PubMed Health⌕ Search

Biomedical subjects

D R Labarthe

Publications and source records attributed to D R Labarthe.

At least 73 records · Page 4Linked to original sources
PubMed1988

The relation between degree of blood pressure reduction and mortality among hypertensives in the Hypertension Detection and Follow-Up Program.

The relation between degree of diastolic blood pressure reduction and mortality was examined among hypertensive persons in the Hypertension Detection and Follow-up Program. This program, conducted from 1973-1979, was a multicenter community-based trial, which followed 10,940 hypertensive participants for five years. The one-year annual visit was the first occasion on which change in blood pressure could be measured on all participants. During the subsequent four years of follow-up on 10,053 participants, 568 deaths occurred. With time-dependent life tables and time-dependent Cox life table regression analyses, the existence of a quadratic function which modeled the relation between diastolic blood pressure reduction and mortality was supported, even after adjusting for other risk factors. The minimum mortality hazard ratio, based on a particular model, occurred at a diastolic blood pressure reduction of 26.2 mmHg (standard error = 13.4) in the whole population and 10.0 mmHg (standard error = 5.3) in the baseline diastolic blood pressure stratum 90-104 mmHg. After this reduction, there was a small increase in the risk of death. There was no evidence of the quadratic function after fitting the same model with systolic blood pressure. Methodological issues involved in studying a particular degree of blood pressure reduction were considered. The confidence interval around the change corresponding to the minimum hazard ratio was wide, and the obtained blood pressure level should not be interpreted as a goal for treatment. Blood pressure reduction was attributed not only to pharmacologic therapy but also to regression to the mean, and to other factors unrelated to treatment.

Actuarial Analysis↗
PubMed1986

Epidemiology of primary hypertension in the young.

This presentation is to provide a broad epidemiologic perspective on the problem of blood pressure in childhood and adolescence and a background for the presentations which follow, addressing the aspects of tracking, risk factors, and electrolytes. Two fundamental issues are addressed here: first, the different patterns of blood pressure by age, as observed in population surveys in the USA, Japan, and elsewhere around the world; and second, the relation of blood pressure to indices of growth and development at different ages during childhood and adolescence. The pattern of blood pressure by age in the young is often more complex than the simple linear pattern ascribed to adult populations. The relations of blood pressure to body measurements are strong but vary importantly with age. The implications of these observations for the design of future epidemiologic studies are discussed.

Adolescent↗
PubMed1984

Structural anomalies of the cervix and vagina in women enrolled in the Diethylstilbestrol Adenosis (DESAD) Project.

Among women exposed in utero to diethylstilbestrol (DES) and enrolled in the Diethylstilbestrol Adenosis (DESAD) Project, structural anomalies of the cervix or vagina were found in 25% of the 1,655 subjects identified by review of prenatal records, 43% of the 800 who themselves requested entry into the project, and 49% of the 1,089 referred by physicians but in only 2% of the 963 control subjects. Among the 367 cases found by record review to have complete information on the DES exposure, multivariate analysis indicated close association of the anomalies with the gestational week of first exposure and the total dose. Also, the prevalence rate of the anomalies was lower among subjects who had been pregnant and higher among those with later age at menarche.

Abnormalities, Drug-Induced↗
PubMed1984

Blood pressure during growth and development.

Data obtained from the United States Health and Nutrition Examination Survey of 1971-74 (HANES I) were analyzed to explore the relationship between blood pressure and differences in selected body measurements like weight, height, triceps skinfold, upper arm girth and heart rate. The period of growth and development was studied in a sample of 4238 persons aged 7-19 years. Strong concordance of the patterns of change in blood pressure up to age 14 years and of the patterns of correlations between blood pressure and various body measurements were seen in the four different groups analyzed (White males and females, Black males and females). From 14 years onwards differences in changes in several parameters were seen in both sexes and possibly also in the different racial groups.

Adolescent↗
PubMed1983

Serum cholesterol and cancer in the Hypertension Detection and Follow-up Program.

The relation between serum cholesterol and cancer incidence was investigated in the population of the Hypertension Detection and Follow-up Program. During the 5 years of follow-up, 286 new cancer cases were documented among the 10,940 participants. Overall, age-adjusted cancer incidence rates, computed by baseline serum cholesterol quartiles, showed a small, but statistically significant, inverse relation between serum cholesterol and cancer incidence. No evidence suggested that the observed relationship was primarily due to confounding by other cancer risk factors, association of low serum cholesterol with incipient but undiagnosed cancer, or problems of competing risks. However, the relationship is weak and a causal interpretation of these immediate results cannot be argued persuasively. Examinations of specific cancer sites and factors related to serum cholesterol are suggested as important lines of research toward clarification of the complex relationships observed.

