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Biomedical subjects

M H Alderman

Publications and source records attributed to M H Alderman.

190 records · Page 11Linked to original sources
PubMedDate not supplied

Profile of hypertensives as a determinant of long-term antihypertensive medication needs.

The experience of 110 hypertensives who participated in a worksite stepped-care treatment program has been examined to draw a patient profile at entry that would determine medication needs on a long-term basis. Patients entered untreated with a blood pressure (BP) level of greater than or equal to 160 mm Hg systolic and/or greater than or equal to 95 mm HG diastolic (DBP) and had a minimum follow-up of 1 year. Treatment was initiated with diuretics, and additional drugs were added as necessary to achieve BP control. Patients were divided into three groups according to initial DBP levels: Group A (33 patients, greater than or equal to 105 mm Hg), Group B (43 patients, 95-104 mm Hg), and Group C (34 patients, less than 95 mm Hg). Using a life table method, we analyzed the therapeutic experience of these patients to obtain 5-year cumulative rates of adding a second drug to diuretics. Within the first 2 years of treatment, the cumulative rates were: 64% in Group A, 33% in Group B, and 23% in Group C. In all three groups the rates after the second year remained stable. This stepped-care approach resulted in BP control (less than 160/95) which ranged from 78% in the first year to 96% in the fifth year. Findings suggest that initial DBP level and age are principal factors in determining medication needs. Furthermore, at higher DBP levels, younger nonwhite and younger white males are most likely to require a second drug within the first year of treatment. The need for a second drug is apparent within the first 2 years.

Adult↗
PubMedDate not supplied

Reduction of cardiovascular disease events by worksite hypertension treatment.

A retrospective cohort study of hypertensive employees to evaluate the impact of worksite antihypertensive treatment (WST) on cardiovascular disease (CVD) over 8 1/2 years is reported. In a union-sponsored screening from August 1973 to February 1974, 604 hypertensives (greater than or equal to 160 and/or 95 mm Hg, or on medication) were identified. Of these, standardized criteria were met by 344, of whom 150 chose WST and 194 referred care (RC). The study groups were similar in age and sex composition. Union hospitalization and death records through 1982 revealed that CVD rates were fewer in WST than RC (3.0 vs 5.4/100 person-years; p less than 0.01). By contrast, nonCVD rates were similar (8.1 vs 9.6). All-cause mortality rate in WST (0.89) was significantly (p less than 0.05) lower than that in RC (1.81), as was the standard mortality ratio (55.1), based on U.S. mortality in 1978. CVD mortality was also lower (0.48 vs 1.10; NS). Persons with an initial blood pressure (BP) less than 160/95 mm Hg had CVD event rates that were low and similar in WST and RC (3.6 vs 3.5). However, among those with elevated BP at entry, WST subjects fared significantly better than RC (2.8 vs 6.1; p less than 0.001). Furthermore, in WST, previously treated patients with elevated BP at screening experienced one-third the CVD morbidity of their counterparts in RC (3.1 vs 10.8; p less than 0.01). These results extend previous evidence that WST is an effective method to achieve BP control and demonstrate that this approach to the management of hypertension alters health outcomes favorably and significantly.

Age Factors↗
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Increased cardiac performance in mild essential hypertension. Left ventricular mechanics.

