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Biomedical subjects

E J Roccella

Publications and source records attributed to E J Roccella.

At least 19 recordsLinked to original sources
PubMed1992

Considerations regarding the cost and effectiveness of public and patient education programmes.

For nearly two decades, the National High Blood Pressure Education Programme has administered a programme of public, patient, and professional education in an effort to reduce uncontrolled hypertension, an important public health problem in the USA. A broad network has been established and many partners have joined forces to form the NHBPEP. During the tenure of the programme, awareness, treatment, and control rates for high BP have increased dramatically, and this has been associated with a nearly 57% reduction in age adjusted stroke mortality. In 1988, stroke cost this nation about $23.3 billion a year in direct and indirect costs. Much of this is attributed to uncontrolled hypertension. It seems likely that controlling hypertension saved nearly $1.5 billion in direct and indirect costs for stroke in one year alone. This is in addition to the other health care costs attributed to coronary heart disease that have been reduced as a result of treating high BP. A portion of this may be related to the NHBPEP.

Cost-Benefit Analysis↗
PubMed1990

Hypertension as a risk factor.

Hypertension has been demonstrated to be a clear risk factor for CHD. The finding that hypertension is a risk factor has been demonstrated in observation studies, actuarial data and clinical trials. The relationship between blood pressure and CHD is strong. As blood pressure rises, risk for cardiovascular events increases. This is true for both sexes, for blacks and whites, and for all age categories. Clinical trials, both large and small, have demonstrated that lowering blood pressure can reverse the risk and reduce morbidity and mortality. This cause-and-effect relationship has been replicated consistently, and there is not one well-controlled trial of adequate size that has failed to show this finding. It is important to know which concept of risk to use in developing hypertensive programs. The concept of relative risk is useful to determine whether a public health program is needed within a population, but it has less value in identifying which subset of the population in which to intervene. In essence, relative risk is used to mandate a program but cannot determine where the program should be directed. Hypertension attributable risk describes which individuals are at greatest risk and serves to guide planners as to which groups have the greatest mortality once blood pressure becomes elevated. Population attributable risk becomes the most useful tool in identifying or locating those communities of highest-risk individuals.

Adult↗
PubMed1989

Regional and racial differences among stroke victims in the United States.

Examination of the 1980 age-adjusted mortality data by geographic region shows that death rates for black males and females are higher in the Southeast than in other parts of the United States. The reason for these higher death rates was sought by examining the NHANES II data. The prevalence of hypertension among black females was significantly higher in the Southeast (44%) than in all other regions (34%). The prevalence of hypertension among males, both black and white, and among white females in the Southeast was similar to that in all other regions. Although black and white hypertensives in the Southeast were as aware of their condition as hypertensives in the rest of the nation, the rate of hypertension control among black females in the Southeast was significantly lower than elsewhere. In addition, both male and female black hypertensives in the Southeast were more likely to be obese than their counterparts in the other regions. Analysis of smoking patterns showed that among hypertensives in the Southeast, only white males had higher rates of smoking than their counterparts elsewhere in the United States.

Adolescent↗
PubMed1989

Cost of hypertension medications: is it a barrier to hypertension control?

Surveys conducted in the 1970s indicated that the cost of antihypertensive drugs was seldom a barrier to the control of hypertension. More recent surveys of both patients and physicians, however, have revealed that the cost of these medications is a growing problem. Physicians have more options than were available a decade ago, and many of the newer drugs are expensive. It is important that physicians consider the cost when selecting a course of treatment for their patients.

Adult↗
PubMed1988

Nonpharmacologic treatment of hypertension in the United States.

Although efficacious pharmacologic approaches to the control of high blood pressure are available, concern about risk versus benefit in the use of antihypertensive drug therapy for patients with mild hypertension has led to renewed interest in nonpharmacologic interventions. In the United States, the National High Blood Pressure Education Program, an organization comprised of research scientists and a variety of other professionals concerned with the control of high blood pressure has, through a consensus process, recommended some nonpharmacologic approaches to the treatment of hypertension. These include weight reduction for the obese, moderate sodium restriction (although this is controversial), and restriction of alcohol consumption to less than 1 oz of ethanol daily.

Alcohol Drinking↗
PubMed1988

The National High Blood Pressure Education Program: measuring progress and assessing its impact.

The National High Blood Pressure Education Program has been designed to translate the results of basic and clinical research to medical practice through a program of education for the public, patients, and health professionals. It has continuously used health-education principals of media development, patient education, social networking, community organizations, theories of social change, and program evaluation and measurement to reach its objectives. After 15 years, public knowledge regarding blood pressure and its sequelae has improved dramatically.

Health Education↗
PubMed1987

Epidemiologic considerations in defining hypertension.

Definitions of hypertension have historically been based on at least one of three concepts. The first approach identifies thresholds of hypertension based on the frequency of occurrence in the population. The statistical approach designates a point in the distribution (e.g., the 95th percentile), as the threshold for hypertension. This distribution method identifies different limits for hypertension depending on the age, sex, and race, of the population, all of which affect the average pressure. Although distribution curves do not by themselves identify thresholds for intervention, they are useful for examining changes in population groups over time. The second approach to defining hypertension relates pressures to the risk of morbidity and mortality and is characterized by a continuously graded curve with no clear categorical thresholds. Studies correlating both diastolic and systolic pressures with cardiovascular complications demonstrate continuous risks from lowest to highest values for both sexes, all ages, and both blacks and whites in the United States. The blood pressure-risk relationship provides a compelling rationale for treatment but does not by itself define thresholds for the initiation of therapy. The third approach uses data from clinical intervention trials to identify thresholds where the benefits of therapy outweigh the costs and side effects of long-term treatment. Although results of large randomized trials have clearly demonstrated reductions in morbidity and mortality by lowering blood pressures, consensus on the lowest threshold within the mild range for which antihypertensive drug treatment is recommended has not been reached. Because an optimal definition of hypertension must encompass all three approaches and the resultant classification scheme must be sufficient for all purposes, attempts to refine and improve upon the presently recommended thresholds will undoubtedly continue.

Age Factors↗
PubMed1987

Nonpharmacologic treatment of hypertension: does it work?

Abundant clinical and epidemiological data suggest that hypertension, or high blood pressure is a disease of high prevalence in industrialized societies, with cardiovascular morbidity and mortality directly related to the level of blood pressure. Although efficacious pharmacologic approaches to the control of high blood pressure are available, concern about risk versus benefit in the use of antihypertensive drug therapy for patients with mild hypertension has led to renewed interest in nonpharmacologic interventions. In the U.S.A. the National High Blood Pressure Education Program, an organization comprised of research scientists and a variety of other professionals concerned with the control of high blood pressure, has through a consensus process, recommended some nonpharmacologic approaches to the treatment of hypertension. The pros and cons of nutritional interventions, exercise and biobehavioral treatments are discussed. Nonpharmacologic recommendations in the treatment of hypertension for which there appear to be sufficient requisite data include weight reduction for the obese, moderate sodium restriction (although this is controversial) and restriction of alcohol consumption to less than 57 g of ethanol daily.

Animals↗
PubMed1984

The national high blood pressure education program: a description of its utility as a generic program model.

The National High Blood Pressure Education Program recently celebrated its tenth anniversary. It is timely and appropriate to assess progress toward the realization of its mission and to examine the critical elements of this large-scale, community-based intervention program. This article describes the origin of the National Program, the planning process and models used in undertaking this national health education effort, the application of theoretical models, and approaches used to evaluate the effort. The lessons learned and the application of the National Program as a model for health education interventions are offered.

Cardiovascular Diseases↗