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Biomedical subjects

D G Beevers

Publications and source records attributed to D G Beevers.

At least 253 records · Page 14Linked to original sources
PubMed1987

The clinical relevance of alcohol in the Blood Pressure Clinic.

There is a limited number of studies conducted in hypertensive patients which support the hypothesis that high alcohol intake is an important reversible cause of raised blood pressure. The validity and effectiveness of alcohol restriction as a treatment of hypertension is difficult to study as there is no suitable placebo substance that can be employed on a clinical trial basis. However, such clinical data that there are, taken with the confirmatory epidemiological work, strongly suggest that hypertensive patients should be questioned and investigated for evidence of high alcohol intake and advised accordingly.

Alcohol Drinking↗
PubMed1987

Nifedipine as a second line antihypertensive drug in pregnancy.

Slow-release nifedipine has been used in the treatment of severe hypertension in 23 pregnant women. In 22 this was in combination with other drugs, in 18 including atenolol. Good control of blood pressure was achieved in 20 women. The perinatal mortality of the group was 130/1000, with a high caesarean section rate (71% of live-births), a high rate of abnormal CTGs, a high rate of premature delivery, and a high rate of infants who were small-for-dates. Whether this is due to the disease process or the medication is uncertain. For the present time these combinations should only be used in severe hypertensives or in the context of a controlled trial.

Adult↗
PubMed1987

'Neutropenia' in black west Indians.

A prospective case control study routine haematological parameters was conducted in 294 healthy Black and White age/sex-matched subjects. The most important finding relevant to clinical practice was a reduction of total white cell count in Blacks due mainly to reduced neutrophil numbers. Twenty-one percent of sickle negative Blacks had white cell counts below the lowest value seen in Whites. The haemoglobin concentration, erythrocyte mean cell volume and monocyte count were also significantly lower amongst Blacks though lymphocyte counts were higher. The racial differences in haemoglobin and white count were not accounted for by differences in smoking and drinking habits. They were also found when Blacks with sickle cell trait were compared to age/sex-matched Whites and in others taking the oral contraceptive pill. Awareness of racial group should aid interpretation of routine tests and avoid unnecessary investigation of normal 'neutropenic' Blacks.

Adult↗
PubMed1987

The effects of bendroflumethiazide added to nifedipine in patients with hypertension.

It has been suggested that a diuretic added to a calcium antagonist may not reduce blood pressure further in patients with hypertension. Bendroflumethiazide 5 mg was given to 17 patients with essential hypertension who had persistent mild to moderate hypertension despite treatment with nifedipine slow-release tablets 20 mg bid. One group received bendroflumethiazide before (N = 8) and the other after placebo (N = 9) in a double-blind, randomized cross-over trial. Supine blood pressure following active bendroflumethiazide administration was significantly reduced in both groups compared with trial entry (166/105 to 150/96 mm Hg, P less than .01; 170/108 to 156/98 mm Hg, P less than .01). A reduction in serum potassium level and a rise in serum uric acid concentration were seen with combined treatment. We cannot substantiate theoretic arguments for the ineffectiveness of a bendroflumethiazide-nifedipine combination on blood pressure.

Adult↗
PubMed1987

Effect of nifedipine on glucose tolerance, serum insulin, and serum fructosamine in diabetic and nondiabetic patients.

The hypothesis that nifedipine may cause an insidious but reversible change in glucose tolerance, similar to that associated with thiazide therapy, was studied in six nondiabetic and six noninsulin-dependent diabetic patients with hypertension. After medium-term nifedipine therapy (mean duration, 11.5 months) was stopped for one month and then resumed for a month, values for fasting blood glucose, fasting serum insulin, serum fructosamine, glucose tolerance, and insulin release in response to oral glucose were unchanged in both groups. These findings suggest that nifedipine in conventional doses does not have important effects on glucose handling in either diabetic or nondiabetic patients.

Blood Glucose↗
PubMed1987

Atenolol improves blood pressure control in patients taking captopril and frusemide.

In a double-blind randomised cross-over study atenolol 100 mg daily and matching placebo were given to 14 patients whose blood pressure (BP) was uncontrolled on a fixed dose of captopril and frusemide. Atenolol produced a further reduction in both supine (170/105 mmHg to 163/94 mmHg) and standing (171/114 mmHg to 160/96 mmHg) BP and a significant fall in pulse rate and plasma renin activity (PRA). This fall in BP showed a highly significant correlation with pre-treatment plasma renin levels. No adverse side effects were encountered during the study. Previous suggestions that beta-blockade had no additional hypotensive effect in patients receiving captopril were not substantiated. For patients whose BP was poorly controlled with captopril and a diuretic, a selective beta-blocker is suggested as a useful third line agent.

