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2.  Use of statins 
BMJ : British Medical Journal  1998;317(7156):473.
PMCID: PMC1113724  PMID: 9703541
4.  Acute renal failure with ACE inhibition in aortic coarctation. 
Postgraduate Medical Journal  1994;70(830):927-929.
A 43 year old man with inoperable aortic coarctation and severe hypertension requiring near maximal anti-hypertensive treatment was admitted in severe heart failure. After 2 weeks of treatment the heart failure and blood pressure were incompletely controlled and angiotensin converting enzyme (ACE) inhibitor was started. Serum creatinine was normal before starting the ACE inhibitor and on discharge from hospital. The patient was re-admitted a week later with gross fluid retention and in renal failure. In the absence of alternative causes, a diagnosis of ACE inhibitor-induced renal failure was made and treatment was stopped. The patient required haemodialysis for 2 days and within 1 week the renal function had reverted to normal and has remained so for 1 year. We propose that the renal haemodynamics in severe aortic coarctation are similar to those in bilateral severe renal artery stenosis and advise caution in the use of ACE inhibitors for adults with aortic coarctation.
PMCID: PMC2398015  PMID: 7870644
5.  The association between haemospermia and severe hypertension. 
Postgraduate Medical Journal  1991;67(784):157-158.
The association between haemospermia and hypertension was examined in a case-control study comparing 5 hypertensive patients with haemospermia to 20 age-matched hypertensive men. Patients with haemospermia had much higher blood pressures than hypertensive controls (200/131 mmHg vs 147/90 mmHg; P less than 0.0005/P less than 0.0001), higher left ventricular voltage on ECG (P less than 0.02), and higher concentrations of serum creatinine, proteinuria and renovascular disease (all P = 0.06 vs controls). Haemospermia is associated with severe uncontrolled hypertension. It is not, however, associated with hypertension per se, as the prevalence of hypertension in published series of patients with haemospermia is no higher than that expected in the general population. Men presenting with haemospermia should have their blood pressure measured carefully as they may require antihypertensive treatment urgently.
PMCID: PMC2398961  PMID: 2041846
6.  Local confidential inquiry into avoidable factors in deaths from stroke and hypertensive disease. 
BMJ : British Medical Journal  1993;307(6911):1027-1030.
OBJECTIVE--To audit avoidable deaths from stroke and hypertensive disease. DESIGN--Details of care before death were obtained from general practitioners and other doctors, anonymised, and assessed by two experts against agreed minimum standards of good practice for detecting and managing hypertension. SETTING--Health authority with population of 250,000. SUBJECTS--All patients under 75 years who died of stroke, hypertensive disease, or hypertension related causes during November 1990 to October 1991. MAIN OUTCOME MEASURES--Presence of important avoidable factors and departures from minimum standards of good practice. RESULTS--Adequate information was obtained for 88% (123/139) of eligible cases. Agreement between the assessors was mostly satisfactory. 29% (36/123, 95% confidence interval 21% to 37%) of all cases and 44% (36/81, 34% to 55%) of those with definite hypertension had avoidable factors that may have contributed to death. These were most commonly failures of follow up and continuing smoking. Assessment against standards of minimum good practice showed that care was inadequate but not necessarily deemed to have contributed to death, in a large proportion of patients with definite hypertension. Common shortcomings were inadequate follow up, clinical investigation, and recording of smoking and other relevant risk behaviours. CONCLUSIONS--This method of audit can identify shortcomings in care of patients dying of hypertension related disease.
PMCID: PMC1679247  PMID: 8251776
7.  Systemic Weber-Christian disease with reversible bilateral ureteric obstruction. 
Postgraduate Medical Journal  1989;65(764):410-416.
It has been proposed that idiopathic retroperitoneal fibrosis may be a consequence of 'healed' retroperitoneal lesions of systemic Weber-Christian disease. However ureteric obstruction which is the hallmark of idiopathic retroperitoneal fibrosis, has not been described in systemic Weber-Christian disease. We report a patient with systemic Weber-Christian disease who, during a relapse, developed bilateral ureteric obstruction which resolved when the Weber-Christian disease remitted. The radiological appearances were consistent with a diagnosis of idiopathic retroperitoneal fibrosis, but the clinical course was slightly atypical in that the ureteric obstruction resolved completely and rapidly. Ureteric obstruction can complicate systemic Weber-Christian disease and this observation gives support to the hypothesis that idiopathic retroperitoneal fibrosis is related to systemic Weber-Christian disease.
