Biomedical subjects
Publications and source records attributed to S N Hunyor.
1. A highly significant inverse relationship was found between blood pressure in untreated hypertensive subjects in late pregnancy and birth weight. 2. Reversal of this intrauterine growth retardation was achieved in 19 patients by treatment of hypertension with oxprenolol. 3. No adverse effects from oxprenolol were found in the patients or in their babies.
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82 initially normotensive pregnant women with no known history of renal disease were seen at monthly intervals from 16 weeks' amenorrhoea onwards, and their blood-pressure (B.P.) was measured sitting and lying on their left side. 15 developed hypertension (B.P. greater than 135/85 mm Hg lying on the left side) in late pregnancy. When these women were compared with the 67 who remained normotensive throughout, their B.P.s were found to be significantly higher even in early pregnancy, although individual patients were not always separable in this way. When B.P. measured in this rigidly standardised manner was compared with routine antenatal clinic values, it was apparent that the latter did not detect the difference between the two groups. Women who develop hypertension in the third trimester of pregnancy (pre-eclampsia) may represent a separate group from entirely normal pregnant women from the beginning of pregnancy.
A national screening project has detected 989 subjects aged 30 to 69 years with untreated moderate or severe hypertension. The 1-2% incidence of this condition indicates a total of about 100,000 people in the Australian community potentially requiring therapy. The sample showed that half the subjects were previously unaware of a blood pressure problem. Those so detected showed a very high rate (90-7%) of acceptance of advice to see their own doctor. The local doctors confirmed the elevated pressure level in nearly two-thirds of the patients referred, and initiated treatment in a similar proportion.
The Royal Prince Alfred Hospital experience with Australian-made pacemakers shows that the Telectronics P7 fixed-rate pacemaker has a 90% survival rate at two years. Such a figure compares favourably with those of its predecessor and other makes of pacemaker. Survival of the P6 ventricular synchronized units is slightly less than that of the P7.
The effect on blood pressure of high (400 mg/day-S400) and moderate dose (200 mg/day-S200) spironolactone and chlorthalidone (100 mg/day-C100), given in a random double-blind manner was related to plasma renin activity and plasma volume in 38 essential hypertensives. The fall in pressure from a control of 154/103 mm Hg was essentially the same after four weeks of each drug--S400 deltaBP 24/13 mm, S200 18/9 mm, C100 17/12 mm (all P less than 0-001). Twelve of 37 patients (32%) had low initial renin, but this appeared as responsive to the chlorthalidone stimulus as that of the normal renin group. The antihypertensive effect of all regimens was unrelated to plasma renin activity. Plasma volume was significantly lowered at the end of each treatment period, but the decline could not be correlated with blood pressure effects. Patients with initially low plasma volume were more likely to respond to S400 (r = 0-545, P less than 0-001), whereas the antihypertensive effect of the S200 and C100 regimens was independent of this variable.
In 30 refractory hypertensives a hydrallazine beta blocker combination was added to or substituted for previous antihypertensives. Over a mean period of 12 months a good or satisfactory blood pressure response resulted in 12 patients each, while six others had an unsatisfactory outcome. (Good = diastolic pressure (DP) less than 95 mmHg; Satisfactory = deltaDP greater than 15 mmHg or DP 95-105 mmHg; Unsatisfactory = DP greater than 105 mmHg or deltaDP less than 15mmHg.) Twelve of the patients had significant renal disease with serum creatinine greater than 2 mg/100 ml, but in these there was no evidence that renal hydrallazine retention potentiated an antihypertensive effect. Those with an unsatisfactory response were receiving slightly higher doses hydrallazine and propranol when compared with good responders. The average dose of hydrallazine was 258 mg/day and of propranolol 308 mg/day. Transient headache was not uncommon at the commencement of hydrallazine therapy. Angina and vertebro-basilar insufficiency were each aggravated in one patient, but resolved with dosage adjustment. A lupuslike rash developed in one patient, a slow acetylator on 300 mg hydrallazine/day who had received a total of 92 g over eleven months. The genetically determined acetylator phenotype was assessed in 75 subjects. A little over one third were found to be rapid acetylators. Those with slow acetylator phenotype did not show a more favourable phenotype did not show a more favourable blood-pressure response to equivalent doses of hydrallazine.
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A severe rebound rise in blood pressure with agitation and insomnia had been noted in five patients when they had previously ceased clonidine (Catapres) This has been shown to be reproducible in these patients and to be associated with a significant increase in urinary catecholamine excretion. The blood pressure can be controlled and the symptoms alleviated promptly by alpha and beta adrenergic receptor blockade using intravenous phentolamine and propranolol.
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