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Biomedical subjects

L Michael Prisant

Publications and source records attributed to L Michael Prisant.

At least 19 recordsLinked to original sources
PubMed2005

Nonarteritic anterior ischemic optic neuropathy.

Nonarteritic anterior ischemic optic neuropathy is a common cause of sudden, painless loss of vision present commonly on awakening from sleep. It most commonly affects middle-aged and elderly Caucasian men and women. Involvement of the opposite eye occurs within 3 years in less than 43% of patients. Hypertension, diabetes, and nocturnal hypotension are risk factors. A congenital small cup-to-disk ratio also predisposes to the optic nerve ischemia. There is no effective therapy to treat patients acutely or to prevent recurrence. After 6 months of careful follow-up, 57.3% of patients will have no significant change or worsening of their vision in the involved eye.

Arteritis↗
PubMed2005

Gynecomastia and hypertension.

Palpable dense and mobile subareolar tissue in the male breast defines the presence of gynecomastia. For the hypertension specialist, breast enlargement in men provides a clue to a secondary cause of hypertension or an adverse antihypertensive drug reaction. Hyperthyroidism, chronic renal failure, adrenal hyperplasia or tumors, amphetamine, cyclosporine, and anabolic steroids are secondary causes of hypertension associated with gynecomastia. Reserpine, methyldopa, and spironolactone are older drugs associated with gynecomastia; however, calcium antagonists (more commonly), angiotensin-converting enzyme inhibitors, and alpha1 blockers may also be associated with this finding. Treatment is directed to removal of the underlying cause.

Antihypertensive Agents↗
PubMed2005

Aortic dissection.

Aortic root enlargement is generally asymptomatic, with few clinical clues, but may be observed as an incidental finding on a chest x-ray, echocardiogram, or contrast-enhanced computerized tomogram of the chest. Aortic dissection is one of the most feared complications of hypertension. A history of hypertension is commonly present, but the systolic blood pressure in type A dissection (proximal to the left subclavian artery) has been found to be less than 150 mm Hg in 64% of patients. However, 71% of type B dissections (distal to the left subclavian artery) present with a systolic blood pressure 150 mm Hg or higher (International Registry of Acute Aortic Dissection). Most frequently, onset of symptoms is in the daytime, especially between 6 a.m. and noon. Severe sharp chest pain that is abrupt in onset is the most likely presentation. Migrating pain is uncommon. Although a pulse deficit with decreased or absent carotid, brachial, or femoral pulses occurs in only 30% of patients, three or more deficits predict an in-house mortality of about 60%. A chest x-ray finding of a widened mediastinum is present in 62.6% of type A and 56% of type B dissections. Contrast-enhanced computerized tomography or transesophageal echocardiography is the most commonly performed procedure for diagnosis. In-house mortality has been found to be 32.5% in type A dissections and 13% in type B dissections.

Acute Disease↗
PubMed2005

Chronotherapeutic oral drug absorption system verapamil is effective in reducing morning blood pressure in African Americans: a post hoc analysis of the chrono trial.

Results of several clinical trials have shown that verapamil is effective in reducing blood pressure (BP) in African Americans, a population at high risk for hypertension and target-organ damage. Nonetheless, adequate control of BP is perceived as difficult to achieve in this population. A post hoc analysis of data from the community-based CHRONO trial (Controlling Hypertension in the moRning with a ChrONO medication) was undertaken to assess racial/ethnic differences in the safety and efficacy of the Chronotherapeutic Oral Drug Absorption System (CODAS) formulation of verapamil in a real-world setting. Once-daily administration of the CODAS formulation of verapamil significantly reduced morning BP (P<0.0001) regardless of race or ethnicity. In the African-American population (N=466), the response rate for systolic BP (<140 mmHg or > or =10% reduction from baseline) and diastolic BP (<90 mmHg or reduction > or =10 mmHg from baseline) combined was 70.8%, and 60% of those individuals responded at the lowest (200 mg) dose. Of the 59.7% of African Americans who reached the target BP of <140/90 mmHg, 64% did so at the 200-mg dose. Response rates were not affected by gender, age or treatment history, and CODAS-verapamil was well tolerated in all ethnic/racial treatment groups. In a trial conducted in actual clinical practices, the CODAS formulation of verapamil was shown to be safe and effective in African Americans, Caucasians, Hispanics and Asians.

Administration, Oral↗
PubMed2005

Hypertensive heart disease.

