Effects of modulators of the renin-angiotensin-aldosterone system on cough. Losartan Cough Study Group.

Objective: To compare the incidence of cough in patients with a history of angiotensin converting enzyme (ACE) inhibitor-related cough who received losartan [a type 1 angiotensin II (Ang II) receptor antagonist], lisinopril (an ACE inhibitor) or hydrochlorothiazide (a diuretic).

Design: An international, multicentre, randomized double-blind, parallel-group controlled trial.

Setting: Outpatient clinics at 20 tertiary care medical centres in 11 countries.

Inhibition of CYP2D6 activity by treatment with propranolol and the role of 4-hydroxy propranolol.

1. The 4-hydroxylation of propranolol by rat and human liver microsomes is associated with formation of a chemically reactive species which binds irreversibly to cytochrome P4502D6 (CYP2D6) destroying its catalytic function. Therefore, the effect of propranolol treatment (80 mg twice daily) on debrisoquine phenotype was examined, to see if it resulted in phenocopying in vivo.

Non-pharmacological therapy of hypertension.

Weight reduction, moderate sodium restriction and alcohol reduction all lower blood pressure significantly in the short-term, and appear feasible in the long-term. Dynamic exercise may have a useful role in selected patients. Cessation of cigarette smoking has no important effect on blood pressure itself but is likely to improve the prognosis.

Clinical research and the culture of collaboration.

This article aims to share some of the strategies and principles that facilitated the completion of an experimental research project undertaken at the Liverpool Health Service (formerly Liverpool Hospital) in the South West of Sydney. The experience demonstrated the interdependence of the academic and clinical nurse practitioners undertaking the project. A collaborative approach to nursing research in which complementarity of participants is recognised and valued is recommended.

Metabolic effects of diuretics.

Hypokalaemia, hyperuricaemia, hypomagnesaemia and alterations to lipid and glucose metabolism undoubtedly occur with loop and thiazide diuretic treatment. Many of the metabolic effects induced by thiazide diuretics, however, can be limited by the use of low doses. Apart from precipitation of gout and worsening control of diabetes the clinical importance of these changes is slight.

Hepatitis B in the non-residential mentally handicapped population.

This study describes seroprevalence and risk factors for hepatitis B in seven centres caring for non-residential mentally handicapped individuals. Overall, 11% were hepatitis B marker seropositive and 4% had the hepatitis B surface antigen (HBsAg). Male sex and increasing age were associated with seropositive status, and Down's syndrome was associated with the presence of HBsAg.

Local confidential inquiry into avoidable factors in deaths from stroke and hypertensive disease.

Objective: To audit avoidable deaths from stroke and hypertensive disease.

Design: Details of care before death were obtained from general practitioners and other doctors, anonymised, and assessed by two experts against agreed minimum standards of good practice for detecting and managing hypertension.

Setting: Health authority with population of 250,000.

Management guidelines in essential hypertension: report of the second working party of the British Hypertension Society.

Several important new issues have arisen in the management of patients with hypertension. A working party of the British Hypertension Society has therefore reviewed available intervention studies on anti-hypertensive treatment and made recommendations on blood pressure thresholds for intervention, on non-pharmacological and pharmacological treatments, and on treatment goals. This report also provides guidelines on blood pressure measurement, essential investigations, referrals for specialist advice, follow up, and stopping treatment.

Diabetes, impaired glucose tolerance and insulin resistance with diuretics.

There is a definite relation of diuretic treatment to impaired glucose tolerance and biochemical diabetes, and a probable relation to insulin resistance. The effect of diuretics on glucose tolerance is dose-related. Spironolactone does not impair glucose tolerance even at high dosage, but apparent differences between other diuretics may well be due to comparison at doses which are not equivalent.

Thiazide diuretics: first-line therapy for hypertension.

Purpose: To compare low-dose thiazides to beta-blockers, angiotensin converting enzyme (ACE) inhibitors, calcium antagonists and alpha-blockers for simplicity, tolerability, efficacy, safety and cost-effectiveness as first-line treatment for hypertension.

Method: Review of short-term comparative studies, and the outcome of long-term trials with vascular complications of hypertension as endpoints. SIMPLICITY: Among the advantages of thiazides are a flat dose-response; no dose titration; effectiveness when used once a day; no first-dose hypotension; and few contra-indications.

Investigation of selected patients with hypertension by the rapid-sequence intravenous urogram.

The rapid-sequence intravenous urogram (IVU) has tended to fall from favour for investigating hypertension because of its perceived imprecision for detecting renovascular disease. However, no study has examined the value of the IVU as a screening test in appropriately selected patients. We have analysed the diagnostic yield of the rapid-sequence IVU in hypertensive patients selected for features suggesting renal or renovascular disease in a retrospective review of case records from a hypertension clinic.