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

The clinical efficacy of using specially trained nurses to treat hypertension at the patient's place of work was compared in a controlled trial with management by the patient's family doctor. The 457 study participants were selected from 21 906 volunteers in industry and government whose blood-pressure was screened. The nurses were allowed to prescribe and change drug therapy at the work site without prior physician approval. Patients randomly allocated to receive care at work were significantly more likely to be put on antihypertensive medications (94.7% vs 62.7%, to reach goal blood-pressure in the first six months (48.5% vs 27.5%), and to take the drugs prescribed (67.6% vs 49.1%). Only 6% of patients were dissatisfied with the care provided by the nurses. Thus provision of care at work by specially tranined nurses was well accepted and resulted in significantly improved blood-pressure control and medication compliance among employees with asymptomatic and uncomplicated hypertension.
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PMID:Work-site treatment of hypertension by specially trained nurses. A controlled trial. 9 1

The pivotal role of the kidney in sustaining hypertension from any source or etiology is becoming increasingly clear. The possibility that the renal vasculature participates not only in the pathogenesis of renal vascular hypertension, but also in that of essential hypertension, has been the subject of continuing interest for 40 years. Evidence that a functional abnormality resulting in increased renal vascular tone is present in about two-thirds of patients with uncomplicated essential hypertension is reviewed, along with more circumstantial evidence that sympathetic nervous system activity operating on the renal vasculature is responsible. Two additional groups of patients in whom a characteristic abnormality of the renal vasculature is present have also been identified. In one group there is severe hypertension which is resistant to most forms of antihypertensive therapy but which is especially responsive to propranolol. In these patients renal blood flow and glomerular filtration rate are reduced, renin secretion rate is increased and the renal vessels are resistant to vasodilators, suggesting the presence of advanced organic arteriolonephrosclerosis, as a complication of long-standing, severe hypertension. The renal lesion, in turn, contributes to the increasing severity of the process. In a second group of patients, generally young and with uncomplicated hypertension, renal blood flow is inappropriately increased. In these patients a number of observations on their renal vasculature, renin and aldosterone responses to a volume challenge suggest an abnormality in the perception of extracellular fluid volume. A perfectly normal renal arterial tree, free of organic abnormality or an increase in tone due to active vasoconstriction, is distinctly unusual in essential hypertension.
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PMID:The renal circulation in hypertensive disease. 79 87

A program linking detection to treatment was designed to improve blood-pressure control among adults with asymptomatic, uncomplicated hypertension. Key elements of this program were provision of all diagnostic and therapeutic services at work site, integration of delivery system with the administration of a labor union, adherence to rigid protocol, and continuous patient surveillance by nurses and paraprofessionals. At the first program site, Gimbels's principal New York City department store, 84 per cent of 1850 employees were screened, and 65 per cent of 186 with confirmed hypertension elected the treatment program. Of the 94 patients followed for one year, 97 per cent remained under therapy, with no untoward effect, and 81 per cent of patients had satisfactory blood-pressure reduction. This approach appears to be a safe, effective, and acceptable method for hypertension control in large numbers of patients.
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PMID:Detection and treatment of hypertension at the work site. 112 41

The prevalence of primary and secondary hypertension and of heart and kidney involvement was thoroughly studied in 689 hypertensive subjects derived from a blood pressure screening examination of a total population sample of Swedish men (n = 7,452). The prevalence of secondary hypertension was found to be only 5%, the prevalence of surgically curable hypertension being even lower. Left ventricular hypertrophy and slight heart enlargement were each found in about one-third of the hypertensive patients, while severe heart enlargement, left ventricular hypertrophy on ECG, proteinuria, abnormal serum creatinine and urinary sediment were each found in about 5%. On the basis of these findings, a minimum pre-treatment workup in uncomplicated hypertension is proposed.
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PMID:Pre-treatment workup for antihypertensive treatment. 127 68

