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

The general practice records of 2371 hypertensive patients on drug therapy in 12 practices were reviewed retrospectively. It was found that the mean systolic blood pressure of the patients had fallen by 29 mmHg and the mean diastolic pressure by 16 mmHg after one year of treatment and that there was a further reduction of 5 mmHg in the systolic pressure and 5 mmHg in the diastolic pressure at the most recent recording of blood pressure. Half of the patients had only a single blood pressure reading recorded before treatment was started and for 56% of the patients there was no record of smoking habit and for 69% no record of weight. Twenty-seven per cent of the patients suffered from mild hypertension, that is blood pressure less than 180/110 mmHg, and 56% were over 65 years of age. These results indicate the need for policies for selection of patients for treatment and for standards of recording. It is suggested that practices should review their results and undertake to treat elderly hypertensive patients and those with mild hypertension only when they can demonstrate that their policies are effective for young hypertensive patients and for those with moderate or severe hypertension.
J R Coll Gen Pract 1986 Dec
PMID:Management of hypertension in twelve Oxfordshire general practices. 366 4

The authors conducted a population-based case--control study to determine the risk of myocardial infarction in patients who reported angina-like symptoms. The cases studied were those of patients who had high blood pressure and had sought treatment in 1984 with myocardial infarction as the first manifestation of coronary artery disease. Controls, a random sample of patients who had hypertension, were frequency-matched to cases by age and gender. Blind to case--control status, the authors reviewed the medical records of the 32 cases and 64 controls for reports of angina-like symptoms. While controls reported such symptoms at a constant rate, the events for the cases clustered near their infarctions. When a patient with hypertension sought medical advice for angina-like symptoms, the risk of infarction within 30 days was 14.2 (95% confidence interval, 2.8 to 71), and after 30 days it fell to 1.03. Among patients who have high blood pressure but no history of angina, presentations with prodromal symptoms in the primary care setting are so common that only about one in 100 such visits actually heralds myocardial infarction.
J Gen Intern Med
PMID:The relative risk of myocardial infarction in patients who have high blood pressure and non-cardiac pain. 369 97

The authors examined the relationship between hypertension treatment, control, and functional status among 356 "uncomplicated" hypertensive patients receiving care in 16 teaching hospital group practices. Antihypertensive drug therapy and blood pressure control were determined from a medical record review. Functional status (health perceptions, mental health, role, and physical functioning) was assessed with a questionnaire. After adjustment for potential confounders, hypertensive patients without drug therapy were less likely to have impairment in mental health functioning, compared with patients receiving one or more than one antihypertensive medication (9% versus 25% and 20% respectively, p less than 0.05). However, uncontrolled hypertensive patients were more likely to have role limitations than patients controlled only at the end or throughout the record review period (51% versus 39% and 36%, respectively, p less than 0.05). Patients controlled throughout the review period had the least impairment for each measure of functional status. These preliminary findings suggest that pharmacologic therapy may have a negative influence on the mental health of "uncomplicated" hypertensive patients, but that the dual goals of blood pressure control and positive functional status are not incompatible.
J Gen Intern Med
PMID:The association between hypertension treatment, control, and functional status. 369 1

A management-by-objective approach was used by the health care administration of the Kupat Holim Sick Fund to improve the detection and quality of treatment of hypertension in 20 family practices in Ashdod, Israel. The number of hypertensive patients in each practice was estimated from the age-sex register and this was compared with the actual number. The combined prevalence in the 20 practices was only 20.8% of the expected prevalence, and of those treated the blood pressure of 29.6% was not under control (diastolic pressure 95 mmHg or over). The practice teams committed themselves to improving the detection of hypertension by active case finding. Once every six months for three years the health care consultant reviewed the results of detection and treatment with each team. After three years the number of hypertensive patients had increased from 977 patients (20.8% of expected prevalence) to 2914 patients (62.1%) - a three-fold increase. The percentage of treated patients whose blood pressure was not under control (diastolic pressure 95 mmHg or over) did not change substantially (from 29.6% to 27.9%). A management-by-objective approach, when accompanied by regular feedback, appears to motivate primary care teams to improve the detection of hypertension in their patients.
J R Coll Gen Pract 1986 Jan
PMID:Use of management-by-objective for the case finding and treatment of hypertension. 370 87

This paper reports an experimental study of general practitioners' use of an interactive computerized protocol for the management of hypertension, focussing particularly on the protocol's effects on doctors' clinical behaviour. Prior to its computerization a paper-based version of the protocol was used enabling a comparison of the alternative forms. Doctors' delivery of care was assessed from video recordings of 89 consultations and from the records made during these consultations. Comparisons were made of consultations conducted under control and experimental conditions. Use of paper and computer protocols resulted in significant improvements in the doctors' delivery of care, in terms of the range of verbal and physical examinations conducted and recorded. The protocol's effects were most marked when the computerized version was used. However, use of the computer protocol resulted in the recording of information on the non-occurrence of certain events which had not been explicitly elicited during the verbal examination; features of the design which were intended to encourage adherence to the protocol may have been inappropriate to the realities of a general practice consultation. The findings provide some useful insights for the design of future computerized protocols for the management of chronic conditions.
J R Coll Gen Pract 1986 May
PMID:An interactive computerized protocol for the management of hypertension: effects on the general practitioner's clinical behaviour. 374 62

