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C J Bulpitt

Publications and source records attributed to C J Bulpitt.

At least 127 records · Page 7Linked to original sources
PubMed1992

Pharmacoeconomic evaluation of risk factors for cardiovascular disease: an epidemiological perspective.

Over the past 30 years the identification of high blood pressure and hypercholesterolaemia as major predictors of cardiovascular disease has led to an increasing expenditure on healthcare costs in pharmacological treatment of these risk factors. Most of the cost has been due to antihypertensive treatment, but evidence from randomised trials of the benefits of cholesterol-lowering drugs, along with the introduction of therapies with fewer side effects, suggests that expenditure on cholesterol treatment will rise dramatically. Cost-effectiveness analyses can aid decision making in the use of these treatments. For both hypertension and hypercholesterolaemia, the most favourable cost-effectiveness ratios were found in late middle age, in men compared to women, at the highest level of the risk factor, and in subjects with multiple risk factors. The most cost-effective treatments appear to be those which were the cheapest and which also produced the largest reductions in the risk factor. However, certain findings were based on assumptions which may be invalid. The most important of these in hypertension, and to a lesser extent in hypercholesterolaemia, is that different treatments have similar effects on morbidity and mortality for a given level of risk reduction. Experimental evidence that might confirm or refute this is not available for most treatments of hypertension. Moreover there are no trials in women or in the elderly of cholesterol-lowering treatments. The burden of disease due to these risk factors has been underestimated, and further research is required to establish the benefits of treatment on prevention of conditions such as heart failure, peripheral vascular disease, and vascular dementia.

Adult↗
PubMed1992

Quality of life evaluation of antihypertensive drugs.

Eleven studies (10 randomised controlled trials and 1 large open study) that evaluated quality of life (QOL) are reviewed. The areas of QOL measured by the studies are compared and a consensus is reported that health-related QOL measures in patients with hypertension should include: symptomatic and psychological well-being, activity (work, leisure, sleep, sexual activity and social participation), cognitive function and life satisfaction. Recommended methods for measuring these aspects of QOL are noted. Seven studies included atenolol as 1 of the treatments and the effects of this drug on QOL are reviewed. The drug appears to maintain QOL as well as the angiotensin converting enzyme (ACE) inhibitors captopril, enalapril and cilazapril. One trial also suggests that verapamil maintains QOL as well as atenolol, although this was not suggested by the nonrandomised study. Nifedipine slow release (SR) and propranolol both fared worse than atenolol in 2 separate trials, but 1 trial suggested that nifedipine gastrointestinal therapeutic system (GITS) was preferred to atenolol in terms of QOL. In the latter study, however, only patients completing the prescribed therapy revealed a preference for nifedipine GITS; this was absent in an intention-to-treat analysis. The rate of discontinuation of nifedipine therapy was high, underlining the necessity for an intention-to-treat analysis in trials assessing QOL.

Antihypertensive Agents↗
PubMed1992

Aging, blood pressure and mortality.

UNLABELLED: POPULATION STUDIES: We reviewed population studies that relate mortality to blood pressure in the elderly. A positive relationship between blood pressure and mortality at the age of 60-69 years was weaker over the age of 75 and became a negative relationship over the age of 85, with hypertensive subjects living longer. This negative relationship probably reflects cardiac, respiratory and neoplastic disease in very elderly subjects with low blood pressure. Therefore, in very elderly hypertensive subjects we cannot conclude that a reduction in blood pressure will not be beneficial, for example in reducing stroke events. CLINICAL TRIALS: The results of clinical trials of antihypertensive treatment in the elderly provide inadequate evidence to assess the benefit of treating hypertensive subjects over the age of 80 years. A randomly allocated controlled trial is required in this age group.

Aged↗
PubMed1992

Prevalence of venous disease: a community study in west London.

