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

An integrated approach, progressively implemented in the ARTEMIS system since 1975, is described for the computerized management of hypertensive patients. From a medical point of view, computerized programs can be used to memorize patients' individual records and profiles, to facilitate patient management and follow-up, to store medical knowledge about hypertension and to provide facilities for decision making at the level either of the individual patient or of the population followed up. From a technical point of view, the methodology used integrates data and knowledge management facilities into the same software. Five hypertension clinics are presently using the system in France and more than 22,000 records have been registered. Answer rates to 12 mandatory questions regarding past history and examination at first visit were superior to 95% in 19,601 records created between January 1976 and December 1987. Patient database interrogation can be used to evaluate the sensitivity and specificity of various signs and symptoms for the diagnosis of secondary hypertension, and to predict, for each patient, his/her cardiovascular risk, the risk of drop-out, the risk of insufficient blood pressure control and the probable blood pressure level. It also serves to test the content and validity of the associated expert system which is progressively built up. A prospective evaluation of the performance of the expert system on 80 cases of hypertension showed overall agreement between the specialists and the expert system ranging from 58 to 91% depending on the decision.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Computer-assisted techniques for evaluation and treatment of hypertensive patients. 240 67

The computerized medical specialized records covering the follow-up of hypertension (ARTEMIS), diabetes (MELLITEE), chronic renal failure and the minimum medical record of Nephrology (THESEE) using the temporal database management system LIED, have been developed in several units of University Hospitals. The authors show that these computerized records are usable in a Nephrology Unit in a General Hospital.
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PMID:[Experience of decentralized informatics at a nephrology unit of a general hospital]. 307 Apr 63

An expert system has been integrated to the data management system of the ARTEMIS programme for hypertensive patients. The patient database, which has been used since 1975, contains the medical records of about 20,000 patients. Information is interactively entered by physicians, nurses and secretaries on video display units. The computerised medical record has replaced the traditional handwritten medical record. The database management system is used to produce different summary reports (inpatient and outpatient care) and personalized recall letters which are mailed to the patients before their appointments. Suggestions provided by the expert system include additional information to be obtained (complementary patient interrogation, biological or radiological investigations, etc.), possible causes of hypertension, and medical prescriptions. The information base allows the description of both static knowledge (in the form of a semantic network) and dynamic knowledge (in the form of production rules). The inference system sequentially uses a combination of forward and backward chaining and performs both exact and approximate reasoning. The diagnostic performance of the expert system was evaluated in 100 cases of hypertension (50 of essential hypertension and 50 of secondary hypertension. Concordance between the diagnosis proposed by the expert system and the one proposed by the specialist was achieved in 92% of secondary hypertension cases and 88% of essential hypertension cases. It is suggested that the integration of data and knowledge management might enhance the overall acceptance by medical staff of a computerised system, and facilitate the validation of a knowledge base.
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PMID:Integrating management and expertise in a computerised system for hypertensive patients. 312 10

By using information prospectively collected in the computerized ARTEMIS databank, the long-term metabolic consequences of spironolactone, hydrochlorothiazide-amiloride combination and cyclothiazide-triamterene combination were evaluated in 100 patients for each group matched according to sex, age and blood pressure (BP). Spironolactone was prescribed at a mean dose of 98 mg, hydrochlorothiazide at 36 mg and cyclothiazide at 2 mg, during a mean follow-up of 20 months. Compared with the pretherapeutic values, BP decreased equally in both treatment groups (18/9 mm Hg on average). Creatinine increased significantly in the 3 groups (9, 8, 14 mumol/liter, p less than 0.001) as did uric acid (18, 31, 42 mumol, p less than 0.001). Plasma potassium increased with spironolactone (0.7 mmol/liter, p less than 0.001) and remained stable with the combinations of the thiazide-potassium-sparing agents. For the 3 groups, the slight and nonsignificant variations of fasting blood glucose and cholesterol were mainly the results of a phenomenon of regression to the mean. However, when both groups of thiazide-treated patients were considered, the reduction of plasma potassium was accompanied by a slight increase in glucose (0.1 mmol/liter) and cholesterol levels (0.2 mmol/liter) compared with when kalemia decreased (-0.1 and -0.1 mmol/liter, respectively, p less than 0.05 and p less than 0.05). It is concluded that in a clinical daily practice of a hypertension clinic low doses of spironolactone or of thiazides combined with potassium-sparing agents reduced BP without alteration in lipid or carbohydrate metabolism on long-term follow-up.
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PMID:Long-term metabolic effects of spironolactone and thiazides combined with potassium-sparing agents for treatment of essential hypertension. 318 69

