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D G Beevers

Publications and source records attributed to D G Beevers.

At least 145 records · Page 8Linked to original sources
PubMed1996

Differences between office and 24-hour ambulatory blood pressure measurement during pregnancy.

OBJECTIVE: To compare blood pressure (BP) measurements in ambulatory pregnant women with well-taken office readings. METHODS: A cohort of 209 nulliparous pregnant women who underwent 24-hour ambulatory BP monitoring throughout pregnancy was studied; 62 of these women were also studied 12 weeks after delivery. In addition, 30 nulligravid, nonpregnant women were studied as controls. RESULTS: The 24-hour median systolic and diastolic ambulatory pressures were higher than office pressures during pregnancy (the differences between the office and ambulatory systolic and diastolic BP measurements were +5 and +5.5 mmHg at 18 weeks, +3 and +6.5 mmHg at 28 weeks, and +5 and +5.5 mmHg at 36 weeks, P < .001). Ambulatory BP showed a consistent rise over the three measurement points, resulting in higher levels of pressure at 36 weeks than those found 12 weeks after delivery (the difference between ambulatory BP at these measurement points was +5 and +1 mmHg). At the postpartum measurement point, the relationship between ambulatory and office BP was similar to that in other surveys in nonpregnant women of comparable ages and in our own control group of nulligravidas (the difference between ambulatory and office BPs after delivery was +1.5 and +2 mmHg, a nonsignificant difference). CONCLUSION: There are important differences between ambulatory and office BPs measured throughout pregnancy, findings that could not be explained by activity or our present knowledge of cardiovascular hemodynamics in pregnancy. Ambulatory BP readings must be considered different entities than office BP readings. Care should be taken in predicting obstetric outcome from the results of ambulatory BP recordings.

Adult↗
PubMed1996

The acute and long-term ocular effects of accelerated hypertension: a clinical and electrophysiological study.

Thirty-four patients with accelerated hypertension were clinically examined. The visual evoked potential (VEP) and electroretinogram (ERG) were recorded: acutely in 12 patients, being repeated in 7 patients up to 6 months later. In the remaining 22 patients these tests were performed 2-4 years after presentation. Visual acuity was < or = 6/12 in 22 of 68 (32%) eyes at presentation and < or = 6/12 in 10 of 58 (19%) eyes at follow-up. The cause of severest loss of vision appeared to be anterior ischaemic optic neuropathy, found in 3 cases. During the acute stage 11 patients (92%) had abnormal VEPs and all had abnormal ERGs. The group mean P100 latency, of the 7 patients (14 eyes) seen acutely and followed up at 6 months, was 123.8 ms with significant recovery of latency (p < 0.005) to 110.9 ms. The ERGs, however, remained reduced and delayed. In those patients recorded 2-4 years after their acute episode the VEP was abnormal in only 2 patients (9%); group mean P100 latency was 109.1 ms. However, 18 patients (82%) had abnormal ERGs. We suggest that during the acute stage of accelerated hypertension there is a high incidence of ischaemic optic neuropathy that usually resolves but can cause a permanent anterior ischaemic optic neuropathy, in addition to vascular retinopathy that persists.

Acute Disease↗
PubMed1996

Alpha-adrenoceptor blocking drugs and female urinary incontinence: prevalence and reversibility.

There have been occasional reports of female stress incontinence related to prazosin therapy for hypertension. This drug is now rarely used but recently longer acting alpha-adrenoceptor blocking drugs have been introduced. We have, therefore, investigated the prevalence of urinary incontinence in all our female patients who were receiving alpha-adrenoceptor blockers in comparison with women, matched for age and parity who were receiving other drugs. We identified a total of 49 women taking alpha-adrenoceptor blocking drugs (prazosin 4, terazosin 5, doxazosin 40) among current patients who were attending our hypertension clinic. Twenty of these (40.8%) reported some urinary incontinence whereas in the control patients, only 8 (16.3%) had this symptom (P = < 0.02, relative risk 2.5, 95% CI 1.22-5.13). alpha-Adrenoceptor blockers were withdrawn in 18 of the 20 patients with incontinence and in 13, their symptoms abated. Our results suggest that there is a significantly higher prevalence of urinary incontinence in women taking alpha-adrenoceptor antagonists with reversibility on withdrawal of these drugs. As both female urinary incontinence, hypertension and the use of alpha-adrenoceptor blocking drugs are common, this distressing side effect should be borne in mind so that gynaecological or urological treatment may be avoided in some women.