OBJECTIVE: To find out the prevalence of venous disease in patients aged between 35 and 70 years. DESIGN: Self-administered questionnaire. SETTING: Community study in west London, England. SUBJECTS: A random sample of 2,103 patients aged between 35 and 70 years who were registered with three general practices. RESULTS: 1,338 (64%) subjects filled in the questionnaires. Of these, 323/1,303 (25%) said that they had varicose veins, 81/1,338 (6%) had a deep vein thrombosis or pulmonary embolism, and 52/1,336 (5%) said that they had had phlebitis. In addition, 94/1,326 (7%) had worn support stockings, and 84/1,304 (6%) had been treated with anticoagulants at some time; 31% of responders reported that they had had some form of venous disease. CONCLUSIONS: Increased age and female sex were independent risk factors for varicose veins and phlebitis. Thrombosis and pulmonary embolism were both significantly associated with the presence of diabetes, female sex, and increased age. The facts that a quarter of the sample had varicose veins, and that nearly a third had had venous disease of some kind at some time, suggest that venous disease may place a heavier burden on health resources than had been realised.

Adult↗
PubMed1992

A questionnaire to assess risk factors, quality of life, and use of health resources in patients with venous disease.

OBJECTIVE: To test the accuracy and usefulness of a questionnaire to assess risk factors and symptoms of venous disease, quality of life, and dependence on health and social services. DESIGN: Case-control study. SETTING: Multicentre study in three general practices. SUBJECTS: Patients drawn from a larger investigation of prevalence of venous disease. RESULTS: Patients who had venous disease were taller and heavier and had spent more time standing at work than those who did not. It was strongly associated with both number of pregnancies and number of children. There were weak but not significant associations with the wearing of a corset, constipation, and a family history of venous problems. CONCLUSIONS: The questionnaire was able to pick out recognised risk factors, and is suitable for use in studies of patients with venous disorders. It may also provide information about factors that have not yet been accepted. The case-control study is an appropriate way of assessing not only risk factors, but also signs and symptoms, quality of life, and use of health resources in patients with venous disease.

Case-Control Studies↗
PubMed1992

Quality of life on antihypertensive therapy: a double-blind trial comparing quality of life on pinacidil and nifedipine in combination with a thiazide diuretic. European Pinacidil Study Group.

The quality of life (QL) was evaluated in a 6 month double-blind trial in six European countries. Patients with a sustained supine diastolic blood pressure (SDBP), phase V, of 95 mm Hg or more on bendrofluazide, 5 mg daily (or an equivalent dose of a thiazide diuretic) were randomised to additional pinacidil (n = 127), 25 mg up to 100 mg daily, or nifedipine (n = 130), 20 mg up to 80 mg daily. The treatment groups were similar at entry for QL scores, average DBP of 103 +/- 6 (SD) mm Hg, and average age of 56 +/- 10 (SD) years. Eighteen patients on pinacidil and 12 on nifedipine withdrew due to side effects, such as oedema (both drugs) and flushing (nifedipine). The maximum antihypertensive effect was achieved within 6 weeks and maintained, resulting in a significant fall in SDBP of 13.7 mm Hg on pinacidil and 15.5 mm Hg on nifedipine at the end of the trial. There was no significant difference in the antihypertensive effect. The target SDBP was achieved in 57% of pinacidil-and 63% of nifedipine-treated patients. The average number of symptomatic complaints fell in both groups, with significant decreases in the reporting of blurred vision and headaches on nifedipine. Complaints of growth of body and facial hair increased on pinacidil but there were no significant between-drug comparisons with respect to side effects. In measures of psychological well being, patients on pinacidil showed a significant (p less than 0.05) improvement in total and cognitive function scores compared to nifedipine.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Epidemiological aspects of cardiovascular disease in the elderly.

