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The quality of the control of hypertension has been assessed in 18 European population groups, in a multicentre cooperative project. Five approaches were taken: epidemiological survey, clinical evaluation of samples of patient records, assessment of patient satisfaction, exploration of physicians' attitudes and knowledge, and drug utilisation studies. The participating centres could choose any or all of the above approaches; a total of 31 subprojects was carried out. Undiagnosed hypertension varied in different centres from 17% to 34% of all hypertension, and not more than 29% of all treated hypertensive patients had attained normal BP. Diuretics were the most commonly prescribed drugs, followed by beta-blockers. Although physicians expressed their concern about other cardiovascular risk factors and declared that they considered nonpharmacological treatment important, the findings in the patient survey did not confirm such attitudes. Finally, an analysis of patient satisfaction showed a mixed pattern. In conclusion, the control of hypertension in populations, through detection and treatment, as well as patient education and physician information, was studied.

It is well known that combinations of risk factors result in higher risk than their mere sum. The present paper describes, in quantitative terms, the differences between risks pertaining to equal blood pressure elevations at different constellations with other risk factors (smoking and hypercholesterolaemia). From the practical point of view, this concept of 'constellation risk' convincingly underscores the need for controlling, in hypertensive patients, coexisting hypercholesterolaemia and smoking. Also, at equal blood pressure elevations, smoking and hypercholesterolaemic patients are in greater need of antihypertensive medication. This applies in particular to the range of mild hypertension, where individual decisions have to be taken whether to initiate drug treatment.

Sprayer-Spruche sind, international verbreitet, zu einem unubersehbaren Phanomen offentlicher Subkultur geworden. “No future” ist der mit Abstand bekannteste dieser Spruche. Er formuliert elementar und quintessentiell die Befindlichkeit, die sich in einer Wolke analoger Spruche zum Ausdruck bringt. „Hilflos“ tauchte vor einigen Monaten in zittriger Schrift auf Betonwanden in allen Zurcher Stadtquartieren auf. Am Schwarzen Brett des Philosophischen Seminars warnte „Es tickt der Zeitgeist“ wie vor einer Hollenmaschine. „Es gibt ein Leben vor dem Tode“ — ein Konstanzer Universitatssprayerspruch — wirkt in diesem Spruchemilieu schon als Trostwort.

Despite the great therapeutic advances, the control of hypertension in populations is far below the achievable level, even in populations with highly developed health care. By the end of the 1980's, in selected European centres, 18-34% of cases of hypertension were undetected, and among those previously known, 22-38% were untreated. The cooperative WHO/WHL Hypertension Management Audit Project aimed at assessing some of the impediments to better control of hypertension. The concepts and attitudes of 2,215 physicians were surveyed. In various centres and at various patient ages, 25-45% of physicians would not start drug treatment below 100 mm Hg. When inquiring into the perceived reasons why hypertension had not been detected earlier, among other reasons, physicians tended to incriminate their workload, while patients often felt that there was a lack of interest on the doctor's part to take a blood pressure reading. In general, patient satisfaction seemed suboptimal. Physician's sources of information were varied; neither WHO, nor ISH or WHL seemed to play an important role in informing the physicians.

The relationship between serum total cholesterol, measured at randomization, and mortality was investigated in 822 patients, who were followed for an average of 3.1 years in a double-blind trial, conducted by the European Working Party on High Blood Pressure in the Elderly. Serum cholesterol, measured at randomization, was 0.54 mmol/l higher in women than in men, and declined with increasing age in both men (0.028 mmol/l per year) and women (0.036 mmol/l per year). During follow-up on randomized treatment, cholesterol fell by a similar amount with placebo (0.11 mmol/l per year) and with active treatment (0.14 mmol/l per year). Active treatment consisted of hydrochlorothiazide (25-50 mg/day) plus triamterene (50-100 mg/day) with the addition of alpha-methyldopa (0.5-2.0 g/day) in one-third of the patients. Serum total cholesterol, measured at randomization, was independently and inversely correlated with total (P = 0.03), non-cardiovascular (P = 0.03) and cancer (P = 0.04) mortality during follow-up on double-blind treatment. Total and non-cardiovascular mortality were also negatively correlated with haemoglobin and body weight at randomization.

