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Biomedical subjects

M H Alderman

Publications and source records attributed to M H Alderman.

At least 55 records · Page 3Linked to original sources
PubMed1998

Differential effects of angiotensin converting enzyme inhibition and diuretic therapy on reductions in ambulatory blood pressure, left ventricular mass, and vascular hypertrophy.

Diuretic-based therapy is less effective in reducing the cardiac complications of hypertension than the risk of stroke and may be less effective in reducing left ventricular (LV) mass than is therapy with angiotensin converting enzyme (ACE) inhibition. In view of the strong association of LV hypertrophy with cardiovascular risk, this study was designed to compare the impact of therapy with a diuretic and ACE inhibition on cardiac and vascular structure. Fifty essential hypertensives (74% male, 88% nonwhite) participated in a double-blind study for 6 months and were randomized to either ramipril or hydrochlorothiazide (HCTZ). Echocardiography, carotid ultrasonography, and ambulatory blood pressure (BP) monitoring were performed at baseline and 3 and 6 months after initiation of therapy. The 22 ramipril patients were comparable to the 28 HCTZ patients at baseline in age, race, and 24-h BP. Although HCTZ resulted in a greater reduction in 24-h BP, only treatment with ramipril resulted in a decrease in LV mass (193 to 179 g, P < .005, v 184 to 182 g, P = NS), attributable to a reduction in wall thicknesses but not in chamber diameter. In multivariate analysis, both change in BP and treatment group were independent predictors of change in LV mass. Importantly, although neither drug reduced carotid artery cross-sectional area, relative wall thickness increased due to a tendency for vessel diameter to decrease and wall thickness to increase, particularly in the diuretic group. Ramipril caused a sustained fall in plasma angiotensin II, whereas HCTZ increased angiotensin II levels. Although diuretic therapy was more effective in lowering ambulatory BP in this predominantly nonwhite population, only therapy with ACE inhibition was associated with regression of LV mass. Vascular geometry was altered consistent with the reduction in distending pressure resulting in vascular remodelling.

Adult↗
PubMed1998

Epidemiology of risk in hypertensives: experience in treated patients.

Knowledge of the epidemiology of cardiovascular disease (CVD) in hypertensive patients derives primarily from observation of populations composed largely of untreated subjects. Increasingly, however, individuals with elevated blood pressure are treated. An 18-year observational study of 8690 participants in a systematic hypertension control project reveals that cardiovascular events continue to be the principal morbid and mortal outcomes. Over time, the incidence of stroke and heart attack remained stable, whereas congestive heart failure (CHF), as a first event, increased tenfold after 10 years. Diabetes and evidence of vascular disease at entry predicted morbidity. Persisting cardiovascular morbidity in the face of satisfactory blood pressure control suggests the need for additional preventive intervention.

Age Factors↗
PubMed1998

Assessment of a new dipstick test in screening for microalbuminuria in patients with hypertension.

The prevalence of elevated urinary albumin levels is significantly greater in hypertensive than in normotensive subjects. To determine the sensitivity and specificity of a new dipstick test for microalbunimuria (the Micral-Test), 171 hypertensive patients were studied at a union-sponsored hypertension treatment program. Sensitivity, specificity, predictive values, and correlation coefficients between urinary albumin concentration results obtained by the Micral-Test and by nephelometry were determined in three urine samples. Sensitivity values of the Micral-Test, compared with 24-h nephelometry, were 81%, 75%, and 92% in a 24-h, overnight, and random sample, respectively. Specificity values were 89%, 90%, and 63% in the three samples, respectively. Positive predictive value ranged from 41% to 67%, whereas negative predictive value ranged from 93% to 97%. Correlation coefficients between the logarithms of albumin concentrations obtained from the three different urine specimens using nephelometry fell between 0.71 and 0.78, whereas those obtained with the Micral-Test fell between 0.49 and 0.71, and across techniques, 0.29 to 0.53 (all P < .001). Results obtained with both nephelometry and the Micral-Test using overnight and random urine collections approximated those obtained with 24-h collection. These results, coupled with the ease and convenience of both specimen collection and the Micral-Test itself, support the use of the test as a valuable screening tool for microalbuminuria in patients with hypertension.

Adult↗
PubMed1998

Distribution and determinants of cardiovascular events during 20 years of successful antihypertensive treatment.