PMCID: PMC2429349  PMID: 2608584
8.  beta blockade and intermittent claudication: placebo controlled trial of atenolol and nifedipine and their combination. 
BMJ : British Medical Journal  1991;303(6810):1100-1104.
OBJECTIVE--To determine the effects of the beta 1 selective adrenoceptor blocker atenolol, the dihydropyridine calcium antagonist nifedipine, and the combination of atenolol plus nifedipine on objective and subjective measures of walking performance and foot temperature in patients with intermittent claudication. DESIGN--Randomised controlled double blind four way crossover trial. SETTING--Royal Hallamshire Hospital, Sheffield. SUBJECTS--49 patients (40 men) aged 39-70 with chronic stable intermittent claudication. INTERVENTIONS--Atenolol 50 mg twice daily; slow release nifedipine 20 mg twice daily; atenolol 50 mg plus slow release nifedipine 20 mg twice daily; placebo. Each treatment was given for four weeks with no washout interval between treatments. MAIN OUTCOME MEASURES--Claudication and walking distances on treadmill; skin temperature of feet as measured by thermistor and probe; blood pressure before and after exercise; subjective assessments of walking difficulty and foot coldness with visual analogue scales. RESULTS--Atenolol did not significantly alter claudication distance (mean change -6%; 95% confidence interval 1% to -13%), walking distance (-2%; 4% to -8%), or foot temperature. Nifedipine did not alter claudication distance (-4%; 3% to -11%), walking distance (-4%; 3% to -10%), or foot temperature. Atenolol plus nifedipine did not alter claudication distance but significantly reduced walking distance (-9%; -3% to -15% (p less than 0.003)) and skin temperature of the more affected foot (-1.1 degrees C; 0 to -2.2 degrees C (p = 0.05)). These effects on walking distance and foot temperature seemed unrelated to blood pressure changes. CONCLUSIONS--There was no evidence of adverse or beneficial effects of atenolol or nifedipine, when given singly, on peripheral vascular disease. The combined treatment, however, affected walking ability and foot temperature adversely. This may have been due to beta blockade plus reduced vascular resistance, which might also explain the reported adverse effects of pindolol and labetalol on claudication.
PMCID: PMC1671261  PMID: 1747577
9.  Severe disseminated intravascular coagulation associated with massive ventricular mural thrombus following acute myocardial infarction. 
Postgraduate Medical Journal  1988;64(756):791-795.
We describe three patients who developed severe disseminated intravascular coagulation associated with large ventricular mural thrombi shortly after presenting with acute myocardial infarction. To our knowledge this association has not been reported before.
PMCID: PMC2428998  PMID: 3255921
10.  Prolongation of the QT interval by ketanserin. 
Postgraduate Medical Journal  1988;64(748):112-117.
In hypertensive patients single doses of ketanserin 40 mg prolonged the corrected QT interval (QTc) for at least 8 hours, with a maximal increase of 35 ms (P less than 0.001, n = 6) after 2 hours. During chronic dosing (20 and 40 mg b.d.) the QTc was further prolonged, by 46 and 45 ms respectively. QTc prolongation after treatment with a mean dose of 73 mg/day for 7 weeks (n = 26) was significantly related to body weight (r = -0.58, P less than 0.01), and to the dose of ketanserin corrected for body weight (r = 0.63, P less than 0.01), but not to plasma concentrations of ketanserin, ketanserinol, potassium or calcium. High doses of ketanserin (mean dose 167 mg/day, n = 9) increased the QTc by 40 ms (P less than 0.001), with prolongation of up to 80 ms in individual patients. Treatment with ketanserin at doses proposed for clinical use (40-80 mg/day) may carry a risk of ventricular arrhythmias.
