Blood pressures in subjects for life assurance medical examination and the effect of ten minutes recumbent rest.

BACKGROUND: The prevalence of hypertension in a population is the sum of those individuals with a blood pressure (BP) exceeding 140/90 mm Hg plus those with normal BP on antihypertensive therapy (this is usually about 20-30% of the population). Rest normally reduces BP but the frequency and extent of the fall remains unclear. METHODS: This study analysed the results of 1,008 consecutive life assurance examinations in which BP was recorded twice, before and after a ten minute period of recumbent rest. RESULTS: Two hundred and twelve subjects had initial BPs of more than 140/90 mm Hg (21%). When all those receiving antihypertensive treatment but with normal BPs were included, this was 26.5%. Of the 212 subjects, BP was at a normal level in 147 (69%) after ten minutes at rest. CONCLUSION: BP measurement after a ten minute period of standardised rest could more accurately identify true hypertension.

Body mass index and weight distribution.

It has been accepted for many years that being overweight or obese, as indicated by a body mass index (BMI) of 25 or over for the former and 30 or over for the latter, is associated with impairment of long term health and prognosis. The World Health Organisation (WHO) has indicated that, in Caucasians, waist measurements of 94 cm or more in men, and 80 cm or more in women have similar adverse effects on health, with increased risks at 102 cm or more in men and 88 cm in women. The role of waist-hip ratio (W/H) and whether it represents a better index than waist (W) measurement alone is being debated; many papers favour waist measurement alone. But two papers in 2005 discussing 27,098 subjects, 12,461 of whom had myocardial infarction and 14,637 controls, come down firmly in favour of W/H and were followed by a Lancet Editorial entitled 'Farewell to Body Mass Index?' Life assurance companies at medical examination usually request height and weight measurements (and therefore BMI). Most ask for waist measurements and a few hip measurements in addition (and therefore W/H). The authors have reviewed the data in 816 consecutive subjects for life assurance examination in whom BMIs, Ws and W/Hs were all recorded. In these the evidence supports the use of W as the best indicator of risk in men (634 cases), but not in the relatively small number of women (182 cases) in whom H appeared better. We believe that BMI, W and W/H should be recorded in every subject at life assurance examination so that the insurance companies in the long term will be able to reach valid conclusions about their individual and collective value.

Are measurements of chest expansion and peak expiratory flow rate worthwhile in assessing candidates for life assurance?

Measurements of chest expansion (CE) and peak expiratory flow rate (PEFR) were taken in 117 subjects for life assurance medical examinations in 1989. The results for both values were significantly greater in males than in females, but there was no significant correlation between them in either males or females. Seventy-four per cent of the subjects were accepted as average assurance risks and 26% were below average. However, there was no significant difference between CE and PEFR in the two groups and smoking appeared to have no influence. The reasons for not accepting subjects as average risk are tabulated and it is concluded that CE and PEFR are not helpful in assessing candidates for life assurance.

A prospective randomized trial of vagotomy in chronic duodenal ulceration.

In a prospective, randomized trial, 76 patients with duodenal ulceration treated by truncal vagotomy and pyloroplasty were compared with 77 patients who underwent highly selective vagotomy. A total of 149 patients was followed up for from 1 to 4 years, the average follow-up period being 2.6 years. There was no operative mortality and no significant difference in postoperative morbidity between the two groups. The incidence of recurrent ulceration was greater after highly selective vagotomy, but this difference was not statistically significant. The clinical results were comparable in each group, and although the incidence of diarrhoea and dumping was greater after vagotomy and pyloroplasty, this difference was not statistically significant.

Remission of active chronic hepatitis after treatment with cyclophosphamide and prednisolone. Report of four cases.

A description is given of four patients with active chronic hepatitis, all of whom were treated with prednisolone and cyclophosphamide. In all the patients diagnosis was established by the finding of a clinical picture of hepatic dysfunction associated with abnormal results of biochemical tests of liver function, evidence of disturbed immunity mechanisms and liver biopsy. After treatment all four patients made a clinical recovery. Three eventually had normal serum tests for liver function, normal bromsulphthalein excretion tests and normal histology in their needle liver biopsies. The fourth patient has shown considerable improvement in her serum tests of liver function, but she has been treated for a much shorter period than the others. Her test results are still improving. It is concluded that the combination of prednisolone and cyclophosphamide therapy is a satisfactory one for active chronic hepatitis, and probably superior to other therapeutic measures based upon the suppression of autoimmune mechanisms.