Search

Two hundred and nineteen psoriatic in-patients and 747 non-psoriatic subjects were asked to report in a semiquantitative, self-administered questionnaire on the frequency of consumption of different foodstuffs and cooking and seasoning fats and the daily intake of alcohol (glasses/day) and coffee (cups/day). According to this a definite score was assigned to each of the 46 food items, which were divided into five groups: carbohydrates (CH), low-fat foods (LFF), high-fat foods (HFF), saturated fats (SF) and polyunsaturated fats (PUF) and the alcohol consumption in grams/day was calculated. The mean scores for each food group and the means of alcohol (grams/day) and coffee (cups/day) intake were compared in the two groups, after age-adjustment through ANOCOVA. Psoriatic patients showed higher scores for HFF and SF in males and for CH, HFF, SF and PUF in females and a higher intake of alcohol in both sexes. These dietary habits could explain the higher prevalence of metabolic abnormalities in psoriatic patients.

324 normo- and hypertensive subjects were investigated for neurotic symptoms during outpatient screening for arterial hypertension. The patients were randomly selected and subdivided into three groups: 'new' hypertensives, 'old' hypertensives and normotensives. Neurotic symptoms were evaluated using the Kellner and Sheffield Symptom Rating Test. The mean values thus obtained were adjusted using covariance analysis, with age and sex as the covariants. The 'new' hypertensives scored significantly lower for total neuroticism, depression and inadequacy than the normotensives. They also differed from the 'old' hypertensives, scoring significantly lower for total neuroticism, anxiety, somatization and inadequacy. However, no differences were revealed between the 'old' hypertensives and the normotensives. The significance and implications of these psychological differences are discussed.

The possibility that subjects examined during a population screening programme may develop psychological disturbances as a consequence of being labelled as hypertensives has been investigated. The Symptom Rating Test (SRT) for the assessment of neurotic symptoms was completed by 210 screenees. Aware hypertensives were excluded from the study. It was subsequently found that 81 subjects had raised BP (systolic greater than or equal to 160 or diastolic greater than or equal to 95 mmHg; group 1), and 129 subjects were 'normotensive' (group 2). The total SRT score was significantly higher in group 2 than in group 1. After screening, all subjects were returned to their GPs, and 82% of them were re-examined 2 years later. SRT scores were significantly lower than the initial ones in both groups. At re-examination 35% of 'hypertensives', were found to have 'normal' BP values. The SRT scores of these falsely-labelled subjects were similar to those of the subjects found still to be hypertensive. These findings suggest that subjects with raised BP at screening have lower neuroticism scores than normotensives. More importantly still, hypertension labelling, whether 'true' or 'false', does not have any negative long-term psychological consequences.

Spontaneous changes in blood pressure (BP) over a week after admission to the hospital were investigated in 127 patients admitted with diastolic BP at or above 120 mm Hg. Average BP decreased from 205/129 at admission to 174/110 on the 8th day. Regression analysis showed highly significant negative slopes which were related to initial levels but not to the presence or type of target organ involvement. After 1 week, 66% of the subjects attained a diastolic BP lower than 120 mm Hg. More remarkably, 36% attained values lower than 105 mm Hg: 33% of these had BP values less than 95 mm Hg. While not ruling out the importance of very high BP readings, it is concluded that they do not necessarily represent any pattern of either fixed or severe hypertension nor imply a need for urgent antihypertensive treatment.

In this study, 953 patients (48 percent men) more than 60 years old with mild to moderate hypertension (class I or II) were included. After a two-week wash-out period, a starting dosage of captopril--12.5 mg twice a day--was given. Patients were examined after one and three weeks and, subsequently, at monthly intervals for a total period of four months. The dosage was adjusted to a maximum of 50 mg twice a day plus, when needed, 25 mg of hydrochlorothiazide per day. Thirty-two patients were lost to follow-up, 10 withdrew because of inadequate control of blood pressure, and only 21 (2 percent) dropped out because of side effects. Mean blood pressure decreased from 184/104 to 152/87 mm Hg. The lowest dosage (25 mg a day) was sufficient to control blood pressure in 15 percent of patients, 31 percent needed 50 mg a day, and 24 percent required 100 mg a day. Hydrochlorothiazide was added to the captopril regimen in 30 percent. No substantial changes in biochemical variables or electrocardiographic results were observed. "Quality of life" (judged as physical fitness, positive well being, mood, and sexual desire) remarkably improved.

