Metabolic considerations in the choice of therapy for the patient with hypertension.


:The objective of treating patients with hypertension is not simply to reduce blood pressure but rather to prevent the associated morbidity and mortality. Recent assessments of clinical trials have shown that while the risk of stroke is consistently lower with antihypertensive therapy, the same degree of success has not been demonstrated for coronary artery disease (CAD). Although there are many explanations of why we have not done as well in preventing CAD, one possibility is that the therapy used in clinical trials, primarily thiazide diuretics and beta-adrenoreceptor blockers, has increased the patient's risk of developing coronary atherosclerosis or lethal arrhythmias. Four classes of antihypertensive agents are recommended for initial therapy--thiazide diuretics, beta-adrenoreceptor blockers, angiotensin-converting enzyme (ACE) inhibitors, and calcium entry blockers. The metabolic effects of thiazide diuretics include electrolyte disturbances (hypokalemia, hypomagnesemia, and hyponatremia), dyslipidemia (increased triglycerides), abnormalities of glucose metabolism (hyperglycemia, hyperinsulinemia, and peripheral insulin resistance), and hyperuricemia. beta-Adrenoreceptor blockers have many of the same metabolic adverse reactions. beta-Adrenoreceptor blockers without intrinsic sympathomimetic activity (ISA) also cause dyslipidemias (lowered high-density lipoprotein cholesterol and increased triglycerides) and abnormalities of glucose metabolism (hyperglycemia, hyperinsulinemia, and peripheral insulin resistance). beta-Adrenoreceptor blockers with ISA and third-generation beta-blockers with selective partial agonist activity (celiprolol and dilevalol) do not cause dyslipidemia and to date do not appear to induce abnormalities in glucose metabolism. ACE inhibitors may decrease triglycerides and increase high-density lipoprotein cholesterol, and captopril may improve insulin sensitivity. Calcium entry blockers are metabolically neutral.(ABSTRACT TRUNCATED AT 250 WORDS)


Am Heart J


American heart journal


Black HR




Has Abstract


1991-02-01 00:00:00




2 Pt 2










  • Rationale and design of a randomized controlled trial of pneumococcal polysaccharide vaccine for prevention of cardiovascular events: The Australian Study for the Prevention through Immunization of Cardiovascular Events (AUSPICE).

    abstract:BACKGROUND:Research has shown that vaccination with Streptococcus pneumoniae reduced the extent of atherosclerosis in experimental animal models. It is thought that phosphorylcholine lipid antigens in the S. pneumoniae cell wall induce the production of antibodies that cross-react with oxidized low-density lipoprotein,...

    journal_title:American heart journal

    pub_type: 杂志文章,多中心研究,随机对照试验


    authors: Ren S,Hure A,Peel R,D'Este C,Abhayaratna W,Tonkin A,Hopper I,Thrift AG,Levi C,Sturm J,Durrheim D,Hung J,Briffa T,Chew DP,Anderson P,Moon L,McEvoy M,Hansbro P,Newby D,Attia J,AUSPICE study group.

    更新日期:2016-07-01 00:00:00

  • Trial design: Rivaroxaban for the prevention of major cardiovascular events after transcatheter aortic valve replacement: Rationale and design of the GALILEO study.

    abstract:BACKGROUND:Optimal antithrombotic treatment after transcatheter aortic valve replacement (TAVR) is unknown and determined empirically. The direct factor Xa inhibitor rivaroxaban may potentially reduce TAVR-related thrombotic complications and premature valve failure. DESIGN:GALILEO is an international, randomized, ope...

    journal_title:American heart journal

    pub_type: 杂志文章,多中心研究,随机对照试验


    authors: Windecker S,Tijssen J,Giustino G,Guimarães AH,Mehran R,Valgimigli M,Vranckx P,Welsh RC,Baber U,van Es GA,Wildgoose P,Volkl AA,Zazula A,Thomitzek K,Hemmrich M,Dangas GD

    更新日期:2017-02-01 00:00:00

  • Serial plasma catecholamine response early in the course of clinical acute myocardial infarction: relationship to infarct extent and mortality.

