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Biomedical subjects

M J Horan

Publications and source records attributed to M J Horan.

At least 19 recordsLinked to original sources
PubMed1995

Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988-1991.

The purpose of this study was to estimate the current prevalence and distribution of hypertension and to determine the status of hypertension awareness, treatment, and control in the US adult population. The study used a cross-sectional survey of the civilian, noninstitutionalized population of the United States, including an in-home interview and a clinic examination, each of which included measurement of blood pressure. Data for 9901 participants 18 years of age and older from phase 1 of the third National Health and Nutrition Examination Survey, collected from 1988 through 1991, were used. Twenty-four percent of the US adult population representing 43,186,000 persons had hypertension. The age-adjusted prevalence in the non-Hispanic black, non-Hispanic white, and Mexican American populations was 32.4%, 23.3%, and 22.6%, respectively. Overall, two thirds of the population with hypertension were aware of their diagnosis (69%), and a majority were taking prescribed medication (53%). Only one third of Mexican Americans with hypertension were being treated (35%), and only 14% achieved control in contrast to 25% and 24% of the non-Hispanic black and non-Hispanic white populations with hypertension, respectively. Almost 13 million adults classified as being normotensive reported being told on one or more occasions that they had hypertension; 51% of this group reported current adherence to lifestyle changes to control their hypertension. Hypertension continues to be a common finding in the general population. Awareness, treatment, and control of hypertension have improved substantially since the 1976-1980 National Health and Nutrition Examination Survey but continue to be suboptimal, especially in Mexican Americans.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population. Data from the health examination surveys, 1960 to 1991.

The objective of this study was to describe secular trends in the distribution of blood pressure and prevalence of hypertension in US adults and changes in rates of awareness, treatment, and control of hypertension. The study design comprised nationally representative cross-sectional surveys with both an in-person interview and a medical examination that included blood pressure measurement. Between 6530 and 13,645 adults, aged 18 through 74 years, were examined in each of four separate national surveys during 1960-1962, 1971-1974, 1976-1980, and 1988-1991. Protocols for blood pressure measurement varied significantly across the surveys and are presented in detail. Between the first (1971-1974) and second (1976-1980) National Health and Nutrition Examination Surveys (NHANES I and NHANES II, respectively), age-adjusted prevalence of hypertension at > or = 160/95 mm Hg remained stable at approximately 20%. In NHANES III (1988-1991), it was 14.2%. Age-adjusted prevalence at > or = 140/90 mm Hg peaked at 36.3% in NHANES I and declined to 20.4% in NHANES III. Age-specific prevalence rates have decreased for every age-sex-race subgroup except for black men aged 50 and older. Age-adjusted mean systolic pressures declined progressively from 131 mm Hg at the NHANES I examination to 119 mm Hg at the NHANES III examination. The mean systolic and diastolic pressures of every sex-race subgroup declined between NHANES II and III (3 to 6 mm Hg systolic, 6 to 9 mm Hg diastolic). During the interval between NHANES II and III, the threshold for defining hypertension was changed from 160/95 to 140/90 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Changes in hypertension awareness, treatment, and control rates. 20-year trend data.

In the last 2 decades, public knowledge, awareness, treatment, and control of high blood pressure have changed remarkably. These changes are real, and have been associated with the activities of the National High Blood Pressure Education Program. Without a control group it is always difficult to attribute causality; however, the improving levels are remarkably large and consistent, and they have occurred concurrently with the decline in age-adjusted stroke mortality.

Adult↗
PubMed1992

Heterogeneity of hypertension.

Although all forms of hypertension have in common the finding of elevated blood pressure, further examination reveals great heterogeneity. The risk of hypertension is related not only to the level of blood pressure but also to the presence of other risk factors; the prevalence of hypertension is affected by demographic, clinical, and psychologic characteristics; the pathophysiology of hypertension reflects varying participation of salt-sensitivity, the renin-angiotensin system, and other control mechanisms; and treatment responses differ among patients both with regard to the degree of blood pressure lowering by various therapies and the clinical benefit obtained. Knowledge of these heterogeneities at present is useful but only partial. Additional research is needed to improve prediction of hypertension, to enhance stratification of patients by the mechanisms and risk of their hypertension, to refine the matching of specific therapies and treatment goals to the underlying pathophysiology, and to facilitate transfer of evolving information to the clinician.

Blood Pressure↗
PubMed1991

Antihypertensive therapy and atherosclerosis.

Hypertension and atherosclerosis make independent contributions to the pathogenesis of cardiovascular disease. Diuretics and beta adrenergic blockers, effective antihypertensive medications, exhibit some untoward effects on lipid metabolism, while most other antihypertensive medications tend not to exhibit such effects. In animal models, beta adrenergic blockers, angiotensin converting enzyme (ACE) inhibitors, and calcium antagonists have anti-atherogenic effects. A vascular biological approach to therapy for the patient with both hypertension and atherosclerosis is recommended. This includes effective reduction of blood pressure--preferably with agents that do not adversely affect lipid metabolism--and treatment of lipid metabolism disorders.

Animals↗
PubMed1990

Epidemiology of blood pressure and predictors of hypertension.

