Jozef Victor Joossens

Moderate sodium restriction and diuretics in the treatment of hypertension

Using a cross-over type setup with 4 periods of 1 month each in 22 patients with mild, mostly essential hypertension, the antihypertensive action of the following therapeutic regimens were compared: (1) a regular diet and placebo (period RP), (2) a regular diet and 100 mg. hydrochlorothiazide and 100 mg. spironolactone (period RD), (3) a moderate sodium restriction and placebo (LP period), and (4) this diet together with the same diuretics (period LD). The diuretics or placebo were administered on a double blind basis, while the sodium restriction or regular sodium diet was prescribed in an open, but randomized system. The 24 hour urinary sodium averaged 191.1 ± 61.2 mEq. during the RP period and 92.8 ± 41.8 mEq. during the LP period. Compared to the RP period, the reduction in home blood pressures was more important with diuretics alone (16.18.1 mm. Hg) than with this moderate sodium restriction alone (7.74.4 mm. Hg), while the combination of both produced a statistically significantly (p < 0.005) higher blood pressure reduction (20.710.8 mm. Hg). Not only the diuretics but also the sodium restriction increased the serum uric acid, and this could be related to the decreased urinary uric acid clearance. A significant (p < 0.001) correlation (r = 0.66) was obtained between the decrease in systolic blood pressure (expressed in mm. Hg) produced by the sodium restriction (y) and the decrease in 24 hour urinary sodium excretion (expressed in mEq.) produced by the same diet: y=−6.58+0.163x These data suggest that a reduction of the daily NaCl intake from 10 to 5 Gm. could produce a decrease of blood pressure of about 105 mm. Hg.

Nutrition and gastric cancer.

Summary Gastric cancer (Gc) is generally conceived as having a multifactorial origin. Different genetic factors, soil, nutritional and socioeconomic factors have all been mentioned in the literature as possible causes. Further research on the causation of Gc has, in fact, been hampered by the large number of hypotheses. A strong geographic association between gastric cancer and stroke mortality was found by chance in 1964; this association could be spurious, but the quantitative analysis of the data showed similar relationships both between countries and within countries (e.g., in countries as different as the US and Japan), a very unlikely situation if due to chance. The same quantitative relationship was maintained using multiple regression analysis of stroke mortality. All this was observed for each sex separately and for both sexes combined. The working hypothesis was set forth in 1965 that salt intake was the predominant linking factor for both types of mortality. Stroke would then be influenced by t...: Gastric cancer (Gc) is generally conceived as having a multifactorial origin. Different genetic factors, soil, nutritional and socioeconomic factors have all been mentioned in the literature as possible causes. Further research on the causation of Gc has, in fact, been hampered by the large number of hypotheses. A strong geographic association between gastric cancer and stroke mortality was found by chance in 1964; this association could be spurious, but the quantitative analysis of the data showed similar relationships both between countries and within countries (e.g., in countries as different as the US and Japan), a very unlikely situation if due to chance. The same quantitative relationship was maintained using multiple regression analysis of stroke mortality. All this was observed for each sex separately and for both sexes combined. The working hypothesis was set forth in 1965 that salt intake was the predominant linking factor for both types of mortality. Stroke would then be influenced by the relationship between salt and blood pressure; Gc would result from the delaying and caustic properties of a hypertonic stomach content. The latter condition could produce atrophic gastritis, a common problem in Japan, Chile and Columbia. Atrophic gastritis favors the synthesis of endogenous nitrites and, henceforth, of nitroso-carcinogens. The salt hypothesis can give an explanation for the geographical and time behavior of Gc and stroke mortality and for the socioeconomic gradient of both diseases. Gc mortality can also be used to provide a rough estimate of the salt intake in a given country and year. The hypothesis was tested in Belgium through a deliberate attempt to lower the salt intake of the population. The observed decreases in Gc and stroke mortality were consistent with the measured decrease in salt excretion. Further research is urgently needed through the monitoring of 24-hour salt and creatinine excretion in different countries and over many years.

Serum lipids in the People's Republic of China. Comparison of Western and Eastern populations.

Serum cholesterol and HDL cholesterol levels were measured in an urban and a rural population of the Peoples Republic of China and compared with cholesterol values obtained in Belgium and in the Republic of Korea, with use of the same methodology. Total cholesterol levels were markedly lower In the Peoples Republic of China than in Belgium and generally lower than in Korea, both in male and female subjects. However, the differences In HDL cholesterol levels among the three populations were small in males and only significantly higher in Belgium in the age classes below 34 years. In women of all age groups, HDL cholesterol values were significantly higher In Belgium than in China and Korea. Total cholesterol levels below 100 mg/dl were found In the Peoples Republic of China in about 2% of the participants. Apolipoprotein B was significantly lower, and the apolipoprotein A,/B ratio was significantly higher, In China and Korea compared to Belgium.

Trends in stomach cancer and stroke in Finland. Comparison to northwest Europe and USA.

