Hypertension at the threshold of the year 2000: classification, treatment, prevention

Despite the clear benefits of treating established hypertension, this approach alone will not prevent all of the blood pressure-related cardiovascular-renal disease in the community. Primary prevention of hypertension is a natural extension of hypertension treatment which provides opportunity to reduce costly cycle of managing hypertension and its complications. The purpose of this report is to guide practician physicians and health professionals in their care of hypertensive patients. In order to provide specific guidelines, a new classification schema of high blood pressure that includes systolic as well diastolic levels is proposed (source, Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure 1993). Furthermore, recommendations for follow-up based on initial set of blood pressure measurements, life-style modifications and pharmacologic therapy are proposed, suggesting a new treatment algorithm in which diuretics and beta-blockers are preferred as first-choice agents because their confirmed reduction in morbidity and mortality (unless they are contraindicated or unacceptable), but including an expanded list of agents that are suitable for initial monotherapy and guidelines for selecting and individualizing the antihypertensive drug regimen.     

A survey of management practices for isolated systolic hypertension

OBJECTIVE: To determine the management practices of clinicians for patients with isolated systolic hypertension, with particular attention to treatment thresholds, medication choices, and target blood pressures. DESIGN: Self-administered questionnaire. SETTING: Edmonton, Alberta, a large Canadian city. PARTICIPANTS: A random sample of 348 family physicians and 125 internists. MEASUREMENTS: Demographics of the respondents, first and second choice of antihypertensives, treatment thresholds, and target blood pressures for patients with isolated systolic hypertension. RESULTS: Excluding 54 nondeliverable questionnaires, a response rate of 67% (281 surveys) was obtained. The responding clinicians reported treatment thresholds and target blood pressures consistent with the evidence from randomized clinical trials and the recommendations of the Canadian Hypertension Society and the Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Thiazide diuretics were recommended as first line therapy by 74% of internists and 58% of family physicians. Angiotensin converting enzyme inhibitors were the most frequently chosen second line drug (27% of internists and 45% of family physicians). CONCLUSIONS: The reported management practices of this group of clinicians are consistent with the evidence from randomized clinical trials and the recommendations of national consensus guidelines.     

Pleasure or frustration? Satisfaction of nursing students with the choice of their profession at the end of their second school year

Patient education has always been an integral part of quality patient care. Effective patient education is a necessary component of patient satisfaction and has proven instrumental in decreasing hospital days while improving clinical outcomes. Joint Commission and state public health departments regard patient education as one of many organizational performance standards. To be effective, health education must be coordinated among all disciplines involved in the continuum of care. The Patient Family Educational Advisory Committee (PFEAC) directed its efforts in identifying common patient education issues. The committee's initial work focused on areas dealing with culture, documentation and competency.     

Who needs an immunization in a pediatric subspecialty clinic?

BACKGROUND: The Standards for Pediatric Immunization Practices recommends that subspecialty clinics screen children's immunization status and ensure the receipt of needed immunizations. OBJECTIVES: To determine the proportion of children presenting to a pediatric subspecialty clinic in whom immunization status can be assessed, and which of those assessed are due an immunization (eligible to receive an immunization on the day of clinic visit). DESIGN: Standardized survey of 196 patients or accompanying children presenting to a pediatric cardiology clinic. Need for immunizations was determined by the Advisory Committee on Immunization Practices recommendations. RESULTS: The reason for visit included 58% return (enrolled in the clinic), 25% initial, and 17% accompanying another patient. Usual immunization provider included 51% health department, 42% primary care physician, and 7% military. We could assess the immunization status of 79 (40%) of 196, and 19 (24%) of these 79 were due an immunization. Logistic regression analysis revealed that children enrolled in the clinic were more likely to be due for immunization than those presenting for initial visits (38% vs 8%; adjusted odds ratio, 7.42; 95% confidence interval, 1.43 to 38.55). CONCLUSIONS: We could not assess the immunization status of most children presenting to this pediatric clinic. Patients enrolled in the clinic were at increased risk for being due immunization. Having a primary care physician as a provider of immunizations did not ensure the receipt of immunizations. Pediatric subspecialists should assess the immunization status of their patients and make sure that they receive needed immunizations.     

Annual Reports.

Presents the Annual Reports of the Canadian Psychological Association. Annual Reports for the following include: Report of the Election Committee; Editor's Annual Report--Volume X--1969; Canadian Journal of Psychology Editor's Annual Report for 1969, Volume 23; Canadian Journal of Behavioural Science Annual Report from May 1969-May 1970; Advisory Committee on Aging Annual Report 1969-1970; and the Report of the Advisor in Criminology to the Board of Directors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rapports Annuels.

