Van Gool & Bridges
Hypertension
Hypertension is a major risk factor for CHD. It has been shown that untreated
malignant hypertension has an extremely high mortality rate. Further, treated
hypertension can effectively reduce mortality and morbidity (Lawrence and
Cruickshank, 1996).
Men within the western world with blood pressure of 140/90 mmHg will face a risk of
mortality 50% above the average. At 145/95 mmHg the risks of mortality are doubled
(Kannel, 1985). MacMahan et al (1990) reviewed a number of studies, correcting for
any measurement biases. This analysis showed that the relative risk of CHD has a log
linear relationship with blood pressure at all ranges of blood pressure.
Thus a reduction in blood pressure across the whole population would reap greater
rewards than if treatment were focused only on the very high-risk populations
(Lawrence and Cruickshank, 1996).
Diastolic blood pressure was the main criterion used in many early studies18. More
recently, however, systolic blood pressure has been shown to be a better predictor of the
effects Ofhypertension on CHD Liechtenstein et al, 1985).
Alcohol
For a number of years there have been considerable discussions on the protective effects
that a moderate consumption of alcohol can have on CHD. The relationship is however
a complex one (Anderson, 1995 & Holman and Armstrong, 1995). A number of studies
have shown that the consumption of alcohol in the range of one to five drinks a day
reduces the risk of CHD by 40-60% (Jackson and Beaglehole, 1993).
In a review of the epidemiological literature, Anderson (1996) finds that the majority of
papers published in the period of 1978-1990 showed a significant negative relationship
between moderate alcohol consumption and the risk of CHD. Furthermore, the
relationship is present across all ages and sexes, but does seem to be stronger for older
people.
18 See Lawrence and Cruickshank (1996) p27 for references.
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Chere Project Report 11- November 1999