The effect of adding either nifedipine or captopril as third-line agents was studied in a single-blind crossover fashion in 24 patients with essential hypertension uncontrolled by combination beta blocker and diuretic therapy. Nineteen patients completed both phases of the study. The mean initial sitting blood pressure before the addition of nifedipine was 164/109 mm Hg and captopril 165/108 mm Hg. Both nifedipine and captopril produced further significant reductions in both sitting and standing blood pressure, 47% of the captopril-treated patients achieving target blood pressure of less than 160/95 mm Hg compared with 67% with nifedipine. Further increase in the dosage resulted in 63% of the captopril- and 81% of the nifedipine-treated patients achieving target blood pressure. There were, however, no statistically significant differences in the mean fall in blood pressure or in the number of patients obtaining target pressure at the end of each treatment period. Captopril treatment also resulted in a small reduction of pulse rate, and, although pulse rates rose with nifedipine, these changes were not significant. Both treatments were generally well tolerated, and serious side effects were not reported. Both nifedipine and captopril were effective and well tolerated as third-line antihypertensive agents.

Adrenergic beta-Antagonists↗

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Some recent advances in non-communicable diseases in the Tropics. 1. Hypertension: an emerging problem in tropical countries.

With increasing urbanization, hypertension and its complications are becoming major health problems in many tropical countries. In particular, hypertension is a major cause of illness in black Africans. There is good evidence that an increasing dietary salt intake is partly responsible for this rising incidence of hypertension and possibly restriction of salt may help in prevention. The public health requirements for the prevention, detection and management of hypertension are likely to consume scarce resources in countries where life expectancy is gradually rising due to improved control of communicable disease and malnutrition. Failure to address the problem of hypertension could have serious effects on morbidity and mortality of economically active individuals in developing countries.

Black or African American↗

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Drug therapy for coronary heart disease: the Sheffield table.

Explore the source record for details and available documents.

Aged↗

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Occupational lead exposure and renin release.

Hypertension may result from chronic lead exposure. Lead poisoning arising from "moonshine whiskey" drinking has been associated with a rise in plasma renin activity. In the present study, plasma renin concentration following intravenous administration of frusemide was measured in eleven subjects with moderate or severe lead poisoning of industrial origin. The results were compared with those obtained for seven normal, control subjects. There was no significant difference in response obtained in the two groups. Industrial lead poisoning does not appear to affect renin release. The combined insult of lead and alcohol may explain the findings in the previous study.

Adolescent↗

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Mortality and quality of life 12 months after myocardial infarction: effects of depression and anxiety.

OBJECTIVE: The purpose of this study was to determine the impact of symptoms of depression and anxiety on mortality and quality of life in patients hospitalized for acute myocardial infarction (MI). METHODS: The Beck Depression Inventory and the State-Trait Anxiety Inventory were completed by 288 patients hospitalized for MI. Twelve-month survival status was ascertained, and quality of life among survivors was assessed at 12 months using the Dartmouth COOP charts. RESULTS: Thirty-one (10.8%) patients died, 27 of cardiac causes, during the 12-month follow-up. Symptoms of depression and anxiety predicted neither cardiac nor all-cause mortality. Severity of infarction and evidence of heart failure predicted both cardiac and all-cause mortality. The same findings emerged from supplementary analyses of data from patients who died after discharge from the hospital. Symptoms of depression and anxiety, measured at entry, predicted 12-month quality of life among survivors, as did gender, partner status, employment status, living alone, previous frequency of exercise, and indices of disease severity (Killip class and Peel Index). In a multiple regression model in which all of these variables were entered, initial depression scores provided the best independent prediction of quality of life, although living alone, severity of infarction, and state anxiety also entered the model. CONCLUSIONS: Symptoms of depression and anxiety did not predict either cardiac or all-cause mortality after MI, but they did predict quality of life among those who lived to 12 months.

Adult↗

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Clinical evaluation of the Copal UA-251 and the Dinamap 1848 automatic blood-pressure monitors.

The Copal UA-251 is a small automatic blood-pressure monitor, which relies on a piezo-electric microphone for detection of Korotkoff sounds. The Dinamap 1848 automatic monitor uses the oscillometric method for blood-pressure determination. When compared with the Hawksley random-zero sphygmomanometer, the Copal UA-251 recorded higher systolic blood-pressure, with this discrepancy widening at the upper end of the systolic pressure range. The agreement between these machines was reasonable for diastolic blood-pressure. The Dinamap 1848 had a tendency to consistently over-read systolic and under-read diastolic blood-pressure compared with the Hawksley sphygmomanometer, with median differences of 7 mmHg and -2.5 mmHg respectively.

Blood Pressure Determination↗

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Clinical evaluation of the sphygmomat 2 semi-automatic blood pressure monitor.

