Search

Objective: To compare the efficacy of three types of diet and lifestyle interventions for lowering plasma lipid levels., Design: Randomised parallel-group trial., Subjects and Setting: Adults with plasma cholesterol levels of 5.5-8.0 mmol/L attending two Sydney community health screening clinics were asked to participate: 179 agreed and 131 completed the study., Interventions: A pamphlet with brief advice; group dietary counselling; or individual counselling. Counselling included three sessions with a dietitian/nutritionist over six months., Main Outcome Measures: Plasma total cholesterol levels measured by Reflotron analyser; fasting serum lipid levels measured by standard laboratory methods; and calculated low-density lipoprotein cholesterol levels., Results: Significantly lower plasma total cholesterol levels (Reflotron) were observed at two months and at six months with each of the three interventions. Additionally, both types of dietitian-based counselling resulted in small but significant decreases in plasma low-density lipoprotein cholesterol levels at six months in a subset of subjects., Conclusion: Although there were no statistically significant differences in efficacy between the three types of intervention, dietitians have a role to play in setting up such counselling programs.

Administration of the vasodilator agent, prazosin, in dosages from 3-0 to 7-5 mg per day, significantly reduced diastolic and systolic blood pressure in a group of 14 patients with mild or moderate hypertension. Nine of these patients had a lowering of diastolic blood pressure which was at least 10 mm Hg greater than that caused by placebo. Side effects, chiefly dizziness or lassitude, occurred in over half the patients, but were mild and of short duration and did not necessitate suspension of treatment. The antihypertensive effect of prazosin was similar to that produced by methyldopa or propranolol given in comparable doses. If prazosin and propranolol were given concurrently, blood pressure fell to a level which was significantly lower than that associated with the use of either of these agents alone.

We studied the association between stated alcohol consumption and blood pressure, making allowance for age, adiposity and smoking in 13535 men and 7385 women who were not receiving antihypertensive treatment. They represented a wide cross-section of the inner Sydney working population with 95% aged between 18 and 70. We found a high degree of linear correlation between stated alcohol consumption and blood pressure, diastolic and systolic. This relationship was independent of age, adiposity and smoking. For each 100 g/week increase in stated alcohol consumption, diastolic blood pressure increased by 0.12 kPa (0.92 mmHg) in men and by 0.20 kPa (1.5 mmHg) in women; no threshold for this effect was evident. A plateau appeared at about 500 g/week. Blood pressure increased significantly with age and adiposity (Quetelet's index). Smoking was associated with a lower diastolic blood pressure. The difference in mean diastolic blood pressure between smokers and non-smokers was 0.20 kPa (1.5 mmHg) for men and 0.27 kPa (2.1 mmHg) for women.

Labetalol, a combined alpha-blocking and beta-blocking agents, was administered by intravenous bolus to six severely hypertensive patients. The blood pressure response was unsatisfactory in every case. It is concluded that intravenous administration of labetalol is not useful in hypertensive emergencies which occur in patients who are already receiving other antihypertensive agents.

An attempt was made, through a hospital-based health screening service, to ensure proper longterm care of clients with hypertension and other cardiovascular risk factors. Of 8755 subjects screened on one occasion, 1274 (14.6%) had a blood pressure reading above defined limits; of these, 1058 were not receiving antihypertensive drugs. Apparently hypertensive subjects were rescreened within one week or were referred to their local doctors. At their second visits, over half of the 716 rescreened subjects had reading consistently below the defined limits. Those with intermittent blood pressure elevation (89 patients) were designated as having labile hypertension, and were reviewed regularly. The remainder, with persisting hypertension, were sent to their local doctors or to the hospital's hypertension clinic. After six months, the group ith labile hypertension showed no change in mean left cardiac ventricular voltage, and more than 50% the group had normal blood pressure; 14 patients were receiving antihypertensive drugs. Subjects referred to the hypertension clinic had a high prevalence of cardiovascular risk factors and a low prevalence of clinically evident organ damage. Only half of this group were deemed to require drug therapy. In a postal survey of clients referred to private doctors, 35% of respondents reported that they had started taking anti-hypertensive drugs. Thorough rescreening of blood pressure is essential in preventing the unnecessary use of antihypertensive drugs, and this can be facilitated by providing management streams appropriate to the needs of the individual subject.

Blood-pressure responses and changes in plasma drug concentration were studied in 11 hypertensive patients after an initial oral dose of 2 mg of prazosin. Subsequently, blood pressure was monitored during long-term treatment with prazosin. The prazosin reactivity index, a value derived during the first-dose study, appeared to predict the long-term antihypertensive effect of prazosin alone or prazosin combined with bendrofluazide.