    abstract::Clinical and experimental evidence suggest that sympathoadrenal activation contributes to mortality in patients with ischemic heart disease. To determine the level of sympathoadrenal activation in the very early phase of acute myocardial infarction (AMI) and to determine if location of infarction (anterior versus infe...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Karlsberg RP,Cryer PE,Roberts R

    更新日期:1981-07-01 00:00:00

  • Expanding the outcomes in clinical trials of heart failure: the quality of life and economic components of EPHESUS (EPlerenone's neuroHormonal Efficacy and SUrvival Study).

    abstract:BACKGROUND:Although quantification of the impact of treatment on survival remains the cornerstone of clinical research, the assessment of a broader range of disease outcomes is growing increasingly important. This manuscript provides an overview of the considerations made regarding quantification of a range of clinical...

    journal_title:American heart journal

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验


    authors: Spertus JA,Tooley J,Jones P,Poston C,Mahoney E,Deedwania P,Hurley S,Pitt B,Weintraub WS

    更新日期:2002-04-01 00:00:00

  • Factors associated with development of atrial septal restriction in patients with tricuspid atresia involving the right-sided atrioventricular valve.

    abstract:BACKGROUND:Clinical practice is discrepant regarding routine enlargement of the interatrial communication (IAC) in patients with right-sided atrioventricular valve atresia. We determined the percentage and risk factors of those who develop a restrictive IAC. METHODS:Medical records were reviewed for patients treated f...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Tzifa A,Gauvreau K,Geggel RL

    更新日期:2007-12-01 00:00:00

  • Cigarette smoking and coronary heart disease in blacks: comparison to whites in a prospective study.

    abstract::The American Cancer Society's prospective study of 1 million Americans was analyzed to determine whether coronary heart disease (CHD) mortality rates by cigarette smoking in blacks differed from those in whites. More than 22,000 blacks were followed up for nearly 200,000 person-years in the 12-year study, 1960-1972. A...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Garfinkel L

    更新日期:1984-09-01 00:00:00

  • Vasodilatation with felodipine in chronic asymptomatic aortic regurgitation.

    abstract:BACKGROUND:Afterload reduction decreases volume overload on the left ventricle and may thereby delay the need for valve replacement in chronic asymptomatic aortic regurgitation. The aims of this randomized double-blind, placebo-controlled trial were to examine short- and long-term hemodynamic effects of felodipine in c...

    journal_title:American heart journal

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Søndergaard L,Aldershvile J,Hildebrandt P,Kelbaek H,Ståhlberg F,Thomsen C

    更新日期:2000-04-01 00:00:00

  • Cost-effectiveness of beta-blocker therapy with metoprolol or with carvedilol for treatment of heart failure in Canada.

    abstract:OBJECTIVE:The purpose of this study was to estimate the cost-effectiveness of beta-blocker therapy with either metoprolol or carvedilol in addition to conventional therapy for patients with heart failure (HF) in Canada. DESIGN:A Markov simulation was used to estimate the costs and life expectancy for treating patients...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Levy AR,Briggs AH,Demers C,O'Brien BJ

    更新日期:2001-09-01 00:00:00

  • Effect of vesnarinone on cardiac function in patients with severe congestive heart failure.

    abstract:BACKGROUND:Vesnarinone has yielded controversial results on morbidity in patients with congestive heart failure. We tested the hypothesis that vesnarinone may have a beneficial effect on cardiac remodeling and function. METHODS:Thirty-four patients with left ventricular ejection fraction (LVEF) <30% (17 treated with v...

    journal_title:American heart journal

    pub_type: 临床试验,杂志文章


    authors: Scherrer-Crosbie M,Cocca-Spofford D,DiSalvo TG,Semigran MJ,Dec GW,Picard MH

    更新日期:1998-11-01 00:00:00

  • Prospective evaluation of parenteral magnesium sulfate in the treatment of patients with reentrant AV supraventricular tachycardia.

