Rapid reversal of circadian blood pressure rhythm in shift workers.

The blood pressure and heart rates of seven normotensive shift workers were monitored automatically for 24 h with a non-invasive ambulatory method on 3 different days. The first monitoring session took place at the end of an ordinary work period of morning shifts, the second on the first day of a period of night shifts, and the third on the last day of a period of night shifts. The circadian blood pressure rhythm, which showed a normal pattern during the daytime work shift, was totally reversed from the first day of the night shift. The blood pressure rhythm closely followed the sleep-wakefulness cycle. The changes in circadian heart rate rhythm were not as pronounced as those in blood pressure but showed a similar trend.

Exercise capacity and hemodynamics in persons aged 20 to 50 years with systemic hypertension treated with diltiazem and atenolol.

Hemodynamic responses and exercise capacity were studied during maximal exercise in 25 young hypertensive persons (mean age 40 years) taking placebo, diltiazem (mean 216 mg/day) and atenolol (mean 80 mg/day). The study was a crossover, double-blind, randomized trial, each medication period lasting 2 months. Sitting blood pressure (BP) was 160 +/- 19/109 +/- 8 mm Hg after run-in. Both drugs decreased BP significantly, diltiazem by 10/ 11 mm Hg and atenolol by 16/14 mm Hg (difference not significant between drugs). During exercise there were no differences among patients taking placebo, diltiazem and atenolol in peak workload and rating of perceived exertion. Atenolol significantly attenuated the increase in heart rate, BP and heart rate-BP product at each workload. Diastolic BP during exercise was significantly lower (6 to 10 mm Hg) during diltiazem therapy than during placebo at each workload. Thus, both diltiazem and atenolol decrease rest BP significantly without impairing exercise capacity.

Relationship between the self-assessment and clinical assessment of health status and work ability.

Clinical assessments of health status and work ability were compared with subjective assessments reported on a questionnaire. The clinical examinations included cardiorespiratory, musculoskeletal, and psychological measurements. The subjective work ability comprised an index based on estimations of work ability in relation to diseases, job demands, and psychological resources. For the clinical examinations 89 male and 85 female workers aged 44-58 years were selected according to health and subjective work ability as reported on the questionnaire. Half of the group was healthy and half suffered from either coronary artery disease (men) or low-back pain (women), and the subjective estimations of work ability varied from good to poor. The results indicated that the questionnaire responses on health and work ability related well with the clinically assessed factors at the group level. Some divergence was detected at the individual level, but it could usually be explained on the basis of the available data.

Comparison of the diuretic effects of single dose frusemide/triamterene and hydrochlorothiazide/amiloride in healthy adults.

The diuretic and potassium- and magnesium-conserving action of a single dose of frusemide/triamterene, F + TRI (40 mg/50 mg), and hydrochlorothiazide/amiloride, HCT + AMI (50 mg/5 mg), fixed combination preparations were compared in ten healthy adults in a randomised double-blind placebo-controlled study. Urinary volume during 24 hours was significantly higher after HCT + AMI ingestion than after F + TRI. The urine and sodium excretions caused by HCT + AMI lasted markedly longer and were smoother than the short and somewhat unpleasant effects of F + TRI. HCT + AMI also spared potassium and magnesium relatively more effectively than F + TRI.

Carvedilol and atenolol once daily in the treatment of hypertension.

Fifty milligrams of carvedilol and 100 mg atenolol were administered in a random order once a day for 2 months to 43 patients with mild to moderate hypertension, in a double-blind crossover study. Blood pressure, heart rate and peripheral blood flow parameters (n = 11) were recorded 2 and 24 h after the drug administration. Supine blood pressure was the same 2 h after both carvedilol and atenolol administration, but carvedilol caused a greater decrease in standing systolic blood pressure 2 h after the administration (P less than 0.05). The heart rate decreased less with carvedilol (P less than 0.01). There was no difference in the effects exerted by the two therapies on systolic blood pressure and the heart rate 24 h after drug administration, but the diastolic blood pressure was higher in patients given carvedilol (92 versus 88 mmHg; P less than 0.05). Forearm blood flow, forearm vascular resistance and calf blood flow did not change significantly with either of the therapies. In conclusion, 50 mg carvedilol once a day is an effective antihypertensive therapy, though its duration of action did not reach that of 100 mg atenolol once a day. Peripheral vasodilation was similar with both therapies.

Maintenance of potassium balance during long-term diuretic therapy in chronic heart failure patients with thiazide-induced hypokalemia: comparison of potassium supplementation with potassium chloride and potassium-sparing agents, amiloride and triamterene.