A genetically determined alteration of the cell membrane sodium metabolism may play a role in the pathogenesis of essential hypertension. The most consistent finding in patients with essential hypertension is an increased red blood cell Li/Na exchange (countertransport). It is genetically determined but it is also associated to potentially confounding variables (body weight, race, age and so on). The present study investigates the relationship between red cell Li/Na countertransport and various potentially confounding variables in a random sample of the population. It shows that this membrane cation transport system is increased in males compared to females and significantly correlated to body mass index in males and to blood pressure, alcohol consumption and, negatively, to urinary calcium excretion in females. Since body weight and alcohol consumption are correlated to blood pressure in several epidemiological studies, it can be hypothesized that they influence blood pressure control through an alteration of the cell membrane sodium transport.

During the National Research Council (CNR) program called Atherosclerosis-Risk Factors 2 (ATS-RF2) a random sample of 1903 subjects (50.1% male) aged 20-59 years was examined in the general population of Mirano-Venice. Mean values of serum total cholesterol and triglycerides, body mass index, as well as systolic and diastolic blood pressure were assessed. On the whole these turned out to be higher in men and increased with age. The continuously distributed variables showed an approximately normal distribution and a close correlation. Comparing our results with those obtained by other Italian units co-operating in the same CNR program, different levels of serum total cholesterol and systolic blood pressure were observed. The overall risk factor pattern in northern Italian regions is closer to that reported in the literature for central European countries than to that of southern Italian regions. These findings might explain why mortality due to ischaemic heart disease is higher in northern Italy and becomes progressively smaller in central and southern Italy.

A long term project to improve the treatment of hypertension in a community is described. The results to date indicate that intervention can improve the proportion of hypertensives treated and the adequacy of such treatment. The final analysis of the project will include a comparison with a reference community and assessment of the impact of intervention on cardiovascular mortality.

1. Blood pressure has been measured in a random sample of 5852 subjects (both sexes, 20-64 years old). The prevalence of hypertension (blood pressure greater than or equal to 160 mmHg and/or 95 mmHg; 150 mmHg and/or 90 mmHg under the age of 30 years) was 29-5%. 2. In a cohort of 972 detected hypertensive subjects, longitudinal changes (2 and 5 months after the initial examination) were evaluated. The phenomenon of regression toward the mean value was evident. 3. The implications of the variability of blood pressure in a community control programme of hypertension are discussed.

An increase in intra-erythrocytic sodium (IENa) content has been proposed as a genetic marker of essential hypertension. Intra-erythrocytic sodium was studied using hypotonic lysis and flame photometry after four washings with isotonic MgCl2 in 240 normotensive subjects (aged 10-45 years) on a free diet with (F+, 121 patients) or without (F-, 119 patients) hypertensive parents, recruited from a random sample of the general population. Systolic blood pressure was significantly higher in males F+ than in males F- (130 +/- 2 versus 125 +/- 2 mmHg, mean +/- s.e.m., P < 0.05), while IENa did not differ. In contrast, intra-erythrocytic potassium content (IEK) was significantly lower and red cell sodium potassium (Na:K) ratio significantly higher in F+ than F-. This might reflect decreased NaK pump activity, or increased membrane permeability to cations which causes increased K leakage. No differences in blood pressure, IENa or IEK showed in female F+ versus F-. It is concluded that IENa is not a genetic marker of hypertension, and that it is probably influenced by exogenous factors. Being associated with differences in blood pressure, the abnormalities of IEK and Na:K ratio might be pathogenetically linked to an early increase in blood pressure.