To analyze cardiovascular dynamics in essential hypertension, 81 subjects with untreated mild essential hypertension (mean blood pressure, 112 +/- 14 mm Hg) and 87 normotensive subjects from the same working population were studied by echocardiography and simultaneous blood pressure determination. Hypertensive subjects had significantly higher pulse pressure, stroke volume index, cardiac index, left ventricular internal dimension, end-systolic pressure/volume ratio, end-systolic stress, left ventricular mass index, and relative wall thickness than normotensive subjects. Among both normotensive and hypertensive subjects, cardiac performance was closely dependent on afterload, as indicated by close inverse linear relationships between left ventricular fractional shortening and log end-systolic stress (r = -0.83 and -0.78 respectively; both, p less than 0.001). However, 19 of 81 hypertensive patients (23%) fell above the 95% confidence limits of this relationship in normotensive subjects (p less than 0.001 compared with that in normotensive subjects), with a bimodal distribution of fractional shortening as a percent of predicted in relation to end-systolic stress among patients with essential hypertension. This subgroup of hypertensive subjects, with increased resting cardiac performance independent of afterload, was similar in age to the remaining hypertensive subjects but had higher fractional shortening (41 +/- 5% vs 35 +/- 7%; p less than 0.001) and cardiac index (4.3 +/- 1.3 L/min/m2 vs 3.4 +/- 1.0 L/min/m2; p less than 0.005) and lower total peripheral resistance (1257 +/- 502 dyn sec cm-5 vs 1582 +/- 584 dyn sec cm-5 p less than 0.05) and left ventricular relative wall thickness (0.34 +/- 0.06 vs 0.42 +/- 0.10; p less than 0.005). Thus, analysis of cardiac mechanics detected a subset of patients with essential hypertension in whom increased cardiac function cannot be attributed either to relative youth or to supercompensatory left ventricular hypertrophy.

Adult↗
PubMedDate not supplied

Can we stratify risk to guide therapy.

The relation of blood pressure to cardiovascular (CVD) disease is direct, continuous, and independent. Nevertheless, blood pressure alone is a poor predictor of CVD events. In fact, the totality of factors, including smoking, cholesterol, diabetes, target organ damage, and existing cardiovascular disease, together, permit discrimination of persons with similar blood pressure into subgroups with event expectations that might differ by more than twenty-fold. Thus, absolute CVD risk, rather than level of blood pressure, should determine the need for antihypertensive treatment. In addition, conventional treatment, even when effective, prevents only 25% of expected events. Observational study of long term treated patients provides the basis for pre-treatment stratification of CVD risk in patients who will maintain "normal" blood pressure in treatment. This stratification scheme makes it possible to modulate the intensity of therapy to match the potential for CVD prevention. Finally, specific risk factors, influenced by particular antihypertensive therapies, may guide drug selection in individual cases.

Blood Pressure↗
PubMedDate not supplied

Waist-to-hip ratio as an index of risk for hyperglycemia among hypertensive patients.

Participants in a systematic antihypertensive care program were examined to determine whether the site of fat predominance--measured by the waist-to-hip ratio--is related to hyperglycemia in patients taking diuretics. Among 1,044 hypertensive patients meeting a set of selection criteria, 22 men who developed hyperglycemia during a mean treatment period of 25.6 months were identified and individually matched for age, race, body mass index, and duration of diuretic treatment to a comparable group of hypertensive patients who remained normoglycemic. The mean waist-to-hip ratio was higher among the hyperglycemic men, although this difference did not reach conventional levels of statistical significance. However, a significantly greater proportion of the hyperglycemic men than those who were normoglycemic fell into a higher ratio category when waist-to-hip ratios were classified according to whether they were less than or greater than or equal to 0.90. When the ratios were examined in relation to body mass index, the greatest difference between the two groups was observed in the leanest group. This study suggests that the waist-to-hip ratio, in conjunction with total body fatness, may be an important tool for distinguishing persons with hypertension who may develop hyperglycemia when treated with diuretics.

Adipose Tissue↗
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A company-instituted program to improve blood pressure control in primary care.

An occupation-based effort to improve the outcome of antihypertensive therapy provided in the community was instituted by the Massachusetts Mutual Life Insurance Company in 1977. The goal of the program was to utilize the administrative and organizational resources of the company to enhance employee/patient adherence to treatment provided in conventional primary care settings. Key elements of the program were: companywide education and on-site screening, referral to community physicians and company assumption of all patient costs, linked to a monitoring system to permit oversight of care. Initially, 98% of employees were screened, 70% accepted referral for care and 59% fully adhered to program performance criteria. Blood pressure control has risen from 36% at the beginning to 69% at the end of the second year. Fully compliant patients have achieved the greatest lowering of blood pressure and compiled the best work attendance record. Program costs are modest and acceptance by employees and physicians supports the concept that occupation-based, systematic efforts can enhance the impact of primary care.

Adult↗