Adult↗
PubMed1987

Genetic and ethnic influences on the distribution of sodium and potassium in normotensive and hypertensive subjects.

To examine the interrelationship of blood pressure, ethnic origin, genetic predisposition to hypertension, and cellular sodium handling, 49 hypertensive and 70 normotensive subjects were studied. Those with a positive family history of essential hypertension were found to have higher intracellular sodium levels and lower ratios of intracellular potassium to sodium than those without, regardless of their blood pressure. Only hypertensive subjects with a positive family history had depressed sodium efflux rate constants. Hypertensive subjects with no family history of essential hypertension had normal intracellular sodium levels and sodium pump activity. Black subjects had significantly higher levels of intracellular sodium than whites, regardless of blood pressure. Black hypertensive subjects had higher plasma sodium and lower plasma potassium concentrations than normotensive subjects did. These results suggest that cellular sodium handling is more closely associated with a genetic predisposition to essential hypertension than to hypertension itself and cast doubt on the significance of abnormalities of cellular sodium handling in the development of essential hypertension.

Adult↗
PubMed1986

Stroke and alcohol consumption.

We conducted a retrospective case-control study to investigate a possible association between alcohol intake and stroke. Reported recent alcohol consumption and biochemical and hematologic markers of alcohol intake were examined for 230 patients with stroke (20 to 70 years old) and compared with concurrently collected data on controls matched for age, sex, and race. A single estimate of current intake was used as a measure of alcohol consumption. Among men, the relative risk of stroke (adjusted for hypertension, cigarette smoking, and medication) was lower in light drinkers (those consuming 10 to 90 g of alcohol weekly) than in nondrinkers (relative risk, 0.5), but was four times higher in heavy drinkers (consuming greater than or equal to 300 g weekly) than in nondrinkers. Because very few women in our study drank heavily, we were unable to determine whether heavy alcohol intake influenced the risk of stroke in women. With increasing serum concentrations of the biochemical markers of alcohol intake (aspartate aminotransferase, uric acid, and gamma-glutamyl transferase), we observed similar trends in the relative risk of stroke. Only the erythrocyte mean cell volume did not follow this pattern. We conclude that heavy alcohol consumption is an important and underrecognized independent risk factor for stroke in men, but our data are not adequate to settle the issue for women. Our conclusions are qualified by our reliance on reported recent alcohol consumption as the primary measure of intake.

Adult↗
PubMed1986

Lack of difference between malignant and accelerated hypertension.

The clinical features and survival rates of 200 consecutive patients with malignant and accelerated hypertension admitted to a district hospital were investigated. Ninety five patients had bilateral haemorrhages and exudates and papilloedema (grade IV retinopathy) and 31 had bilateral haemorrhages and exudates with no papilloedema (grade III). A further 74 patients had bilateral retinopathy but failed to meet the criteria for grade IV or III and were investigated separately. No overall differences were found in survival when comparing the various grades of retinopathy. Cigarette smoking was significantly commoner only in grade IV patients compared with those with non-malignant hypertension matched for age, sex, and race. In patients with grade III retinopathy excess smoking was not statistically significant. In conclusion, the clinical features and survival rate showed that malignant and accelerated hypertension are one and the same disease.

Female↗
PubMed1986

The association of hypertension, the Ask-Upmark kidney and other congenital abnormalities.

We report 2 cases of hypertension with segmental renal hypoplasia (Ask-Upmark kidney) and other anomalies in the absence of vesicoureteral reflux. These cases support the view that the Ask-Upmark kidney is a defect of renal development rather than acquired as a consequence of vesicoureteral reflux. In 1 patient the abnormal renal vein renin ratio suggested that the renin-angiotensin system may have had a part in the pathogenesis of the hypertension.

Abnormalities, Multiple↗
PubMed1986

The survival of treated hypertensive patients and their causes of death: a report from the DHSS hypertensive care computing project (DHCCP).

