Reuben Berman

Nutritional Therapy for High Blood Pressure: Final Report of a Four-Year Randomized Controlled Trial— The Hypertension Control Program

A four-year trial assessed whether less severe hypertensives could discontinue antihypertensive drug therapy, using nutritional means to control blood pressure. Randomization was to three groups: group 1--discontinue drug therapy and reduce overweight, excess salt, and alcohol; group 2--discontinue drug therapy, with no nutritional program; or group 3--continue drug therapy, with no nutritional program. In groups 1 and 2 patients resumed drug therapy if pressure rose to hypertensive levels. Loss of at least 4.5 kg (10 + lb) was maintained by 30% of group 1, with a group mean loss of 1.8 kg (4 lb); sodium intake fell 36% and modest alcohol intake reduction was reported. At four years, 39% in group 1 remained normotensive without drug therapy, compared with 5% in group 2. Study findings demonstrated that nutritional therapy may substitute for drugs in a sizable proportion of hypertensives or, if drugs are still needed, can lessen some unwanted biochemical effects of drug treatment.

Do hypertensive patients have a different diurnal pattern of electrolyte excretion

Studies generally indicate that excretion of sodium, potassium, and water is greater during the day than during the night. To determine whether hypertensive patients exhibit this same pattern of excretion, diurnal variations in excretion of sodium, potassium, creatinine, and water were examined in 107 hypertensive men and women from a clinical trial on control of hypertension by nonpharmacological means--the Hypertension Control Program. Each participant provided two carefully timed 24-hour urine collections divided into daytime and overnight specimens. The median ratios of 24-hour to 8-hour overnight excretion were 2.84, 3.95, 2.99, and 2.77 for sodium, potassium, creatinine, and water, respectively. Thus, more than half of this hypertensive group exhibited a greater rate of sodium and water excretion during sleep than during daytime hours, a reversal of the usual pattern. When the group was subdivided based on age, sex, race, trial randomization group, use of diuretics, and hypertension severity, women had significantly lower ratios of 24-hour to overnight excretion for sodium and water than men and blacks had significantly lower 24-hour to overnight ratios for water and potassium than whites. When the 24-hour to overnight ratios for these hypertensive patients were compared with those for a group of 30 men and women with high-normal blood pressure, those with high-normal blood pressure had significantly larger ratios for sodium and water excretion than the hypertensive group. The results of this study suggest that hypertensive patients may have a different diurnal pattern of sodium and water excretion than normotensive subjects and that further research is needed to clarify this issue.

Ventricular septal defect with aortic insufficiency

Abstract 1. 1. A case of ventricular septal defect with aortic insufficiency due to prolapse of the right aortic cusp is reported. 2. 2. Cardiac catheterization and x-ray studies failed to show evidence of a left-to-right shunt. 3. 3. Surgery directed at correction of the aortic insufficiency by plastic repair of the aortic valve serendipitously revealed a ventricular septal defect and permitted successful repair of both defects by the transaortic approach.

Nonpharmacological control of hypertension

Ability to safely withdraw well-controlled mild hypertensives from drugs is being tested in a three-group randomized trial. Group I (intervention) was removed from drugs after the first 2 months of nutrition counseling. Counseling is continuing through the remaining years of the trial to achieve a minimum weight loss of 10 lb if overweight, reduction of sodium intake to less than 1,800 mg, and reduction of alcohol intake to not more than two drinks per day. Group II (the first control group) was also removed from drugs to see if previous long-term blood pressure control had a carryover effect without dietary change. Blood pressure is monitored frequently in both groups, with return to drug treatment in the event of specified blood pressure rise. Group III (the second control group) has remained on drugs for comparison of blood pressure and biochemical variables. In Group I mean 30-month weight loss was 8 lb, with 35% losing 10+ lb; sodium intake was reduced by 38%. Blood pressure control without drugs was maintained for 47% of Group I patients but only 16% of group II patients (P less than 0.05). These findings indicate it may be possible, after establishing good blood pressure control, to maintain control in a sizable proportion without medication, when reduction of weight, sodium, and alcohol intake is achieved.

Myocardial infarction in young people—Experience in U.S.S.R.