Presents the Annual Reports of the Canadian Psychological Association. Annual Reports for the following include: Report of the Election Committee; Editor's Annual Report--Volume X--1969; Canadian Journal of Psychology Editor's Annual Report for 1969, Volume 23; Canadian Journal of Behavioural Science Annual Report from May 1969-May 1970; Advisory Committee on Aging Annual Report 1969-1970; and the Report of the Advisor in Criminology to the Board of Directors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Melanoma-specific cytotoxicity induced by a tyrosinase promoter-enhancer/herpes simplex virus thymidine kinase adenovirus

BACKGROUND: High blood pressure is a major risk factor for coronary artery disease, kidney disease, and stroke. More people are aware of treating and controlling their blood pressure, but overall control rates are low and the incidence of hypertension-related morbidity and mortality remains high. METHODS: The National Heart, Lung, and Blood Institute released The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) as the most recent national guideline to hypertension control for primary care clinicians. RESULTS: JNC VI identifies 10 hypertension-related public health challenges: (1) prevent the rise of blood pressure; (2) decrease prevalence of hypertension; (3) increase awareness and detection of hypertension; (4) improve control of hypertension; (5) reduce cardiovascular risks; (6) increase recognition of importance of isolated systolic hypertension; (7) improve recognition of importance of high-normal blood pressure; (8) reduce ethnic, socioeconomic, and regional variations; (9) improve treatment; and (10) enhance community programs. CONCLUSIONS: The eye is a target organ and retinopathy is a frequent complication--as well as a prognostic indicator--of sustained hypertension. As part of a multidisciplinary team approach, the optometrist assumes a significant role in the prevention, detection, evaluation, and treatment of high blood pressure and its associated morbidities.     

Alpha brainwave training and perception of time passing: preliminary findings

The costs of treating hypertension are out of control. The Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure and others recommend the use of diuretics and beta-blockers as first-line agents. Newer drugs such as calcium channel blockers, alpha-blockers, and angiotensin-converting-enzyme inhibitors have improved metabolic profiles, but have not been proved in long-term, randomized, controlled trials to reduce morbidity and mortality. Our General Medicine Clinic has gradually shifted toward prescribing the newer agents. We reviewed our drug use, evaluated the literature, and made recommendations in the form of guidelines. Clinicians' concerns included quality-of-life issues, sexual dysfunction, metabolic changes--lipids, potassium, insulin resistance--and others. These concerns were addressed, and a consensus was reached. Our goal is to streamline therapy, reduce costs, and provide proven effective medication.     

Patient-centered culturally sensitive health care: Model testing and refinement.

Objectives: This article presents the results of an empirical test of a literature-based Patient-Centered Culturally Sensitive Health Care Model. The model was developed to explain and improve health care for ethnically diverse patients seen in community-based primary care clinics. Design: Samples of predominantly low-income African American (n = 110) and non-Hispanic White American (n = 119) patients were recruited to complete questionnaires about their perceived health care provider cultural sensitivity and adherence to their provider's treatment regimen recommendations. Main Outcome Measures: Patients completed written measures of their perceived provider cultural sensitivity, trust in provider, interpersonal control, satisfaction with their health care provider, physical stress, and adherence to provider-recommended treatment regimen variables (i.e., engagement in a health promoting lifestyle, and dietary and medication adherence). Results: Two-group path analyses revealed significant links between patient-perceived provider cultural sensitivity and adherence to provider treatment regimen recommendations, with some differences in associations emerging by race/ethnicity. Conclusion: The findings provide empirical support for the potential usefulness of the Patient-Centered Culturally Sensitive Health Care Model for explaining the linkage between the provision of patient-centered, culturally sensitive health care, and the health behaviors and outcomes of patients who experience such care. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Antihypertensive drug therapy and coronary heart disease risk

Coronary heart disease (CHD) is the major cause of death in the United States. Major modifiable risk factors for CHD are hypertension, hypercholesterolemia, and cigarette smoking, with concomitant risk factors, especially left ventricular hypertrophy, that act synergistically to significantly increase overall risk. Antihypertensive therapy, while reducing the incidence of stroke, has not consistently reduced the incidence of CHD. This may be a result, in part, of adverse effects on the metabolic profile, especially on blood lipids, which are induced by diuretics and certain beta-blockers. Other antihypertensive agents appear to be either lipid neutral, such as calcium channel blockers and angiotensin-converting enzyme inhibitors, or lipid positive, such as selective alpha 1-blockers. The choice of initial antihypertensive therapy should be made with all of a patient's risk factors in mind. In addition to the drugs recommended in the 1988 Guidelines of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure, selective alpha 1-blockers should also be considered since they improve the lipid profile as well as reduce blood pressure.     

Differences in treatment of ischemic heart disease at a public and a voluntary hospital: sources and consequences

A study of hospital patients with ischemic heart disease reports that patients in a public hospital received fewer needed diagnostic tests, surgeries, and follow-up visits for their conditions than their private hospital counterparts. Factors in the hospitals' organizational environments and the patients' social backgrounds were observed to have an impact on content of treatment and to affect patient as well as provider perspectives on the quality of care. To facilitate the analysis, data were collected from four sources: direct observation of the care of each patient on rounds and at the bedside; interviews with physicians concerning the rationale for their decisions; a process-oriented chart audit assessing the appropriateness of care; and an extensive home interview with each patient three months following hospital discharge to establish further use of health services, health status, and satisfaction with care.     

