Blood pressure and cardiovascular morbidity and mortality in a Dutch population: the Nijmegen cohort study.

BACKGROUND: The objective was to determine the influence of systolic blood pressure and diastolic blood pressure on the development of coronary heart disease over an 18-year period in a Dutch general practice population. METHODS: The Nijmegen Cohort Study is a prospective cohort study with an 18-year follow-up. In 1977 systolic blood pressure, diastolic blood pressure, and other cardiovascular risk factors were measured in 7,092 Caucasians, men and women. The screening took place in six general practices, participating in a university registration network. Cardiovascular disease and all mortality was registrated during the 1977-1995 period. A Cox proportional hazard model was performed separately for men and women with the first onset of a coronary heart disease as the outcome variable. Age, smoking, serum cholesterol, blood pressure, and socioeconomic class were included as independent variables. RESULTS: During the 18-year follow-up period, 205 men and 63 women suffered a nonfatal myocardial infarction. During this time, 205 deaths were identified, of which 54 were cardiovascular. Of all deaths, 139 were noncardiovascular, of which 10% were due to accident or suicide, while in 12 participants the cause of death was uncertain. The analysis indicated that both the systolic and the diastolic blood pressure were independently associated with the likelihood for developing coronary heart disease, as were the other risk factors. For coronary heart disease, the significant risk ratios for the systolic blood pressure were 1.6 for men and 2.1 for women. For the diastolic blood pressure a risk ratio was found of 1.4 for men and 2.0 for women. CONCLUSION: A significant relation between blood pressure and coronary heart disease was demonstrated. As mean blood pressures, cholesterol levels, smoking habits, and socioeconomic class in this cohort did not differ from other figures in The Netherlands, extrapolation of the results to the Dutch population is possible.

On the accuracy of history, physical examination, and erythrocyte sedimentation rate in diagnosing low back pain in general practice. A criteria-based review of the literature.

STUDY DESIGN: A criteria-based review of the literature was conducted regarding the accuracy of history, physical examination, and erythrocyte sedimentation rate in diagnosing low back pain. OBJECTIVES: To perform meta-analysis of the literature regarding signs and symptoms in diagnosing radiculopathy, ankylosing spondylitis, and vertebral cancer. SUMMARY OF BACKGROUND DATA: Diagnosing low back pain, especially in general practice, depends largely on history taking, physical examination, and the erythrocyte sedimentation rate. No previous review has assessed the diagnostic accuracy of signs and symptoms in a systematic way, taking into account the methodological quality of studies. METHODS: The literature was reviewed for relevant studies. Retrieved studies were independently rated for methodological quality by two reviewers. The reported sensitivity and specificity in the rated studies were reviewed. RESULTS: Thirty-six eligible studies were retrieved. Major methodological shortcomings were observed, and only 19 studies scored > or = 55 points (maximal score 100). Not one single test appeared to have high sensitivity and high specificity in radiculopathy. The combined history and the erythrocyte sedimentation rate had relatively high diagnostic accuracy in vertebral cancer. Getting out of bed at night and reduced lateral mobility seemed to be the only moderately accurate items in ankylosing spondylitis. CONCLUSIONS: Additional studies that take into account the shortcomings identified would be needed to produce definite conclusions. Few of the studied signs and symptoms seemed to be valuable diagnostics for radiculopathy, ankylosing spondylitis, and vertebral cancer. Reproducibility of signs and symptoms over time might be a valuable diagnostic criterion. However, this was neglected in almost all studies.