Hypertension Research
Online ISSN : 1348-4214
Print ISSN : 0916-9636
ISSN-L : 0916-9636
Volume 17 , Issue SupplementI
Showing 1-19 articles out of 19 articles from the selected issue
  • Benjamin O. Osuntokun
    1994 Volume 17 Issue SupplementI Pages S1-S9
    Published: 1994
    Released: August 10, 2006
    JOURNALS FREE ACCESS
    I reviewed the literature on epidemiology of Stroke in Blacks in Africa. Stroke, said to be rare in Black Africans some four decades ago, has become increasingly common now accounting for 4% to 9% of deaths and 6.5% to 41% of neurological admissions in hospital populations. In community-based studies, it is the third or fourth commonest non-infective neurological disease, after headache, epilepsy and diseases of peripheral nerves. In both hospitals and communities, males are more afflicted than females. The age specific incidence rates are similar to those found in Caucasians and Japanese. Occlusive stroke is the commonest type accounting for about 60%, followed by cerebral haemorrhage (20%) subarachnoid haemorrhage (10%). The major risk factor is hypertension which is present in 80% or more in patients with cerebral haemorrhage and subarachnoid haemorrhage, and in 60% in those with occlusive stroke. Other risk factors are age, sickle cell disease, diabetes mellitus, non-ischaemic heart disease (including cardiomyopathies, infective endocarditis, atrial fibrillation mitral valve prolapse) infections, arteritis, smoking, alcohol consumption and cocaine use (in the young people), Transient ischaemic attracts are relatively uncommon reflecting the rarity of large vessel atherosclerotic disease. Case fatality rate is higher than in the developed countries. About 15% of young people (below age of 40 years) with stroke have no identifiable risk factor. Studies are needed on the effectiveness of population-based control of hypertension (which afflicts 10% to 30% of African communities) to reduce the incidence of stroke, especially as atherosclerotic ischaemic heart disease, although emerging is still relatively uncommon in Sub-Saharan African communities. (Hypertens Res 1994; 17 Suppl. I: S1-S10)
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  • Kazuo Ueda, Teruo Omae, Masatoshi Fujishima
    1994 Volume 17 Issue SupplementI Pages S11-S21
    Published: 1994
    Released: August 10, 2006
    JOURNALS FREE ACCESS
    We reviewed the characteristics of stroke epidemiology in Japan mainly based on the 30-year experience of the Hisayama study which is a prospective and autopsy-based population survey conducted since 1961 in a Japanese subrural area. The most frequent type of cerebral stroke was cerebral infarction, sequentially followed by intracerebral hemorrhage and subarachnoid hemorrhage for men, while subarachnoid hemorrhage was more frequent than intracerebral hemorrhage for women. Among subtypes of cerebral infarction, lacunar infarction was a major type for the Hisayama residents. Hypertension was the most powerful risk factor for both intracerebral hemorrhage and cerebral infarction, and diabetes mellitus contributed to the occurrence of cerebral infarction through conferring an excess risk of hypertension to the ictus. Hypertension and diabetes could play an important role as an accerelating factor for brain small arteriolar lesions. The incidence of both intracerebral hemorrhage and cerebral infarction decreased in the recent Hisayama residents, and this could be related to the decreased prevalence of hypertension. However, the type of cerebral stroke will change into that more related to atherosclerosis in the future, since the prevalence of metabolic disorders such as hypercholesterolemia, obesity or glucose intolerance has much more increased among the recent Hisayama population. (Hypertens Res 1994; 17 Suppl. I: S11-S21)
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  • Stephen MacMahon, Anthony Rodgers
    1994 Volume 17 Issue SupplementI Pages S23-S32
    Published: 1994
    Released: August 10, 2006
    JOURNALS FREE ACCESS
