essential hypertension but tended to give sedatives in mild cases. Renal impairment was considered more important that raised blood pressure as an indication for terminating pregnancy; but even without a raised blood urea concentration over a quarter of respondents (especially the more senior obstetricians) would have considered it. The more junior obstetricians were more likely to admit the least severely affected patients to hospital. Pre-eclampsia was usually treated with bed rest and sedatives (most frequently diazepam); but the choice of drug varied with the seniority of the respondents, the more senior obstetricians tending to confine themselves to the more familial drugs. There was considerable unanimity in the replies, even though most of the treatments and practices have not been validated by controlled trials, and two-thirds of the obstetricians gave the same answers to most of the questions.

Abortion, Therapeutic↗