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

Three groups of allied health professionals, including dental hygienists, dietitians, and certified nurse-midwives, were surveyed to determine current practice, beliefs, and attitudes regarding health promotion and disease prevention. The study aimed to explore the power of selected variables drawn from social learning theory in predicting self-reported level of counseling. We conducted separate analyses for 10 areas of health promotion and disease prevention: high blood pressure, smoking, lack of exercise, overweight, high-fat diet, alcohol abuse, illicit drug use, stress, isolation and loneliness, and nonuse of safety belts. The predictor variables were respondents' professional group membership, confidence that they possess appropriate skills and knowledge to counsel patients (self-efficacy), belief that patients will follow through on recommendations (adherence expectation), and belief that reduction of risk will improve patients' health status (expectation of health impact). The level of counseling activity varied markedly across the risk areas, with blood pressure and weight receiving the most emphasis on average and isolation and loneliness and nonuse of safety belts receiving markedly less attention. There also was variation across the professional groups. Certified nurse-midwives had higher mean counseling scores in all topics except those related to diet, where the dietitians' mean scores were approximately the same. Of all the areas about which counseling might be increased, use of safety belts stands out as having the lowest reported prevalence, the least complexity in terms of implementation, and the most relevance to at least two of the professional groups. These findings suggest the importance of skills training, including the provision of actual or simulated counseling experience and modeling by others in the same professional group.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Selected predictors of health promotion counseling by three groups of allied health professionals. 239 39

Returning to the patient presented today, perhaps we can now understand some of his findings. As I noted, men are more likely to demonstrate alterations in calcium metabolism associated with elevations in blood pressure. Furthermore, blacks are more likely than whites to develop hyperparathyroidism, particularly in the third and fourth decades of life. It is unlikely, however, that parathyroid hormone was responsible for the increase in this patient's arterial pressure because PTH has a vasodilating action. Moreover, the long-term response to parathyroidectomy is more likely to be an increase rather than a decrease in blood pressure. It is also unlikely that the mild elevations in the serum total calcium observed in this patient were responsible for his hypertension. Correction of hypercalcemia by surgical intervention failed to improve the blood pressure. There is little evidence that mild, protracted hypercalcemia can account for increases in arterial pressure. Finally, the patient's alcohol abuse might have contributed to his elevated blood pressure; it is possible that his hypertension was in part a reflection of the abnormal calcium metabolism he developed as a consequence of the alcohol abuse. Answers to some questions we faced when we first studied this patient more than a decade ago can be provided by the wealth of basic research and clinical investigation that has occurred since. We now know that calcium metabolism is a factor in blood pressure regulation in some humans and in some experimental models. Epidemiologic studies document a consistent association between lower dietary calcium intake and higher blood pressures in humans. An additional non-pharmacologic approach has been identified that can produce a modest but important lowering of blood pressure in a subset of hypertensive individuals. Much data show that calcium-regulating hormones have important cardiovascular actions that might account for some of the mechanisms by which increased dietary calcium lowers blood pressure. Research in this area also has set the stage for exploring another theoretical mechanism for sodium-chloride-sensitive hypertension. Finally, a theoretical mechanism(s) has emerged that could provide a pathophysiologic link between hypertension and certain high-risk populations such as blacks, the elderly, type-II diabetics, and pregnant women. The principal clinical implication derived from this work to date is the following: In patients with mild to moderate hypertension, the level of dietary calcium intake should be assessed. Patients whose intake is deficient should be encouraged simply to maintain calcium intake at 800 to 1000 mg/day.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Calcium metabolism and hypertension. 254 Mar 74

