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Peters R, Beckett N, Antikainen R, Rockwood K, Bulpitt CJ, Anstey KJ. Subjective memory complaints and incident dementia in a high risk older adult hypertensive population. Age Ageing 2019; 48:253-259. [PMID: 30615065 DOI: 10.1093/ageing/afy193] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/07/2018] [Accepted: 12/02/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND there is a growing body of evidence demonstrating an association between subjective memory complaints (SMC) and an increased risk of incident cognitive decline or dementia. To date this has not been examined in hypertensive older adults, a prevalent and growing population group at high risk of cognitive decline. METHODS using data from participants in the Hypertension in the Very Elderly Trial cohort the association between baseline SMC and incident cognitive decline and dementia was examined using Cox proportional hazard regression. Cognitive function was assessed using the Mini-Mental State Exam and diagnoses of dementia were made using standard diagnostic criteria. SMC was assessed by the question 'do you feel that you have more problems with memory than most?' Analyses were rerun to examine the associations by level of baseline cognitive function, to evaluate the role of SMC by dementia type and by sex. RESULTS baseline SMC were associated with an increased risk of developing any dementia (hazard ratio (HR)1.63 (95% confidence intervals (CI): 1.18:2.25)), Alzheimer's disease (HR1.59 (95% CI: 1.08:2.34)) and vascular dementia (HR2.05 (95% CI: 1.19:3.54)). Similar patterns were seen across all levels of baseline MMSE but were strongest in those with scores of 25-27. There were no clear differences by sex. DISCUSSION a positive report of SMC assessed by a single question in an older adult with hypertension raises the possibility of increased risk of incident dementia. As such its use may be a useful addition to the repertoire of the general practitioner and geriatrician when assessing older adults.
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Affiliation(s)
- R Peters
- Neuroscience Research Australia, Sydney, Australia
| | - N Beckett
- Guys and St Thomas’ NHS Foundation Trust, London, UK
| | | | | | | | - K J Anstey
- Neuroscience Research Australia, Sydney, Australia
- University of New South Wales, Sydney, Australia
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De Vries TI, Peters R, Beckett NS, Dorresteijn JAN, Westerink J, Emmelot-Vonk MH, Muller M, Van Der Graaf Y, Bulpitt CJ, Visseren FLJ. 114Estimating individual cardiovascular disease risk reduction by blood pressure lowering in elderly patients: results from the HYVET study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T I De Vries
- University Medical Center Utrecht, Vascular Medicine, Utrecht, Netherlands
| | - R Peters
- Imperial College London, School of Public Health, London, United Kingdom
| | - N S Beckett
- Imperial College London, Imperial Clinical Trials Unit, London, United Kingdom
| | - J A N Dorresteijn
- University Medical Center Utrecht, Vascular Medicine, Utrecht, Netherlands
| | - J Westerink
- University Medical Center Utrecht, Vascular Medicine, Utrecht, Netherlands
| | - M H Emmelot-Vonk
- University Medical Center Utrecht, Department of Geriatrics, Utrecht, Netherlands
| | - M Muller
- VU University Medical Center, Department of Internal Medicine, Amsterdam, Netherlands
| | - Y Van Der Graaf
- Julius Health Center - Julius Gezondheidscentra, Utrecht, Netherlands
| | - C J Bulpitt
- Imperial College London, Imperial Clinical Trials Unit, London, United Kingdom
| | - F L J Visseren
- University Medical Center Utrecht, Vascular Medicine, Utrecht, Netherlands
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Abstract
A descriptive method has been presented to identify the symptoms of patients treated for hypertension and to determine the features producing these symptoms, including the treatment given, psychological features, the level of blood pressure, renal function, the plasma concentration of potassium, and obesity.The study used a self-administered questionnaire, and as an illustration five symptoms have been fully analysed for 859 treated patients and the effects of obesity, impaired renal function and a low plasma potassium evaluated in a further 21 symptoms. Statistical methods included the comparison of a stepwise multiple regression approach and a maximum likelihood solution using a logistic transformation. Having selected >significant< variables from a stepwise multiple regression program, the two methods gave very similar measures of treatment and other effects.Obesity was associated with vertigo, nocturia and palpitations. The complaints of dry mouth and a slow walking pace were more common in patients with a raised plasma urea, but no symptom could be associated with a low plasma potassium.
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Fantin F, Bulpitt CJ, Zamboni M, Cheek E, Rajkumar C. Arterial compliance may be reduced by ingestion of red wine. J Hum Hypertens 2015; 30:68-72. [PMID: 25787780 DOI: 10.1038/jhh.2015.19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 01/30/2015] [Accepted: 02/16/2015] [Indexed: 11/09/2022]
Abstract
The aim of this study was to assess the effect of alcohol on blood pressure and arterial compliance over 24 h in a group of volunteers, comparing the same group of subjects on two consecutive but separate days, one with alcohol intake (alcohol day) and one free of alcohol (control day). We studied 18 healthy subjects (mean age 34.2 years, range 25-53). The subjects received the two days in random order. On the alcohol day, the subjects were asked to drink two glasses of red wine (12% ethanol) between 1830 hours and 0430 hours. Measurements of heart rate, blood pressure and QKD interval (Q wave to Korotkoff (K) sound, diastolic phase (D) using Diasys Integra (Novacor, France)) were recorded (usually 1500 hours to 1500 hours). Three 'ingestion' periods were defined, from 1500 hours to 1830 hours ('before'), 1900 hours to 0430 hours ('during') and from 0430 hours to the following afternoon ('after') on both the alcohol day and on the control day. Red wine increased heart rate during alcohol ingestion and reduced arterial compliance after ingestion. The significant effect of interaction between day and ingestion period on heart rate, diastolic blood pressure and QKD were found, suggesting that the differences in response among the ingestion periods depended on whether alcohol has been consumed that day. For the first time our study indicates the effect of alcohol on 24 h arterial stiffness in a healthy group of volunteers.
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Affiliation(s)
- F Fantin
- Department of Medicine, Brighton and Sussex Medical School, Brighton, UK.,Department of Medicine, Section of Geriatrics, University of Verona, Verona, Italy
| | - C J Bulpitt
- Department of Medicine, Imperial College School of Medicine, London, UK
| | - M Zamboni
- Department of Medicine, Section of Geriatrics, University of Verona, Verona, Italy
| | - E Cheek
- Department of Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - C Rajkumar
- Department of Medicine, Brighton and Sussex Medical School, Brighton, UK
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Bulpitt CJ, Beckett NS, Peters R, Leonetti G, Gergova V, Fagard R, Burch LA, Banya W, Fletcher AE. Blood pressure control in the Hypertension in the Very Elderly Trial (HYVET). J Hum Hypertens 2011; 26:157-63. [PMID: 21390056 DOI: 10.1038/jhh.2011.10] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To report blood pressure control in the Hypertension in the Very Elderly Trial, a placebo-controlled trial of hypertensive (systolic blood pressure (SBP) 160-199 mm Hg, diastolic blood pressure (DBP) <110 mm Hg) participants over the age of 80 years, given treatment in three steps: indapamide slow release 1.5 mg alone, indapamide plus 2 mg perindopril and indapamide plus 4 mg perindopril. The difference in control between participants with combined systolic and diastolic hypertension (SDH, DBP90 mm Hg) and those with isolated systolic hypertension (ISH, DBP<90 mm Hg) is determined together with the effects of increments in the treatment regimen. At 2 years, the active treatment lowered blood pressure by 16.5/6.9 mm Hg more than that on placebo in participants with SDH and by 19.3/4.8 mm Hg more in those with ISH. The 2-year falls in pressure on placebo alone were 13.2/8.5 mm Hg in SDH and 8.2/1.5 mm Hg in ISH participants. With full titration of active treatment, 62% of SDH participants achieved goal SBP (<150 mm Hg) by 2 years and 71% of those with ISH. The corresponding results for DBP control (<80 mm Hg) were 40 and 78%. The addition of active perindopril 2 mg roughly doubled the percentage controlled, as did increasing to 4 from 2 mg. Blood pressure control was good with ISH and better than with SDH. The fall in SBP accounted for the observed 30% reduction in strokes, but the 21% reduction in total mortality and 64% reduction in heart failure were greater than predicted.
