Alcohol consumption and dependence in elderly patients in an urban community.
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Aged↗
Biomedical subjects
J F Potter
Publications and source records attributed to J F Potter.
The clinical relevance of alcohol in the Blood Pressure Clinic.
There is a limited number of studies conducted in hypertensive patients which support the hypothesis that high alcohol intake is an important reversible cause of raised blood pressure. The validity and effectiveness of alcohol restriction as a treatment of hypertension is difficult to study as there is no suitable placebo substance that can be employed on a clinical trial basis. However, such clinical data that there are, taken with the confirmatory epidemiological work, strongly suggest that hypertensive patients should be questioned and investigated for evidence of high alcohol intake and advised accordingly.
Alcohol Drinking↗
Clinical features and prognosis of alcoholic liver disease in respect of advancing age.
The signs, symptoms, alcohol history, and histological findings together with prognosis of 208 consecutive patients with alcoholic liver disease (ALD) are presented in respect of age. 200 were followed for at least 1 year. 28% of patients first presented over age 60, 6% over 70 years. Signs and symptoms were more severe at presentation in the 70+-year-old age group than in the young patients though the elderly more often presented with symptoms not directly related to liver disease. Prognosis was age-related, 1 year mortality was 50% among cirrhotics over the age of 60 versus 7% under 60 years. Alcohol consumption at presentation was similar in all age groups with no evidence of a significant reduction in the elderly. The care of older patients with ALD will become an increasing problem in developed countries where alcohol consumption has continued to rise.
Adult↗
Atenolol improves blood pressure control in patients taking captopril and frusemide.
In a double-blind randomised cross-over study atenolol 100 mg daily and matching placebo were given to 14 patients whose blood pressure (BP) was uncontrolled on a fixed dose of captopril and frusemide. Atenolol produced a further reduction in both supine (170/105 mmHg to 163/94 mmHg) and standing (171/114 mmHg to 160/96 mmHg) BP and a significant fall in pulse rate and plasma renin activity (PRA). This fall in BP showed a highly significant correlation with pre-treatment plasma renin levels. No adverse side effects were encountered during the study. Previous suggestions that beta-blockade had no additional hypotensive effect in patients receiving captopril were not substantiated. For patients whose BP was poorly controlled with captopril and a diuretic, a selective beta-blocker is suggested as a useful third line agent.
Adult↗
Alcohol raises blood pressure in hypertensive patients.
The acute effect of drinking beer on blood pressure was studied in 18 hypertensive patients who were either regular, moderate (MI) or low intake (LI) drinkers. Patients in the MI group showed a significant rise in systolic blood pressure (SBP; average 12 mmHg) and pulse rate with alcohol, but no change after alcohol-free drink. No such changes with alcohol were seen in LI patients. There was a small transient rise in diastolic pressure (DBP) in response to alcohol in both the MI and LI patients. Resting plasma catecholamine levels were similar in both groups but only the MI group showed a significant rise in plasma noradrenaline (P less than 0.05) with alcohol, paralleling the rise in SBP and pulse rate. Plasma renin activity (PRA) and cortisol were unaffected by alcohol. In both groups significant falls in plasma calcium levels occurred with alcohol. The greater haemodynamic changes with alcohol in the MI group were associated with increased sympathetic activity. Chronic moderate alcohol intake, however, does not alter resting plasma catecholamine levels, at least, after hypertension is established.
Adult↗
The pressor and metabolic effects of alcohol in normotensive subjects.
Changes in blood pressure, pulse rate, and plasma catecholamines, renin activity, cortisol, and calcium were studied in 16 normotensive subjects (eight with a family history of hypertension) for 5 hours following ingestion of alcohol-free and alcohol-loaded beer. Both systolic and diastolic blood pressure rose after alcohol consumption; maximum responses occurred at peak blood alcohol concentrations and were significantly higher than those seen after placebo. Pulse rate was also significantly higher after alcohol ingestion and continued to rise throughout the study. There was no difference in the pressor response to alcohol between the groups with and without a family history of hypertension. No difference was found in plasma norepinephrine or epinephrine levels between alcohol and placebo phases. However, subjects with no family history of hypertension had significantly higher plasma norepinephrine levels (p less than 0.01) than did those with a family history during both the alcohol and placebo phases, although baseline blood pressures were not significantly different. Plasma epinephrine level was similar in both groups. Plasma renin activity was unchanged throughout, but plasma cortisol fell during both phases. Plasma calcium showed a small but significant fall with alcohol consumption in both groups (p less than 0.001). These results indicate that in normotensive subjects alcohol ingestion causes a rise in systolic and diastolic blood pressure that is not influenced by a family history of hypertension. This effect does not appear to be sympathetically mediated but may be due to a direct vasoconstrictor effect of alcohol, possibly with an alcohol-induced shift in intracellular calcium.