The relative efficacy of potassium chloride, amiloride and triamterene in maintaining potassium and magnesium balance was evaluated in 23 hypokalemic (S-K less than or equal to 3.5 mmol/l) patients with chronic heart failure receiving diuretic therapy. Amiloride and triamterene were administered in a randomized, crossover manner, followed by potassium chloride in an open manner. During a 5-month treatment with hydrochlorothiazide 50 mg twice/day, potassium chloride 1 g twice/day was not as effective as amiloride 5 mg or triamterene 75 mg twice/day in maintaining serum potassium and magnesium and total-body potassium, while amiloride and triamterene seemed to be equally effective. During all three supplementations, a decrease in serum potassium to a hypokalemic level was observed in some patients. The need for higher doses of potassium chloride, amiloride and triamterene was clearly concentrated to the same patients, and correction was easily reached by increasing the respective doses.

Magnesium and ascorbic acid supplementation in diabetes mellitus.

The effect of magnesium (Mg) and ascorbic acid (AA) supplementation on metabolic control was assessed in 56 outpatient diabetics. A 90-day run-in period was followed by two 90-day treatment periods, during which Mg (600 mg/day) and AA (2 g/day) were administered in a randomized double-blind cross-over fashion. A decrease in systolic and diastolic blood pressure (132 +/- 3 vs. 138 +/- 4 and 77 +/- 2 vs. 82 +/- 2 mm Hg; p < 0.05) was observed in insulin-dependent diabetes mellitus subjects during Mg supplementation. No beneficial effect of Mg supplementation was observed on glycemic control, lipids or blood pressure in non-insulin-dependent diabetes mellitus (NIDDM) subjects. AA supplementation improved glycemic control among NIDDM subjects and both fasting blood glucose (9.1 +/- 0.5 vs. 10.1 +/- 0.6 mmol/l; p < 0.05) and HbA1c (8.5 +/- 0.3 vs. 9.3 +/- 0.3%; p < 0.05) improved. Beneficial effects of AA supplementation on cholesterol (5.9 +/- 0.2 vs. 6.2 +/- 0.2 mmol/l; p < 0.05) and triglycerides (2.2 +/- 0.2 vs. 2.5 +/- 0.2; p < 0.05) were also observed in NIDDM subjects. The results suggest that high-dose AA supplementation may have a beneficial effect in NIDDM subjects on both glycemic control and blood lipids.

Maintenance of potassium balance during diuretic therapy.

The relative efficacies of potassium chloride, amiloride, triamterene and spironolactone in maintaining potassium balance were studied in 40 patients with essential hypertension receiving diuretic therapy. The preparations were administered in random order in a cross-over manner. In 31 patients treated with 50 mg hydrochlorothiazide daily, addition of 1500 mg potassium chloride daily was the weakest and 50 mg spironolactone daily the most effective agent for maintaining serum potassium. Amiloride (5 mg daily) and triamterene (75 mg daily) were less effective and equally so. Similar results were obtained with 9 patients treated with double dosages of the diuretic and supplements. Despite changes in serum potassium, total body potassium remained constant throughout the trial.

Antihypertensive and biochemical effects of different doses of hydrochlorothiazide alone or in combination with triamterene.

The antihypertensive and biochemical effects of 25 mg hydrochlorothiazide alone or 50 mg hydrochlorothiazide alone or in combination with triamterene (either 37.5 or 75 mg) once daily were studied in 26 patients with essential hypertension. After a 5-week run-in period the patients were randomized to receive active therapy in a cross-over manner. Each treatment period lasted 3 months. All drugs significantly (p less than 0.01) lowered both systolic and diastolic blood pressure. There were no differences in blood pressure between the medication periods. Serum potassium concentration was slightly lower during all medication periods than during the run-in period. This change was statistically significant (p less than 0.01) only on 50 mg hydrochlorothiazide daily. There were no significant changes in serum magnesium during any of the periods compared to the run-in period. The lowest values were recorded on 50 mg hydrochlorothiazide alone and the highest on 50 mg hydrochlorothiazide plus 75 mg triamterene daily. A slight increase in serum urate was recorded in all medication periods compared to the run-in period. No significant changes were observed in serum total cholesterol, HDL cholesterol or triglycerides between any of the periods. It can be concluded that 25 mg of hydrochlorothiazide is as effective in lowering blood pressure as higher doses of the diuretic. Higher doses of thiazides will in some patients cause adverse metabolic reactions of which the fall in serum potassium and magnesium is effectively hindered by triamterene.

Response of plasma endorphins, prolactin and catecholamines in women to intense heat in a sauna.

