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

Psychiatrists and cardiologists have collaborated in clinical care and research for decades. This article reviews some of the current areas of mutual interest, with special attention focused on research on behavior and hypertension, type A behavior pattern, sudden death, and the physiology of emotional arousal. In clinical care and epidemiologic and physiologic research, there are numerous issues at the cutting edge of knowledge that will be clarified by continued collaboration.
Gen Hosp Psychiatry 1988 Sep
PMID:Research links between psychiatry and cardiology. Hypertension, type A behavior, sudden death, and the physiology of emotional arousal. 304 29

The drinking behaviour of 7735 middle-aged men drawn from general practices in 24 British towns was determined in 1978-80 and five years later in 1983-85. Those with heavier initial drinking were more likely to have reduced consumption after five years. At every level of consumption manual workers showed a greater tendency to decrease drinking than non-manual workers. Of those who became non-drinkers over the five years, 12% had been moderate or heavy drinkers. Men who were told by a doctor that they had developed ischaemic heart disease during the five years were more likely to reduce their alcohol consumption than men who remained free of ischaemic heart disease. Similarly, men who were put on regular medical treatment of any kind or who acquired two or more diagnoses of illness (including ischaemic heart disease) were more likely to become occasional or non-drinkers. Nondrinkers at both reviews had higher rates of diagnosed illness than drinkers. In particular, the ex-drinkers, who comprised 70% of non-drinkers at follow up, had higher rates of ischaemic heart disease and cardiovascular-related problems, such as high blood pressure and diabetes, than drinkers.It is essential to be aware of the tendency for moderate or heavy drinkers to reduce or stop drinking over time, particularly if illness has been diagnosed. Non-drinkers and exdrinkers should not be used as a baseline in studies relating alcohol to disease.
J R Coll Gen Pract 1988 Oct
PMID:Changes in drinking habits in middle-aged British men. 325 67

This paper reviews the use of acupuncture to treat several disorders where pain is not the primary symptom. Studies on asthma have shown a small but consistent short-term therapeutic effect of acupuncture. One study of long-term effects found no improvement in asthma after acupuncture while the other reported a modest effect on symptom relief but with a greater impact on medication reduction. Further studies of the long-term effects of acupuncture on asthma would seem desirable even though the currently available findings are equivocal. Sufficient work has now been carried out on sensorineural deafness to conclude that acupuncture has no worthwhile effects on this condition. Only two studies have been carried out on tinnitus; they indicate that the effects of short courses of acupuncture are at best slight. There are some encouraging findings for acupuncture treatment of hypertension, although the study was seriously flawed by the lack of a no treatment control group. With regard to giving up smoking it seems that acupuncture may assist during the withdrawal period and that it compares favourably with other forms of treatment; whether there is any specific effect of the acupuncture is not yet clear. As with other attempts to stop people smoking, however, there is a high relapse rate. The trials of acupuncture on psychiatric disorders have suffered from the lack of detailed assessment and control groups; no conclusions can be drawn without further studies. The studies on weight loss similarly do not permit any firm conclusions about the usefulness of acupuncture.
J R Coll Gen Pract 1987 Feb
PMID:Acupuncture for some common disorders: a review of evaluative research. 331 97

When a physician advises a patient to modify unhealthy behaviors, the physician may be tempted to prescribe a target for change by selecting the single "risk factor" that poses the greatest threat to health. The present study was conducted to determine how frequently a statistical approach to health risk appraisal would conflict with a patient's priorities for lifestyle change, even when the patient was fully informed of the rationale for the advice. Coronary artery disease (CAD) risk factor assessment was performed using the American Heart Association's RISKO scale, a validated health risk appraisal instrument. Two hundred forty-one patients were seen in an ambulatory clinic that specialized in heart disease prevention. Risk of CAD was estimated based on age, sex, smoking status, blood pressure, body weight, and serum cholesterol. Using RISKO, patients were told which single risk factor posed the greatest threat to health; patients then selected a personal priority for risk factor intervention. The overall rate of agreement between the patients' priorities and RISKO targets was 63%. If weight loss is considered a nonpharmacologic "target" for controlling hypertension, then the agreement rate rises to 70%. Disagreement was observed even though patients were fully informed of the relative importance of all possible risk factor choices. Since risk factor intervention efforts are less successful unless the target of the intervention is negotiated with the patient, these data should be of clinical importance in devising plans for behavioral change interventions by practitioners.
J Gen Intern Med
PMID:Patient priorities for behavioral change: selecting from multiple coronary disease risk factors. 337 91

A group of previously untreated obese hypertensive patients were started on a weight reduction programme supervised by two dietitians working in a general practice surgery. It was stressed from the beginning of the programme that reducing blood pressure was the purpose of the diet. The results of follow-up after six months are presented together with results for a control group of obese hypertensive patients not receiving dietary advice or drug therapy, but being followed by the general practitioner. The weight, systolic blood pressure and diastolic blood pressure of the dieting hypertensive group were significantly lower than those of the non-dieting group after six months. However, the drop-out rate was significantly higher for the dieting group than for the non-dieting group.The results of a separate comparison between a control group of obese normotensive patients following the same dietary programme and the group of dieting obese hypertensive patients are also presented. Attendance rates and weight loss achieved were significantly better for the hypertensive group than for the normotensive group after 12 months.Weight reduction appears to be an effective first-line therapy for approximately 50% of obese patients with mild to moderate hypertension, and raised blood pressure appears to provide motivation for such patients to attend a dietitian's clinic and to lose weight.
J R Coll Gen Pract 1986 Oct
PMID:How useful is weight reduction in the management of hypertension? 344 Sep 87