Abstract The high incidence of myocardial infarction in young people has been of major concern to Russian cardiologists resulting in a large number of publications in the past 15 years. This is a review of the most important Russian publications in regard to the differences in the clinical course, symptoms, complications, precipitating factors, etiology, and mortality rate in young and old patients with myocardial infarctions.

Successful repair of a ruptured ventricular septum complicating a recent myocardial infarction

Abstract Rupture of interventricular septum or disruption of the competence of the mitral valve may complicate a myocardial infarction. The patient does not usually survive. A corrective open-heart surgical procedure, although of high risk, may prevent the rapid deterioration of the patient. A description is presented of a 68 year old man who suffered a rupture of the interventricular septum following occlusion of a posterior coronary artery. The details of the differential diagnosis, the cardiac catheterization, and the unusual surgical approach to the intracardiac defect are presented. The patient recovered after successful closure of the defect.

New approach in treatment of cardiac decompensation in U. S. S. R.

Abstract Based on Meersons fundamental work 3,4 on the genesis of ventricular hypertrophy and decompensation, Russian investigators supplemented the conventional therapy of cardiac decompensation with preparations related to the synthesis of protein and nucleic acids. The merit of the supplemental treatment was shown in the clinical course as well as in various objective criteria (blood chemistry, hemodynamics, systolic parameters, ECG). The reported results are highly significant and their method merits trial in other centers.

Clinical use of quinidine in atrial flutter and fibrillation.

Abstract Quinidine, after 40 years since its introduction by Frey as an antifibrillatory agent, is still the drug of choice for conversion of atrial flutter and fibrillation to sinus rhythm. It is effective in both supravcntricular and ventricular arrhythmias. The suggested maximal dose orally in the adult is 2.5 g in one day in divided doses. The toxic dose may overlap the therapeutic dose. Toxic effects should be anticipated at the time of conversion. Quinidine regulation of arrhythmias calls for hospital management with daily electrocardiographic monitoring and clinical examination before each dose is given. Seven cases are presented illustrating problems in the use of quinidine. Three episodes of paroxysmal atrial tachycardia with 2:1 block occurred in two cases during quinidine therapy prior to conversion.

Comparison of therapeutic effects of coronary drugs in the USSR

T he prevalence of coronary artery disease in urban Union of Soviet Socialist Republics (USSR) population appears to be similar to that in Western European countries and the United States and, therefore, is a problem of major concern. Numerous articles, proceedings of conferences, and monographs on coronary heart disease appeared during the past decade. Naturally, drug therapy plays a substantial part, as demonstrated in the articles by Goldberg,’ Doshitsyn and co-workers2 and in the monographs of Kissin and VotchaL4 However, there does not seem to be a project in the USSR comparable in scale to the National Institutes of Health supported “Coronary Drug Project.” In the United States a massive double-blind therapeutic trial of lipid lowering drugs in coronary disease is in progress. This study known as the Coronary Drug Project has 8,341 male myocardial infarction patients enrolled in 55 centers throughout the country. At the time of enrollment they were between the ages of 30 and 64 years. The drugs under study are: nicotinic acid, clofibrate (Atromid S), estrogen, D-thyroxine (Coloxin), and placebo. The duration of follow-up is set at five years. Events studied include recurrent myocardial infarction, acute coronary insufficiency, angina, and other manifestations of arteriosclerosis, such as electrocardiographic changes, serum lipids, and mortality rates. The study will have completed five years for all patients by 1974 and should answer the question whether such drugs are useful in the therapy of arteriosclerosis, particularly coronary arteriosclerosis. The large control group of patients will provide invaluable information on the natural history of male coronary patients, a necessary yardstick for comparison with coronary patients treated by any means. One of the best controlled recent studies is the comparison of the therapeutic effect of several drugs used in the USSR for treatment of coronary heart disease by Votchal and Goldberg5 of the Central Institute of Postgraduate Medical Education in Moscow. In double-blind technique, the therapeutic effect of preparations-Papaverin, Nospa,* Segontin,t Ustimon,

COMPARISON OF SELF-REPORTED AND MEASURED HEIGHT AND WEIGHT

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