The long-term efficacy and tolerance of spironolactone in essential hypertension was evaluated among 20,812 patients referred to the Broussais and St. Joseph systemic hypertension clinics between 1976 and 1985 by using information prospectively collected in the computerized ARTEMIS data bank. In 182 patients (51 men, 131 women) treated with spironolactone alone during a mean follow-up period of 23 months, a mean dose of 96.5 mg decreased systolic and diastolic blood pressure (BP) by 18 and 10 mm Hg, respectively, below pretherapeutic levels. The BP decrease was greater with doses of 75 to 100 mg (12.4% and 12.2%) than with doses of 25 to 50 mg (5.3 and 6.5%, p less than 0.001), but no additional decrease was found with doses above 150 mg. Plasma creatinine level increased modestly (8.3 mumol/liters), as did plasma potassium level (0.6 mmol/liters) (both p less than 0.001); uric acid level increased, but not significantly (10.5 mumol/liter). Fasting blood glucose and total cholesterol levels did not change, triglyceride levels increased slightly (0.1 mmol/liter, p less than 0.05). These changes were similar in both sexes and were not influenced by length of follow-up. Among the 699 men prescribed spironolactone alone or in association with another antihypertensive treatment, 91 cases of gynecomastia developed (13%). Gynecomastia was reversible and dose-related; at doses of 50 mg or less the incidence was 6.9%, but 52.2% for doses of 150 mg or higher. Despite limitations inherent in the interpretation of data banks, it is concluded that spironolactone administered in daily practice reduced BP without inducing adverse metabolic adverse effects and that in patients with essential hypertension, doses should be kept below 100 mg.
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PMID:Efficacy and tolerance of spironolactone in essential hypertension. 366 95

A computerized system called ARTEMIS has been taking part in the management of a referral hypertension clinic since September 1975. From January 1, 1976 to January 1, 1979, 3,624 patients' records were set up and updated, all of them accessible on line. The mean rate of response to 17 questions with obligatory answers concerning patients' past history was 97.6 per cent. The 10 routine laboratory tests included in the initial in-hospital work-up were registered in over 92 per 100 of the 2,651 hospital records examined. Negative responses were registered with the same accuracy as positive ones, when the computerized questionnaires were appropriately drafted. Standardized collection of information insured homogeneity of the medical staff and has already made possible epidemiologic studies. ARTEMIS has detected strategical errors such as the lack of yearly programmed tests for cardiovascular risk-factors associated with hypertension. The computer has helped to achieve a high rate of patient compliance at one year (81.3 per cent), by providing patients up-dated editions of their personal summary reports as well as sending periodical letters of recall to them and to their physicians. At a total annual cost of 11 dollars per patient, the computer provides continuous information on process and outcome, for each patient and physician, and for the entire population followed up at the clinic. It facilitates physician adherence to predefined protocols and reinforces follow-up continuity by creating a communications network between the referral clinic, the patient and the general practitioner.
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PMID:Hypertension management: the computer as a participant. 736 34

"Diagnostica" is a Bayesian statistical tool designed to collect and store the patient's data, suggest a diagnosis, and explain the decision in terms of density distributions. The program is written in C language on MacIntosh support. It is described using the case study of differential diagnosis between essential and secondary hypertensions (i.e., fibrodysplastic renal artery stenosis, atheromatous renal artery stenosis, Conn's syndrome, nephropathy and pheochromocytoma). Seventeen experimental parameters were taken into consideration, all of them available during the first medical examination. The density distributions of all items were established from the ARTEMIS experimental database. Both a priori probabilities of different types of hypertension and loss coefficients are taken into account in the calculations. Diagnostica can be used in a "make diagnosis" mode or in an "edition" mode. In the first case it can serve a physician in everyday practice; in the second it becomes a tool for medical research.
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PMID:Diagnostica--a Bayesian decision-aid system--applied to hypertension diagnosis. 833 26

