[Pharmacological treatment of hypertension. Low frequency of adverse effects in the elderly].
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Aged↗
Biomedical subjects
H Aberg
Publications and source records attributed to H Aberg.
Hyperlipidaemia--management and views amongst physicians in general practice, in occupational health care and in internal medicine.
OBJECTIVES: To study aspects of management and views about hyperlipidaemia and its treatment amongst different categories of physicians. DESIGN: A postal questionnaire was sent to selected physicians. Reminders were used. SETTING: The study included physicians in primary health care (PHCPs), occupational health care (OHCPs), and in departments of internal medicine in hospitals (IMPHs). SUBJECTS: All 146 PHCPs in the south-western region of Stockholm, 147 OHCPs, randomly selected from the directory of occupational health care offices, and all 157 IMPHs in six hospitals, in the greater Stockholm area, were offered the questionnaire. MAIN OUTCOME MEASURES: Differences in views, attitudes and treatment policy amongst different categories of physicians. RESULTS: Response rate was 70% (61-81%). Intervention was initiated by the OHCPs at lower levels of cholesterol than by the other two groups, with diet (P < 0.001) and with drug intervention as primary (P < 0.01) and secondary prevention (P < 0.005). When other cardiovascular risk factors were present, intervention was started earlier by the OHCPs only in comparison with the PHCPs (P < 0.01). Knowledge of one's own cholesterol level was more common amongst the OHCPs than in the other two groups (P < 0.001). Patient follow-up was the same in all groups. CONCLUSIONS: Disagreement amongst physicians about hyperlipidaemia leads to conflicting information being given to patients. It is important to be aware of these differences when trying to reach a consensus on this topic. Corresponding knowledge and attitudes amongst members of the public should also be studied.
Adult↗
Desmopressin in elderly women with increased nocturnal diuresis. A short-term study.
We report the changes in the pattern of diuresis in 20 women (average age 71 years) with increased nocturnal diuresis who were treated with 20 micrograms desmopressin (Minirin). Before treatment, antidiuretic hormone levels were measured every 4 h over a 24-h period and 75% of the levels were found to be beneath the lowest detectable limit (< 0.4 pmol/l). Nocturnal diuresis decreased by 355 +/- 208 ml and in 8 cases the decrease exceeded 400 ml. Diurnal diuresis, on the other hand, increased by 226 +/- 331 ml. Side effects were mild and occurred in only 2 women.
Aged↗
Desmopressin in elderly subjects with increased nocturnal diuresis. A two-month treatment study.
This study describes changes in diuresis during a two-month treatment with 40 micrograms desmopressin (Minirin) in a group of elderly persons with increased nocturnal diuresis and decreased ADH secretion. The average age of the men (n = 7) was 72 +/- 4 years and of the women (n = 14) 73 +/- 6 years. Nocturnal diuresis decreased after one and two months by 21% and 20% in the men and by 36% and 34% in the women, respectively. Half of the change persisted among the women but not among the men one month after the treatment. The decrease in nocturnal diuresis was greatest among those who, before the treatment, had a large part of their diuresis during the night. Diuresis during the day changed only insignificantly. Body weight did not change during treatment, nor did blood pressure, osmolality, sodium or potassium in serum. Sleep improved during treatment. In one case, side-effects were observed, with a feeling of swelling in the body and decreased diuresis in the morning.
Administration, Intranasal↗
Smoking habits before, during and after pregnancy among Swedish women and their partners in suburban Stockholm.
Smoking habits of pregnant women and their partners at three health centres in Stockholm, Sweden, were monitored by a postal questionnaire. Of 582 women enlisted at the antenatal clinics, 433 (74%) were included. 253 (58%) women and 230 (53%) partners responded. 30% of the women were smokers at the start of pregnancy, compared with 27% of the men. During pregnancy 18% continued to smoke, and after the birth of the child 21% were smokers. The male partners stopped or decreased smoking less often. Fewer women aged 25 or more were smokers. The number of heavy smokers decreased considerably during and after pregnancy. The women were more prone to stop smoking if the partner was a non-smoker. 87% made some restriction in their smoking habits after the baby was born.
