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Hypertension Treatment (hypertension + treatment)
Selected AbstractsHypertension Treatment,A Success StudyJOURNAL OF CLINICAL HYPERTENSION, Issue 5 2006Marvin Moser MD Editor in Chief No abstract is available for this article. [source] ,-Blocker use and diabetes symptom score: results from the GEMINI studyDIABETES OBESITY & METABOLISM, Issue 3 2007J. B. McGill Aim:, The Glycemic Effect in Diabetes Mellitus: Carvedilol,Metoprolol Comparison in Hypertensives (GEMINI) trial compared the metabolic effects of two ,-blockers in people with type 2 diabetes and hypertension treated with renin,angiotensin system (RAS) blockade and found differences in metabolic outcomes. In this paper, we report the results of a prespecified secondary analysis of GEMINI that sought to determine the effect of these two ,-blockers on commonly reported symptoms. Methods:, The Diabetes Symptom Checklist (DSC), a self-report questionnaire measuring the occurrence and perceived burden of diabetes-related symptoms, was completed by GEMINI participants at baseline and at the end of the study (maintenance month 5). The DSC assessed symptoms in eight domains: psychology (fatigue), psychology (cognitive), neuropathy (pain), neuropathy (sensory), cardiology, ophthalmology, hyperglycaemia and hypoglycaemia. Results:, Comparison of the mean change in self-reported diabetes-related symptoms indicated a significant treatment difference favouring carvedilol over metoprolol tartrate in overall symptom score (,0.08; 95% CI ,0.15, ,0.01; p = 0.02) and in the domains for hypoglycaemia symptoms (,0.12; 95% CI ,0.23, ,0.02; p = 0.02) and hyperglycaemia symptoms (,0.16; 95% CI ,0.27, ,0.05; p = 0.005). Carvedilol resulted in fewer perceived diabetes-related symptoms in patients with diabetes and hypertension. Conclusion:, Carvedilol resulted in a lower perceived burden of diabetes-related symptoms in patients with type 2 diabetes and hypertension. The addition of a well-tolerated ,-blocker to RAS blockade may improve hypertension treatment and quality of life in patients with diabetes. [source] Trends in yield and effects of screening intervals during 17 years of a large UK community-based diabetic retinopathy screening programmeDIABETIC MEDICINE, Issue 10 2009A. Misra Abstract Aims, To describe changes in risk profiles and yield in a screening programme and to investigate relationships between retinopathy prevalence, screening interval and risk factors. Methods, We analysed a population of predominantly Type 2 diabetic patients, managed in general practice, and screened between 1990 and 2006, with up to 17 years' follow-up and up to 14 screening episodes each. We investigated associations between referable or sight-threatening diabetic retinopathy (STDR), screening interval and frequency of repeated screening, whilst adjusting for age, duration and treatment of diabetes, hypertension treatment and period. Results, Of 63 622 screening episodes among 20 788 people, 16 094 (25%) identified any retinopathy, 3136 (4.9%) identified referable retinopathy and 384 (0.60%) identified STDR. The prevalence of screening-detected STDR decreased by 91%, from 1.7% in 1991,1993 to 0.16% in 2006. The prevalence of referable retinopathy increased from 2.0% in 1991,1993 to 6.7% in 1998,2001, then decreased to 4.7% in 2006. Compared with screening intervals of 12,18 months, screening intervals of 19,24 months were not associated with increased risk of referable retinopathy [adjusted odds ratio 0.93, 94% confidence interval (CI) 0.82,1.05], but screening intervals of more than 24 months were associated with increased risk (odds ratio 1.56, 95% CI 1.41,1.75). Screening intervals of < 12 months were associated with high risks of referable retinopathy and STDR. Conclusions, Over time the risk of late diagnosis of STDR decreased, possibly attributable to earlier diagnosis of less severe retinopathy, decreasing risk factors and systematic screening. Screening intervals of up to 24 months should be considered for lower risk patients. [source] Long-term outcomes after a structured hypertension education programme for patients with diabetes and hypertensionEUROPEAN DIABETES NURSING, Issue 2 2005B Osterbrink Nurse Teacher, Diabetes Counsellor, Principal of the Academy of Health Professions Abstract A structured hypertension treatment and education programme (HTEP) was developed in the Düsseldorf area in the 1990s for patients with diabetes mellitus and hypertension and was found to be effective in a randomised controlled trial. The German Association of Diabetes Education and Counselling Professions (VDBD) implemented the HTEP all over Germany in order to optimise the care of patients with diabetes and hypertension. The objectives of the HTEP are to enable patients to gain knowledge of hypertension, to participate actively in their treatment to improve blood pressure (BP) and metabolic control and to self-measure their BP. The implementation consisted of two stages. The first stage comprised the training of 312 diabetes counsellors (DCs). During the second stage 473 patients with type 1 or type 2 diabetes and hypertension in 35 diabetes centres throughout Germany received the HTEP including instructions in BP self-measurement. The HTEP consists of four units each one with a duration of 90 minutes covering the topics: hypertension, BP self-monitoring according to the standards of the German Hypertension League, antihypertensive medication including effects and side effects, recommendations to moderate exercise, weight reduction, dietary advice with reference to reduction of salt