BACKGROUND: Cardiovascular disease is the leading cause of death in the elderly in industrialized societies. However, in the elderly, unlike middle-aged subjects, little attention has been paid to strategies for reducing morbidity and mortality from this disease. OBJECTIVES: To review studies of risk factors for cardiovascular diseases in the elderly and the evidence, if any, of risk factor modification. FINDINGS: Overall, the evidence suggests that the established risk factors for cardiovascular disease in middle-aged subjects persist into old age. Several studies have shown that serum cholesterol is positively associated with a risk of coronary heart disease. In the very elderly, U-shaped distributions have been reported for the relationship between cholesterol and total mortality, probably as a result of other confounding factors. At present there is little experimental evidence of benefits from lowering cholesterol in the elderly. In contrast, several randomly allocated, placebo-controlled trials have established the benefits of blood pressure reduction (systolic or diastolic) up to the age of 84 years. A high blood pressure in the very old probably remains a risk factor, but prospective studies have reported non-linear relationships. Smoking has been reported to be a risk factor in the elderly in some, but not all studies. CONCLUSIONS: At present, only the treatment of high blood pressure can be definitively recommended in the elderly. The effects of both dietary and pharmacological modification of cholesterol need to be investigated.

Aged↗
PubMed1991

Blood pressure, the prevalence of cardiovascular diseases, and exposure to cadmium: a population study.

In a population study conducted from 1985 to 1989 in Belgium, the authors investigated whether exposure to cadmium is associated with blood pressure elevation and with an increased prevalence of cardiovascular diseases. The participants, aged 20-88 years, constituted a random sample of the households living in two low exposure areas (n = 803) and two high exposure areas (n = 1,283). For each exposure level, a rural and an urban district were selected. The cadmium levels in blood (8.5 vs. 11.0 nmol/liter) and urine (7.2 vs. 8.7 nmol/24 hours) were significantly (p less than 0.001) raised in the two high exposure areas compared with the two low exposure areas (p less than 0.001). Systolic pressure was similar in both rural areas, but in the urban area with high exposure systolic pressure was 5 mmHg (p less than 0.001) higher than in the control town. Diastolic pressure was similar in the four districts and the same was true for the prevalence of hypertension and of other cardiovascular diseases. Adjustment of systolic pressure for blood and urinary cadmium did not remove the difference in systolic pressure between both urban areas, suggesting that it was not related to the cadmium burden on the environment. Further analyses in individual subjects showed that neither blood pressure nor the presence of cardiovascular diseases were significantly and positively correlated with blood and urinary cadmium. Thus, the present population study did not confirm the hypothesis that increased exposure of the population to cadmium is associated with blood pressure elevation and with a higher prevalence of cardiovascular diseases.

Adult↗
PubMed1991

Risk of serious morbidity associated with hydralazine versus methyldopa treatment in hypertensive patients.

The medical records of patients presenting to the Hammersmith Hospital hypertension clinic between 1971 and 1981 were examined to determine presenting clinical data, treatment regimes, and both cardiovascular and non cardiovascular mortality and morbidity. When compared with 1004 patients receiving treatment other than hydralazine 310 patients on hydralazine had a significantly higher risk of developing renal disease (RR = 2.71) in men, and severe weight loss in women (RR = 3.06). Renal disease risk also tended to be high in women on hydralazine (RR = 1.95) compared with all other treatments, but this was not statistically significant and could be explained by poorer renal function and significantly higher untreated blood pressure in the hydralazine treated group at presentation. The 422 patients who were treated with methyldopa but not hydralazine had similar risk factors for cardiovascular disease compared with a group of 167 who received hydralazine but not methyldopa. Comparisons of event rates failed to find significant differences in morbidity or mortality between these two groups. The age adjusted male mortality was 14/1000 patient years on hydralazine and 12/1000 on methyldopa and 13/1000 and 6/1000 years for women respectively. There was no evidence of an increased risk of either renal disease (RR = 0.3 in men, RR = 0.3 in women) on hydralazine or weight loss (RR = 0.7 in men, RR = 1.6 in women), with similar presenting data. Systemic lupus erythematosus was a rare complication (2 of 314) of treatment with hydralazine.

Cardiovascular Diseases↗
PubMed1991

The effects of two centrally-acting anti-hypertensive drugs on the quality of life.