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Affiliation(s)
- C J Bulpitt
- Imperial College London, Hammersmith Campus, Care of the Elderly, London, UK
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Abstract
AIM To examine knowledge and management of diabetes by older people. METHODS A representative sample of 1047 people with Type 2 diabetes, aged 75 years and over, were asked a series of questions relating to their diabetes management and their understanding of self management. The impact of cognitive impairment and socio-economic status were assessed. RESULTS The majority of people, 1015 (96.9%), were under the care of a health professional and 1018 (97.2%) were taking insulin, tablets, controlling their diet or a combination. Cognitive impairment (Mini-Mental State Examination ≤ 23) was found in 235 (22.5%) people. Recent eye, foot and dietician assessment was reported by 813 (77.7%), 836 (79.7%) and 326 (31.1%) people, respectively. A quarter overall and 70% of those taking insulin tested their blood glucose. In the insulin group, 78 (54.2%) reported hypoglycaemia and those with cognitive impairment gave more incorrect responses when asked about diabetes management. Socio-economic status made very little difference to any of these outcomes. CONCLUSIONS Most older people with diabetes, regardless of their socio-economic status, are under the care of a healthcare professional and use medication or diet to manage their disease. Large numbers also attend foot and eye examinations. However, over one fifth of older people with diabetes have cognitive impairment. Older people had a reasonable understanding of their diabetes management but this was worse in those people with cognitive impairment.
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Affiliation(s)
- J Hewitt
- London School of Hygiene and Tropical Medicine and Portsmouth Hospitals Trust, Queen Alexandra Hospital, Portsmouth, UK.
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Lewis PJ, Bulpitt CJ, Zuspan FP. A comparison of current British and American practice in the management of hypertension in pregnancy. J OBSTET GYNAECOL 2009. [DOI: 10.3109/01443618009067350] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Affiliation(s)
- Francesco Fantin
- Department of Medicine, Brighton and Sussex Medical School, Brighton, UK.
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Roderick PJ, Atkins RJ, Smeeth L, Nitsch DM, Hubbard RB, Fletcher AE, Bulpitt CJ. Detecting chronic kidney disease in older people; what are the implications? Age Ageing 2009. [DOI: 10.1093/ageing/afp047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
AIMS Prevalence estimates of Type 2 diabetes and its associated health problems in elderly populations are rare, especially in the very elderly. METHODS A sample of 15 095 community-dwelling older people aged > or = 75 years were assessed. Type 2 diabetes and associated health problems were identified using self-reporting, general practitioner records, drug histories, and blood and urine measurements. RESULTS There were 1177 people identified as having Type 2 diabetes mellitus, giving an overall prevalence of 7.8% (95% confidence interval 7.1, 8.5), 9.4% (8.4, 10.5) for men and 6.8% (6.1, 7.6) for women. The age, sex and smoking adjusted odds ratios for various health problems, comparing people with and without diabetes were: low vision 1.6 (1.3, 1.9), proteinuria 1.7 (1.4, 2.1), chronic kidney disease stage 4 or 5 1.5 (1.0, 2.1), angina 1.3 (1.1, 1.6), myocardial infarction 1.5 (1.2, 1.8), cerebrovascular event 2.0 (1.8, 2.1) and foot ulceration 1.7 (1.2, 2.4). CONCLUSIONS The prevalence of Type 2 diabetes is not high in community-dwelling older people, but diabetes was a contributory factor to a number of health problems.
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Affiliation(s)
- J Hewitt
- Portsmouth Hospitals Trust, Portsmouth, UK.
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Antikainen RL, Grodzicki T, Palmer AJ, Beevers DG, Webster J, Bulpitt CJ. Left ventricular hypertrophy determined by Sokolow–Lyon criteria: a different predictor in women than in men? J Hum Hypertens 2006; 20:451-9. [PMID: 16708082 DOI: 10.1038/sj.jhh.1002006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The clinical usefulness of the Sokolow-Lyon voltage criteria in the assessment of electrocardiographic left ventricular hypertrophy (ECG LVH) is addressed. We prospectively studied 3,338 women and 3,330 men referred with hypertension, with an average follow-up of 11.2 years. The voltage amplitude sum SV1+max (RV5 or RV6) was calculated and ECG LVH was defined as a sum >or=3.5 mV. We adjusted survival for age, treatment status before presentation and a previous myocardial infarction or cerebrovascular accident. The risk of stroke, coronary heart disease (CHD) and cardiovascular disease (CVD) mortality increased significantly for each quantitative 0.1 mV increase in baseline electrocardiogram (ECG) voltage, in women within the range of 1.6-3.9% and in men 1.4-3.0%. After further adjustments for race, body mass index, smoking and systolic blood pressure, increasing voltage independently predicted CVD mortality in both men and women. In women, both increasing voltage and the presence of left ventricular hypertrophy (LVH) were predictors of stroke mortality, whereas in men this risk was attenuated. In men, the adjusted association between increasing voltage and CHD mortality tended to be stronger than in women. The use of different thresholds for the two genders made little difference. For stroke and CHD mortality, the population attributable fractions associated with LVH were 15.2 and 5.4% in women and 12.8 and 8.5% in men, respectively. In conclusion, the greater the baseline ECG voltage sum, the greater the associated CVD mortality risk. Women tended to have a high risk of stroke mortality owing to LVH despite adjustments.
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Jani B, Bulpitt CJ, Rajkumar C. Blood pressure measurement in patients with rate controlled atrial fibrillation using mercury sphygmomanometer and Omron HEM-750CP deice in the clinic setting. J Hum Hypertens 2006; 20:543-5. [PMID: 16598291 DOI: 10.1038/sj.jhh.1002016] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Dumitraşcui D, Comşa M, Enăchescu V, Jianu D, Lazăr DJ, Moisin MD, David L, Winston B, Peters R, Beckett N, Fletcher A, Bulpitt CJ. Romanian subjects entered in the hypertension in the very elderly trial (HYVET). Rom J Intern Med 2006; 44:389-396. [PMID: 18386615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The baseline characteristics, possibly related to cardiovascular outcome, in 94 Romanian hypertensive men and 168 women over the age of 80 entered into the Hypertension in the Very Elderly Trial (HYVET) were compared with those in 725 men and 1128 women entered into the trial in the rest of Western and Eastern Europe (mainly Russia and Bulgaria). There was a tendency for more women in the Romanian subjects (66.7% versus 60.9% (P = 0.08)) and therefore all comparisons were adjusted for this non significant difference. The Romanian subjects were slightly younger, had more previous hypertension, but more previous strokes than the rest of Europe, and consumed a similar amount of alcohol. The Romanian subjects were, on average, lighter and shorter. Romanians had higher mean concentrations of blood urea and glucose and higher concentrations of HDL cholesterol. Total cholesterol was, on average, lower in Romanian subjects than was serum creatinine. Serum sodium, blood hematocrit and hemoglobin were all, on average, lower in Romanian subjects. The Romanian subjects were recruited from predominantly rural areas and it is hypothesised that their diet may have contained less salt, iron and other haematinics. Calorie restriction, compared to the rest of Europe, may have resulted in lower stature and weight but recent increases in calorie intake may have resulted in the increasing average blood glucose in both sexes. DDT is known to block the uptake of HDL cholesterol by the liver and may explain the increased HDL concentrations in Romania. Some of these biochemical differences may reflect different methodologies employed in Romanian laboratories, but we could not confirm this possibility.
