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Pressure Control (pressure + control)
Kinds of Pressure Control Selected AbstractsImprovement In Blood Pressure Control With Impedance Cardiography-Guided Pharmacologic Decision MakingCONGESTIVE HEART FAILURE, Issue 1 2004Donald L. Sharman MD Previous reports have demonstrated improvement in blood pressure (BP) control utilizing noninvasive hemodynamic measurements with impedance cardiography (ICG). The purpose of this article is to report the effect of utilizing ICG-guided decision making to treat uncontrolled hypertension in a community generalist setting. Patient medical records were retrospectively reviewed for subjects on two antihypertensive agents with systolic blood pressure ,140 mm Hg or diastolic blood pressure ,90 mm Hg. All subjects were treated utilizing a previously published ICG-guided treatment algorithm. Twenty-one subjects met the BP and medication criteria. BP at entry was 157.2±13.9/78.7±9.9 mm Hg. Subjects were treated for 215±85 days (5.0±2.0 visits). After ICG-guided treatment, 12/21 (57.1%) achieved sustained BP control (p<0.001). BP was lowered to 141.6±22.0 (p<0.001)/77.1±10.7 (p>0.05) mm Hg. Antihypertensive agents increased from 2.0±0.0 to 2.5±0.7 (p<0.05). In this series of subjects with uncontrolled BP taking two antihypertensive agents, ICG-guided pharmacologic decision making resulted in significant reduction in BP and improvement in BP control. [source] What Price For Blood Pressure Control?JOURNAL OF CLINICAL HYPERTENSION, Issue 10 2009Stephen C. Textor MD No abstract is available for this article. [source] Overcoming Racial and Ethnic Disparities in Blood Pressure Control: A Patient-Centered Approach to Cross-Cultural CommunicationJOURNAL OF CLINICAL HYPERTENSION, Issue 8 2008Michael J. Bloch MD "It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.",William Osler1 [source] Renin-Angiotensin System Blockade: Therapeutic Implications Beyond Blood Pressure ControlJOURNAL OF CLINICAL HYPERTENSION, Issue 2007Norman M. Kaplan MD No abstract is available for this article. [source] Importance of Consistent 24-Hour Blood Pressure ControlJOURNAL OF CLINICAL HYPERTENSION, Issue 2002Giuseppe Mancia MD No abstract is available for this article. [source] Fine-Tuning Blood Pressure Control to Minimize Cardiovascular RiskPREVENTIVE CARDIOLOGY, Issue 4 2007Bodh I. Jugdutt MBChB No abstract is available for this article. [source] Better Correction of Metabolic Acidosis, Blood Pressure Control, and Phagocytosis with Bicarbonate Compared to Lactate Solution in Acute Peritoneal DialysisARTIFICIAL ORGANS, Issue 2 2001Visith Thongboonkerd Abstract: Lactate solution has been the standard dialysate fluid for a long time. However, it tends to convert back into lactic acid in poor tissue-perfusion states. The aim of this study was to evaluate the efficacy of magnesium (Mg)- and calcium (Ca)-free bicarbonate solution compared with lactate solution in acute peritoneal dialysis (PD). Renal failure patients who were indicated for dialysis and needed acute PD were classified as shock and nonshock groups, and then were randomized to receive either bicarbonate or lactate solution. Twenty patients were enrolled in this study (5 in each subgroup). In the shock group, there were more rapid improvements and significantly higher levels of blood pH (7.40 ± 0.04 versus 7.28 ± 0.05, p < 0.05), serum bicarbonate (23.30 ± 1.46 versus 18.37 ± 1.25 mmol/L, p < 0.05), systolic pressure (106.80 ± 3.68 versus 97.44 ± 3.94 mm Hg, p < 0.05), mean arterial pressure (80.72 ± 2.01 versus 73.28 ± 2.41 mm Hg, p < 0.05), percentages of phagocytosis of circulating leukocytes (65.85%± 2.22 versus 52.12%± 2.71, p < 0.05), and percentages of positive nitroblue tetrazolium (NBT) reduction test without and with stimulation (14.43 ± 1.93 versus 9.43 ± 2.12, p < 0.05 and 65.08 ± 6.80 versus 50.23 ± 4.21, p < 0.05, respectively) in the bicarbonate subgroup compared with the lactate subgroup. In the nonshock group, blood pH, serum bicarbonate, and phagocytosis assays in both subgroups were comparable. Lactic acidosis was more rapidly recovered and was significantly lower with bicarbonate solution for both shock and nonshock groups (3.63 ± 0.37 versus 5.21 ± 0.30 mmol/L, p < 0.05 and 2.92 ± 0.40 versus 3.44 ± 0.34 mmol/L, p < 0.05, respectively). Peritoneal urea and creatinine clearances in both subgroups were comparable for both shock and nonshock groups. There was no peritonitis observed during the study. Serum Mg and Ca levels in the bicarbonate subgroup were significantly lower, but no clinical and electrocardiographic abnormality were observed. We concluded that Mg- and Ca-free bicarbonate solution could be safely used and had better outcomes in correction of metabolic acidosis, blood pressure control, and nonspecific systemic host defense with comparable efficacy when compared to lactate solution. It should be the dialysate of choice for acute PD especially in the poor tissue-perfusion states such as shock, lactic acidosis, and multiple organ failure. [source] The role of the ,-adrenergic receptor in the leg vasoconstrictor response to orthostatic stressACTA PHYSIOLOGICA, Issue 3 2009M. Kooijman Abstract Aim:, The prompt increase in peripheral vascular resistance, mediated by sympathetic ,-adrenergic stimulation, is believed to be the key event in blood pressure control during postural stress. However, despite the absence of central sympathetic control of the leg vasculature, postural leg vasoconstriction is preserved in spinal cord-injured individuals (SCI). This study aimed at