The mortality rates of stomach cancer and stroke were found to decrease in a similar way over a given time in different countries. The same phenomenon can be observed in Finland for both sexes. Salt is suggested to be the linking factor in the stroke-stomach cancer relationship. Recent studies indicate that salt intake in Finland is very high. Actual salt consumption levels are in Finland as high as they were in Belgium 15 years ago. The same observations can be made for cerebrovascular and stomach cancer mortality, making the salt hypothesis plausible. In contrast from 1972-73 on stroke mortality decreases faster than stomach cancer mortality. This could be observed in other western countries: USA, Austria, England and Wales, Belgium, West Germany, etc. The steeper decline may be the consequence of mass drug treatment of hypertension which started in Finland during the early years of 1970s, and also the conse-quence of changes in dietary habits, especially in fat intake in Finland. Stroke Vol 15, No 5, 1984

A comparative study of serum lipids between Belgium and Korea.

Serum cholesterol values are markedly lower in Korea than in Belgium in both males and females. This is attributed to the much lower consumption of saturated fat in Korea. A mean population serum cholesterol value of about 160 mg/dl appears to be compatible with excellent general health and with the absence of ischemic heart disease or other atheromatous diseases. The influence of age, height and weight on cholesterol between Belgium and Korea is qualitatively similar but quantitatively different. High-density lipoprotein cholesterol values are lower in Korea than in Belgium, particularly in females. Differences in the HDL cholesterol level thus cannot explain the low prevalence of ischemic heart disease in Korea.

Methyldopa in the Treatment of Hypertension

cause of spontaneous abortion, which still remains unknown. Although only six of the abortuses have been recovered for detailed study, four of them were grossly abnormal. The abnormalities were distributed evenly between patients who received either solution A or solution B. It remains to be determined whether these abnormalities are environmentally or genetically determined. It has taken over three years to collect the 50 cases published in this paper, and because of this relatively small number the investigation will continue to ensure that small, but perhaps ultimately significant, differences do not escape detection.

Bread as a source of salt: an international comparison.

OBJECTIVE The salt (NaCl) content of bread, obtained from Belgium and 25 other regions or countries worldwide, was analyzed to evaluate the importance of bread as a source of dietary salt in a population. METHODS A total of 1166 dried bread samples were analyzed using a hot HCl extraction technique followed by flame photometry and performed by the same laboratory technician in Leuven (Belgium); 534 samples from Leuven were analyzed over 10 time periods from 1967-73 to 1992 together with 562 samples from 11 other European countries, 44 from the United States and Peru, and 26 from Asia. RESULTS The average mean salt content of fresh bread (= dried bread times 0.6) in European countries was 12.4 +/- 1.7 g/kg for white and 13 +/- 1.0 g/kg for brown bread. In Japan and Korea it was about 8.5 g/kg and in Pakistan, Thailand, Nepal, and Laos about 5 g/kg. The mean sodium/potassium ratio with Na and K in mmol was 8.0 for white and 4.5 for brown bread, much higher than the recommended value of 1.0. Bread with a very low salt content was found in certain areas of Peru, Spain, and Italy. CONCLUSION The overall salt content of bread in Western countries is excessive, and a gradual reduction is highly desirable.

Traumatic rupture of the interventricular septum.

Abstract A case is reported in which traumatic rupture of the interventricular septum and mitral insufficiency were proved by cardiac catheterization. The patient was still alive 112 years after the episode occurred. The diagnosis and physiopathology of this condition are discussed.

Cancer mortality and age: Relationship with dietary fat

Highly significant correlations exist between total cancer mortality and age expressed by a log total cancer mortality-log age equation (mean r2 0.991 in men and 0.996 in women) or by a second-order polynomial equation including age and age2 (mean r2 0.999 in men and 0.998 in women). In all countries considered (n = 32), the second-order term of age is negative, indicating a decrease in the rate of rise of log cancer mortality at older age. This could be explained by a lesser accuracy of the diagnosis of cancer at older age, by selective survival of subjects resistant to cancer, by a cohort effect, or by a decrease in the rate of growth of cancer at older age. The decrease in the rate of rise of cancer mortality after 65 years of age occurs in all countries and applies to nearly all cancers except breast cancer in women after 75 years of age. A high cancer mortality in a country is characterized by a low intercept and a steep slope of the log mortality-log age equation. These parameters are influenced by dietary fat intake in men and women, with saturated fat increasing total cancer mortality and the ratio of polyunsaturated to saturated fat and the ratio of unsaturated to saturated fat decreasing it. The data on dietary fat were obtained from the Food and Agriculture Organization of the United Nations (FAO) food balance sheets (n = 32) and from dietary surveys (n = 21). Both vary in the same direction, but only the dietary data from the FAO correlate significantly with cancer mortality. This finding points toward a relationship between the level of dietary fat intake and total cancer mortality at the population level.

The influence of a new p-tert-octylphenol derivative on the clearing factor and on the plasma lipids of rabbits

Summary S16a20, a para -octylphenol polymer, accelerates and increases the clearing reaction in vitro . It has a pronounced antagonistic action on the clearing inhibition exerted by the detergent Triton. Post-heparin plasma of rabbits injected with S16a20 has a higher clearing activity than controls. The antagonistic action on Triton is also demonstrable in this condition. By contrast, S16a20 causes a slight increase of plasma lipids when injected alone and it acts synergistically with Triton and cholesterol in producing hyperlipaemia. It also retards the removal of intravenously injected fat emulsions. It can be concluded that clearing activity is of minor importance in the development of these different hyperlipaemias.