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D G Beevers

Publications and source records attributed to D G Beevers.

At least 199 records · Page 11Linked to original sources
PubMed1992

Salt intake and stroke: a possible direct effect.

We have performed an ecological analysis of the relationship between regional mortality from cerebrovascular disease in western Europe and regional data on urinary sodium excretion, systolic blood pressure and relevant confounding variables. We have used published WHO cerebrovascular disease mortality rates and data provided by the INTERSALT study. Inter-relationships between these variables were investigated by linear regression analysis, with the regression coefficients, weighted for population size. On univariate analysis a significant linear relationship was observed between regional stroke mortality and median 24 hour urinary sodium excretion (coef. = 0.01, t = 3.28, P = 0.008), body mass index (coef. = 0.24, t = 3.21, P = 0.009) and alcohol intake (mls/week, coef. = 1.54, t = 3.99, P = 0.003). The relationship between stroke mortality and systolic blood pressure, though positive, was weaker than that between stroke mortality and sodium excretion and was not significant in this data. The stroke mortality sodium excretion relationship was independent of BMI on multivariate analysis. These data are consistent with the hypothesis that a high intake of salt may increase the risk of stroke, independent of effects on blood pressure.

Alcohol Drinking↗
PubMed1991

Comparison of lisinopril versus atenolol for mild to moderate essential hypertension.

The antihypertensive effects and safety profiles of lisinopril (10 to 40 mg) and atenolol (50 to 100 mg) were compared in a randomized, double-blind, parallel group trial in 144 patients with essential hypertension. After 8 weeks of therapy, seated blood pressure (BP) decreased by 26/15 mm Hg with lisinopril and by 19/14 mm Hg with atenolol. Lisinopril produced a greater reduction (p less than 0.05) in sitting systolic BP than did atenolol. Standing BP decreased by 25/15 mm Hg with lisinopril and by 19/14 mm Hg with atenolol. No important changes in hematologic and biochemical profiles were seen with either drug. Eleven patients, 7 receiving lisinopril and 4 receiving atenolol, were withdrawn because of adverse experiences; another 3 patients defaulted during treatment, 1 in the lisinopril group and 2 in the atenolol group. Both drugs were well-tolerated and are therefore suitable for first-line therapy in essential hypertension.

Antihypertensive Agents↗
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

Seasonal variation of cerebrovascular diseases.

The seasonal variation in all admissions of all types of cerebrovascular disease within the West Midlands Region was examined between the years 1973-1980. There was a fluctuation for both sexes with a peak in winter, between the months of October and April; a trough was observed in late summer, in July and August. Multivariate analysis of the meteorological factors showed an association between hours of sunshine and intracerebral haemorrhage. The meterological variables were strongly correlated with each other making the selection of the most predictable variable to stroke difficult.

Cerebral Hemorrhage↗
PubMed1991

Is prevention of vascular dementia possible? The Syst-Eur Vascular Dementia Project.

Vascular dementia (VD) is the second most common cause of dementia in the elderly after Alzheimer's disease (AD). Prevalence estimates from community surveys indicate that, on average, 5% of persons over 65 and 15 to 20% of people over 80 suffer from "severe dementia". Clinico-pathological studies have shown that AD accounts for 50 to 60% of the cases and VD for about 10 to 20%; 20% of the patients have both disorders. The incidence rate of VD ranges from 7 per 1,000 person-years in normal volunteers to 16 per 1,000 person-years in subjects with risk factors for strokes, particularly high blood pressure. The only effective therapeutic approach to VD is the prevention of strokes, mainly through the treatment of hypertension; however, none of the therapeutic trials has included VD prevention as one of its treatment goals. Syst-Eur Study is a European placebo controlled trial which aims to determine whether morbidity and mortality are changed when elderly patients (60 years and over) with isolated systolic hypertension are treated. In this trial, the incidence of VD will be carefully recorded during the five year follow-up of the expected 3,000 patients. The present side project to the Syst-Eur trial will specifically address the following questions: does antihypertensive treatment reduce the incidence of VD?, and how do the cognitive functions of elderly patients change when treated with active or placebo treatment? The protocol is based on the administration of the MMS (Folstein) once a year to all patients. If the MMS score is 23 or less, a set of criteria will be used to establish the diagnosis of vascular dementia. A pilot study has demonstrated the feasibility of the trial. The main study is in progress.

Aged↗
PubMed1991

Conflicting views on the measurement of blood pressure in pregnancy.

Current practice with regard to the technique of blood pressure measurement in pregnancy was assessed by means of a self-completed questionnaire sent to all midwives (116) and obstetricians (11) working in a UK District General Hospital obstetric unit. The response rate was 72% (91 respondents). Over half of the respondents (53%) use the fifth phase diastolic end point (contrary to current recommendations). Of the 75 respondents who had access to a large adult cuff 54 (72%) had used it on 'less than two occasions' over the preceding four weeks. Only 10% (9) of respondents reported that they record blood pressure to the nearest 2 mmHg and 23% (22) reported that they round blood pressure readings to the nearest 10 mmHg. There were diverse views on the interpretation of multiple blood pressure recordings. The conclusion is that compliance with current recommendations on blood pressure measurement technique in pregnancy is poor. There is poor agreement among midwives and obstetricians as to how blood pressure should be recorded in pregnancy.

Blood Pressure Determination↗
PubMed1991

Hypertension.

Explore the source record for details and available documents.

