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Biomedical subjects

C J Bulpitt

Publications and source records attributed to C J Bulpitt.

At least 145 records · Page 8Linked to original sources
PubMed1991

Myocardial infarction and stroke during treatment of hypertensive patients with different diuretic regimes.

A retrospective analysis of mortality and cardiovascular morbidity in patients being treated with a potassium losing diuretic alone or the combination of a potassium losing and sparing diuretic was performed in 1,935 patients attending a hypertension clinic between 1971 and 1981. In all, 713 patients were treated with a potassium losing diuretic and 472 patients were on a potassium sparing diuretic, usually in combination with a potassium loser. Presenting data on risk factors were similar between the two groups and age-adjusted cardiovascular morbidity and mortality was similar between the two groups. The relative risk (RR) for a myocardial infarction event on a potassium losing drug was 1.1 (95% CI 0.5-2.3) in men and 1.0 (0.4-2.5) in women. The corresponding risks for stroke were 0.8 and 0.7 respectively and total mortality was 1.3 and 1.1. However, following exclusion of patients with previous history of cardiovascular disease the risk of myocardial infarction in the potassium losing group was over three times that on a sparing diuretic, though the confidence intervals were wide. Total male mortality tended to be higher (RR = 2.4) but again failed to achieve statistical significance. An excess risk from potassium losing diuretics was found only in patients without cardiovascular disease and cannot be readily explained. This may be the result of treatment selection in different 'at risk' groups or chance in the performance of subgroup analyses.

Cardiovascular Diseases↗
PubMed1990

Economic assessments in randomized controlled trials.

When comparing costs and benefits of different medical strategies, cost-effectiveness analysis, cost-utility analysis and cost-benefit analysis may be used. Both direct and indirect costs and benefits must be considered. Integrating survival with a measure of quality of life such as a health status index permits calculation of quality of life adjusted years of survival (QALYS). In any trial where it is expected that a more expensive treatment is the most effective, a full economic assessment should be made. Examples are provided from the use of verapamil and propranolol in hypertension, naftidrofuryl in stroke and auranofin in the treatment of rheumatoid arthritis.

Cost-Benefit Analysis↗
PubMed1990

Measuring costs and financial benefits in randomized controlled trials.

Economic assessment can be incorporated into clinical trials to evaluate and compare the costs and benefits of different health care programs. In this article the three main types of evaluation are discussed: cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis. The measurement of direct and indirect costs is described and specific examples are quoted. Full economic analyses are given for the use of naftidrofuryl in the treatment of acute cerebral hemisphere infarction and the use of auranofin in the treatment of rheumatoid arthritis. Economic evaluation is seen to be justified whenever a more expensive treatment is expected to produce greater benefit. Such analyses should consider quality of life and health status, as well as the more easily identifiable outcomes.

Arthritis, Rheumatoid↗
PubMed1990

The progress of the visual field in chronic simple glaucoma and ocular hypertension treated topically with pilocarpine or with timolol.

It is theoretically possible that the vascular effects of topical sympathetic beta-blocking therapy in chronic simple glaucoma (CSG) might tend to neutralise the beneficial effect of a reduced intraocular pressure on the preservation of the visual field. We therefore followed the progress of 422 right eyes and 420 left eyes of 483 patients with CSG and 119 right eyes and 132 left eyes of 151 patients with an original diagnosis of ocular hypertension (OH). These patients were observed for a minimum of one year and up to 13 years, being followed for an average of 5.1 years in the case of CSG and of 4.5 years in OH. The majority of eyes with CSG were treated topically with a miotic and 38% of these received beta blocking therapy in the form of topical timolol. It was concluded that despite suggestions that beta blockers might reduce vascular perfusion of the optic nerve head, which might in turn cause an adverse effect on the visual field progress, the results of this analysis showed that there was less mean deterioration of visual field in eyes treated with beta blocker plus miotic treatment compared with those on miotic therapy alone.

Administration, Topical↗
PubMed1990

Blood cadmium in London civil servants.