The objectives of this study were to compare the effects of two centrally-acting antihypertensive drugs on measures of quality of life in a three-month double-blind trial of hypertensive patients randomized to methyldopa (n = 79) or rilmenidine (n = 78). We studied men and women aged over 21 y attending eight hospital out-patient clinics in the United Kingdom. They had average diastolic blood pressures between 95 and 110 mm Hg and systolic pressures below 210 mm Hg after a 4-week placebo run-in period. The doses ranged from 1 to 2 mg daily of rilmenidine and 500 mg to 1 g of methyldopa. Hydrochlorothiazide (25 mg daily) was added after 8 weeks when the diastolic blood pressure remained at 90 mm Hg or more in 29% of patients on rilmenidine and 35% of those on methyldopa. Quality of life was assessed from self-completed questionnaires using standardized instruments. Both drugs reduced blood pressure, but at the end of the trial the fall in the methyldopa group (19.3/13.0 mm Hg) was significantly greater than in the rilmenidine group (13.2/10.0 mm Hg). Ten patients in the methyldopa group withdrew from the trial compared with three in the rilmenidine group, primarily because of adverse effects. In both groups there was a significant increase in the overall reporting of adverse effects. Reports of dry mouth increased on both drugs, and sleepiness on rilmenidine but not methyldopa. There was no significant difference between the drugs in the overall reporting of adverse effects or of individual adverse effects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic alpha-Agonists↗
PubMed1991

Syst-Eur. A multicentre trial on the treatment of isolated systolic hypertension in the elderly: objectives, protocol, and organization.

The Syst-Eur Trial is a concerted action of the European Community's Medical and Health Research Programme. The trial is carried out in consultation with the World Health Organization, the International Society of Hypertension, the European Society of Hypertension and the World Hypertension League. This article describes the objectives and the protocol of Syst-Eur, a multicentre trial designed by the European Working Party on High Blood Pressure in the Elderly (EWPHE), to test the hypothesis that antihypertensive treatment of elderly patients with isolated systolic hypertension results in a significant change in stroke morbidity and mortality. Secondary endpoints include cardiovascular events, such as myocardial infarction and congestive heart failure. To be eligible patients must be at least 60 years old and have a systolic blood pressure averaging 160-219 mmHg with a diastolic pressure less than 95 mmHg. Patients must give their informed consent and be free of major cardiovascular and non-cardiovascular diseases at entry. The patients are randomized to active treatment or placebo. Active treatment consists of nitrendipine (10-40 mg/day), combined with enalapril (5-20 mg/day) and hydrochlorothiazide (12.5-25 mg/day), as necessary. The patients of the control group receive matching placebos. The drugs (or matching placebos) are stepwise titrated and combined in order to reduce systolic blood pressure by 20 mmHg at least to a level below 150 mmHg. Morbidity and mortality are monitored to enable an intention-to-treat and per-protocol comparison of the outcome in the 2 treatment groups. A one-year pilot trial (1989) showed that the protocol is practicable. The Ethics Committee therefore decided to start the definite study (1990), in which randomized patients will be followed for 5 years. Recruitment of new centres and of the required 3,000 patients will last 3 years (until 1993).

Aged↗
PubMed1991

Pulse rate and sodium intake interact to determine blood pressure. A population study.