Adrenergic alpha-Antagonists↗
PubMed1996

Adverse change in low-density lipoprotein subfractions profile with oestrogen-only hormone replacement therapy.

In a prospective longitudinal study in 17 women, we investigated the effects of surgical menopause and subsequent oestrogen-only hormone replacement therapy (HRT) on plasma concentrations of total cholesterol, HDL cholesterol, LDL cholesterol, triglyceride and LDL subfractions profile. Plasma LDL is a heterogeneous population of particles of varying size, density and chemical composition. The predominance of small LDL particles is a newly-recognized risk factor for coronary artery disease. The LDL score is used to describe LDL subfractions profile and the greater the score, the higher the proportion of small LDL particles. Six weeks after hysterectomy and bilateral oopherectomy, total cholesterol and triglyceride concentrations were significantly increased (p < 0.01) as well as the LDL score (p < 0.05). After 6 weeks of oestrogen-only HRT, total cholesterol concentration was significantly lower and HDL cholesterol concentration significantly higher than before the treatment (p < 0.05). At the same time, mean LDL score significantly increased and in none of the women did LDL subfractions profile change favourably.

Adult↗
PubMed1996

Physician variation in the management of patients with atrial fibrillation.

OBJECTIVE: To investigate variations in the management of patients with atrial fibrillation among consultant physicians. DESIGN: Questionnaire survey. SUBJECTS: Consultant physicians in England, Wales, and Scotland. RESULTS: 214 consultant physicians (88 cardiologists and 126 non-cardiologists) were surveyed between May and July 1994. Most physicians (47.7%) reported that they saw one to five patients with atrial fibrillation weekly. Some 52% of cardiologists and 40% of non-cardiologists considered that the main factor influencing their decision of whether or not to anticoagulate was the clinical history--that is, heart failure, valve disease, or stroke. When encountering a patient admitted acutely with new onset atrial fibrillation, significantly more cardiologists (66% v 52%, chi 2 = 6.89, P = 0.03) would immediately start anticoagulant treatment, most favouring intravenous heparin. Most physicians would also introduce antiarrhythmic treatment or digoxin, but more cardiologists would attempt immediate pharmacological (39% v 18% of non-cardiologists, P < 0.001) or later electrical (86% v 69%, chi 2 = 11.7, P = 0.003) cardioversion to sinus rhythm, while non-cardiologists tended to prefer "rate control" with digoxin. Although many physicians would not continue antiarrhythmic treatment post-cardioversion, more cardiologists than non-cardiologists would do so (the commonest choice being class III agents) (31% v 17%, P = 0.04). Fewer non-cardiologists would continue anticoagulant treatment post-cardioversion (27% v 69% of cardiologists, chi 2 = 39.8, P < 0.0001). When treating patients with atrial fibrillation, decisions about anticoagulation were usually related to the perceived relative risk of thromboembolism versus haemorrhage derived for each of six case management scenarios in the questionnaire. There was, however, general agreement between cardiologists and non-cardiologists in the use of antithrombotic treatment in the management of lone atrial fibrillation, paroxysmal atrial fibrillation, and patients with atrial fibrillation and mitral valve disease or thyrotoxicosis. CONCLUSION: There is considerable variation in the management of atrial fibrillation, with more cardiologists than non-cardiologists considering cardioversion to sinus rhythm (and the use of antiarrhythmic and anticoagulant treatment post-cardioversion) and thrombo-prophylaxis with anticoagulation. Guidelines on the management of this common arrhythmia are clearly required.

Acute Disease↗
PubMed1996

Hypertensive retinopathy: a review of existing classification systems and a suggestion for a simplified grading system.

With the advent of sophisticated ophthalmological investigations and a better understanding of the pathophysiology and clinical or prognostic correlates of the fundal lesions in hypertension, the limitations of early classification schemes using simple ophthalmoscopic appearances are increasingly apparent. This review describes the existing classification systems for hypertensive retinopathy and their limitations, as well as the pathophysiological effects of hypertension on the retinal vasculature. A new and simpler grading system for hypertensive retinopathy is proposed, dividing the features according to prognosis into two categories of non-malignant vs malignant hypertension. Such a simpler, updated system for our medical practice has been long overdue.

