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Biomedical subjects

J G Clara

Publications and source records attributed to J G Clara.

At least 19 recordsLinked to original sources
PubMed2000

Polypharmacy and non-compliance in the hypertensive elderly patient.

BACKGROUND: Elderly patients are major consumers of prescription and nonprescription medications and the proper use of these agents can lead to more cost-effective strategies in reaching optimal health. The use of medications for the treatment of multiple co-morbid conditions in a single patient increases the risks of polypharmacy and non-compliance and raises the burden on the health care system and society. OBJECTIVES: To analyse the extent and nature of total and anti hypertensive, polypharmacy the most prevalent groups of drugs, the compliance rate and the costs related to polypharmacy in the hypertensive elderly. METHODS: A descriptive cross-sectional study was made of sixty-nine patients 65 years of age or older on follow-up for arterial hypertension at a central hospital in Lisbon. The study protocol consisted of a questionnaire performed by the physician. We calculated the monthly amount of individual prescription expense, after cost reduction from social insurance. RESULTS: The patients used an average of 4.4 prescribed medications with a corresponding average of 6.4 pills per day. Drug use was greater in women than men. Hypertensive therapy involved a mean of 2 drugs. Antiplatelet drugs, coronary vasodilators, bezodiazepines, glucose regulators and hypolipidemic agents were the other major groups of drugs. Non-compliance was identified in only 14% of the patients. The average of individual prescription expenses was 5,076 Portuguese escudos (PTE) per month, of which 2,226 PTE was the average cost of antihypertensive agents. CONCLUSIONS: With this study we were able to show the extent of poly-pharmacotherapy in a population of hypertensive elderly patients. We found a high rate of compliance, although the costs were frequently high.

Aged↗
PubMed2000

Nocturnal sleep quality and circadian blood pressure variation.

OBJECTIVE: To verify whether non-dipper behavior is associated with poor nocturnal sleep quality and a higher rate of obstructive sleep apnea than dipper behavior. METHODS: A sample of 36 subjects older than 50 years (mean age = 70 +/- 6.49 years), 8 males and 28 females, 27 (75%) hypertensive and 9 (25%) normotensive, was studied. Nocturnal polysomnography was carried out in the patients' homes. 24-hour ambulatory blood pressure was studied with Spacelabs 90,207 device. The statistical tests used were Student's t test, Pearson's correlation and the Chi-square test. RESULTS: In the overall sample, higher rates of apnea, higher rates of arousal and shorter duration of the REM (rapid eye movement) phase were linked to high levels of nocturnal diastolic blood pressure, with statistical significance (p < 0.01, p < 0.01, p < 0.05 respectively). Sleep fragmentation was associated with the lowest percentages of variation in daytime to nighttime systolic blood pressure (p < 0.03). Apnea rates were significantly higher in the hypertensive group compared to the normal blood pressure population (p = 0.04). We also observed that higher rates of nocturnal apnea corresponded to lower variations in daytime to nighttime systolic blood pressure (p = 0.015) and to a lower dipper index (p < 0.05). Higher indexes of arousal and lower REM latency were associated with higher nocturnal blood pressure, both systolic (p = 0.039 and p = 0.008, respectively) and diastolic (p = 0.003 and p = 0.029, respectively). Sleep efficiency was also negatively correlated with mean levels of nocturnal diastolic blood pressure (p = 0.038). CONCLUSIONS: The quality of nocturnal sleep seems to play an important role in blood pressure levels, particularly in the nocturnal blood pressure profile. A poor quality of nocturnal sleep and the rate of obstructive sleep apnea were associated with non-dipper behavior in the hypertensive population. Sleep evaluation is particularly useful in non-dipper subjects with hypertension.

Aged↗
PubMed2000

[Acute effects of tobacco and vascular risk modulated by genetic factors].

Most studies regarding the acute effects of cigarette smoking refer to the higher sympathetic and adrenomedullary activity as a result of sympathetic ganglia and adrenal medulla nicotinic receptor activation. Although it is reasonable to suppose that the renin-angiotensin system might be activated, this possible effect of nicotine has not been studied. We have studied the effects of cigarette smoking on blood pressure, cardiac output, pulse pressure, renin-angiotensin system, kinins-NO, oxidative stress and insulin. Also, we have investigated if the variability of the biochemical parameters was dependent on genetic polymorphisms of the angiotensin converting enzyme and the acute phase protein haptoglobin. 39 normotensive individuals, 18 males and 21 females, of mean age 35.4 +/- 8.9 years were included in this study. Oxidative stress was dependent on the ACE I/D and Hp1/2 polymorphisms, with the ACE DD genotype and the Hp2-2 phenotype not showing variation in the anti-oxidant defense systems, and the ACE II-ID genotypes and Hp1-1 + 2-2 phenotypes showing a higher anti-oxidant response, hence a lower cardiovascular risk being predictable in the latter individuals.

