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Biomedical subjects

C J Bulpitt

Publications and source records attributed to C J Bulpitt.

At least 73 records · Page 4Linked to original sources
PubMed1996

Quality of life with ACE inhibitors in chronic heart failure.

The randomized trials assessing the effect of angiotensin-converting enzyme (ACE) inhibitors in chronic heart failure (CHF) are reviewed. The Minnesota Living with Heart Failure Questionnaire has demonstrated the benefits of enalapril in some but not all circumstances and the Yale Dyspnea-Fatigue Index improves with lisinopril. A recent trial of both cilazapril and captopril vs. placebo employed the Sickness Impact Profile and supports the concept that ACE inhibitors have a small (and in this trial nonsignificant) beneficial effect on mobility. Other vasodilators and inotropes may also have small benefits on quality of life, such that comparisons of an ACE inhibitor with vasodilators, as was done in the V-HeFT II trial, fail to reveal any different effects on quality of life.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1996

The prevalence of pseudohypertension in the elderly.

Pseudohypertension (PHT) could lead to the initiation of unnecessary antihypertensive treatment and potentially adverse consequences. The Finapres is reported to be a reliable alternative to intra-arterial blood pressure (BP) measurements and is unlikely to be distorted by arterial calcification, suggested to be a cause of PHT. Finapres measurements were compared with sphygmomanometric measures of brachial BP. PHT was defined as a systolic pressure (brachial) > or = 190 mm Hg and finger systolic < 160 mm Hg or a diastolic pressure (brachial) > or = 100 mm Hg and finger pressure < 90 mm Hg. One hundred and twenty-five elderly in-patients and out-patients, both hypertensive and normotensive, had a 2.5% prevalence of PHT (1 had diastolic PHT in the left arm, 1 had systolic PHT in the right arm and 1 had systolic PHT in both arms). A group without PHT, but with higher systolic readings with the sphygmomanometer compared with the Finapres (> or = 30 mm Hg) was identified. It was thought that the same factors may affect both pseudohypertensive and non-pseudohypertensive subjects with such large differences. Our data suggest that age plays a role in the presence of higher brachial pressures.

Age Factors↗
PubMed1995

Prolonging life in elderly people: a worthwhile goal of medical care.

The very elderly (over 80 years) have a relatively high level of disability and dependency, and this has been reported to be a greater problem in women. It has, therefore, been proposed that there may be little to gain from prolonging life of the very elderly, especially very elderly women. However, there is very little evidence to suggest that increasing survival leads to a higher prevalence of disability at a given age. Preventive measures that prolong life appear to postpone both morbidity and mortality. Moreover, there is little reliable evidence that an elderly woman is more dependent than a man of the same age. It is also suggested that there is a 'cap' on survival and, therefore, we should concentrate on preventing morbidity and compress it into the last few years of life. We consider whether or not the elderly are approaching a 'cap' on survival and think that they are not. We conclude that preventive medicine in the elderly should aim to prolong survival and prevent morbidity. It is uncertain whether morbidity can be prevented more than mortality or vice versa. The concept of compressing morbidity at the end of life is an attractive concept, but data are lacking to support this idea.

Aged↗
PubMed1995

Alcohol intake and cardiovascular mortality in hypertensive patients: report from the Department of Health Hypertension Care Computing Project.

OBJECTIVE: To determine the benefits and risks of drinking alcohol in treated hypertensives. DESIGN: A prospective study of 6,369 hypertensives (3,161 men) attending primarily hospital clinics in the UK. METHODS: Relative risks both for drinkers compared with non-drinkers and for level of alcohol consumption were calculated for mortality from ischaemic heart disease, stroke, non-circulatory and all causes. RESULTS: At presentation 76% of the men and 48% of the women reported recent alcohol consumption. Compared with drinkers, non-drinkers were older, less likely to smoke and had a higher untreated blood pressure. After adjustment for confounding factors, male drinkers had a reduced risk of stroke mortality and possibly of ischaemic heart disease mortality. Similar results were observed in women for stroke mortality but not for ischaemic heart disease mortality. The trend remained after adjustment for previous cardiovascular disease. In men the lowest risk of ischaemic heart disease mortality occurred at intakes of > 21 units per week and stroke mortality was lowest at 1-10 units per week. Men consuming > 21 units per week had a twofold higher non-circulatory mortality. Total mortality was lowest in men who drank 1-10 units per week. Similar effects of alcohol on cardiovascular mortality were observed in women. CONCLUSIONS: Alcohol intake may reduce stroke mortality in treated hypertensives. Ischaemic heart disease mortality in men may also be reduced, especially at higher intakes ( > 21 units per week). The beneficial effects were offset by increasing incidence of non-circulatory causes of death. Alcohol consumption of 1-10 units per week was associated with the lowest mortality in men.