assessing the contribution of both central and local sympathetically induced ,-adrenergic leg vasoconstriction to head-up tilt (HUT) by including healthy individuals and SCI, who lack central sympathetic baroreflex control over the leg vascular bed. Methods:, In 10 controls and nine SCI the femoral artery was cannulated for drug infusion. Upper leg blood flow (LBF) was measured bilaterally using venous occlusion strain gauge plethysmography before and during 30° HUT throughout intra-arterial infusion of saline or the non-selective ,-adrenergic receptor antagonist phentolamine respectively. Additionally, in six controls the leg vascular response to the cold pressor test was assessed during continued infusion of phentolamine, in order to confirm complete ,-adrenergic blockade by phentolamine. Results:, During infusion of phentolamine HUT still caused vasoconstriction in both groups: leg vascular resistance (mean arterial pressure/LBF) increased by 10 ± 2 AU (compared with 12 ± 2 AU during saline infusion), and 13 ± 3 AU (compared with 7 ± 3 AU during saline infusion) in controls and SCI respectively. Conclusion:, Effective ,-adrenergic blockade did not reduce HUT-induced vasoconstriction, regardless of intact baroreflex control of the leg vasculature. Apparently, redundant mechanisms compensate for the absence of sympathetic ,-adrenoceptor leg vasoconstriction in response to postural stress. [source] Nitric oxide, superoxide and renal blood flow autoregulation in SHR after perinatal L -arginine and antioxidantsACTA PHYSIOLOGICA, Issue 4 2007M. P. Koeners Abstract Aim:, Nitric oxide (NO) and superoxide are considered to be regulatory in renal blood flow (RBF) autoregulation, and hence may contribute to development of hypertension. To extend our previous observations that dynamic NO release is impaired in the spontaneously hypertensive rat (SHR) we investigated, firstly, if superoxide dependency of RBF autoregulation is increased in SHR and, secondly, if the beneficial effect of perinatal supplementation in SHR is partly as a result of early correction of RBF autoregulation. We hypothesized that perinatal supplementation by restoring dynamic NO release and/or decreasing superoxide dependency and would improve life-long blood pressure regulation. Methods:, Autoregulation was studied using stepwise reductions in renal perfusion pressure in anaesthetized male SHR, SHR perinatally supplemented with arginine and antioxidants (SHRsuppl) and Wistar-Kyoto (WKY), prior to and during i.v. N, -nitro- l -arginine (NO synthase inhibitor) or tempol (superoxide dismutase mimetic). Results:, Spontaneously hypertensive rat displayed a wider operating range of RBF autoregulation as compared with WKY (59 ± 4 vs. 33 ± 2 mmHg, respectively; P < 0.01). Perinatal supplementation in SHR decreased mean arterial pressure, renal vascular resistance and the operating range of RBF autoregulation (43 ± 3 mmHg; P < 0.01). In addition autoregulation efficiency decreased. RBF autoregulation characteristics shifted towards those of normotensive WKY. However, dynamic NO release was still impaired and no clear differences in superoxide dependency in RBF autoregulation between groups was observed. Conclusion:, Perinatal supplements shifted RBF autoregulation characteristics of SHR towards WKY, although capacity of the SHRsuppl kidney to modulate NO production to shear stress still seems impaired. The less strictly controlled RBF as observed in perinatally supplemented SHR could result in an improved long-term blood pressure control. This might partly underlie the beneficial effects of perinatal supplementation. [source] A Single Ventilator for Multiple Simulated Patients to Meet Disaster SurgeACADEMIC EMERGENCY MEDICINE, Issue 11 2006Greg Neyman MD Objectives To determine if a ventilator available in an emergency department could quickly be modified to provide ventilation for four adults simultaneously. Methods Using lung simulators, readily available plastic tubing, and ventilators (840 Series Ventilator; Puritan-Bennett), human lung simulators were added in parallel until the ventilator was ventilating the equivalent of four adults. Data collected included peak pressure, positive end-expiratory pressure, total tidal volume, and total minute ventilation. Any obvious asymmetry in the delivery of gas to the lung simulators was also documented. The ventilator was run for almost 12 consecutive hours (5.5 hours of pressure control and more than six hours of volume control). Results Using readily available plastic tubing set up to minimize dead space volume, the four lung simulators were easily ventilated for 12 hours using one ventilator. In pressure control (set at 25 mm H2O), the mean tidal volume was 1,884 mL (approximately 471 mL/lung simulator) with an average minute ventilation of 30.2 L/min (or 7.5 L/min/lung simulator). In volume control (set at 2 L), the mean peak pressure was 28 cm H2O and the minute ventilation was 32.5 L/min total (8.1 L/min/lung simulator). Conclusions A single ventilator may be quickly modified to ventilate four simulated adults for a limited time. The volumes delivered in this simulation should be able to sustain four 70-kg individuals. While further study is necessary, this pilot study suggests significant potential for the expanded use of a single ventilator during cases of disaster surge involving multiple casualties with respiratory failure. [source] A cardiologist view of vascular disease in diabetesDIABETES OBESITY & METABOLISM, Issue 4 2008Christopher J. Lockhart Diabetes mellitus is a potent risk factor for the development