Lawrence V. Perlman

Overweight and Hypertension A Review

The interrelationships between hypertension and obesity, two common and major health hazards, are reviewed. Comparisons of simultaneous intra-arterial and cuff blood pressure measurements indicate in general that the association between blood pressure and body weight is real and independent of arm circumference. Hypertension is more common among the obese than among the nonobese and, conversely, a significant proportion of hypertensive persons in the population are overweight. Obese hypertensive subjects experience a greater risk of coronary heart disease than the nonobese, and mortality rates for obese hypertensive persons are higher than for those with obesity alone or hypertension alone. Weight reduction has been shown to lower blood pressure, and it may bring about a more favorable prognosis in obese hypertensive persons. Possible mechanisms that may be responsible for the frequent association between obesity and hypertension have been discussed. Irrespective of the underlying pathophysiologic mechanisms, the adverse metabolic and hemodynamic effects of obesity upon hypertension impose an extra burden and strain on the circulatory system and compromise its functional adequacy. Although it is not precisely known to what extent weight reduction alone may be effective in controlling or preventing the lesser degrees of hypertension, the control of obesity should be an intrinsic part of any therapeutic or preventive antihypertensive regimen.

Relationship of Premature Systoles to Coronary Heart Disease and Sudden Death in the Tecumseh Epidemiologic Study

Abstract Electrocardiograms were recorded on 5,129 persons aged 16 and over in Tecumseh, Mich. Premature systoles occurred in 264 individuals (5.1%); they were ventricular in 70% and supraventricul...

Predisposing Factors in Sudden Cardiac Death in Tecumseh, Michigan A Prospective Study

In an epidemiologic study of the total population of Tecumseh, Michigan, 98 deaths from coronary heart disease were observed between 1959 and 1965. Forty-five of the fatalities occurred within 1 hour of the onset of symptoms and were classified as sudden. The proportion of sudden deaths among men was nearly twice that among women, and the incidence increased progressively with age in both sexes.Hypertensive heart disease, coronary heart disease, or diabetes mellitus had been detected on prior examination in 62% of those who died suddenly. Physiologic abnormalities associated with a high risk of coronary heart disease were also found more frequently than in the total Tecumseh population.All but seven of the persons who died suddenly had abnormalities including arrhythmias and conduction defects which were detected in the standard 12-lead electrocardiogram.Although sudden deaths often seem to occur without warning, the victims are predisposed by conditions which are detectable long before the catastrophic event. The identification of conditions which are precursors of sudden death from coronary heart disease permits a rational consideration of possible preventive measures.

Precipitation of Congestive Heart Failure: Social and Emotional Factors

Abstract Because of discrepancies in the literature and common lack of knowledge about the role of emotions in the precipitation of congestive heart failure, a group of 105 patients with congestive...

Primary and Secondary Renal Failure in a Total Community (Tecumseh, Michigan): Preponderance in the Elderly and Possible Antecedent Factors*

ABSTRACT: In 14 (8 men and 6 women) of the 8,641 original examinees in the Tecumseh Study, renal failure (RF) was found to have developed during an eight‐year period. The proportion rose significantly with age. At the initial examination (one to eight years before the onset of RF), no subject subsequently uremic had a history of acute glomerulonephritis or chronic renal disease nor was frankly azotemic, although in 4 there was a suggestion of early disease. Six of the 12 subjects (50 per cent) over age 45 who later became uremic gave a history compatible with urinary‐tract infection (UTI), compared with 380 (22 per cent) of the remaining 1,746 examinees in this age range. Conversely, in 6 of 386 persons (1.6 per cent) with a history of UTI, renal failure developed, in contrast to 6 of 1,372 persons (0.4 per cent) without such a history. Common disorders noted at the initial examination one to eight years before RF were congestive heart failure (9 cases), loss of hearing (7 cases), coronary heart disease (5 cases), hyperuricosemia (5 cases), and hyperglycemia (5 cases). This study shows that most persons in whom renal failure develops are elderly and have pre‐existing vascular disease; in about a quarter of them, the findings at the time of the initial examination indicate early renal disease. Although these data point to a relationship between UTI and RF in some cases, in most patients with a history of UTI, renal failure does not develop.