Adult↗
PubMed1983

Evaluation of the treatment of hypertension.

Recent reports have demonstrated the efficacy and safety of community-wide hypertension control. This new evidence, which offers great potential for improving health and life expectancy, can be viewed as the culmination of decades of research on the treatment of hypertension. Over this period, as a number of approaches to treatment have become available, their evaluation has been conducted with increasing rigor and, especially recently, with progressively broader community applicability. This historical development illustrates the impact that long-term trials can have. Looking ahead, we ask what are the main challenges of the future in the control of hypertension? Several areas of interest are suggested: 1) To what degree can the demonstrated benefits of hypertension control be realized in different populations today? What are the obstacles to this achievement and how can they be overcome? 2) How much of the demonstrated benefit of hypertension control can be achieved by nonpharmacologic means, or by reduced pharmacologic intervention? 3) Can true primary prevention avert the development of high blood pressure itself? How does elevated blood pressure arise in relation to the normal biologic process of human development, characterized by marked "growth" of blood pressure during childhood and adolescence? The extent to which these questions might be approached through long-term trials is discussed.

Clinical Trials as Topic↗
PubMed1980

Reserpine and breast cancer. A community-based longitudinal study of 2,000 hypertensive women.

To supplement several case-control studies questioning whether use of reserpine is associated with occurrence of breast cancer, we conducted a longitudinal study of nearly 2,000 hypertensive women residing in Rochester, Minn. Exposure to antihypertensive agents and subsequent incidence of breast cancer were ascertained. Expected numbers of cases, derived from local population data and from the Connecticut Tumor Registry, were compared with the numbers of cases observed in exposure groups of interest. No evidence was found of any association of reserpine use, thiazide use, or untreated hypertension with subsequent occurrence of breast cancer in these hypertensive women. In addition, several issues were investigated that warrant consideration in evaluating reports published to date, especially before conclusions are drawn as to the questionable contention that reserpine has caused breast cancer in women.

Benzothiadiazines↗
PubMed1980

Breast cancer in DES-exposed mothers: absence of association.

Reports in the popular press have suggested that exposure to diethylstilbestrol (DES) is followed by an abnormally high incidence of breast cancer. The reports were based on a reanalysis of data not considered ominous originally; and both data and analyses are summarized here. In addition, new data are presented on mothers of young women enrolled in the National DESAD Project at its Mayo Clinic Center. Among 408 women given DES, there were 8 confirmed instances of breast cancer, in comparison with an expected number of 8.1, based on breast cancer incidence rates among parous women in the local population. A previous case-control study of the possible association of antihypertensive therapy and breast cancer in the local population revealed DES exposure in 10% of the breast cancer group and 12% of the controls. These apparently negative results clearly indicate a need of further studies of the alleged effect of DES.

Adult↗
PubMed1979

Use of a self-administered questionnaire for detection of transient cerebral ischemic attacks: I. Survey of elderly persons living in retirement facilities.

A self-administered questionnaire designed to identify people with transient cerebral ischemia (TIA) in large population groups was distributed to approximately 10,000 elderly persons living in public and private retirement facilities in the United States. The population resided in eight cities, and 74% completed the survey. Transient focal neurological symptoms compatible with a diagnosis of TIA within the previous year were reported by 6.4% of the respondents. Uncertain manifestations of TIA, i.e., dizziness, light-headedness, or loss of balance, were noted by an additional 15.4%; the remaining 78.2% had no manifestations of this disorder. A clinical history for TIA was taken by a neurologist in a sample of 1,712 respondents to determine the validity of the questionnaire responses. Thirty (7.1%) of 423 persons presumed by the questionnaire to have TIA met the standard clinical criteria for the diagnosis. An additional 8 cases of TIA were found by the neurologist among the 1,289 interviewed persons presumed by the questionnaire to have uncertain TIA or no evidence of the disorder. The twelve-month period prevalence of TIA was estimated to be 8.2 per 1,000 in the total respondent population and 5.8 per 1,000 among those without a history of prior completed stroke. Despite the high proportion of false-positive neurological symptoms of TIA elicited by the questionnaire, this survey instrument nevertheless screened out for further study the 6% of the population in whom 55% of the TIAs occurred.

Aged↗
PubMed1979

The Mayo Three-Community Hypertension Control Program. I. Design and initial screening results.

The Mayo Three-Community Hypertension Control Program implemented graduated programs for the control of high blood pressure in three rural southeastern Minnesota communities, beginning in 1974. Prevalence of hypertension (when defined as diastolic blood pressure, at initial screening, of 95 mm Hg or more) was similar to that found for comparable groups by age and sex in the United States generally, but an atypically high frequency of known but untreated hypertension was found. Programs of public and professional information, systematic household screening, continuing professional education (two communities), and a new community hypertension clinic (one community) were initiated, and plans were made to evaluate the programs simultaneously by means of total rescreening of persons found to be hypertensive initially. The present report describes in detail the design of the program and the results of initial screening in relation to findings in other populations at the time. Subsequent reports assess the impact of each program on its target community and of a community hypertension clinic within the one setting where this component of a model program was established.