of a wide spectrum of cardiovascular (CV) complications. The complex metabolic milieu accompanying diabetes alters blood rheology, the structure of arteries and disrupts the homeostatic functions of the endothelium. These changes act as the substrate for end-organ damage and the occurrence of CV events. In those who develop acute coronary syndromes, patients with diabetes are more likely to die, both in the acute phase and during follow-up. Patients with diabetes are also more likely to suffer from chronic cardiac failure, independently of the presence of large vessel disease, and also more likely to develop stroke, renal failure and peripheral vascular disease. Preventing vascular events is the primary goal of therapy. Optimal cardiac care for the patient with diabetes should focus on aggressive management of traditional CV risk factors to optimize blood glucose, lipid and blood pressure control. Targeting medical therapy to improve plaque stability and diminish platelet hyper-responsiveness reduces the frequency of events associated with atherosclerotic plaque burden. In patients with critical lesions, revascularization strategies, either percutaneous or surgical, will often be necessary to improve symptoms and prevent vascular events. Improved understanding of the vascular biology will be crucial for the development of new therapeutic agents to prevent CV events and improve outcomes in patients with diabetes. [source] Treatment of isolated systolic hypertension in diabetes mellitus type 2DIABETES OBESITY & METABOLISM, Issue 4 2006Ingrid Os Age-related arterial stiffness is more pronounced in diabetics compared to non-diabetics, which could explain the prevalence of isolated systolic hypertension (ISH, systolic blood pressure ,140 mmHg and diastolic blood pressure <90 mmHg) being approximately twice that of the general population without diabetes. Large-scale interventional outcome trials have also shown that diabetics usually have higher pulse pressure and higher systolic blood pressure than non-diabetics. Advanced glycation end-product formation has been implicated in vascular and cardiac complications of diabetes including loss of arterial elasticity, suggesting possibilities for new therapeutic options. With increasing age, there is a shift to from diastolic to systolic blood pressure and pulse pressure as predictors of cardiovascular disease. This may affect drug treatment as different antihypertensive drugs may have differential effects on arterial stiffness that can be dissociated from their effects on blood pressure. While thiazide diuretics are associated with little or no change in arterial stiffness despite a robust antihypertensive effect, angiotensin converting enzyme inhibitors, angiotensin II receptor blockers and calcium-channel blockers have been shown to reduce arterial stiffness. However, combination therapy is nearly always necessary to obtain adequate blood pressure control in diabetics. There are no randomized controlled trials looking specifically at treatment of ISH in diabetics. Recommendations regarding treatment of ISH in diabetes mellitus type 2 are based on extrapolation from studies in non-diabetics, post-hoc analyses and prespecified subgroup analysis in large-scale studies, and metaanalysis. These analyses have clearly demonstrated that blood pressure lowering in ISH confers improved prognosis and reduced cardiovascular and renal outcomes in both diabetics and non-diabetics. [source] Characterizing blood pressure control in individuals with Type 2 diabetes: the relationship between clinic and self-monitored blood pressureDIABETIC MEDICINE, Issue 9 2003R. S. Mazze Abstract Aims To determine the relationship between blood pressure (BP) measurement in the clinic and self-monitored blood pressure (SMBP); and to evaluate the accuracy of self-reported data in patients with Type 2 diabetes treated intensively for hypertension. Methods Seventy subjects had baseline and 1-week follow-up clinic BP measured using an Omron 907® automated device. During a contemporaneous 14-day period these subjects measured their BP at least four times each day using an Omron IC® semiautomatic portable monitor which, unknown to them, contained an onboard memory capable of storing BP with corresponding time and date. Results There was no significant difference between mean clinic and mean self-monitored BP. Correlations between clinic BP and SMBP were r = 0.61 (P < 0.0001) for systolic BP and r = 0.69 (P < 0.0001) for diastolic BP. Clinic BP classified 56 subjects as uncontrolled hypertension (BP , 130/80 mmHg, adjusted for diabetes) and 14 subjects as controlled hypertension. Using World Health Organization-International Society of Hypertension criteria for SMBP (, 125/75 mmHg), 55 cases of clinic classified uncontrolled hypertension were confirmed, resulting in 98% sensitivity. Clinic and SMBP agreed in one case of controlled hypertension, resulting in 7% specificity. For all subjects, the median percent of values exceeding SMBP criteria for controlled hypertension was systolic 92% and diastolic 70%. Self-reporting precision averaged 89 ± 10% (range 45,100%); under-reporting was 25 ± 16% (ranging from 0 to 56%) and over-reporting was 12 ± 15% (ranging from 0 to 46%). The overall logbook mean was not significantly different from the downloaded data from the Omron IC® monitors. Conclusions SMBP was able to identify 13 patients with uncontrolled hypertension who, by clinic BP measurement, had been classified as controlled. [source] Mechanistic studies of blood pressure in rats treated with a series of