Adolescent↗
PubMed1995

Assessing biological age: practicality?

There are many problems in measuring "biological" age rather than chronological age, not least the necessity of demonstrating that this measure has validity in terms of better predicting mortality or morbidity. This review considers nine problems in measuring biological age and attempts to provide a full or partial solution to these difficulties. The problems presented include the fact that different organs age at different rates; biological age depends on the parameters studied; 'regression dilution bias' may produce misleading results; the validity of the measurement has to be established; the age range for measures has to be agreed; persons affected by accident or disease may or may not be excluded; accidental deaths may have to be excluded from a study of validation; individuals age at different rates at different times, and the fact that longitudinal data are necessary. The solutions suggested include both the presentation of aging profiles including several systems and the provision of summary statistics; adjusting for 'regression dilution bias', and calculating rate of aging from longitudinal studies over different age ranges and in the two sexes separately. It is argued that in this field of research it is well worth confronting the difficulties and extending our body of knowledge by further careful studies.

Aging↗
PubMed1995

Proportion of patients with isolated systolic hypertension who have burned-out diastolic hypertension.

In a community survey of 3242 subjects, 1663 did not initially have isolated systolic hypertension (ISH) and were re-screened an average of 8 years later. ISH developed in 53 (22%) of untreated patients with previous diastolic hypertension. Similarly, 8% of subjects with transient hypertension and 8% of normotensive controls developed ISH. Of all cases of ISH, 16% had previous diastolic hypertension. These subjects were more likely to have continued to smoke (P = 0.01) and lost more weight (P = 0.001) than patients with ISH who did not have burned-out diastolic hypertension.

Adolescent↗
PubMed1995

Quality of life in treated hypertension: a case-control community based study.

The aim of this case-control community study was to determine whether there was a difference in quality of life between hypertensive subjects and matched normotensive controls. Cases aged 40-79 years were randomly selected from a hypertensive register and matched with controls for age, sex, ethnicity and health centre. Cases had phase V diastolic blood pressure (DBP) > or = 100 mm Hg or systolic blood pressure (SBP) > or = 180 mm Hg, or were on anti-hypertensive medication. Controls had DBP < or = 90 mm Hg and no record of raised BP or anti-hypertensive treatment within the past year. Quality of life was measured by self-administered questionnaire. Data from 90 matched pairs, average age 62 years, with 47% men, were analysed; 80 hypertensive subjects were on anti-hypertensive medication. Hypertensive subjects showed an impairment in well-being compared with controls. They had a lower Health Status Index, had more sickness absence from work, greater symptomatic complaint and impaired psychological well-being. Relatives also reported a poorer quality of life in the hypertensive subjects. This impairment could be a result of the disease, adverse effects of drug treatment or to the effects of labelling.

Adult↗
PubMed1994

The assessment of biological age: a report from the Department of Environment Study.

Indicators of ageing were measured in 397 male and 130 female London Civil Servants aged from 37 to 58 years of age. Grey hair, skin inelasticity, and arcus senilis were strongly and independently related to chronological age. Also independently related were serum albumin (negatively related in both sexes), baldness, serum creatinine, systolic blood pressure, serum calcium (negatively) and ESR in men, and serum cholesterol in women. Chronological age was regressed on the above variables for men and women separately to provide regression equations. Biological age for an individual was calculated by entering his or her results and calculating the residuals. Biological age in those who stopped smoking tended to be younger than chronological age by an average of 12-13 months in men and 1-4 months in women. Men and women who had never smoked had higher biological than actual ages but not after adjusting for regression dilution bias. Men who currently smoked had higher biological ages of 2-3 months but not women smokers (4-6 months lower). Similarly, men of lower employment grades had an average biological age 13 months older and women 8 months, compared with higher employment grades. These differences between employment grade appeared to be due to ESR, arcus senilis, systolic blood pressure and serum cholesterol. These four measurements may be markers of biological rather than chronological age, and the value of attempting to measure biological age is discussed.