PMCID: PMC2428798  PMID: 3050936
11.  Profound hypotension after the first dose of ketanserin. 
Postgraduate Medical Journal  1987;63(738):305-307.
Two patients developed profound hypotension approximately one hour after taking an initial oral dose of ketanserin 40 mg. The reaction appeared similar to that reported with prazosin, and may have been due to the alpha 1-adrenoceptor antagonist action of ketanserin. Both patients were taking regular beta-blocker therapy, which may exacerbate such a reaction.
PMCID: PMC2428148  PMID: 3684842
12.  Comparison of nifedipine, prazosin and hydralazine added to treatment of hypertensive patients uncontrolled by thiazide diuretic plus beta-blocker. 
Postgraduate Medical Journal  1987;63(736):99-103.
In 93 patients with hypertension uncontrolled by bendrofluazide 5 mg plus atenolol 100 mg daily, the effects of adding nifedipine (up to 60 mg/day, n = 31), prazosin (up to 20 mg/day, n = 31), or hydralazine (up to 200 mg/day, n = 31) were compared in a 6 month open random parallel group study. The three drugs did not differ significantly as regards antihypertensive effect, withdrawal rate, total number of side effects, or effect on serum biochemical variables. The pattern of side-effects differed. Headache, flushing and oedema were common with nifedipine, tiredness and drowsiness with prazosin, and headache with hydralazine. Nifedipine is an acceptable third-line antihypertensive drug which may have some advantage over hydralazine and prazosin.
PMCID: PMC2428247  PMID: 3671250
13.  Ketanserin in essential hypertension: a double-blind, placebo-controlled study. 
Postgraduate Medical Journal  1985;61(717):583-586.
The antihypertensive effect of the selective serotonin antagonist ketanserin was examined in a double-blind, placebo-controlled, parallel group study in 20 patients with essential hypertension. After 7 weeks treatment with ketanserin (mean dose 71 mg/d) there was a significant fall of both systolic and diastolic blood pressure, as compared to placebo, with a peak effect of 19.1/9.1 mmHg lying (P less than 0.01/P less than 0.01), and 16.5/11.3 mmHg standing (P less than 0.01/P less than 0.01); twice daily dosage appeared satisfactory. Subjective side effects were similar in the ketanserin and placebo groups. Ketanserin is an effective antihypertensive drug of moderate potency when given twice daily, with no orthostatic effect.
PMCID: PMC2418322  PMID: 3161013
14.  The lupus syndrome induced by hydralazine: a common complication with low dose treatment. 
The true incidence of the lupus syndrome induced by hydralazine was determined in a longitudinal study of 281 patients consecutively starting hydralazine for hypertension over a 51 month period. Data on the duration of treatment and the maximum dose achieved were examined using life table analysis. After three years' treatment with hydralazine the incidence of the lupus syndrome was 6.7% (95% confidence limits 3.2-10.2%). The incidence was dose dependent, with no cases recorded in patients taking 50 mg daily and incidences of 5.4% with 100 mg daily and of 10.4% with 200 mg daily. The incidence was higher in women (11.6%) than in men (2.8%). In women taking 200 mg daily the three year incidence was 19.4%. Hydralazine is an effective antihypertensive drug that has come to be used in restricted dosage (not more than 200 mg daily) because of its risk of inducing the lupus syndrome. This study shows that the true incidence of the syndrome is still unacceptably high even when the drug is prescribed according to current recommendations.
PMCID: PMC1442447  PMID: 6432120
15.  Haematemesis during oral aminophylline treatment. 
Postgraduate Medical Journal  1979;55(644):409-410.
Two cases of gastrointestinal bleeding in patients being treated with continuous-release aminophylline tablets are reported.