Adult↗
PubMed1998

[Fibrinolysis in the therapy of cerebrovascular accident].

Thrombolytic therapy for acute ischemic stroke based on data reported from recent prospective clinical trials was discussed and analyzed. The author presents some conclusions and suggestions for effective stroke management therapy with rtPA, which he believes will be the future of medical treatment of ischemic stroke.

Brain Ischemia↗
PubMed1997

[The medical therapy of angina pectoris].

The angina pectoris crisis should be treated with nitroglycerin S.L.. In our days as in the 19th century, the non pharmacological therapeutic approach for angina pectoris (per se and to improve the free interval between crises) is still the same. This consists of the reduction of mental and physical stress, to stop smoking, improve light exercise, reduce obesity, and control other risk factors for coronary disease. Beta blockers are the choice drugs followed by calcium antagonists and nitrates. It is recommended that no short action calcium antagonists be used. Nitrates must be given with free intervals of action to avoid tachyphylaxis. The anti-platelet therapy can not be forgotten with aspirin or ticlopidine. Patients with refractory angina pectoris should be coronariography for performed eventual revascularization process.

Angina Pectoris↗
PubMed1996

[Sleep disturbances in elderly hypertensive patients].

OBJECTIVE: To investigate the subjective and objective perturbations in the elderly hypertensive patients. SAMPLE: 32 individuals were studied with ages > or = 65 years, 14 men and 18 women, with controlled idiopathic high blood pressure, diagnosed over a year ago, and able to lead autonomous lives. METHODS: These outpatients were asked to answer sleep questionnaires adapted from Stanford's questionnaire, and a nocturnal sleep polygraphic register was kept. RESULTS AND CONCLUSIONS: This group of elderly hypertensive outpatients slept badly but never consulted a doctor due to sleeping problems. The most frequent complaints were fatigue, body pains, frequent interruptions of sleep during the night and sleepiness during the day. In the polysonographic register, we highlight insomnia, snoring, obstructive apnea and the periodic movements during sleep. These findings could explain the patient's complaints. Research must be continued on sleep apnea in the elderly hypertensive patients particularly in those with snoring.

Aged↗
PubMed1995

[Acute myocardial infarct: apropos a clinical case].

The AA describe a clinical case of acute myocardial infarction (A.M.I.) with prodromal angina and an initial diagnosis based exclusively on clinical criteria; the patient was submitted to thrombolysis and had recurrent angina which led to the performance of rescue percutaneous coronary angioplasty (P.T.C.A.) that was successful. The clinical situations that may precede A.M.I. are discussed and the importance of the clinical presentation in its diagnosis are stressed. The indications and benefits of rescue P.T.C.A. are also discussed and the AA. conclude that the patients with prodromata of A.M.I. must be kept under clinical observation, so that prompt necessary therapeutic measures may be undertaken and that rescue P.T.C.A. is a therapeutic option of proven clinical benefit.

Diagnosis, Differential↗
PubMed1993

[Blood glucose and insulin in arterial hypertension. The elderly hypertensive patient].

The clinical importance of relationship between insulin resistance, hyperinsulinemia and high blood pressure is not yet fully understood. The aim of this study was to evaluate the influence of age in the relation between hyperglycemia, hyperinsulinemia and hypertension (HT). Two groups of patients with moderate to severe essential hypertension, aged < 65 (n = 40) and > or = 65 (n = 55) were compared with two other groups of normotensive subjects (NT) matched for sex (n = 14) and age (n = 18). The radioimmunoassay method and glucose oxidase methods were used to evaluate plasma insulin and plasma glucose concentrations. The global analysis shows: The plasma glucose level was significantly lower (p < 0.02) in NT group (n = 32; glycemia: 67.52 +/- 44 mg/dl) than in the HT group (n = 95; glycemia: 86.25 +/- 34.7 mg/dl. Further more the plasma insulin level in NT (3.37 +/- 3.18 microU/ml) was also lower than in HT (4.29 +/- 3.08 microU/ml) although without statistical significance. The patients (HT) aged < 65 years old had higher glycemia (85.76 +/- 26.8 mg/dl) and insulinemia (4.92 +/- 3.56) than NT of same age (glycemia: 59.0 +/- 11.8 mg/dl, insulinemia: 2.86 +/- 1.86), respectively p < 0.001 and p < 0.05. In HT aged > or = 65 the glycemia (82.38 +/- (9.67 mg/dl) was higher than in the NT matched group (65.5 +/- 20.36 mg/dl), p < 0.01, but plasma insulin was not different in the two groups (3.88 +/- 2.63 and 3.80 +/- 2.27 microU/ml).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Arterial hypertension in the elderly and renal function].

