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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Using cholestyramine as a model, we considered the cost-effectiveness of antihyperlipemic therapy in the primary prevention of coronary heart disease among men between 35 and 74 years of age with elevated levels of total plasma cholesterol. Our findings indicate that the cost-effectiveness of treatment varies substantially, ranging from about $36,000 to over $1 million per year of life saved. Cost-effectiveness was highest for younger patients, for those with additional coronary risk factors (eg, smoking or hypertension), and for those whose course of therapy is of less-than-lifelong duration. Conversely, it is lowest for older patients, for those with no additional coronary risk factors, and for those who are treated for a lifetime. Our results suggest that pharmacologic therapy may not be cost-effective for all patients with elevated cholesterol levels, especially those over 65 years of age. For many younger patients, however--those with additional coronary risk factors and more severe elevations in cholesterol levels--the cost-effectiveness of therapy may be comparable with other accepted medical practices.
JAMA 1987 Nov 06
PMID:Cost-effectiveness of antihyperlipemic therapy in the prevention of coronary heart disease. The case of cholestyramine. 311 60

Isolated systolic hypertension (ISH), defined as systolic blood pressure of 160 mm Hg or greater when the diastolic pressure is less than 95 mm Hg, is a common form of hypertension among the elderly. We collected incidence and prevalence data on ISH and evaluated several potential factors for its occurrence in the Framingham Heart Study during 16 biennial examinations. The factors evaluated were age, sex, all components of the blood pressure (systolic and diastolic blood pressure, pulse pressure, and mean arterial pressure), Metropolitan relative weight, serum cholesterol level, serum uric acid level, cigarette smoking, ventricular heart rate, glucose intolerance, and hematocrit. The population at risk (1687 men and 1992 women) were those members of the Framingham cohort with a systolic blood pressure less than 160 mm Hg in the first four biennial examinations. Results showed ISH in 14.4% of the men and 22.8% of the women. Cumulative incidence rates were 418 per 1000 in men and 533 per 1000 in women. Significant risk factors for ISH were age, sex, all components of the blood pressure, and increased relative weight in women. We conclude that ISH is a highly prevalent disorder. Its major determinants are age, sex, increasing levels of blood pressure, and obesity in women.
JAMA 1988 Dec 16
PMID:Determinants of isolated systolic hypertension. 321 Feb 85

Nitroglycerin and the long-acting nitrates are beneficial in stable and unstable angina pectoris and acute myocardial infarction and as adjunctive therapy in congestive heart failure. Nitroglycerin compounds relax vascular smooth muscle, producing venous, arterial, and arteriolar dilatation. These actions are modulated by stimulation of intracellular cyclic guanosine monophosphate. Nitrate efficacy in ischemic heart disease is due to peripheral venous and arterial vasodilatation that results in decreased myocardial oxygen consumption. Nitrates also dilate coronary arteries and collaterals, reverse coronary vasoconstriction, and enlarge some coronary atherosclerotic lesions. Nitrates improve exercise performance in stable angina pectoris. Intravenous nitroglycerin should be used in the initial treatment of unstable angina. Nitrates may be beneficial in myocardial infarction for control of ischemic pain, acute hypertension, and left ventricular failure. In subjects with congestive heart failure, nitrates reduce symptoms and improve exercise tolerance. Nitrate tolerance is a problem with continuous nitrate therapy. Tolerance is most likely to occur with frequent dosing or the use of long-acting nitrates, particularly transdermal nitroglycerin disks, and can be prevented or reversed with intermittent-dosing regimens.
JAMA 1988 Jan 15
PMID:A reappraisal of nitrate therapy. 327 14

Recent studies have linked regular physical activity with reduced likelihood of developing coronary heart disease. Even low- and moderate-intensity exercise such as walking, when carried out consistently, is associated with important cardiovascular health benefits. Walking has also been shown to reduce anxiety and tension and aid in weight loss. Regular walking may help improve cholesterol profile, help control hypertension, and slow the process of osteoporosis. Recent physiological studies have demonstrated that brisk walking provides strenuous enough exercise for cardiovascular training in most adults. A recently developed submaximal 1-mile walk test provides a simple and accurate means for estimating aerobic capacity and guiding exercise prescription. These new insights and tools will assist the clinician in the prescription of safe and effective walking programs.
JAMA 1988 May 13
PMID:Walking for health and fitness. 328 85

The scientific basis of treatment decisions is analyzed, using controversies about the treatment of mild hypertension to illustrate both the importance and limitations of using data obtained from clinical trials to guide decisions involving risk factor intervention. The ethical aspects of treatment decisions are then considered, with emphasis on the role of patient participation in treatment decisions. It is recommended that, to improve the ability of clinical medicine to apply successfully and ethically the fruits of medical science, further research must be undertaken to understand the full effects of medical diagnoses and treatments; what physicians understand about the risks and benefits of treatment; what patients expect when they consent to the manipulation of risk factors; and how collaborative decision making between physician and patient can be improved.
JAMA 1988 Jun 03
PMID:Science, ethics, and the making of clinical decisions. Implications for risk factor intervention. 328 47

