PubMed Health⌕ Search

Biomedical subjects

E Reisin

Publications and source records attributed to E Reisin.

16 recordsLinked to original sources
PubMed1992

The relation of culturally influenced lay models of hypertension to compliance with treatment.

Problems in compliance with treatment and illness management have frequently been traced to differences between patients' explanatory models of illness and the biomedical model. We investigated the relationship of cultural beliefs about hypertension to compliance with treatment. Using semistructured interviews, we elicited the explanatory models of hypertension held by 60 black hypertensive women being treated at Charity Hospital in New Orleans. The patient sample was followed for 2 months to obtain data on compliance with antihypertensive treatment and blood pressure control. As described, 53% of the patient sample recognized two basic folk illness models: "high blood" and "high-pertension." Patients' illness models were significantly related to compliance with treatment at the P = .01 and .001 levels. Compliance was related to blood pressure control at the P = .05 level. These results indicate that culturally influenced health beliefs are an important influence on compliance and, in turn, blood pressure control. Improved understanding of these problems by physicians may improve the management of their patients' illness.

Black or African American↗
PubMed1992

The treatment of obese hypertensive black women: a comparative study of chlorthalidone versus clonidine.

OBJECTIVE: We attempted to determine a valid pharmacological approach for the control of high blood pressure in obese hypertensive patients using two antihypertensive agents with different pharmacological actions. DESIGN: Thirty-two obese hypertensive black women were randomly treated with chlorthalidone or clonidine to achieve adequate blood pressure control. Unresponsive patients received combination therapy with both agents. RESULTS: Twenty-nine patients completed the study. Systolic and diastolic blood pressures were reduced with both agents, more so with chlorthalidone. Of the 15 patients treated with chlorthalidone, 14 had satisfactory reduction in diastolic pressure compared with only four of the 14 treated with clonidine. Of the 11 unresponsive patients treated with combination therapy, 10 achieved satisfactory control of blood pressure. CONCLUSIONS: We conclude that a rational approach to the treatment of hypertension in obese black women includes diuretics, a first choice attempt that tries to address the hemodynamic alterations previously identified in those patients. Combining diuretics with an alpha-adrenergic agonist resulted in complete control of blood pressure in most of the hypertensive patients in our study. The lowest dose of each antihypertensive medication, especially when used in combination, was effective in a high percentage of patients. The use of this antihypertensive approach also helps to clarify which of the underlying pathophysiological mechanisms should be targeted when other currently available antihypertensive medications are used.

Black People↗
PubMed1990

Intravenous fenoldopam versus sodium nitroprusside in patients with severe hypertension.

In an open-label study, we compared the efficacy and safety of intravenous infusion of fenoldopam mesylate with that of sodium nitroprusside in patients with severe hypertension or in hypertensive crisis. Both antihypertensive medications were infused at a maximal dose increment of 0.2 microgram/kg/min (fenoldopam) and 1 microgram/kg/min (nitroprusside), with a maximal infusion rate of 1.5 micrograms/kg/min fenoldopam mesylate or 8 micrograms/kg/min sodium nitroprusside. Once the desired reduction in diastolic blood pressure was achieved (less than 110 mm Hg if initial diastolic blood pressure was 120-149 mm Hg, or by at least 40 mm Hg if initial diastolic blood pressure was 150-190 mm Hg), the maximal infusion rate used was maintained for at least 1 hour, and then, the infusion was slowed gradually over 2 hours. After the infusion treatment, patients remained in the hospital for 2 days of follow-up. Both antihypertensive agents successfully controlled the blood pressure in all the patients by the end of the maintenance periods. Between the baseline and the end of the maintenance period, analysis of variance showed that the changes in the variables induced by fenoldopam mesylate did not differ significantly from those induced by sodium nitroprusside. The incidence of side effects listed were similar in both groups of patients. The detection of toxic levels of thiocyanate in two patients treated with nitroprusside, however, shows that fenoldopam might be preferable for the control of a hypertensive crisis or severe hypertension in patients with decreased renal function.

2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-ben↗
PubMed1978

Effect of weight loss without salt restriction on the reduction of blood pressure in overweight hypertensive patients.

Overweight patients with uncomplicated essential hypertension were followed up biweekly for six months: 24 not receiving antihypertensive-drug therapy (Group I) and 83 on regular but inadequate (despite drug manipulation) antihypertensive-drug therapy (Group II). All patients in Group I and 57 randomly selected patients from group II (IIa) participated in a weight-reduction program. The remaining 26 from Group II (IIb) did not receive a dietary program. Salt intake was in the normal range in all three groups. All patients on the dietary program lost at least 3 kg (mean, 10.5 kg), and all but two showed a meaningful reduction in blood pressure; 75 per cent of Group I and 61 per cent of Group IIa returned to normal blood pressure. The weight and blood-pressure reductions were highly significant (P less than 0.001), were present in both sexes and all ages, and were directly associated. In Group IIb, no significant change in blood pressure or weight occurred (P greater than 0.30).

Adult↗
PubMed1978

Acid-activated renin responses to hydrochlorothiazide, propranol and indomethacin.

1. Six essential hypertensive patients (five with low renin) were treated in successive weeks with placebo; hydrochlorothiazide 100 mg (382 micromol)/day; hydrochlorothiazide and 50 mmol of sodium/day diet; hydrochlorothiazide, 50 mmol of sodium diet and propranolol 160 mg (544 micromol)/day; and hydrochlorothiazide, 50 mmol of sodium and indomethacin 100 mg (287 micromol)/day. 2. Although blood pressure remained unchanged and serum potassium fell on diuretic with or without low salt, there was a marked increase of active renin and a lesser increase of inactive renin, resulting in an increased proportion of active to total renin. 3. Propranolol decreased both active and inactive renin, but not significantly. 4. Indomethacin produced a marked suppression of active renin, a smaller reduction in inactive renin, and a reduction of the ratio of active to total renin almost to placebo values. 5. Blood pressure rose to control values on indomethacin despite the fall in renin whereas it fell with propranolol with little change in renin. 6. Serum aldosterone rose with stimulation but remained elevated despite effective renin suppression with indomethacin and continuing reduced serum potassium concentration.

