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