Adult↗
The role of alcohol in hypertension.
The association between alcohol and hypertension was first described by Lian in 1915. He found that the prevalence of hypertension was high in heavy drinkers. However, this association did not receive much attention until the past 20 years. In this relatively short time, several epidemiological and a few clinical studies have been performed to investigate this association. In this article, the various studies are discussed, with a review of the possible mechanisms and a discussion of the importance of this association.
Alcohol Drinking↗
Glucose metabolism in glucose-intolerant older people during chromium supplementation.
The effects of chromic chloride (CrCl3) administered orally for 12 weeks to five elderly subjects with glucose intolerance were assessed. Pretreatment and posttreatment, the hyperglycemic clamp technique was employed to determine glucose utilization, beta-cell sensitivity to glucose, and tissue sensitivity to insulin. In addition, erythrocyte insulin binding was studied. Urinary chromium excretion increased approximately 5 fold indicating good compliance with supplementation. The oral glucose tolerance curves following supplementation were lowered from 60 to 120 minutes but only the 60-minute values were significantly lowered. In agreement with this was significantly increased glucose utilization during the hyperglycemic clamp studies. Tissue sensitivity to insulin, receptor affinity, and total insulin binding were unchanged by supplementation while beta-cell sensitivity to glucose increased following supplementation (P less than 0.04), and explained the increased glucose utilization. HDL and LDL and total cholesterol levels were slightly lower after chromium supplementation, but no change reached statistical significance. The LDL/HDL cholesterol ratio was unchanged. This study shows small but statistically significant effects of CrCl3 on carbohydrate metabolism. The clinical relevance of these effects, that is, their prophylactic or therapeutic significance, remains to be determined.
Aged↗
Pseudo-phaeochromocytoma due to alcohol withdrawal.
Alcohol withdrawal hypertension is a common clinical problem which often goes unrecognized. We report a case in which the symptoms and signs of withdrawal with a marked elevation in blood pressure mimicked the features of a phaeochromocytoma. Despite a positive phentolamine test no further evidence for phaeochromocytoma was found and both blood pressure and symptoms settled as the features of alcohol withdrawal abated.
Adrenal Gland Neoplasms↗
Two possible mechanisms for alcohol associated hypertension.
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Adult↗
Pressor effect of alcohol in hypertension.
The effect of alcohol on blood-pressure was studied in 16 men with hypertension who regularly drank up to 80 g of alcohol daily. Antihypertensive treatment was stopped 2 weeks before the men were admitted to hospital for a 7-day study. Blood pressure remained high in 8 patients who continued their regular alcohol consumption up to the fourth day after admission. In the next 4 days no alcohol was taken and diastolic and systolic blood pressures fell significantly. 8 other patients had no alcohol for the first 3 days after admission, but they resumed alcohol consumption from day 4 to 7. In these patients, blood pressure fell slightly after admission. Reintroduction of alcohol produced statistically significant increases in both systolic and diastolic pressures. This study demonstrated a pressor effect of alcohol in patients with hypertension and confirms the link between alcohol and blood-pressure reported in population studies. The mechanism of alcohol-induced hypertension is uncertain and is more likely to be due to an effect of alcohol rather than to the pressor response produced by alcohol withdrawal.
Alcohol Drinking↗
Effect of alcohol withdrawal on blood pressure, plasma renin activity, aldosterone, cortisol and dopamine beta-hydroxylase.
