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Biomedical subjects

D G Beevers

Publications and source records attributed to D G Beevers.

At least 73 records · Page 4Linked to original sources
PubMed2000

Effects of depression and anxiety on mortality and quality-of-life 4 months after myocardial infarction.

OBJECTIVE: The purpose of this study was to determine the impact of depression and anxiety on mortality and quality-of-life in patients hospitalized for an acute myocardial infarction (MI). METHODS: Questionnaire measures of depression and anxiety were completed during hospitalization by 288 MI patients. The main outcomes were mortality and quality-of-life, assessed by the Dartmouth COOP charts, at 4 months. RESULTS: A total of 25 patients died, 22 from cardiac causes, during the 4-month follow-up. Symptoms of depression and anxiety did not predict either cardiac or all-cause mortality. Severity of infarction, extent of heart failure, and a longer stay in hospital predicted mortality. Symptoms of depression and anxiety predicted 4-month quality-of-life among survivors, as did gender, partner status, occupational status, living alone, previous exercise behaviour, length of hospital admission, and Peel Index scores. In a multiple regression model, depression emerged as the strongest predictor of quality-of-life. State anxiety, severity of infarction, and partner status also entered the model. CONCLUSION: Neither depression nor anxiety predicted mortality 4 months after MI. Both depression and anxiety predicted quality-of-life at 4 months among survivors.

Adult↗
PubMed2000

Matrix metalloproteinase-9 and tissue inhibitor metalloproteinase-1 levels in essential hypertension. Relationship to left ventricular mass and anti-hypertensive therapy.

To test the hypothesis that the activity of enzymes degrading the extracellular matrix in hypertensive patients are abnormal, and that the treatment of hypertension will normalise these abnormalities, we measured the serum levels of metalloproteinase MMP-9, and its inhibitor, tissue metalloproteinase inhibitor (TIMP-1). Thirty-two patients with untreated hypertension (BP 168/96) had significantly lower levels of both MMP-9 and TIMP-1 when compared to 24 matched normotensive controls (BP 123/80) (P<0.001). There was no significant correlation between MMP-9 and TIMP-1 levels (P>0.2). In the patients, there were no significant correlations observed between left ventricular mass, Doppler V(E)/V(A) ratio (an index of diastolic function), blood pressure, left ventricular mass index and either MMP-9 or TIMP-1 levels (all P=NS). Levels of MMP-9 and TIMP-1 were not significantly altered after 2 months of antihypertensive treatment of 29 patients despite mean blood pressure falling from 170/96 to 143/85 mmHg (P<0.001). Correspondingly, there were also no significant alterations in indices of diastolic function and left ventricular mass. Our study suggests that the proteolytic activities of MMP-9 and TIMP-l are depressed in hypertensive patients and were not significantly affected by short-term antihypertensive treatment. The relationship between collagen metabolism in hypertensive subjects, especially in those with cardiac hypertrophy, and the effects of treatment needs to be further explored in larger trials over a longer period of time.

Aged↗
PubMed2000

Do patients with de novo hypertension differ from patients with previously known hypertension when malignant phase hypertension occurs?

Malignant phase hypertension (MHT) represents the most severe form of hypertension, and many consider that this condition only occurs in poorly managed patients with previously known hypertension. To investigate this further, we studied 350 patients with MHT on the West Birmingham MHT database: 195 (55.7%) of these presented de novo, without any known past history of hypertension (Group 1), and 146 (41.7%) were previously known hypertensives (Group 2), of whom 86 were receiving antihypertensive therapy; in 9 patients, the status was uncertain. Median duration of clinical followup was similar in both groups (36.0 v 37.5 months, Mann-Whitney test P = .795). Patients presenting de novo with MHT (Group 1) were younger, with a predominance of whites and men. Nevertheless, the clinical features, blood pressures, and renal function at presentation were similar to MHT patients with previously known hypertension. Renal function at follow-up was also similar in both groups. There was an excess of women and nonwhites in MHT patients with previously known hypertension (Group 2), who also had higher mean follow-up blood pressures. On univariate life-table analysis, there was no statistically significant difference in survival time between Groups 1 and 2 (mean 57.5 v 63.5 months, median 36.0 v 37.0 months; log-rank test, P = .456). Using a multivariate Cox analysis of baseline variables, the independent predictors of outcome (death or dialysis) were age at presentation (P = .0019), diastolic blood pressure (P = .0466), serum urea (P = .006), and serum creatinine (P < .001). Whether the patient had presented de novo, without any known history of hypertension (Group 1) or had previously known hypertension (Group 2) did not independently predict outcome (P = .6549). We suggest that MHT can occur de novo in patients without previously known hypertension, and the clinical characteristics and prognosis in such patients were similar to MHT patients with previously known hypertension.