It is worth recalling, not only as a mere curiosity, that as recently as the student years of today’s senior physicians, small doses of phenobarbitone were the best available treatment for hypertension. Phlebotomy and leeches were considered the last recourse in intractable cases, at least in some parts of Central Europe, when combinations of hypnotics, garlic extracts, and mistletoe failed to reduce blood pressure, and the patient, bleeding severely from the nose, was irreparably heading towards uremic death.

Interactions between blood and dialysis membranes lead to activation of the 5-lipoxygenase pathway of the arachiodonic acid metabolism during hemodialysis. Newly generated leukotriene B4 (LTB4) may contribute to the multifaceted granulocyte abnormalities of uremic patients.

As an alternative for MTG bulk YBCO we now report some results on MTG bulk Y(Ho)BCO with the well developed melt texture technology by applying precursor with Y 1-X Ho X Ba 2 Cu 3 O 7.δ (x=0.4) and Y 2 O 3 addition. High zfc levitation forces up to 49N can be measured on the samples, but maximum trapped magnetic fields remain relative low (

Angle-resolved photoemission spectra have been calculated with the one-step model for S/GaAs(0 0 1) and compared with experimental distributions. The data are analysed in terms of the ideal 1 × 1 and, furthermore, of the reconstructed 2 × 6 surface which is assumed to be closest to the experimentally realized structure. Emissions are characterized by electronic structure terms such as energy bands and orbital composition, though partly also by geometric properties. In particular, the determination of the second layer as consisting of Ga atoms has been achieved because of the distinct differences in the theoretical spectra with S–Ga and those with S–As bonds.

Quelques dizaines de publications affirment que l'inactivite physique est un des facteurs de risque de la maladie coronarienne mais la preuve que l'exercice physique contribue a la prevention de cette maladie nous echappe. Toutefois, la poursuite d'une controverse sur la valeur prophylactique de l'activite physique parait deplacee puisqu'une etude controlee n'est pas faisable; d'autre part, l'activite physique etant une fonction physiologique, elle est a recommander meme sans preuve ultime et irrefutable de sa valeur prophylactique. Une activite continue des l'adolescence est recommandee et, sur un plan plus general, une reintroduction de l'activite physique dans la vie quotidienne s'impose comme un important devoir medico-social.

Synthesis of leukotriene B4 (LTB4) upon stimulation of peripheral blood samples with the calcium ionophore A 23187 was studied in patients with primary hyperparathyroidism who underwent parathyroidectomy. Preoperatively, an increased LTB4 concentration of 1.76 +/- 0.19 ng/ml plasma was found, vs. 0.95 +/- 0.28 ng/ml in healthy individuals. On the fourth day after operation, the LTB4 concentration was almost normalized, reaching 1.25 +/- 0.23 ng/ml plasma. At the same time, mean serum calcium levels were reduced from 6.1 +/- 0.6 meq/liter before operation to 4.53 +/- 0.28 meq/liter after operation. In a control group, euthyroid patients with thyroid adenomas who underwent adenomectomy had normal LTB4 levels before operation (0.84 +/- 0.11 ng/ml) and did not show significant changes in LTB4-synthesizing capacity. The results indicate that synthesis of LTB4 in vivo may depend in part on factors related to serum calcium concentration or calcium metabolism.

1. A number of major therapeutic trials in mild hypertension were conducted from 1972 to 1980. With one exception, there was little or no coordination between the trials, although they were dealing with the same problem. 2. A Joint WHO/ISH Mild Hypertension Liaison Committee was set up after most of the trials had started. The objective of the Committee, to promote information exchange and comparisons among the trials, was attained. Certain similarities and disparities between the trials were also identified. 3. Some of the disparities proved useful because they made it possible to analyse the problem from different points of view. Others did not introduce any new elements but, on the contrary, hampered inter-trial comparability. 4. Early standardization of methodological details in such trials is essential, particularly if several studies are to investigate the same problem. This would be possible only if prior agreement were reached concerning research policy, especially in rapidly developing fields of hypertension research.