    Data from prospective observational studies indicate that usual levels of blood pressure are directly and continuously related to the risk of stroke. The strength of this association has been substantially underestimated by many previous analyses that have not taken account of the "regression dilution bias;" correction for this increases by about 60% the strength of the association between blood pressure levels and stroke risk. From corrected analyses it is apparent that a difference in usual blood pressure levels of just 9/5 mmHg would ultimately confer about a one-third difference in stroke risk. The associations between blood pressure and stroke risk are of similar size in hypertensives and in normotensives. Moreover, because most strokes occur in normotensives, the stroke avoidance that is likely to be conferred by a downward shift in population blood pressure is actually greater in normotensives than hypertensives. For large populations in which stroke is common, a relatively small change in the average adult blood pressure could have large effects on stroke mortality and morbidity. In China, for example, a decline of 9/5mmHg in the average adult blood pressure might be expected to prevent about 400, 000 deaths from stroke each year; more than three quarters of the deaths prevented would have occurred in normotensive individuals. For individuals, the benefits of blood pressure reduction are likely to be greatest in those at highest risk of stroke. It is possible that blood pressure reduction among either hypertensives or normotensives with a history of cerebrovascular disease could confer particularly worthwhile effects. This hypothesis requires investigation in a large-scale randomised trial. (Hypertens Res 1994; 17: Suppl. I S23-S32)
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  • Michael G. Hennerici, Andreas Schwartz
    1994 Volume 17 Issue SupplementI Pages S33-S36
    Published: 1994
    Released: August 10, 2006
    JOURNALS FREE ACCESS
    Hypertension represents the major risk factor for both large and small artery diseases. It is suggested to represent the main cause for cerebral ischemia attributed to both diseases as well, which may be separated in patients to some extent only. Interpretation of individual mechanisms in patients with cerebral ischemia may help to improve further concepts of treatment. (Hypertens Res 1994; 17 Suppl. I: S33-S36)
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  • Dwayne Reed
    1994 Volume 17 Issue SupplementI Pages S37-S42
    Published: 1994
    Released: August 10, 2006
    JOURNALS FREE ACCESS
    The accumulated data from a collaborative study of stroke among Japanese men in Japan and Hawaii since 1965, was used to examine the question of why the risk of stroke is much higher in Japan, in spite of lower coronary heart disease. Earlier studies have shown that these differences are not due to misclassification of disease, that the higher risk of stroke in Japan is true for both thromboembolic and hemorrhagic disease, and that the higher risk could not be accounted for by atherosclerosis in large vessels of the Circle of Willis, as such pathology was more common in Hawaii than in Japan. A more likely explanation is that the difference in stroke is due to lesions in the small intracerebral arteries. The present study compares the prevalence of different measures of small artery pathology and lacunar infarcts found in histologic sections of basal ganglia from 232 Japanese men in Japan and 175 men of Japanese ancestry in Hawaii. Most of the lesions were more common at every age in Japan than in Hawaii. Such lesions were also much more common among men who died of stroke than of other causes, in both study populations. Among a large number of risk factors measured at the baseline exam in Hawaii, only high- blood pressure and reported diet of Asian food were significantly associated with one or more of the measures of small artery lesions. The inferences from the accumulated data are that small artery pathology plays a more important role in the high risk of stroke in Japan than does atherosclerosis in the larger arteries. These studies support the idea that hypertension is an important causal factor, but also indicate that some other factors must be involved. (Hypertens Res 1994; 17 Suppl. I: S37-S42)
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  • Jack P. Whisnant
    1994 Volume 17 Issue SupplementI Pages S43-S46
    Published: 1994
    Released: August 10, 2006
    JOURNALS FREE ACCESS