    abstract::This study prospectively assessed the electrophysiologic effects of parenteral magnesium sulfate administration on paroxysmal atrioventricular (AV) reentrant supraventricular tachycardia and the efficacy of magnesium to terminate these arrhythmias. Eleven normomagnesemic patients, seven with orthodromic reentrant supr...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Sager PT,Widerhorn J,Petersen R,Leon C,Ryzen E,Rude R,Rahimtoola SH,Bhandari AK

    更新日期:1990-02-01 00:00:00

  • Circadian variation and triggering of acute coronary events.

    abstract::The recognition that the onset of cardiovascular events follows a circadian periodicity and is frequently triggered by physical or mental stresses has created new possibilities for disease prevention. Morning peaks in occurrence are now well-documented for acute myocardial infarction, sudden cardiac death, transient m...

    journal_title:American heart journal

    pub_type: 杂志文章,评审


    authors: Muller JE

    更新日期:1999-04-01 00:00:00

  • Managing hypertension in urban underserved subjects using telemedicine--a clinical trial.

    abstract:BACKGROUND:We evaluated an Internet- and telephone-based telemedicine system for reducing blood pressure (BP) in underserved subjects with hypertension. METHODS:A total of 241 patients with systolic BP ≥140 mm Hg were randomized to usual care (C; n = 121) or telemedicine (T; n = 120). The T group reported BP, heart ra...

    journal_title:American heart journal

    pub_type: 杂志文章,随机对照试验


    authors: Bove AA,Homko CJ,Santamore WP,Kashem M,Kerper M,Elliott DJ

    更新日期:2013-04-01 00:00:00

  • Integrative noetic therapies as adjuncts to percutaneous intervention during unstable coronary syndromes: Monitoring and Actualization of Noetic Training (MANTRA) feasibility pilot.

    abstract:BACKGROUND:Patients undergoing percutaneous coronary intervention (PCI) for unstable coronary syndromes have substantial emotional and spiritual distress that may promote procedural complications. Noetic (nonpharmacologic) therapies may reduce anxiety, pain and distress, enhance the efficacy of pharmacologic agents, or...

    journal_title:American heart journal

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Krucoff MW,Crater SW,Green CL,Maas AC,Seskevich JE,Lane JD,Loeffler KA,Morris K,Bashore TM,Koenig HG

    更新日期:2001-11-01 00:00:00

  • Percutaneous transluminal coronary angioplasty in acute myocardial infarction.

    abstract::Percutaneous transluminal coronary angioplasty (PTCA) has, in general, been restricted to therapy for patients with angina pectoris. Thrombolytic therapy and guide wire recanalization have been used to recanalize coronary arteries in patients with evolving myocardial infarction. Recently we and others have examined th...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Pepine CJ,Prida X,Hill JA,Feldman RL,Conti CR

    更新日期:1984-04-01 00:00:00

  • Incidence and clinical relevance of supraventricular tachyarrhythmias in pulmonary hypertension.

    abstract:BACKGROUND:In patients with severe pulmonary hypertension (PH), right ventricular function is a main determinant of clinical stability and outcome. Supraventricular tachyarrhythmias (SVTs) may compromise cardiac function and threaten prognosis in patients with PH, but the incidence and clinical relevance of SVTs in PH ...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Tongers J,Schwerdtfeger B,Klein G,Kempf T,Schaefer A,Knapp JM,Niehaus M,Korte T,Hoeper MM

    更新日期:2007-01-01 00:00:00

  • Accuracy of three-dimensional echocardiography with unrestricted selection of imaging planes for measurement of left ventricular volumes and ejection fraction.

    abstract:BACKGROUND:Accurate, reproducible, noninvasive determination of left ventricular (LV) volumes and ejection fraction (EF) is important for clinical assessment, risk stratification, selection of therapy, and serial monitoring of patients with cardiovascular disease. Three-dimensional echocardiography (3DE) approaches hav...

    journal_title:American heart journal

    pub_type: 临床试验,杂志文章


    authors: Hibberd MG,Chuang ML,Beaudin RA,Riley MF,Mooney MG,Fearnside JT,Manning WJ,Douglas PS