Sixty-five alcoholic patients admitted for detoxification had blood pressure, withdrawal symptoms, plasma cortisol (PC) and plasma aldosterone (PA) levels, plasma renin activity (PRA), and serum dopamine beta-hydroxylase (DBH) levels measured on the first and fourth days after admission. On the morning after admission blood pressure was elevated (greater than 140/90) in 32 patients (49%) and was 160/95 mmHg or more in 21 (32%). PRA was initially elevated in 41 patients, PA levels in 14, and 13 patients had raised PC levels. By the fourth day, blood pressure and biochemical measures had fallen significantly while urine volume and sodium output, low on admission, had increased significantly. On admission urinary metanephrine levels were raised in four out of the 31 patients who had them measured. The height of both the systolic and diastolic blood pressures was significantly related to the severity of the alcohol withdrawal symptoms. Of the biochemical parameters measured, PC level correlated with systolic but not diastolic pressure, and urinary volume was inversely correlated with the height of the diastolic pressure. No relationship was found between blood pressure and PRA or PA level. The pressor effect of alcohol withdrawal could be due to sympathetic nervous system overactivity, or possibly to hypercortisolaemia . The first hypothesis seems more likely.
Adult↗
Alcohol and hypertension.
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Alcohol Drinking↗
Aggressive chemotherapy for diffuse histiocytic lymphoma in the elderly: increased complications with advancing age.
Twenty patients greater than or equal to 70 years of age were included in a study of the treatment of diffuse histiocytic lymphoma utilizing cyclophosphamide, adriamycin, vincristine, and prednisone. These patients ranged in age from 70 to 94 years (median 75 years). There were also 55 younger patients (age range 33 to 69 years) in the treatment trial. There were no dose adjustments for age. The complete remission rate in the elderly patients (45 per cent) was not different from that in the younger patients (53 per cent). The overall survival in the elderly patients (median 13 months) was somewhat shorter than that in the younger patients (medians 22 months for patients 56-69 years of age and 41 months for patients 33-55 years of age), but not significantly different. Death during the first two treatment cycles from causes other than lymphoma occurred in 25 per cent of the patients greater than or equal to 70 years of age versus 2 per cent of younger patients (P less than 0.01). In addition, three other patients aged 79, 65, and 59 years died in the fourth or fifth cycles of treatment from causes other than lymphoma. Thus, 30 per cent of patients greater than or equal to 70 years of age died during therapy from causes other than lymphoma, versus 5 per cent of younger patients (P less than 0.01). Whether this altered ability to tolerate therapy in the older patients reflected decreased marrow function, altered drug metabolism, other effects of aging, or a combination of these factors is not clear. It might be appropriate to alter drug doses when treating elderly patients, and particular attention to supportive measures seems appropriate.
Adult↗
The effect of a non-selective lipophilic beta-blocker on the blood pressure and noradrenaline, vasopressin, cortisol and renin release during alcohol withdrawal.
Alcoholics during detoxification have elevated blood pressures which are related to the severity of their withdrawal symptoms. We studied the effect of a non-selective beta-blocker, timolol on symptoms, blood pressure and plasma levels of cortisol (PC), noradrenaline (NA), vasopressin (AVP) and renin activity (PRA) during alcohol withdrawal. Eighteen alcoholics, admitted for detoxification, were randomly allocated to timolol or placebo in a double blind trial. Alcohol withdrawal symptoms did not differ either before or after timolol or placebo but patients receiving timolol required less sedation with chlormethiazole. Systolic blood pressures (SBP) and pulse both fell significantly during detoxification in both groups, the change being greater with timolol. Plasma levels of cortisol, NA, AVP and PRA fell significantly, though only NA and PC correlated with initial SBP. Timolol had no effect on any of the biochemical parameters observed. The pressor response to alcohol withdrawal is reduced by beta-blockade and the height of the blood pressure is related to plasma NA and PC levels. Alcohol withdrawal hypertension is probably due to increased sympathetic activity.
Adult↗
The possible mechanisms of alcohol associated hypertension.
The association between alcohol intake and blood pressure has been known for nearly 70 years. It was postulated that the alcohol blood pressure association was not causal but linked to common factors such as stress, obesity or salt intake. Recently large population studies have shown that the association is independent of these factors. Alcohol dependent persons have a high incidence of hypertension which is a common clinical problem. It is probably due to alcohol withdrawal and is mediated via increased cortisol and catecholamine production. Alcohol has also a direct effect causing arteriolar vasoconstriction. This direct effect may result from an alcohol associated alteration of intracellular Ca in arteriolar smooth muscle leading to supersensitivity to circulating pressor agents.
Arteries↗
Cancer in blacks, whites and Asians in a British hospital.
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Adult↗