Diagnosis, Differential↗
PubMed2000

Calcium channel blockers, ACE inhibitors, and the risk of cancer in hypertensive patients: a report from the Department of Health Hypertension Care Computing Project (DHCCP)

OBJECTIVE: Recent studies have shown inconsistent results on the risk of cancer in hypertensive patients using calcium channel blockers (CCBs) and angiotensin-converting enzyme (ACE) inhibitors. We investigated a large number of patients from the Department of Health Hypertension Care Computing Project (DHCCP) observational database treated with these drugs for hypertension to see whether the use of CCBs for hypertension is associated with an increased risk of cancer mortality and the use of ACE inhibitors with a reduction. DESIGN: Matched case-control study and a longitudinal study of survival from 1 year after presentation. PATIENTS: A total of 11663 patients treated for hypertension from 1971 through 1987. They were recruited on presentation to one of the hospital hypertension clinics or general practices involved. MAIN OUTCOME MEASURES: Death with any mention of cancer on the death certificate in patients treated with an Index drug group; CCBs, ACE inhibitors, beta adrenergic blocking drugs (BBs), or receiving a diuretic. The treatment groups were mutually exclusive. RESULTS: A total of 391 cases of cancer were matched with 1050 controls. In this case-control study the adjusted relative risk estimate in comparison to diuretic treatment for CCBs was 0.79 (95% CI 0.37 to 1.69), and for CCBs plus a diuretic, 1.05 (0.65 to 1.69). Non-significant results were also observed for ACE inhibitors (1.48 (0.43 to 5.1), and 1.40 (0.56 to 3.50) with a diuretic), and also for the BB and methyldopa groups. In the longitudinal survival study, the adjusted relative risk estimate for CCBs was 1.1 (0.60 to 1.94) and 1.0 (0.53 to 1.86) for CCBs plus a diuretic, and for ACE inhibitors 1.33 (0.37 to 4.76) and 1.47 (0.67 to 3.23), respectively. CONCLUSIONS: In this population there was no increased cancer mortality with the use of CCBs and a relative risk greater than 1.7 to 2.0 was excluded with 95% confidence. The suggestion that ACE inhibitors reduce cancer mortality was not supported with best estimates of relative risk of 1.3 to 1.5 and exclusion of values less than 0.4 to 0.7.

Adolescent↗
PubMed2000

The placebo effect and white coat effect in isolated systolic hypertension and systo-diastolic hypertension.