Humans↗
PubMed1996

Does non-malignant essential hypertension cause renal damage? A clinician's view.

Clinical research amongst hypertensive patients, randomised controlled trials, and population studies confined to white communities all show scant evidence that 'essential' non-malignant non-proteinuric normo-creatininaemic hypertension leads to renal impairment. Retrospective data from dialysis and transplantation units also tend to confirm this point. The only convincing exception is in studies of African Americans where there does appear to be a relationship between blood pressure (BP) at screening and the subsequent development of renal impairment. However, it is not possible to be certain that those patients who develop renal impairment might not have had a low grade sub clinical glomerulonephritis when first seen. One must conclude, therefore, that if benign essential hypertension does damage the kidneys, it does so very rarely. In that respect the epidemiology of hypertension-induced renal damage is different from that of coronary heart disease and stroke. Additional and novel risk factors need to be sought.

Humans↗
PubMed1995

Predictors of ratio of placental weight to fetal weight in multiethnic community.

OBJECTIVE: To determine whether placental ratio is influenced by maternal ethnic origin, obesity, hypertension, and haematological indices of iron deficiency anaemia. DESIGN: Observational study. SETTING: District general hospital in Birmingham. SUBJECTS: 692 healthy nulliparous pregnant women, of whom 367 were European, 213 Asian, 99 Afro-Caribbean, and 13 of other or undocumented ethnic origin. MAIN OUTCOME MEASURES: Placental ratio and maternal body mass index, blood pressure, and haematological indices. RESULTS: Though birth weight and placental weight were lower in Asian women than in other groups, mean placental ratio was similar in Asian (19.5% (SD 3.3%)), European (20.0% (4.0%)), and Afro-Caribbean women (20.4% (5.3%)). Gestational age at birth was the main predictor of placental ratio in the univariate analysis (r = -0.34, P < 0.001) and multivariate analysis. The only other significant predictor of placental ratio in multivariate analysis was maternal body mass index, which was positively associated with placental ratio (r = 0.1, P = 0.01). Mean (SD) placental ratio was not significantly higher in women who developed gestational hypertension (20.4% (4.5%)) and pre-eclampsia (23.3% (7.3%)) than in normal women (19.8% (3.8%)). No evidence of a relation between placental ratio and first antenatal visit haemoglobin concentration or mean cell volume was detected, and placental ratio was not associated with change in mean cell volume during pregnancy or with third trimester serum ferritin concentration. CONCLUSIONS: These data do not support the proposed association between poor maternal nutrition and increased placental ratio. The association between high placental ratio and adult hypertension may be confounded by genetic and environmental factors associated with maternal obesity (and possibly maternal hypertension).

Adult↗
PubMed1995

Left ventricular diastolic function in hypertensive patients with unstable angina and single coronary artery disease.

The present study was performed to investigate left ventricular diastolic (LVD) function in hypertensive patients with unstable angina. Three groups of 17 patients each were studied. Group 1 consisted of hypertensives with unstable angina (HTU); group 2, normotensives with unstable angina (NTU); and group 3, untreated, uncomplicated hypertensives (HT). The LVD function was assessed echocardiographically by transmitral valve Doppler flow to measure the ratio between the early diastolic filling (E) and the atrial contraction phase (A). An E/A ratio of < 1 was suggestive of LVD dysfunction. Left ventricular mass (LVM), from an M-mode echocardiogram using the Penn-Cube formula, was corrected to body surface area (LVM/S) using a standard nomogram. Data are represented as median values and analyzed by Mann-Whitney test. P was significant at < .05. The HTU group had an E/A ratio of 0.8, and the NTU and HT groups had ratios of 1.17 and 1.1, respectively. There was significant diastolic dysfunction in the HTU group compared with the NTU and HT groups (P = .037 and .049, respectively). Although the LVM/S was significantly higher in the HTU group when compared with the HT group (110.6 and 96.9, respectively, P = .017), there was no significant difference between the HTU and NTU groups (123.1), P = .67. Hypertensive patients with unstable angina have significant LVD dysfunction that seems to be independent of LVM and ischemia. This may be attributable to increased stiffness of the left ventricle or structural left ventricular abnormalities.

Adult↗