OBJECTIVE: To define the distribution and determinants of cardiovascular disease events among participants undergoing long-term antihypertensive therapy, and to stratify them into risk groups on the basis of pretreatment clinical profiles. DESIGN: A prospective cohort study of participants in a worksite-based antihypertensive treatment program in New York city (1973-1994). PATIENTS: We studied 8690 systematically treated patients who had at least 6 months of follow-up (average of 5.7 years) and, at entry, had had a systolic blood pressure of > or = 160 mmHg or a diastolic blood pressure of > or = 95 mmHg (after 1992 > or = 140/90 mmHg), or had been being administered antihypertensive medication. MAIN OUTCOME MEASURES: Blood pressure and incidence of morbid and mortal cardiovascular events. RESULTS: Blood pressure control (to 140 +/- 3/87 +/- 7 mmHg) was achieved by the first year and maintained through 18 years of therapy. In nearly 50,000 person-years of follow-up, there were 468 cardiovascular disease events [myocardial infarction including revascularization (282), strokes (93), congestive heart failure (30) and other cardiovascular deaths (63)]. Deaths from cardiovascular disease events accounted for 68% of all deaths. Myocardial infarction was most common throughout, but congestive heart failure incidence surpassed stroke incidence after 10 years. A scheme for risk stratification was constructed after analysis of the independent association of baseline factors and incident cardiovascular events. Upon the basis of ease of ascertainment and their demonstrated associations with occurrence of cardiovascular disease during treatment, we selected five pretreatment factors (history of heart attack, stroke, diabetes, age > or = 55 years and pulse pressure > or = 60 mmHg) to stratify patients into four groups. Those with no risk factor had a low risk (n=2999), those with one had a moderate risk (3042), those with two had a high risk (2237), and those with three or more had a very high risk (412). Overall, the unadjusted rates of incidence of cardiovascular disease events per 1000 person-years for patients in very high and low risk groups differed by factors of six and 14 for men and women, respectively. CONCLUSION: These results demonstrate that long-term control of blood pressure can be achieved in a general population. Nevertheless, cardiovascular disease events still accounted for most morbidity and mortality among these 'recovered' hypertensive patients. At entry, on the basis of readily identifiable characteristics, it was possible to stratify patients according to likelihood of subsequent events occurring despite control of blood pressure. This scheme could provide the basis for targeting more aggressive therapy where the potential for further cardioprotection is greatest.

Antihypertensive Agents↗
PubMed1997

Influence of nativity on cancer mortality among black New Yorkers.

BACKGROUND: Cancer is the second leading cause of death in U. S., and blacks have higher cancer death rates than whites. The authors conducted an analysis to determine the influence of birthplace on cancer mortality among blacks in New York City. METHODS: Death records for New York City from 1988 through 1992 were linked to the 1990 U. S. Census data. Age-adjusted cancer death rates by race and birthplace were computed. The experience of black residents born in the South and Northeast of the U. S. and in Caribbean countries were compared with that of New York City whites. RESULTS: The cancer mortality rate of blacks exceeded that of whites for males (512.6 vs. 385.6 per 100,000 per year), but was similar for females (270.8 vs. 270.6). However, cancer death rates of Southern-born black males (615.7) were substantially higher than those of black males born in the Northeast (419.1) or the Caribbean (352.4). Carcinomas of the lung, prostate, breast, and colon/rectum accounted for >50% of all cancer deaths. Lung carcinoma mortality varied greatly by birthplace, with Caribbean-born blacks (63.5 and 19.2 for males and females, respectively) having approximately one-third the death rates of Southern-born blacks (187.8 and 52.5 for males and females, respectively), and <50% that of New York City whites (108.7 and 53.2 for males and females, respectively). These differences were present in each age category, but were most pronounced among those age 45-64 years. In striking contrast, death rates from prostate carcinoma were highest in Caribbean-born black men, and this was especially apparent in persons age > or = 65 years. CONCLUSIONS: The generally higher cancer mortality of blacks compared with whites masks even greater intraracial heterogeneity revealed through stratification by birthplace. In general, Caribbean-born blacks are at lower risk of cancer mortality than other blacks, and whites, but their advantage does not hold for prostate carcinoma, for which Caribbean-born men had the highest mortality rate.

Adult↗
PubMed1997

Effect of long-acting and short-acting calcium antagonists on cardiovascular outcomes in hypertensive patients.