cholesteryl ester transfer protein inhibitors,DRUG DEVELOPMENT RESEARCH, Issue 1 2009Michael DePasquale Abstract ILLUMINATE, the Phase 3 clinical trial of morbidity and mortality (M&M) with the cholesteryl ester transfer protein inhibitor (CETPi), torcetrapib (CP-529,414), was terminated in December 2006 due to an imbalance in all cause mortality. The underlying cause of the M&M remains undetermined. While torcetrapib produced dose-related increases in blood pressure in clinical trials, the mechanism of the increase in blood pressure is also undetermined. The pressor effects of torcetrapib and structurally related compounds were studied in several pathways involved in blood pressure control. Studies were conducted in rats treated with a series of structurally related molecules (CP-529,414, CP-532,623, PF-868,348, CP-746,281, CP-792,485, PF-868,343, and CE-308,958). CP-529,414, CP-532,623, CP-868,343, and CP-792,485 are potent CETP inhibitors; PF-868,348 is weakly potent and CP-746,281 and CE-308,958 are CETP-inactive. Changes in blood pressure were determined in conscious animals in conjunction with pharmacologic blockade of numerous pressor agents/pathways. Torcetrapib and CP-532,623 increased blood pressure following both chronic PO and acute IV administration. The CETP-inactive enantiomer of CP-532,623, CP-746,281 failed to raise blood pressure. PF-868,348, a structural analogue with ,50-fold lower CETPi activity also displayed pressor activity. Blockade of adrenergic, cholinergic, angiotensin, endothelin, NOS, Rho kinase, and thromboxane pathways failed to attenuate the pressor response. These data demonstrate that the blood pressure activity seen with torcetrapib can be dissociated from CETP inhibitor pharmacology and numerous pharmacology pathways can be discounted in the attempt to understand the molecular basis of the pressor pharmacology. Drug Dev Res 70:2009 © 2009 Wiley-Liss, Inc. [source] New Developments in Vertical Gradient Freeze Growth,ADVANCED ENGINEERING MATERIALS, Issue 7 2004O. Pätzold The Vertical Gradient Freeze (VGF) technique is an important method for growing high quality compound semiconductors such as GaAs. Results obtained with a novel VGF set-up developed for the growth under influence of a rotating magnetic field (RMF) and under vapour pressure control are presented in this paper. The RMF is shown to be a powerful tool to affect the heat and mass transport within the melt in a definite way. In GaAs:Si growth, RMF induced flow results in a decreased curvature of a nominally concave-shaped interface, i.e., it contributes to an axial heat transfer at the solid-liquid interface. The axial dopant segregation of Ga in Ge is found to be improved under continuous RMF action due to better mixing of the melt. The set-up also allowed to determine the influence of carbon and the arsenic vapour pressure on the dopant incorporation and crystal quality. [source] Optimal treatment of hypertension in the elderly: A Korean perspectiveGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 1 2008Kwang-Il Kim With the progression of the aging population, common diseases of the elderly have become the center of attention in most developed countries. Hypertension is one of the most common morbid conditions in the elderly and has a great impact on their health status because it is the main risk factor of cardiovascular and cerebrovascular diseases. However, a considerable amount of uncertainty remains regarding hypertension in the elderly, such as the benefits of hypertension control in oldest-old populations, the optimal level of blood pressure control, and the efficacy of antihypertensive drugs for the prevention of cognitive dysfunction. While there are many controversial issues concerning the optimal management of hypertension in the elderly, the number of elderly hypertensive patients that require treatment is expected to increase due to the aging population. As a result, knowledge regarding the mechanisms of hypertension in the elderly and specific consideration in managing hypertensive elderly patients are needed to improve the clinical outcome. Furthermore, new therapeutic interventions that are aimed at attenuating age-related vascular changes should be investigated, because hypertension in the elderly, especially isolated systolic hypertension has specific characteristics of increased arterial stiffness in most cases. [source] Fallacies of High-Speed HemodialysisHEMODIALYSIS INTERNATIONAL, Issue 2 2003Zbylut J. Twardowski Chronic hemodialysis sessions, as developed in Seattle in the 1960s, were long procedures with minimal intra- and interdialytic symptoms. Financial and logistical pressures related to the overwhelming number of patients requiring hemodialysis created an incentive to shorten dialysis time to four, three, and even two hours per session in a thrice weekly schedule. This method spread rapidly, particularly in the United States, after the National Cooperative Dialysis Study suggested that time of dialysis is of minor importance as long as urea clearance multiplied by dialysis time and scaled to total body water (Kt/Vurea) equals 0.95,1.0. This number was later increased to 1.3, but the assumption remained unchanged that hemodialysis time is of minimal importance as long as it is compensated by increased urea clearance. Patients accepted short dialysis as a godsend, believing that it would not be detrimental to their well-being and longevity. However, Kt/Vurea measures only removal of low molecular weight substances and does not consider removal of larger molecules. Besides, it does