    The independent predictors of moderate to severe extracranial carotid stenosis in addition to age and sex, are duration of cigarette smoking, hypertension (whether or not it is treated), and diabetes mellitus. In the presence of these variables, there is also a small independent effect of LDL cholesterol and perhaps a small protective effect of HDL cholesterol. The predictors of Intracranial carotid stenosis are very similar, but there appears to be relatively little overlap between extracranial and intracranial carotid stenosis in individual patients. The prevalence of extracranial carotid stenosis and of intracranial carotid stenosis increases with age, and for an individual age group extracranial carotid stenosis is more prevalent than intracranial carotid stenosis. For persons with ischemic stroke, the pathologic substrate is either extracranial carotid stenosis or intracranial carotid stenosis in about 25%. About half of all ischemic strokes are related to some type of extracranial or intracranial arterial disease. (Hypertens Res 1994; 17 Suppl. I: S43-S46)
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  • Lennart Hansson
    1994 Volume 17 Issue SupplementI Pages S47-S50
    Published: 1994
    Released: August 10, 2006
    JOURNALS FREE ACCESS
    During 1991 and 1992 three major intervention trials were published that dealt with the value of antihypertensive treatment in the elderly. The three studies were the American Systolic Hypertension in the Elderly Program (SHEP), the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension) and the British Medical Research Council Trial of Treatment of Hypertension in Older Adults. The three trials all compared active antihypertensive treatment, mainly consisting of diuretics or β-adrenoceptor blocking agents or the two in combination, with placebo. Two of the trials were double-blind (SHEP and STOP) whereas the MRC trial was single-blind. All three were multicenter, prospective and patients were randomized to either of the treatment modalities. One of the trials (SHEP) was specifically designed to evaluate antihypertensive treatment in patients with isolated systolic hypertension. The SHEP, STOP and MRC trials all showed that treatment of hypertension in the elderly reduces the risk of stroke and cardiovascular events. In two of the trials total mortality was also positively affected, and in the STOP-Hypertension trial, which included the oldest patients with the most severe hypertension, total mortality was reduced by 43%. Based on these trials, it is apparent that antihypertensive treatment with low dose thiazides or β-blockers or the two in combination produced highly beneficial results in elderly patients, i.e. a reduction in stroke and other cardiovascular events as well as in total mortality. Special analyses indicate that the cost/benefit aspects of such treatment is at least as positive as in young and middle-aged hypertensive patients. (Hypertens Res 1994; 17 Suppl. I: S47-S50)
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  • Geoffrey A. Donnan, Roger X. You, Amanda Thrift, John J. McNeil, Colin ...
    1994 Volume 17 Issue SupplementI Pages S51-S54
    Published: 1994
    Released: August 10, 2006
    JOURNALS FREE ACCESS
    Hypertension is one of the most important risk factors for stroke. However, it is less clear what stroke subtypes have particulary high relative risks associated with treated hypertension. On theoretical grounds, lacunar infarction syndromes and primary intracerebral haemorrhage are more likely to fall into this category since their pathogenesis is thought to relate to underlying hypertensive small vessel changes (lipohyalinosis). For lacunar infarction syndromes there is considerable debate as to whether hypertension is actually a more potent risk factor than for all other formms of cerebral infarction combined. In the case of cerebral haemorrhage, there have been very few studies performed in the post-CT scan era and hence the true relative risk is very poorly quantitated. More epidemiological studies are required to clearly identify stroke subgroups in which hypertension has had the most impact. (Hypertens Res 1994; 17 Suppl. I: S51-S54)
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  • Kazuyuki Shimada, Akiko Kawamoto, Kozo Matsubayashi, Masanori Nishinag ...
