Day 252 - 20 May 96 - Page 34


     
     1        unreliability of a single baseline blood pressure of blood
     2        pressure as a guide to an individual's usual pressure and
     3        for the effects of blood cholesterol, smoking and age, a
     4        7.5 millimetre HG difference in diastolic pressure within
     5        the range 70-110 millimetres HG was accompanied by a 29
     6        percent difference in CHD risk and a 46 percent difference
     7        in risk of stroke, irrespective of sex, age group or
     8        ethnicity.  The association almost certainly arises through
     9        enhancement of several components of cardiovascular
    10        pathology by raised blood pressure."
    11
    12        Would you agree with that?
    13        A.   Yes.
    14
    15   Q.   And 5.3.2:
    16
    17        "Blood pressure and stroke:  Reducing blood pressure leads
    18        to reduced risk of stroke.  The overview of 9 prospective
    19        trials found that a difference of 5 millimetre HG in
    20        diastolic blood pressure was associated with at least 34
    21        per cent less stroke.  In an overview of 14 radomised
    22        trials" -- that is not particularly relevant, but I might
    23        as well read it all:
    24
    25        "In an overview of 14 radomised trials of anti-hypertensive
    26        potensive drugs, in which the mean diastolic reduction in
    27        diastolic blood pressure was 5-6 millimeters HG over 5
    28        years, stroke was reduced by 42 percent.  This suggests
    29        that all the epidemiologically expected stroke reduction
    30        appears rapidly."
    31
    32        You would agree with that, would you?
    33        A.  Yes, I have no problem with it.
    34
    35   Q.   The last paragraph in this section reads:
    36
    37        "5.3.4:  For the individual patient, the importance of
    38        hypertension is directly related to the degree of elevation
    39        of the blood pressure.  For the community, the more
    40        important burden of hypertension-related morbidity comes
    41        from higher levels of blood pressure within the
    42        conventionally accepted normal range than from more severe
    43        grades because they are much more common and account for
    44        the majority of deaths and non-fatal clinical events
    45        attributable to raised blood pressure."
    46
    47        You would agree with that?
    48        A.   Yes, I accept that.
    49
    50   Q.   On page 26, in the Burden of Disease, which is 1.4.4, you 
    51        said you did not have figures off the top of your head but 
    52        it says here: 
    53
    54        "Cardiovascular disease (CHD and stroke) are the major
    55        causes of death in men and women.  In 1990 CHD accounted
    56        for 30 per cent of male deaths and 23 percent of female
    57        deaths.  Stoke accounted for 15 percent of female deaths
    58        and 9 per cent of male deaths.  Coronary heart disease and
    59        stroke are also importance causes of premature, (ie before
    60        age 65) mortality; in men CHD caused 37 per cent of deaths

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