It has been suggested that certain factors need to be present for the pressor effect of sodium to become apparent. The present population study investigated whether pulse rate (PR) and salt intake interact to determine blood pressure (BP). Twenty-four hour urinary sodium (UNaV) was used as a measure of salt intake. A random population sample, including 2081 subjects with a minimum age of 18 years, was stratified on tertiles of PR. In subjects with a slow PR(less than 68 beats/min) and in those with a fast PR (greater than 78 beats/min), a significant curvilinear relationship between BP and UNaV was found, while in subjects with an intermediate PR the BP-UNaV correlation was not significant. There was also a significant interaction between PR and UNaV, indicating that when UNaV increased from 160 to 300 mmol/24 h, systolic/diastolic BP rose by 2/1 mm Hg in the fast PR third, but declined by 1/1 mm Hg in the slow PR third. These divergent trends could not be explained by smoking habits or alcohol consumption and were still present after cumulative adjustment for other important correlates of BP, ie, gender, age, body weight, urinary potassium, and contraceptive pill intake in women. In conclusion, the present data suggest that in subjects with a pulse rate greater than 78 beats/min a high salt intake may be associated with blood pressure elevation, whereas the opposite tendency is observed in individuals with a pulse rate less than 68 beats/min.

Adolescent↗
PubMed1991

The assessment of the relationship between blood pressure and sodium intake using whole-day, daytime and overnight urine collections.

The usefulness of whole-day, daytime (waking to retiring time) and overnight urine samples for assessing the relationship between blood pressure and sodium intake was examined in 301 male London civil servants, aged from 37 to 58 years old. Systolic blood pressure (SBP)/diastolic blood pressure (DBP) averaged 126/78 mmHg and the 24-h urinary excretion of sodium and potassium was 174 and 73 mmol, respectively. There was poor consistency between day- and night-time urine samples with respect to both sodium and potassium content. The urinary excretion of sodium and potassium was lower (P less than 0.001) in overnight than in daytime samples. After standardization for creatinine, the night: day ratio was 0.79 for sodium output and 0.55 for potassium excretion. Blood pressure, adjusted for age and body mass index, was significantly and positively correlated with overnight sodium excretion (SBP/DBP: slope = 0.061/0.046 mmHg/mmol) whereas the correlations with sodium excretion in daytime (0.010/0.004 mmHg/mmol) and whole-day (0.024/0.016 mmHg/mmol) urine samples were not significant. Blood pressure was significantly correlated with the sodium:potassium ratio in whole-day urine (1.941/1.968 mmHg/unit). As the agreement between daytime and overnight urine samples was low with respect to both sodium and potassium content, and due to the fact that the relationship between blood pressure and sodium in overnight samples may at least partially reflect pressure diuresis, overnight urinary sodium, even if related to sodium intake, cannot be employed to assess the association between salt in the diet and blood pressure.

Adult↗
PubMed1991

Rationale for a primary prevention study using low-dose aspirin to prevent coronary and cerebrovascular disease in the elderly.

The benefits of prophylactic aspirin therapy to prevent cardiovascular and cerebrovascular disease in asymptomatic individuals remains unclear. The rationale for developing a multicentered, double-blind, placebo-controlled clinical trial to determine whether low-dose aspirin (100 mg daily) prevents cardiovascular and cerebrovascular morbidity and mortality in persons aged 70 years and over with no evidence of pre-existing cardiovascular or cerebrovascular disease is described. Sample size calculations have indicated that 15,000 subjects would be required over a 4-year follow-up period in order to demonstrate a 20% reduction in overall cardiovascular mortality at the 0.01 level with a power of 0.8. Such a large-scale community-based clinical trial has never been conducted in Australia in this age group. Therefore the PACE (prevention by low-dose aspirin of cardiovascular disease in the elderly) pilot study has been developed to test recruitment strategies and methods and ascertaining disease end-points.

Adult↗
PubMed1991

Stroke death and unemployment in London.

