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Biomedical subjects

J W van Ree

Publications and source records attributed to J W van Ree.

29 records · Page 2Linked to original sources
PubMed1996

Low dosages of felodipine ER once daily as monotherapy in elderly hypertensive patients: effect on ambulatory blood pressure and quality of life.

OBJECTIVE: To establish the efficacy of 24-h ambulatory and casual blood pressure (BP) reduction, and the tolerability of once daily felodipine extended release (ER) 2.5 mg and felodipine ER 5 mg as monotherapy. DESIGN: Randomised, double-blind placebo controlled 6 weeks parallel study. SETTING: From 15 general practices centres (with 19 GPs) in the region of the University of Maastricht, The Netherlands. SUBJECTS: A total of 129 subjects aged 50-80 years with primary hypertension were screened; 27 men and 61 women with a casual diastolic BP of 100-115 mm Hg and/or a systolic BP of less than 200 mm Hg entered the study. MAIN OUTCOME MEASURES: Casual and 24-h ambulatory BP and a subjective symptom assessment (SSA) questionnaire after 6 weeks of therapy. RESULTS: After correlation for placebo response the mean casual systolic/diastolic BP (SBP/DBP) reduction was 10/5 mm Hg (NS) and 12/10 mm Hg (P < 0.05) for felodipine ER 2.5 and 5 mg, respectively. By using 24-h ambulatory BP measurements these reduction were 6/4 mm Hg (NS) and 13/8 mm Hg (P < 0.05), respectively. No significant difference for SBP and DBP was found during the night time between felodipine 2.5 and placebo (-1/0). Felodipine ER 5 mg lowered the BP load significantly during both daytime and night time but felodipine ER 2.5 mg only for DBP during the daytime. There was a significant difference for the number of responders between placebo (28%) vs felodipine ER 2.5 mg (55%) and ER 5.0 mg (59%). Both felodipine dosages and placebo were comparable in (a low) number of adverse events and results of the SSA. CONCLUSIONS: During daytime felodipine ER 2.5 mg and 5 mg are effective in BP lowering in elderly hypertensive patients. However, only felodipine ER mg is effective in reducing BP during night time (22.00-7.00). Only felodipine ER 5 mg has a significant reducing effect on BP load during day and night time. Both felodipine ER 2.5 and ER 5.0 have a significant effect on the responder rate. It appeared from this study that compared to placebo, and in contrast with felodipine ER 5 mg, the ER form of felodipine 2.5 mg has no BP lowering effect during night time in elderly patients. To assess the effectivity during night time of felodipine ER 2.5 mg in an individual patient it is recommendable to measure the BP at the end of the dose interval.

Aged↗
PubMed1995

[Hypertension diagnosis by the family physician: measurements according to the NHG-standard (Dutch College of General Practitioners) compared with ambulatory blood pressure determination].

OBJECTIVE: To compare the standard procedure (SP) for determining hypertension as described by the DCGP with the results of ambulatory blood pressure measurement (ABM). DESIGN: Prospective study. SETTING: Practices of 17 GPs in central and south Limburg, the Netherlands. METHOD: The SP of the DCGP was executed in 94 of 102 patients with possible hypertension. In each patient a 24-hour ABM was performed simultaneously as reference value. RESULTS: The correlation between the SP and the ABM was low (r = 0.51) and the blood pressure was mostly overestimated by the SP. Sensitivity and specificity of the SP were 0.67 and 0.52 respectively. When the first blood pressure measurement was high in a patient with probable hypertension (diastolic pressure 105-115 mmHg) SP correlated well with ABM. When the first blood pressure measured was relatively low (diastolic pressure 95-105 mmHg) correlation was also low. CONCLUSION: The difference in blood pressure measured by the physician in his office compared with measurement at home ('white coat effect') was observed in this study also. The results support the advice of the DCGP to check the blood pressure more often in hypertensive patients with low than in those with high initial diastolic values.

Blood Pressure Determination↗
PubMed1994

[Role of the family practitioner in the management of patients following a myocardial infarct].

OBJECTIVE: Determining the role of the general practitioner (GP) in the management of the postinfarction patient, the factors that influence this role, and the relation between GP and cardiologist. DESIGN: Descriptive. SETTING: Registration Network of Family Practice (RNF) of the University of Limburg, the Netherlands. METHOD: Data were obtained from a sample of 284 patients from 30 GPs, all participating in the RNF. The GPs completed a questionnaire about their own patients while the data concerning the cardiac state of the patients were obtained from their problem lists. RESULTS: Postinfarction care was given in only 50% of the patients. Relatively more patients with a more severe cardiac condition were under regular medical follow-up than those with a less severe cardiac condition. However, the severity of the disease had no effect on the specialty of the doctor performing the follow-up (GP or cardiologist), nor had the time expired after the myocardial infarction. In almost 50% of the cases the GPs found continuation of the follow-up by the cardiologist not necessary, in 25% of the cases they were not satisfied with the complementary roles of both disciplines. CONCLUSION: Postinfarction care by the GPs was not uniform. They need guidelines for the management of such patients, based on the patient's risk profile. There is a need for better coordination between GP and cardiologist.