BACKGROUND: Short-acting calcium antagonists may increase coronary artery morbidity, mortality, and non-cardiovascular complications in hypertensive patients. We assessed whether this association was also true for long-acting calcium antagonists. METHODS: We did a case-control study, which was nested within a systematic hypertension control programme for a prospective cohort of 4350 people (first seen 1981-94). Cases (n = 189) were hypertensive patients who had had a first cardiovascular event, including all cardiovascular deaths and hospitalisations, between 1989 and 1995. Controls (n = 189) were individually matched to cases for sex, ethnic origin, age, type of previous antihypertensive treatment, year of entry into the study, and length of follow-up. We collected data on any prescribed drug regimen that was being taken on the event data for cases and on the same date for matched controls. Calcium antagonists were classified by duration of action. FINDINGS: Compared with those on beta-blocker monotherapy, patients on long-acting calcium antagonists (n = 136) had no increased risk of a cardiovascular event (adjusted odds ratio 0.76 [95% CI 0.41-1.43]), whereas patients on short-acting calcium antagonists (n = 27) were at significantly greater risk (adjusted odds ratio 3.88 [1.15-13.11], p = 0.029). Among 38 matched pairs who were both on calcium antagonists, the adjusted risk ratio for short-acting versus long-acting was 8.56 (1.88-38.97), p < 0.01. INTERPRETATION: Long-acting and short-acting calcium antagonists differ in cardiovascular outcomes. Consistent with earlier findings, the use of short-acting calcium antagonists was associated with increased risk of a cardiovascular event. This finding highlights the need to complete on-going clinical trials so that the relative cardiovascular impact of various antihypertensive agents can be assessed.

Antihypertensive Agents↗
PubMed1997

Plasma renin activity: a risk factor for myocardial infarction in hypertensive patients.

To determine whether pretreatment plasma renin activity (PRA), without accompanying 24-h urine sodium, can predict myocardial infarction (MI), the PRA levels of 2,902 hypertensive patients [white (38%), male (65%), median age 55 years], with mean entry blood pressure (BP) of 150/97 mm Hg were examined. During an average 3.6 years follow-up (87% > or = 9 months), there were 55 MIs, 21 strokes, and 16 other cardiovascular disease (CVD) deaths. Classification of PRA levels into 3 renin strata [high (H) PRA > or = 4.5 (n = 354), normal (N) 0.75 to 4.49 (n = 1,622), and low (L) < 0.75 (n = 926) ng/mL/h] yielded subgroups that did not differ in LVH (9% v 11%) or smoking prevalence (26% v 25%) but high versus low PRA subjects included more aged < 55 years (64% v 53%); white (49% v 25%); men (79% v 52%); cholesterol > or = 6.3 mmol/L (33% v 25%); all P values < .01. MI rates per 1,000/year were H: 9.3, N: 5.5, L: 2.5 (H v L, RR = 3.8, 95% CI: 1.7 to 8.4). A similar relationship was seen with total CVD (H: 12.5, N: 9.3, L: 5.2; RR = 2.4, 95% CI: 1.3 to 4.5) and all-cause mortality (H: 7.0, N: 6.2, L: 2.5; RR = 2.8, 95% CI: 1.2 to 6.8) but not CVA (H: 1.6, N: 2.0, L: 1.9). In a Cox survival analysis only renin, age, sex, smoking, LVH, and cholesterol were significantly (P < .02) related to MI occurrence. There was, for every 2 unit increase in PRA, an overall 25% increase in MI incidence. Among hypertensive subjects, PRA level (without urine sodium), is independently and directly associated with the incidence of MI.

Black People↗
PubMed1997

Serum ionized magnesium: relation to blood pressure and racial factors.

To study potential ionic factors predisposing to vascular disease in hypertension, particularly among black subjects, we used a recently developed combined magnesium and calcium specific, ion selective electrode apparatus to measure extracellular ionized calcium (Ca-ion), ionized magnesium (Mg-ion), and Ca-ion/Mg-ion ratios in the serum of fasting, nonmedicated white and black normotensive (n = 61) and hypertensive (n = 23) subjects, studied consecutively in a tertiary referral center. Both race and blood pressure status had independent effects on the distribution of Mg-ion values. Although Mg-ion levels for the group as a whole were lower in hypertensive versus in normotensive subjects (0.571+/-0.012 v 0.601+/-0.005 mmol/L; P < .01), this was only true of white subjects (0.579+/-0.021 v 0.620+/-0.006 mmol/L; P = .0095). The lack of a significant difference in Mg-ion levels between black hypertensive versus normotensive subjects (0.553+/-0.012 v 0.577+/-0.007 mmol/L, P = NS) was attributable to the significantly lower Mg-ion levels present in normotensive blacks compared to those in normotensive white subjects (0.577+/-0.007 v 0.620+/-0.006 mmol/L, P = .0001). Resultant Ca-ion/Mg-ion ratios were elevated in all black subjects and in white hypertensive subjects. These data support the presence among hypertensives and among black subjects (independently of blood pressure) of a consistent depletion of circulating magnesium and of an imbalance of calcium and magnesium that may potentiate vascular disease among these subjects.