not correlate with the other important function of hemodialysis, namely ultrafiltration. Whereas patients with substantial residual renal function may tolerate short dialysis sessions, the patients with little or no urine output tolerate short dialyses poorly because the ultrafiltration rate at the same interdialytic weight gain is inversely proportional to dialysis time. Rapid ultrafiltration is associated with cramps, nausea, vomiting, headache, fatigue, hypotensive episodes during dialysis, and hangover after dialysis; patients remain fluid overloaded with subsequent poor blood pressure control, left ventricular hypertrophy, diastolic dysfunction, and high cardiovascular mortality. Short, high-efficiency dialysis requires high blood flow, which increases demands on blood access. The classic wrist arteriovenous fistula, the access with the best longevity and lowest complication rates, provides "insufficient" blood flow and is replaced with an arteriovenous graft fistula or an intravenous catheter. Moreover, to achieve high blood flows, large diameter intravenous catheters are used; these fit veins "too tightly," so predispose the patient to central-vein thrombosis. Longer hemodialysis sessions (5,8 hrs, thrice weekly), as practiced in some centers, are associated with lower complication rates and better outcomes. Frequent dialyses (four or more sessions per week) provide better clinical results, but are associated with increased cost. It is my strong belief that a wide acceptance of longer, gentler dialysis sessions, even in a thrice weekly schedule, would improve overall hemodialysis results and decrease access complications, hospitalizations, and mortality, particularly in anuric patients. [source] An Incenter Nocturnal Hemodialysis Program,Three Years ExperienceHEMODIALYSIS INTERNATIONAL, Issue 1 2003M. Gene Radford We report our experience with a program of long, slow, overnight hemodialysis (HD) performed 3 times a week in an existing dialysis facility. Beginning in April 1999, 14 chairs in one bay of our facility were replaced with beds, subdued lighting was installed, and machine alarms were decreased to minimum volume. Fresenius F60 dialyzers were selected with a QB of 220,300 ml/min and a QD of 400,500 ml/min. Patients dialyze for 7,8 hrs overnight. Staffing is with 1 nurse and 1 PCT for 10 patients. Standard dialysate is used, and heparin is dosed 100 U/kg at treatment initiation and again at mid-treatment. All access types are utilized. The program is open to all patients in our area. A total of 65 patients have participated, with a current census of 20 patients. Participants have tried nocturnal dialysis for a variety of reasons including work/school schedules, excessive interdialytic weight gains, inadequate dialysis (due to poor access function or large body mass), and hemodynamic instability with standard daytime HD. Blood pressure control has improved among the participants in the program, perhaps due to more gentle ultrafiltration and improvement in maintenance of dry weight. Among 31 patients who remained on nocturnal dialysis for over 6 months, 21 started the program on an average of 2.5 antihypertensive agents (AHA). After 6 months, 9 patients no longer needed AHA while 12 patients remain on an average of 1.3 AHA. URR also improved by an average of 4.35 among 13 patients who transferred from standard incenter HD to the nocturnal program. In all, 45 patients have left the program, for reasons which include insomnia/social (15), death (9), transfer to home HD (8), renal transplantation (6), noncompliance (3), moved away (2), and other (2). In conclusion, long overnight HD can be performed in an existing dialysis facility, providing patients with another HD option. Patients who may benefit from this modality include those with daytime jobs, patients with inadequate clearance on standard HD, patients with excessive interdialytic weight gains, and those who poorly tolerate standard HD. [source] The value of a specialist lipid clinicINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 6 2008S. C. Martin Summary Aims:, To establish the value of the first 3 years of a cardiovascular risk factor clinic in tackling the major risk factors for cardiovascular disease (CVD). Methods:, A database review of all 339 patients referred to the clinic. Results:, Blood pressure levels in the hypertensive patients were significantly reduced and 9% of the smokers managed to quit for 12 months, half of them subsequently relapsing. Ninety-eight oral glucose tolerance tests were performed and 40% were abnormal yielding 10 patients with hitherto unsuspected diabetes and 29 with impaired glucose tolerance. Sixty-four of the 97 referrals of patients in the primary prevention group (no evidence of CVD) were found to have calculated Framingham coronary heart disease risk estimates of < 15% per decade, the lowest being 0.3%. Lipid levels were significantly reduced in both the hypercholesterolaemic (n = 290) and hypertriglyceridaemic (n = 49) patient groups through the use of more potent statins, extensive use of combination therapy and appropriate use of fibrates and omega-3 fish oil supplements. The annual drug cost per patient treated only increased from £310.72 to £398.08, yet there was a 3.5-fold increase in the number of patients achieving the General Medical Services 2 target of a total cholesterol < 5 mmol/l and a 4.5-fold increase in patients achieving the Joint British Societies 2 target of a low-density lipoprotein (LDL) cholesterol < 2 mmol/l. Conclusion:, The need for a specialist clinic was demonstrated by