Adult↗
PubMed1978

Propranolol for the treatment of hypertension in pregnancy.

Twenty-five women were treated with propranolol during 26 pregnancies complicated by hypertension. The fetal wastage, which had been 48 per cent before treatment with propranolol was reduced to 15.4 per cent, with one missed abortion and three stillbirths. Of the 22 liveborn infants 2 were small-for-dates but all 22 had Apgar scores of 9 or 10 at five minutes. There were no congenital anomalies in 25 viable infants and none of the 22 liveborn infants had clinical or laboratory evidence of hypoglycaemia. The blood pressure was controlled in 17 of 19 patients taking propranolol alone (40 to 160 mg/day) and in 6 of 7 taking propranolol with diuretics.

Adult↗
PubMed1978

Reproducibility of plasma renin activity (PRA) profile in essential hypertension patients.

Whether the same patient with essential hypertension (EH) has the same PRA profile at different occasions, is still uncertain. The validity of the classification of these patients into low or normal renin hypertension depends upon the reproducibility of this profile. A nomogram based on PRA and 24 hr urine sodium in normals, was constructed by computing the regression line with its tolerance limits of not less than 95%. In 30 patients with EH, the PRA and 24 hr urine sodium were determined in 2 separate occasions. Classification of patients showed a change of 30% when PRA was taken during at least 2 hours recumbency. However, when PRA following ambulation is considered, the change appeared only in 6/30 (20%). This change was not large. Thus good reproducibility of PRA is obtained on post-ambulation PRA and changes larger than the 95% tolerance limits, are considered.

Humans↗
PubMed1977

Cholestyramine in uraemic pruritus.

In a patient with longstanding severe uraemic pruritus who was undergoing chronic haemodialysis cholestyramine caused the pruritus to disappear completely within a few days. A four-week randomised controlled double-blind study was therefore performed in 10 other patients with uraemic pruritus who were on chronic haemodialysis. The pruritus improved considerably in four of the five treated patients, whereas only one of those treated with placebo experienced relief. The patient who had no relief while on cholestyramine showed a considerable improvement when the dose subsequently doubled. One of the five patients receiving cholestyramine experienced mild and easily reversible constipation, and another suffered nausea. Neither of these complications prevented the patients from continuing treatment. Cholestyramine seems to be useful in treating uraemic pruritus, although it is not known how it acts.

Cholestyramine Resin↗
PubMed1977

Two methods for determination of renin secretion rates in rats.

1. Renin secretion rates in normal rats were determined with two different methods: (a) the product of renal plasma flow as measured by sodium p-aminohippurate and the difference between renal and peripheral vein renin activity; (b) the product of this latter difference and the renal plasma flow as calculated from the clearance and extraction of inulin. 2. The renin secretion rates, as calculated by these two methods, were not significantly different (P greater than 0-1) and were found to be highly correlated (r = 0-943; P less than 0-001).

Animals↗
PubMed1977

Probability of survival in hypertensive and nonhypertensive patients on maintenance hemodialysis.

The actuarial survival rate for 58 unselected patients who entered a program of maintenance hemodialysis and transplantation was found to be 43.0 +/- 8.3 (SE)% for the six-year period of observation. The survival rate was considerably lower in hypertensive patients as well as in patients with familial Mediterranean fever with amyloidosis, all of whom were nonhypertensive. When the patients with familial Mediterranean fever were excluded from the non-hypertensive group, the expected survival rate of this group became greater than that of the hypertensive group, the difference being about 25% in five years and about 50% in six years. This difference in the survival rate approaches that between normotensive subjects and untreated severely hypertensive patients in the general population. It is concluded that hypertension is a serious limiting factor in the survival of patients on chronic hemodialysis, and that the difference in survival between the hypertensive and the non-hypertensive patients is attributable to hypertension.

Adolescent↗
PubMed1976

Cardiovascular complications in matched pairs of low and normal renin hypertensive patients.

A nomogram for plasma renin activity (PRA), based on 31 normal volunteers, was constructed, and the 95% tolerance limits were computed to the regression line of PRA on 24-h urinary sodium excretion. On this nomogram, reproducibility of the PRA profile for the same patient with essential hypertension was good. Retrospectively, 20 essential hypertension patients with low PRA were matched for age and sex with essential hypertension patients with normal PRA. No statistically significant difference was found between the two groups in either the number of cardiovascular complications or in the blood pressure means. It is concluded that the incidence of cardiovascular complications tends to be similar in all cases of essential hypertension of a similar degree of severity.

Adolescent↗
PubMed1975

Acute renal failure in combat injuries.

The mortality in 25 patients suffering from post-combat injury acute renal failure (ARF) was 64%. Abdominal injuries were present in 17 patients with a mortality rate of 64.7%. Respiratory insufficiency occurred in 14 patients, jaundice occurred in 13, and septicemia in 10. The mean period of oliguria was high, 24.1 days per survivor, and the number of hemodialyses averaged 21.6 per survivor. It is concluded that the high mortality is primary due to the severity of the underlying injury itself and not due to the renal failure, that the ARF is more severe than in civilian injuries, as evidenced by a prolonged oliguric phase, and that frequent and intensive hemodialysis regimen is necessary for the elimination of deaths from uremia per se.

Acute Kidney Injury↗