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Biomedical subjects

F J Milne

Publications and source records attributed to F J Milne.

At least 37 records · Page 2Linked to original sources
PubMed1990

Hypertension as a cause of end-stage renal failure in South Africa.

We reviewed the data of 3,632 patients with end-stage renal failure entered into the South African Dialysis and Transplantation Registry over a six-year period. The male to female ratio was 1.4:1. Of these patients, 48.8% were white, 26.2% black, 17.6% coloured and 7.4% Asian. Essential hypertension was the cause of end-stage renal failure in 15.9% of patients. Malignant hypertension was the diagnosis in 57% of the essential hypertensives. Hypertension was responsible for 34.6% of end-stage renal failure in blacks, 20.9% in coloureds, 4.3% in whites and 13.8% in Asians. In the age group 30-39 years, 37.4% of patients with malignant hypertension commenced dialysis, while 28.4% and 28.8% of benign hypertensives commenced dialysis in the 30-39 and 40-49 age groups, respectively. The survival at 36 and 72 months was the same whether hypertension was the cause of end-stage renal failure or not, and whether the hypertension was malignant or benign. Cardiac causes were responsible for most of the deaths. The percentage of deaths from cardiac causes was similar in patients with renal failure from essential hypertension and other causes (33.2% and 29.3% respectively). Hypertension is the commonest cause of end-stage renal failure in black South Africans and the most common preventable cause of end-stage kidney disease in the country.

Adult↗
PubMed1990

Twenty-four hour ambulatory blood pressure in therapeutically resistant hypertensive patients.

Circadian blood pressure and heart rate rhythms were determined in essential and renal hypertensive patients who failed to respond to drug therapy. Indirect ambulatory blood pressure and heart rate recordings were measured in 31 subjects for 24 hours. Essential hypertensive patients exhibit 'white coat hypertension', are normotensive outside the clinic and have a higher awake than sleep blood pressure. Blood pressure and heart rate of renal hypertensive patients do not increase in the presence of a physician and there is no difference between awake and sleep values. In contrast to patients with essential hypertension, the circadian fluctuations of blood pressure were depressed in renal hypertensive patients. We conclude that essential hypertensive patients who appear clinically uncontrolled are in fact well controlled in their domestic environment, whereas renal hypertensive patients are consistently uncontrolled. Ambulatory monitoring may help in differentiating the various types of patient and in the evaluation of antihypertensive therapy.

Adult↗
PubMed1989

Hypertension in black South Africans--new perspectives on old material.

Autopsy material was examined from cases diagnosed as malignant nephrosclerosis in the years 1956-1961, a period when adequate antihypertensive therapy had not yet become available, a second group of malignant nephrosclerosis from the years 1970-1980, an era during which effective antihypertensive therapy was available, and a third group of essential benign nephrosclerosis, once more from the early pretreatment period (1956-1961). The observations suggest that malignant and benign hypertension may be two different diseases. Further studies will be pursued to assess whether hypertensive renal changes seen in this study are a spectrum of one disease extending from malignant nephrosclerosis de novo presenting with acute renal failure or chronic renal failure to benign hypertensive nephrosclerosis.

Black People↗
PubMed1989

Malignant hypertension and its renal complications in black South Africans.

Malignant hypertension is an important cause of morbidity and mortality among urban black South Africans. Hypertension accounts for 15.9% of all patients and for 34.6% of blacks receiving treatment for end-stage renal failure. Malignant hypertension is more commonly diagnosed than benign hypertension and two-thirds of patients present in the age group 30 - 49 years. Together they are the most common preventable cause of end-stage renal failure in this country. Acute partially reversible renal failure occurs in 20% of patients with malignant hypertension who require dialysis. This is an important subgroup, who may be recognised by their younger age, female preponderance and fulminant presentation. Short-term peritoneal dialysis and effective control of blood pressure will result in satisfactory return of renal function. However, only adequate country-wide control of hypertension will prevent these costly renal complications.

Black People↗
PubMed1989

Hypertension, alcohol and cations in urban black and coloured South Africans.