    更新日期:2000-09-01 00:00:00

  • The Romhilt-Estes left ventricular hypertrophy score and its components predict all-cause mortality in the general population.

    abstract:BACKGROUND:The same electrocardiographic (ECG) criteria that have been used for detection of left ventricular hypertrophy (LVH) have recently been recognized as predictors of adverse clinical outcomes, but this predictive ability is inadequately explored and understood. METHODS:A total of 14,984 participants from the ...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Estes EH,Zhang ZM,Li Y,Tereschenko LG,Soliman EZ

    更新日期:2015-07-01 00:00:00

  • Vitamin D deficiency and coronary artery disease: a review of the evidence.

    abstract::Coronary artery disease remains the leading cause of death in developed countries despite significant progress in primary prevention and treatment strategies. Older patients are at particularly high risk of poor outcomes following acute coronary syndrome and impaired nutrition, including low vitamin D levels, may play...

    journal_title:American heart journal

    pub_type: 杂志文章,评审


    authors: Kunadian V,Ford GA,Bawamia B,Qiu W,Manson JE

    更新日期:2014-03-01 00:00:00

  • Value of color Doppler estimation of regurgitant volume in patients with chronic aortic insufficiency.

    abstract::We studied 16 patients with chronic aortic insufficiency to compare a method for measuring regurgitant volume with color Doppler flow mapping to stroke count ratio determined by radionuclide ventriculography and to ventricular volumes assessed by two-dimensional echocardiography. A real-time color flow map of the left...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Bouchard A,Yock P,Schiller NB,Blumlein S,Botvinick EH,Greenberg B,Cheitlin M,Massie BM

    更新日期:1989-05-01 00:00:00

  • Significance of hypotension preceding fatal ventricular tachyarrhythmias in post-coronary obstruction sudden death.

    abstract::While sudden death after acute myocardial infarction or ischemia most commonly occurs in the first few minutes, usually from tachyarrhythmias, little is known of associated hemodynamics. We monitored hemodynamics for 15 minutes following coronary embolization with mercury in 31 awake dogs. In 17 nonsurvivors, mean art...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Franciosa JA,Heckel R

    更新日期:1981-04-01 00:00:00

  • Danish multicenter randomized study on fibrinolytic therapy versus acute coronary angioplasty in acute myocardial infarction: rationale and design of the DANish trial in Acute Myocardial Infarction-2 (DANAMI-2).

    abstract:BACKGROUND:Randomized trials have indicated that primary coronary angioplasty performed in patients admitted directly to highly-experienced angioplasty centers offers certain advantages over intravenous fibrinolytic therapy. However, the large majority of patients with acute myocardial infarction are submitted to hospi...

    journal_title:American heart journal

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验


    authors: Andersen HR,Nielsen TT,Vesterlund T,Grande P,Abildgaard U,Thayssen P,Pedersen F,Mortensen LS,DANAMI-2 Investigators.

    更新日期:2003-08-01 00:00:00

  • Myocardial infarct size reduction by the synergistic effect of hyperbaric oxygen and recombinant tissue plasminogen activator.

    abstract::Fasting mongrel dogs underwent hyperbaric oxygen treatment (HBOT), recombinant tissue plasminogen activator (rt-PA) treatment, and simultaneous HBOT and rt-PA treatment following prior experimental left anterior descending coronary artery occlusion for 2 hours. Thrombosis in and around a copper coil was recorded angio...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Thomas MP,Brown LA,Sponseller DR,Williamson SE,Diaz JA,Guyton DP

    更新日期:1990-10-01 00:00:00

  • Endothelin and von Willebrand factor as parameters of endothelial function in idiopathic dilated cardiomyopathy: different stimuli for release before and after heart transplantation?

    abstract:BACKGROUND:Congestive heart failure (CHF) and heart transplantation (HTX) are characterized by endothelial dysfunction as indicated by elevation of markers of endothelial function, including endothelin and von Willebrand factor (vWF). However, previous studies included both patients with idiopathic dilated cardiomyopat...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Galatius S,Wroblewski H,Sørensen VB,Bie P,Parving HH,Kastrup J