    1994 Volume 17 Issue SupplementI Pages S55-S58
    Published: 1994
    Released: August 10, 2006
    JOURNALS FREE ACCESS
    Silent cerebrovascular disease can be frequently revealed by magnetic resonance imaging (MRI) in asymptomatic elderly subjects. These incidental lesions include lacunae and periventricular hyperintensity (PVH), and are associated with several vascular risk factors including age and blood pressure. The relationship between diurnal blood pressure variations and hypertensive cerebrovascular disease, however, has not been fully understood. We found that ambulatory blood pressure monitoring is superior to casual pressure measurements in predicting these lesions. Furthermore, the absence of a nocturnal blood pressure reduction is associated with greater abnormalities of these MRI lesions. Other factors such as high predicted blood viscosity and low HDL-cholesterol levels were associated with advanced multiple (defined as more than four) lacunar lesions. In particular, left ventricular hypertrophy on ECG had high positive and negative predictive values for the advanced multi-lacunar lesions in the asymptomatic elderly patients with hypertension. The most important questions which remain to be answered, however, is the prognosis of the subjects with these silent cerebrovascular disease. (Hypertens Res 1994; 17 Suppl. I: S55-S58)
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  • Svend Strandgaard
    1994 Volume 17 Issue SupplementI Pages S59-S61
    Published: 1994
    Released: August 10, 2006
    JOURNALS FREE ACCESS
    Antihypertensive treatment effectively prevents haemorrhagic and lacunar stroke, and apparently also transient ischaemic attacks. It is likely that treatment also affords some protection against other thrombotic strokes. Acute stroke is often associated with a transient rise in blood pressure, which may be superimposed on a chronic hypertensive state. Emergency treatment of hypertension should probably only be given to the most extremely elevated pressures in acute stroke. In the occasional patient, overzealous antihypertensive treatment may cause cerebral ischaemia or even ischaemic stroke. Aside from acute stroke with transient hypertension, the risk of overtreatment is most marked in very severe hypertension, in the frail elderly hypertensive with postural hypertension, and in the rare cases of haemodynamically mediated transient ischaemic attacks. (Hypertens Res 1994; 17 Suppl. I: S59-S61)
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  • Masatoshi Fujishima, Setsuro Ibayashi, Kenichiro Fujii, Hiroaki Oobosh ...
    1994 Volume 17 Issue SupplementI Pages S63-S69
    Published: 1994
    Released: August 10, 2006
    JOURNALS FREE ACCESS
    In mild hypertensive patients, regional cerebral blood flow measured by positron emission tomography was reduced in the frontal cortex and basal ganglia. In moderate-severe hypertensive patients, cerebral oxygen metabolism was diminished, although they were neurologically intact. In elderly hypertensives, white matter lesions by brain imaging were more frequently observed and their cognitive function was impaired, compared to those in age-matched normotensives. Local cerebral blood flow was decreased in spontaneously hypertensive rats (SHR). Spatial memory and learning at maze test were more greatly impaired in aged SHR, which was related to decreased cerebral glucose utilization in hippocumpus, basal ganglia etc. Long-term antihypertensive treatment in SHR improved cerebral blood flow, media thickness of cerebral arteries and cognitive function. Cerebral circulation and metabolism in chronic brain infarction were different from those in non-infarcted patients. In human as well as animals, long-standing hypertension per se leads to reduction of cerebral blood flow, metabolism, and cognitive function. (Hypertens Res 1994; 17 Suppl. I: S63-S69)
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  • Yoshihiro Kuriyama, Takaji Kaneko, Kohji Matsushita, Kazuyuki Nagatsuk ...
    1994 Volume 17 Issue SupplementI Pages S71-S76
    Published: 1994
    Released: August 10, 2006
    JOURNALS FREE ACCESS
    The control of blood pressure in acute stroke patients and management of hypertension in chronic stroke patients are highly important. So we attempted to clarify the clinical significance of cerebral blood flow (CBF) autoregulation in stroke patients. 1) Orthostatic hypotension in early rehabilitation: The incidence of neurological symptoms decreased when the head of the bed was elevated gradually, over days, rather than rapidly. The results indicate that a gradual elevation of the head of the bed in stepwise fashion is safer than an abrupt elevation, especially in patients with occlusions of the main cerebral artery. 2) CBF autoregulation in patients with acute brain hemorrhage: Blood pressure control is essential in managing patients with acute brain hemorrhage. Measurements of CBF autoregulation in cases wlth acute brain hemorrhage indicate that a 20% reduction in blood pressure is the maximum for maintaining cerebral circulation. 