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Affiliation(s)
- D Dumitraşcui
- Iuliu Hatieganu University of Medicine and Pharmacy, 3rd Medical Dept., Cluj-Napoca, Romania
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Strain WD, Chaturvedi N, Nihoyannopoulos P, Bulpitt CJ, Rajkumar C, Shore AC. Differences in the association between type 2 diabetes and impaired microvascular function among Europeans and African Caribbeans. Diabetologia 2005; 48:2269-77. [PMID: 16193289 DOI: 10.1007/s00125-005-1950-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2005] [Accepted: 07/16/2005] [Indexed: 11/27/2022]
Abstract
AIMS/HYPOTHESIS Diabetes is associated with microvascular damage in all populations, but diabetic patients of Black African descent (African Caribbeans) have a greater risk of vascular target organ damage than would be anticipated for any given blood pressure level. We investigated whether this may be due to differences in the microvasculature. MATERIALS AND METHODS To assess the maximum hyperaemic response to heating and the post-ischaemic response, Laser Doppler fluximetry was performed on 51 and 100 Europeans, and on 66 and 88 African Caribbeans with and without diabetes, respectively. Subjects were aged between 40 and 65 years and recruited from the general population. Echocardiographic interventricular septal thickness (IVST) was measured as a proxy for vascular target organ damage. RESULTS In diabetic subjects of both ethnic groups, the maximum hyperaemic response and peak response to ischaemia were attenuated as compared to the corresponding non-diabetic subjects (p=0.08 for diabetic and 0.03 for non-diabetic Europeans; p=0.03 and 0.1 for African Caribbeans). Adjustment for cardiovascular risk factors, in particular insulin and blood pressure, abolished these differences in Europeans (p=0.8 for diabetic and 0.2 for non-diabetic Europeans), but not in African Caribbeans (p=0.03 and 0.05). CONCLUSIONS/INTERPRETATION Persisting microvascular dysfunction in African Caribbeans may contribute to the increased risk of target organ damage observed in diabetes in this population. The weak contribution of conventional cardiovascular risk factors to these disturbances indicates that conventional therapeutic interventions may be less beneficial in these patients. There was a risk-factor-independent, inverse association between IVST and maximal hyperaemia. These ethnic differences in microvascular responses to temperature and arterial occlusion could account for increased target organ damage in African Caribbeans.
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Affiliation(s)
- W D Strain
- International Centre for Circulatory Health, Faculty of Medicine, Imperial College London at St Mary's, Norfolk Place, London, UK.
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Affiliation(s)
- C J Bulpitt
- Experimental Medicine (Care of the Elderly), Imperial College, Hammersmith Campus, Du Cane Road, London W12 0NN, UK.
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Wingfield D, Grodzicki T, Palmer AJ, Wells F, Bulpitt CJ. Transiently elevated diastolic blood pressure is associated with a gender-dependent effect on cardiovascular risk. J Hum Hypertens 2005; 19:347-54. [PMID: 15744334 DOI: 10.1038/sj.jhh.1001825] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We assessed the morbidity and mortality of subjects with transiently elevated diastolic pressure in the General Practice Hypertension Study Group (GPHSG) population. A total of 23 578 patients (aged 18-65 years) from seven UK general practices were screened in 1974 for a diastolic blood pressure (DBP4) of > or = 90 mmHg. Two further readings of DBP4 determined hypertensive (either DBP4 > or = 90 mmHg) or transient hypertensive (both DBP4 < 90 mmHg) status. Transients (n = 850) were matched with normotensive controls (n = 824) and risk ratios calculated over a mean follow-up of 18.7 years. Rescreening was conducted in six of the practices (n = 20 942) after 7.7 years. Male transients had a higher relative hazard for cardiovascular mortality than controls (11.8%, 8.6%, adjusted relative hazard 1.59, P = 0.056). Female transients had a lower relative hazard for cardiovascular mortality than controls (3.6%, 5.4%, adjusted relative hazard 0.39, P = 0.018). In all, 422 patients with transient hypertension were rescreened along with 367 matched controls. Significantly more transients were on antihypertensive treatment compared with their controls (odds ratio (OR) [95% CI]) for both male (4.2 [1.6-11.1]) and female patients (2.4 [1.0-5.56]) and more untreated female transients developed hypertension. Male transients had a higher rates of diabetes mellitus (adj OR = 5.1, P = 0.04) and stroke (adj OR 15.9, P = 0.03). This study has shown that transiently elevated DBP in GPHSG is associated with a significantly higher risk of later hypertension in men and women and of diabetes, stroke and cardiovascular mortality in men. Women with this condition have a significantly lower cardiovascular mortality.
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Affiliation(s)
- D Wingfield
- Brook Green Medical Centre, Bute Gardens, London, UK.
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Abstract
BACKGROUND A study was undertaken to assess the prevalence of reported respiratory symptoms in a population aged over 75 years and their association with mortality. METHODS A total of 14 458 people aged 75 years and over participating in a trial of health screening of older people in general practice answered questions on three respiratory symptoms: cough, sputum production, and wheeze. The association of symptoms with mortality was examined for all cause and respiratory causes of death taking account of potential confounders. RESULTS Coughing up phlegm in winter mornings had a prevalence of 27.0% (95% confidence interval (CI) 26.8 to 27.2). Those with this symptom had an adjusted hazard ratio for all cause mortality of 1.35 (95% CI 1.21 to 1.50), p<0.001 and for respiratory specific mortality of 2.01 (95% CI 1.66 to 2.41), p<0.001. Phlegm at any time of the day in winter had a prevalence of 16.5% (95% CI 16.3 to 16.7) with hazard ratios for all cause and respiratory specific mortality of 1.28 (95% CI 1.15 to 1.42) and 2.28 (95% CI 1.92 to 2.70), p<0.001. Wheeze or whistling from the chest had a prevalence of 14.3% (95% CI 14.1 to 14.5) with hazard ratios of 1.45 (95% CI 1.31 to 1.61) and 2.86 (95% CI 2.45 to 3.35), p<0.001. CONCLUSIONS The prevalence of respiratory symptoms is widespread among elderly people and their presence is a strong predictor of mortality.
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Affiliation(s)
- J Hewitt
- Centre for Ageing and Public Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
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Breeze E, Jones DA, Wilkinson P, Bulpitt CJ, Grundy C, Latif AM, Fletcher AE. Area deprivation, social class, and quality of life among people aged 75 years and over in Britain. Int J Epidemiol 2005; 34:276-83. [PMID: 15659477 DOI: 10.1093/ije/dyh328] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There is a shortage of research studies that assess how selected characteristics of neighbourhood and personal social circumstances contribute towards health-related quality of life (QoL) among older people. METHODS Analysis of baseline data for 5581 people aged > or =75 years and over from the Trial of Assessment and Management of Older People in the Community. The scores for four dimensions from the UK version of the Sickness Impact Profile and for the Philadelphia Geriatric Morale Scale were analysed in relation to individual social class and the Carstairs score of socioeconomic deprivation for the enumeration district of residence. RESULTS In age and sex adjusted analyses, the proportion of participants of social class IV/V living in the most deprived areas who were in the quintile with worst QoL scores was more than double that among those from social class I/II living in the least deprived areas. Individual social class and area deprivation score contributed roughly equally to this doubling for home management, self-care and social interaction, whereas social class appeared a stronger determinant for mobility. Adjustment for living circumstances, health symptoms, and health behaviours substantially reduced the excess risk associated with social class and area deprivation. Being in a rural area was associated with lower risk of poor morale. CONCLUSION Poor socioeconomic characteristics of both the area and the individual are associated with worse functioning (QoL) of older people in the community. This is not fully explained by health status. Policy should consider community-level interventions as well as those directed at individuals.