Adult↗
PubMed1994

Age differences in biochemical and hematological measures during middle age.

Biochemical and hematological measures possibly associated with ageing were measured on a single occasion in 3402 male and 2152 female London Civil Servants aged from 35 to 59 years of age. These included erythrocyte sedimentation rate (ESR), blood hemoglobin and serum albumin, calcium, bilirubin, creatinine, urea, urate, high density lipoprotein (HDL), and total cholesterol. Independently and positively related to age were ESR with an estimated 47% 'increase' in men over the 15 years between ages 40 to 55 and a 40% increase in women; serum urea had a 6%/15-year increase in men and 20% in women; total cholesterol had a 6%/15-year increase in men and 18% in women; serum creatinine 'increased' by 2%/15-years in men and 5% in women. In women, urate, HDL cholesterol and hemoglobin increased with age group. Negatively related to age was serum bilirubin in both sexes (8% and 6% 'fall'/15-years in men and women respectively). Serum albumin and calcium fell with age group in men. The sexes differed in their relationship to aging for total cholesterol and HDL cholesterol (greater increase in women), serum calcium (small decrease in men and small increase in women), urate and hemoglobin (increases in women but not men). Urea increased more in women than men, and albumin decreased more in men than women (p < 0.001 for all comparisons with the exception of HDL cholesterol, p < 0.01). Changes during the menopause were thought to explain some of these findings.

Adult↗
PubMed1994

A comparison of three quality of life instruments in subjects with angina pectoris: the Sickness Impact Profile, the Nottingham Health Profile, and the Quality of Well Being Scale.

Three instruments for the assessment of quality of life, the Quality of Well Being index (QWB), the Nottingham Health Profile (NHP) and the Sickness Impact Profile (SIP) were assessed in 59 patients with angina pectoris. The NHP showed increased statistically significant impairment with higher New York Heart Association (NYHA) class in 4 out of 6 subscales but not in single responses to questions on daily life. In the SIP 9 out of 11 dimensions increased with NYHA grade as did the physical and psychosocial subscores and the total score. There were statistically significant increases in six of the eleven dimensions. In the QWB an increase was observed only for two out of four categories employed in this instrument. The QWB was the most difficult to administer and thought likely to be insensitive to changes in anginal pain. There was a high level of agreement in similar dimensions of NHP and SIP. A psychological distress score was evaluated using the Symptom Rating Test and correlated with all summary dimensions of both instruments. The coefficients of variation were lower in SIP than in NHP categories. In conclusion quality of life instruments like NHP and SIP may be able to identify treatment effects in angina patients and so yield a useful addition to the traditional measures employed for the assessment of their condition.

Adult↗
PubMed1994

Is a positive association between lead exposure and blood pressure supported by animal experiments?

The possible association between low-level lead exposure and blood pressure and the causal nature of any such relationship continue to be debated. A recent meta-analysis of the human model data showed that on average a doubling of blood lead was associated with a rise in blood pressure averaging 1 mm Hg systolic and 0.6 mm Hg diastolic. The older animal studies, however, failed to show a significant pressure increase with massive lead exposure. This review therefore attempts to determine whether the more recent animal studies are supportive of a positive association between lead exposure and blood pressure elevation. Of the 21 animal studies published since 1977, one was carried out in dogs, one in pigeons, and the remainder in various rat strains. In the articles in which all the lead doses had been higher than 1 ppm, the association between blood pressure and exposure was found to be positive in seven, inconsistent in three, absent in four, and negative in one. Of the six animal experiments that employed lead doses not exceeding 1 ppm, five reported a small pressor effect. One of these five positive low-dose studies, however, failed to show a dose-effect relationship when exposure was increased from 0.1 to 1 ppm. In conclusion, most, but not all animal studies published since 1977 found a positive association between blood pressure and lead exposure. However, publication bias may have inflated the number of positive studies appearing in the literature.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