Proportion of patients with isolated systolic hypertension who have burned-out diastolic hypertension.

In a community survey of 3242 subjects, 1663 did not initially have isolated systolic hypertension (ISH) and were re-screened an average of 8 years later. ISH developed in 53 (22%) of untreated patients with previous diastolic hypertension. Similarly, 8% of subjects with transient hypertension and 8% of normotensive controls developed ISH. Of all cases of ISH, 16% had previous diastolic hypertension. These subjects were more likely to have continued to smoke (P = 0.01) and lost more weight (P = 0.001) than patients with ISH who did not have burned-out diastolic hypertension.

Survival of hypertensive subjects identified on screening: results for sustained and unsustained diastolic hypertension.

Casual readings of blood pressure predict mortality and may reflect either the risk of sustained hypertension, additional components of 'white coat' hypertension or variable blood pressure. This study investigated mortality in 442 men and 360 women with a diastolic pressure (Phase IV) of 90 mmHg and over, unsustained on two subsequent monthly visits, followed for an average of 11 years and compared with a matched control cohort with an initial diastolic pressure (DBP) of less than 90 mmHg. Subjects were identified between 1975 and 1979 by screening 28,257 subjects aged 18-65 years on the lists of general practitioners in seven practices in the United Kingdom. Additionally, 912 men and 844 women with sustained hypertension (DBP > 90 mmHg on at least two out of three occasions) were identified and matched with normotensive controls. In men with sustained hypertension the relative risk (RR) for death from circulatory disease was 1.76, P < 0.01, 95% confidence interval 1.21, 2.58 and in women 1.85, P < 0.05, 95% confidence interval 1.06, 3.24 respectively, while in men with unsustained hypertension the RR = 1.52, P = 0.2, 95% confidence interval 0.81, 2.84. Few circulatory deaths occurred in women with transient hypertension or their controls (five and seven respectively). Despite the screening programme and further treatment, newly discovered subjects with sustained hypertension, both men and women, remain at high risk of cardiovascular mortality. The 95% confidence interval for men with transient hypertension does not exclude a similar adverse effect.

A randomised comparative trial of nicardipine versus amiloride and hydrochlorothiazide in mild to moderate hypertension. A report from the General Practitioner Hypertension Study Group.

In 1984 the General Practitioner Hypertension Study Group undertook a rescreening of their patient population, looking for patients who still had untreated mild to moderate essential hypertension. Suitable patients were entered into a clinical trial comparing the safety and efficacy of nicardipine (a calcium antagonist) and amiloride + hydrochlorothiazide (HCTZ) (moduretic). The study included one year of long-term follow-up. Both drugs significantly lowered BP in both the short and long term. Numbers and percentages of patients from each group reporting adverse experiences were similar in the short term, but in the long term the frequency of adverse event reporting was much lower with nicardipine treatment than with amiloride + HCTZ treatment (2/10 versus 9/17). Treatment with amiloride + HCTZ led to elevations in serum levels of cholesterol, uric acid and urea, which were maintained at one year, whilst no abnormalities in blood biochemistry were seen in patients treated with nicardipine. In conclusion we have found that nicardipine compares very favourably with amiloride + HCTZ in the treatment of mild to moderate hypertensive patients.

Screening for schistosomiasis among the Yemeni population in Eccles.

A population of Yemenis living in the north of England was screened for schistosomiasis. Schistosome ova were found in the urine of five of the 104 patients who were screened, but only two received treatment, owing mainly to the mobility of the population. The results of the screening programme showed that it is possible to obtain the enthusiastic cooperation of many individuals, and organisations, most of whom do not normally work together as a team.

A comparative trial of clomipramine and placebo as adjunctive therapy in arthralgia.

Several studies have reported that both imipramine and clomipramine are valuable adjuncts in the management of chronic pain, in particular that associated with the arthritides. A double-blind between-patients clinical trial of clomipramine and placebo was performed in general practice in patients suffering from arthralgia and who had stable regular predictable pain in the joints without the immediate prospect of natural remission. Clomipramine (25 mg daily) or placebo was administered in addition to standard analgesic or anti-inflammatory therapy. Twenty-eight general practitioners recruited seventy-four patients. Forty-nine patients satisfactorily completed the study and twenty-five 'dropped out'. Twenty-three completers received active medication and twenty-six received placebo. The trial failed to demonstrate any difference between the two adjunctive treatments. These results are in marked contrast to those obtained in other studies. Possible reasons are discussed. The dose may have been inadequate and the consumption of 'rescue analgesics' was inadequately controlled. Previous 'positive studies' had been within-patients designs as opposed to between-patients studies. This methodological difference may be important.