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Biomedical subjects

L Michael Prisant

Publications and source records attributed to L Michael Prisant.

At least 37 records · Page 2Linked to original sources
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↗
PubMed2002

Arterial elasticity among normotensive subjects and treated and untreated hypertensive subjects: influence of race.

OBJECTIVES: To determine arterial elasticity in normotensives and in treated and untreated hypertensive Black and White subjects. METHODS: A prospective multicenter, controlled clinical trial evaluated large (C-) and small (C2) artery elasticity indices among 3 groups: 1) normotensive subjects with or without a family history of hypertension; 2) controlled and treated hypertensive subjects; and 3) untreated and uncontrolled hypertensive subjects. Blood pressure was measured using a mercury manometer and arterial compliance or elasticity was determined using a CVProfilor DO-2020 CardioVascular Profiling System (Hypertension Diagnostics, Inc, Eagan, Minn). These parameters were measured in triplicate 3 minutes apart in a random sequence, with the patient in a supine position. Two-way ANOVA was used for statistical evaluation. RESULTS: One hundred seventy eight subjects met stratification and enrollment criteria. The mean age was 46 years. 109 were White and 69 were Black. [table: see text] CONCLUSION: Small and large arterial elasticity indices are reduced as hypertension status worsens. Age and height were important covariates of C1 and C2. Race was not found to be a significant predictor of either C1 or C2. Large and small artery elasticity indices do not differ between White and Black subjects with varying degrees of hypertension after adjusting for covariates. More studies with a larger number of subjects are required.

Adolescent↗
PubMed2002

Fixed low-dose combination in first-line treatment of hypertension.

Hypertension is poorly controlled in most patients. The control rate, defined as a systolic blood pressure (SBP) < 140 mmHg and diastolic blood pressure (DBP) < 90 mmHg, is 27% in the USA, despite data documenting the reduction of cardiovascular events by treating diastolic hypertension and isolated systolic hypertension. Control rate is even lower for patients with renal insufficiency and type 2 diabetes mellitus. Thus, monotherapy is unlikely to achieve blood pressure control. Supported by the 6th Joint National Committee Report (JNC VI), interest has been sparked in the use of fixed low-dose combination drugs as first-line treatment of hypertension. The rationale is to enhance hypertension control by using drugs that are additive while avoiding complex regimens that result in non-compliance. When low doses of two drugs are used, adverse drug reactions are fewer compared with the maximal dose of each drug tested separately. Multifactorial trials document the efficacy of hydrochlorothiazide (HCTZ) 6.25 mg in combination with bisoprolol 2.5-10 mg once daily. DBP control rates have been 64-77% and equal to or superior to HCTZ 25 mg once daily, amlodipine 2.5-10 mg once daily, enalapril 5-40 mg once daily or losartan 50-100 mg and losartan 50 mg with 12.5 mg HCTZ once daily. This low-dose combination has a side-effect profile similar to placebo. Erectile dysfunction and hypokalaemia are uncommon. Fixed-dose combination antihypertensive drugs simplify dosing regimens, improve compliance, improve hypertension control, decrease dose-dependent side-effects, and reduce cost as the first-line treatment of hypertension.

Antihypertensive Agents↗
PubMedDate not supplied

Chrono: a community-based hypertension trial of a chronotherapeutic formulation of verapamil.

An open-label, multicenter, dose-titration study evaluated 2,556 patients with stage I or II essential hypertension (untreated or previously treated with one antihypertensive agent) to assess the effect of a chronotherapeutic formulation of verapamil (Verelan PM) designed to provide maximum plasma concentrations in the midmorning hours. After starting with 200 mg/d at bedtime, the dose of Verelan PM was titrated to a maximum of 400 mg/d at 4-week intervals to achieve a target blood pressure (BP) <140/90 mm Hg using morning BP measurements. In 85.3% of patients, a diastolic blood pressure (DBP) response to less than 90 mm Hg or a 10-mm Hg decline from baseline DBP was achieved. The systolic BP response (<140 mm Hg or 10% decline from baseline) was attained in 76.9% of patients. Blood pressure was controlled in 62.6% of patients with Verelan PM monotherapy. Upward titration of Verelan PM from 200 to 400 mg nearly doubled the DBP response rate (45.8% to 85.3%). This chronotherapeutic formulation of verapamil was well tolerated in this community trial.

Adult↗
PubMedDate not supplied

Diabetes mellitus and hypertension: a mandate for intense treatment according to new guidelines.

Diabetics without a prior myocardial infarction have the same risk of a future myocardial infarction as nondiabetics with a prior myocardial infarction; however, epidemiologic studies suggest that lower blood pressure treatment goals may have potential benefit for diabetics with hypertension. Low-dose diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, and dihydropyridine calcium antagonists have reduced cardiovascular events in patients with diabetes. Angiotensin receptor blockers with diabetic renal disease have reduced the rate of end-stage renal disease, whereas dihydropyridine calcium antagonists show no benefit. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers reduce overall mortality, cardiovascular events, and the development of the overt nephropathy in high-risk patients with diabetes without advanced renal disease. The blood pressure treatment goal for patients with diabetes without macroalbuminuria is less than 130/80 mm Hg and less than 125/75 mm Hg for patients with diabetes and nephrotic syndrome. To achieve these goals, multiple antihypertensive drugs are required.

Angiotensin-Converting Enzyme Inhibitors↗
PubMedDate not supplied

Treatment of elderly hypertensive patients with a delayed-release verapamil formulation in a community-based trial.

This report of a practice-based clinical trial describes an open-label, multicenter dose-titration study of an elderly (age >or=65 years) subset of patients (N=628) with systolic blood pressures between 140 and 179 mm Hg or diastolic blood pressures between 90 and 109 mm Hg, to assess the effects of the Chronotherapeutic Oral Drug Absorption System (CODAS) formulation of verapamil hydrochloride. After starting 200 mg/d at bedtime, dosing was titrated to a maximum of 400 mg/d at 4-week intervals to achieve a target blood pressure of <140/<90 mm Hg using morning blood pressure measurements. Target blood pressure was reached in 57.1% of the elderly patients with CODAS verapamil monotherapy. A diastolic response (<90 mm Hg or a 10 mm Hg reduction from baseline) was achieved in 89.5% of these subjects, and a systolic blood pressure response (<140 mm Hg or 10% reduction from baseline) was attained in 75.5%. The percentages of patients achieving target blood pressure or the diastolic and systolic blood pressure responses were comparable to those previously reported for younger patients. It is notable that although 359 of the 628 patients reached control on treatment, 182 of the remaining 269 noncontrolled patients were not titrated to higher doses, indicating that even with a well tolerated drug there may be reluctance among clinicians to increase doses. CODAS verapamil was found to be efficacious and well tolerated among elderly hypertensive patients in this community trial.

Aged↗
PubMedDate not supplied

Transdermal clonidine skin reactions.

The clonidine transdermal therapeutic system is being used as a therapy for blood pressure treatment. Systemic side effects seem to be fewer than with oral clonidine. However, localized skin reactions occur frequently and the incidence increases with the dose and duration of use. Common signs include erythema, scaling, vesiculation, excoriation, and induration. Allergic contact dermatitis is less frequent but common. Hyperpigmentation and depigmentation also occur. Pretreatment with 0.5% hydrocortisone is associated with less skin irritation and higher blood levels. Although oral clonidine is no longer widely used in the management of hypertension, awareness of these reactions to the transdermal delivery of this agent is important.

Adrenergic alpha-Agonists↗