    更新日期:1999-03-01 00:00:00

  • C-Reactive protein and coronary artery disease: additional evidence of the implication of an inflammatory process in acute coronary syndromes.

    abstract:BACKGROUND:Inflammation might promote the development of atherosclerosis, and high levels of C-reactive protein (CRP) and fibrinogen are associated with an increased risk of acute coronary events. OBJECTIVE:We assessed the levels of CRP and other risk factors in patients with angiographically documented coronary arter...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Abdelmouttaleb I,Danchin N,Ilardo C,Aimone-Gastin I,Angioï M,Lozniewski A,Loubinoux J,Le Faou A,Guéant JL

    更新日期:1999-02-01 00:00:00

  • Open clinical studies at a referral center: chronic maintenance tocainide therapy in patients with recurrent sustained ventricular tachycardia refractory to conventional antiarrhythmic agents.

    abstract::Chronic maintenance tocainide therapy was effective in controlling symptomatic, recurrent ventricular tachycardia in 11 of 15 patients. Patients were selected for tocainide therapy on the basis of refractoriness to conventional antiarrhythmic agents and responsiveness to the intravenous administration of lidocaine. Si...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Maloney JD,Nissen RG,McColgan JM

    更新日期:1980-12-01 00:00:00

  • Chronic obstructive pulmonary disease in heart failure. Prevalence, therapeutic and prognostic implications.

    abstract:BACKGROUND:Patients with heart failure (HF) frequently have comorbidities. Frequency, prognostic, and therapeutic implications of chronic obstructive pulmonary disease (COPD) in HF are largely unknown. We aimed to assess the prevalence and prognostic implications of COPD in a sample of stable patients with HF and to de...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Mascarenhas J,Lourenço P,Lopes R,Azevedo A,Bettencourt P

    更新日期:2008-03-01 00:00:00

  • Unsuccessful reperfusion in patients with ST-segment elevation myocardial infarction treated by primary angioplasty.

    abstract:BACKGROUND:Several studies have shown that patency of the epicardial vessel does not guarantee optimal myocardial perfusion in patients undergoing primary angioplasty for ST-segment elevation myocardial infarction (STEMI). The aim of the current study was to identify clinical and angiographic correlates of unsuccessful...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: De Luca G,van 't Hof AW,Ottervanger JP,Hoorntje JC,Gosselink AT,Dambrink JH,Zijlstra F,de Boer MJ,Suryapranata H

    更新日期:2005-09-01 00:00:00

  • Association between a healthy cardiovascular risk factor profile and coronary artery calcium score: Results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

    abstract:BACKGROUND:Our goal was to evaluate cross-sectionally the association between ideal risk factor (IRF) profile and the presence and severity of subclinical atherosclerosis measured as coronary artery calcium (CAC) in the Brazilian Longitudinal Study of Adult Health. METHODS:We included 4,077 participants with no prior ...

    journal_title:American heart journal

    pub_type: 杂志文章,多中心研究


    authors: Bensenor IM,Goulart AC,Santos IS,Bittencourt MS,Pereira AC,Santos RD,Nasir K,Blankstein R,Lotufo PA

    更新日期:2016-04-01 00:00:00

  • Cardiac rehabilitation participation predicts lower rehospitalization costs.

    abstract::The effect of participation in cardiac rehabilitation on medical costs was determined by measuring hospitalization charges for cardiac admissions over a 3-year period in 580 post-coronary event patients (58% after coronary bypass surgery, 42% after myocardial infarction), of whom 230 entered a cardiac rehabilitation p...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Ades PA,Huang D,Weaver SO

    更新日期:1992-04-01 00:00:00

  • Prevalence of congenital heart disease.

    abstract:BACKGROUND:Today most patients with congenital heart disease survive childhood to be cared for by adult cardiologists. The number of physicians that should be trained to manage these lesions is unknown because we do not know the number of patients. METHODS:To answer this question, the expected numbers of infants with ...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Hoffman JI,Kaplan S,Liberthson RR

    更新日期:2004-03-01 00:00:00