Black People↗
PubMed1997

Nativity, race, and mortality: influence of region of birth on mortality of US-born residents of New York City.

Among non-Hispanic black and white residents of New York City the association between birthplace by region (South, West/ Midwest, and Northeast) within the United States and mortality was determined by linking mortality records for 1988-1992 with the 1990 United States census data for New York City. Age-adjusted death rates computed by birthplace for blacks and whites were examined and also compared with total US data. The results indicate that death rates for New Yorkers generally exceed those of the United States overall, and black rates exceed those of whites. Moreover, Southern-born blacks have substantially higher death rates than do blacks born in the Northeast. The most striking variations are for cancer and diseases of the heart. Deaths from AIDS and homicide are higher among blacks than among whites, but the rates for Southern-born blacks do not exceed those for Northeastern-born blacks. For whites those born in the South have higher death rates overall than those born in the Northeast, but differences in cause-specific mortality are less consistent than for blacks. The results reveal substantial heterogeneity of health status based on nativity, among blacks in particular. To understand the role of the related factors, both genetic and environmental, further population and epidemiologic studies are important.

Adult↗
PubMed1997

The influence of birthplace on mortality among Hispanic residents of New York City.

To determine the mortality experience of Hispanic residents of New York City and the influence of birthplace on their mortality rates, NYC Department of Health mortality records for 1988 to 1992 were linked for analysis with 1990 United States census data for New York City. Age-specific death rates for all Hispanics were compared by birthplace with those of non-Hispanic whites. Age-adjusted death rates were also compared. Overall, Hispanics had death rates lower than non-Hispanic blacks, and death rates similar to those of non-Hispanic whites. Hispanics had higher rates of death from HIV-infection, diabetes, stroke/hypertensive disease, cirrhosis and homicide, and fewer deaths from cancer and coronary heart disease than did non-Hispanic whites. Moreover, there were substantial differences in mortality between Hispanic subgroups categorized by birthplace. Migrants from Puerto Rico had the highest, and those from Central and South America the lowest mortality rates. United States-born Hispanics, although younger, had age-adjusted mortality rates higher than New York City non-Hispanic whites. In summary, the mortality of Hispanics generally approximated that of non-Hispanic whites, and was lower than that of non-Hispanic blacks. However, stratification of Hispanics by birthplace revealed substantial variation within the Hispanic population of New York City.

Adolescent↗
PubMed1997

Nativity, race, and mortality: favorable impact of birth outside the United States on mortality in New York City.

To determine the association of birthplace (US-born vs. foreign-born) with mortality among blacks and whites in New York City, we examined death records for 5 years from 1988 to 1992 and the 1990 census data. Mortality rates by race and birthplace were compared for all causes of death and for specific causes. Although overall death rates for blacks generally exceeded those for whites (1224.8 per 100,000 inhabitants vs. 721.4 for males and 593.7 vs. 393.1 for females), foreign-born blacks had death rates (664.6 for males and 350.2 for females) slightly lower than those for whites. The most striking variation among blacks was among those aged 25 to 64 years. US-born black males were three times as likely (1588.9 vs. 525.2) and US-born black females were more than 2.5 times as likely (673.5 vs. 263.4) to die as were foreign-born blacks. Among US-born blacks AIDS, homicide, and cancer for males and AIDS, heart disease, and cancer for females were the most important determinants of excess deaths, defined as the difference between observed deaths and expected deaths; these causes of death account for about half of the excess deaths for each sex. Among whites natives generally had higher death rates than migrants, but less prominently and consistently so than for blacks. Excess mortality of blacks is largely explained by higher death rates of US-born compared with foreign-born Americans.

Adolescent↗
PubMed1996

The association between birthplace and mortality from cardiovascular causes among black and white residents of New York City.

BACKGROUND: Life expectancy is shorter and mortality from cardiovascular disease higher among blacks than among whites in the United States. We studied whether place of birth was associated with mortality from cardiovascular causes among non-Hispanic black and white residents of New York City. METHODS: We linked mortality records from 1988 through 1992 with 1990 U.S. census data for New York City. Mortality data for blacks born in the U.S. South and Northeast and in the Caribbean were compared with those for whites born in the Northeast. RESULTS: Among blacks, the rates of overall mortality and mortality from cardiovascular causes exceeded those among whites. Among persons born in the Northeast, the rates of death from cardiovascular disease for white men (285 per 100,000), as compared with black men (299), and for white women (155), as compared with black women (165), were similar. However, Southern-born black men and women both had mortality from cardiovascular disease that was substantially higher than that of their counterparts born in the Northeast, and Caribbean-born blacks had rates substantially lower than their Northeastern-born counterparts. The differences among the groups in the rates of death from coronary heart disease were greater than those for death due to stroke or hypertension. In each category defined by age and sex, Caribbean-born blacks had significantly lower rates of death from coronary heart disease than did whites. Black men who were 25 to 44 years of age and were born in the South had a rate of death from coronary heart disease that was 30 percent higher than that of Northeastern-born blacks, and four times that of Caribbean-born blacks of the same sex and age. CONCLUSIONS: The higher rate of mortality from cardiovascular causes among blacks, as compared with whites, in New York City masks substantial variation among blacks based on their place of birth.