Adult↗
Health of the elderly with regard to sleep and nocturnal micturition.
A questionnaire study was carried out among pensioners in Jämtland County, Sweden. The questionnaire was answered by 1,115 persons, representing a response rate of 74%. It covered various aspects of health, with emphasis on sleep, fatigue, thirst, and other symptoms that may interfere with night-time sleep. The data were analysed with regard to the stated number of night-time disturbances due to urination. Nocturnal micturition was often associated with increased sleep disorders, a poorer quality of sleep, increased thirst, particularly at night, and increased fatigue in the daytime. All the relationships were clearer in women than in men. There was no relationship between reported enuresis in childhood and an increased frequency of voiding when the subject became older.
Aged↗
Treatment of pelvic joint dysfunction in primary care--a controlled study.
The study evaluated the manual treatment of dysfunction of the pelvic joints. This is one of many condition causing low back pain. In 1987-1988 a general practitioner with special knowledge of physical examination and manual treatment of lumbar and pelvic dysfunctions made a survey of patients with acute or subacute low back pain as the main cause of the patient-to-doctor contact. Patients with defined criteria of pelvic joint dysfunction (n = 46) were randomized. After dropouts and exclusions, 18 patients with defined criteria of pelvic joint dysfunction received manual treatment, while 21 patients with similar dysfunction served as controls and received placebo treatment in a form of massage. Both groups were seen only once to evaluate whether a single treatment might be sufficient. After a period of three weeks, evaluation was made by an independent observer. Subjective pain measurement and a mobility test showed no significant difference. Sick-leave and consumption of analgesics (both decided by patient) were significantly less in the treatment group.
Acute Disease↗
[Caution needed when evaluating blood pressure measurement taken in the home].
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Adult↗
[What is the cost of hypertension treatment to society?].
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Antihypertensive Agents↗
Evaluation of the adenosine triphosphate test in the diagnosis of urinary tract infection.
Determination by bioluminescence of the bacterial adenosine triphosphate (ATP) level in urine was evaluated as a method for detection of bacteriuria in 1126 women with symptoms of UTI and 530 attending for follow-up. Conventional urine culture was used as reference method. The criterion for bacteriuria was growth of greater than or equal to 10(5) cfu/ml, giving a prevalence of 0.60. ATP levels of less than 10 nmol/l and greater than 50 mmol/l indicated abacteriuria and bacteruiria, respectively, whereas intermediate concentrations required culture if the nitrite test was negative. With this diagnostic strategy the sensitivity and specificity was 0.96 and 0.90 at the first visit and 0.90 and 0.98 at follow-up. With some methodological improvement the ATP test could be useful in medium-sized and small laboratories.
Adenosine Triphosphate↗
Diurnal variation in the levels of antidiuretic hormone in the elderly.
The secretion of antidiuretic hormone (ADH) and the serum osmolality were measured at 4-h intervals throughout a 24-h period in 69 healthy elderly volunteers. In male subjects the concentrations of plasma ADH were always twofold higher than in female subjects. The normal diurnal rhythm, with increased ADH secretion during the night, was not seen in this group of elderly subjects, with the exception of elderly men who did not urinate during the night, in whom a substantial increase in plasma ADH levels occurred. In as many as 25% of all the ADH measurements performed (n = 455) ADH was not detectable by the method used. The lack of a definite diurnal rhythm in most of the elderly subjects could to some extent explain the increased diuresis during the night in the elderly.
Aged↗
Cost-benefit analysis of non-pharmacological treatment of hypertension.