the 66% of primary prevention referrals who did not meet the current NICE treatment threshold. Additionally, the clinic was able to diagnose and treat 39 patients with undiagnosed diabetes mellitus/impaired glucose tolerance and 12 with hypothyroidism. LDL cholesterol was reduced overall by 36% implying a greater than one-third reduction in future cardiovascular events before the improvements in blood pressure control and smoking cessation are included and this was achieved at marginal extra cost to the mean drug bill at referral. [source] Prevention of secondary stroke and transient ischaemic attack with antiplatelet therapy: the role of the primary care physician roleINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 10 2007H. S. Kirshner Summary Background:, Stroke risk is heightened among patients who have had a primary stroke or transient ischaemic attack (TIA). The primary care physician is in the best position to monitor these patients for stroke recurrence. Because stroke recurrence can occur shortly after the primary event, guidelines recommend initiating antiplatelet therapy as soon as possible. Aspirin, with or without extended-release dipyridamole (ER-DP), and clopidogrel are options for such patients. Low-dose aspirin (75,150 mg/day) has the same efficacy as higher doses but with less gastrointestinal bleeding. Clopidogrel remains an option for prevention of secondary events and may benefit patients with symptomatic atherothrombosis, but its combined use with aspirin can harm patients with multiple risk factors and no history of symptomatic cerebrovascular, cardiovascular or peripheral vascular disease. Results:, Low dose aspirin is effective in secondary stroke prevention. Trials assessing aspirin plus ER-DP have shown that the combination is more effective than aspirin monotherapy in preventing stroke, with efficacy increasing among higher risk patients, notably those with prior stroke/TIA. Clopidogrel does not appear to have as much advantage over aspirin in secondary stroke prevention as aspirin plus ER-DP. Smoking cessation and cholesterol, blood glucose and blood pressure control are also important concerns in preventing recurrent stroke. In choosing pharmacological therapy, the physician must consider the individual patient's risk factors and tolerance, as well as other issues, such as use of aspirin among patients with ulcers. Conclusion:, Antiplatelet therapy is effective in secondary stroke prevention. Low dose aspirin can be used first-line, but aspirin plus ER-DP improves efficacy. Clopidogrel is another option in secondary stroke prevention, especially for aspirin-intolerant patients, but it appears to have less advantage over aspirin than aspirin plus ER-DP, and its combined use with aspirin has only marginally better efficacy and increased bleeding risk. [source] The normal circadian pattern of blood pressure: implications for treatmentINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 2004J. Redon Summary Blood pressure fluctuates over 24 h following a circadian rhythm that reaches a peak in the morning shortly after awakening. The onset of many acute cardiovascular and cerebrovascular events shows a synchronous cyclical pattern, with the highest incidence of morbidity and mortality in the early morning hours. Strong, although circumstantial, evidence suggests that the early morning surge in blood pressure may contribute to the onset of acute cardiovascular episodes. Sustained blood pressure control that blunts the early morning blood pressure surge may help to reduce the incidence of these events. Antihypertensive agents are needed that provide smooth and sustained blood pressure control for the full 24 h, including the risky early morning hours. The angiotensin II receptor blocker telmisartan given once daily, because of its long half-life and mechanism of action, is likely to confer benefit in terms of 24-h blood pressure control and may reduce cardiovascular risk at the time of greatest patient vulnerability. [source] Cavity pressure control during cooling in plastic injection moldingADVANCES IN POLYMER TECHNOLOGY, Issue 3 2006B. Pramujati Abstract Cavity pressure control during filling, packing, and cooling phases is imperative for maintaining product quality in injection molding process. This paper presents the design and implementation of a strategy to control cavity pressure profile during the cooling phase. In order to do this, a controlled variable parameter was defined to be the time constant , of the pressure profile. This parameter can be used effectively to control the shape of the cavity pressure over the cooling cycle. The coolant flow rate through the mold was used as the manipulated variable. A predictive control system was designed and implemented successfully to allow monitoring and control of , at several setpoints ,sp resulting in good and effective cavity pressure control. © 2006 Wiley Periodicals, Inc. Adv Polym Techn 25:170,181, 2006; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/adv.20068 [source] ASH Position Paper: Adherence and Persistence With Taking Medication to Control High Blood PressureJOURNAL OF CLINICAL HYPERTENSION, Issue 10 2010Martha N. Hill RN J Clin Hypertens (Greenwich). 