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Affiliation(s)
- E Breeze
- Centre for Ageing and Public Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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Antikainen R, Grodzicki T, Palmer AJ, Beevers DG, Coles EC, Webster J, Bulpitt CJ. The determinants of left ventricular hypertrophy defined by Sokolow-Lyon criteria in untreated hypertensive patients. J Hum Hypertens 2003; 17:159-64. [PMID: 12624605 DOI: 10.1038/sj.jhh.1001523] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Left ventricular hypertrophy (LVH) measured by electrocardiography (ECG LVH) in hypertensive patients has been shown to be associated with an increased risk of cardiovascular sequelae. Analysis of the determinants predisposing to ECG LVH may be helpful in the prevention of LVH. The Department of Health and Social Security Hypertension Care Computer Project studied 2994 hypertensive patients in whom an electrocardiogram was recorded while not on treatment. LVH was determined as the voltage sum SV1+RV5 or RV6>or=35 mm using Sokolow-Lyon voltage criteria. The relations were determined between the presence of LVH or voltage sum and different variables. Untreated systolic (SBP) and diastolic (DBP) blood pressure and pulse pressure were positively related to the increasing ECG voltage, while body mass index (BMI) and serum cholesterol were inversely related. Blood glucose and age did not correlate significantly. Patients with the presence of ECG LVH were more often men, black people, smokers and users of alcohol. In multiple logistic regression analyses, SBP, DBP, male gender and black race were positively, whereas BMI was negatively related to the presence of LVH. The positive relation of smoking and negative relation of serum cholesterol concentration to the presence of ECG LVH were apparent in men but not in women. This study confirms the adverse association between ECG LVH and SBP and DBP, male gender, black race and decreased BMI. It also addresses the less well-known associations of blood glucose, cholesterol, smoking and alcohol consumption.
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Affiliation(s)
- R Antikainen
- Imperial College School of Medicine, London, UK.
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Dockery F, Bulpitt CJ, Agarwal S, Rajkumar C. Testosterone suppression in men with prostate cancer is associated with increased arterial stiffness. Aging Male 2002; 5:216-22. [PMID: 12630068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Low androgen levels in men are associated with increased cardiovascular risk, through unclear mechanisms. We measured arterial stiffness ('compliance') in 21 men receiving complete testosterone suppression therapy for prostate cancer, and in 25 controls. Systemic arterial compliance (SAC), which assesses proximal aortic stiffness, was calculated by simultaneous recording of aortic flow and carotid artery pressure (the 'area method'). Aorto-femoral (A-F), aorto-radial (A-R) and femoral-dorsalis pedis (F-DP) pulse-wave velocities (PWVs) were recorded using the 'Complior' system. SAC was significantly lower in the androgen-depleted men compared to controls (0.81 +/- 0.53 vs. 1.18 +/- 0.43 arbitrary compliance units, p = 0.01, mean +/- SD). Correspondingly, their A-F PWV was higher (14.1 (10.1-21.8) vs. 12.4 (9.6-17.4) m/s, p = 0.03, median (range)). Cases tended to be older (75 +/- 7 vs. 71 +/- 6 years, p = 0.07), and to have higher systolic blood pressure (148 +/- 22 vs. 143 +/- 17 mmHg, p = 0.40); however, SAC was still significantly lower (p = 0.03) after adjustment for age and stratification for central systolic pressure (< or = or > the median). Adjustment of A-F PWV for age and central systolic pressure reduced significance to p = 0.07. There was no significant difference in peripheral PWVs between groups. In conclusion, testosterone suppression is associated with increased aortic stiffness, only partly explained by age and blood pressure. Loss of androgens in men might therefore adversely affect cardiovascular risk.
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Affiliation(s)
- F Dockery
- Section of Geriatric Medicine, Imperial College School of Medicine, Hammersmith Hospital, London, UK
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Fletcher AE, Jones DA, Bulpitt CJ, Tulloch AJ. The MRC trial of assessment and management of older people in the community: objectives, design and interventions [ISRCTN23494848]. BMC Health Serv Res 2002; 2:21. [PMID: 12398790 PMCID: PMC134467 DOI: 10.1186/1472-6963-2-21] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2002] [Accepted: 10/25/2002] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The benefit of regular multidimensional assessment of older people remains controversial. The majority of trials have been too small to produce adequate evidence to inform policy. Despite the lack of a firm evidence base, UK primary care practitioners (general practitioners) are required to offer an annual health check to patients aged 75 years and over. DESIGN Cluster-randomised factorial trial in primary care comparing a package of assessments (i) universal versus targeted assessment and (ii) management by the primary care team (PC) or a multidisciplinary geriatric assessment team (GM). The unit of randomization is the general practice. METHODS Older people aged 75 and over eligible for the over 75s health check and excluding those in nursing homes or terminally ill were invited to participate. All participants receive a brief assessment covering all areas of the over 75s check. In the universal arm all participants also receive a detailed health and social assessment by a study nurse while in the targeted arm only participants with a pre-determined number and range of problems at the brief assessment go on to have the detailed assessment. The study nurse follows a standard protocol based on results and responses in the detailed assessment to make referrals to (i) the randomised management team (PC or GM) (ii) other medical services, health care workers or agencies (iii) emergency referrals to the GP. The main outcomes are mortality, hospital and institutional admissions and quality of life. 106 practices and 33,000 older people have been recruited to the trial.
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Affiliation(s)
- AE Fletcher
- Centre for Ageing and Public Health, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - DA Jones
- University Department of Geriatric Medicine, Llandough Hospital, Penlan Rd, Penarth, Cardiff, CF64 2XX, UK
| | - CJ Bulpitt
- Section of Care of the Elderly, Faculty of Medicine, Imperial College, Hammersmith Campus, Du Cane Road, London W12 ONN, UK
| | - AJ Tulloch
- Unit of Health Care Epidemiology, Institute of Health Sciences, University of Oxford, OX3 7LF, UK
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Abstract
BACKGROUND Rounding blood pressure (BP) to the nearest 10 mmHg (terminal digit preference) and selecting for particular values near treatment cut-offs (number preference) have both been previously described. Both reduce measurement accuracy, and may have consequences for treatment and survival. AIM To check for number preference in screening for hypertension, and whether this influenced subsequent mortality. DESIGN Prospective case-control screening study. METHODS In the General Practice Hypertensive Study Group (GPHSG), prospective case control study patients (n=23 574) were screened on one occasion for high phase-IV diastolic BP (DBP4) (> or =90 mmHg). Identified cases were matched with normotensive controls for age, sex, date of screen and ethnic group, and were registered for mortality follow-up (n=6310). Patients with a high DBP4 had two further readings, and were treated if it remained elevated. RESULTS For DBP4 terminal digit, '0' was over-represented (28.2% vs. 20%), and the number '88' was over-represented in both men and women. There was an excess adjusted death rate for females with DBP4 88-89 mmHg vs. 90-99 mmHg for both cardiovascular (RR 2.56, 95%CI 1.43-4.56, p=0.0015) and all-cause (1.56, 95%CI 1.06-2.29, p=0.023) mortality. For males, the corresponding rates were non-significantly reduced: cardiovascular RR 0.69, 95%CI 0.42-1.14, p=0.15; all-cause RR 0.93, 95%CI 0.68-1.27, p=0.64. DISCUSSION The quality of BP measurements should be monitored both in research studies and in clinical practice as part of clinical governance procedures.
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Affiliation(s)
- D Wingfield
- Department of Primary Health Care and General Practice and. Section of Care of the Elderly, Imperial College, Faculty of Medicine, London, UK.
