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Biomedical subjects

M Beevers

Publications and source records attributed to M Beevers.

At least 19 recordsLinked to original sources
PubMed1998

Obstetric and neonatal outcome following chronic hypertension in pregnancy among different ethnic groups.

We retrospectively studied pre-eclampsia rate and obstetric outcome in a cohort of 436 pregnancies amongst 318 women of different ethnic backgrounds attending an antenatal hypertension clinic from 1980-1997, identifying 152 women (213 pregnancies) with chronic essential hypertension. The ethnic breakdown was: White, 64 (30.0%) pregnancies in 48 (31.5%) women; Black/Afro-Caribbean, 79 (37.1%) pregnancies in 56 (36.8%) women; and Indo-Asians, 70 (32.3%) pregnancies in 48 (31.6%) women. The prevalences of pre-eclampsia in White, Black and Indo-Asian women were 17.2%, 12.7% and 18.6%, respectively (p = 0.58). Pregnancies of Indo-Asian women were of shorter gestation, and babies in this group also had lower birth weight and ponderal index compared to those of White and Black women (all p < 0.05). The proportions of overall perinatal mortality were 1.6% for Whites (1/64), 3.8% for Blacks (3/79) and 10.0% for Indo-Asians (7/70), suggesting increased risk in the Indo-Asian group. Indo-Asian women with chronic essential hypertension need careful antenatal care and observation during pregnancy.

Africa↗
PubMed1997

Effect of atenolol on birth weight.

To investigate the possible harmful effects of early antihypertensive drug therapy with atenolol versus other therapies on pregnancy outcome, we reviewed the records of 398 women referred to our antenatal hypertension clinic between 1980 and 1995. Babies born to women taking atenolol were significantly lighter than babies born to women taking other beta blockers, other antihypertensive drugs, or no therapy, suggesting that atenolol might be detrimental in early pregnancy.

Analysis of Variance↗
PubMed1997

Malignant hypertension in young women is related to previous hypertension in pregnancy, not oral contraception.

Previous studies have suggested that one-third of women of childbearing age who develop malignant phase hypertension (MHT) are likely to be taking oral contraceptives (OC). We surveyed 104 women with a history of MHT. None of the 65 aged > 45 years were taking OC or other sex hormones. Thirty-nine (mean age 34.9 years, SD 8.0) were aged 15-44 years at presentation: 22 Caucasian, 10 Black/Afro-Caribbean and seven Indo-Asian. Of these 39, 22 had a history of hypertension in pregnancy (group 1), and 17 did not (group 2). Three of group 1 also had a history of OC-induced hypertension. None were pregnant, but one was taking an OC at presentation with MHT. Blood pressures at presentation and follow-up, and mean serum urea and creatinine at presentation were similar between groups, as was median survival (96 vs. 47 months, Lee-Desu statistic 0.75, p = 0.38). There was a trend towards poorer renal function at follow-up in group 1 patients, with higher mean serum urea and creatinine levels. The causes of death were renal failure (5), stroke (4) and heart disease (2). The OC was not a common cause of MHT-amongst our sample of women of childbearing age, but a past history of hypertension in pregnancy was important. Such patients also had a longer duration of hypertension and poorer renal function at follow-up.

Adolescent↗
PubMed1997

Does renal function improve after diagnosis of malignant phase hypertension?