Hypertensive heart disease encompasses anatomical changes and altered physiology of heart muscle, coronary arteries, and great vessels. Left ventricular hypertrophy is not only a target organ response to increased afterload, but is also the most potent cardiovascular risk factor. Regression of hypertrophy reduces morbidity and mortality. Heart failure may be present in the absence of a reduction of myocardial contractility. Ischemic heart disease occurs in the absence of epicardial coronary disease. Left atrial size and atrial fibrillation are associated. Potentially lethal ventricular arrhythmias and sudden cardiac death are more common in hypertensive patients. The relationship of aortic root size to blood pressure is weaker than expected; however, the relationship to aortic dissection is stronger. Careful attention and treatment of left ventricular hypertrophy, heart failure, ischemic heart disease, and atrial fibrillation will improve survival.

Blood Pressure↗
PubMed2004

Abdominal aortic aneurysm.

An abdominal aortic aneurysm (AAA) is defined as a localized dilation of the artery that is 1.5 times the diameter of the normal segment. The most common location for an aortic aneurysm is the infrarenal segment where a diameter that exceeds 3 cm in diameter is considered aneurysmal. Duplex ultrasonography and spiral computerized tomography are the imaging modalities most commonly performed to detect the longitudinal and transverse diameter of the aorta. The prevalence of AAA may be increasing. Smoking, male gender, and increasing age are the most powerful predictors of AAA. Considering the higher prevalence of hypertension, it is surprising that the prevalence of AAA among African-American men is 39% less than white men. The risk of rupture is independently associated with female gender, large initial aneurysm diameter, lower forced expiratory volume in the first second, current smoking, and higher mean blood pressure. Inflammation rather than atherosclerosis may be essential to the development of AAA. Treatment is directed at smoking cessation and control of blood pressure and lipids. Beta blockers (propranolol) have not been shown to modify aneurysm growth rates, but drop out rates in the studies have been high. Antibiotics do show a modest benefit. Surgery is generally performed when the aneurysm exceeds 5.5 cm in men. For women, an AAA size between 4.5 cm and 5.0 cm is recommended for elective repair.

Age Distribution↗
PubMed2004

Blunted nocturnal decline in blood pressure.

Blood pressure normally declines 10%-20% from daytime to sleep. Patients with less than a 10% reduction in daytime blood pressure are referred to as nondippers. A blunted nocturnal decline in blood pressure may be due to diminished sodium excretory capacity, alteration in the autonomic nervous system, or other factors. Secondary hypertension should be considered as a possibility. Target organ damage appears to be more common in nondippers, however, poor reproducibility of nondipping status raises the question as to the appropriate duration of monitoring to establish a diagnosis. Nondippers tend to have a greater reduction in nocturnal blood pressure with nonpharmacologic and pharmacologic treatment.

Blood Pressure↗
PubMed2004

Clinical trials and lipid guidelines for type II diabetes.

The management of dyslipidemia in adults with diabetes is receiving more attention. However, there is a paucity of large, prospective, randomized outcome trials designed for diabetic patients. Diabetic dyslipidemia is characterized by an increase in triglyceride levels, low high-density lipoprotein (HDL) cholesterol concentrations, and small, dense low-density lipoprotein (LDL) particles. The treatment goals include an LDL cholesterol less than 100 mg/dL, triglyceride level less than 150 mg/dL, and an HDL greater than 40 mg/dL for men and more than 50 mg/dL for women. In the Diabetic Atherosclerosis Intervention Study, fenofibrate resulted in a 42% less increase in the percent stenosis, as assessed by quantitative coronary arteriography. The Heart Protection Study documented the unambiguous benefit of simvastatin in reducing all-cause mortality among 5963 diabetic patients. The Lescol Intervention Prevention Study observed a reduction in major adverse cardiac events in diabetics undergoing percutaneous intervention who received fluvastatin. The Veterans Affairs HDL Cholesterol Intervention Trial reported a reduction in major coronary events among 627 diabetic patients with low HDL cholesterol who sustained a myocardial infarction. The Fenofibrate Intervention and Event Lowering in Diabetics (FIELD) Trial (n = 9795), the Action to Control Cardiovascular Risk in Diabetes (ACCORD, n = 10,000), the Atorvastatin Study for Prevention of Coronary Heart Disease Endpoints in Non Insulin Dependent Diabetes Mellitus (ASPEN, n = 2421), and the Collaborative Atorvastatin Diabetes Study (CARDS, n = 2140) will provide the prospective outcome data that are needed for the management of patients. Combination drug therapy will be necessary to achieve treatment goals. Careful monitoring will be required to avoid myositis and hepatotoxicity.

Cardiovascular Diseases↗
PubMed2004

Preventing type II diabetes mellitus.