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Evans JR, Fletcher AE, Wormald RPL, Ng ESW, Stirling S, Smeeth L, Breeze E, Bulpitt CJ, Nunes M, Jones D, Tulloch A. Prevalence of visual impairment in people aged 75 years and older in Britain: results from the MRC trial of assessment and management of older people in the community. Br J Ophthalmol 2002; 86:795-800. [PMID: 12084753 PMCID: PMC1771210 DOI: 10.1136/bjo.86.7.795] [Citation(s) in RCA: 128] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To measure the prevalence of visual impairment in a large representative sample of people aged 75 years and over participating in the MRC trial of assessment and management of older people in the community. METHODS 53 practices in the MRC general practice research framework. Data were obtained from 14 600 participants aged 75 years and older. Prevalence of visual impairment overall (binocular visual acuity <6/18) which was categorised separately into low vision (binocular visual acuity <6/18-3/60) or blindness (binocular visual acuity of <3/60). The prevalence of binocular acuity <6/12 was presented for comparison with other studies. Visual acuity was measured using Glasgow acuity charts; glasses, if worn, were not removed. RESULTS Visual acuity was available for 14 600 people out of 21 241 invited (69%). Among people with visual acuity data, 12.4% overall (1803) were visually impaired (95% confidence intervals 10.8% to 13.9%); 1501 (10.3%) were categorised as having low vision (8.7% to 11.8%), and 302 (2.1%) were blind (1.8% to 2.4%). At ages 75-79, 6.2% of the cohort were visually impaired (5.1% to 7.3%) with 36.9% at age 90+ (32.5% to 41.3%). At ages 75-79, 0.6% (0.4% to 0.8%) of the study population were blind, with 6.9% (4.8% to 9.0%) at age 90+. In multivariate regression, controlling for age, women had significant excess risk of visual impairment (odds ratio 1.43, 95% confidence interval 1.29 to 1.58). Overall, 19.9% of study participants had a binocular acuity of less than 6/12 (17.8% to 22.0%). CONCLUSION The results from this large study show that visual impairment is common in the older population and that this risk increases rapidly with advancing age, especially for women. A relatively conservative measure of visual impairment was used. If visual impairment had been defined as visual acuity of <6/12 (American definition of visual impairment), the age specific prevalence estimates would have increased by 60%.
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Affiliation(s)
- J R Evans
- Department of Epidemiology and International Eye Health, Institute of Ophthalmology, London, UK
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Smeeth L, Fletcher AE, Stirling S, Nunes M, Breeze E, Ng E, Bulpitt CJ, Jones D. Randomised comparison of three methods of administering a screening questionnaire to elderly people: findings from the MRC trial of the assessment and management of older people in the community. BMJ 2001; 323:1403-7. [PMID: 11744565 PMCID: PMC60986 DOI: 10.1136/bmj.323.7326.1403] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare three different methods of administering a brief screening questionnaire to elderly people: post, interview by lay interviewer, and interview by nurse. DESIGN Randomised comparison of methods within a cluster randomised trial. SETTING 106 general practices in the United Kingdom. PARTICIPANTS 32 990 people aged 75 years or over registered with participating practices. MAIN OUTCOME MEASURES Response rates, proportion of missing values, prevalence of self reported morbidity, and sensitivity and specificity of self reported measures by method of administration of questionnaire for four domains. RESULTS The response rate was higher for the postal questionnaire than for the two interview methods combined (83.5% v 74.9%; difference 8.5%, 95% confidence interval 4.4% to 12.7%, P<0.001). The proportion of missing or invalid responses was low overall (mean 2.1%) but was greater for the postal method than for the interview methods combined (4.1% v 0.9%; difference 3.2%, 2.7% to 3.6%, P<0.001). With a few exceptions, levels of self reported morbidity were lower in the interview groups, particularly for interviews by nurses. The sensitivity of the self reported measures was lower in the nurse interview group for three out of four domains, but 95% confidence intervals for the estimates overlapped. Specificity of the self reported measures varied little by method of administration. CONCLUSIONS Postal questionnaires were associated with higher response rates but also higher proportions of missing values than were interview methods. Lower estimates of self reported morbidity were obtained with the nurse interview method and to a lesser extent with the lay interview method than with postal questionnaires.
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Affiliation(s)
- L Smeeth
- Centre for Ageing and Public Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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28
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Bulpitt CJ. What should be the goal blood pressure? J Hum Hypertens 2001; 15:831-2. [PMID: 11773983 DOI: 10.1038/sj.jhh.1001291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- C J Bulpitt
- Imperial College, Faculty of Medicine, Hanmersmith Hospital, Du Cane Road, London W12 0NN, UK.
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29
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Celis H, Thijs L, Staessen JA, Birkenhäger WH, Bulpitt CJ, de Leeuw PW, Leonetti G, Nachev C, Tuomilehto J, Fagard RH. Interaction between nonsteroidal anti-inflammatory drug intake and calcium-channel blocker-based antihypertensive treatment in the Syst-Eur trial. J Hum Hypertens 2001; 15:613-8. [PMID: 11550107 DOI: 10.1038/sj.jhh.1001235] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2000] [Accepted: 03/28/2001] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the relationship between chronic intake of nonsteroidal anti-inflammatory drugs (NSAID) and outcome, in particular (gastrointestinal) bleeding and to investigate whether the effect of chronic NSAID intake was similar in untreated and treated elderly hypertensives. METHODS Eligible patients (> or = 60 years, with systolic blood pressure 160-219 mm Hg and diastolic blood pressure < 95 mm Hg) were randomised to active treatment or placebo. Active treatment consisted of nitrendipine, with the possible addition of enalapril, hydrochlorothiazide, or both, titrated or combined to reduce the sitting systolic blood pressure by at least 20 mm Hg to below 150 mm Hg. Patients never taking NSAIDs (n = 2882) were compared with patients on chronic NSAID intake (n = 861), defined as reporting NSAID intake on at least 50% of the patient forms. RESULTS There was a tendency towards lower mortality (relative hazard rate (95% confidence interval (CI), 0.77 (0.56-1.06)) and higher incidence of bleeding (1.13 (0.63-2.05) with chronic NSAID intake. Although there was no significant interaction between calcium-channel blocker (CCB)-based treatment and chronic NSAID intake for any of the end points, chronic NSAID intake tended to be associated with a lower incidence of bleeding on active treatment as compared to placebo (P-value of the interaction term = 0.07). CONCLUSION The effect of chronic NSAID intake on outcome was similar in patients on active treatment based on a dihydropyridine CCB or on placebo. However, chronic NSAID intake might have a less deleterious effect on bleeding on active treatment as compared to placebo.
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Affiliation(s)
- H Celis
- The Hypertensie en Cardiovasculaire Revalidatie Eenheid, Departement Moleculair en Cardiovasculair Onderzoek, Katholieke Universiteit Leuven, Leuven, Belgium.
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Abstract
BACKGROUND As a component of studies on biological age, the age of subjects from their appearance (perceived age) was estimated. OBJECTIVE To determine the factors associated with looking older. METHODS Cross sectional study of London civil servants (318 men, 129 women) in the Department of the Environment study. Perceived age was recorded by an observer and the difference between this age and chronological age was analysed according to 20 different variables. RESULTS Men had an average perceived age of 0.37 years older than their actual age and women a perceived age of 0.54 years younger. In men, looking older was related to greying of the hair, grade of arcus senilis, and grade of baldness. Less expected, looking older was positively related to total serum cholesterol (p=0.03) and blood haemoglobin (p<0.01). In women, looking older was related to greying of the hair, positively to blood erythrocyte sedimentation rate (ESR), and negatively to serum bilirubin (p=0.01). Looking older was not related to alcohol consumption, employment grade, serum high density lipoprotein cholesterol, glucose, albumin, and calcium in either sex. CONCLUSION The relationships between looking older and total cholesterol and haemoglobin in men and ESR and bilirubin in women, require further investigation.
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Affiliation(s)
- C J Bulpitt
- Section of Care of the Elderly, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK.
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31
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Bulpitt CJ. The management of the elderly with hypertension. J Renin Angiotensin Aldosterone Syst 2001; 2:11-3. [PMID: 11881057 DOI: 10.3317/jraas.2001.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- C J Bulpitt
- Care of the Elderly, Imperial College School of Medicine, London, UK.
