R. B. Blacket

COMPARISON OF WEIGHT REDUCTION WITH METOPROLOL IN TREATMENT OF HYPERTENSION IN YOUNG OVERWEIGHT PATIENTS

Weight reduction was compared with metoprolol (200 mg daily) in a randomised placebo-controlled trial of first-line treatment of mild hypertension (diastolic blood pressure 90-109 mm Hg) in 56 overweight patients aged under 55 years. After 21 weeks of follow up the weight-reduction group had lost an average of 7.4 kg. The fall in their systolic pressure of 13 mm Hg was significantly greater than that in the placebo group (7 mm Hg) but not different from that in the metoprolol group (10 mm Hg). Their fall in diastolic pressure (10 mm Hg) was greater than that in both the metoprolol (6 mm Hg) and placebo (3 mm Hg) groups. At the end of the follow-up period 50% of patients in the weight-reduction group had a diastolic pressure of less than 90 mm Hg. In the metoprolol group there was a decrease in high density lipoprotein (HDL)-cholesterol and an increase in the ratio of total to HDL-cholesterol; in the weight-reduction group there was a decrease both in total cholesterol and in the ratio of total to HDL-cholesterol. Thus in this study population weight reduction produced significant and clinically important reductions in blood pressure but not the adverse effects on plasma lipids commonly associated with antihypertensive drug therapy.

Obesity, Alcohol Consumption and Blood Pressure in Australian Men and Women The National Heart Foundation of Australia Risk Factor Prevalence Study

The associations of obesity and alcohol consumption with blood pressure and the prevalence of hypertension were studied in 5550 male and female subjects aged 25 to 64 years, surveyed in the National Heart Foundation of Australia 1980 Risk Factor Prevalence Study. Body mass index was significantly and independently associated with blood pressure levels in both sexes. A maximum of 30% of hypertension in the study population could be attributed to overweight. The association between body mass index and hypertension was greater in men under 45 years in whom a maximum of 60% of hypertension could be attributed to overweight. In both men and women receiving antihypertensive treatment, body mass index was positively associated with blood pressure. Overweight hypertensives were less likely to achieve normal blood pressure on treatment. Alcohol consumption was significantly and independently associated with blood pressure levels in males. A similar trend in females failed to reach statistical significance because of the lesser consumption of alcohol by females. A maximum of 11% of hypertension in males and 1% in females could be attributed to alcohol consumption. These estimates were reduced when age and body mass were taken into account.

Low fat, low cholesterol diet in secondary prevention of coronary heart disease.

Four hundred fifty-eight men with coronary heart disease participated in a trial of secondary prevention for 2 to 7 years. Overall five year survival was 81%. For those with first heart attacks it was 86%.

Plasma lipoprotein levels in treated and untreated hypertensive men and women. The National Heart Foundation of Australia Risk Factor Prevalence Study.

Experimental studies have reported that common antihypertensive drugs such as diuretics, beta-blockers, and methyldopa have adverse effects on plasma lipids and lipoproteins. To investigate whether such effects can be observed in the general population, plasma lipid and lipoprotein levels were compared in subjects receiving antihypertensive treatment, subjects with untreated high blood pressure, and subjects with normal blood pressure in a random sample of 5603 subjects screened in a national study of risk factor prevalence in Australia. In both sexes, high density lipoprotein (HDL) cholesterol was lower in the group receiving treatment than in the others (p < 0.001). In men, triglycerides (TG) (p < 0.001) and the ratio of total cholesterol to HDL cholesterol (TC/HDL cholesterol) (p < 0.05) were higher in the group receiving treatment. In both sexes, the differences in plasma lipids and lipoproteins between treated and untreated hypertensive groups were independent of age, body mass index, alcohol consumption, and smoking. More than 40% of the treated or untreated hypertensive men and women had elevated total cholesterol (TC > 252 mg/dl) or an elevated TC/HDL cholesterol ratio (>6.0). In men receiving antihypertensive treatment, the prevalence of an elevated TC/HDL cholesterol ratio was significantly greater than in men with untreated high blood pressure (p < 0.01). The results of this study suggest that the effects of antihypertensive treatment on plasma lipids and lipoproteins can be observed in population lipid and lipoprotein levels. Even before treatment, a large proportion of high blood pressure patients have a significant plasma cholesterol abnormality, which may be aggravated by conventional antihypertensive therapy.

Lipoprotein lipids in chronic renal failure and haemodialysis. The influence of etiology and implications for atherogenesis

Lipoprotein lipid analysis has been carried out in 39 women and 28 men with chronic renal failure on haemodialysis. The results have been analysed in relation to the etiology of the renal disease and compared with those obtained in age- and sex-matched controls and in triglyceride-matched controls. Serum cholesterol was normal or low in glomerulonephritis but was normal in analgesic nephropathy. Serum triglycerides and VLDL lipids were raised uniformly regardless of the etiology of the renal disease. LDL triglyceride and HDL triglyceride were also raised. LDL cholesterol and phospholipid were low in glomerulonephritis but were normal in analgesic nephropathy. HDL cholesterol was reduced in both male and female patients regardless of etiology, statistical significance was not reached for the women. The ratio of esterified to free cholesterol tended to be reduced in all the lipoproteins regardless of sex or etiology but the changes were not significant in all groups. Comparison of the lipid abnormalities with those found in other hyperlipidaemic states suggests that the lipid disorders found in chronic renal failure are probably insufficient to explain the rapid development of vascular disease which has been reported.

A RANDOMIZED CONTROLLED TRIAL OF WEIGHT REDUCTION AND METOPROLOL IN THE TREATMENT OF HYPERTENSION IN YOUNG OVERWEIGHT PATIENTS

1. The effects of weight reduction and metoprolol (100 mg, b.d.) in the treatment of hypertension (diastolic blood pressure 90–109 mmHg) in 56 young, overweight patients were investigated in a randomized placebo controlled trial. After a 4‐week baseline, subjects were followed up for 21 weeks.

REGRESSION OF XANTHOMATA OF THE EYELIDS WITH MODIFIED FAT DIET

Abstract The treatment of type-2 hyperlipoproteinaemia by diet and drugs has been practised for only a few years. Xanthomata are slow to regress, and the usual yardstick of effective therapy is reduction of serum-cholesterol. A patient is described with extensive xanthomatous deposits in the eyelids which began to regress in the sixth year of treatment with a modified fat diet and disappeared in the eighth year. Serum-cholesterol showed no significant change until the eighth year of treatment, when it declined precipitously. These events are consistent with the view that serum-cholesterol is only weakly indicative of changes in total body economy of cholesterol.

Hyperlipidaemia and Weight Gain After Maturity

In affluent western societies average weight gain in males over the two decades after maturity is of the order of 9–12 kg Increase in total plasma lipids over this period tends to parallel increase in body weight but whether there is a causal relationship is not clear. One approach to the problem is to use the tool of weight reduction; this is the subject of this paper.

Coronary Heart Disease Profile in Australian Men and Some Factors Influencing Survival

Australia is an affluent country with a high mortality from coronary disease. Before 1966 no systematic study of the coronary profile of Australians had been made. In that year our group began a study of the effect of dietary modification in secondary prevention. We present here data on entry characteristics and survival in relation to them.

Measures on qualitative variables in coronary heart disease studies

Abstract A qualitative variable such as ‘marital status’ may be recorded as single, married, widowed, divorced or separated. A procedure, relevant to coronary heart disease studies, is suggested for putting a measure on such a categorised variable. The advantages of such a procedure are discussed. Examples on cigarette smoking, alcohol consumption and dyspnoea are also presented.