It is well recognised from many clinical trials that there is a blood pressure lowering effect when placebo is administered to patients with essential hypertension ("placebo effect"). The reduction in blood pressure, however, may also be partly due to loss of the alerting response ("white coat effect") as a result of familiarisation with the clinical environment. To investigate the hypothesis that there may be a more marked placebo effect and white coat effect in isolated systolic hypertension (ISH) compared with systo-diastolic hypertension (SDH), we studied 78 patients with hypertension: 34 had ISH and 44 patients had SDH. The 34 patients with ISH were older (68.7 vs 54.9 years), had a higher SBP (192.2 vs 169.6 mmHfg) and lower DBP (85.5 vs 102.0 mmHg) when compared to patients with SDH. Amongst the patients with ISH, there were no significant changes in mean blood pressures pre-placebo (paired t-test, p = NS). In the placebo period, there was a significant reduction in systolic blood pressures at all three points, and a significant reduction in diastolic blood pressures after 2 and 3 months placebo (paired t-test, p < 0.05). There was a mean reduction in mean systolic blood pressure at visit 1 by 5.2%, visit 2 by 5.1% and visit 3 by 4.6%, when compared to mean pre-placebo systolic blood pressures (p < 0.05). The mean reduction in diastolic blood pressure was 5.8% at visit 2 and 3.5% at visit 3, when compared to mean pre-placebo diastolic blood pressure (p < 0.05). At the 4-week visit after receiving placebo, the mean systolic blood pressure decreased by 9.4 mmHg (p = 0.003) and mean diastolic blood pressure by 2.7 mmHg (p = NS) in the patients with ISH. In patients with SDH, there were no statistically significant changes in recorded BP readings following the introduction of placebo. We suggest blood pressures in some patients with ISH may settle with careful follow up and initiation of treatment in these patients could potentially be delayed for at least 3 months, as therapy may not prove necessary.

Adult↗
PubMed2000

Do depression and anxiety predict recurrent coronary events 12 months after myocardial infarction?

We examined the association between depression and anxiety and recurrent coronary heart disease events during the first 12 months subsequent to myocardial infarction. The Beck Depression Inventory and the State-Trait Anxiety Inventory were completed during hospitalization by 288 myocardial infarction patients. Peel Index score and Killip class were used as indices of disease severity. The 12-month incidence of recurrent coronary heart disease events (fatal and non-fatal) was determined. Eighty-two patients experienced recurrent coronary heart disease events, including 27 cardiac fatalities, during follow-up. Whereas the Peel Index differentiated patients who experienced recurrent events from those who did not (OR 3.00, 95% CI 1.46-6.20), symptoms of depression (OR 0.97, 95% CI 0. 55-1.70) and anxiety (OR 1.00, 95% CI 0.98-1.02) were unrelated to outcome. Depression and anxiety did not predict subsequent coronary heart disease events and were not associated with either Peel Index scores or Killip class.

Anxiety↗
PubMed2000

Serum urate is associated with baseline renal dysfunction but not survival or deterioration in renal function in malignant phase hypertension.

BACKGROUND: There has been speculation whether serum uric acid levels are an independent prognostic factor in patients with hypertension. OBJECTIVE: To investigate the clinical associations and prognostic value of serum urate in patients with malignant phase hypertension (MHT), by comparing clinical features in patients with serum urate levels above and below the median levels for this population, and secondly, by performing a survival analysis in these patients. PATIENTS AND METHODS: Review of the data on 153 patients (98 males; mean age 50.3 years, SD 13.5) with MHT on the west Birmingham MHT register. Median uric acid levels in this population was 0.41 mmol/l (6.9 mg/dl), with an interquartile range of 0.34-0.50 mmol/l (5.7-8.4 mg/dl). Clinical characteristics of patients with a serum urate <0.41mmol/1 (group 1) were compared to those with levels above the median (0.41 mmol/l, group 2). RESULTS: Mean duration of follow-up was similar in both groups. The mean diastolic blood pressure at presentation and both mean systolic and diastolic blood pressures at follow-up were significantly higher in group 2 (that is, those with high serum urate levels) (unpaired t test, P= 0.039). There was also more renal dysfunction in group 2 patients with MHT, with higher mean serum urea and creatinine levels, both at presentation and at follow-up (unpaired t test, P< 0.01). The commonest causes of death were myocardial infarction (n = 7), heart failure (n = 4), stroke (n = 10) and renal failure (n = 5). There was no difference in mean survival duration between groups 1 and 2 (Kaplan-Meier, 64.6 versus 66.8 months; log-rank test, P= 0.519). Serum urate levels also did not predict the rise in serum creatinine levels (log-rank test, P= 0.84) or urea (P= 0.4033) amongst these patients. Using a multivariate Cox proportional hazards analysis, the only independent predictors of outcomes (death or the need for dialysis) were age (P = 0.007) and serum creatinine levels at presentation (P = 0.0046). CONCLUSION: Our analysis of a large series of patients with MHT shows that those with high urate levels had higher diastolic blood pressures and greater renal impairment at baseline. At follow-up, patients with median serum urate >0.41 mmol/l showed a greater deterioration in renal function and higher blood pressures, but no significant difference in survival. Serum urate levels also do not appear to be predictive of the deterioration in renal function or overall survival in patients with MHT.