In the past years several studies have confirmed the causal role of the three major risk factors, i.e. hypercholesterolemia, hypertension and cigarette smoking in the determination of atherosclerosis and its major complication, coronary heart disease (CHD). In particular the Lipid Research Clinics Primary Prevention Trial and, more recently, the Helsinki Heart Study, have demonstrated beyond doubt the effectiveness of dietary and pharmacological intervention in subjects affected by hypercholesterolemia. The mounting alertness derived from the results of these and other trials has generated the need for "codifying" strategies directed towards the prevention of CHD in the industrialized western world. The population strategy tends to modify cultural and environmental habits such as diet, cigarette smoking, alcohol abuse, physical exercise etc. The individual strategy is directed at identifying, within each population, those individuals who are probably carriers of a particular risk factor, for instance those affected by hyperlipidemia of genetic origin. The two strategies are intended to be two complementary moments in the ceaseless fight against CHD.
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PMID:[New trends in the prevention of ischemic heart disease]. 270 23

It is common for patients to be diagnosed as having valvular regurgitation by Doppler echo when no such murmur has been heard by the referring clinician. To test the hypothesis that such patients have clinically unimportant heart disease, the authors evaluated the records of 213 consecutive men in whom mitral regurgitation had been found by pulsed Doppler. In 95 patients (group I) mitral regurgitation was audible, whereas in the other 118, it was not. In 97 patients with inaudible mitral regurgitation there were no structural mitral valve abnormalities by 2D echo. This group of 97 patients (group II) was defined as having unexpected Doppler mitral regurgitation. In group II patients there was a high prevalence of hypertension (50%), congestive heart failure (44%), alcohol abuse (46%), diabetes (27%), coronary artery disease (63%), and atrial fibrillation (13%). The following variables were distributed similarly in groups I and II: survival time, age, presence of congestive heart failure or coronary artery disease, left ventricular short-axis end diastolic and end systolic dimensions, E point septal separation, and the severity of dyssynergy. Atrial fibrillation was more common in group I (p = 0.017), and group I patients had a higher Quetelet's Index (weight/height squared) (p = 0.03). In group II, the factors most closely related to survival were the presence of dyssynergy, of atrial fibrillation, or of congestive heart failure. Although no group II patient had endocarditis or required mitral valve replacement, their survival was markedly decreased compared with people of similar age in the general population. The majority of cardiogenic deaths in group II patients were due to coronary artery disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The natural history of unexpected Doppler mitral regurgitation. 270 50

A random sample of the rural community (two villages) were examined by means of questionnaire. Seventy-four percent of the community could not denote any risk factors of arterial hypertension. A very low percentage were informed of the role played by sodium chloride in the genesis of hypertension. Moreover, the community was very poorly informed of the adverse effects of overweight, tobacco smoking, and alcohol abuse. Excess use of sodium chloride was likely to be one of the causes promoting high prevalence of arterial hypertension. Some of the people were of opinion that arterial blood pressure might be influenced by definite nutritional and non-nutritional factors. The data obtained point to a low enough level of hygienic knowledge of the rural community regarding arterial hypertension risk factors. It is concluded that high prevalence of arterial hypertension risk factors and the low level of information of those factors provide evidence in favour of carrying out large-scale measures aimed at primary prophylaxis of arterial hypertension in the rural community. It is stressed that one should begin with the raising of the hygienic knowledge standards of the community.
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PMID:[Knowledge of the rural population on factors promoting the emergence of arterial hypertension]. 271 7

This second part of a study comparing general practice consultations in Bourke in 1968 and 1985 examines attendances with non communicable diseases. Over the period, Aboriginal consultations for genitourinary diseases, diabetes, alcohol abuse, hypertension, and musculoskeletal disorders have increased. By 1985, most of these were more common among Aboriginal than non Aboriginal patients in the 30 to 50 year age group. This group also has a higher mortality. The role of the general practitioner is discussed.
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PMID:The change in rural practice. Bourke 1968 to 1985. 278 62

The role of preventive medicine in reducing mortality and morbidity is now widely recognized. Although general practitioners appear to be in an excellent position to offer preventive care, there is evidence that they currently do not detect or intervene for common risk behaviours. One reason for this may be the general practitioner's perception that patients do not expect such preventive activities to be a part of the doctor's role. A postal survey of 309 people randomly selected from the community was undertaken to examine perceptions about the general practitioner's role in detection and intervention for smoking, alcohol abuse, emotional problems and hypertension. Responses to the survey from 264 usable questionnaires indicated that people in the community accepted the general practitioner's role in preventive care, with most respondents indicating that they would appreciate being asked about the risks examined, would like the offer of intervention and would try treatments in these areas offered by the doctor. Few respondents indicated that they would change doctors as a result of preventive activity.
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PMID:Community views about the role of general practitioners in disease prevention. 279 21

