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Biomedical subjects

J F Potter

Publications and source records attributed to J F Potter.

At least 73 records · Page 4Linked to original sources
PubMed1995

Malignant hypertension in the elderly.

To investigate age-related differences in malignant hypertension (MHT), we studied 38 elderly patients (18 males, 20 females; mean age 70.6 years, SD 4.6 years, range 65 to 84) and 277 younger patients (193 males, 84 females; mean age 46.4 years, SD 10.5, range 15 to 64) with MHT presenting 1965-93. Mean duration of known hypertension before presentation was greater in the elderly group (43.8 months vs. 23.1 months). The elderly group included 18 (47.4%) newly diagnosed hypertensives, compared to 160 (55.8%) in the younger group. At presentation, 19 (50.0%) elderly patients were receiving no antihypertensive drug therapy, whilst 18 (47.4%) were taking one or more drugs for hypertension. Presenting clinical features in elderly MHT patients included visual disturbance (9), headaches (2), headaches with visual disturbance (2), stroke (3), and heart failure (2). Six patients were asymptomatic. The commonest clinical complications were ischaemic heart disease (angina and myocardial infarction) (5), heart failure (4) and stroke (4). The majority (58%) of patients, however, had no vascular complications at presentation. Comparing elderly and younger MHT groups, there was no significant difference in presenting systolic blood pressures, although mean diastolic blood pressure was significantly greater in the younger group (mean 143.7 mmHg +/- 19.3 vs. 130.0 mmHg +/- 15.2; p < 0.0001). After a mean follow-up of 30.9 months (SD 37.1; range 1 to 123 months), 17 (44.7%) of the elderly patients were still alive, 15 were dead (39.5%) and six were lost to follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1995

Twenty-four-hour ambulatory blood pressure in old and very old subjects.

OBJECTIVE: To compare clinic and 24-h blood pressure levels and profiles in young elderly (aged 65-79 years) and old elderly (aged > or = 80 years) subjects. SUBJECTS AND METHODS: A cross-sectional observational study was conducted on 108 ambulant subjects (51 males) aged 65-95 years with no known history of hypertension, recruited from the community (55%) and hospital outpatients (35%) and inpatients (10%). Three clinic blood pressure measurements were taken, followed by 24-h ambulatory blood pressure monitoring and then a further three clinic measurements, the mean of these being defined as the clinic blood pressure. RESULTS: Clinic systolic blood pressure was significantly higher in females than males (148 +/- 20 versus 136 +/- 23 mmHg, P = 0.02), but 24-h systolic blood pressure was similar. Mean 24-h and daytime blood pressure levels were significantly lower than clinic blood pressure in females but in males only 24-h systolic blood pressure was lower than the clinic level. In young elderly compared to old elderly females the clinic-daytime ambulatory systolic blood pressure difference was significantly reduced (14 +/- 22 versus 1 +/- 17 mmHg, respectively; P = 0.04). A significant nocturnal systolic/diastolic blood pressure fall was seen in young elderly and old elderly males (9 +/- 12/7 +/- 7 versus 6 +/- 11/7 +/- 8 mmHg) but in females the nocturnal systolic blood pressure fall was inversely related to age (r = -0.32, P = 0.02). CONCLUSIONS: The white-coat effect is common in young elderly females, but uncommon in very elderly females and males aged > or = 65 years; a decline in casual blood pressure in the very elderly may partly arise from a reduction in the white-coat effect. Nocturnal blood pressure falls also decline in the very elderly, especially in females.

Aged↗
PubMed1994

Can topical zinc accentuate tuberculin reactivity in the elderly?

We examined the effect of topical zinc on Heaf tests in 58 elderly hospitalized patients in a double-blind study. Plasma zinc levels were measured. Thirty-eight subjects (66%) had negative reactions with placebo ointment. Fourteen of these negative responders (37%) had positive reactions with topical zinc ointment; 12 (32%) had weakly positive reactions and 12 remained negative. There was no significant difference in the plasma zinc levels between the different grades of topical zinc effect in the negative responders. Zinc deficiency is therefore unlikely to account for the observed booster effect of topical zinc on tuberculin reactivity.

Administration, Topical↗
PubMed1994

The outcome of a medical examination for applicants to Leicestershire homes for older people.