Adult↗
PubMed1979

The Mayo Three-Community Hypertension Control Program. II. Outcome of intervention in entire communities.

A pronounced decline in blood pressure levels of hypertensive patients occurred in each of three rural Minnesota communities 1 to 2 years after the inception of community programs to control high blood pressure in these populations. An experimental hypertension clinic was established in one community to integrate a nurse practitioner into a physician-supervised program of long-term patient management. In the community with this innovative, partially subsidized practice arrangement, we observed declines in diastolic pressures of hypertensives. However, comparable degrees of blood pressure reduction occurred in the two other communities, with traditional solo or small group practice arrangements, where intervention was limited to detection and referral alone or was supplemented with continuing education of physicians in the management of hypertension. The evaluation of these three community programs suggests, among other conclusions, that this innovative community model for hypertension control, based on the recommendations of the Inter-Society Commission for Heart Disease Resources, contributed to favorable short-term blood pressure outcomes for the community. The observation of similar overall outcomes as measured by blood pressure reduction in all three communities was unexpected; the clinic's impact appears to have been matched by the effectiveness of screening and referral, alone or with continuing education, in the two other communities.

Adult↗
PubMed1979

The Mayo Three-Community Hypertension Control Program. III. Outcome in a community-based hypertension clinic.

As part of a broader community program to evaluate approaches to hypertension control, a Community Hypertension Clinic, staffed by two nurse practitioners, was set up in a rural community. Hypertensive persons were identified either by an initial central blood pressure screening or by a subsequent home screening. Slightly more than half of the hypertensive patients at initial screening, or 256 persons, elected to go to the Community Hypertension Clinic for second-stage screening, whereas the remainder elected to see their physicians or to do neither. After secondary screening at the Clinic, 120 patients eventually came under care and were managed by the nurse practitioners. After 2 years of follow-up, 57% of the Clinic patients had office-recorded diastolic blood pressures of less than 90 mm Hg. The Community Hypertension Clinic dropout rate was only 5% after 30 months of operation, for participants whose duration of follow-up ranged from 12 to 27 months (median 16 months), when a repeat home blood pressure screening examination was performed. Comparison of outcomes was thus possible between persons who attended the Community Hypertension Clinic and those who were referred to their physicians' offices. Persons with more severe hypertension most often elected to go to the Clinic, whereas patients with milder degrees of hypertension tended to go to their private physicians for follow-up or failed to make the recommended second-stage screening contact altogether. Greater declines in blood pressure were observed in the Clinic group.

Adult↗
PubMed1978

The blacks of Panama: their genetic diversity as assessed by 15 inherited biochemical systems.

Panama's black citizens are culturally and historically divisible into two groups, the Spanish-speaking coloniales and the English-speaking anglos or afro-antillanos. Until recently these groups have been geographically as well as culturally isolated one from the other, although both are predominantly of West and Southwest African origin. Assessment of the genetic diversity within-villages and within language groups reveals as much, possibly somewhat more, diversity in 15 inherited biochemical markers within villages and language groups as that which obtains between villages and language groups. A number of rare variants at the 6-phosphogluconate dehydrogenase, lactate dehydrogenase, and esterase D loci were encountered and are described.

Adult↗
PubMed1977

Frequency of surgical treatment for hypertension in adults at the Mayo Clinic from 1973 through 1975.

We reviewed the records at the Mayo Clinic for the years 1973, 1974, and 1975 to determine the number of patients with hypertension who had had operations for repair of renal artery stenosis, excision of pheochromocytoma, or resection of aldosterone-producing adenoma. During the years studied, the average numbers of procedures per year were, respectively, 46.7, 10.3, and 2.7. For the purpose of estimating the frequency of each one of these three conditions among the population of hypertensive patients examined at the Mayo Clinic, we applied age- and sex-specific incidence figures from the US National Health Survey to the 162-273 patients examined who were more than 15 years old in 1974. We estimate that there were 26,589 patients who had diastolic blood pressures equal to or greater than 95 mm Hg. The indices generated estimated that renal artery stenosis repair was done in 18/10,000 (0.18%) hypertensive patients, pheochromocytoma excision in 4/10,000 (0.04%), and aldosterone-producing adenoma resection in 1/108000 (0.01%). These indices are strikingly lower than those frequently reported elsewhere, suggesting that these conditions are truly rare among hypertensive patients seen in clinical practice.

Adenoma↗