A prospective study has been carried out to determine the causes of death and risk factors for survival in 4994 patients referred with a diagnosis of hypertension to hospital specialist clinics and 457 patients treated by their general practitioners for this condition. At the time of entering the prospective study, 69% of the patients were already being treated for hypertension. Four hundred and eleven patients have died, and their causes of death and death rates have been compared with the rates for the population of England and Wales. Ischaemic heart disease accounted for over one-third of the deaths and stroke for one-fifth. The death rates for these conditions were two to five times those expected for men and women aged 50-59 years and up to twice the rate expected for the age group 60-69 years. Survival in these selected patients was impaired by the following independent risk indicators: cigarette smoking, previous history of myocardial infarction or stroke, diagnosis of angina, impaired renal function and raised blood sugar. The following factors were not independent positive risk factors: smoking a pipe or cigars, obesity, a low plasma potassium and an elevated serum uric acid.

Adolescent↗
PubMed1986

Alcohol raises blood pressure in hypertensive patients.

The acute effect of drinking beer on blood pressure was studied in 18 hypertensive patients who were either regular, moderate (MI) or low intake (LI) drinkers. Patients in the MI group showed a significant rise in systolic blood pressure (SBP; average 12 mmHg) and pulse rate with alcohol, but no change after alcohol-free drink. No such changes with alcohol were seen in LI patients. There was a small transient rise in diastolic pressure (DBP) in response to alcohol in both the MI and LI patients. Resting plasma catecholamine levels were similar in both groups but only the MI group showed a significant rise in plasma noradrenaline (P less than 0.05) with alcohol, paralleling the rise in SBP and pulse rate. Plasma renin activity (PRA) and cortisol were unaffected by alcohol. In both groups significant falls in plasma calcium levels occurred with alcohol. The greater haemodynamic changes with alcohol in the MI group were associated with increased sympathetic activity. Chronic moderate alcohol intake, however, does not alter resting plasma catecholamine levels, at least, after hypertension is established.

Adult↗
PubMed1986

An audit of nifedipine in a hypertension clinic.

The results of treating 235 hypertensive patients who had been prescribed nifedipine in a hypertension clinic were examined for factors affecting blood pressure response and the frequency of side-effects. Pretreatment systolic and diastolic blood pressure correlated significantly with the decrease in blood pressure but this effect was lost following statistical correction. No relation was found between response and age or race nor did any biochemical or haematological parameter predict the antihypertensive effect. Fifty-nine (25%) patients complained of side-effects which were dose related; the drug had to be discontinued in 30 patients (13%) but the remaining 29 continued at the same or reduced dosage. Small, but statistically significant, elevations were seen in serum albumin, alkaline phosphatase and bilirubin as well as a rise in average blood glucose levels. Although side-effects are fairly common nifedipine is an effective antihypertensive drug when given alone or in combination with other therapies.

Age Factors↗
PubMed1986

The pressor and metabolic effects of alcohol in normotensive subjects.

Changes in blood pressure, pulse rate, and plasma catecholamines, renin activity, cortisol, and calcium were studied in 16 normotensive subjects (eight with a family history of hypertension) for 5 hours following ingestion of alcohol-free and alcohol-loaded beer. Both systolic and diastolic blood pressure rose after alcohol consumption; maximum responses occurred at peak blood alcohol concentrations and were significantly higher than those seen after placebo. Pulse rate was also significantly higher after alcohol ingestion and continued to rise throughout the study. There was no difference in the pressor response to alcohol between the groups with and without a family history of hypertension. No difference was found in plasma norepinephrine or epinephrine levels between alcohol and placebo phases. However, subjects with no family history of hypertension had significantly higher plasma norepinephrine levels (p less than 0.01) than did those with a family history during both the alcohol and placebo phases, although baseline blood pressures were not significantly different. Plasma epinephrine level was similar in both groups. Plasma renin activity was unchanged throughout, but plasma cortisol fell during both phases. Plasma calcium showed a small but significant fall with alcohol consumption in both groups (p less than 0.001). These results indicate that in normotensive subjects alcohol ingestion causes a rise in systolic and diastolic blood pressure that is not influenced by a family history of hypertension. This effect does not appear to be sympathetically mediated but may be due to a direct vasoconstrictor effect of alcohol, possibly with an alcohol-induced shift in intracellular calcium.

Adult↗
PubMed1986

Oligoclonal immunoglobulin G in acute subarachnoid hemorrhage and stroke.

Oligoclonal Ig bands were found in serum and CSF of 13 of 83 patients (16%) with verified subarachnoid hemorrhage (SAH). Serum Ig bands were more common in patients with SAH than in those with cerebral ischemia. The reverse was true with oligoclonal Ig bands in CSF. These patterns suggest that there are two different mechanisms and sites of IgG synthesis: an inflammatory process after acute stage of vascular damage and a latent immunologic process--ie, polyclonal B-cell activation by injury to the brain.

Acute Disease↗