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Biomedical subjects

Marvin Moser

Publications and source records attributed to Marvin Moser.

At least 19 recordsLinked to original sources
PubMed2003

Management of hypertension in light of the new national guidelines.

The JNC-7 treatment recommendations, if followed by a majority of physicians, should help to reduce the number of resistant hypertensive patients in the United States and should result in an improved proportion of patients with controlled blood pressure.

Antihypertensive Agents↗
PubMed2003

Outcomes trials underlying the JNC-7 guidelines.

Guidelines in medicine have become useful instruments to improve outcomes for many diseases. The JNC-7 report puts the available data into perspective and provides suggestions to physicians and health plans for improving treatment. The JNC-7 guidelines are based on sound scientific evidence.

Antihypertensive Agents↗
PubMed2002

Current recommendations for the treatment of hypertension: are they still valid?

Recent trials have helped to clarify indications for the initial pharmacological therapy of hypertension. Both the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) and World Health Organization-international Society of Hypertension (WHO-ISH) recommendations should be revised. The more recent trials indicate that: (1) diuretics and beta-blockers appear to be as effective in reducing overall morbidity/ mortality as other agents (Swedish Trial in Old Patients with Hypertension [STOP-2], United Kingdom Prospective Diabetes Study [UKPDS], Intervention as a Goal in Hypertension Treatment [INSIGHT], Nordic diltiazem [NORDIL]); (2) the use of an a-blocker results in more cardiovascular events, especially congestive heart failure, when compared with a diuretic (Antihypertensive Therapy and Lipid Lowering Heart Attack Trial [ALLHAT]); (3)the use of an angiotensin-converting enzyme (ACE) inhibitor results in fewer myocardial infarctions and episodes of heart failure than calcium channel blockers in the elderly and in diabetic patients (Fosinopril vs. Amlodipine Cardiovascular Events Randomized Trial [FACET], Appropriate Blood Pressure Control in Diabetes [ABCD], STOP-2) - other data (Captopril Prevention Project [CAPPP]) suggest that the use of an ACE inhibitor is preferred in diabetic patients; (4) overall cardiovascular events are similar with calcium channel blockers compared with a diuretic - however, there are fewer strokes with non-dihydropyridine calcium channel blockers (NORDIL) and a trend towards an increase in heart failure and myocardial infarctions with either a dihydropyridine or non-dihydropyridine calcium channel blockers compared with a diuretic (INSIGHT, NORDIL); (5) angiotensin receptor blockers (ARBs) will decrease proteinuria and slow progression of renal disease in type 2 diabetic patients when compared with regimens that do not include an ARB or an ACE inhibitor (Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan [RENAAL], Irbesartan Type II Diabetic Nephropathy Trial [IDNT], Irbesartan Type II Diabetes with Microalbuminuria [IRMA Il]). The debate over initial therapy may be moot. High-risk hypertensive patients should probably be treated initially with combination therapy, one of which should be a diuretic. The use of diuretics and beta-blockers as well as ACE-inhibitors alone or with a diuretic should be considered as initial therapy (a change from JNCVI). Alpha-blockers should be reserved for special situations, i.e. prostatic hypertrophy (in contrast to WHO-ISH recommendations). An ACE-inhibitor or ARB, usually along with a diuretic, can be considered as preferred therapy in hypertensive diabetic patients. Some data suggest equal or greater reduction in strokes with a calcium channel blocker than other medications.

Antihypertensive Agents↗
PubMed2000

The Effects of Candesartan Cilexetil in Isolated Systolic Hypertension: A Clinical Experience Trial.

An 8-week, multicenter, open-label, clinical experience trial evaluated the efficacy of candesartan cilexetil either alone (34%) or as add-on therapy (66%) in 1014 patients with untreated or uncontrolled isolated systolic hypertension defined as systolic blood pressure 140-179 mm Hg/diastolic less than 90 mm Hg. Candesartan cilexetil 16 mg once daily was given initially and was up-titrated to 32 mg once daily at week 2 or week 4 if systolic blood pressure remained at or above 140 mm Hg. Overall, candesartan cilexetil reduced both blood pressures by 16.5Â+/-0.6/4.5Â+/-0.2 mm Hg from 158Â+/-0.4/81Â+/-0.2 to 142Â+/-0.6/76Â+/-9.6 mm Hg with a control rate (systolic blood pressure less than 140 mm Hg) of 49%. Of the 492 (51%) patients remaining on the lower dose of candesartan cilexetil (40% as monotherapy; 60% as add-on), candesartan cilexetil 16 mg reduced blood pressure by 19.7Â+/-1.0/5.5Â+/-0.3 mm Hg and 62% of patients were controlled. For the 475 (49%) patients uncontrolled on candesartan cilexetil 16 mg and titrated to 32 mg (30% as monotherapy, 70% as add-on), the dose increase further reduced blood pressure by 8.9Â+/-0.4/3.8Â+/-0.1 mm Hg at week 8, and 36% of patients not responsive to the lower dose achieved blood pressure control on the higher dose. This dose response from candesartan cilexetil 16 mg to 32 mg was seen across age, sex, and race. Overall, tolerability was well maintained. Most adverse events were relatively infrequent, and only 8% withdrew due to adverse events; the most frequent adverse effects were dizziness (7%), headache (6%), and upper respiratory tract infection (5%). In conclusion, in this clinical experience trial for patients with isolated systolic hypertension, candesartan cilexetil 16 mg to 32 mg once daily produced a dose-related decrease in systolic blood pressure with a lesser decrease in diastolic blood pressure, resulting in a substantial decrease in pulse pressure. The dose response without dose dependent adverse effects was consistent across age, sex, and race, demonstrating that candesartan cilexetil is a therapeutic option for patients with isolated systolic hypertension. (c)2000 by Le Jacq Communications, Inc.

Journal Article↗
PubMed1999

World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension-Do These Differ From the U.S. Recommendations? Which Guidelines Should the Practicing Physician Follow?

The recent World Health Organization-International Society of Hypertension (WHO-ISH) recommendations for the treatment of hypertension are consistent with the guidelines established by the Sixth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) in the U.S. with several exceptions. Both reports define hypertension as a persistent elevation of blood pressure greater than 140/90 mm Hg and advocate the lowering of blood pressure for all patients with cardiovascular (CV) risk factors in addition to hypertension. The WHO-ISH report, however, suggests continuing monitoring without medication for subjects without other risk factors if pressures are not greater than 150/95 mm Hg. The JNC VI recommends drug therapy even in these subjects if blood pressures remain greater than 140/90 mm Hg after a 6-12 month period of nonpharmacologic interventions. Based on available data this would appear to be a more reasonable recommendation. The WHO-ISH indicates that all classes of medication are suitable initial therapy, despite the lack of morbidity and mortality data with several of them. The JNC VI continues to use outcome data to recommend diuretics or à -blockers as initial treatment. The WHO-ISH recommendations may prove to be appropriate-i.e., the lowering of blood pressure makes the difference and not which medication is used-There are some data to support this position but at present the strongest outcome data support the JNC VI recommendations. Both reports stress the importance of lowering blood pressure to levels of 130/85 mm Hg or even lower in patients with diabetes, renal, or heart failure. The addition of the WHO-ISH report should help to focus more clearly the need for better blood pressure control. (c)1999 by Le Jacq Communications, Inc.

Journal Article↗