The Sphygmomat 2 blood pressure monitor is a compact and portable electronic device based on detection of Korotkoff sounds using a piezo-electric microphone. We have compared its accuracy with the Hawksley random zero sphygmomanometer, which is commonly used in epidemiological and pharmacological studies. Comparison of manometers was conducted by two trained observers on 49 people with a wide range of blood pressures. The Sphygmomat 2 was found to have a median difference of 5.2 mmHg for systolic and 1 mmHg for diastolic pressure, in both cases reading higher than the Hawksley sphygmomanometer. The portability, versatility and accuracy suggest that the Sphygmomat 2 is a valuable instrument for general clinical use.

Blood Pressure↗

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Mortality amongst patients of the Glasgow Blood Pressure Clinic was high in the 1970s and 80s but has fallen since, why?

Established in 1968 the Glasgow Blood Pressure Clinic has over 11,000 patients on its computer record. Up to 1980, mortality from all-causes and from cardiovascular causes was high: relative risks compared with two local control populations were greater than 2.0. Since 1980, all-cause mortality has decreased to 1.31 (859 deaths, CI 1.23-1.39). Lower mortality from cardiovascular causes, particularly coronary heart disease, contributes to the decrease. Reasons for the decrease are under investigation currently. Referral of patients with slightly lower blood pressure contributes, as may better blood pressure control with newer antihypertensive drugs. ACE inhibitors and calcium channel blockers were introduced in 1980 and during the 16-year period to 1995, all-cause mortality has decreased most in patients taking ACE inhibitor. A decrease also occurred in patients taking antihypertensive drugs other than ACE inhibitor.

Adrenergic beta-Antagonists↗

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The prevalence of pre-eclampsia and obstetric outcome in pregnancies of normotensive and hypertensive women attending a hospital specialist clinic.

To study the prevalence of pre-eclampsia (PE) and other obstetric outcomes (growth restriction and fetal mortality) in pregnancies of normotensive and hypertensive women attending an antenatal hypertension clinic, we studied a cohort of 372 pregnancies from 267 women. The prevalence of PE in the groups of pregnancies of normotensive and chronic hypertensive women was 11.9% (19/159 cases) and 16.0% (34/213 cases) respectively (chi 2 = 1.2, p = 0.27). There were no significant differences in respect of ethnicity, being primi- or multigravida and smoking status or age. Treatment with antihypertensive drugs during pregnancy did not decrease the prevalence of PE. In pregnancies with hypertensive complications (with or without PE) there was a trend towards higher rates of pre-term delivery (< 37 weeks), caesarean section, small for gestational age babies, stillbirth and lower baby birth weight and ponderal index values. Pregnancies in women with uncomplicated hypertension had an increased risk for emergency caesarean section, pre-term delivery (< 37 weeks), birth weight < 2500 g and stillbirth (relative risks [with confidence intervals] 2.5 [1.9-3.2], 2.3 [1.8-2.9], 3.1 [2.5-3.7] and 5.5 [2.6-11.9] respectively) compared with the general hospital obstetric population. After classification according to the type of hypertensive syndrome, a progressively higher risk for fetal growth restriction and adverse perinatal outcome was shown in the hypertensive and pre-eclamptic groups. In chronic hypertension, this was irrespective of superimposed pre-eclampsia or antihypertensive therapy. The high prevalence of PE in chronic hypertensive women (16.0%) was not statistically significant to that of normotensive women (11.9%), reflecting the referral selection of 'high risk' normotensive women to our clinic.

Adult↗

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Do clinicians prescribe HRT for hypertensive postmenopausal women?

Despite the benefits of hormone replacement therapy (HRT) in relieving menopausal symptoms, there continues to be anxiety about its use in women who also have hypertension. To examine clinical practice in relation to HRT, especially in patients with hypertension, and to canvass opinions on potential or perceived side-effects, the authors conducted a postal survey of HRT prescribing habits among 285 GPs, physicians and obstetricians in the West Midlands. The overall response rate to the questionnaire was 191 (66.3%): 61 clinicians reported that they would not prescribe HRT in women whose hypertension was difficult to control, but only 3 would withhold treatment if blood pressure was well controlled; 9% of physicians and 13% of gynaecologists did not routinely measure blood pressure before starting HRT or monitor BP at follow-up (24% and 10% respectively). A proportion of GPs (20%), physicians (21%) and gynaecologists (9%) reported that in their opinion HRT raised blood pressure, and a minority in each group considered that HRT increased the risk of venous thrombosis, stroke and myocardial infarction. This study demonstrates differences among GPs, physicians and gynaecologists in the use of HRT in menopausal women with hypertension, the authors suggest that, in view of data from studies of the effects of HRT on blood pressure and the possible reduction of cardiovascular disease, these clinicians can be reassured and hypertensive women need not be denied the benefits of HRT, as long as there is careful monitoring.

Attitude of Health Personnel↗