STUDY OBJECTIVE: to evaluate the effects of antihypertensive treatment on renal function, in an elderly population of 29 patients with arterial hypertension. DESIGN: retrospective study of the first six months follow-up. SETTING: outpatients clinic of arterial hypertension in the elderly at a central hospital. PATIENTS AND METHODS: twenty nine elderly (> or = 65 years old) patients with a mean age of 71.8 +/- 5.6 years, with arterial hypertension (> or = 160/95 mmHg) submitted to antihypertensive treatment. Fourteen males and fifteen females. The systolic, diastolic and mean blood pressure was determined with a DINAMAP 1846, previously and at the first, third and sixth month of antihypertensive treatment (diuretic, calcium antagonists and angiotensin converting enzyme inhibitors). The serum creatinine was evaluated in the beginning of treatment and six months later. Means (+/- standard deviation) were compared with Student's t-test (statistically significant findings < 0.05). MEASUREMENTS AND RESULTS: the initial mean arterial pressure was 127.0 +/- 17 mmHg; with the antihypertensive treatment, was 119.1 +/- 16 mmHg in the first month, 114.4 +/- 12 mmHg in the third and 117.6 +/- 12 mmHg in the sixth month. The serum creatinine was 1.26 +/- 0.75 mg/dl in the beginning of the study and the final result was 1.30 +/- 0.74 mg/dl (p-NS). CONCLUSIONS: the antihypertensive treatment was effective in reducing the blood pressure, without a significant increase in serum creatinine.

Aged↗
PubMed1992

[Hemorrheologic changes in the hypertensive elderly patient].

The aim of this work is to make a review of the papers about hemorheology and hypertension on the aged. The paucity of the works did not allow any conclusions. However, some of the drugs frequently used have tight links with hemorheology, which must be in our minds when dealing with old people.

Age Factors↗
PubMed1990

[Automatic measurement of arterial pressure. A new method for analysis, quantification and evaluation of hypertensive disease].

The authors try to analyse the role of ambulatory 24 h blood pressure monitoring (ABP) in the diagnosis of hypertension, and review medical literature on this subject. They emphasized the quantification and definition value of normal results and circadian profiles in ABP. The accuracy of the device and the choice of a correct statistical parameter of prognosis is essential in all prospectives studies. In the future a better correlation is expected between blood pressure and organ damage when blood pressure is measured by ambulatory recordings then office method.

Blood Pressure Determination↗
PubMed1989

[Hyponatremia--new concepts and therapy. Apropos of a clinical case].

The therapeutic approach of hyponatremia is reviewed, and the authors describe their recent experience of a clinical case of a woman with acute hyponatremia. After analysing the main publications of the last years, they conclude that the way of correcting hyponatremia largely depends of its acute or chronic character. Chronic hyponatremia must be corrected with slow rate infusion of sodium chloride (0.5 mmol/l/h), and acute hyponatremia with a rapid (2 mmol/l/h) or intermediate (1-1.5 mmol/l/h) rate of infusion of the same solution. This is the current advisable approach, until a new better orientation will virtually be clarified by further prospective studies.

Acute Disease↗
PubMedDate not supplied

[The successes and failures in the primary prevention of coronary disease].

The modification of major behavioural and environmental risk factors has helped reduce coronary heart disease. It seems, however, that prevention results were not so good as expected. It is assumed that the major cause of this apparent unsuccessful data is basically due to world population ageing, as it is known that coronary heart disease is much more frequent in older people. Therefore the current life expectancy shows that the preventive measures have indeed been successful. From the analysis and discussion of the preventive epidemiological recommendations and the identification of new risk factors, the Authors suggest new strategies for health promotion and particularly for coronary heart disease reduction.

Age Distribution↗
PubMedDate not supplied

[Clinical significance of hypercholesterolemia in the elderly].

Hypercholesterolemia is known as a cardiovascular risk factor for the non elderly man. But it still remains the controversy about the significance of dislipidemia on the aged. The authors discuss the problem and suggest a therapeutic approach following the European Consensus Conference Guidelines.

Aged↗