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Fagard RH, Staessen JA, Thijs L, Gasowski J, Bulpitt CJ, Clement D, de Leeuw PW, Dobovisek J, Jääskivi M, Leonetti G, O'Brien E, Palatini P, Parati G, Rodicio JL, Vanhanen H, Webster J. Response to antihypertensive therapy in older patients with sustained and nonsustained systolic hypertension. Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Circulation 2000; 102:1139-44. [PMID: 10973843 DOI: 10.1161/01.cir.102.10.1139] [Citation(s) in RCA: 213] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The goal of the present study was to assess the effect of antihypertensive therapy on clinic (CBP) and ambulatory (ABP) blood pressures, on ECG voltages, and on the incidence of stroke and cardiovascular events in older patients with sustained and nonsustained systolic hypertension. METHODS AND RESULTS Patients who were >/=60 years old, with systolic CBP of 160 to 219 mm Hg and diastolic CBP of <95 mm Hg, were randomized into the double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) Trial. Treatment consisted of nitrendipine, with the possible addition of enalapril, hydrochlorothiazide, or both. Patients enrolled in the Ambulatory Blood Pressure Monitoring Side Project were classified according to daytime systolic ABP into 1 of 3 subgroups: nonsustained hypertension (<140 mm Hg), mild sustained hypertension (140 to 159 mm Hg), and moderate sustained hypertension (>/=160 mm Hg). At baseline, patients with nonsustained hypertension had smaller ECG voltages (P<0.001) and, during follow-up, a lower incidence of stroke (P<0.05) and of cardiovascular complications (P=0.01) than other groups. Active treatment reduced ABP and CBP in patients with sustained hypertension but only CBP in patients with nonsustained hypertension (P<0.001). The influence of active treatment on ECG voltages (P<0.05) and on the incidence of stroke (P<0.05) and cardiovascular events (P=0.06) was more favorable than that of placebo only in patients with moderate sustained hypertension. CONCLUSIONS Patients with sustained hypertension had higher ECG voltages and rates of cardiovascular complications than did patients with nonsustained hypertension. The favorable effects of active treatment on these outcomes were only statistically significant in patients with moderate sustained hypertension.
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Affiliation(s)
- R H Fagard
- Hypertension and Cardiovascular Rehabilitation Unit, Catholic University of Leuven, Leuven, Belgium.
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35
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Dockery F, Rajkumar C, Agarwal S, Waxman J, Bulpitt CJ. Androgen deprivation in males is associated with decreased central arterial compliance and reduced central systolic blood pressure. J Hum Hypertens 2000; 14:395-7. [PMID: 10878703 DOI: 10.1038/sj.jhh.1001028] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The higher incidence of coronary artery disease in men is often attributed to androgens. Arterial compliance or 'stiffness' is increasingly regarded as a modifiable risk factor for cardiovascular disease. We wanted to look at the effects of complete androgen withdrawal, on arterial compliance in men. We performed arterial compliance studies on 12 men with complete androgen deprivation as treatment for prostate cancer, and on 12 age-matched healthy controls. Central pulse wave velocities were significantly higher in the androgen-deprived men (14.2 +/- 2.7 vs 11.8 +/- 1.6 m/sec, P = 0. 02). The cases tended to have higher brachial systolic pressures than controls though this difference was not significant (P = 0.2). We conclude that androgen withdrawal is associated with a reduction in central arterial compliance. Conversely androgen withdrawal does not affect peripheral arterial compliance. It is unlikely that the presence of normal concentrations of androgens can explain the sex difference in mortality rates. Longitudinal studies are needed for further evaluation. Journal of Human Hypertension (2000) 14, 395-397
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Affiliation(s)
- F Dockery
- Division of Medicine, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK.
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36
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Stahl M, Bulpitt CJ, Palmer AJ, Beevers DG, Coles EC, Webster J. Calcium channel blockers, ACE inhibitors, and the risk of cancer in hypertensive patients: a report from the Department of Health Hypertension Care Computing Project (DHCCP). J Hum Hypertens 2000; 14:299-304. [PMID: 10822315 DOI: 10.1038/sj.jhh.1001000] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Recent studies have shown inconsistent results on the risk of cancer in hypertensive patients using calcium channel blockers (CCBs) and angiotensin-converting enzyme (ACE) inhibitors. We investigated a large number of patients from the Department of Health Hypertension Care Computing Project (DHCCP) observational database treated with these drugs for hypertension to see whether the use of CCBs for hypertension is associated with an increased risk of cancer mortality and the use of ACE inhibitors with a reduction. DESIGN Matched case-control study and a longitudinal study of survival from 1 year after presentation. PATIENTS A total of 11663 patients treated for hypertension from 1971 through 1987. They were recruited on presentation to one of the hospital hypertension clinics or general practices involved. MAIN OUTCOME MEASURES Death with any mention of cancer on the death certificate in patients treated with an Index drug group; CCBs, ACE inhibitors, beta adrenergic blocking drugs (BBs), or receiving a diuretic. The treatment groups were mutually exclusive. RESULTS A total of 391 cases of cancer were matched with 1050 controls. In this case-control study the adjusted relative risk estimate in comparison to diuretic treatment for CCBs was 0.79 (95% CI 0.37 to 1.69), and for CCBs plus a diuretic, 1.05 (0.65 to 1.69). Non-significant results were also observed for ACE inhibitors (1.48 (0.43 to 5.1), and 1.40 (0.56 to 3.50) with a diuretic), and also for the BB and methyldopa groups. In the longitudinal survival study, the adjusted relative risk estimate for CCBs was 1.1 (0.60 to 1.94) and 1.0 (0.53 to 1.86) for CCBs plus a diuretic, and for ACE inhibitors 1.33 (0.37 to 4.76) and 1.47 (0.67 to 3.23), respectively. CONCLUSIONS In this population there was no increased cancer mortality with the use of CCBs and a relative risk greater than 1.7 to 2.0 was excluded with 95% confidence. The suggestion that ACE inhibitors reduce cancer mortality was not supported with best estimates of relative risk of 1.3 to 1.5 and exclusion of values less than 0.4 to 0.7.
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Affiliation(s)
- M Stahl
- Division of Medicine, Imperial College School of Medicine, Hammersmith Campus, London, UK
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Abstract
Subjects over the age 60 with sustained sitting diastolic pressures of 95-115 mm Hg were randomised to a regime based on bisoprolol (n = 368) or nifedipine retard (n = 379) for 24 weeks. The goal diastolic pressure was < or =90 mm Hg and to achieve this, double-blind medication could be doubled (5/10 mg bisoprolol, 40/80 mg nifedipine retard) or hydrochlorothiazide 25 mg (unblinded) could be added to the higher dose. In an intention-to-treat analysis, 309 subjects in both the bisoprolol and nifedipine retard treated group provided at least a baseline and a second quality of life assessment (82%). An excess of symptoms was observed in the nifedipine group for oedema of the legs, nocturia, constipation, racing heart and heart thumping. Fewer patients reported wheeze in the nifedipine group. For quality of life, there were no statistically significant differences between the two groups after 8 weeks. However, when analysing the results of the last available assessment (usually at 24 weeks) there were significant (P < 0.05) improvements in tension/anxiety, anger/ hostility, vigour/activity, and confusion/bewilderment, assessed by the Profile of Mood States (POMS) in patients receiving bisoprolol in comparison to those receiving nifedipine retard. The Sickness Impact Profile and objective tests of cognitive function did not differ statistically between the two groups. Quality of life was maintained at a good level on both treatments with advantages for bisoprolol in certain areas. Journal of Human Hypertension (2000) 14, 205-212.
