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Biomedical subjects

M H Alderman

Publications and source records attributed to M H Alderman.

At least 181 records · Page 10Linked to original sources
PubMed1976

Hypertension control among employed persons in New York City: 1973-75.

A recent survey of 8, 579 employed persons in New York City has revealed that 85.7 percent of the 1,440 hypertensives identified were already aware of their condition and 66.1 percent were being treated. These results are in marked contrast to those obtained only a few years ago, when in a similar setting only half of those with high blood pressure were aware of their condition and relatively few had entered treatment. Unfortunately, however, the potential impact of this considerable shift in behavior has not been realized because only half of those who enter treatment achieve normal blood pressure. Thus, despite far greater emphasis on the community problem of hypertenstion, fewer than one-third of all those with high blood pressure are controlled. These data indicate that further screening and referral can, at best, increase the rate of control only slightly. The urgent need now is for development and implementation of programs that provide effective long-term patient management.

Adolescent↗
PubMed1975

Detection and treatment of hypertension at the work site.

A program linking detection to treatment was designed to improve blood-pressure control among adults with asymptomatic, uncomplicated hypertension. Key elements of this program were provision of all diagnostic and therapeutic services at work site, integration of delivery system with the administration of a labor union, adherence to rigid protocol, and continuous patient surveillance by nurses and paraprofessionals. At the first program site, Gimbels's principal New York City department store, 84 per cent of 1850 employees were screened, and 65 per cent of 186 with confirmed hypertension elected the treatment program. Of the 94 patients followed for one year, 97 per cent remained under therapy, with no untoward effect, and 81 per cent of patients had satisfactory blood-pressure reduction. This approach appears to be a safe, effective, and acceptable method for hypertension control in large numbers of patients.

Aged↗
PubMedDate not supplied

How prevalence of hypertension varies as diagnostic criteria change.

In a effort to determine what impact diagnostic criteria might have in defining the magnitude of the "hypertensive" population, various definitions of high blood pressure were applied to the same population. At the initial encounter, 23.3 per cent of the subjects had blood pressures greater than or equal to 160/95 mm Hg, but less than half of these sustained that level on two subsequent occasions over the next three weeks. When an initial diastolic blood pressure of greater than or equal to 105 mm Hg was used to define hypertension, prevalence fell by more than two thirds (23.3 to 7.2 per cent). These results clearly demonstrate that even a very simple modification of diagnostic criteria can markedly alter the prevalence of "hypertension."

Adolescent↗
PubMedDate not supplied

History of treatment for depression: risk factor for myocardial infarction in hypertensive patients.

OBJECTIVE: Psychological factors have been suspected of contributing to the development of cardiovascular disease. This study examined the relationship between a self-reported history of treatment for depression and subsequent myocardial infarction among treated hypertensive patients. METHODS: Participants (5564) in a union-sponsored, hypertension control program in New York City, who entered the program during 1981-1994 without a history of cardiovascular disease and who were asked whether they had been treated for depression, were followed in a prospective cohort study. The primary outcome of interest was hospitalization or death due to myocardial infarction. RESULTS: At entry, 3.5% of men and 6.4% of women reported a history of treatment for depression. During 4.9 years (average) of follow-up, 112 fatal and nonfatal myocardial infarctions were recorded. The sex-adjusted relative risk of myocardial infarction was 2.24 (confidence interval = 1.13-4.45). Controlling for known cardiovascular risk factors with multivariate proportional hazards models, history of treatment for depression was significantly associated with subsequent myocardial infarction (hazard ratio = 2.10, confidence interval = 1.04-4.23). CONCLUSIONS: A self-reported history of treatment for depression is independently associated with subsequent myocardial infarction in treated hypertensive patients without prior cardiovascular disease. Whether additional or different treatment for depression will be cardioprotective is unknown and merits further study.

Adult↗
PubMedDate not supplied

Management of the hypertensive patient: a continuing dilemma.

The proper management of mild and moderate hypertension remains a matter of considerable professional disagreement. Major clinical and population research has largely been designed to define a level of blood pressure (BP) at which treatment should be initiated. This paper reviews studies of the natural history of hypertension and the findings of intervention trials to determine whether the BP level alone is adequate to identify, diagnose, and predict the future course of hypertensive patients. Observational data suggest that patients defined by mild elevation of BP are a heterogeneous group who do not share a common prognosis. Moreover, intervention trials reveal that not all those at risk of cardiovascular disease will benefit from hypotensive therapy. Thus, BP level alone defines neither the group at risk nor those likely to benefit from BP reduction. It is therefore concluded that the management of each patient with hypertension should be determined on the basis of available clinical, biochemical, and behavioral as well as epidemiological data.

Adult↗