For hypertension management, it is increasingly recommended to individualize treatment according to the individual patient's characteristics. However, the ability of physicians to predict the patient's risk in the absence of a computer aid is unknown. Our aim was to determine if senior hypertension specialists were able to assess reproducibly cardiovascular disease (cvd) risk in hypertensive patients. The records of 100 patients were selected at random from the ARTEMIS database. The group comprised 53% of males, mean age was 43.7 (15), blood pressure 160 (25) / 99 (12) mmhg and serum cholesterol 5.6 (1.1) mmol/l. The records were summarized on a standardized form. Nineteen items were devoted to general characteristics and medical history of patients, 15 to clinical examination and 7 to biological tests. These items have been chosen because they were used in the framingham cvd risk prediction equation and/or had decisional value in a bayesian program designed for secondary hypertension diagnosis. Six physicians, twice at one month intervals, assigned each patient to one of the three categories of risk (low, moderate, high). The order of cases was randomized. Chance corrected agreement (intra-physician agreement) between the two estimations was only moderate except for one expert (kappa values: 0.658, 0,543, 0.439, 0.363, 0.328 and 0.207 for each expert, respectively). The proportion of patients assigned by each physician to each category ranged from 22.7% to 77.3% for the low risk, and from 4.5% to 43.9% for the high risk category. One physician overestimated risk, one underestimated it and the three others were in keeping with framingham predictions. Bias and lack of reproducibility influence physician judgment in assessing cvd risk of hypertensive patients. Application of computer aids could result in more rational assessments and better decision making.
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PMID:Do physicians estimate reliably the cardiovascular risk of hypertensive patients?. 859 74

The aim of the study was to evaluate the completion of medical records of a hypertension clinic and to compare standardized computerized records versus standard medical records. The medical records of 163 consecutive hypertensive patients attending at the Broussais hospital hypertension clinic between December 1995, 6th and January 1996, 21st were checked. At the last visit, the patients were attended by 16 physicians working in 4 different teams. The medical data were recorded by physicians in the computerized system called ARTEMIS in 120 patients and in standard structured forms in 43 patients. The patients notes were checked to see if 9 clinical items were recorded at the first visit (V1), at the visit before last (V2) and at the last visit (V3). The overall completion rate was high at V1 (92.2%) and significantly decreased at follow-up visits (82.6% at V2 and 83.2% at V3). The completion rate was significantly higher in the computerized records than in the standard notes: 95.8% vs 82.2% at V1, 91.9% vs 56.3% at V2 and 91.6% vs 59.7% at V3. During follow-up (V2 vs V1), a significant decrease in the completion rate of 6 items was observed in the standard notes (tobacco use, alcohol consumption, physical activity, compliance to treatment, body weight, manual blood pressure measurement). In the computerized records, only physical activity completion rate decreased. In conclusion, the computer may help to increase the quality of the medical records as reflected by the completion rate of items related to hypertension care.
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PMID:[Evaluation of the quality of filling out medical records in a hypertension consultation]. 940 34

A clinical trial was performed to assess the effects on quality of life of a treatment (ifenprodil tartrate 20 mg, 3 times daily for one year) in patients suffering from peripheral arterial obliterative disease of the lower extremities with intermittent claudication. A specific questionnaire--ARTEMIS--was used to evaluate quality of life. The study enabled the responsiveness over time of the ARTEMIS questionnaire to be checked. During this open, prospective, multicentre study, patients requiring treatment for peripheral arterial disease of the lower extremities and recruited by angiologists and general practitioners filled in the complete or short form of the ARTEMIS questionnaire, respectively, at baseline, and at 3, 6, 9 and 12 months. 4821 patients were recruited. 4494 questionnaires were analysed (169 from the angiologist group and 4325 from the general practitioner group). The majority of the patients (mean age 67 years) were men (70%), either former or current smokers (68%), with high blood pressure (54%), hyperlipidaemia (48%) and type 2 (non-insulin-dependent) diabetes mellitus (16%), and with a 3-year history of intermittent claudication (+/- 3.5) on average. Quality-of-life scores improved (as from month 3) between baseline and month 12. This progression was significant for all dimensions of the reduced questionnaire (p < or = 0.0001) and for 12 of the 15 dimensions of the complete version. These quality-of-life results should be measured against the global clinical improvement, which was rated as good by the investigators (70% of cases). Treatment tolerability was assessed for the 4821 patients recruited and was judged satisfactory. The number and type of serious events and recorded deaths corresponded to events commonly observed in this elderly population. These results show how the ARTEMIS quality-of-life scales can be used in community practice during symptomatic treatment with a vasoactive agent such as ifenprodil, to assess quality-of-life improvements in patients suffering from stage II peripheral arterial disease of the lower extremities.
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PMID:[Quality of life of patient with peripheral arterial obliterative disease treated with ifenprodil tartrate. Results of an ARTEMIS study]. 984 1


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