Aged↗
PubMed1991

High blood pressure due to alcohol. A rapidly reversible effect.

The hypothesis that the action of alcohol on blood pressure is rapidly reversible and that its effect is therefore mainly due to very recent alcohol consumption was examined in this study. Five hundred and seventy-seven subjects were screened in an occupational survey. Alcohol consumption, documented with a 1-week retrospective diary was divided into two categories: "recent" and "previous" intake. Recent intake was defined as the amount consumed on days 1, 2, and 3 immediately preceding blood pressure measurement. Previous intake was defined as the amount consumed on days 4, 5, and 6 preceding blood pressure measurement. High recent alcohol intake significantly raised systolic and diastolic blood pressure in both men and women. Previous alcohol intake, however, did not appear to influence blood pressure. We conclude that the effect of alcohol on blood pressure appears to be predominantly due to alcohol consumed in the few days immediately preceding blood pressure measurement, with alcohol consumption before those few days exerting little effect on blood pressure.

Adult↗
PubMed1991

Factors determining the acute pressor response to alcohol.

The pressor response to acute alcohol loading is variable and the factors influencing it are unknown. Data from 34 standardized alcohol loading studies were analysed to try to identify any factor(s) that might predict the pressor response to oral alcohol. The maximum blood pressure rise following an acute alcohol load was assessed for each subject over a 4 hour period. Age, weight, recent alcohol intake, baseline blood pressure, pulse rate and serum gamma glutamyl transferase levels were entered, as the independent variables, into a multiple linear regression analysis with the maximum blood pressure response as the dependent variable. Alcohol consumption in the week prior to the study predicted the systolic blood pressure pressor response to acute alcohol loading. None of the independent variables entered had any predictive value for diastolic or mean arterial blood pressure response.

Adult↗
PubMed1991

The mechanisms of hypertension and the role of ACE inhibitors.

Hypertension, a condition characterized by narrowing of the arteriolar lumen, is related in part to vasoconstriction and in part to vascular hypertrophy. Complex and interlocking mechanisms involving the autonomic nervous system and both circulating and local vasoconstrictor and vasodilator hormones contribute to this narrowing. Endothelin, 5-HT (serotonin), the kinins and ouabain may all participate by altering sodium, potassium and calcium fluxes in vascular smooth muscle cells. Recently the concept of insulin resistance as a mechanism of hypertension has emerged. Insulin may be a vascular growth factor as well as a local hormone facilitating a rise in intracellular sodium concentration. The observation that ACE inhibitors lower BP when plasma renin and angiotensin levels are low has led to an increased interest in local non-circulating renin-angiotensin systems. These systems probably influence arteriolar tone as well as vascular hypertrophy, and their inhibition leads to reduction in BP and some reversal of arteriolar thickening. Thus the ACE inhibitors represent a logical and effective method of treating hypertension and their use is likely to increase in the next few years.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1991

Alcohol consumption--a risk factor for hemorrhagic and non-hemorrhagic stroke.

PURPOSE: The risks of alcohol consumption and its association with stroke were studied in 621 patients with stroke and 573 control subjects using case-control methods. PATIENTS AND METHODS: Patients with stroke were subdivided into 193 with subarachnoid hemorrhage, 91 with intracerebral hemorrhage, and 337 with cerebral infarction. Data on recent alcohol consumption were obtained by questionnaire in patients with stroke and compared with data from an occupational screening survey in control subjects. RESULTS: Relative risks, adjusted for confounding variables, exhibited J-shaped associations with increasing levels of alcohol consumption classified into four categories--abstainer, 1 to 90 g, 100 to 390 g, and greater than or equal to 400 g weekly). The individual risks were 1, 0.7, 0.5, and 1.3 for subarachnoid hemorrhage; 1.0, 0.6, 0.5., and 2.5 for intracerebral hemorrhage, and 1.0, 0.6, 0.7, and 2.4 for cerebral infarction for men and women combined. CONCLUSIONS: The results suggest that low levels of alcohol consumption may have some protective effect upon the cerebral vasculature, whereas heavy consumption predisposes to both hemorrhagic and non-hemorrhagic stroke.

Adult↗
PubMed1991

An emerging consensus among clinicians on treating mild hypertension but persistent uncertainty as to how blood pressure should be measured.

In 1986 and 1989 the British Hypertension Society published its recommendations on the techniques for the measurement of blood pressure and the level of pressure requiring drug therapy. In order to assess the impact of these recommendations on clinical practice among non-members of the society, we have conducted a survey using a self-reported questionnaire among 196 hospital-based clinicians, and compared our findings with a similar survey conducted in 1979. The response rate to the 1990 survey was 64% (126 respondents). Over one-third (37%) of respondents reported that they usually record the diastolic blood pressure at the fourth Korotkoff phase (muffling of sounds), 52% reported that they use the fifth phase (disappearance of sounds), and 10% reported that they record both the fourth and fifth phase. They also disagreed considerably on a number of other basic issues, including whether blood pressure should be routinely measured in the sitting or lying position, and whether readings should be taken to the nearest 2, 5 or 10 mmHg. A clear majority of clinicians indicated that they would prescribe antihypertensive drugs if the diastolic blood pressure was consistently over 100 mmHg. This represents a marked shift from the opinions expressed in 1979 and is in line with the British Hypertension Society's recommendations. However, many clinicians still measure blood pressure in a manner contrary to the society's guidelines.

Blood Pressure Determination↗
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↗