and alcohol and normalising the intake of protein. These patients participated in a prospective non-experimental study with a follow up of three years investigating the long-term outcomes of the HTEP in uncontrolled settings. The DCs assessed the accuracy of patients' self-monitoring by parallel measurement. Assessments included questionnaires evaluating patients' understanding of hypertension and metabolic control. The mean BP monitored by the DC fell from 150/85mmHg to 147/80mmHg (p<0.0001). The accuracy of self-measurements increased from 76% to 86% (p<0.005) and mean self-measurement readings decreased from 142/81mmHg to 139/78mmHg. HbA1c fell significantly from 7.9±1.6% to 7.3±1.1% (mean ± SD, p<0.001) and total cholesterol was lowered from 241±67.1mg/dl to 200±40.4mg/dl (p<0.001). Patients' knowledge of hypertension increased from 62% before the intervention to 72% after three years' follow up. Patients over 70 years showed less knowledge than younger patients (p<0.005). It was concluded that the HTEP is effective in improving BP, metabolic control and knowledge of hypertension. It enables patients to measure their BP precisely and regularly. Copyright © 2005 FEND. [source] Renin inhibitors: an important advance in hypertension treatment?INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 11 2006A. Ferro No abstract is available for this article. [source] Blood Pressure and Brain Injury in Older Adults: Findings from a Community-Based Autopsy StudyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2009Lucy Y. Wang MD OBJECTIVES: To examine correlations between blood pressure (BP) and dementia-related pathological brain changes in a community-based autopsy sample. DESIGN: Prospective cohort study. SETTING: A large health maintenance organization in Seattle, Washington. PARTICIPANTS: A cohort of 250 participants aged 65 and older and cognitively normal at time of enrollment in the Adult Changes in Thought (ACT) Study and who underwent autopsy. MEASUREMENTS: BP and history of antihypertensive treatment were taken at enrollment. A linear regression model was used to examine the relationship between BP (systolic (SBP) and diastolic (DBP)) at enrollment and pathological changes in the cerebrum (cystic macroscopic infarcts, microinfarcts, neuritic plaques, neurofibrillary tangles, and cortical Lewy bodies). RESULTS: The presence of more than 2 microinfarcts, but not any other pathological change, was independently associated with SBP in younger participants (65,80, n=137) but not in older participants (>80, n=91). The relative risk (RR) for more than two microinfarcts with each 10-mmHg increase in SBP was 1.15 (95% confidence interval (CI)=1.00,1.33) in the younger participants, adjusted for age at entry, sex, and time to death. This RR was particularly strong in younger participants not taking antihypertensive medications (RR=1.48, 95% CI=1.21, 1.81); significant associations were not observed in participants treated for hypertension. Findings for DBP were negative. CONCLUSION: The association between high SBP and cerebrovascular damage in untreated older adults (65,80) suggests that adequate hypertension treatment may reduce dementia risk by minimizing microvascular injury to cerebrum. [source] Pathophysiology of Target-Organ Disease: Does Angiotensin II Remain the Key?JOURNAL OF CLINICAL HYPERTENSION, Issue 2007Ronald G. Victor MD Basic research provides an increasingly compelling rationale for renin-angiotensin system (RAS) blockade in hypertension treatment and cardiovascular risk reduction. Clinical trials addressing blood pressure-independent effects of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, however, have yielded mixed results, in part because of incomplete RAS blockade. Animal studies have shed new light on the complexity of RAS pathways involved in the induction of target-organ damage. New outcomes trials are under way to explore the full potential of more complete RAS blockade with regard to cardiovascular target-organ protection. [source] Roundtable Discussion: Problems in the Management of HypertensionJOURNAL OF CLINICAL HYPERTENSION, Issue 3 2002Marvin Moser MD Following a symposium on hypertension sponsored by the National Heart, Lung, and Blood Institute in Chicago, IL on October 3, 2001, a panel was convened to discuss various aspects of hypertension treatment. Moderating the panel was Dr. Marvin Moser, Clinical Professor of Medicine at The Yale University School of Medicine. Panel members included Dr. George Bakris, Professor of Preventive Medicine and Director, Hypertension/Clinical Research Center at the Rush-Presbyterian-St. Luke's Medical Center in Chicago, Illinois and Dr. Henry Black, Professor of Medicine, Associate Vice President for Research, and Chairman of the Department of Preventive Medicine at Rush-Presbyterian. [source] Potential roles of melatonin and chronotherapy among the new trends in hypertension treatmentJOURNAL OF PINEAL RESEARCH, Issue 2 2009Fedor Simko Abstract:, The number of well-controlled hypertensives is unacceptably low worldwide. Respecting the circadian variation of blood pressure, nontraditional antihypertensives, and treatment in early stages of hypertension are potential ways to improve hypertension therapy. First, prominent variations in circadian rhythm are characteristic for blood pressure. The revolutionary MAPEC (Ambulatory Blood Pressure Monitoring and Cardiovascular Events) study, in 3000 adult hypertensives investigates, whether chronotherapy influences the cardiovascular prognosis beyond blood pressure reduction per se. Second, melatonin, statins and aliskiren are hopeful