Burgeoning obesity is increasing the prevalence of type II diabetes mellitus. As a consequence, there will be an even greater burden of cardiovascular disease, end-stage renal disease, blindness, and lower extremity amputations. If diagnosed, impaired glucose tolerance presents an opportunity for intervention that potentially could delay or prevent the development of diabetes. Recent prospective studies document the effectiveness of exercise and weight reduction in preventing diabetes. Metformin is less effective than intense lifestyle interventions. Acarbose, losartan, orlistat, pravastatin, ramipril, and hormone replacement therapy are associated with lower rates of the development of diabetes. The Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication (DREAM) trial and the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) trial were designed to assess not only the prevention of diabetes but also the impact on cardiovascular morbidity and mortality.

Blood Glucose↗
PubMed2004

New national guidelines on hypertension: a summary for dentistry.

BACKGROUND: Periodically, the National Heart, Lung, and Blood Institute publishes recommendations on the prevention, detection, evaluation and treatment of high blood pressure. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure--known as "JNC 7"--substantially revises previous recommendations. METHODS: This report represents the consensus opinion of a coalition of 39 major professional, public and voluntary organizations and seven federal agencies. All currently available literature on hypertension was reviewed by a select committee of experts on hypertension (including one of the authors [L.M.P.]) and was used to formulate this new report. RESULTS: The authors present highlights of the JNC 7 report. In addition, they offer the findings of their review of dental literature dealing with patients who have hypertension, into which they integrate information from the JNC 7, and update dental management recommendations. These new guidelines provide key messages to all health care professionals and are designed to improve the diagnosis and treatment of people with hypertension. CONCLUSIONS: Because hypertension affects nearly 50 million people in the United States and underlies most cardiovascular disease, its diagnosis and control should be of concern to all health care providers. Many people have undetected hypertension, and current levels of detection and control need to be improved. CLINICAL IMPLICATIONS: All health care providers, including dentists and members of the dental team, need to be involved in detection and management of this important public health problem. The dentist can play an important role in the detection and management of hypertension.

Antihypertensive Agents↗
PubMed2003

The human sexuality education of physicians in North American medical schools.

Individuals seeking treatment for sexual problems frequently would like to turn to a source they consider knowledgeable and worthy of respect, their doctor. The objective was to assess how well the 125 schools of medicine in the United States and the 16 in Canada prepare physicians to diagnose and treat sexual problems. A prospective cohort study was carried out. The main outcome results were description of the medical educational experiences, teaching time, specific subject areas, clinical programs, clerkships, continuing education programs in the domain of human sexuality in North American medical schools. The results were as follows. There were 101 survey responses (71.6%) of a potential of 141 medical schools (74% of United States and 50% of Canadian medical schools). A total of 84 respondents (83.2%) for sexuality education used a lecture format. A single discipline was responsible for this teaching in 32 (31.7%) schools, but a multidisciplinary team was responsible in 64 (63.4%) schools (five schools failed to respond to the question). The majority (54.1%) of the schools provided 3-10 h of education. Causes of sexual dysfunction (94.1%), its treatment (85.2%) altered sexual identification (79.2%) and issues of sexuality in illness or disability (69.3%) were included in the curriculum of 96 respondents. Only 43 (42.6%) schools offered clinical programs, which included a focus on treating patients with sexual problems and dysfunctions, and 56 (55.5%) provided the students in their clerkships with supervision in dealing with sexual issues. In conclusion, expansion of human sexuality education in medical schools may be necessary to meet the public demand of an informed health provider.

Canada↗
PubMed2003

Can renin status predict the antihypertensive efficacy of eplerenone add-on therapy?

Since neither angiotensin-converting enzyme inhibitors (ACE-I) nor angiotensin II receptor blockers (ARB) can completely suppress aldosterone levels, there is a need for alternative/supplementary antihypertensive medications, such as the selective aldosterone blocker eplerenone (Inspra). This multicenter study measured the safety and efficacy of add-on eplerenone therapy to reduce blood pressure not controlled by ACE-I or ARB monotherapy. An ad hoc analysis evaluated whether active plasma renin or serum aldosterone levels could predict blood pressure response to eplerenone therapy. Patients (N = 341) with a diastolic blood pressure > 95 mmHg on a fixed dose of ACE-I or ARB were randomized to 8 weeks of double-blind treatment with eplerenone 50 mg qd or placebo. If blood pressure remained uncontrolled following 2, 4, or 6 weeks of treatment, the eplerenone dose was increased to 100 mg qd. In a combined cohort analysis of these patients, the placebo-adjusted change in systolic and diastolic blood pressure was -5.9/-2.4 mmHg (p< 0.001 and p = 0.006, respectively). While adding eplerenone to an ACE-I or ARB is safe and effective for blood pressure reduction, there was no baseline value or range of values of active plasma renin, serum aldosterone, or their ratio that predicted a favorable response to either of these drug combinations.

Adolescent↗
PubMed2003

Drug delivery systems for treatment of systemic hypertension.