Blood cadmium was measured in 466 randomly selected London civil servants not exposed to heavy metals at work. Blood cadmium ranged from 3.6 to 75.6 nmol/L (0.4 to 8.5 micrograms/L) with a geometric mean of 6.4 nmol/L (0.7 micrograms/L) in nonsmokers and 13.6 nmol/L (1.5 micrograms/L) in smokers (p less than 0.001). Blood cadmium was higher in women than in men (9.5 versus 7.8 nmol/L) and was inversely correlated with employment grade (p less than 0.001). The associations with age, body weight and alcohol intake were not significant. After adjusting for gender and the number of cigarettes smoked per day, 36% of the variance of blood cadmium was explained, while the contribution of employment grade was not significant. There was an unexpected negative relationship between serum creatinine and blood cadmium in men (r = -0.16; p less than 0.01). This was not true in women (r = +0.03), but the correlation remained present in men after adjustment for age, body mass index and smoking. In contrast, in the two sexes, the correlations between blood pressure and blood cadmium were weak and not statistically significant. In conclusion, in unexposed subjects, gender and smoking are important determinants of blood cadmium. In addition, a low level of environmental exposure to cadmium is not associated with a deterioration of renal function or an increase in blood pressure.

Age Factors↗
PubMed1990

Predicting death from coronary heart disease using a questionnaire.

The ten-year coronary heart disease (CHD) mortality is reported for 18,322 male civil servants aged 40 to 64 according to questionnaire responses at entry into the Whitehall study. In all 1714 died, 723 from CHD. The predictive power of the questionnaire was examined with a view to its use as a screening tool in population studies. In predicting death from coronary heart disease the greatest specificity (true negative rate) was achieved with men reporting both angina (A) and a history of severe chest pain (possible myocardial infarction, PMI). This strategy (A plus PMI) achieved a specificity of 99% but a sensitivity (true positive rate) of only 7%. In contrast, in men reporting angina and/or PMI, specificity was 90% and sensitivity 29%. If this 'and/or' algorithm was extended to include the report of dyspnoea, diabetes, and/or attending a primary care physician with heart disease or hypertension, then specificity was still 85%, but sensitivity increased to 44%. This combination (11 questions in all) is therefore recommended for screening purposes. Identifying and excluding those who favour positive answers ('yes-set' responders), using questions such as the effect of weather on breathing, led to small increases in specificity but relatively large falls in sensitivity. Among subjects reporting chest pain, those who also complained of non-specific symptoms experienced only half the mortality of those with none of these additional complaints.

Adult↗
PubMed1990

Quality of life on antihypertensive therapy: a randomized double-blind controlled trial of captopril and atenolol.

A randomized double-blind study lasting 2 months was performed with either 25 mg captopril twice a day or 50 mg atenolol once a day in 125 patients with established diastolic hypertension (diastolic blood pressure greater than 95 mmHg) identified during a population screening programme of subjects aged less than 65 years. Quality of life was assessed from self-completed questionnaires. A significant fall in diastolic blood pressure occurred with both captopril (106.7 +/- 7.0 to 98.6 +/- 8.6 mmHg) and atenolol (107.4 +/- 7.5 to 98.2 +/- 8.1 mmHg) but there was no difference between the two drugs in the size of the fall. A measure of the number of symptomatic complaints, the symptom complaint rate, decreased with both drugs, by 1.3% for captopril and 3.1% for atenolol, but the difference between the drugs was not significant [1.8%; 95% confidence interval (Cl) - 1.3%, 4.9%]. There was a significant increase in the reporting of cough and runny nose in those on captopril compared with atenolol. A health index increased by 1.1% with captopril in comparison with no change on atenolol (difference 1.1%; 95% Cl - 2.0%, 4.2%). Psychological well-being was measured using the Symptom Rating Test. The improvement in total score was 1.4% with captopril and 2.3% with atenolol. The difference of 0.9% was not statistically significant (95% Cl - 1.2%, 3.0%).(ABSTRACT TRUNCATED AT 250 WORDS)

Affect↗
PubMed1990

Mortality associated with captopril and enalapril: a report from the DHSS Hypertension Care Computing Project.