Women of low socioeconomic status (SES) are known to have a higher incidence of low birthweight (LBW) infants who are a major source of neonatal mortality and morbidity. SES, however, does not define a homogeneous population. If prenatal programs could be oriented specifically toward women of higher risk within the low SES population, they should be more effective. Within our uniformly low SES population, we compared mothers who had given birth to infants weighing less than 2000 g with mothers of infants weighing over 3000 g in order to identify factors associated with a LBW birth. We found medical factors, including hypertension and infection during pregnancy, demographic factors, including race, marital status, and lack of prenatal care, and lifestyle factors, including drug and alcohol abuse, to be more common among women giving birth to infants weighing less than 2000 g. These factors can be used to develop more effective intervention programs for low SES populations.
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PMID:Maternal factors associated with delivery of infants with birthweight less than 2000 grams in a low socioeconomic population. 280 82

The prevalence of heavy alcohol consumption is a major problem of increasing proportions throughout the world. Although alcohol sensitizing drugs and more recently serotonin uptake inhibitors are drug interventions with some following, their long term beneficial consequences have yet to be demonstrated. In recent years, we have demonstrated that manipulating activity in the renin-angiotensin system will dramatically alter voluntary alcohol consumption in rats. Based on these findings, the present study evaluated the ability of a class of drugs known as the angiotensin converting enzyme inhibitors to reduce voluntary alcohol drinking in laboratory animals. These drugs prevent the conversion of angiotensin I to angiotensin II. They have been licensed for use in Europe and North America and are indicated in the treatment of hypertension. Our experiments showed that both captopril (Capoten, Squibb) and enalapril (Vasotec, Merck Sharpe & Dohme) can reduce alcohol drinking in both normotensive and hypertensive animals regardless of whether the pattern of intake is in a bout or of a less exaggerated nature. Furthermore, this change in alcohol intake can occur without concomitant changes in blood pressure, plasma renin activity, overall fluid balance, or the distribution and metabolism of alcohol. Taken together these findings suggest that the angiotensin converting enzyme inhibitors should be evaluated in a clinical setting for they may prove to be a useful new treatment or treatment adjunct for alcohol abuse in humans.
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PMID:Angiotensin converting enzyme inhibitors: animal experiments suggest a new pharmacological treatment for alcohol abuse in humans. 283 50

Alcohol abuse is a frequent contributor to elevated blood pressure, but the literature is ambiguous about the role of hypertension in producing left ventricular dysfunction. Fifty asymptomatic male alcoholics admitted for detoxification were studied using echocardiograms and systolic time intervals. Alcoholics were separated into Group I (28 with hypertension) and Group II (22 without hypertension). Forty-four patients had analyzable echocardiograms and were compared to 29 nonalcoholics. Group III consisted of 14 nonalcoholics with hypertension. Group IV consisted of 15 normotensive nonalcoholics (controls). The ejection fraction and shortening fraction were reduced in Group I (p less than 0.05). Hypertensive alcoholics had increased left ventricular mass indices but less than hypertensive nonalcoholics. Left ventricular wall stress was compared to mass as an index of ventricular compensation. The wall stress to mass index for hypertensive alcoholics was 1.65 as compared to 1.43 for the controls. Alcoholics without hypertension had a wall stress to mass ratio of 1.54. Hypertensive patients had a reduced wall stress to mass ratio of 1.38 when compared to controls. These data suggest an inappropriate compensatory response to afterload. Alcohol and hypertension combined may be more harmful to left ventricular function than either disease alone.
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PMID:Echocardiographic abnormalities in chronic asymptomatic alcoholics. 292 41


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