2010;12:757-764. © 2010 Wiley Periodicals, Inc. Nonadherence and poor or no persistence in taking antihypertensive medications results in uncontrolled high blood pressure, poor clinical outcomes, and preventable health care costs. Factors associated with nonadherence are multilevel and relate not only to the patient, but also to the provider, health care system, health care organization, and community. National guideline committees have called for more aggressive approaches to implement strategies known to improve adherence and technologies known to enable changes at the systems level, including improved communication among providers and patients. Improvements in adherence and persistence are likely to be achieved by supporting patient self-management, a team approach to patient care, technology-supported office practice systems, better methods to measure adherence, and less clinical inertia. Integrating high blood pressure control into health care policies that emphasize and improve prevention and management of chronic illness remains a challenge. Four strategies are proposed: focusing on clinical outcomes; empowering informed, activated patients; developing prepared proactive practice teams; and advocating for health care policy reform. With hypertension remaining the most common reason for office visits, the time is now. [source] Original Paper: Aspirin Resistance in Hypertensive PatientsJOURNAL OF CLINICAL HYPERTENSION, Issue 9 2010Beste Ozben MD J Clin Hypertens (Greenwich). 2010;12:714,720. ©2010 Wiley Periodicals, Inc. Aspirin resistance is associated with poor clinical prognosis. The authors investigated aspirin resistance in 200 hypertensive patients (111 men, age: 68.3±11.4 years) by the Ultegra Rapid Platelet Function Assay-ASA (Accumetrics Inc., San Diego, CA). Aspirin resistance was defined as an aspirin reaction unit ,550. Aspirin resistance was detected in 42 patients. Aspirin resistance was present in 25.6% of the patients with poor blood pressure control, while in 17.8% of the patients with controlled blood pressure (P=.182). Female gender and creatinine levels were significantly higher (P=.028 and P=.030, respectively), while platelet count was significantly lower (P=.007) in aspirin-resistant patients. Multivariate analysis revealed that female gender (odds ratio [OR], 2.445; P=.045), creatinine levels (OR, 1.297; P=.015) and platelet count (OR, 0.993; P=.005) were independent predictors of aspirin resistance. The frequency of aspirin resistance is not low in hypertensive patients. Female hypertensive patients, especially, with higher creatinine levels and lower platelet count are at higher risk for aspirin resistance. [source] A Comparison of Web Sites Used to Manage and Present Home Blood Pressure ReadingsJOURNAL OF CLINICAL HYPERTENSION, Issue 6 2010Birju Patel BS J Clin Hypertens (Greenwich). 2010;12:389,395. ©2010 Wiley Periodicals, Inc. Home blood pressure (HBP) monitoring is now recommended as a routine component of blood pressure management in patients with known or suspected hypertension. Over the last few years, a large number of Web sites, commonly termed Personal Health Records, have been developed so that patients can manage and present HBP readings. The objective of this report is to describe and compare these Web sites. A list of 33 desirable Web site features, organized into 4 categories, was developed. Between June and August of 2009, a total of 60 Web sites was identified, of which 20 were free or free to try. Each of the 20 Web sites displayed HBP readings in tabular and graphical formats, most offered an option to print results in tabular (70%) and graphical (70%) form, and many (47%) could download HBP data from Microsoft HealthVault. In contrast, none of the Web sites directly linked with common electronic medical records. Overall, Web sites offered between 41% and 77% of the 33 features considered desirable. In conclusion, there is considerable variation in available features on Web sites used to manage HBP data. Information presented in this report should be useful to physicians and patients in selecting a Web site for managing and presenting HBP readings and ultimately improving blood pressure control. [source] Regression of Alterations in Retinal Microcirculation Following Treatment for Arterial HypertensionJOURNAL OF CLINICAL HYPERTENSION, Issue 8 2006Antonio Pose-Reino MD Evaluation of early hypertension-related alterations in retinal microcirculation has been subjective and poorly reproducible. The authors recently described a semiautomatic computerized system for evaluation of the calibre of retinal blood vessels that has shown very good reproducibility. In the study, this system was used to measure the calibres of retinal arterioles and veins, and their ratio, in a group of 51 hypertensive outpatients before and after 6 months of treatment with losartan or, if required for satisfactory blood pressure control, losartan plus hydrochlorothiazide. Mean retinal arteriole diameter increased from 0.0842±0.003 mm to 0.0847±0.003 mm (p=0.001). Arteriovenous ratio increased from 0.753±0.03 to 0.756±0.03 (p=0.005). This observation suggests regression of early hypertension-related alterations in retinal microcirculation after 6 months of antihypertensive treatment. [source] Pharmacotherapy Review: Calcium Channel BlockersJOURNAL OF CLINICAL HYPERTENSION, Issue 1 2006Domenic A. Sica MD As a drug class, calcium channel blockers encompass a heterogeneous group of compounds with distinctive structures and pharmacologic characteristics. These agents are widely used in the treatment of hypertension, chronic coronary ischemia, and/or supraventricular arrhythmias. Much of the early debate alluding to increased cardiovascular risk associated with calcium channel blocker use has been silenced by an array of outcomes trials that show these drugs to be both safe and effective in reducing hard cardiovascular end points. The most common