Bulpitt, C. J., Hodes, C., and Everitt, M. G. (1976). British Journal of Preventive and Social Medicine, 30,[158][159][160][161][162]. The relationship between blood pressure and biochemical risk factors in a general population. The relationship between blood pressure, ponderal index, sex, blood glucose, haemoglobin, serum uric acid, calcium, cholesterol and creatinine, and albumin has been examined in 698 subjects aged between 44 and 49 years from the register of a group general practice. Sixty per cent of the variation in systolic pressure could be explained by statistically significant associations with diastolic pressure, sex, blood glucose, serum calcium, and cholesterol. The diastolic blood pressure (not corrected for systolic pressure) was significantly related only to ponderal index, haemoglobin in men, and cholesterol in women. Pulse pressure was also positively related to the risk factors blood glucose, serum cholesterol, and calcium. The possibility is discussed that one or more of these variables reduce aortic compliance and that the serum calcium contributes to this end. Diastolic, but not systolic pressure, had a prime association with relative weight, obesity being only basically associated with an increase in diastolic pressure.Both systolic and diastolic pressure are good predictors of subsequent mortality and morbidity (Kannel and Dawber, 1974). Diastolic blood pressure is more dependent on peripheral resistance than systolic pressure and the systolic pressure is determined to a larger extent by the compliance of the aorta and large arteries. A raised systolic pressure not only predicts subsequent disease but itself results from vascular damage which has already occurred, the compliance of the aorta being reduced by atherosclerotic disease. On the other hand, peripheral resistance arises mainly in the smaller arteries and arterioles and would be little affected by this condition. It must be noted that diastolic pressure is closely correlated with systolic pressure and factors that increase diastolic pressure may thereby increase systolic pressure.This paper examines the relationship in a general population between systolic and diastolic blood pressure, a weight-height index and biochemical results, some of which are known to be risk factors for atherosclerotic disease. Also assessed are the factors influencing mean blood pressure, pulse pressure, and systolic pressure adjusted for diastolic pressure. The analyses are intended to identify risk factors affecting systolic or diastolic pressure alone and which may operate by reducing aortic compliance or raising peripheral resistance. METHODS POPULATION STUDIEDThe subjects studied were taken from 16 000 patients on the list of a group practice near London, covering mainly an urban area. The middle-aged subjects were screened for hypertension and other abnormalities as previously described (Hodes, 1968a).The subjects were included in a computer file (Hodes, 1968b) and letters were sent to those aged between 44 and 49 years inviting them to attend f...
paralysis had started with an attack six months earlier for which he had been admitted to hospital and which recovered spontaneously after two days with no diagnosis being made. Subsequently he had had several attacks. His mother was told to bring him as soon as the next attack began and the diagnosis of "pulled elbow" was immediately obvious. Other cases were those of young children with episodes of painful arm whose families were suspected of causing non-accidental injury.Altogether 30 children had symptoms for 12 hours or more before being treated. There was no indication that parents of children who had had previous episodes were quicker in coming for medical help than those whose children had not had an earlier attack. A girl of 5k years who had had at least five earlier episodes was not brought for 12 hours and a 4-year-old with two previous attacks arrived after 48 hours. The striking exceptions were the twin sisters who between them had had pulled elbows at least six times and who both came half an hour after the onset. Apart from these twin sisters there was no evidence that siblings of patients were at increased risk of pulled elbow. Even when symptoms had been present for up to four days the child obtained immediate and complete relief with the first manipulation. The exceptional child who needed six manipulations had had symptoms for only two hours before being seen. After the sixth manipulation the mother, when the child was seen a few minutes later, said, "I knew it was all right this time -she forgot about it straight away."Just as pain in the knee may be referred from a hip and vice versa, pain from an elbow may be referred to the wrist or shoulder; 15 children had pain only in the wrist, and a further six had pain predominantly in the shoulder. If this is not realized by doctors it may cause difficulty in diagnosis.
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