Analysis of the available evidence indicates that diuretics do not increase coronary heart disease morbidity and mortality. The multiclinic trials supporting the cardiotoxicity hypothesis are few in number and flawed in design. The majority of the trials, including the well designed trials, indicate no excess of coronary heart disease (CHD) events in diuretic-treated patients compared with those given other drugs or placebo. Recent studies indicate no increase in cardiac arrhythmias after diuretic treatment. Also, although depletion of intracellular potassium and magnesium occurs in patients with congestive heart failure even without diuretics, intracellular concentration of these ions is not significantly reduced by diuretics in patients with uncomplicated hypertension. Modest elevations of serum cholesterol may occur during the first 6 to 12 months of treatment with thiazide diuretics. However, after this time these elevations fall to or below the pretreatment level. The fall may be greater in patients receiving other drugs but the differences are small and their clinical significance is questionable. The incidences of hyperglycaemia and diabetes were only minimally increased in long term clinical trials while the importance of hyperinsulinism and insulin resistance in causing CHD remains unproven in patients. Thiazides remain, therefore, a safe and effective treatment for patients with hypertension.
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PMID:Adverse effects of diuretics. 141 93

The objective of this study was to determine whether a hypertension management program in which patients monitor their own blood pressure (BP) at home can reduce costs without compromising BP control. The prospective, randomized, controlled 1-year clinical trial was conducted at four medical centers of the Kaiser Permanente Medical Care Program in the San Francisco Bay Area. Of 467 patients with uncomplicated hypertension who were referred by their physicians, 37 declined to participate in the study; 215 were randomly assigned to a Usual Care (UC) group and 215 to a Home BP group. Twenty-five UC patients and 15 Home BP patients did not return for year-end BP measurements. Patients in the UC group were referred back to their physicians. Patients in the Home BP group were trained to measure their own BP and return the readings by mail. Patients were given a standard procedure to follow in case of unusually high or low BP readings at home. The number and type of outpatient medical services used were obtained from patient medical records for the study year and the prior year. Costs of care for hypertension were calculated by assigning relative value units to each outpatient service. Trained technicians measured each patient's BP at entry into the study and 1 year later. Home BP patients made 1.2 fewer hypertension-related office visits than UC patients during the study year (95% confidence interval (CI): 0.8, 1.7). Mean adjusted cost for physician visits, telephone calls, and laboratory tests associated with hypertension care was $88.76 per patient per year in the Home BP group, 29% less than in the UC group (95% CI: $16.11, $54.74). The annualized cost of implementing the home BP system was approximately $28 per patient during the study year and would currently be approximately $15. After 1 year, BP control in men in the Home BP group was better than in men in the UC group; BP control was equally good in women in both groups. Management of uncomplicated hypertension based on periodic home BP reports can achieve BP control with fewer physician visits, resulting in substantial cost savings.
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PMID:Home blood pressure monitoring. Effect on use of medical services and medical care costs. 151 17

To understand the content of ambulatory family practice and find effective ways to improve clinical service, education and research in the Department of Family Medicine of Kaohsiung Medical College Hospital, we surveyed 14,064 patients from Jan. 1984 to Feb. 1991 and analysed (a) their basic demographic data including sex, age, insurance type, source and residential district and (b) clinical health problems covering 25,679 diagnoses and 148,994 diagnostic visits. Clinical health problems were recorded by the ICHPPC-2 code system. Results of basic demographic survey were as follow: 49.1% of patients was male and 50.9% female; 58.9% fell in the age group of 16-40 years and 22.4%, 12.0% and 6.7% of patients fell into the age groups of 41-65, under 16 and over 65 years respectively; 62.8% was insured usually by labor insurance and 26.9% had no insurance; the commonest referrals were other patients, colleagues, company personnel, doctors, media ... etc.; 58.8% lived in Kaohsiung City and 19.6% in Kaohsiung county. As for clinical health problems, the data showed that the commonest thirty diagnoses encountered at our clinic accounted for 69.3% of 25,679 diagnoses and the commonest ten diagnoses in descending order were medical health examination, acute URI, abdominal pain, uncomplicated hypertension, prophylactic immunization, hepatitis B carrier, back pain, anxiety disorder, viral hepatitis and irritable bowel syndrome. By calculating the average value of each diagnosis in a sample of 148,994 diagnostic visits to evaluate the habits of practice, we found that the commonest ten diagnostic visits at clinic in descending order were diabetes mellitus, hypertension involving target organ, uncomplicated hypertension, gout, hyperthyroidism, duodenal ulcer, tuberculosis, lipid metabolism disorder, other peptic ulcer and depressive disorders; all were chronic diseases. We concluded it was very important and helpful for the development of family medicine program and primary care unit to understand the content of their own ambulatory practice.
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PMID:[The content of ambulatory family practice in Kaohsiung Medical College Hospital]. 156 Apr 75