A pilot project for the control of hypertension in the Community was carried out in Italy as a part of the WHO Programme "Community Control of Hypertension". 1190 subjects identified as hypertensive (BP greater than or equal to 160 and/or 95 mmHg at two subsequent measurements, or under treatment) during the screening of a random sample of the population between 20 and 64 years in the District of Camposampiero (Padova) were enrolled in a Hypertension Register during a subsequent visit (Registration Visit: VR) carried out two months after the screening. In the following 5 years they were recalled about once a year at a Hypertension Clinic for a complete visit (VA). On both the VR and the VAs a resting electrocardiogram (ECG) was recorded and subsequently assessed according to the Minnesota Code (MC). Out of the 1190 registered hypertensive subjects, 872 (400 males and 472 females) participated in the last VA visit after 5 years, which corresponds to an overall participation rate of 69.4% in males (M) and 76.9% in females (F). Among subjects with normal and abnormal ECG at the VR, the participation rates at the last VA were, respectively, 67.9 and 71.5% in M (not significant difference); 80.0% and 70.8% in F (significant difference: P less than 0.001). Between the VR and the last VA the mean BP values of the 872 subjects investigated decreased from 162. 9/102.2 mmHg to 148. 6/90.4 mmHg in M and from 168. 7/102.2 mmHg to 155. 3/91.7 mmHg in F. The rate of abnormal ECGs increased from 44.0% to 50.3% in M and from 36.4% to 47.9% in F, involving most single items and all the classes of the MC with the exception of classes 8 and 9. The items which diminished generally had a rather low prevalence or were those indicating minor abnormalities. The apparent regression of some pathological patterns could actually be accounted for by a shift towards more severe abnormalities. The most remarkable changes occurred in codes indicating respectively left ventricular hypertrophy (3: 1 or 3: 3) and myocardial ischaemia (4: 1-3 or 5: 1-3 or 7: 1).(ABSTRACT TRUNCATED AT 400 WORDS)

The incidence of aortic recoarctation has been evaluated after a mean follow-up period of 8.2 years in 161 patients aged from 2 to 54 years at the time of the operation. To this aim, blood pressure levels in the upper and lower limbs were measured at rest and after bicycle ergometer exercise. Patients whose systolic pressure gradient was significant (either above 20 mmHg at rest or 35 mmHg after exercise) underwent aortic digital angiography. Aortic coarctation was diagnosed when the ratio of the aortic area at the site of the operation was less than 40% of that at diaphragmatic level (Frederiksen's index III). Thus the overall incidence of recoarctation was 10.1%. All patients with a significant gradient at rest also showed a significant gradient after exercise. This suggests that it is worthwhile performing digital angiography directly, without exercise testing, in these patients. However, 39.8% of the patients without significant rest gradients displayed a significant gradient after exercise. On the whole, only 21.4% of the patients with a significant gradient after exercise had signs of recoarctation on digital angiography.

A "Community Control Programme of Hypertension" has been implemented in a Northern Italian population as part of an international co-operative pilot project promoted by World Health Organization. The programme was planned to last five years. Three years after the start we performed what we called a "capillary" screening in the community involved in the project. In fact a team of physicians and medical students moved about in the villages of the area where extemporary ambulances were set up with the aim of identifying new hypertensives, evaluating the state of the control of hypertension as compared with the situation at the outset of the study and, more generally, as a means of strengthening the ties between the project organization and the community. In doing so we also evaluated the feasibility of an alternative approach, based upon the cooperation with an organization outside the health service system, namely the Catholic Church, to achieve the set aims in a very religious population as ours. The parish priests of the villages did eagerly cooperate with our work both in the form of propaganda and in making available the parish buildings in which the ambulances were set up. We examined 1306 subjects (47.3% males), of whom 39.5% were hypertensives ("casual" blood pressure at or above 160 or 95 or treated). Of all the hypertensives, 28.6% were new hypertensives ("unaware"), 45.3% were being treated and 13.7% had a blood pressure lower than 160/95 mmHg while under treatment "effectively treated"); 16%, though, had blood pressure values at or above 200 or 120 mmHg. The state of control of hypertension was better in women and with increasing age. As compared with the findings at the outset of the study, 27,6% more "aware", 23.9% more treated and 9.6% more "effectively treated" hypertensives were found. Using the support of an alternative (non-medical) organization in a programme of preventive medicine in the community has proved to be, in our experience, a feasible, valuable and very cheap approach.

In the context of a W.H.O. Community Control Program of Hypertension, 15.187 subjects aged 20-64 years were examined in three distinct areas of the Veneto region: Camposampiero (Padua), Valdagno (Vicenza) and Mirano (Venice). The prevalence of hypertension was evaluated according to W.H.O. criteria. The prevalence of the three forms of hypertension "systolic only", "diastolic only" and "systo-diastolic together", the difference according to sex and the correlation with age were also calculated. In particular the correlation with age was evaluated in four arbitrary classes of relative weight. The mean prevalence of hypertension into the three samples was 30.7%. The most common form was "systo-diastolic together" (15.5%). The prevalence of hypertension was higher in males and increased with age in both sexes. A positive association between the prevalence of hypertension and the age was observed in all the three classes of relative weight. This association was more noticeable in the classes of a higher relative weight. The association between weight and prevalence of hypertension is discussed in view of a primary prevention of hypertension. The results obtained clearly show the extent of the effort involved in order to control hypertension in the community.