3) CBF autoregulation in patients of chronic brain infarction: The reduction of blood pressure in hypertensive patients with ischemic cerebrovascular disease should be within 20% in those without arterial occlusion, and within 10% in those with a stem occlusion of the middle cerebral artery. 4) Periventricular lucency (PVL) and CBF autoregulation: Mean cerebrovascular resistance value was elevated in chronic hypertensive patients with CT findings of severe PVL; cases of severe PVL also showed impaired CBF autoregulation. This indicates that hypertensive patients whose brain CT reveal severe PVL have an impaired CBF autoregulation. In these cases a strict regimen for lowering the blood pressure is required to prevent deterioration of the cerebral microcirculation. (Hypertens Res 1994; 17 Suppl. I: S71-S76)
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  • Bo Carlberg
    1994 Volume 17 Issue SupplementI Pages S77-S82
    Published: 1994
    Released: August 10, 2006
    JOURNALS FREE ACCESS
    Patients with acute stroke often have high blood pressure levels the first days after hospital admission. The causes of high blood pressure in patients with acute stroke are incompletely known. In stroke patients with large cerebral lesions and impaired consciousness, high blood pressure seems to be secondary to high intracranial pressure and in these patients high blood pressure indicates a worse prognosis. In the majority of patients, alert on hospital admission, high blood pressure increases from hospitalization stress and is not related to a worse prognosis. (Hypertens Res 1994; 17 Suppl. I: S77-S82)
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  • Philip A. Wolf, Ralph B. D' Agostino
    1994 Volume 17 Issue SupplementI Pages S83-S88
    Published: 1994
    Released: August 10, 2006
    JOURNALS FREE ACCESS
    Hypertension is the pre-eminent risk factor for stroke with incidence of both ischemic stroke and hemorrhage increasing with level of blood pressure. However, at any blood pressure level, risk of stroke varies widely according to the presence and intensity of other risk factors. These include: age; antihypertensive therapy; presence of cardiovascular disease; cigarette smoking; diabetes; LVH by ECG; and atrial fibrillation. Without risk factor abnormalities, a hypertensive individual may actually have a lower probability of stroke than a normotensive with multiple elevated risk factor levels. The person with multiple borderline risk factor levels is particularly difficult to categorize. To determine probability of stroke, taking the risk factor and blood pressure levels into account, a stroke risk profile was developed using Framingham Study data. Key to the usefulness of the risk profile is the knowledge, derived from observational studies and controlled clinical trials, that modification of a number of these risk factors can reduce the incidence of stroke. These include: reduction of elevated blood pressure, systolic as well as diastolic; cessation of cigarette smoking; improved control of blood sugar level in diabetics; and treatment of persons with atrial fibrillation with low intensity warfarin. Thus, the Framinghan stroke risk profile may guide the physician in identifying patients at heightened risk, and provide guidance in measures that can reduce the likelihood of stroke. (Hypertens Res1994; 17 Suppl. I: S83-S88)
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  • John S. Meyer, Shutaro Takashima, Katsuyuki Obara, Kazuhiro Muramatsu, ...
    1994 Volume 17 Issue SupplementI Pages S89-S96
    Published: 1994
    Released: August 10, 2006
    JOURNALS FREE ACCESS
    This longitudinal study was designed to measure local cerebral perfusion and volumes of leuko-araiosis among four groups of patients with multiple cerebral infarctions in order to: 1) compare results among those with and those without cognitive impairments and 2) compare results among IVD patients that stabilized and those whose cognitive test performance continued to deteriorate over a follow-up interval of two years. An important part of the study was designed to analyze the effects of control of hypertension among a group of 49 patients with IVD who have been followed prospectively for a mean interval of two years. Results indicate that cognitive impairments among IVD patients are regularly associated with leuko-araiosis. Leuko-araiosis is associated with both ischemia and hypoperfusion of white matter, the latter reflecting disconnections between cortico-thalamic projection systems. Significant improvements in cognitive test performance and neurologic status occurred in IVD patients when systolic blood pressure is controlled within the 135 to 150mmHg range. Progressive cerebral hypoperfusion contributes to cognitive declines in stroke patients with IVD so that early interventions should be instituted for controlling risk factors for stroke, especially hypertension, in order to prevent or improve cognitive deterioration. (Hypertens Res 1994; 17 Suppl. I: S89-S96)
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  • Jun Ogata, Junichi Masuda, Chikao Yutani, Toru Sawada, Takenori Yamagu ...