We present a case in which a patient took an overdose of captopril (Capoten) and alprazolam (Xanax) in a suicide attempt. The patient presented with hypotension (systolic blood pressure of 80 mm Hg) and drowsiness. The hypotension initially responded to administration of intravenous fluids and dopamine; however, it recurred twice at 18.5 and 24.5 hours after ingestion. These episodes again responded to administration of fluids and dopamine. A plasma captopril level of 27,391.1 nmol/L (5982 ng/mL) was documented, as well as a depressed level of angiotensin converting enzyme. Captopril is an angiotensin converting enzyme inhibitor used in the management of hypertension and ventricular failure; to our knowledge, this is the first case of an acute captopril overdose reported in the English-language literature. The role of captopril in inducing hypotension is discussed herein.
JAMA 1988 Jun 10
PMID:Captopril overdose resulting in hypotension. 328 10

Twenty-one percent of 292 patients with untreated borderline hypertension (clinic diastolic blood pressures persistently between 90 and 104 mm Hg) were found to have normal daytime ambulatory pressures (defined from a population of normotensive subjects). These patients were defined as having "white coat" hypertension, and they were more likely to be female and younger, to weigh less, and to be more recently diagnosed than patients whose pressure was elevated both in the clinic and during ambulatory monitoring. Patients with white coat hypertension did not show a generalized increase of blood pressure lability, nor an exaggerated pressor response while at work. The phenomenon is more pronounced when blood pressure is measured by a physician than by a technician. In such patients, the pressor response may be relatively specific to the physician's office and lead to significant misclassification of hypertension.
JAMA 1988 Jan 08
PMID:How common is white coat hypertension? 333 40

The impact of cigarette smoking on stroke incidence was assessed in the Framingham Heart Study cohort of 4255 men and women who were aged 36 to 68 years and free of stroke and transient ischemic attacks. During 26 years of follow-up, 459 strokes occurred. Regardless of smoking status and in each sex, hypertensive subjects had twice the incidence of stroke. Using the Cox proportional hazard regression method, smoking was significantly related to stroke after age and hypertension were taken into account. Even after pertinent cardiovascular disease risk factors were added to the Cox model, cigarette smoking continued to make a significant independent contribution to the risk of stroke generally and brain infarction specifically. The risk of stroke increased as the number of cigarettes smoked increased. The relative risk of stroke in heavy smokers (greater than 40 cigarettes per day) was twice that of light smokers (fewer than ten cigarettes per day). Lapsed smokers developed stroke at the same level as nonsmokers soon after stopping. Stroke risk decreased significantly by two years and was at the level of nonsmokers by five years after cessation of cigarette smoking.
JAMA 1988 Feb 19
PMID:Cigarette smoking as a risk factor for stroke. The Framingham Study. 333 99

The Hypertension Detection and Follow-up Program (HDFP) previously described a significant reduction in five-year, all-cause mortality in its intensively treated stepped care (SC) group relative to its referred care (RC) control group. At the time this finding was described, a proportion of the SC cohort had been treated for periods as long as 6.7 years, but comparable RC and SC mortality data beyond five years were not available. These data, which are described herein, indicate that the 6.7-year life-table mortality rates were 95.1/1000 participants for SC vs 116.3/1000 participants for RC, a larger mortality difference than was observed at five years. This favorable finding for SC extended to all major subgroups, including white women and those aged 30 to 49 years at trial entry. Six months after the close of the treatment trial, a two-year posttrial surveillance study, which extended mortality follow-up to 8.3 years, was conducted. The posttrial use of antihypertensive medication declined in SC and increased in RC participants so that by the end of the posttrial period, there was little difference in the percentages of SC and RC participants taking medication. Control of blood pressure, indicated by mean diastolic blood pressure and by percent of participants with a pressure of 90 mm Hg or less, was slightly better for SC than for RC participants (SC group, 86.5 mm Hg and 68% controlled; RC group, 87.8 mm Hg and 62% controlled). The absolute mortality advantage found at 6.7 years persisted and increased throughout the posttrial period of follow-up despite discontinuation of the formal SC therapy program. It is postulated that regression of hypertensive end-organ changes brought about by the more effective SC treatment caused this favorable outcome.
JAMA 1988 Apr 08
PMID:Persistence of reduction in blood pressure and mortality of participants in the Hypertension Detection and Follow-up Program. Hypertension Detection and Follow-up Program Cooperative Group. 334 88

Whole-day ambulatory monitoring is used for diagnosing hypertension and for judging response to treatment. We evaluated both of these properties in an antihypertensive trial with the calcium channel blocker diltiazem hydrochloride. Measured by a conventional sphygmomanometer, systolic and diastolic blood pressures fell significantly in patients who received diltiazem, whereas no consistent changes occurred in those who received placebo. Administration of the drug also decreased systolic and diastolic blood pressures evenly throughout the day, as determined by automated monitoring. The 15 diltiazem-treated patients were subdivided into those whose clinically diagnosed hypertension was confirmed by pretreatment blood pressure monitoring (24-hour average diastolic blood pressure, greater than or equal to 90 mm Hg; n = 9) and those whose 24-hour blood pressures failed to meet this criterion (n = 6). Diltiazem therapy decreased average whole-day blood pressures by 18/13 mm Hg in the hypertensives but by only 0/1 mm Hg in the others. Thus, whole-day blood pressure monitoring strengthens antihypertensive trials by documenting efficacy and duration of treatment. In addition, it enhances the diagnosis of hypertension, thereby identifying those patients in whom treatment seems justified.
JAMA 1988 Jun 10
PMID:Characterization of antihypertensive therapy by whole-day blood pressure monitoring. 337 59


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