Medical screening of applicants to residential homes for older people has been shown to redirect inappropriate applications, although other outcomes have not been reported. This study assessed 117 applicants, of whom 63% were medically examined and offered medically directed interventions if indicated. All applicants were then reassessed at 6 and 12 weeks. No significant differences in survival, or changes in cognitive score, disability, incontinence or self-reported health were found between intervention and control groups. Intervention did redirect some applicants to more appropriate care and resulted in significantly greater improvements in morale. These results raised the question of whether it is appropriate for medical assessment to be used primarily to enforce admission criteria in the absence of other significant health benefits. However, the greater improvements in morale of the intervention group did indicate some benefit from the medical examination.

Activities of Daily Living↗
PubMed1994

Eligibility of acute stroke patients for pharmacological therapy.

The aims of this study were to analyse the characteristics of patients with acute stroke and to ascertain the number of patients meeting eligibility criteria commonly applied in clinical trials of pharmacological agents for ischaemic stroke. Details of all consecutive admissions with a diagnosis of acute stroke (n = 410, 55% female, mean age 77, range 22-99 years) admitted over a 12-month period to a district general hospital were recorded. Major exclusion criteria used in acute stroke trials were applied to data collected from the study patients. Exclusion criteria were met by 386 (94%) stroke patients, 188 (46%) had admission delay > 12 hours, 85 (21%) had pre-existing major disability, 80 (20%) minor stroke, 66 (15%) had coexisting severe illness, 51 (12%) were unconscious, and 30 (7%) had major electrolyte or ECG abnormalities. One hundred and five (26%) had two or more exclusion criteria. The majority of acute stroke patients admitted to a district general hospital would be likely to be excluded from most current pharmacological treatment studies.

Adult↗
PubMed1994

Predictors of mortality in outpatient geriatric evaluation and management clinic patients.

BACKGROUND: This study describes characteristics and predictors of survival in an outpatient Geriatric Evaluation and Management (GEM) population. METHODS: Prospective evaluation and longitudinal follow-up of consecutive patients (N = 636) seen in a GEM Clinic between January 1986 and September 1991. RESULTS: The typical patient was 78.4 years of age, White, female (73%), unmarried (66%), and living with a spouse or relative (47%). Although two-thirds were demented, most were independent in Activities of Daily Living (ADL) and partially dependent in Instrumental Activities of Daily Living (IADL). Subjects were followed for an average of 25 months. In bivariate analysis, IADL was the strongest predictor of survival (O.R. = 4.4). Higher ADL, better cognitive status, lower comorbid illness, and lack of recent hospitalization were also predictive of survival. In stepwise logistic regression, only IADL (O.R. = 4.2) and comorbid illness (O.R. = 1.5) predicted survival. In Kaplan-Meier Lifetable Analysis, survival at two years was 91% in the least dependent IADL group while survival was 75% in the most dependent group. Comorbid illness was the only factor that improved prediction of survival above that seen with IADL alone. When subjects are stratified by both function and illness, mortality was 36% in the ill and disabled group and 8% in those of high function and limited illness. CONCLUSIONS: IADL and comorbid illness scores offer a means of stratifying subjects for risk of death and may be useful in evaluating and comparing mortality experience in outpatient GEM and control populations. Stratification may increase the likelihood that studies aimed at improving survival will detect a difference resulting from the intervention.

Activities of Daily Living↗
PubMed1994

Hypertension and the elderly.

Cardiovascular disease remains the major cause of death in elderly people, with hypertension the main treatable risk factor. Despite this there has been little consensus with regard to assessment or treatment of the elderly hypertensive patient. Several recent large intervention trials have shown blood pressure (BP) reduction in elderly patients with combined and isolated systolic hypertension using thiazide diuretics or beta-blockers significantly reduces cardiovascular morbidity and mortality. However, only the STOP-Hypertension Trial has shown a reduction in total mortality with active treatment. Patients under 80 years with an SBP > or = 160 mmHg and DBP > or = 90 mmHg or SBP > or = 160 mmHg and DBP < 90 mmHg should be considered for anti-hypertensive therapy, initially using non-pharmacological methods. Thiazide diuretics and beta-blockers remain first-line pharmacological therapy, the long-term benefits of other types of anti-hypertensive agent have yet to be assessed. In general the negative attitudes to treating hypertension in the elderly can no longer be upheld, although in certain sub-groups the benefits of treatment are as yet unproven.