Epidemiological evidence shows a positive relationship between alcohol consumption and blood pressure. High alcohol intake and hypertension are common in urban South African men. Relationships between mean arterial pressure (MAP), serum gamma-glutamyltransferase (GGT) as an index of alcohol intake, age, mass and levels of cations in the serum and erythrocytes were investigated in normotensive and hypertensive black and coloured men. Serum levels of potassium, magnesium and calcium and the red blood cell magnesium level were found to be significantly decreased in the black hypertensives. Serum GGT was equally raised in normotensive and hypertensive blacks and was positively correlated with systolic blood pressure in the hypertensive subjects. The coloured hypertensives were heavier, older and had significantly higher serum GGT levels than their normotensive counterparts. Serum GGT was positively correlated with MAP in the coloured subjects. No consistent relationships were found between GGT and blood cations. These data suggest that in younger black subjects alcohol is associated with systolic blood pressure only once hypertension has developed. Other factors, such as cations, may be more important than alcohol in the pathogenesis of hypertension in this group. Alcohol consumption is an important risk factor in coloured hypertensives.

Adult↗
PubMed1989

The relationship between magnesium, calcium, sodium, potassium and blood pressure in South African adult males.

The interaction between magnesium, calcium, sodium, potassium and blood pressure (BP) was assessed in three urban male groups (n = 463). Each group was at a different phase of urbanisation. 27% of black labourers (n = 296), 37% of city blacks (n = 94) and 14% of "coloureds' (mixed race;n = 73) were hypertensive. In the black labourers, serum Mg, K, Ca and erythrocyte Mg were inversely related to BP. Of all the cations, Mg correlated most closely with BP. In the coloured group, there was a weak inverse relationship between serum magnesium and BP. There were no biochemical abnormalities in the city blacks. During urbanisation or in the early phases of hypertension changes occur in blood cation levels. Mg and its interactions with Ca, Na and K may, in certain individuals, play an important role in the pathogenesis of hypertension.

Adult↗
PubMed1988

Effect of indapamide on serum and red cell cations, with and without magnesium supplementation, in subjects with mild hypertension.

Unlike some thiazide diuretics, indapamide--a non-thiazide chlorosulphonamide derivative--has been shown to have a magnesium-sparing effect in normotensive subjects. This effect has not been studied in hypertensive subjects. In a randomised double-blind trial indapamide 2,5 mg and placebo were given daily to a group of elderly patients with mild hypertension, with and without supplemental magnesium chloride. Blood pressure and serum and red blood cell cations were measured. The significant antihypertensive effect of indapamide was confirmed. There was no effect of indapamide on serum and red cell magnesium concentrations compared with placebo, both with and without magnesium supplementation. Indapamide induced hypokalaemia with a shift of sodium into the red cells. In this group of elderly hypertensive subjects indapamide induced potassium but not magnesium loss.

Adult↗
PubMed1988

An assessment of internship at the teaching hospitals of the University of the Witwatersrand.

Medical internship can be a physically exhausting and emotionally traumatic experience. This study assesses various aspects of internship, including continuing medical education, workload and stress, at the five Johannesburg teaching hospitals during 1985 and 1986. Data were analysed from a confidential questionnaire. Eighty-two interns completed the questionnaire at the end of 1985 and 120 at the end of 1986. Problem areas defined were excessive patient load, sleep deprivation and severe stress. The commonest symptoms of stress were fatigue, irritability and weight loss. In 1985, 53% of interns stated that they could not cope, and in 1986 this increased to 65%. Forty-eight per cent of 1985 and 69% of 1986 interns lost interest in medicine during their intern year. The implications of these results are discussed and the importance and impact on the medical profession and hospital services analysed.

Attitude of Health Personnel↗
PubMed1987

Acute renal failure--10-year experience of the Johannesburg Hospital renal unit.

The 10-year experience of Johannesburg Hospital's renal unit in treating acute renal failure (ARF) is described; 290 patients were treated by haemodialysis--169 drawn from the surgical disciplines, 109 from the medical disciplines and 12 from obstetrics and gynaecology, suffering 55%, 41% and 33% mortality rates, respectively. The mortality rates were found to correlate strongly with the cumulative number of acute insults to renal function accruing as a result of the particular surgical or medical illness ('precipitating event') and culminating in ARF. Age was also shown to have a powerful influence on outcome, the survival rate falling steadily with each decade of life. A plea is made to limit the potential insults to renal function actively, particularly in the elderly, in an attempt to further reduce the high mortality rate with which ARF continues to be stubbornly associated.