In 1986, the Committee on Safety of Medicines published a report suggesting that enalapril may have an adverse effect on renal function. The prescription event monitoring scheme subsequently published figures on adverse drug reactions and mortality for patients treated with enalapril. They concluded that enalapril did not have an adverse effect on renal function and survival. Similar data were not available for captopril, as the drug was marketed before prescription event monitoring had been developed. In the Department of Health and Social Security (DHSS) Hypertension Care Computing Project (DHCCP), 368 hypertensive patients treated with captopril and 371 treated with enalapril were followed for an average of 3.1 and 1.6 years, respectively. Thirty-two patients died; none had renal failure as an underlying cause of death. The death rate was similar in both drug groups, at 17.5 (enalapril) and 24.0 (captopril) per 1000 patient-years. The present report shows that, for patients treated for high blood pressure, the relative risk of mortality with captopril compared with enalapril was 1.37, an insignificant difference (95% confidence interval 0.63, 2.98).

Acute Kidney Injury↗
PubMed1990

Age-related effects of placebo and active treatment in patients beyond the age of 60 years: the need for a proper control group.

The age-related response to placebo and active antihypertensive treatment was evaluated in 742 elderly hypertensive patients who were followed in the double-blind placebo-controlled trial conducted by the European Working Party on High blood pressure in the Elderly (EWPHE). In the two treatment groups, the fall in systolic and diastolic blood pressures after 3 months was negatively correlated with age (P less than 0.02), indicating that the hypotensive effect of placebo and active treatment was more pronounced in older patients. Further comparison of the two treatment groups failed to demonstrate any statistical differences in the slopes of the hypotensive effect on age. These conclusions were not altered by cumulative adjustments for baseline blood pressure, pulse rate, serum creatinine and the presence of cardiovascular complications at entry. In conclusion, in the present study, a similar blood-pressure-lowering action which increased with age was observed on active and placebo treatment; thus, proof that an observed age-related hypotensive effect is caused by a particular drug requires comparison with a control group on placebo.

Aged↗
PubMed1990

Association between intraocular pressure and loss of visual field in chronic simple glaucoma.

This paper reports the analyses on data from 747 patients with chronic simple glaucoma (CSG) recorded in the King's College Hospital glaucoma data base between January 1970 and February 1985, having a mean follow-up time of 5.1 years (mode 8 years) with the object of determining the relationship of intraocular pressure (IOP) and visual field loss in CSG. A highly significant negative relationship was found between the presenting visual field coefficient (FC) and the untreated IOP (r = -0.26, p = 0.0001) - that is, the higher the IOP on detection, the worse is the visual field. A weak negative correlation was present between the change of FC per year and the treated IOP (r = -0.06), p = less than 0.05). At treated IOPs less than or equal to 18 mmHg visual field loss averaged 0.6 unit per year and for IOPs greater than 18 mmHg the average loss was 1.2 units per year. The data confirm both the importance of a raised IOP in the causation of chronic glaucomatous visual field loss and the importance of reducing the IOP in patients with chronic simple glaucoma.

Adolescent↗
PubMed1990

Blood lead concentration, renal function, and blood pressure in London civil servants.