Aged↗
PubMed1994

The changes in blood pressure after acute stroke: abolishing the 'white coat effect' with 24-h ambulatory monitoring.

OBJECTIVES: To assess the changes in 24-h and casual blood pressure (BP) levels following hospitalization for acute stroke. DESIGN: Prospective study of patients admitted with acute hemispheric stroke and hospitalized controls using casual and 24-h BP monitoring. SETTING: Medical wards in a large teaching hospital. SUBJECTS: Thirty-three patients (median age 77 years, 17 male) and 21 control subjects admitted non-acutely. INTERVENTIONS: All subjects underwent 24-h BP monitoring within 24 h of stroke onset (patients) or admission (controls) and again at 1 week. Casual BPs were recorded over the same period. MAIN OUTCOME MEASURES: The change in BP over the first week in each group. Eleven stroke subjects had 24-h BP monitoring repeated at 6 months. RESULTS: In the stroke group, 24-h systolic BP (SBP) fell by 7 mmHg (95% CI, 0 to 14 mmHg; P < 0.05) and diastolic BP (DBP) by 3 mmHg (95% CI, 0 to 6 mmHg; P < 0.02) over the first week. Mean 24-h BP levels in the control group did not change during this period. However, casual BP recordings fell in both stroke (18/12 mmHg) and control (19/9 mmHg) groups. Stroke subjects followed to 6 months showed no further change in 24-h BP (day 7: 137 +/- 17/79 +/- 13 mmHg; month 6: 138 +/- 16/78 +/- 11 mmHg). CONCLUSIONS: Although there was a large fall in causal BPs seen in both groups there was only a small, but a significant fall in mean 24-h BP over the first week following hemispheric stroke that was not seen in control subjects. Although the 'white coat effect' and admission to hospital play an important part in the high casual BP observed in the days following acute stroke they are unlikely to be the sole factors.

Acute Disease↗
PubMed1994

Orthostatic hypotension and anti-hypertensive therapy in the elderly.

The effect of withdrawing or continuing anti-hypertensive therapy on orthostatic blood pressure change in elderly hypertensive subjects was examined. Subjects meeting criteria for therapy withdrawal had supine and standing blood pressure measurements taken on treatment, and at 1, 3, 6, 9 and 12 months off treatment whilst receiving standard non-pharmacological advice to lower blood pressure. Subjects not meeting blood pressure criteria for treatment withdrawal or were unwilling to stop treatment had blood pressure measurements taken after 6 and 12 months whilst also receiving non-pharmacological advice. Orthostatic hypotension was defined as a mean systolic blood pressure fall > or = 20 mmHg on standing from a supine position. Forty-seven subjects (median age 76 years, range 65-84 years) had treatment withdrawn. Thirteen subjects (median age 73 years, range 68-82 years) continued on their treatment. Twelve months after treatment withdrawal there was a significant reduction in the number demonstrating orthostatic hypotension from 11 (23%) to four (11%) (P < 0.05), whilst the group continuing on treatment showed no change. In the withdrawal group those with orthostatic hypotension on treatment (n = 11) were older (79 versus 74 years, P = 0.05), had higher prewithdrawal systolic blood pressure (164 +/- 21 versus 147 +/- 17 mmHg, P = 0.02) compared to those without, although there was no difference in body mass index, gender, number or type of anti-hypertensive drugs taken. In elderly hypertensive subjects withdrawal of anti-hypertensive therapy and institution of non-pharmacological treatment can over several months reduce the prevalence of orthostatic hypotension.

Aged↗
PubMed1994

Factors affecting changes in blood pressure after acute stroke.