    1994 Volume 17 Issue SupplementI Pages S97-S101
    Published: 1994
    Released: August 10, 2006
    JOURNALS FREE ACCESS
    To elucidate whether hypertension can be a cause of dementia in the elderly, and, if so, what mechanisms are involved in, a clinicopathological analysis was performed in 109 consecutive necropsied patients aged over 65 years. The diagnosis of vascular dementia was established in 17 cases, of which 11 showed leuko-araiosis (L-A) on CT scans and six did not. Of the 17 cases with vascular dementia and 71 nondemented cases, the pathological findings for the brain in 40 cases with L-A were compared with 48 cases without L-A, and those in 11 demented cases with L-A with those in 29 nondemented cases with L-A. Statistical analysis revealed that hypertensive changes of the intracerebral arteries (such as fibrinoid necrosis), lacunes, arteriosclerosis of subcortical white matter arteries, atherosclerosis of Willis circle, and cerebral amyloid angiopathy-associated vasculopathy (CAA-AV) were significantly more frequently found in the cases with L-A than in the cases without L-A. Among the cases with L-A, the incidence of hypertensive changes of the intracerebral arteries and lacunes was significantly higher in those with dementia than in those without. These results suggest that effects of hypertension on small parenchymal arteries and on cerebral atherosclerosis play important roles in the occurrence of L-A, and that the presence of lacunes is an important factor in the development of dementia. Although the proportion of cases with CAA-AV was small, L-A was thought to be caused by CAA-AV independently from the hypertensive and atherosclerotic processes. Senile changes are also suggested to play some role in the development of vascular dementia. (Hypertens Res 1994; 17 Suppl. I: S97-S101)
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  • Takehiko Yanagihara
    1994 Volume 17 Issue SupplementI Pages S103-S107
    Published: 1994
    Released: August 10, 2006
    JOURNALS FREE ACCESS
    With a steady increase in elderly population worldwide, senile dementia has drawn increasing attention. Even though vascular dementia is a common type of senile dementia in some parts of the world, we have had controversies in the definition and diagnostic criteria and the neuropathologic substrates of vascular dementia. To make the matter more complicated, there are regional differences in prevalent type of ischemic vascular dementia in different parts of the world. Those disagreement and regional differences have generated confusion and prevented establishment of a universally acceptable diagnostic criteria. While further efforts are necessary to settle the controversies, it is important, meanwhile, that investigators are aware of the presence of different types of vascular dementia in different parts of the world, and are careful in selecting the diagnostic criteria of vascular dementia which fits well to their purposes and the type of vascular dementia prevalent in their regions. (Hypertens Res 1994; 17 Suppl. I: S103-S107)
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  • Murray Goldstein
    1994 Volume 17 Issue SupplementI Pages S109-S113
    Published: 1994
    Released: August 10, 2006
    JOURNALS FREE ACCESS
    The stroke mortality rate has continued to decline steadily since 1950. This has been paralleled by a decline in the stroke incidence rate. However, in recent years, the stroke incidence rate has leveled and may be increasing. As a result of cerebrovascular and related research, improved methods of primary prevention are now available through control of identified risk factors. In addition, several variables are under investigation which may control the consequences of stroke and improve the quality of life of those afflicted. The direct and indirect economic costs of stroke are very high and there is a high probability they will increase. This is particularly true in populations in which incidence remains high but mortality decreases. (Hypertens Res 1994; 17 Suppl. I: S109-S113)
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  • Christopher J. Bulpitt
    1994 Volume 17 Issue SupplementI Pages S115-S119
    Published: 1994
    Released: August 10, 2006
    JOURNALS FREE ACCESS
    The benefits of treatment with anti-hypertensive drugs not only include a reduction in stroke incidence of 40% but also a reduction in cardiac deaths, severe congestive heart failure, severe retinal changes and almost certainly a reduction in the incidence of angina. The risks depend on the drug employed and include gout and diabetes mellitus for diuretics and symptom side effects with all drugs. Certain drugs have been proven to impair the quality of life of treated patients. The cost of an extra year of life gained is lower in men, in the elderly and at higher levels of diastolic pressure. It is desirable to adjust the years of life gained by their quality (a cost-utility analysis) but such methods await good data. (Hypertens Res 1994; 17 Suppl. I: S115-S119)
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