side effects associated with calcium channel blockers are vasodilatory in nature and include a non-volume-dependent form of peripheral edema, flushing, and headache. Despite the sometimes discomforting side effects seen with calcium channel blocker therapy, their robust blood pressure-lowering effect makes them an important component of most multidrug regimens used for blood pressure control. [source] Patient Knowledge and Awareness of Hypertension Is Suboptimal: Results From a Large Health Maintenance OrganizationJOURNAL OF CLINICAL HYPERTENSION, Issue 4 2003Mark Alexander PhD; Patient knowledge and awareness of hypertension are important factors in achieving blood pressure control. To examine hypertensive patients' knowledge of their condition, the authors randomly surveyed 2500 hypertension patients from a large health maintenance organization; questionnaires were supplemented with clinic blood pressure measurements. Approximately 72% of the subjects completed surveys. Of patients with uncontrolled hypertension (systolic blood pressure [SBP] 140 mm Hg and/or diastolic blood pressure [DBP] 90 mm Hg), only 20.2% labeled their blood pressure as "high" and 38.4% as "borderline high." Forty percent of respondents couldn't recall their most recent clinic-based SBP and DBP values. Overall, 71.7% and 61% were unable to report a target SBP or DBP, respectively, or identify elevated targets based on the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) criteria. Most patients perceived DBP to be a more important risk factor than SBP. Hypertensive patients' awareness of blood pressure targets and current hypertension control status, particularly with respect to SBP, is suboptimal. The authors' findings support the need to improve patient education for better management of hypertension. [source] Queen Mary Utilization of Antihypertensive Drugs Study: side-effects of antihypertensive drugsJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 4 2005B. M. Y. Cheung PhD FRCP Summary Background and objective:, Effective prevention of cardiovascular events in hypertensive patients requires good control of blood pressure. Side-effects of antihypertensive drugs affect tolerability and compliance. Accordingly, we surveyed side-effects in the hypertension outpatient clinic. Methods:, A total of 228 patients (109 men, 119 women) were interviewed in April,May 2004 in the Queen Mary Utilization of Antihypertensive Drugs Study. Results:, The percentage of patients receiving no drug (life-style modification), one, two, three and over three drugs were 3, 30, 40, 22 and 6% respectively. The proportion of patients taking calcium channel blockers, , -blockers (BB), angiotensin-converting enzyme inhibitors, thiazide diuretics, , -blockers and angiotensin receptor blockers were 65, 64, 33, 24, 4 and 7% respectively. Blood pressure on treatment was 144 ± 21/82 ± 11 mmHg. Among patients on antihypertensive drug therapy, 34% reported adverse effects: dizziness (9%), ankle swelling (7%), headache (5%), fatigue (4%), chest discomfort (3%) and cough (3%). Fewer patients on BBs reported side-effects (OR 0·46, P = 0·008). The likelihood of experiencing side-effects was unrelated to sex, age, weight, BMI, years of treatment, number of drugs used, heart rate on treatment or compliance. Conclusions:, To achieve good blood pressure control, multiple drugs are used. Thiazides are underused whereas BBs are popular. The popularity of the latter may be related to its tolerability. [source] Twenty-four hour ambulatory blood pressure in a population of elderly menJOURNAL OF INTERNAL MEDICINE, Issue 6 2000K. Björklund Abstract. Björklund K, Lind L, Lithell H (University of Uppsala, Uppsala, Sweden). Twenty-four hour ambulatory blood pressure in a population of elderly men. J Intern Med 2000; 248: 503,512. Objectives. The principal aim was to study ambulatory and office blood pressure in a population of elderly men. We also wanted to describe the prevalence of hypertension and investigate the blood pressure control in treated elderly hypertensives. Design. A cross-sectional study of a population of elderly men, conducted between 1991 and 1995. Subjects. Seventy-year-old men (n = 1060), participants of a cohort study that began in 1970. Main outcome measures. Office and 24 h ambulatory blood pressure. Results. Average 24 h blood pressure in the population was 133 ± 16/75 ± 8 mmHg, and daytime blood pressure 140 ± 16/80 ± 9 mmHg. Corresponding values in untreated subjects (n = 685) were 131 ± 16/74 ± 7 and 139 ± 16/79 ± 8, respectively. An office recording of 140/90 mmHg corresponded to an ambulatory pressure of 130/78 (24 h) and 137/83 mmHg (daytime) in untreated subjects. In subjects identified as normotensives according to office blood pressure (n = 270), the 95th percentiles of average 24 h and daytime blood pressures were 142/80 and 153/85 mmHg, respectively. The prevalence of hypertension, defined as office blood pressure , 140/90 mmHg, was 66%. Despite treatment, treated hypertensives (n = 285) showed higher office (157/89 vs. 127/76 mmHg) and 24 h ambulatory (138/78 vs. 122/71 mmHg) pressures than normotensives (P < 0.05). Fourteen per cent of the treated hypertensives had an office blood pressure < 140/90 mmHg. Conclusions. Our results provide a basis for 24 h ambulatory blood pressure reference values in elderly men. The study confirms previous findings of a high prevalence of hypertension at older age. It also indicates that blood pressure is inadequately controlled in elderly treated hypertensives. [source] | |||||||||||||||||||||||||||||||||||||