BACKGROUND: The nature of the relationship between high blood pressure and kidney damage is controversial. There is a view that essential non-malignant hypertension does not cause renal damage in patients with normal renal function and no proteinuria at first presentation. In contrast, patients with malignant hypertension (MHT) not due to underlying renal disease often exhibit progressive renal impairment, although there can be a dissociation between short-term changes in renal function and the long-term renal outcome. It has been established that the association of MHT and renal impairment is associated with a grave prognosis. OBJECTIVE: To investigate further the changes in renal function after diagnosis of MHT. METHODS: We studied the clinical features, renal function and survival of patients on the West Birmingham MHT Register. Patients presenting with no or only mild-to-moderate renal impairment (defined as an initial serum creatinine level < 300 micromol/L) were categorized as group 1 patients. Patients with severely impaired renal function, defined as a serum creatinine level > or = 300 micromol/l at presentation, were categorized as group 2 patients. Patients who subsequently suffered a deterioration in renal function were defined as those whose serum creatinine level had risen at follow-up (group A). Patients with an invariant or improving renal function at follow-up were those whose serum creatinine level neither rose nor fell (group B). Clinical characteristics and survival of patients in group 1 were therefore compared with those of patients in group 2; features of patients in group A were compared with those of patients in group B. RESULTS: We studied a total of 169 patients with MHT [107 men, aged 49.4 +/- 13.3 years (mean +/- SD)]. Of these, 136 (80.5%) patients had an initial serum creatinine level < 300 micromol/l (group 1). After a median follow-up of 53 months (interquartile range 15-103), the serum creatinine level of 56.8% (96 of 169) patients had risen (group A). Patients with MHT with only mild-to-moderate renal impairment at presentation (creatinine level < 300 micromol/l, group 1) had lower serum urea, creatinine and blood pressure levels at follow-up compared with those of patients with initially impaired renal function. Although there was no significant change in follow-up serum urea and creatinine levels compared with initial levels in patients in group 2 (paired Wilcoxon test, NS), there was a significant deterioration in renal function in patients in group 1 (P = 0.001). Group 2 patients had a shorter median survival time than did group 1 patients (15 versus 59 months, Lee-Desu statistic 15.4, P = 0.0001). Patients whose serum creatinine level had risen (group A) had significantly higher initial serum urea and creatinine levels and follow-up blood pressures than did those whose renal function had remained invariant or improved (group B). However, there was no significant difference between the median survival times of patients in groups A and B (51 versus 58 months, Lee-Desu statistic 0.377, P = 0.54). CONCLUSION: We suggest that renal function continues to deteriorate in some patients with MHT, despite a good degree of control of their blood pressures having been achieved at follow-up. However, the renal function of 16 of the 33 patients with severe renal impairment at presentation either remained invariant or was found to have improved at follow-up. There was no evidence that those cases whose renal function remained invariant were confined to those who had presented with less renal impairment. The severity of MHT at presentation and the amount of renal impairment did not predict the outcome. In contrast the quality of control of the blood pressure that had been obtained at follow-up did predict the outcome. Careful monitoring of renal functioning and effective treatment of the blood pressure is mandatory in patients with MHT.

Adult↗
PubMed1996

Ambulatory blood pressure monitoring in atrial fibrillation.

Ambulatory blood pressure monitoring (ABPM) devices are increasingly used in the assessment of hypertension, but patients with atrial fibrillation are usually excluded because device accuracy in this patient group is unproved. The present study investigates the clinical use of the Spacelabs 90207 oscillometric ABPM device in outpatients with chronic atrial fibrillation and suggests that such devices can be used in clinical practice to assess blood pressure in stable outpatients with chronic atrial fibrillation.

Aged↗
PubMed1995

Complications and survival of 315 patients with malignant-phase hypertension.

