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J Coope

Publications and source records attributed to J Coope.

At least 19 recordsLinked to original sources
PubMed1992

Can we improve compliance with long-term HRT?

In order to increase awareness of strategies to prevent osteoporosis and heart disease we designed a clinic offering education and screening to all women aged 40-60 years on our practice list of 8600 patients, starting in January 1988. Screening and supervision of HRT users occurred at a weekly clinic run by the doctor and nurse. Audit in August 1991 showed that there were 260 present users of HRT (20%) of our population of 1322 women aged 40-60 years. Seventy-eight percent had taken HRT for over a year and 15% for more than 5 years. Ex-users totalled 117, of whom 52% had taken HRT for over a year and 14% for over 5 years. Examination of the clinic registers and responses to postal questionnaires showed that 681 (51.5%) of patients attended the health education clinic. Of the clinic attenders, 25% took HRT compared with 10.8% of non-attenders. Compliance with long-term therapy measured by audit of repeat prescriptions varied between 84% and 92% over a period of 5 years. Reasons for stopping treatment were anxiety over possible side-effects, especially breast cancer and dislike of bleeding.

Adult↗
PubMed1990

Menopause clinics.

Explore the source record for details and available documents.

Clinical Protocols↗
PubMed1990

Primary protection with beta-blockers in the treatment of hypertension.

The treatment of hypertension has been associated with a reduction of stroke by nearly a half but with little or no effect on the incidence of heart attack. Hypotheses to account for this discrepancy include the short duration of the trials, the differential effects on initial subsets according to age, sex and smoking status, the adverse effects of antihypertensive agents, the excessive lowering hypothesis and the common causal link hypothesis. Each of these hypotheses is examined in this paper.

Adrenergic beta-Antagonists↗
PubMed1990

A clinic for the prevention of osteoporosis in general practice.

A clinic for women aged 40-60 years, offering screening and education about diet and hormone use and other measures for the prevention of osteoporosis, was organized in a group practice. Out of 582 eligible women contacted from the age-sex register, 252 (43%) attended the clinic. A year after the start of the clinic postal questionnaires were sent to all attenders and non-attenders to ascertain smoking habit, hormone use, calcium intake and social class. The use of hormone replacement therapy by the clinic attenders increased from a baseline of 15% to 45% but this had decreased to 38% one year later. Attending women were of higher social class and had slightly higher calcium intake than non-attenders. Although the use of hormone replacement therapy for prevention of osteoporosis is controversial, the risks and benefits were explained carefully to the women and the clinic provided a valuable opportunity for screening for weight problems, high blood pressure, menstrual problems and for health education about diet for the woman and her family.

Adult↗
PubMed1990

Hypertension: the cause of the J-curve.

Many studies have established that mortality from heart attacks is related to diastolic blood pressure in a J-curve with increased mortality at low as well as high pressures. This has been observed in untreated as well as treated patients and a similar phenomenon has been found in large population studies. Two hypotheses to account for this curve have been advanced. The direct causation hypothesis attributes the increased mortality at low pressures to low coronary perfusion. The reverse causation hypothesis attributes the curve to a subgroup of patients with low blood pressures as a result of pre-existing disease. This controversy is still unresolved and needs a prospective trial to decide the issue.

Blood Pressure↗
PubMed1989

A greater role for systolic pressure?

The large intervention trials on the treatment of hypertension have been based on the diastolic component of blood pressure. Recent work indicates that elevation of the systolic pressure is just as powerful in predicting stroke and heart attacks. The incidence of systolic-only hypertension in the elderly is between 5 and 20 per cent. How to approach the management of these patients is the subject of current research in the United States.

Age Factors↗
PubMed1988

The prognostic significance of blood pressure in the elderly.

Whilst recruiting for the Randomised Trial of the Treatment of Hypertension in Elderly Patients in Primary Care, 10,732 people aged 60-79 years of age (4,736 males and 5,996 females) were screened for hypertension. This constituted 78% of those eligible on the practice lists in this age range. These patients were followed up for a mean period of 2.6 years (range 0.1-11.2 years). All those leaving the practices were registered with the National Health Service Central Registry to ensure completeness of death ascertainment. 1,009 deaths were analysed and standardised mortality ratios computed for all deaths, stroke, coronary artery disease and all cardiovascular causes. Hypertensive patients included in the control group of the trial were also matched with patients found to be normotensive and their mortalities compared. Both high and low levels of SBP were associated with increased mortality producing a U-shaped curve for all deaths and J-shaped curves for cardiovascular causes. With increasing age the higher mortality associated with lower SBP became more pronounced. Similar effects were evident for DBP but in women high DBP was less dangerous than in men. Although the relative impact of hypertension declines with advancing age, the absolute impact is maintained up to the age of eighty.

Age Factors↗
PubMed1987

Hypertension in the elderly.

Hypertension is a common finding in patients aged over 60 years, but the following questions need answering. How dangerous is it? Will lowering the blood pressure reduce the attendant risks? What is the 'cost' of such treatment in terms of side effects, drug-induced disease and health service finance? Two recently completed trials throw light on these problems: EWPHE (European Working Party on Hypertension in the Elderly), a European study based on hospital-clinic attenders, using a diuretic backed up with methyldopa; and HEP (randomized trial of treatment of Hypertension in Elderly Patients in Primary Care), based on general-practice screening in England and Wales using atenolol and bendrofluazide. The results of these trials were compared and the findings were broadly similar in the two studies. Some of the differences may be due to the different selection of patients. It is concluded that elderly patients with sustained blood pressures greater or equal to 170/90 mmHg would benefit from treatment by substantial reduction of stroke. Diuretics or beta-blockers, alone or together, are acceptable treatments in elderly subjects.

Adult↗
PubMed1986

Randomised trial of treatment of hypertension in elderly patients in primary care.

A randomised trial of the treatment of hypertension in 884 patients aged 60 to 79 years at the onset showed a reduction of 18/11 mm Hg in blood pressure over a mean follow up period of 4.4 years. The principal antihypertensive agents were atenolol and bendrofluazide. There was a reduction in the rate of fatal stroke in the treatment group to 30% of that in the control group (95% confidence interval 11-84%, p less than 0.025). The rate of all strokes (fatal and non-fatal) in the treatment group was 58% of that in the control group (95% confidence interval 35-96%, p less than 0.03). The incidence of myocardial infarction and total mortality was unaffected by treatment. Questionnaires completed by the patients and their relatives failed to identify any differences in symptoms that were likely to be due to treatment.

Aged↗