Aftercare↗
PubMed1993

Dutch general practitioners' attitudes towards the climacteric and its treatment.

In order to obtain insight into general practitioners' (GPs) point of view regarding climacteric problems and possible treatment, a survey was conducted among 195 GPs in the Limburg Province in the Netherlands. Ultimately, 159 GPs participated (response-rate 82%). The GPs were either members of the Society for the Improvement of the Expertise of GPs, or filled out the questionnaire previous to participation in a medical training course. The climacteric and its typically related complaints were generally well recognized by the surveyed GPs. Ninety-five percent of the GPs were of the opinion that women with climacteric complaints need some kind of medical help, and 62% were found to prescribe medication, mainly hormone replacement therapy (HRT). Remarkably, 75% of all GPs were of the opinion that prescribing HRT for climacteric complaints is a form of medicalization. Twelve percent of the GPs stated they never prescribe HRT for solely preventive purposes. In case of preventive treatment merely 32% of the GPs prescribed HRT for a period longer than 5 years.

Adult↗
PubMed1993

Prevalence of left ventricular hypertrophy as assessed by electrocardiogram in treated hypertensive persons in general practice.

Many studies have paid attention to the prevalence of left ventricular hypertrophy (LVH) as assessed by electrocardiogram (ECG) in hypertensive patients. Patients with ECG-LVH show a considerably higher risk of cardiovascular morbidity and mortality than patients without ECG-LVH. This paper describes the prevalence of LVH and the relation between LVH, age, sex and BP. ECG, BP, treatment, duration of hypertension, body mass index and total serum cholesterol were recorded. The dimension of LVH was computed in accordance with the Minnesota Code. One of five hypertensive patients (21%) had LVH with or without repolarisation abnormalities. LVH based on high QRS voltages only was found more often in men. LVH with repolarisation abnormalities was more frequent in elderly patients. LVH was found more often in the highest SBP categories (SBP > 160 mmHg) and in the highest DBP categories (DBP > 105 mmHg). A logistic regression analysis showed the influence on the occurrence of LVH of the following parameters: being male, age > 65 years, SBP > 160 mmHg and DBP > 105 mmHg.

Aged↗
PubMed1990

Preventive cardiology in general practice: computer-assisted hypertension care.

Research investigations of general practice on the prevention of cardiovascular disease indicate that preventive detection and intervention programmes can be effective. Long-term results on hypertension control are better when systematic follow-up accompanies surveillance of the hypertensive population. Based on research and international experience, we developed the Nijmegen Hypertension Monitoring System, a computer-assisted system consisting of monthly feedback of treatment results and regular meetings of the participating general practitioners. We describe an experiment in seven study practices and eight practices continuing with usual care, to study the effectiveness and feasibility of the system. This Monitoring System could also be adapted for other chronic diseases.

Adult↗
PubMed1989

[The correlation of transient ischemic attack and cerebrovascular accident].

Correlation exists between the occurrence of a transient ischemic attack (TIA) and a cerebrovascular accident (CVA). The strength of this correlation however is a point for debate. We studied the sequential relation between the occurrence of TIA and CVA in patients over 50 years in general practice. Based on Continuous Morbidity Registration (CMR) in four general practices we analysed the morbidity in patients who presented symptoms of TIA and (or) CVA during the period 1971-1983. In this period a TIA was diagnosed in 134 persons and a CVA in 214 persons. The maximal observation period of the TIA patients after presentation of the symptoms was 12 1/2 years. In 8% of the CVA cases a TIA had been diagnosed in the period preceding the CVA. Of the TIA patients 13% developed a CVA in the subsequent observation period, half of them within two years after the TIA diagnosis. Comparison of the incidence rate of CVA in the general population with that in the population with a TIA reveals that a CVA development is about six times more frequent in the latter. This higher risk has only a relative meaning because the absolute number of cases is small.

Cerebrovascular Disorders↗
PubMed1987

[CVA and TIA in family practice. Incidence and perspectives].

Although the Cerebro-Vascular Accident (CVA) and the Transient Ischaemic Attack (TIA) are relatively rare in general practice, they subjectively demand great attention because of their specific problems. To get a picture of for example their incidence in the general population and referral patterns in general practice, we collected and analysed the data from a (continuing) morbidity registration over 12 years in four general practices (Department of General Practice/Family Medicine University Nijmegen). The diseases occur mainly over age 50. The incidence of CVA is slightly higher than the incidence of TIA. The incidence of the diseases over the two sexes is practically equal. Because of the overpresentation of older women in the general population, more women than men present these diseases. Male patients are younger than female. Only a part of the patients has been referred or admitted to hospital. The referral depends on age of the patient: The older the patient the lower the referral-rate. The case-fatality of CVA is about 25%. Patients who die within a month, usually die in hospital. When patients survive this period, they die more often at home than in a nursing home. Patients who die in a nursing home, are more often male than female. In older age groups a CVA means more often than not the end of life. In our view a referral is often not in the interest of the patient. If a patient stays at home, the GP has to create a team with family members, a district nurse or a physiotherapist in order to offer the patients optimal medical and psychosocial attendance care.

Aged↗