The long-term sequelae of vasectomy were studied in a retrospective cohort study of 4596 vasectomized and 4340 nonvasectomized farmers from eight rural communes in Sichuan, People's Republic of China. The mean duration since the operation was 14.5 years with a range of 10 to 25 years. At the time of evaluation the vasectomized men were generally healthier than the non-vasectomized for a wide range of health indicators including clinical signs of cardiovascular disease, resting ECG changes, positive ECG changes following a maximal stress test, or fundus abnormalities. The lack of association between vasectomy and cardiovascular disease noted in Europe and the USA is supported by the present study conducted in a population with a low prevalence of cardiovascular disease and risk factors.A study was conducted in Sichuan, China to further determine if any correlation exists between vasectomy and the risk of heart disease. In a retrospective analysis of 4596 men who had received vasectomies and 4340 who had not been vasectomized, it was found that the cardiovascular status of men who had had a vasectomy was actually better that those who had not. The mean duration since the operation was 14.5 years with a range of 10-25 years. The results confirmed past conclusions that vasectomy is not linked with coronary disease. Testing for other endpoints and areas such as stomach ulcer and hypertension indicated that men who had received a vasectomy were in general in better health. Resting ECG changes and positive ECG changes following a stress test further confirmed the results. Mortality associated with vasectomy was also examined with no negative connection found. Vasectomy has been extensively studied and has been proven repeatedly to be a safe procedure that is not linked to adverse effects.

The latter was due to a reduction in cardiac mortality (−38%, p=0.036) and a nonsignificant decrease in cerebrovascular mortality (−32%, p=0.16). In the double-blind part of the trial, the total mortality rate was not significantly reduced (−26%, p=0.077). However, cardiovascular mortality was reduced in the actively treated group (−38%, p=0.023), owing to a reduction in cardiac deaths (−47%, p=0.048) and a non-significant decrease in cerebrovascular mortality (−43%, p=0.15). Deaths from myocardial infarction were reduced (−60%, p=0.043), and study-terminating morbid cardiovascular events were significantly reduced by active treatment (−60%, p=0.0064). Non-terminating cerebrovascular events were reduced (−52%, p=0.026), but the non-terminating cardiac events were not (+ 3%, p=0.98). In the patients randomised to active treatment there were 29 fewer cardiovascular events and 14 fewer cardiovascular deaths per 1000 patient years during the double-blind part of the trial.

The essential implication of the notion of risk factor is that preventive action should be undertaken if certain factors, predisposing to cardiovascular diseases are present in an individual or in a group. Risk factors are thus categorized from the pragmatic point of view, according to the relative ease and practicability of prophylactic intervention -- and their justification. A brief review of the risk factors of the major cardiovascular diseases (coronary heart disease, hypertension, chronic pulmonary heart disease, stroke, rheumatic heart disease and congenital malformations) shows that the risk factor concept is the basis of preventive cardiology.

The epidemiologic associations of smoking with atherosclerosis, especially that of the peripheral and coronary arteries are well known and often quoted. Less frequently are references made to morphological population studies, such as the WHO Cooperative Study of Atherosclerosis of the Aorta and Coronary Arteries in Five Towns (1), although it has clearly demonstrated the grave anatomical consequences of smoking.

High blood pressure readings are relatively frequent during dynamic exercise testing. However, because of the paucity of date concerning normal blood pressure values during exertion and the prognostic significance of exertion hypertension, the attitude to be adopted towards such patients is ill-defined. The present study proposes mean values for BP at a given workload, per age group (less than 20, 20-39, 40-59, greater than 60) and per sex. These values were computed from measurements during dynamic exercise tests performed by 303 subjects (177 male, 126 female) at 100 and 150 watts workloads. Systolic and diastolic pressures during exertion correlated positively with resting blood pressure values (p less than 0.001) and increased with age (p less than 0.001). Hypertension during exertion was defined as values more than 2 SD above mean values for the corresponding age group and sex. 20 subjects met these criteria in our study.