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Affiliation(s)
- C J Bulpitt
- Section of Care of the Elderly, Imperial College School of Medicine, Hammersmith Hospital, London, UK. The European Bisoprolol Trial Inestigators
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Rajkumar C, Mensah R, Meeran K, Armstrong S, Bulpitt CJ. Peripheral arterial compliance is lower in Afro-Caribbeans compared to white Caucasians with type 2 diabetes after adjustment for blood pressure. J Hum Hypertens 1999; 13:841-3. [PMID: 10618674 DOI: 10.1038/sj.jhh.1000900] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Arterial compliance declines with age. However this decline occurs more rapidly in both the hypertensive and diabetic states. Afro-Caribbeans have a higher prevalence of hypertension and other complications of diabetes than the indigenous white Caucasian population. We hypothesise that accelerated decline in arterial compliance may account for this racial difference. Forty-one volunteers, age 62.5 +/- 6.8 years (mean +/- s.d., range 48-75), were selected from diabetic clinics. Twenty-one were Caucasian and 20 were Afro-Caribbean. Pulse wave velocity (PWV) was measured using non-invasive techniques: the 'Complior' system was used to record PWV in the carotid-to-radial (C-R) and carotid-to-femoral (C-F) regions. Central arterial compliance (CAC) was measured by simultaneous aortic flow velocimetry and carotid artery applanation tonometry. The duration of diabetes was taken as the time from clinical diagnosis. Baseline characteristics in the two racial groups were comparable for age, BMI, cholesterol, HbA1c, blood pressure and duration of diabetes. Comparing the PWV in the C-F region showed that the mean PWV was 13.84 +/- 0.28 m/sec in the Caucasians and 13.97 +/- 0.34 m/sec in the Afro-Caribbeans (P = 0. 86) whereas in the C-R region the mean PWV was 11.13 +/- 0.28 m/sec in Caucasians and 12.10 +/- 0.34 m/sec in the Afro-Caribbeans (P = 0. 03). In agreement with the C-F findings there was no statistical difference in CAC between the two races. Adjustment of PWV in the carotid-radial (C-R) region for systolic and diastolic blood pressure, confirmed that the racial differences were independent of blood pressure (difference 0.91 m/sec, P = 0.046 after adjustment for diastolic pressure and 0.89 m/sec, P = 0.056 after adjustment for both systolic and diastolic blood pressure). Accelerated decline in peripheral arterial compliance may account for the increased stroke rate with diabetes in Afro-Caribbeans.
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Affiliation(s)
- C Rajkumar
- Section of Geriatric Medicine, Imperial College School Medicine, Hammersmith Hospital, London, UK
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Beckett NS, Connor M, Sadler JD, Fletcher AE, Bulpitt CJ. Orthostatic fall in blood pressure in the very elderly hypertensive: results from the hypertension in the very elderly trial (HYVET) - pilot. J Hum Hypertens 1999; 13:839-40. [PMID: 10618673 DOI: 10.1038/sj.jhh.1000901] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- N S Beckett
- Imperial College School of Medicine, Hammersmith Campus, Section of Care of the Elderly, Du Cane Road, London W12 0NN, UK
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Bulpitt CJ, Cameron JD, Rajkumar C, Armstrong S, Connor M, Joshi J, Lyons D, Moioli O, Nihoyannopoulos P. The effect of age on vascular compliance in man: which are the appropriate measures? J Hum Hypertens 1999; 13:753-8. [PMID: 10578219 DOI: 10.1038/sj.jhh.1000879] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Vascular compliance declines rapidly with age and measures of arterial compliance may help understanding of the aging process. Of the different measures of vascular compliance, those more closely related to chronological age need to be identified. These measures may help in the estimation of 'biological age'. We measured pulse wave velocity as the carotid-finger interval, carotid-toe interval and QKD interval (time between the Q wave and the arrival of the diastolic Korotkoff sound (K) over the brachial artery in diastoly (D)); central aortic compliance (CAC) and SV/PP (the stroke volume divided by pulse pressure in the brachial artery). Thirty-six volunteers were studied (30 men), ages 20 to 84, mean 49 years, to give the relationship of these measurements with age. CAC, the QKD interval and the carotid-toe interval were most closely related to age (r = - 0.51, -0.60 and -0.58 respectively). After adjustment for age, the only measure related to blood pressure was the carotid-finger interval; b for diastolic blood pressure = -0.83 (P = 0.01), the higher the pressure the shorter the interval. Measurements of CAC, QKD interval and carotid-toe interval may be employed to assess the impact of age on vascular compliance. Measures of peripheral vascular compliance, such as the carotid-finger interval, may prove useful in assessing the relationship between blood pressure and vascular compliance.
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Affiliation(s)
- C J Bulpitt
- Section of Care of the Elderly, Imperial College School of Medicine, London, UK
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O'Brien AA, Rajkumar C, Bulpitt CJ. Blood pressure lowering for the primary and secondary prevention of stroke: treatment of hypertension reduces the risk of stroke. J Cardiovasc Risk 1999; 6:203-5. [PMID: 10501269 DOI: 10.1177/204748739900600402] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hypertension is the most important risk factor in the development of stroke. It is also the risk factor most amenable to treatment. The results from 18 controlled trials show a reduction in relative risk of stroke of 25-47% among treated hypertensive patients. This reduction applies both to the elderly and to younger patients, but the absolute reductions are greater among the elderly and the number of patients with hypertension that need to be treated to prevent a stroke is lower in the elderly because they have a higher risk of stroke. The reductions in relative but not absolute risk appear to be similar for both isolated systolic hypertension and combined systolic and diastolic hypertension in the elderly. The case for antihypertensive treatment in the secondary prevention of stroke is less clear but the results of four clinical trials of antihypertensive treatment among patients with and without hypertension and a history of cerebrovascular disease point to a probable benefit. The results of the PROGRESS trial will elucidate this further.
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Bulpitt CJ, Fletcher AE, Thijs L. SYMPTOMS REPORTED BY ELDERLY HYPERTENSIVE PATIENTS. South Med J 1999. [DOI: 10.1097/00007611-199907000-00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Staessen JA, Thijs L, Birkenhäger WH, Bulpitt CJ, Fagard R. Update on the systolic hypertension in Europe (Syst-Eur) trial. The Syst-Eur Investigators. Hypertension 1999; 33:1476-7. [PMID: 10373236 DOI: 10.1161/01.hyp.33.6.1476] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- J A Staessen
- Studiecoördinatiecentrum, Hypertensie en Cardiovasculaire Revalidatie Eenheid, Campus Gasthuisberg, Leuven, Belgium
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Abstract
OBJECTIVES To determine the measure of vascular compliance most closely related to age. DESIGN A review of 22 studies relating aortic compliance to age and a discussion of other factors related to vascular compliance. MEASUREMENTS Aortic compliance, elastic modulus, postmortem aortic changes, pulse wave velocity in the aorta, common carotid, lower limb and upper limb. RESULTS 1. Aortic compliance and carotid artery compliance is closely related to age; 2. Compliance in the peripheral arteries, in 16 reports, appears less closely related to age; 3. There is evidence that aortic compliance is related to hypertension, cardiac function, and left ventricular hypertrophy and can be increased by exercise, hormonal therapy, antioxidant and antihypertensive treatment; and 4. Vascular compliance is more closely related to chronological age than other measures such as skin inelasticity, greying of hair, baldness etc. CONCLUSIONS Because of the close relationship between aortic and carotid compliance and chronological age, deviation from the age-predicted norm (biological age) may prove to be a good predictor of cardiovascular pathology.
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Affiliation(s)
- C J Bulpitt
- Section of Geriatric Medicine, Imperial College School of Medicine, Hammersmith Hospital, London, UK
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Tuomilehto J, Rastenyte D, Birkenhäger WH, Thijs L, Antikainen R, Bulpitt CJ, Fletcher AE, Forette F, Goldhaber A, Palatini P, Sarti C, Fagard R. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. Systolic Hypertension in Europe Trial Investigators. N Engl J Med 1999; 340:677-84. [PMID: 10053176 DOI: 10.1056/nejm199903043400902] [Citation(s) in RCA: 538] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Recent reports suggest that calcium-channel blockers may be harmful in patients with diabetes and hypertension. We previously reported that antihypertensive treatment with the calcium-channel blocker nitrendipine reduced the risk of cardiovascular events. In this post hoc analysis, we compared the outcome of treatment with nitrendipine in diabetic and nondiabetic patients. METHODS After stratification according to center, sex, and presence or absence of previous cardiovascular complications, 4695 patients (age, > or =60 years) with systolic blood pressure of 160 to 219 mm Hg and diastolic pressure below 95 mm Hg were randomly assigned to receive active treatment or placebo. Active treatment consisted of nitrendipine (10 to 40 mg per day) with the possible addition or substitution of enalapril (5 to 20 mg per day) or hydrochlorothiazide (12.5 to 25 mg per day) or both, titrated to reduce the systolic blood pressure by at least 20 mm Hg and to less than 150 mm Hg. In the control group, matching placebo tablets were administered similarly. RESULTS At randomization, 492 patients (10.5 percent) had diabetes. After a median follow-up of two years, the systolic and diastolic blood pressures in the placebo and active-treatment groups differed by 8.6 and 3.9 mm Hg, respectively, among the diabetic patients. Among the 4203 patients without diabetes, systolic and diastolic pressures differed by 10.3 and 4.5 mm Hg, respectively, in the two groups. After adjustment for possible confounders, active treatment was found to have reduced overall mortality by 55 percent (from 45.1 deaths per 1000 patients to 26.4 deaths per 1000 patients), mortality from cardiovascular disease by 76 percent, all cardiovascular events combined by 69 percent, fatal and nonfatal strokes by 73 percent, and all cardiac events combined by 63 percent in the group of patients with diabetes. Among the nondiabetic patients, active treatment decreased all cardiovascular events combined by 26 percent and fatal and nonfatal strokes by 38 percent. In the group of patients receiving active treatment, reductions in overall mortality, mortality from cardiovascular disease, and all cardiovascular events were significantly larger among the diabetic patients than among the nondiabetic patients (P=0.04, P=0.02, and P=0.01, respectively). CONCLUSIONS Nitrendipine-based antihypertensive therapy is particularly beneficial in older patients with diabetes and isolated systolic hypertension. Thus, our findings do not support the hypothesis that the use of long-acting calcium-channel blockers may be harmful in diabetic patients.