The possibility that antihypertensive drug treatment may induce neurotic symptoms was investigated in a random sample of 114 hypertensives enrolled in an "Hypertension Register" by means of the Kellner and Sheffield Symptom Rating Test (S.R.T.). Of them 73 were on antihypertensive treatment; 41 untreated subjects constituted the control group. Covariance analysis adjusting for age and diastolic blood pressure was used as a statistical test. The comparison between treated and not treated hypertensive subjects did not show any significant difference either for total S.R.T. score (12.6 vs 10.6 in M, 11.6 vs 14.6 in F), or for the partial scores of anxiety (3.5 vs 3.0 in M, 3.1 vs 3.4 in F), depression (2.4 vs 2.2 in M, 2.7 vs 3.5 in F), somatization (4.2 vs 3.2 in M, 3.9 vs 5.6 in F), inadequacy (2.4 vs 2.1 in M, 1.9 vs 2.1 in F). Taking into account the total group (M + F) of treated hypertensives, no significant differences were observed between different treatments (reserpine, alphamethyldopa, clonidine; beta-blockers, diuretics). However beta-blockers and clonidine showed the highest scores for total S.R.T. score (17.3 and 13.2 respectively). The study suggests that the antihypertensive drugs taken into consideration, at least at the given regime, do not induce such psychological side effects as to prevent them being used in a programme of secondary prevention of hypertension.

In the Region Veneto, north-eastern Italy, a survey of three random samples of population aged 20-64 has been made during the initial phase of the international cooperative pilot project called "Community Control Programme of Hypertension", promoted by World Health Organization. 15,187 subjects were examined (47.2% males). The prevalence of "isolated" systolic hypertension (ISH: "casual" blood pressure at or above 160 for systolic readings and below 95 for diastolic) was 6.2%, that of "isolated" diastolic (IDH) 9% and that of "simultaneous" systolic diastolic hypertension (SDH) 15.5%. ISH had an awareness rate of 29.4% and a treatment rate of 10.6%, which is less than for SDH but more than IDH. Analysis of the Hypertension Register set up in one of the three areas showed no important differences in heart rate, Body Mass Index, serum sodium or potassium, B.U.N. and total cholesterol between the different forms of hypertension. The assessment of coronary risk by means of Multiple Logistic Function yielded similar figures for ISH and SDH in males, higher figure for SDH in females. Electrocardiographic changes of left ventricular hypertrophy and of ischaemia were more frequent among subjects with ISH than those with SDH and IDH. It is concluded that ISH is present in a substantial proportion of the population and carries with it no less risk of cardiovascular complications than the other forms of hypertension.

The relationship between body weight and blood pressure, total serum cholesterol, triglycerides, uric acid and glucose was investigated in 203 psoriatic patients in comparison with 904 healthy controls. In the psoriatic patients, these parameters were clearly related to their body weight. Those psoriatic patients of normal weight exhibited lower mean values of all the parameters compared with overweight psoriatic patients while they did not differ from control subjects of normal weight. Our results suggest that only overweight psoriatic patients exhibit the metabolic abnormalities frequently reported in the literature, while psoriatic patients of normal weight do not differ from the general population in this respect.

During the initial phase of the international "Community Control Programme of Hypertension" sponsored by W.H.O., and carried out in Italy by the Clinica Medica II of the University of Padua, a random sample of 5852 subjects was screened (11% of the whole population). The response rate was of 75.3%; the prevalence rate of hypertension (160 or 95), based on casual blood pressure readings, was 29.5%. Measures of the control of hypertension and other relevant results are: a 35.6% of all hypertensives were aware of their condition, and of these 41% were under treatment. Effective treatment of hypertension was seen in one 12.3% of all treated hypertensives (values lower than 16/95), while 14.2% of all hypertensives had values at or above 200 (systolic) or 120 (diastolic). 98.2% of all hypertensives were not under effective control. As a whole, control of hypertension was better in women and in elderly patients.