OBJECTIVE: To investigate the factors affecting survival in patients with malignant hypertension by analysing the prognosis of all of the patients referred to the City Hospital, Birmingham, with malignant hypertension since 1965. RESULTS: We identified 315 patients with malignant hypertension (211 men, 104 women; mean age +/- SD 49.4 +/- 12.7 years). Of those patients, 219 were Caucasian, 55 were black and 41 were Asian. Black patients had greater renal impairment and higher blood pressures at presentation. After a median follow-up period of 33 months (range 1-389), 126 patients (40.0%) were still alive, 126 patients (40.0%) were dead, 10 patients (3.2%) were receiving chronic haemodialysis and 53 patients (16.8%) were lost to follow-up. Mean follow-up blood pressures in the patients who died were significantly higher than in those who lived. Median survival times for Caucasian, black and Asian patients were 121.0, 30.4 and 107.5 months, respectively, with the lowest survival time being that of black patients. There was a lower median survival time among patients with proteinuria and high serum urea (> 10 mmol/l) and creatinine (> 200 mumol/l) levels at presentation and if left ventricular hypertrophy was detected on the electrocardiogram, but there was no difference in median survival time between those with and without haematuria, nor between non-smokers and current or former smokers. The most common causes of death were renal failure (39.7%), stroke (23.8%), myocardial infarction (11.1%) and heart failure (10.3%). Median survival times for the patients who presented before 1970, during 1970-1979 and during 1980-1989 were 39.2, 68.6 and 144.0+ months, respectively, demonstrating an improved survival time for the patients who were diagnosed after 1980. Using multivariate Cox's proportional hazards analyses, the duration of known hypertension and serum urea level at presentation were found to be the main predictors of survival. CONCLUSION: Malignant hypertension remains a disease with a poor overall prognosis, namely progression to death or chronic renal haemodialysis. The prognosis has improved with recent advances in therapy, with a 5-year survival of 74% of patients. The poor outlook for black patients could be explained by their late presentation with severe hypertension and the higher prevalence of renal impairment in this group.

Adult↗
PubMed1995

Severe hypertension with lone bilateral papilloedema: a variant of malignant hypertension.

Patients with severe hypertension with retinoscopic bilateral papilloedema only are not classically regarded as having malignant hypertension (MHT). We have encountered 23 such patients between 1965-1993, whilst over a similar period we have seen 315 patients who fulfilled the conventional criteria for MHT with bilateral retinal haemorrhages, exudates with or without papilloedema. We hypothesised that patients with "lone" papilloedema and severe hypertension were suffering from a disease which was identical in aetiology and outcome to conventional MHT. There were no significant differences in age, mean blood pressure, proteinuria or renal function at presentation, ethnic composition, smoking status and followup blood pressure control between the papilloedema group and those presenting with conventional MHT. Clinical features at presentation in the papilloedema only group included strokes in 4, visual disturbance in 2, headaches in 3 and heart failure in 1 patient. Many patients however had no complications at presentation. After a mean followup of 59.8 months, of the "lone" papilloedema group, 7 patients (30.4%) were still alive, 1 patient was on renal dialysis therapy, 13 were dead (56.5%) and 2 (8.7%) were lost to followup. The commonest causes of death were stroke in 4 patients, renal failure in 4 and heart disease in 2. This was a similar pattern of mortality to those patients with "conventional" MHT. Lifetable analyses showed a median survival of 35.9 months for the papilloedema group which was significantly worse than the 108.7 months for the conventional MHT group (Lee-Desu statistic 4.04, p = 0.045). We suggest that patients with high blood pressure and lone bilateral papilloedema may comprise a hitherto unrecognised subgroup of patients with MHT. Once intracerebral pathology has been excluded, these patients need to be treated as aggressively as those with MHT.

Adult↗
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

Soluble adhesion molecule P-selectin and endothelial dysfunction in essential hypertension: implications for atherogenesis? A preliminary report.