A double-blind, parallel-group study was performed to assess the antihypertensive effects and tolerability of felodipine and hydrochlorothiazide (HCT) in black patients with mild to moderate uncomplicated hypertension [entry supine diastolic blood pressure (DBP) of 96-116 mm Hg]. The medicines were given as monotherapy and the additional effect of metoprolol was assessed in patients unresponsive to felodipine or HCT alone. After a 4-week placebo period, 45 patients were randomly allocated to treatment with felodipine (21) or HCT (24). Initial doses of felodipine 2.5 mg or HCT 12.5 mg twice daily were doubled after 1 week and doubled again after week 4 in cases with supine DBP above 90 mm Hg. At week 8, metoprolol 100 mg twice daily was added to the regimen of uncontrolled patients (supine DBP greater than 90 mm Hg) and maintained for the remaining 4-week trial period. Felodipine significantly reduced supine and erect systolic BP (SBP) and DBP after 4, 8, and 12 weeks of treatment. Responses to HCT were similar although standing diastolic BP at week 4 and standing SBP at week 8 were not significantly reduced. After 4 weeks, the mean fall in supine DBP was significantly greater for the felodipine than the HCT group. Eight patients on felodipine and 14 in the HCT group required additional metoprolol to achieve BP control. A significantly greater number of adverse effects were associated with HCT than felodipine treatment. Monotherapy with felodipine produced a more rapid control of hypertension, was more frequently effective, and was associated with a lower incidence of side effects than HCT.
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PMID:Comparison of felodipine and hydrochlorothiazide for the treatment of mild to moderate hypertension in black Africans. 169 38

Women with chronic hypertension who are considering pregnancy should undergo extensive evaluation and work-up prior to conception. This evaluation is important to establish the cause and severity of the hypertension. The patient should be seen early in pregnancy and counseled regarding the possible adverse effects of hypertension and the importance of adherence to prenatal visits and prescribed medications. Patients classified to have high-risk hypertension are at increased risk for significant maternal and perinatal complications. These patients should have intensive antenatal follow-up and will require antihypertensive therapy irrespective of the severity of the hypertension. In contrast, in women with mild uncomplicated hypertension, good perinatal outcome is expected with proper obstetric care, without the use of antihypertensive drugs. Finally, most of the poor perinatal outcome in such pregnancies is related to the development of superimposed preeclampsia.
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PMID:Chronic hypertension in pregnancy. 176 85

1. The importance of total dose to the initial hypotensive response with an angiotensin converting enzyme inhibitor (quinapril) was assessed using a suggested 'maintenance' dose (20 mg) or matched placebo in a randomised double-blind study in patients with uncomplicated hypertension. 2. Thirty-two patients were recruited who were not on therapy or had not received diuretic therapy in their existing drug treatment in the preceding 4 weeks. Secondary causes of hypertension had previously been excluded and sustained clinic blood pressures of SBP greater than 160 mmHg and/or DBP greater than 90 mmHg were taken as indications for a trial of adjuvant or monotherapy with an ACE inhibitor. 3. After uneventful supervised therapy with quinapril in an open pilot study (n = 5) 27 patients entered a double-blind, randomised, crossover study of quinapril or placebo using ambulatory monitoring to assess BP response. 4. All patients remained asymptomatic and both therapy and monitoring were well tolerated. A smooth onset of antihypertensive effect was noted with an overall 24 h placebo corrected fall in systolic BP of 9.9 mmHg (7.2-12.6 95% CI) and diastolic BP of 6.4 mmHg (4.2-8.8) with no significant effect on heart rate. Individual placebo corrected maximal responses during the first 8 h following quinapril showed a wide range for both systolic (+1.56 to 44.0 mmHg) and diastolic (+2.3 to -35.6 mmHg) pressure. Larger falls tended to be associated with higher baseline pretreatment pressures but in no case did absolute systolic pressure fall below 100 mmHg during the first 8 h following administration of placebo or quinapril.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The response to the first dose of an angiotensin converting enzyme inhibitor in uncomplicated hypertension--a placebo controlled study utilising ambulatory blood pressure recording. 177 77


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