SUlYllYlary. The present study was conducted on 15IO persons between 1 December 1973 and 31 December 1980. Of these, 1478 (97·9 per cent) were traced by questionnaire. Of those traced, 1252 were male and 226 were female. There were 194 deaths of whom 160 were male and 34 female. The main causes of death are cardiovascular, renal, respiratory, suicide and neoplastic. Compared with the 1973 study, there has been a marked decrease in deaths due to renal disease and a marked increase in deaths due to suicide and liver disease and the abuse of alcohol. A study of the new deaths allowed one to note a relative mortdlity rate to be 186 per cent for partial paraplegics, 209 per cent for partial tetraplegics; 318 per cent for complete paraplegics and 767 per cent for complete quadriplegics. The approximate application of these rates to current (1975-77) mortality tables permitted the calculation of theoretically derived life expectation at various ages. These indicated an improved life expectation for all categories.
Since the senior author's first publication forty years ago on the relationship of sodium and potassium to hypertension, these clinical investigations have continued, and in 1958 were established at the Geriatric Study Centre in Toronto. Here, studies were started on the urinary excretion (as an index of intake) of sodium and potassium in subjects with normal blood pressure and in patients with hypertension. Some of the findings are reported in this article, including evidence for the accuracy of the laboratory values, and determination of the normal ranges for serum sodium, serum potassium, serum chloride and blood urea nitrogen in a small group of elderly persons. These studies demonstrated: 1) in persons with normal blood pressure, the urinary excretion (and presumably the intake) of sodium averaged 3.75 gm (9.375 gm NaCl) per day; 2) sodium‐restricted diets, as applied before the study, had been grossly inadequate (excretion 2 gm sodium per day); 3) the study regimen (sodium‐restricted, potassium‐rich intake plus chlorothiazide) had a beneficial effect on hypertension; 4) the potassium supplements induced a sharp rise in the urinary excretion of potassium; and 5) the lack of serious abnormalities in the levels of serum sodium, serum potassium and blood urea nitrogen indicated the safety of this regimen within the limits of this study. The authors have continued to treat hypertension with a sodium‐restricted (400 mg daily) diet, a small dosage (250 mg daily) of chlorothiazide, and potassium (4 gm daily) supplements. The findings on groups of patients treated as long as twelve years are recorded. Hypokalemia as a complication of thiazide therapy is discussed and its potential dangers emphasized. A case of recurrent hypokalemia during a three‐year period is presented to demonstrate certain clinical manifestations and the influence of hypokalemia on the electrocardiogram. The effect of the described therapeutic regimen is also detailed in a case of renovascular hypertension engrafted on essential hypertension, and in a case of hypertension treated by the Smithwick operation. The effect of therapy on morbidity and mortality from hypertension is discussed.
A study was made of the residents of Metropolitan Toronto Homes for the Aged attending the Cardiovascular Clinic of the Geriatric Center for the period 1963–1967, who had a systolic blood pressure as high as 180 mm Hg or a diastolic pressure as high as 100 mm on at least two occasions. These 183 patients were classified into two groups: (a) 100 who were treated for hypertension chiefly by thiazide drugs, and (b) 83 who were not treated for hypertension. These two groups were comparable in regard to age, blood pressure, associated diseases and causes of death. For those treated with small doses of thiazide, the mortality rate was about half the rate for the untreated group. Although the findings are based on a small sample (183 persons, 560 life‐years, and 78 deaths), they suggest that even a slight reduction of high blood pressure by thiazide therapy in the elderly population studied was associated with a lower rate of mortality than in a similar group of persons who did not receive thiazides.
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