The feasibility and effectiveness of a programme for the community control of rheumatic fever and rheumatic heart disease were studied in a cooperative multicentre project initiated and coordinated by the World Health Organization. The programme was carried out in seven centres in various developing countries of Africa, America, and Asia according to a common protocol, and is under way in a further eight countries in Latin America. Pilot community programmes were shown to be practicable and effective in reducing the burden of rheumatic heart disease in developing countries and their extension to cover entire populations should be encouraged.

Numerous reports indicate that physical inactivity is one of the coronary risk factors; however, proof that exercise has a protective effect is still elusive. Nevertheless, to continue the existing controversy on the prophylactic value of physical activity seems to be inappropriate. On the one hand, a controlled trial is not feasible; on the other hand, physical activity is a physiological function that should be promoted anyway, regardless whether irrefutable evidence of its value in the prevention of coronary heart disease is available. Activity starting in childhood and continuing throughout life is a safe approach. In more general terms, habitual physical activity should be re-introduced into the pattern of life of contemporary society.

Two sets of data, derived from the WHO Cooperative Hypertension Community Control Project and concerned with spontaneous changes of blood pressure over a period of five years, are described. The first deals with the community as a whole, studied through the examination of two independent random samples of the same population made five years apart. The second pertains to cohorts of hypertensive subjects included in the hypertension registers from various centres participating in the WHO programme and followed up for four years.The population blood pressure distribution showed a clear shift towards lower levels for both systolic and diastolic values. The mean changes, however, were smaller than 5 mmHg. In the subjects initially labelled as "hypertensive", the effects of "regression to the mean" were apparent both in the short-term evaluation (five months) and, more importantly, after four years of follow-up. In the latter case, the decreases were more remarkable in the first year but continued to show until the third year.These findings suggest that a "controlled" design is necessary not only in prospective clinical trials but also in community projects where the effects of an intervention on blood pressure are to be evaluated.

In a cooperative study coordinated by WHO, stroke was registered between 1971 and 1974 in 17 centres both in developing and developed countries. A common operating protocol was used to obtain comparable data. Age-adjusted incidence of stroke shows moderate geographical variations, cerebrovascular accidents being common in all the contrasting populations studied in various parts of the world. Data were also obtained on the types of management of stroke patients, their survival rates, and functional prognosis. Control of hypertension, although known to be effective in the prevention of stroke, seemed to be insufficient in most countries. It is concluded that stroke registers may be used as a source of information for the planning and implementation of stroke control programmes in the community.

The binding of agonists (liquorice derivatives) and antagonists (spironolactones and cyproheptadine) to Type I aldosterone binding sites was evaluated in human mononuclear leucocytes and compared with data previously obtained using kidney cytosol or kidney slices from adrenalectomized rats. The affinity of spironolactones (spironolactone and canrenone) is equivalent in all the preparations. In contrast, carbenoxolone and glycyrrhizic acid show no affinity for aldosterone binding sites in mononuclear leucocytes, but bind to receptors in kidney cytosol. The possible explanation of the discrepancies is that, in cytosolic preparations, the two latter compounds may undergo hydrolysis into glycyrrhetinic acid which does possess a measurable affinity for mineralocorticoid receptors in all the preparations.

In a cross-sectional epidemiological survey of the precursors of cardiovascular risk factors, 8-9- and 14-15-year-old boys and girls of Italian and Swiss origin were studied. Each of the 8 groups comprised about 100 participants chosen at random. In total 387 Italian and 410 Swiss participants of comparable socio-economic origin, and residing in Geneva, were studied under standardized conditions. The anthropometric measurements, the determinations of systolic and diastolic blood pressure and the lipoprotein lipids of both ethnic groups are presented and discussed in detail. The blood pressure values show only slight differences between the two ethnic groups, especially in the higher percentiles; significant differences exist, however, between the various anthropometric characteristics, some lipoprotein lipid measurements and sexual maturity. The blood pressure values are clearly correlated with body mass index, sexual maturity, anthropomorphic measurements, and heart rate. The results of the Geneva survey compare well with the reported results of other international studies.

A comprehensive approach to the control of cardiovascular diseases on community level is a new venture. There is not yet enough experience in any country with this approach. However, the attempts to develop new approaches are fully justified, since the present stress on hospital care and treatment of the patients has only little changed the incidence of cardiovascular diseases among our populations.