BACKGROUND AND PURPOSE: We sought to establish the pattern of blood pressure (BP) change after hospitalization for acute hemispheric stroke. METHODS: In 292 patients from the Leicester teaching hospitals with acute hemispheric stroke within the previous 24 hours (139 men; median age, 75 years [range, 42 to 98 years]), we prospectively studied BP changes between admission, 24 hours, 1 week, and 4 to 6 weeks. Changes were assessed in relation to the main stroke risk factors, stroke type and severity, and antihypertensive drug treatment. All subjects were followed up for 1 week, with 117 subjects followed up for 4 to 6 weeks. Changes were assessed by repeated-measures ANOVA, and Student's t tests were used to compare group pairs. RESULTS: Systolic and diastolic BP fell by 12 mm Hg (95% confidence interval [CI], 8 to 15 mm Hg) and 7 mm Hg (95% CI, 5 to 9 mm Hg), respectively, in the first 24 hours and 22 mm Hg (95% CI, 18 to 25 mm Hg) and 12 mm Hg (95% CI, 10 to 14 mm Hg), respectively, during the first week (all changes significant at P < .01) but no further thereafter. In those patients receiving no antihypertensive medication before or after stroke, the pattern of change was similar to that of the whole group. Previously diagnosed hypertensive subjects (n = 106) had higher initial BP values than did normotensive subjects, although by 1 week the levels were not significantly different. Patients with cerebral hemorrhage confirmed by computed tomography (n = 20) had higher systolic BP, but not diastolic BP, throughout the first week than those with cerebral infarction (n = 89). The severity of stroke, age, and previous stroke history did not appear to alter the BP pattern. Stroke patients who were moderate to heavy alcohol consumers had lower convalescent systolic BP levels than lighter drinkers or abstainers. CONCLUSIONS: We have demonstrated a marked fall in systolic and diastolic BP levels during the first 7 days after acute hemispheric stroke, with little change thereafter. Higher initial systolic BP values were found in patients with cerebral hemorrhage compared with those with cerebral infarct. Moderate to heavy alcohol consumption before stroke was associated with a greater systolic BP decline in the first week after the event compared with stroke patients who were light drinkers or abstainers.

Aged↗
PubMed1994

Clinic and 24h blood pressure in elderly treated hypertensives with postural hypotension.

The objectives of this study were to determine the prevalence of, and factors associated with, postural hypotension (PH) in elderly treated hypertensive subjects, to examine the 24h BP profile in those subjects with and without PH and to determine the effects of antihypertensive treatment withdrawal on the prevalence and symptoms of PH. Eighty-six subjects (mean age +/- standard deviation 76 +/- 6 years) on antihypertensive drug therapy for > 6 months had three clinic BP measurements taken in supine and standing positions followed by 24h ambulatory BP monitoring. Forty-seven subjects underwent repeat BP measurement five weeks after withdrawal of antihypertensive medication and institution of standard nonpharmacological methods. Twenty-six (30%) of the 86 subjects exhibited PH (defined as SBP fall on standing > or = 20 mmHg) within three minutes of standing. Supine clinic and 24h SBP and DBP, age and presence of previous cardiovascular events were similar in the groups with and without PH. There was a significant correlation between the orthostatic BP fall for all subjects and day-night SBP difference (r = -0.30, P = 0.01) and urinary sodium:creatinine ratio (r = -0.33, P = 0.04). Multiple regression analysis revealed only the day-night SBP difference was a significant predictor of orthostatic BP change. In the PH group, 19 subjects had treatment withdrawn resulting in a reduction of 58% (P > 0.001) in those continuing to demonstrate PH. If indicated a trial of antihypertensive drug treatment withdrawal could reduce the risk of PH; the additional benefit of instituting nonpharmacological therapy in reducing BP and orthostatic hypotension warrants further assessment.

Aged↗
PubMed1994

Possibilities for antihypertensive drug therapy withdrawal in the elderly.