STUDY OBJECTIVE: The aim was to investigate the relationship between social factors and stroke mortality in men and women aged between 45 and 74 years using census and mortality data from 32 London boroughs in 1971 and 1981. DESIGN: Census data from 1971 and 1981 on type of accommodation, density of room occupation, male unemployment rate, and proportion of households without a car were linked with stroke mortality available for each London borough. SETTING: 32 London boroughs excluding the City of London. MEASUREMENTS AND MAIN RESULTS: The main outcome measures were the association between age adjusted mortality from stroke and the proportion of households with no car, non-ownership of home, in council housing or rented accommodation, male unemployment rate, and living density of more than 1.5 people per room. There was no strong correlation between social variables and stroke mortality in 1971, but strong correlations were found for male stroke mortality in 1981. The highest correlation was with male unemployment (r = 0.64, p less than 0.001) even after adjusting for the proportion of the population born in the Caribbean and Africa (r = 0.56, p less than 0.01). Other social variables were also highly correlated with male stroke mortality: households without a car (r = 0.63, p less than 0.001), living density of more than 1.5 people per room (r = 0.053, p less than 0.001), council housing (r = 0.45, p = 0.01), and rented accommodation (r = 0.36, p = 0.05). After regressing male mortality on unemployment rate the other social variables were no longer significantly correlated with male stroke mortality. In women, the only significant correlation was found in 1981 between stroke mortality and the proportion of families living in council housing (r = 0.34, p = 0.05). CONCLUSIONS: Social factors are important indicators of stroke mortality. The major increases in unemployment over the decade may explain the generally stronger association in 1981 compared with 1971. Male stroke mortality increased by 0.062/1000 for every one percent increase in male unemployment (0.054/1000 after adjusting for place of birth).

Aged↗
PubMed1991

Reference values for the ambulatory blood pressure and the blood pressure measured at home: a population study.

In order to determine reference values for the ambulatory blood pressure, a population sample of 328 subjects, aged 20-81 years, who reported themselves to be in good health, was investigated. The ambulatory blood pressure was recorded over 24 h, taking measurements at 20 min intervals from 8 am to 10 pm, and at 45 min intervals from 10 pm to 8 am. Blood pressure was also measured by trained observers on each of two separate home visits (5 readings per visit). The ambulatory blood pressure in the 328 subjects averaged 118/71 mmHg over 24 h, 124/76 mmHg during the day (10 am-8 pm), and 108/62 mmHg at night (0 am-6 am). Blood pressure measured by an observer at the occasion of the second home visit was 4/5 mmHg lower (P less than 0.001) than the daytime ambulatory blood pressure. The 95th centiles for the daytime ambulatory pressures were 144/95 mmHg in 85 men below age 50; 154/90 mmHg in 74 men aged greater than or equal to 50 years; 132/85 mmHg in 96 women below age 50; and 151/91 mmHg in 73 women aged greater than or equal to 50 years. The 95th centiles for the nighttime pressures in these four sex-age groups were 124/79, 140/83, 121/70, and 132/72 mmHg, respectively.

Adult↗
PubMed1991

The association between blood pressure, calcium and other divalent cations: a population study.

This report investigated the associations between blood pressure and the levels of various divalent cations in blood and urine in the population at large. The 1,982 participants (963 men and 1019 women; mean age 48 years) constituted a stratified random sample of the population of 4 Belgian districts. Systolic/diastolic pressure averaged 133/78 mmHg in men, and 128/76 mmHg in women. Serum total calcium (2.37 mmol/l), serum magnesium (1.00 mmol/l) and blood cadmium (10.0 nmol/l) were on average similar in the two sexes. By contrast, serum zinc (13.1 and 12.6 mumol/l, respectively), blood lead (0.56 and 0.36 mumol/l) and the urinary excretions of calcium (4.86 and 3.95 mmol/24h), copper (0.16 and 0.13 mumol/24h), and cadmium (9.4 and 7.2 nmol/24h) were significantly higher in men than in women. After adjustment for significant blood pressure covariates (age, body mass index, pulse rate, log gamma-glutamyltranspeptidase, smoking habits, and in women the contraceptive pill), serum total calcium was independently and positively correlated with systolic pressure in both sexes, and with diastolic pressure in women. After similar adjustments systolic pressure was positively correlated with urinary copper in men and women. In addition, systolic pressure and blood lead, and diastolic pressure and urinary cadmium were negatively correlated in men. In conclusion, this population study demonstrated a positive relationship between systolic blood pressure and both serum total calcium and urinary copper.

Adult↗