Abstract:
: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.
journal_name
Am J Hypertensjournal_title
American journal of hypertensionauthors
Alderman MH,Madhavan S,Cohen Hdoi
10.1016/0895-7061(95)00438-6subject
Has Abstractpub_date
1996-05-01 00:00:00pages
413-8issue
5eissn
0895-7061issn
1941-7225pii
0895-7061(95)00438-6journal_volume
9pub_type
临床试验,杂志文章abstract:BACKGROUND:Diabetes mellitus (DM) and hypertension (HT) frequently coexist. Increased central aortic pressures indexes are associated with HT; however, possible associations of these indexes with future development of DM have never been studied in HT. METHODS:We recruited 178 patients with uncomplicated nondiabetic HT...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1038/ajh.2010.145
更新日期:2010-10-01 00:00:00
abstract:BACKGROUND:Liddle's syndrome (LS) is a monogenic form of hypertension simulating a mineralocorticoid excess, and is currently suspected in young hypokalemic hypertensives. The aims of the study were: (i) to evaluate the clinical phenotype of LS in a newly identified Italian family of Sicilian origin carrying a gain-of-...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1038/ajh.2011.76
更新日期:2011-08-01 00:00:00
abstract:BACKGROUND:Pre-eclampsia (PE) is characterized by hypertension and proteinuria, and complicates from 3%-10% of all pregnancies. The hemodynamic pathophysiology of the heart and systemic arteries in pre-eclamptic patients has not been well described. We therefore performed a comprehensive comparison of the systemic arte...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1093/ajh/hps067
更新日期:2013-04-01 00:00:00
abstract::Intranasal administration of some peptides has been shown to directly influence central nervous functions, thus pointing to a nose-brain pathway for these substances in humans. The present study investigated whether intranasal administration of angiotensin II (ANG II) affects central nervous functions of cardiovascula...
journal_title:American journal of hypertension
pub_type: 临床试验,杂志文章
doi:10.1016/s0895-7061(98)00095-8
更新日期:1998-08-01 00:00:00
abstract::The ambulatory blood pressure load is generally defined as the proportion of elevated systolic or diastolic pressures over a 24 h period. This value represents the chronic pressure overload that induces myocardial and vascular damage associated with the hypertensive disease process. Blood pressure load has been define...
journal_title:American journal of hypertension
pub_type: 杂志文章,评审
doi:10.1016/0895-7061(96)87761-2
更新日期:1996-10-01 00:00:00
abstract::To evaluate the existence of a relationship between atrial natriuretic factor (ANF) and plasma Na+/K+ATPase inhibitory activity in humans, we examined the hemodynamic and humoral response to volume expansion in 41 borderline hypertensive patients (BHT) with either normal (n = 33) or low plasma renin activity (n = 8). ...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1093/ajh/4.7.618
更新日期:1991-07-01 00:00:00
abstract:BACKGROUND:Pulse pressure (PP) is an independent predictor of cardiovascular and/or all-cause mortality in patients with underlying cardiovascular disease. We examined whether PP can be used to predict overall mortality in peritoneal dialysis (PD) patients. METHODS:We studied 153 PD patients (mean age, 54.5 +/- 14.2 y...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1038/ajh.2008.286
更新日期:2008-12-01 00:00:00
abstract:BACKGROUND:There is conflicting information with regard to the effect of beta-blockers on arterial stiffness and wave reflection. We compared a vasodilating beta-blocker, nebivolol, with atenolol. METHODS:We randomized 40 subjects with untreated hypertension (mean +/- s.e.m. systolic/diastolic blood pressure (BP) of 1...