The aims of this study were to determine: (1) the proportion of elderly hypertensive subjects currently attending a hospital hypertension clinic suitable for a trial of antihypertensive drug withdrawal, (2) the proportion of suitable patients who can be successfully withdrawn from drug therapy while receiving nonpharmacological advice, and (3) the factors associated with successful withdrawal. One hundred and five consecutive hypertensive subjects, 53% female, mean age 76 years (range 65-84 years) on pharmacological antihypertensive therapy for > 1 year were studied, of whom 78 (74%) had a clinic SBP < 175 mmHg and DBP < 100 mmHg. Subjects with recent myocardial infarction or stroke or with symptoms of ischaemic heart disease were excluded. Antihypertensive drug therapy was withdrawn in this group and nonpharmacological advice to lower BP was instituted. Clinic BP and weight were subsequently recorded monthly for 12 months in all subjects and at every three months in those who had a possible follow-up period of 24 months. The 24h ambulatory BP was measured at baseline and repeated one month off therapy; 24h urine electrolytes were also assessed at baseline and at 12 months or before restarting drug therapy. Seventy-four (70%) subjects had a potential follow-up of 12 months (four were withdrawn from the study) and 64 were available for two years of follow-up. Antihypertensive treatment was restarted if SBP > or = 160 mmHg and/or DBP > or = 90 mmHg on two consecutive visits. After 12 months, 20 (25%) of those withdrawn remained normotensive, the majority restarting therapy did so in the first three months.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Microalbuminuria in elderly hypertensives: reproducibility and relation to clinic and ambulatory blood pressure.

OBJECTIVE: To examine the short-term reproducibility of urinary albumin measurements and the relation of urinary albumin excretion to the clinic and ambulatory blood pressure levels in elderly untreated hypertensive subjects. SETTING: Outpatient hypertension clinic of a District General Hospital. MAIN OUTCOME MEASURES: The within-patient reproducibility of 24-h urinary microalbumin and electrolyte excretion and relation to 24-h and clinic blood pressure levels. PATIENTS: Sixty-four untreated elderly hypertensives (mean age 74.7 years, range 64-82) with systolic blood pressure > or = 160 mmHg or diastolic blood pressure > or = 95 mmHg, or both, were recruited from general practitioner clinics and current outpatient attenders. The patients had not received antihypertensive treatment for at least 4 weeks. METHODS: The clinic and 24-h non-invasive ambulatory blood pressures were recorded with a simultaneous 24-h urine collection for measurement of the urinary albumin and electrolyte excretion. Thirty-seven subjects performed two consecutive 24-h urine collections for an assessment of the short-term reproducibility of the albumin and electrolyte excretion. RESULTS: The coefficient of variation of 24-h urinary albumin excretion was 62%, and for the albumin:creatinine ratio 52%, compared with 19% for sodium and 15% for potassium excretion. The urinary albumin excretion correlated with clinic systolic blood pressure (r = 0.33, P = 0.01) and with 24-h ambulatory systolic (r = 0.48, P < 0.001) and diastolic (r = 0.32, P = 0.01) blood pressure. The subjects with microalbuminuria (24-h urinary albumin excretion in the range 30-300 mg) had higher clinic and ambulatory blood pressures than those with lower levels of albumin excretion. CONCLUSIONS: The low day-to-day intrasubject reproducibility in the 24-h urinary albumin excretion considerably reduces the potential value of single collections in the assessment of microalbuminuria in elderly hypertensives. The urinary albumin excretion correlates with the clinic and 24-h ambulatory blood pressures in elderly hypertensives.

Aged↗
PubMed1994

Clinical correlates of left ventricular mass in elderly hypertensives.

We set out to examine the prevalence of echocardiographically-determined left ventricular hypertrophy (LVH) in a hospital-based population of untreated elderly hypertensives and to study the relationship between left ventricular mass index and clinic and 24h ambulatory BP, urinary electrolyte and microalbumin excretion and ECG changes. We studied 52 untreated elderly hypertensives, mean age 76 years, with no evidence of stroke or heart disease. Subjects underwent 24h ambulatory BP recording together with 24h urine collection for electrolytes and microalbumin estimation. A standard ECG was examined for LVH by commonly used criteria. Subjects were examined by 2-dimensional guided M-mode echocardiography; left ventricular mass was calculated from the formula of Devereux and Riechek and corrected for body surface area (left ventricular mass index, LVMI). Mean LVMI was 168 +/- 39 g/m2 for men and 153 +/- 36 g/m2 for women; 43 (83%) subjects had LVH. LVMI was significantly related to clinic SBP (r = 0.27, P = 0.05), ambulatory daytime SBP (r = 0.27, P = 0.05), nighttime SBP (r = 0.41, P = 0.003) and nighttime DBP (r = 0.29, P = 0.04). LVMI was also related to the difference in mean SBP between day and night (r = -0.32, P = 0.02) and subjects with a day-night SBP difference of > or = 10 mmHg (n = 27) had significantly lower LVMI than those with a day-night SBP difference < 10 mmHg (141 +/- 32 g/m2 vs. 176 +/- 35 g/m2, respectively; P = 0.0005). Fifteen subjects had LVH by ECG criteria giving a sensitivity of 28% and specificity of 66%. LVMI was not related to urinary sodium, potassium or albumin excretion. This study shows that in elderly hypertensives it is measures of nighttime BP which are most closely related to LVMI and subjects with a greater nocturnal fall in BP have lower LVMI, presumably reflecting differences in 24h BP load.