OBJECTIVE: Patients with essential hypertension are at high risk of atherosclerotic vascular disease. To investigate this further, we measured levels of the soluble adhesion molecule P-selectin, which is associated with platelet activity/function and atherosclerosis, von Willebrand factor, which is a marker of endothelial dysfunction, and plasma fibrinogen. PATIENTS AND METHODS: We studied 104 consecutive patients (47 males, 57 females; mean +/- SD age 54.8 +/- 14.1 years) with essential hypertension compared with 47 normotensive healthy controls (55.0 +/- 19.2 years). Levels of soluble adhesion molecule P-selectin and von Willebrand factor were measured by enzyme-linked immunosorbent assay, and plasma fibrinogen by a clotting method (CLAUSS). RESULTS: Compared with normotensives, the hypertensives showed significant increases in soluble P-selectin (300 versus 228 ng/ml; median difference 55 ng/ml, Mann-Whitney test P = 0.03), von Willebrand factor (114 versus 96 IU/I; unpaired t-test P < or = 0.001) and fibrinogen (3.3 versus 2.9 g/l; unpaired t-test P < or = 0.001). There were significant correlations between fibrinogen and P-selectin (r = 0.16; P = 0.02) and von Willebrand factor (r = 0.39; P<0.001), but not between P-selectin and von Willebrand factor. There were no differences in these factors between patients with (n = 53) and without (n = 51) antihypertensive therapy or between those with good blood pressure control (systolic/diastolic < or = 160/90 mmHg; n = 17) and those with poor control. A stepwise multiple regression analysis showed that diastolic blood pressure was a significant predictor for soluble P-selectin levels; diastolic blood pressure and von Willebrand factor levels were significant predictors for fibrinogen levels (P<0.05). CONCLUSIONS: This study suggests that hypertensives have high plasma fibrinogen levels, platelet dysfunction (which could contribute to atherogenesis, as indicated by raised soluble P-selectin levels) and endothelial dysfunction (as indicated by high von Willebrand factor levels), which are related to diastolic blood pressure. These factors may act synergistically to increase atherogenesis and may explain the high risk of atherosclerotic vascular disease in hypertensives.

Arteriosclerosis↗
PubMed1994

The failure of malignant hypertension to decline: a survey of 24 years' experience in a multiracial population in England.

INTRODUCTION: The widespread use of antihypertensive medication and the increasing frequency of diagnosis of mild-to-moderate hypertension should mean that malignant-phase hypertension should be becoming less common, and this trend has been reported elsewhere. No decline in the incidence of malignant hypertension has been apparent in our practice in a district general hospital in a city centre. OBJECTIVE AND METHODS: To investigate the incidence and mode of clinical presentation of patients presenting with malignant hypertension, we performed a retrospective survey of the number of patients presenting with malignant hypertension to our hospital, over the 24-year period from 1970 to 1993. We identified a total of 242 patients (155 male, 87 female; mean +/- SD age 50.1 +/- 13.3 years) with malignant hypertension. RESULTS: There were no significant differences in the number of patients presenting each year, the mean age or the presenting systolic and diastolic blood pressures over the period surveyed. At presentation, 131 patients (54.1%) had no previous history of hypertension; 161 (66.5%) were receiving no antihypertensive therapy and only 70 (28.9%) were receiving antihypertensive treatment (with no record of therapy in 11 patients). The most common presenting symptoms included visual disturbance in 62 (25.6%), headaches in 29 (12.0%), headaches and visual disturbance in 24 (9.9%), heart failure in 19 (7.9%), stroke or transient ischaemic attack in 17 (7.0%) and dyspnoea in 13 (5.4%), although 23 patients (9.5%) were asymptomatic. The most common presenting complications were heart failure [27 patients (11.1%)], stroke [23 patients (9.5%)], angina [10 patients (4.1%)], myocardial infarction [nine patients (3.7%)] and chronic renal failure [77 patients (31.7%)]. In the whole group the majority (147 patients, 60.5%) had no complicating clinical features. Primary or essential hypertension was the most common underlying cause in 137 patients (56.4%). Secondary causes of hypertension (mainly renal disease) were identified in 97 patients (39.9%). CONCLUSION: Our experience suggests that malignant hypertension is still common, with a small proportion of hypertensives presenting each year. In particular, the incidence has failed to decline in Birmingham. The incidence rate in the population served by our hospital is approximately 1-2 cases per 100,000 per year. An awareness of the different presenting clinical features is required to allow better recognition and management of this life-threatening condition.

Aged↗