drugs for hypertension treatment. Melatonin, through its scavenging and antioxidant effects, preservation of NO availability, sympatholytic effect or specific melatonin receptor activation exerts antihypertensive and anti-remodeling effects and may be useful especially in patients with nondipping nighttime blood pressure pattern or with nocturnal hypertension and in hypertensives with left ventricular hypertrophy (LVH). Owing to its multifunctional physiological actions, this indolamine may offer cardiovascular protection far beyond its hemodynamic benefit. Statins exert several pleiotropic effects through inhibition of small guanosine triphosphate-binding proteins such as Ras and Rho. Remarkably, statins reduce blood pressure in hypertensive patients and more importantly they attenuate LVH. Addition of statins should be considered for high-risk hypertensives, for hypertensives with LVH, and possibly for high-risk prehypertensive patients. The direct renin inhibitor, aliskiren, inhibits catalytic activity of renin molecules in circulation and in the kidney, thus lowering angiotensin II levels. Furthermore, aliskiren by modifying the prorenin conformation may prevent prorenin activation. At present, aliskiren should be considered in hypertensive patients not sufficiently controlled or intolerant to other inhibitors of renin,angiotensin system. Third, TROPHY (Trial of Preventing Hypertension) is the first pharmacological intervention for prehypertensive patients revealing that treatment with angiotensin II type 1 receptor blocker attenuates hypertension development and thus decreases the risk of cardiovascular events. [source] Tooth loss and associated factors in long-term institutionalised elderly patientsGERODONTOLOGY, Issue 4 2007Paul Tramini Objective:, To compare partial and total tooth loss in dependent institutionalised elderly patients and identify any associated factors. Background:, A poor oral health status, together with a reduction of autonomy can seriously affect the general health and increase the risk of death in elderly people. Those with total tooth loss and in need of assistance are the most at risk. Materials and methods:, In 2004, a cross-sectional study of 321 elderly patients was conducted in long-term hospital services provided in Montpellier, France. Socio-demographic, behavioural, medical and oral health information was recorded for each patient. Multivariate logistic regression models were performed to test the relationship between those covariates and partial or total tooth loss. Pearson chi-squared tests were used for bivariate analyses. Results:, The proportion of edentulousness was 26.9%; among these12.6% had no dentures. The factors significantly associated with edentulism were: an age ,older than 87 years' [odds ratio (OR) = 9.4], the presence of a nephropathy (OR = 6.8), and inadequate oral hygiene (OR = 0.1). The factors most significantly associated with partial tooth loss (at least 21 missing teeth) were ,cancerous disease' (OR = 9.9), the presence of a nephropathy (OR = 5.6) and the presence of a neurological disease (OR = 4.1). The factors significantly related to dentate status (20 or more natural teeth retained) were ,hypertension treatment' (OR = 2.4), and ,cortisone treatment' (OR = 0.2). Conclusion:, General health problems as well as a poor oral condition were significant risk indicators for tooth loss among the long-term institutionalised elderly. This suggests that the number of remaining teeth has a strong effect on oral health-related quality of life. [source] Comparison between three-dimensional volume-selective turbo spin-echo imaging and two-dimensional ultrasound for assessing carotid artery structure and functionJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 3 2005Lindsey A. Crowe PhD Abstract Purpose To compare a volume-selective three-dimensional turbo spin echo (TSE) technique with ultrasound (US) for assessing carotid artery wall structure and function. Materials and Methods A three-dimensional volume-selective TSE technique was used to image the carotid artery in 10 healthy subjects and five hypertensive subjects (each of whom were scanned three times while they received different hypertension treatments). Lumen and wall area were measured on MR images. Two-dimensional US measurements of the intima-media thickness (IMT) and lumen diameter were taken in three orientations through a single cross section. The lumen area change over the cardiac cycle was used to determine distension. For validation, a Bland-Altman analysis was used to compare the vessel wall and lumen areas measured by three-dimensional MRI volumes with those obtained by US scans. Results Agreement between the two methods was found. The mean difference in distension between US and MRI was 1.2% (±5.1%). For the wall area measurements, good agreement was shown, but there was a systematic difference due to the visualization of the adventitia by MRI. Both techniques offer an easy way to objectively measure lumen indices. MRI can provide the complete circumference over the length of a vessel, while US is flexible and relatively inexpensive. The application of US is limited, however, when subjects are poorly echogenic. A difference between hypertensive and healthy subjects was found. Conclusion There was a good agreement between MRI and the clinically established two-dimensional US method. The MRI method has the advantage of providing increased vessel coverage, which permits one to assess localized abnormalities without assuming vessel uniformity. J. Magn. Reson. Imaging 2005;21:282,289. © 2005 Wiley-Liss, Inc. [source] | ||||||||||