Concentrations of immunoreactive beta-endorphin (ir beta-E), corticotropin, cortisol, prolactin and catecholamines in plasma were followed in 11 healthy women during and after exposure to intense heat in a Finnish sauna bath, and compared to those in a similar control situation without exposure to heat. Heat stress significantly increased prolactin and norepinephrine secretion; the percentage increases from the initial plasma concentrations varied from 113 to 1280% (mean 510%) and from 18 to 150% (mean 86%), respectively. The response of the plasma levels of epinephrine, ir beta-E, corticotropin and cortisol to heat exposure was variable. Compared to the control situation, no statistically significant effect of heat exposure on the plasma levels of these hormones was found.

The Finnish Pain Questionnaire: comparison of descriptions of pain in coronary heart disease and low back pain.

The verbal description of pain is the method most commonly used to study pain symptoms. The Finnish Pain Questionnaire has not been standardized yet. It is impossible to know which descriptors are typical of certain states of pain and which descriptors differentiate states of pain from each other. The aims of this study was to clarify if it is possible to differentiate pain descriptions for coronary heart disease from descriptions for low back pain using the Finnish Pain Questionnaire and to compare the use of pain descriptors and subclasses of descriptors. The patients comprised 57 male patients with coronary heart disease (mean age 52.9 years) and 60 female patients with low back pain (mean age 52.0 years). The results indicated that different descriptors are important in descriptions of coronary heart disease pain and low back pain. The differences of frequencies in the use of descriptors were statistically significant. There were also significant differences in the use of descriptors from different subclasses of the sensory dimension, according to the mechanisms of pain. The results indicated that it is possible to find out which descriptors are the most important for different states of pain and that the Finnish Pain Questionnaire can be a valid method for describing different states of pain.

Clinical experience with cefamandole in pneumonia.

The efficacy and patient acceptance of i.m. cefamandole 1 000 mg 8 h and 500 mg 8 h, were compared in the treatment of assumed community-acquired pneumonia in 59 hospitalized adult patients. Of 31 patients treated with 1 000 mg 8 h, 94% had a satisfactory clinical response with a 13% bacteriological failure rate. Of 28 patients treated with 500 mg 8 h, 89% had a satisfactory clinical response with a 60% bacteriological failure rate. The only side effect registered was pain at the injection site after doses of more than 1 000 mg. The pain could be eliminated by the addition of 0.5 ml of lidocaine to the drug solution before injection.

Role of dietary potassium and magnesium in diuretic-treated patients with cardiac insufficiency.

The role of daily dietary intake of potassium and magnesium in the maintenance of potassium balance was studied in 104 digitalized outpatients with chronic cardiac insufficiency receiving 50 mg hydrochlorothiazide twice daily for 6 weeks. The food consumption data were collected once a week by the 24-hour recall method during the 1st, 2nd and 3rd weeks of the investigation. Serum potassium and magnesium values were followed throughout the study, and total body potassium was measured at the end. During the hydrochlorothiazide treatment, potassium and magnesium levels decreased significantly (p less than 0.001). 46% of the patients became hypokalemic (serum potassium less than or equal to 3.5 mmol/l), hypokalemia being more common (64%) in the patients with a concomitant decrease (-0.063 +/- 0.08 mmol/l) in serum magnesium values. Mean intake of potassium and magnesium was 3.4 g and 299 mg in females and 4.2 g and 380 mg in males, respectively. There was no significant difference in the daily intake of potassium and magnesium between the patients becoming hypokalemic and those remaining normokalemic.

Comparison of potassium alone and potassium-magnesium supplementation in patients with heart failure using hydrochlorothiazide.

Supplementation of potassium alone and in combination with magnesium was compared in 10 patients with chronic compensated heart failure receiving hydrochlorothiazide 50 mg twice daily for the whole trial. After a 3-week run-in period, the patients were randomized to receive active supplementation for 6 weeks in a double-blind cross-over manner. A 3-week wash-out period was kept in between. Addition of 2 g potassium chloride daily (27 mmol K+) did not efficiently correct the serum potassium concentration. After the combined supplementation of 2 g potassium and 1 g magnesium (27 mmol K+ and 17 mmol Mg2+ daily), both serum potassium and magnesium concentrations increased statistically significantly during the first 2 weeks of treatment. After a longer treatment of 6 weeks, the effect of combined supplementation was less clear, even though a trend toward a better maintenance of serum potassium was still evident.

Attitude changes of general practitioners towards lowering LDL cholesterol.