Hypertension is a clinical disease with a prevalence sufficiently high in acculturated societies to warrant it being designated a serious public health problem. In population studies, blood pressure has been found to be a continuously distributed risk variable with mortality directly related to the level of blood pressure. Thus, hypertension is both a disease and a risk factor. Classic genetic studies suggest that the predisposition for the development of hypertension is an inherited trait that becomes manifest when coupled with one or more environmental insults. Risk factors for hypertension include age, weight, sedentary lifestyle, excessive dietary sodium intake, and excessive alcohol intake. Current and future research is being directed toward the identification of predictors of hypertension that can be conceptualized according to demographic, clinical, genetic, challenge-response, and laboratory predictors. The intent is to identify subjects with a high probability for the development of hypertension in advance of the rise in blood pressure so that appropriate interventions can be implemented as early as possible.

Child↗
PubMed1990

Hypertension research. The next five years.

Hypertension is both a disease and a risk factor. Long-term research objectives are to understand blood pressure homeostasis and the pathogeneses of the various forms of hypertension. Short-term research objectives center around enhancing methods for detection, evaluation, treatment, and control of high blood pressure because, even in the absence of precise knowledge of the etiology of hypertension, its control results in substantial reductions in morbidity and mortality. Therefore, a multifaceted national research strategy has been developed that includes basic science, applied research, clinical research, clinical trials, and demonstration and education research approaches. Complementing this research strategy is a congressionally mandated program to facilitate the application of the products of research to the clinical care setting by promoting educational activities aimed at health care providers, patients, and consumers.

Animals↗
PubMed1990

Considerations for a national heart attack alert program.

Coronary heart disease (CHD) remains the leading cause of death in the United States--in women as well as men. In 1987, CHD was responsible for 512,138 deaths, of which 253,542 deaths were attributed to acute myocardial infarction (AMI) and accounted for over $43 billion in direct and indirect costs. The disease spares no one. Primary prevention is clearly important, but for those in whom primary prevention has not been applied or has failed, acting to minimize the effect of a heart attack is of paramount importance. Many of its victims do not obtain appropriate medical care, or obtain it too late for the latest lifesaving technologies to be effective. The goal of treatment is to prevent death and to salvage as much heart tissue as possible. To achieve this goal, it is essential to minimize the time from the first symptoms and signs to treatment. Opportunities exist at each phase of an evolving AMI to intervene promptly and appropriately to prevent sudden death and to preserve cardiac muscle and thereby reduce CHD morbidity and mortality. Yet, formidable problems also exist. These and other issues are presently being studied by the National Heart, Lung, and Blood Institute staff and advisors in consideration of whether to establish a national educational program aimed at reducing CHD morbidity and mortality through the rapid identification and treatment of those with AMI.

Coronary Disease↗
PubMed1989

Implications for research and policy in the treatment of hypertension. Medical considerations.

Hypertension, or high blood pressure, is a disease and a risk factor. Cardiovascular risk is directly proportional to the level of blood pressure. Current therapeutic approaches include the classical medical model of detection, evaluation, and drug treatment of high-risk patients who have elevated blood pressure and also a less-well-studied population approach that seeks to manipulate environmental variables in large groups of subjects to reduce blood pressure and subsequent cardiovascular risk. Future research should center on more precise delineation of cardiovascular risk, evaluation of alternative environmental manipulations to reduce blood pressure, enhanced understanding of the pathophysiological mechanisms of hypertension, better matching of antihypertensive drug therapy to pathophysiology, development of new drugs that not only lower blood pressure but also provide additional benefits with minimal side effects, and finally, investigations to further our understanding of the behavioral aspects of the physician-patient encounter, as well as studies on compliance and other issues that influence therapeutic outcome.

Antihypertensive Agents↗
PubMed1988

Nonpharmacologic treatment of hypertension in the United States.

Although efficacious pharmacologic approaches to the control of high blood pressure are available, concern about risk versus benefit in the use of antihypertensive drug therapy for patients with mild hypertension has led to renewed interest in nonpharmacologic interventions. In the United States, the National High Blood Pressure Education Program, an organization comprised of research scientists and a variety of other professionals concerned with the control of high blood pressure has, through a consensus process, recommended some nonpharmacologic approaches to the treatment of hypertension. These include weight reduction for the obese, moderate sodium restriction (although this is controversial), and restriction of alcohol consumption to less than 1 oz of ethanol daily.

Alcohol Drinking↗
PubMed1988

Hypertension research perspective in the United States.

Hypertension affects 30% of the U.S. adult population or 58 million Americans. A comprehensive national research effort has been developed for attacking this problem on multiple fronts including basic research, applied research and development, clinical research, clinical trials, demonstration and education research, and technology transfer through the National High Blood Pressure Education Program. As a result, important new insights into the etiology and pathogenesis of hypertension and advances in its control have been realized, but this momentum needs to be sustained to meet the many challenges presented by this disease.

Clinical Trials as Topic↗
PubMed1988

The National High Blood Pressure Education Program: measuring progress and assessing its impact.

The National High Blood Pressure Education Program has been designed to translate the results of basic and clinical research to medical practice through a program of education for the public, patients, and health professionals. It has continuously used health-education principals of media development, patient education, social networking, community organizations, theories of social change, and program evaluation and measurement to reach its objectives. After 15 years, public knowledge regarding blood pressure and its sequelae has improved dramatically.

Health Education↗