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J W Graves

Publications and source records attributed to J W Graves.

17 recordsLinked to original sources
PubMed2003

Clinical decision-making in hypertension using an automated (BpTRU) measurement device.

Mercury sphygmomanometers are being removed from clinical practice in the United States due to environmental concerns about mercury toxicity. Accurate blood pressure measurement is central to high-quality hypertension management. In this study of 106 patients, the BpTRU(TM) device was compared to nurse blood pressure measurements that complied with all the JNC VII/American Heart Association guidelines in evaluation of a random casual blood pressure. The intermethod difference in systolic blood pressure was +1.8+/-5.1 mmHg, and for diastolic blood pressure it was 4.8+/-5.1 mmHg (both P<0.001). For the primary study end point of clinical decision-making, there was 92% (97/106) agreement between the hypertension nurse specialist and the BpTRU (kappa 0.8280, 95% confidence interval, 0.721-0.9350). The oscillometric blood pressure measurement with the BpTRU is recommended as a replacement for poorly performed auscultatory blood pressure measurement in clinical practice.

Adolescent↗
PubMed2001

Martorell's hypertensive leg ulcer: case report and concise review of the literature.

Hypertensive leg ulcers (Martorell's ulcers) are a unique form of lower extremity ischaemic leg ulcer. First described by Martorell, and Hines and Farber in the 1940s, these ulcers are defined by pain disproportionate to the size of the ulcer, specific location on the lower extremity, female-to-male predominance, association with long-standing, often poorly, controlled hypertension, and healing response to specific antihypertensive agents. We present a case of Martorell's hypertensive ischaemic leg ulcer and a concise review of the 104 previous cases in the world's English literature. Hypertensive ischaemic leg ulcers will be more commonly recognised with a renewed appreciation of the existence of this clinical entity.

Aged↗
PubMed2001

Prevalence of blood pressure cuff sizes in a referral practice of 430 consecutive adult hypertensives.

Accurate measurement of blood pressure is dependent on a number of factors including use of the appropriate sized cuff. Overestimation of blood pressure by using an inappropriately small cuff has been well documented. The prevalence of the use of the standard adult and large adult cuffs in hypertensive patients is less well defined in the literature. Worldwide, the increasing prevalence of obesity and its associated conditions such as hypertension accentuates the importance of the recognition of the relationship of appropriate sized cuff and accurate blood pressure measurement. This is the largest study to define the prevalence of blood pressure cuff sizes in a hypertensive population. Vendors of blood pressure measurement devices should be aware of the changing demographics and the need for the large adult arm cuff to be routinely available.

Adolescent↗
PubMed2000

Management of difficult-to-control hypertension.

Hypertension is a primary risk factor for heart disease and stroke, the first and third most common causes of death in the United States. The National Health and Nutrition Examination Survey (NHANES) revealed an increase in awareness of hypertension from 51% to 73%, and, among persons with hypertension, the treatment rate has increased from 31% to 55% (from 1976-1980 vs 1988-1991). Of importance, the rate of those achieving goal blood pressure (< 140/90 mm Hg) has only improved from 10% in NHANES-II (1976-1980) to 29% in NHANES-III (1988-1991). Thus, more than 70% of persons with hypertension in whom good blood pressure control has not been achieved are termed "difficult hypertensives." Failure to achieve treatment blood pressure goals of less than 140/90 mm Hg is usually attributed to the presence of resistant hypertension, a resistant physician, secondary causes of hypertension such as renovascular disease, medication adverse effects, or a nonadherent patient. A practical understanding of the pathophysiology of resistant hypertension, appropriate screening techniques for secondary forms of hypertension, and alternative management strategies for a chronic disease such as hypertension can result in treatment goals being achieved in most difficult hypertensives.

Adrenal Gland Neoplasms↗
PubMed1989

Plasma volume in resistant hypertension: guide to pathophysiology and therapy.

It might be expected that the tremendous increase in available antihypertensives would eliminate resistant hypertension by allowing many alternatives to its treatment. In spite of this, resistant hypertension remains a common problem due, the authors feel, to a poor understanding of the pathophysiology of this condition, particularly an understanding of whether plasma volume expansion mediates resistance to antihypertensive therapy. The authors evaluated the status of plasma volume as a major determinant of response to therapy in nine patients with resistant hypertension. Measuring plasma volume using I125 radiolabeled albumin, they found eight patients with elevated plasma volumes and one patient with a contracted plasma volume at the time of presentation with resistant hypertension. In all eight patients with plasma volume expansion, aggressive diuretic therapy allowed goal blood pressure to be achieved. The patient with plasma volume contraction achieved goal blood pressure with vasodilator therapy. Plasma volume expansion is common in resistant hypertension and it mediates resistance to therapy. Measurement of plasma volume gives the clinician important insight into the pathophysiology of resistant hypertension and increases the likelihood of successful management of the resistant hypertensive patient.

Adult↗
PubMed1986

Severe recurrent alkalemia in a patient undergoing continuous cyclic peritoneal dialysis.

Chronic renal failure is commonly associated with acid-base disorders that are corrected with the institution of maintenance peritoneal dialysis. Severe shifts in systemic pH that occur in patients undergoing peritoneal dialysis are usually acidemic shifts due to inadequate replacement of the kidney's ability to excrete acid and regenerate bicarbonate. This report describes a severe alkalemic shift in pH in a patient undergoing continuous cyclic peritoneal dialysis due to a failure of dialysis to substitute for the kidney's normal response to simple respiratory alkalosis. This case emphasizes that in patients undergoing peritoneal dialysis, physicians must actively provide the "renal compensation" for an acid-base disorder and change the dialysis prescription.

Alkalosis, Respiratory↗
PubMed1982

Extravascular lung water values in patients undergoing coronary artery bypass surgery.

Using a commercially produced lung water computer, we measured extravascular thermal volume (ETVL) to study changes in extravascular lung water (EVLW) caused by coronary artery bypass surgery. The normal baseline ETVL before anesthesia was 5.47 +/- 1.67 (SD) ml/kg. ETVL was not significantly changed 2 h after surgery but was significantly lower (P less than 0.05) 24 h later in 9 patients. There was no relationship between P(A-a)O2/FIO2 ratios and values of ETV1.

Body Water↗
PubMed1973

Splenic cysts.

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Adult↗