PMCID: PMC2425578  PMID: 482187
16.  Hydralazine once daily in hypertension. 
The effects of hydralazine formulation and dose interval were assessed in 20 patients with hypertension well controlled on conventional hydralazine tablets, 100 mg twice daily, in addition to atenolol and a diuretic. The double-blind study used four regimens crossed over in random order at five-week intervals; placebo; conventional hydralazine 100 mg twice daily; conventional hydralazine 200 mg once daily; and slow-release hydralazine 200 mg once daily. Blood pressure and pulse rate were assessed soon after (2.5 +/- 0.9 h) and immediately before taking hydralazine (previous dose: once daily, 26.5 +/- 0.9 h; twice daily, 13.6 +/- 2.0 h). Seventeen patients completed the study. All hydralazine regimens were associated with significant falls in blood pressure. Once-daily treatment with conventional hydralazine was unsatisfactory, as its hypotensive effect waned at 24 h; there was a significant difference between the peak and trough effects on blood pressure and pulse in rapid acetylators. Compared with placebo twice-daily conventional hydralazine and once-daily slow-release hydralazine gave satisfactory control for 24 hours in both rapid and slow acetylators, though the hypotensive effect was larger in the slow acetylators. It is concluded that there is no need to administer hydralazine more than twice daily.
PMCID: PMC1498542  PMID: 6805621
17.  Barbiturates and serum calcium in the elderly. 
Postgraduate Medical Journal  1977;53(618):212-215.
In a retrospective study, based on a biochemical survey of people aged 65 and over in a general practice, subjects taking a barbiturate preparation for indications other than epilepsy had a significantly lower serum calcium concentration than did those taking nitrazepam or diazepam. Ordinary doses of barbiturate may adversely affect vitamin D metabolism in the elderly.
PMCID: PMC2496495  PMID: 323838
18.  Clinical evaluation of Dinamap 845 automated blood pressure recorder. 
British Heart Journal  1980;43(2):202-205.
The Dinamap 845 blood pressure recorder has been evaluated over a wide range of blood pressure by comparison with the Hawksley random zero sphygmomanometer in 32 subjects, six of whom had a cardiac arrhythmia. Group mean radings for systolic and phase 5 diastolic pressure were almost identical but Dinamap diastolic values were on average significantly lower (mean difference 3.4 mmHg) than phase 4 diastolic readings obtained with the Hawksley machine. Correlations between readings with the two instruments were high but the slopes and intercepts of the regression for systolic but not diastolic pressure were significantly different from unity and zero, respectively. The Dinamap is easy to use, portable, and capable of rejecting some motion artefact. Its major disadvantage is that the systolic blood pressure measurement is limited to a maximum of 210 mmHg, a point not made clear in the manufacturer's literature. Nevertheless, the Dinamap 845 is acceptable for blood pressure determinations in subjects who are normotensive or who have mild hypertension.
PMCID: PMC482263  PMID: 7362713
19.  Weight reduction in a blood pressure clinic. 
British Medical Journal  1978;2(6132):244-245.
Forty-nine hypertensive patients who were overweight were randomly allocated to one of three strategies for attaining weight reduction and were followed for one year. Those referred to a dietitian lost more weight (mean 5.1 kg) than those given a diet sheet (mean 2.64 kg) or simply advised by the doctor to reduce weight (mean 2.15 kg). One-third of all the patients lost 6 kg or more. Successful weight loss was associated with a highly significant and substantial improvement in blood pressure control and with less frequent increases in antihypertensive treatment.
PMCID: PMC1606357  PMID: 678886
20.  The Elag-Koln automatic blood pressure recorder. A clinical appraisal. 
British Heart Journal  1977;39(7):795-798.
The performance of an Elag-Koln semiautomatic blood pressure recorder was compared with the London School of Hygiene mercury sphygmomanometer in 24 subjects providing a wide range of blood pressure measurements. Readings with the two instruments correlated highly (for systole, r=0-99; for diastole phase 4, r=0-97; for diastole phase 5,r=0-98), and the slopes of the regressions did not differ significantly from unity. Elag-Koln measurements were higher for systole (mean difference 3-7 mmHg,P less than 0-001) and diastole phase 5 (mean difference 7-4 mmHg,P less than 0-001), but agreed closely with diastole phase 4 readings with the London School of Hygiene instrument. The Elag-Koln recorder tested was compact, easy to use, and had acceptable accuracy. This type of instrument deserves further testing to examine its suitability for general use.
PMCID: PMC483318  PMID: 884029

Results 1-25 (59)