Adult↗
PubMed1996

Antihypertensive Drug Therapy. The effect of JNC criteria on prescribing patterns and patient status through the first year.

This study was designed to evaluate the impact of the protocol-driven antihypertensive therapy on outcomes guided by the Joint National Committee (JNC) on Detection, Evaluation, and Treatment of high blood pressure. In a systematic hypertension control program for union employees conducted in New York City, untreated patients who began treatment on monotherapy guided by JNC recommendations during three representative periods: I-pre-JNC IV (1986-1987); II-post-JNC IV (1990-1991); and III (JNC V)-period of application of what were later published as JNC-V guidelines (1992) were observed during 1 year of treatment. A total of 550 presumably untreated patients were prescribed either diuretics, beta-blockers, calcium channel blockers, or angiotensin converting enzyme inhibitors. There were 231 in period I, 213 in II, and 106 in III. The patient composition over time became more predominantly female and Hispanic (I to III: 28% to 34%, and 35% to 45%, respectively). The main outcome measures were type of drug first prescribed and the outcomes at the end of 1 year-changes in blood pressure, clinical chemistry measures and therapy, and clinic attendance are dropout rate. The pattern of first drug prescription changed from 85% to 90% of patients given diuretics or beta-blockers in I to 90% begun on calcium channel blockers or angiotensin converting enzyme inhibitors in II and finally, to an even distribution of drugs in III. Blood pressure response was similar across the three periods, 135/89 mm Hg (I), 138/89 (II), and 140/89 (III). Proportion of patients remaining on their initial drug in each period was fairly similar (60%, 67%, and 69%). Scheduled clinic visits fell significantly from 7.4 visits in I, 6.9 in II, and 6.4 in III (I upsilon III P = .004). Dropouts diminished significantly from 17% in I, to 10% in II, and 9% in III (I upsilon II or III P = .045). Modest positive changes in cholesterol and fasting blood sugar level occurred over time. In this general community setting, dramatic shifts in the choice of initial drug based upon application of JNC guidelines had little discernable impact on short term patient outcomes.

Analysis of Variance↗
PubMed1996

Rationale and design for the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). ALLHAT Research Group.

Are newer types of antihypertensive agents, which are currently more costly to purchase on average, as good or better than diuretics in reducing coronary heart disease incidence and progression? Will lowering LDL cholesterol in moderately hypercholesterolemic older individuals reduce the incidence of cardiovascular disease and total mortality? These important medical practice and public health questions are to be addressed by the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), a randomized, double-blind trial in 40,000 high-risk hypertensive patients. ALLHAT is designed to determine whether the combined incidence of fatal coronary heart disease (CHD) and nonfatal myocardial infarction differs between persons randomized to diuretic (chlorthalidone) treatment and each of three alternative treatments--a calcium antagonist (amlodipine), an angiotensin converting enzyme inhibitor (lisinopril), and an alpha-adrenergic blocker (doxazosin). ALLHAT also contains a randomized, open-label, lipid-lowering trial designed to determine whether lowering LDL cholesterol in 20,000 moderately hypercholesterolemic patients (a subset of the 40,000) with a 3-hydroxymethylglutaryl coenzyme A (HMG CoA) reductase inhibitor, pravastatin, will reduce all-cause mortality compared to a control group receiving "usual care." ALLHAT's main eligibility criteria are: 1) age 55 or older; 2) systolic or diastolic hypertension; and 3) one or more additional risk factors for heart attack (eg, evidence of atherosclerotic disease or type II diabetes). For the lipid-lowering trial, participants must have an LDL cholesterol of 120 to 189 mg/dL (100 to 129 mg/dL for those with known CHD) and a triglyceride level below 350 mg/dL. The mean duration of treatment and follow-up is planned to be 6 years. Further features of the rationale, design, objectives, treatment program, and study organization of ALLHAT are described in this article.

Antihypertensive Agents↗