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Affiliation(s)
- J Tuomilehto
- National Public Health Institute, Helsinki, Finland
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Abstract
BACKGROUND there are few longitudinal studies of the prognosis of falling at home. OBJECTIVE to determine outcomes in older people who fall once and more than once. DESIGN longitudinal prospective cohort study. SETTING primary care in the UK. SUBJECTS 1815 subjects over 75 who had a standardized and validated health check. METHOD annual interviews over 4 years. Practice records were used to establish death and admission to institutions. RESULTS risk of death was increased at 1 year [odds ratio (OR) 2.6, 95% confidence interval (CI) 1.4-4.7] and 3 years (OR 1.9, 95% CI 1.2-3.0) for recurrent fallers but not single fallers (OR 0.9, 95% CI 0.5-1.6 at 1 year; OR 0.97, 95% CI 0.7-1.4 at 3 years). Risk of admission to long-term care over 1 year was markedly increased both for single fallers (OR 3.8, 95% CI 1.8-8.3) and recurrent fallers (OR 4.5, 95% CI 1.7-12). Functional decline was not related to faller status, the latter being very variable from one year to the next. CONCLUSIONS the stronger relationship between falling and admission to long-term care rather than mortality supports the hypothesis that the perceived risks for those who fall only once are exaggerated.
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Affiliation(s)
- I P Donald
- Elderly Care Unit, Gloucestershire Royal Hospital, UK
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Gasowski J, Staessen JA, Celis H, Fagard RH, Thijs L, Birkenhäger WH, Bulpitt CJ, Fletcher AE, Arabidze GG, de Leeuw P, Dollery CT, Duggan J, Kawecka-Jaszcz K, Leonetti G, Nachev C, Safar M, Rodico JL, Rosenfeld J, Seux ML, Tuomilehto J, Webster J, Yodfat Y. Systolic Hypertension in Europe (Syst-Eur) trial phase 2: objectives, protocol, and initial progress. Systolic Hypertension in Europe Investigators. J Hum Hypertens 1999; 13:135-45. [PMID: 10100063 DOI: 10.1038/sj.jhh.1000769] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Systolic Hypertension in Europe (Syst-Eur) trial proved that blood pressure (BP) lowering therapy starting with nitrendipine reduces the risk of cardiovascular complications in older (> or = 60 years) patients with isolated systolic hypertension (systolic BP > or = 160 mm Hg and diastolic BP < 95 mm Hg). After the completion of the Syst-Eur trial on 14 February 1997, 3506 consenting patients (93.0% of those eligible) were enrolled in phase 2 of the Syst-Eur trial. This open follow-up study aims to confirm the safety of long-term antihypertensive therapy based on a dihydropyridine. To lower the sitting systolic BP below 150 mm Hg (target BP), the first-line agent nitrendipine (10-40 mg/day) may be associated with enalapril (5-20 mg/day), hydrochlorothiazide (12.5-25 mg/day), both add-on study drugs, or if required any other antihypertensive agent. On 1 November 1998, 3248 patients were still being followed, 86 patients had proceeded to non-supervised follow-up, and 43 had died. The median follow-up in Syst-Eur 2 was 14.3 months. At the last available visit, systolic/diastolic BP in the patients formerly randomised to placebo (n = 1682) or active treatment (n = 1824), had decreased by 13.2/5.2 mm Hg and by 4.6/1.6 mm Hg, respectively, so that the between-group BP difference was 1.7 mm Hg systolic (95% Ci: 0.8 to 2.6 mm Hg; P < 0.001) and 0.9 mm Hg diastolic (95% Cl: 0.4 to 1.5 mm mm Hg; P < 0.001). At the beginning of Syst-Eur 2, the goal BP was reached by 25.4% and 50.6% of the former placebo and active-treatment groups; at the last visit these proportions were 55.9% and 63.1%, respectively. At that moment, 45.9% of the patients were on monotherapy with nitrendipine, 29.3% took nitrendipine in combination with other study drugs. Until the end of 2001, BP control of the Syst-Eur 2 patients will be further improved. Cardiovascular complications and adverse events, such as cancer or gastro-intestinal bleeding, will be monitored and validated by blinded experts.
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Affiliation(s)
- J Gasowski
- Klinisch Laboratorium Hypertensive, Leuven, Belgium
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Bulpitt CJ, Shipley MJ. Failure of alcohol reduction to lower blood pressure in the PATHS trial. Prevention and Treatment of Hypertension Study. Arch Intern Med 1999; 159:195-6. [PMID: 9927105 DOI: 10.1001/archinte.159.2.195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Bulpitt CJ, Fletcher AE, Thijs L, Staessen JA, Antikainen R, Davidson C, Fagard R, Gil-Extremera B, Jääskivi M, O'Brien E, Palatini P, Tuomilehto J. Symptoms reported by elderly patients with isolated systolic hypertension: baseline data from the SYST-EUR trial. Systolic Hypertension in Europe. Age Ageing 1999; 28:15-22. [PMID: 10203199 DOI: 10.1093/ageing/28.1.15] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To determine the symptomatic well-being of elderly persons with isolated systolic hypertension. DESIGN AND SETTING Well-being determined during the placebo run-in period prior to entry to the Systolic Hypertension in Europe (SYST-EUR) trial. SUBJECTS 641 People, 60 years or older with an average sitting blood pressure of 173/86 mm Hg. OUTCOME MEASURES 33 Symptomatic complaints determined by a standard interview. RESULTS The 437 women complained of 25% of the symptoms and the 204 men 21% (P<0.001). A markedly higher prevalence was observed in women compared with men for: pain in the joints of the hands (35% of women complained of this against 22% of men); 'racing heart' (33% against 17%); dry eyes (16% against 6%); blurring of vision (35% against 23%); cramps in the legs (43% against 31%); and a sore throat (15% against 7%). Nocturia was the most frequent complaint (68% in both sexes). Eight symptoms increased with age and one (rash) tended to decline. With increasing systolic pressure women also reported more headaches, unsteadiness, blurring of vision, irregular heart beat and 'racing heart' but, of these, only headaches increased with diastolic pressure. These observations were made after adjusting for age, blood sugar and body mass index (BMI) and were not observed in men. Higher blood sugars were associated with mouth ulcers, 'racing heart', blurring of vision and cramps in the legs. A higher BMI was associated with six symptoms, and a lower age of leaving education with eight. In men, alcohol consumption was related to 'racing heart', and smoking to wheezing and having a dry cough. CONCLUSIONS A high level of complaint was associated with female gender, increasing age, blood sugar and BMI and a low age of leaving education.
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Affiliation(s)
- C J Bulpitt
- Care of the Elderly, Division of Medicine, Imperial College School of Medicine, Hammersmith Hospital, London, UK
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