Aged↗
PubMed1994

Helping the elderly stay active: a technique for detecting disability in the primary care office.

The inability to perform essential activities of daily living such as cooking, shopping, dressing and bathing is termed functional disability. These deficits can prevent elders from enjoying independent, active lifestyles. The development of functional disability is a gradual process. Early identification and intervention by the primary care physician can often reduce functional decline. Screening for functional decline has traditionally been performed by either questionnaire or direct observation of tasks. This paper reviews methods which have been proposed to integrate functional disability screening into office practice. A method which incorporates both questionnaire and direct observation is recommended by the authors. The method of screening proposed targets specific areas prone to dysfunction. It focuses on simple screens of vision, hearing, arm and leg function, urinary incontinence, mental status, depression, nutrition, activities of daily living, environmental hazards, and social support systems. Appropriate methods of follow up evaluation and treatment are provided. This fifteen minute technique is a practical and applicable means of screening elderly patients for functional deficits in the primary care office.

Activities of Daily Living↗
PubMed1994

Variation of within visit blood pressure readings at a single visit in the elderly and their relationship to ambulatory measurements.

The value of routinely taking one or several BP readings at a single visit in subjects with an initially elevated BP reading is unclear. The variation of sequential BP readings in the elderly, who often have a disproportionate increase in SBP compared with DBP, has received little attention. In addition, no attempt has been made to relate the various BP readings obtained to a subject's ambulatory daytime BP. The aim of this study was to examine the variation in BP between one, two or three readings at a single visit in elderly subjects with elevated BPs and to compare these readings with those obtained from daytime ambulatory BP monitoring (ABPM). Sixty-nine subjects, mean age 76 years (range 66-86 years) with at least one SBP reading > 150 mmHg and who had undergone a minimum of two previous clinic visits for BP measurement by the same physician were included. Following five minutes rest three supine BP readings were taken, spaced two minutes apart, using a Hawksley random zero sphygmomanometer. Seventeen subjects underwent home 24h ABPM commencing immediately after the clinic BP readings. Clinic SBP fell from first to third reading by 11 mmHg (95% Cl 9-13 mmHg, P < 0.001) and from first to second readings by 6 mmHg (Cl 4-8 mmHg, P < 0.01). There was no change in mean DBP between readings. In 85% of readings first SBPs were higher than the second.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Duration of caffeine abstention influences the acute blood pressure responses to caffeine in elderly normotensives.

The effect of an acute oral caffeine load (250 mg capsule) and matching placebo on blood pressure and pulse rate were studied after 48 h caffeine abstention in 8 elderly, normotensive regular caffeine users. The caffeine loading phase was repeated after only 12 h abstention. Following 48 h abstention, supine systolic and diastolic blood pressure were higher for the 120 min study period after the acute caffeine load than placebo (12.1 mm Hg, 95% C.I. 4.3-19.9 mm Hg; P = 0.008 and 7.4 mm Hg, 3.6-11.2 mm Hg; P < 0.001 respectively). Similar differences were seen in standing blood pressure, though pulse rate was unchanged throughout. The pressor response to the acute caffeine load was significantly greater after a 48 h than a 12 hour caffeine abstention period, for supine and standing systolic and diastolic blood pressure. The changes in plasma caffeine levels after acute loading were similar after the 2 different abstention periods. Caffeine ingestion after 48 h abstention has an acute pressor effect in normotensive elderly subjects which is abolished if the abstention period is reduced to 12 h. Acute caffeine ingestion is unlikely to have a significant pressor effect in elderly normotensive subjects who are regular caffeine users as the normal period of caffeine abstention (i.e. overnight) is too short to abolish tolerance.

Administration, Oral↗