The obstetric outcome and experience of care of 96 pregnant women attending an integrated community antenatal clinic staffed by general practitioners, a community midwife and an obstetric accredited senior registrar were compared with those of 100 women receiving traditional shared antenatal care. The views of the women and their practitioners were sought; obstetric data were obtained from obstetric notes, hospital records and cooperation cards.Fewer women attending the community clinic suffered from hypertension than women receiving shared care. The women attending the clinic reported that it had a friendly, relaxed and personal atmosphere. They also reported less inconvenience and a shorter waiting time for the obstetrician than women receiving shared care. They received greater continuity of care from the obstetrician but less from the general practitioners and community midwives than the control women. There was greater satisfaction with communication with staff among women attending the clinic, with the exception of the midwife whose role was not sufficiently well delineated. Practitioners in the integrated scheme appreciated the close working arrangements but experienced an increase in administrative tasks.
J R Coll Gen Pract 1987 Dec
PMID:Evaluation of an integrated community antenatal clinic. 350 40

A randomized controlled trial of an information and medical record booklet designed to improve patient understanding and participation in the management of hypertension was conducted in six inner London general practices. After one year there were no significant differences between the group who had received the booklets and the control group in mean systolic or diastolic blood pressure, but the study group scored significantly higher on knowledge about hypertension and its management. However, the difference between the two groups was small, possibly because both groups started with a high level of understanding about hypertension and its management. In addition, the mean diastolic blood pressure in the control group showed that the treatment provided was already satisfactory, and that there was little need for improvement. Nevertheless, the information booklet evaluated in this study provides health professionals with a highly acceptable method of informing the patient about hypertension and its management and could be used both in hospital and general practice.
J R Coll Gen Pract 1987 Dec
PMID:A randomized controlled trial of an information booklet for hypertensive patients in general practice. 350 41

The outcome of pregnancy of 1303 women admitted for delivery (including those transferred after admission) at an isolated general practitioner maternity unit over the period 1978-85 was studied. The outcome following change of booking before admission was also assessed for the years 1982-85. The crude perinatal mortality rate was 1.5 per 1000 for all admissions between 1978 and 1985. Of the women admitted in 1978-85 7.4% were transferred after admission while for those booked at the unit in 1982-85 11.3% had their place of booking changed. A higher proportion of nulliparous women than multiparous women were transferred or had their place of booking changed. The main reasons for transfer after admission were delay in the first stage of labour (21.9%), spontaneous rupture of membranes not in labour (16.7%) and hypertension (15.6%), and for change of booking postmaturity (26.9%) and hypertension (16.4%).Sufficient information concerning risk of transfer and change of booking may now be available from studies of isolated general practice maternity units for pregnant women at low risk to make an informed choice of place for delivery.
J R Coll Gen Pract 1987 Nov
PMID:Outcome of women booked into an isolated general practice maternity unit over eight years. 350 38

Exacerbation of hypertension by nonsteroidal anti-inflammatory drugs in hypertensive patients remains controversial among physicians and investigators. Because of the many differences among studies of oral nonsteroidal anti-inflammatory drugs and blood pressure control in patients with hypertension, the authors critically evaluated the published clinical evidence on this subject using standardized methodologic criteria. A search of the literature from 1965 to 1986 identified 31 relevant studies, of which only eight were double-blind randomized controlled trials that provided the most clinically useful information. Of these eight best-designed studies, five of the six that studied indomethacin concluded that it may interfere with antihypertensive effectiveness in selected patients with treated, stable hypertension. The remaining double-blind randomized studies included comparisons of other nonsteroidal anti-inflammatory drugs. Their limited results suggest that sulindac is less likely than piroxicam, naproxen or indomethacin to cause an attenuation of antihypertensive therapy. More research on this subject is needed, with greater attention to methodologic details and identification of predisposing risk factors for impairment of blood pressure control by nonsteroidal anti-inflammatory drugs.
J Gen Intern Med
PMID:Do nonsteroidal anti-inflammatory drugs interfere with blood pressure control in hypertensive patients? 355 8

The effect of medication-taking patterns on blood pressure was investigated in 24 hypertensive outpatients being treated with once-daily doses of hydrochlorothiazide or chlorthalidone. Medication-taking patterns were measured with a small pill dispenser that electronically records the time of medication removal. Blood pressure reduction was found to correlate better with the total number of doses the patient removed from the pill pack during a month than with any of four other compliance measures that were based on the timing of dose removal. Analysis also suggested that blood pressure is improved if patients ingest omitted doses to "catch up" to the prescribed regimen. It is concluded that a simple pill count may be the most clinically relevant definition of compliance for patients with hypertension being treated with only hydrochlorothiazide or chlorthalidone, and that such patients should ingest all prescribed doses, regardless of the time interval between doses.
J Gen Intern Med
PMID:The effect of medication compliance on the control of hypertension. 365 55


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