Novel drug delivery systems are available in many areas of medicine. Their application in the treatment of hypertension continues to widen. Oral drug delivery systems permit antihypertensive agents that were previously administered two to four times daily to be administered once daily. Biotechnical use of chemical-dispensing systems has been applied to propranolol (polymer coated beads), clonidine (transdermal therapeutic system), nifedipine (osmotic pump and coat-core), isradipine (osmotic pump), verapamil (sodium alginate and spheroidal oral delivery absorption system), felodipine (coat-core), nisoldipine (coat-core) and diltiazem (polymer coated beads and Geomatrix. The initial goal was to lower blood pressure by a uniform amount throughout the entire day. Now, new drug delivery systems are being developed to target blood pressure in the early morning hours when most cardiovascular events occur. Two chronotherapeutic drug delivery systems are now available for verapamil (chronotherapeutic oral delivery absorption system and delayed coat osmotic pump). Disadvantages of sustained-release products include delayed achievement of pharmacodynamic effect, unpredictable bioavailability, enhanced first-pass hepatic metabolism, dose dumping, sustained toxicity, dosage inflexibility and increased cost. Potential advantages include reduced administration frequency, enhanced adherence and convenience, reduced toxicity, stable drug concentrations, uniform drug effect, decreased cost (occasionally) and decreased daily dosage.

Antihypertensive Agents↗
PubMed2003

Fixed low-dose combination therapy: current recommendations.

JNC-7 recommends initiating combination therapy in specific circumstances. Hypertension involves numerous body systems; interrupting only one of these systems with monotherapy is frequently insufficient to achieve control. Altering two systems by combining drugs with different mechanisms of action increases the likelihood of control.

Black or African American↗
PubMed2002

Assessment of repeatability and correlates of arterial compliance.

OBJECTIVES: The aim of these studies was to assess repeatability of large (C1) and small (C2) arterial elasticity indices over various time intervals using the HDI/Pulsewave CR-2000 Research CardioVascular Profiling System (Hypertension Diagnostics, Inc., Eagan, Minnesota, USA). Non-invasive hemodynamic parameters using this device were compared to invasive measurements. METHODS: After a 5-min period of rest, 31 healthy hospital employees underwent cardiovascular profiling on two occasions within 1 h apart. Another 59 healthy hospital employees underwent cardiovascular profiling on two occasions, an average 52 days apart. An additional group of 23 patients underwent right and left heart catheterizations for routine clinical indications and hemodynamic assessment was performed invasively and non-invasively. RESULTS: For short-term repeatability, the mean difference of C1 was +0.25 +/- 2.83 ml/mmHg x 10 (P = NS) and C2 was -0.14 +/- 1.86 ml/mmHg x 100 (P = NS). For intermediate test repeatability, the mean difference of C1 was -0.415 +/- 2.97 ml/mmHg x 10 (P = NS) and C2 was -0.19 +/- 2.67 ml/mmHg x 100 (P = NS). In the invasive protocol, both aortic diastolic blood pressure (-4.74 +/- 9.7 mmHg) and systemic vascular resistance (-194 +/- 264 dyne x s x cm(-5)) were significantly lower invasively. CONCLUSIONS: Measurements with the HDI/Pulsewave CR-2000 Research CardioVascular Profiling System are repeatable over both a short and intermediate period of observation. Furthermore, non-invasive hemodynamic parameters reasonably agree with invasive measurements.

Adolescent↗
PubMed2002

Comparison of arterial elasticity measured in left and right arms using the HDI/Pulsewave CR-2000 Research System.

BACKGROUND: Arterial elasticity is implicated as a risk factor for or a marker of cardiovascular disease. Current advances in non-invasive devices have now made it possible to measure arterial elasticity in an ambulatory setting. OBJECTIVE: The aim of this study was to determine whether there is a difference in blood pressure and arterial elasticity measured in the right and the left arms. METHODS: Simultaneous measurements were performed with two HDI/Pulsewave CR-2000 Research CardioVascular Profiling Systems. The manufacturer recommends placing the blood pressure cuff on the left upper arm and the sensor on the skin overlying the right radial artery. We followed the manufacturer's recommendations and also placed both the cuff and the sensor on the same arm. Simultaneous measurements were made on both arms with both machines. The average of three measurements was used for each combination. Systolic and diastolic blood pressure, and large-artery and small-artery elasticity indices, were determined for each subject and used in the analysis. RESULTS: The subjects were 11 males and 9 females between 22 and 46 (33.5 +/- 7.4 years) years of age. There was no significant difference in the average difference for each test combination. CONCLUSION: Thus, when using the HDI/Pulsewave CR-2000 Research CardioVascular Profiling System, the blood pressure cuff and the sensor can be placed on either the same arm or opposite arms.

Adult↗