Acute Kidney Injury↗
PubMed1987

Magnesium, calcium, sodium and potassium status in normotensive and hypertensive Johannesburg residents.

Serum magnesium, calcium, sodium and potassium, and erythrocyte magnesium, sodium and potassium levels were measured in a selected group of 296 urbanised black male labourers in Johannesburg. Of these, 214 subjects were normotensive and 82 were hypertensive. The aim of the study was to examine the relationship between serum and erythrocyte electrolytes, specifically magnesium and calcium, and blood pressure in this population sample. The results showed a significant decrease in serum magnesium, calcium and potassium in the hypertensive subjects. Red blood cell magnesium was significantly lowered and red blood cell sodium was significantly raised in this group. A significant inverse correlation was found between serum magnesium and blood pressure, erythrocyte magnesium and blood pressure, serum calcium and blood pressure, and serum potassium and blood pressure. A positive correlation was observed between erythrocyte sodium and blood pressure. Of all the electrolytes assessed, magnesium (serum and erythrocyte) correlated most closely with blood pressure. The data reported here suggest that body magnesium and its interactions with calcium, sodium and potassium may, in certain groups of individuals, play an important role in the development and maintenance of high blood pressure.

Black People↗
PubMed1987

Low mortality from ischemic heart disease among urban blacks in South Africa.

Age- and sex-specific circulatory mortality rates among urban blacks and whites in South Africa in 1977 were compared using newly available census data. Mortality for cerebrovascular, hypertensive, and ischemic heart diseases differed markedly in the two races. Deaths due to cerebrovascular and hypertensive disease were always more common in blacks, whereas deaths attributable to ischemic heart disease were consistently greater among whites, by a factor that varied according to age, from 10-18 in men and 2-9 in women. These results suggest that hypertension is a common cause of death among urban blacks in South Africa but that it is not commonly associated with ischemic heart disease. The continuing low prevalence of ischemic heart disease among urban blacks is striking and may not be explained entirely by the levels of known risk factors.

Adult↗
PubMed1986

Potassium supplementation in blacks with mild to moderate essential hypertension.

Potassium chloride (KCl) salt (65 mmol) daily reduced BP from 153/104 to 146/101 mmHg in 32 hypertensive black females during a 6-week placebo controlled crossover study. The fall in BP was independent of the order of randomization and was significant for systolic (SBP; P less than 0.01) and diastolic (DBP; P less than 0.05) pressure after 4 weeks. Analysis of the 95% confidence intervals in this and in five other studies, two of which were reported as showing no beneficial effect, suggests that potassium supplementation does lower BP, but that the change is small and within the confidence levels of all six trials. Thus, apparent discrepancies in the literature are not genuine statistically.

Adult↗
PubMed1986

A study of 48-hour faecal and urinary electrolyte excretion in normotensive black and white South African males.

Previous studies have shown that 24-h urinary sodium (Na) excretion is similar in blacks and in whites. However, a significantly lower potassium (K) excretion by blacks, with a consequent rise in the Na:K excretion ratio, has been observed. Faecal electrolyte excretion has not been measured. Ten normotensive blacks and 11 normotensive whites on a free diet were studied. Simultaneous 48-h urine and faecal collections were made. The results of the urinary measurements were in accordance with those of previous studies, in that 24-h urinary K excretion by blacks (38.2 +/- 12.4 mmol) was significantly lower than that of whites (78.3 +/- 16.6 mmol). As a result, there was a significantly higher urinary Na:K ratio in the black group. The mean 24-h faecal K excretion of the black group (15 +/- 7.3 mmol) was not significantly lower, even when corrected for weight, than that of the white group (20.8 +/- 10.8 mmol). It is concluded that the low urinary K excretion of South African urban blacks, compared with whites, is a reflection of a lower dietary K intake.

Adult↗