Aged↗
PubMed1999

Atenolol and fetal growth in pregnancies complicated by hypertension.

Atenolol use may be associated with growth retardation when given in pregnancy, although the relationship to trimester of initiation, duration of treatment, and its use as monotherapy is still uncertain. To compare the obstetric and fetal outcome between women receiving atenolol (as monotherapy) and other antihypertensive drug monotherapies, and also to investigate the effect of duration of treatment on fetal growth, we performed a retrospective cohort study of 312 pregnancies in 223 women attending an Antenatal Hypertension Clinic. Atenolol (as monotherapy) was given in 78 pregnancies (25.0%), other types of antihypertensive drugs as monotherapy were given in 53 pregnancies (17.0%), and multiple drug combinations were given in 90 pregnancies (28.8%). In 91 pregnancies (29.2%) no antihypertensive drugs were given. Atenolol was found to be associated with lower birth weight and ponderal index values, with a trend toward a higher prevalence of preterm (<37 weeks) delivery and small-for-gestational-age babies when compared to other antihypertensive drugs as monotherapy, or to no treatment. The adverse effect of atenolol was more pronounced in women receiving the drug earlier in their pregnancy, and continuing the drug for a longer duration. In conclusion, atenolol should be avoided in the early stages of pregnancy and given with caution at the later stages, as it is associated with fetal growth retardation, which is related to duration of treatment.

Adult↗
PubMed1999

Urinary sodium excretion and blood pressure in chronic psychiatric in-patients.

Studies of populations or communities with no rise in blood pressure (BP) with advancing age and low prevalence of hypertension, may provide aetiological clues on the cause of hypertension. Within westernised societies, low blood pressures have been reported amongst chronic psychiatric in-patients and closed order secluded nuns. To investigate factors associated with BP in chronic psychiatric in-patients, we surveyed the BP and lifestyle factors in 89 such subjects in low security wards in three psychiatric hospitals. The average age of examines was 48.1 years (s.d. 15.8) and the patients had been in hospital for a mean of 8.6 years (range 1.1 to 51.7 years). The mean systolic and diastolic blood pressures of this group were 122.0 mm Hg (s.d. 14.2) and 76.9 mm Hg (s.d. 8.5) respectively. This was lower than pressures obtained when they were admitted to hospital (mean systolic BP change -17.1 mm Hg (s.d. 14), paired t-test P < 0.001; mean diastolic BP change -3.7 mm Hg (s.d. 12.2), paired t-test P < 0.001). BP at examination was significantly correlated with the urinary sodium to creatinine ratio (r = 0.302, P = 0.027), but not with the urinary sodium or potassium concentrations or potassium/creatinine ratio. The change in mean systolic BP (that is, the difference in BP between admission and examination) was significantly correlated with sodium/creatinine ratio (r = 0.62, P < 0.0001), urinary sodium concentration (r = 0.27, P = 0.045) and urinary sodium/potassium ratio (r = 0.36, P = 0.008). No relationship was found between BP and the nature of the psychiatric diagnosis or the type of psychotropic medication that was being prescribed. Stepwise multiple regression demonstrated that urinary sodium creatinine ratio and age were predictive of the change in systolic BP since admission to hospital. Our study confirms previous observations of lower mean systolic and diastolic blood pressures in chronic psychiatric subjects after a long in-patient stay. This fall is related to a low urine sodium excretion and suggests that a low dietary sodium intake may, in part, account for the low BP, or the difference between BP in the stressed and relaxed state, seen in these patients.

Adult↗