journal_title:American journal of hypertension
pub_type: 杂志文章,随机对照试验
doi:10.1038/ajh.2008.156
更新日期:2008-06-01 00:00:00
abstract:BACKGROUND:Ionized magnesium levels are elevated in fetal blood compared with maternal blood, suggesting that the placenta may possess an active transport mechanism for magnesium. In the present study, we sought to determine the existence of an active transport mechanism for magnesium in the placenta using cultured tro...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1016/s0895-7061(02)02272-0
更新日期:2002-06-01 00:00:00
abstract::Cigarette smoking, an established cardiovascular (CV) disease risk factor, is known to impair pulsatile arterial function. However, information is scant in this regard on asymptomatic younger adult former smokers. As part of the Bogalusa Heart Study, the pulsatile arterial function was examined noninvasively in 278 no...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1016/j.amjhyper.2006.02.004
更新日期:2006-09-01 00:00:00
abstract::We compared three drugs representing different classes of antidiabetic pharmacology (glyburide, a sulfonylurea; pioglitazone, a thiazolidinedione; and metformin, a biguanide) in terms of their direct effects on proliferation of cultured arterial smooth muscle cells (SMC). Rat aortic SMC were seeded at 4 x 10(4)/35 mm ...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1016/0895-7061(95)00393-2
更新日期:1996-02-01 00:00:00
abstract:BACKGROUND:Home blood pressure measurement (HBPM) is recommended by hypertension guidelines, particularly in the elderly. However, feasibility of HBPM in this age group has not been fully established. Our objective was therefore to assess HBPM feasibility in elderly individuals of the general population. METHODS:After...
journal_title:American journal of hypertension
pub_type: 杂志文章,多中心研究
doi:10.1038/ajh.2012.121
更新日期:2012-12-01 00:00:00
abstract::Understanding the causes and treatment of chronic hypotension is of benefit to affected patients and may also shed light on the physiology and genetics of mechanisms of blood pressure control. Symptomatic hypotension (almost always with a blood pressure fall greater than or equal to 20/10 mm Hg) may reflect unrecogniz...
journal_title:American journal of hypertension
pub_type: 杂志文章,评审
doi:
更新日期:1992-06-01 00:00:00
abstract:OBJECTIVES:Nighttime blood pressure (BP) has been shown to be superior to daytime BP in predicting hypertension related target organ damage and cardiac mortality. In our Georgia Cardiovascular Twin Study, we showed that apart from the genes that also influence daytime BP, specific genetic determinants explained 44% and...
journal_title:American journal of hypertension
pub_type: 杂志文章,meta分析
doi:10.1093/ajh/hpu162
更新日期:2015-04-01 00:00:00
abstract:BACKGROUND:Hypertension (HTN) is a known major cardiovascular disease risk factor, but prevalence, treatment, and control of HTN among rapidly growing minority groups such as Asian Americans and Hispanics are unknown largely due to either underrepresentation in epidemiologic studies or aggregation of Asian American sub...
journal_title:American journal of hypertension
pub_type: 杂志文章,多中心研究
doi:10.1093/ajh/hpu189
更新日期:2015-05-01 00:00:00
abstract:BACKGROUND:The question of whether reduced sodium intake is effective as a health prophylaxis initiative is unsolved. The purpose was to estimate the effects of low-sodium vs. high-sodium intake on blood pressure (BP), renin, aldosterone, catecholamines, and lipids. METHODS:Studies randomizing persons to low-sodium an...
journal_title:American journal of hypertension
pub_type: 杂志文章,meta分析,评审
doi:10.1038/ajh.2011.210
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND:Vitamin D deficiency in pregnancy has been associated with an increased risk of preeclampsia. However, the association between serum vitamin D and blood pressure in pregnant women has been scarcely evaluated, particularly in women with a high risk of developing hypertensive disorders of pregnancy. We sought ...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1093/ajh/hpu043
更新日期:2014-10-01 00:00:00
abstract::Insulin resistance and hypertension, as well as dyslipidemia, frequently cooccur. Evidence that nitric oxide (NO) plays a crucial role in the long-term regulation of systolic blood pressure led us to examine whether enhanced vasoconstriction and hypertension induced by NO synthase inhibitor could lead to insulin and l...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1016/s0895-7061(98)00089-2
更新日期:1998-09-01 00:00:00
abstract::The aim of this study was to investigate the effects of dietary calcium and sodium on blood pressure (BP) in normotensive rats (Wistar, WKY), spontaneously hypertensive rats (SHR) and Dahl rats and on calmodulin (CaM) activator, a newly-discovered hydrophobic compound that increases CaM activity in SHR and spontaneous...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1093/ajh/3.8.210
更新日期:1990-08-01 00:00:00
abstract:BACKGROUND:There is evidence that diuretics and beta blockers impair glucose tolerance, whereas calcium channel blockers and angiotensin converting enzyme blockers lack this metabolic effect. We compared the effect of a combination therapy with a nondihydropyridine calcium channel blocker plus an angiotensin converting...