In this study a non-pharmacological treatment (NPT) programme and conventional drug treatment of hypertension was compared in a cost-benefit analysis. The NPT programme involved 400 patients and was conducted at 8 health centres during the period 1984-1986. It consisted of monthly visits by a nurse, visits by a doctor every 6 months, home blood pressure (BP) measurements, dietary advice, relaxation, physical activity, etc. The patients were also followed up for 2 years after the study to assess whether the programme still worked, and whether future treatment costs were affected. The treatment costs were about SEK 5300 higher per patient for the NPT programme. The benefits, in the form of reduced treatment costs for the period 1986-1988 and willingness to pay (WTP) for the NPT programme, were about SEK 3200. Thus the NPT programme resulted in a loss of about SEK 2100 per patient. However, a longer follow-up period is needed for any specific conclusions to be drawn about the costs and benefits of the NPT programme, as compared with conventional drug treatment.
Adult↗
Non-pharmacological treatment of hypertension: differences between health centres in patients' blood pressure and success at withdrawal from drugs.
Four hundred patients from eight health centres were recruited for this two-year study on the possibility of replacing antihypertensive drugs by non-pharmacological therapy. This consisted of monthly check-ups and blood pressure measurements at home by the patients plus advice about changes of lifestyle--salt restriction, weight reduction, physical activity, and reduction of alcohol and tobacco. The non-pharmacological treatment was effective and 44% had discontinued drugs after two years without any increase in diastolic blood pressure. Twenty-five per cent reduced their weight by 4% or more. There were no changes in sodium or potassium output. Thirty-five per cent increased their physical activity and 20% decreased it. When the results for each health centre were compared, striking differences in hypertensive characteristics of patients and the outcome of antihypertensive drug treatment were found. In one health centre 69% of patients were not taking drugs after two years. In some health centres the non-pharmacological treatment was quite successful, but in others the attempt failed. A prerequisite for successful use of pharmacological treatment is that the problem of non-compliance should be solved.
Adult↗
Efficacy of single-dose versus seven-day trimethoprim treatment of cystitis in women: a randomized double-blind study.
Single-dose trimethoprim treatment of cystitis was compared with 7-day treatment in a randomized double-blind study in primary health care. Consecutive female patients (613) with symptoms of lower urinary tract infection (UTI) and positive bacteriuria screening tests were enrolled. In 502 cases UTI was confirmed by urine culture. Follow-up was performed twice, after 2-3 and 5-6 weeks. Short-term efficacy could be evaluated in 425 cases and accumulated efficacy in 344. Short-term efficacy was 82% for single-dose and 94% for 7-day treatment (P less than .001). Accumulated efficacy was 71% for single-dose and 87% for 7-day therapy (P less than .001). Fewer adverse reactions were noted with single-dose therapy (not significant). The cure rate for UTI caused by P-fimbriated Escherichia coli was not different from that of other E. coli infections. Infections with Staphylococcus saprophyticus showed a lower cure rate than E. coli infections with the single-dose regimen (P less than .05 for short-term efficacy).
Adolescent↗
Lower serum magnesium level after exposure to cold in women with primary Raynaud's phenomenon.
Serum levels of magnesium (s-Mg), calcium (s-Ca), potassium (s-K) and sodium (s-Na) were measured in 80 women with primary Raynaud's phenomenon (RP) and in 24 age-matched female controls recruited from a population survey. The blood samples were taken after a 40-min standardized whole body cooling test. The mean s-Mg level in the group with RP was significantly lower than in the controls (0.81 +/- 0.05 vs. 0.86 +/- 0.07 mmol l-1, P less than 0.05). One year later, 66 members of the RP group and 22 members of the control group were investigated further, but without any exposure to cold. No differences in mean s-Mg values were found between the groups. The mean s-Mg level was significantly higher in the blood samples taken later without cold exposure than at the initial examinations after exposure to cold in the RP group, but not in the controls. The s-Mg level was lower after exposure to cold in 82% of the women with RP, compared to 45% of the controls (P less than 0.001). No differences in the other electrolytes were found. It is concluded that exposure to cold under standardized conditions may decrease the s-Mg level in women with primary RP. Further studies of the role of magnesium in patients with RP are required.