Patients with new-onset atrial fibrillation are often hospitalized emergently. To determine whether this is necessary, the authors retrospectively reviewed the care of 97 consecutive patients with this illness. No reason for the atrial fibrillation in 43 patients could be identified. Hypertension, coronary artery disease, and valvular heart disease were the most commonly associated conditions; myocardial infarction occurred in one patient. In 82% of patients, atrial fibrillation reverted to normal sinus rhythm during hospitalization. Three patients needed emergent hospitalization irrespective of the presence of atrial fibrillation. In the remainder, admission was based solely on the diagnosis of new-onset atrial fibrillation. Ninety-eight per cent had an uncomplicated hospital course. It is concluded that hospitalization is not necessary for all patients with new-onset atrial fibrillation. Those in whom reversion to normal sinus rhythm occurs rapidly during digoxin therapy can be discharged. Where no major medical illness is evident patients can be admitted to a bed outside the intensive care unit until reversion to normal sinus rhythm or rate control is achieved.
J Gen Intern Med
PMID:New-onset atrial fibrillation: is there need for emergent hospitalization? 377 81

A study is described in which established treatment for hypertension was interrupted by placebo as part of a change to an alternative treatment.The patients involved were divided into two groups according to their score on the general health questionnaire. All the patients showed an increase in diastolic pressure after the placebo phase of the change-over but the increase was greater for patients with a high score on the general health questionnaire than it was for patients with a low score. For the patients with a high score the diastolic pressure approximated to the level recorded when the diagnosis was first made, but for patients with a low score it was considerably lower than this initial reading.The implication of this finding for the design of ;changeover' studies is discussed.
J R Coll Gen Pract 1986 Sep
PMID:Treatment for hypertension interrupted by placebo: the response of patients with high and low general health questionnaire scores. 380 88

Seven days after sinoaortic denervation (SAD), mean blood pressure (MBP) and heart rate measured in conscious rats were not significantly different from sham-operated animals. A high dose of atropine, 8 mg kg-1, reduced MBP only in SAD rats. Atropine, 0.08-0.8 mg kg-1, or methylatropine, 0.8 mg kg-1, induced tachycardia in sham rats. This effect was reduced after sinoaortic denervation and it involves peripheral muscarinic receptors. The hypertension and tachycardia provoked by physostigmine were more marked in SAD than in sham rats. The cardiovascular responses induced by physostigmine were abolished by atropine and were not affected by methylatropine. The hypertension caused by physostigmine in SAD animals was more sensitive to the antagonism of atropine than in sham rats. Our results show that baroreceptor deafferentation affects peripheral parasympathetic tone to the heart and changes the cholinergic pathways involved in the modulation of cardiovascular response.
Gen Pharmacol 1985
PMID:Participation of cholinergic pathways in sinoaortic denervated rats. 399 83

An audit of a practice which has a policy of opportunistic screening for raised blood pressure showed that 80 per cent of patients born between 1930-44 had been screened in the last five years. Patients who had not been screened were identified and contacted; this increased the percentage screened to 87 per cent. Only four possible new hypertensives were identified. It is suggested that the effort and expense of achieving this result was not worthwhile and that opportunistic screening is the cheapest and easiest method of screening for high blood pressure.
J R Coll Gen Pract 1985 May
PMID:Audit of screening for hypertension in general practice. 402 Jul 48

A diagnosis of malignant hypertension was recorded for 165 patients in the national morbidity study between 1970 and 1973. Three patients with benign hypertension were selected as age- and sex-matched controls for each case. The general practitioners in the study were asked to complete a further questionnaire about the patients and 66% of the practices agreed to take part. Information about the retinal findings for the patients was requested and less than half of those in the national morbidity study proved to have a strict diagnosis of accelerated or malignant hypertension although they were originally recorded as patients with malignant hypertension. Of those patients originally classified as having benign hypertension 5% had the retinal appearance of accelerated or malignant hypertension.Patients had been diagnosed as having hypertension for a mean of more than five years prior to entry into the national morbidity study and the survival of patients with both benign and accelerated or malignant hypertension was good. Thirtyfour per cent of those with confirmed benign hypertension and 62% of those with definite accelerated or malignant hypertension died in the follow-up period which was on average 10 years from entry into the national morbidity study.The survival of patients registered with doctors who did not collaborate and of patients whose clinical details were missing was similar to the survival of patients for whom full details were provided.Blood pressure control was only fair with a mean of 172/101 mmHg for the group with benign hypertension and 177/107 mmHg for the group with accelerated or malignant hypertension. Blood pressure control was the poorest for those who died from a stroke. A high proportion (78%) of deaths in association with accelerated or malignant hypertension were from cardiovascular or renal causes.
J R Coll Gen Pract 1985 Oct
PMID:Malignant hypertension in general practice. 407 97


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