journal_title:American journal of hypertension
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1016/s0895-7061(03)00062-1
更新日期:2003-05-01 00:00:00
abstract:BACKGROUND:Left ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular morbidity in hypertension. Current evidence suggests a contribution to LVH of plasma aldosterone levels that are inappropriately elevated for the salt status. The aim of this study was to investigate whether inappropriate mod...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1093/ajh/hpv104
更新日期:2016-03-01 00:00:00
abstract:BACKGROUND:Exaggerated sympathetic cardiovascular (CV) reactivity to stress associates with elevated risk for clinical and preclinical end points of CV disease. It would be useful to identify these individuals, preferably from feasible measurements commonly used in health care. Our study examined the association betwee...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1093/ajh/hpz011
更新日期:2019-05-09 00:00:00
abstract:BACKGROUND:Ryanodine receptor (RyR) dysfunction in skeletal muscle (RyR1) leads to malignant hyperthermia, and in cardiac muscle (RyR2) triggers cardiac arrhythmias. We hypothesized that RyR dysfunction in vascular smooth muscle could increase vascular resistance and hypertension, and may contribute to increased atrial...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1093/ajh/hpaa021
更新日期:2020-04-29 00:00:00
abstract:BACKGROUND:The aim was to determine the proportions and correlates of essential hypertension among children in a tertiary pediatric hypertension clinic. METHODS:We evaluated 423 consecutive children and collected demographic and clinical history by retrospective chart review. RESULTS:We identified 275 (65%) hypertens...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1093/ajh/hpu083
更新日期:2015-01-01 00:00:00
abstract:OBJECTIVE:We tested the hypothesis that repetitive severe hypoxemia resulting from obstructive sleep apnea would increase serum erythropoietin, and that this increase would be attenuated by effective treatment of obstructive sleep apnea. METHODS:We studied healthy untreated patients with obstructive sleep apnea (18 se...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1016/j.amjhyper.2004.04.011
更新日期:2004-09-01 00:00:00
abstract::Stroke-prone spontaneously hypertensive rats (SHRSP), subjected to high NaCl, show severe hypertension, organ damage, and early death. Preventive treatment with angiotensin II type 1 (AT1) receptor antagonists is known to be effective. Previously, we found that angiotensin converting enzyme (ACE) inhibition could redu...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1016/s0895-7061(00)01231-0
更新日期:2001-01-01 00:00:00
abstract:BACKGROUND:Reduced synthesis of nitric oxide (NO) is considered a major proatherogenic mechanism in patients with end-stage renal disease (ESRD), but genetic factors impinging on this mechanism have been little studied in this population. METHODS:We tested the relationship between carotid intima-media thickness (IMT) ...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1016/j.amjhyper.2007.02.009
更新日期:2007-07-01 00:00:00
abstract:BACKGROUND:It is not known whether strict control of blood pressure (BP) in mild post-transplant hypertension gives any benefit. Our primary objective was to test the antihypertensive effects of lisinopril added to standard therapy on ambulatory BP (ABP) of post-transplant patients. The secondary objective was to monit...
journal_title:American journal of hypertension
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0895-7061(02)02992-8
更新日期:2002-10-01 00:00:00
abstract::It is known that calcium induces the formation of potent vasodilators in endothelial cells and vasoconstriction in smooth muscle cells, whereas in the renal parenchyma, it modulates sodium excretion through vascular and tubular mechanisms. Consequently, an increased concentration of calcium in renal circulation may in...
journal_title:American journal of hypertension
pub_type: 杂志文章,评审
doi:10.1093/ajh/4.7.473s
更新日期:1991-07-01 00:00:00
abstract::The role of renal sympathetic nerve activity (RSNA) in the maintenance phase of essential hypertension has not yet been clearly defined. Renal function and mean arterial pressure (MAP) were studied in four Yucatan miniature swine (YMS) with established DOCA hypertension prior to and for 3 weeks after surgical renal de...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1093/ajh/3.1.62
更新日期:1990-01-01 00:00:00