BACKGROUND: Clinical studies have demonstrated the benefit of lowering cholesterol in decreasing coronary complications. These results need to be implemented in clinical practice, where an important barrier are the attitudes of physicians. DESIGN: General practitioners in the city of Helsinki were asked to respond to two questionnaires sent to them by post 12 months apart (1996 and 1997); 284 responses were received in 1996 and 258 in 1997. METHODS: In addition to brief questions aimed to characterize the responding physician, the questionnaire included four examples of patients: (1) middle-aged man without, or (2) with coronary heart disease (CHD); (3) 70-year-old man with a history of stroke; (4) 70-year-old women with CHD. The physicians were asked at what level of serum low-density-lipoprotein (LDL) cholesterol they usually initiate drug therapy. Comparisons were made longitudinally between 1996 and 1997, as well as between different patients. Analyses are based on the responses of those physicians who reported that they treat atherosclerotic patients (241 and 237 in 1996 and 1997, respectively). RESULTS: In case 1 (primary prevention), 40.1% of general practitioners in 1996 compared with 52.4% in 1997 (difference +12.3, 95% CI +3.2(-)+20.9, P < 0.01) reported that they would initiate drug therapy at the LDL cholesterol level < 5.0 mmol/l. In case 2 (secondary prevention), 42.0% in 1996 and 54.8 in 1997 (difference +12.8, 95% CI +4.0(-)+21.8, P < 0.01) would initiate drug therapy at the LDL cholesterol level < 4.0 mmol/l. In case 3 (70 year man with stroke), 13.8% in 1996 compared with 30.4% in 1997 (difference +16.6, 95% CI +9.4(-)+24.0, P < 0.01) would initiate drug therapy at the LDL cholesterol level < 4.0 mmol/l. In case 4 (70 year old woman with CHD) 12.8% in 1996 compared with 34.2% in 1997 (difference +21.4%, 95% CI + 13.9(-)+28.7, P < 0.01) would initiate drug therapy at the LDL cholesterol level < 4.0 mmol/l. The physicians' attitudes were significantly more active towards LDL cholesterol lowering both in 1996 and 1997 in case 2 compared with case 1, case 3 or case 4. No difference was observed between case 3 and case 4. CONCLUSIONS: Between 1996 and 1997 the attitudes of general practitioners towards lowering LDL cholesterol have become significantly more active in all four patient categories. However, the attitudes are still not optimal concerning coronary patients and especially older atherosclerotic patients.

Serum cholesterol trends among members of the Finnish parliament.

UNLABELLED: BACKGROUND. Mortality from coronary heart disease in Finland has declined remarkably since the early 1970s. Most of the change has apparently been due to the active national strategy for reduction of serum cholesterol levels. This study was undertaken to estimate to what extent members of the Finnish parliament (MPs) have complied with the national recommendations. METHODS: Serum total and HDL cholesterol values were measured from MPs of three subsequent parliaments elected in 1987, 1991, and 1995. RESULTS: From 1987 to 1995, the Finnish MPs showed a reduction of serum total cholesterol that was significant among males (-5.2;%, P < 0.05) but not among females (-6.4%, NS) and was somewhat smaller than the reduction in the general population during 1987 to 1997 (-9.4% among males and -8. 3% among females). The male MPs had a 14% rise in HDL cholesterol (P < 0.01), while among female MPs and in the general population it decreased by 3.1 to 3.8% (all NS). The cholesterol levels of female MPs were altogether a little lower than in the general population. The Finnish MPs tended to have lower total cholesterol levels compared with those reported from Hungarian MPs. CONCLUSION: The favorable change in the lipid profile of members of the Finnish parliament indicates that they have personally been involved in the national change process. Follow-up of risk factors in national decision-makers is a useful part of comprehensive monitoring of national coronary heart disease prevention activity.

Trends in serum cholesterol and lifestyle indicators in Members of the Finnish Parliament.

OBJECTIVE: To examine the extent that public health promotion activity is reflected in life styles of national decision makers, by analysing trends in coronary heart disease risk factors in Members of the Finnish Parliament (MPs). METHODS: The MPs were studied at the beginning of two subsequent 4-year parliamentary periods between 1991 and 1999. The studies included analyses of serum total cholesterol and high-density lipoprotein (HDL) cholesterol, and a questionnaire about alcohol, smoking and physical activity. RESULTS: Serum total cholesterol was above the national recommendation of 5.0 mmol/l in 85% of the male MPs and 62% of the female MPs. The mean level of serum total cholesterol increased in female MPs during the 4-year follow-up period (P < 0.05), and male MPs showed an increase in mean HDL cholesterol (P < 0.001). The mean body mass index increased in both male (P < 0.01) and female (P < 0.01) MPs during the same period. Alcohol consumption, smoking and physical activity were unchanged during follow-up. CONCLUSIONS: From the public health perspective, serum cholesterol is too high in most MPs, and the level in males is above the national average. Both males and females put on weight during the parliamentary period, and male MPs also showed an increase in HDL cholesterol, which may be explained by other lifestyle factors.