Blood lead concentration was measured in 398 male and 133 female London civil servants not subject to industrial exposure to heavy metals. The relation between blood lead and serum creatinine concentrations and blood pressure were examined. Blood lead concentration ranged from 0.20 to 1.70 mumol/l with a geometric mean concentrations of 0.58 mumol/l in men and 0.46 mumol/l in women (p less than 0.001). In women blood lead concentration increased with age (r = +0.27; p = 0.002). In the two sexes blood lead concentration was positively correlated with the number of cigarettes smoked a day (men r = +0.17 and women r = +0.22; p less than or equal to 0.01), with the reported number of alcoholic beverages consumed a day (men r = +0.34 and women r = 0.23; p less than 0.01), and with serum gamma-glutamyltranspeptidase (men r = +0.23 and women r = +0.14; for men p less than 0.01). Blood lead concentration was not correlated with body weight, body mass index, and employment grade. In men 14% of the variance of blood lead concentration was explained by the significant and independent contributions of smoking and alcohol intake and in women 16% by age, smoking, and alcohol consumption. In men serum creatinine concentration tended to rise by 0.6 mumol/l (95% confidence interval from -0.2 to +1.36 mumol/l) for each 25% increment in blood lead concentration. In men and women the correlations between blood lead concentration and systolic and diastolic blood did not approach statistical significance. In conclusion, in subjects not exposed to heavy metals at work gender, age, smoking, and alcohol intake are determinants of blood lead concentration. At a low level of exposure, lead accumulation may slightly impair renal function, whereas blood pressure does not seem to be importantly influenced. Alternatively, a slight impairment of renal function may give rise to an increase in blood lead concentration.

Alcohol Drinking↗
PubMed1990

Should medical screening of the elderly population be promoted?

This article reviews the history of screening in the elderly, the conditions that should be considered, whether or not screening in the elderly is of benefit, whether we should look for disability or diseases and where screening should take place. Thirteen conditions are discussed: hearing loss and anaemia in some detail. Both disability and precise diagnostic criteria are considered. The place where screening is best carried out depends on the mobility of the subject and the nature of the particular screening tests selected for the 13 conditions. The desirability of screening was assessed on the following criteria: prevalence of the condition, severity of the problem, acceptability by the patient of the screening test, false positive rate, consequences of making a false positive diagnosis, the false negative rate and the consequences of this error, the effect of treatment, the cost of the screening test and the burden on the health services produced by the screening test. The criteria were scored 1-5 on a scale defined for each assessment, with higher scores favouring screening. We provide evidence that screening may be worthwhile for: need for chiropody, varicose veins/ulcer, hearing loss, obesity, visual impairment, hypothyroidism, hypertension, anaemia and diabetes mellitus. However, the assessments discussed in this paper need to be tested prospectively in randomised controlled trials.

Aged↗
PubMed1990

Drug treatment and quality of life in the elderly.

The QL of patients on long-term pharmacologic treatment needs to be evaluated, especially in the elderly. This article discusses how this should be done and gives the results of studies on three groups of drugs commonly taken by elderly patients. Diuretic treatment does not appear to grossly impair QL, transdermal nitrates for angina do impair QL if used continuously, and tolerance limits their efficacy. Antihypertensive drugs appear to vary widely in their effects on QL. Drugs such as ACE inhibitors, verapamil, and atenolol appear preferable to the older drugs such as methyldopa and the beta-blocker propranolol, which have a central action.

Aged↗
PubMed1990

Evidence for a curvilinear relation between blood pressure and urinary sodium in men.

With the use of a linear model, the relation between urinary sodium and blood pressure has been reported to be positive, non-significant, or negative. The hypothesis that this relationship is more complex than linear was investigated in two different study populations, which were independently recruited and examined by different observers. In 1,071 men randomly selected from the general population and in an unrelated sample of 1,209 military men, systolic and diastolic blood pressure were correlated with urinary sodium following a model, which included both the linear and quadratic terms of urinary sodium. In both groups of men, these second order models, adjusted for age and body mass index, provided a better fit (P less than 0.05) than the relationships with only the linear term of urinary sodium. The quadratic models explained from 0.35 to 1.10% of the blood pressure variance. Third order models, which in addition included the cubic term of urinary sodium, did not further improve the correlations between systolic and diastolic blood pressure and urinary sodium in men. In 1,010 women drawn from the general population and in 499 military women, neither the first nor the second order correlations between systolic and diastolic blood pressure and urinary sodium were statistically significant. In conclusion, the present results, reproducible in two different study populations, suggest that a second order model is more appropriate than a simple linear correlation to describe the weak relationship between blood pressure and urinary sodium in men. However, recommendations for the prevention of hypertension must not be changed, until the present findings are confirmed by intervention studies.

Adolescent↗