Adult↗
Female urinary tract infection in primary health care: bacteriological and clinical characteristics.
Female patients with symptoms of urinary tract infection (n = 1136) were studied in primary health care with respect to (a) clinical symptoms as predictors of bacteriuria; (b) relation between aetiological agent and clinical picture, especially for P-fimbriated Escherichia coli; and (c) clinical findings in cases with 10(2)- less than 10(5) CFU/ml of E. coli. Prevalence of bacteriuria (greater than or equal to 10(5) CFU/ml) was 61%. Concurrence of urgency/frequency and dysuria, short duration of symptoms and hematuria increased the probability of bacteriuria and were also significantly more frequent among cases with low counts of E. coli (10(2) less than 10(5) CFU/ml in pure culture or mixed flora) than among cases with sterile urine, indicating an aetiological role of E. coli in many of those cases. Infections with P-fimbriated E. coli were as benign as the P-fimbriae-negative. The rate of P-fimbriation was 29% in specimens containing greater than or equal to 10(5) CFU/ml of E. coli, 30% among specimens with less than 10(5) CFU/ml in pure culture and 10% in specimens containing less than 10(5) CFU/ml of E. coli in mixed culture. Patients infected with Klebsiella, Enterobacter or Proteus did not show a higher rate of previous urinary tract disease or anomalies.
Adolescent↗
Life quality in non-pharmacological therapy of hypertension.
Measurements of life quality have recently been included in drug trials on hypertension. In literature, not one single reference was found on life quality in non-pharmacological therapy of hypertension. More or less a tacit understanding is, however, that the life quality is unchanged, or at least not impaired, during non-pharmacological therapy. Experiences from a study of 400 patients with the aim to reduce or withdraw antihypertensive drugs, at the same time as non-pharmacological methods were introduced, show the difficulties to evaluate changes of life quality in a non-pharmacological study.
Antihypertensive Agents↗
Do antihypertensive drugs precipitate diabetes in predisposed men?
OBJECTIVE: To evaluate the influence of antihypertensive treatment and metabolic characteristics on the development of diabetes mellitus in middle aged men. DESIGN: Prospective study over an average of nine years. SETTING: Community based health survey of middle aged men carried out at the University of Uppsala. SUBJECTS: Seventy three hypertensive men aged 49-54 and 65 normotensive controls matched for body mass index, glucose disappearance rate (k value) at an intravenous glucose tolerance test, and serum triglyceride and cholesterol concentrations. INTERVENTIONS: Hypertensive group was treated with beta blockers, thiazides, hydralazine, or combinations of these drugs. Treatment was not randomised. MEASUREMENTS AND MAIN RESULTS: Intravenous glucose tolerance, fasting blood glucose and serum lipid and insulin concentrations, body weight and height, three skinfold measurements, and blood pressure were recorded both during an initial health screening survey in 1970-3 and at a follow up survey in 1980-3. In the period between the two surveys 12 hypertensive men and two controls developed diabetes. Review of values obtained at the initial survey showed that the hypertensive men who developed diabetes or impaired glucose tolerance could be distinguished from those hypertensive men who did not by virtue of a higher fasting serum insulin concentration (26.1 v 15.2 mU/l (confidence interval of difference -15.2 to -6.2)), a lower peak serum insulin concentration (78.9 v 94.3 mU/l (confidence interval of difference -1.1 to 41.1)), and a lower k value (1.29 v 1.68 (confidence interval of difference -0.02 to 0.68)). The insulin index (peak insulin concentration divided by fasting insulin concentration), however, decreased significantly in the hypertensive men over time irrespective of whether they developed diabetes but did not change in the controls. Furthermore, the serum triglyceride concentration increased in the treated group and decreased in the controls. CONCLUSION: A severalfold difference in the incidence of diabetes between treated hypertensive and non-treated, normotensive men may be a consequence of the treatment, which may be particularly deleterious in men predisposed to diabetes.
Antihypertensive Agents↗