Testicular toxicity of allyl chloride

This study deals with the review of the literature regarding the indirect blood pressure measurement in normal pregnant women. It shows the changes that happened with the blood pressure due to pregnancy. Polemical aspects in the procedure of blood pressure measurement are discussed; for example, which one of the Korotkoff phases (4 or 5) that better represent the diastolic blood pressure and the use of Ambulatory Blood Pressure Monitoring in pregnancy. The recommendations from different societies are emphasized (American Heart Association, British Hypertension Society, Australasian Society, National High Blood Pressure Education Program and World Health Organization).     

Public sector psychology in the wake of the 2005 White House Conference on Aging.

The 2005 White House Conference on Aging provides a vantage point for discussion of important public sector topics related to aging. The article points out important implications for psychologists and other health care professionals in the area of aging. After reviewing the resolutions passed by the White House Conference, there is a focus on the geriatric workforce which notes the under supply of psychologists who provide services to older adults. The efforts of professional associations are detailed with emphasis on the American Psychological Association and its collaborative efforts with the American Bar Association. These efforts deal with providing more information for lawyers and judges who deal with the topic of diminished capacity. A case example is provided to elucidate some of the important issues. The article continues with a discussion of the needs of older Veterans, the work of the Veteran's Health Administration and the recommendations by the Geriatric and Gerontology Advisory Committee. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Benefits of comprehensive health care for improving health outcomes in women.

The American Psychological Association Health Care for the Whole Person Task Force was formulated to provide a rationale for integrating behavioral health services in primary care. Collectively, the task force called for a transformation of the biomedical system into one based on the biopsychosocial model. This article is a summary of the Women's Health Committee position paper that reviewed contextual factors in women's health, provided recommendations for clinical service action, and recommended an integrated primary health care system to address women's health needs. This article provides a vision of integrated care and a practical guide for psychology practitioners as they collaborate with other health care providers and health policy groups to improve health outcomes for women over the life course. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Why are physicians not prescribing diuretics more frequently in the management of hypertension?

Diuretics have again been recommended by the Sixth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) as one of the first-choice medications in the management of hypertension. This recommendation is based on the results of numerous randomized, diuretic-based, long-term controlled clinical trials that have demonstrated a reduction in both cerebrovascular and cardiovascular morbidity. Despite this and other national recommendations, the use of diuretics has steadily decreased over the past 15 years. Reasons include heavy promotion of other medications and the perception that diuretics produce adverse metabolic effects and do not reduce coronary heart disease events. Data, however, indicate that (1) changes in glucose and cholesterol metabolism are minor, especially with the smaller doses now being used; (2) cardiovascular morbidity and mortality have been reduced in hypertensive patients, even in those with hyperlipidemia or diabetes, when diuretics are used; and (3) concerns about hypokalemia-induced arrhythmias have been overstated. While special indications exist for other medications in the treatment of hypertension, for example, use of an angiotensin-converting enzyme inhibitor (usually in addition to a diuretic) for a patient with heart failure or diabetic nephropathy, most patients, including those with hyperlipidemia or glucose intolerance, can be effectively treated with a diuretic as initial therapy or as part of a combination regimen. Diuretics should be used more not less frequently; use of diuretics would reduce the number of resistant hypertensive patients.     

International trends in influenza control: preparing for the next pandemic and vaccination

The prevention of influenza continues to be a major public health concern, and a program of vaccination has been promoted, especially to high-risk individuals such as the elderly. In addition, concerted efforts are being expended in many developed countries in order to better cope with the next influenza pandemic. These efforts include enhancing influenza virus surveillance, improving vaccine production and its delivery systems, centralizing vaccine distribution and establishing priorities, etc. In Japan, on the other hand, influenza is only considered a minor illness, and thus little attention has been give to measures against influenza. To disseminate information on recent international trends in influenza control to Japanese public health specialists, I herein outline the recommendations made at two recent international meetings: "Pandemic Influenza: Confronting a Reemergent Threat" held in the u.s., at Bethesda, Maryland, in December 1995; and "The 7th European Meeting of Influenza and Its Prevention" held in Berlin. Germany, in September 1993. Since a routine system capable of responding adequately to annual epidemics is considered to be the best defense against a pandemic, I also describe the present state of influenza control in other countries to contrast it with that in Japan: the target groups for special vaccination programs recommended by the U.S. Advisory Committee on Immunization Practices; the recommendations for influenza vaccination and reimbursement for the vaccination of recommended groups in developed countries: and influenza vaccine distribution in Japan and the U.S., 1980-1994. At present in Japan, the efficacy of the currently used inactivated vaccine is regarded as either very low or none at all. There is also no official national recommendations as to what groups should be targeted for active immunization, nor any system for vaccination reimbursement. Public health specialists in Japan, therefore need to fully understand Japan's peculiar situation and, as a result, better recognize the importance of influenza and its prevention.     

Tertiary structural changes and iron release from human serum transferrin

Guidelines for clinical practice are intended to suggest preferable approaches to particular medical problems as established by interpretation and collation of scientifically valid research, derived from extensive review of published literature. When data are not available that will withstand objective scrutiny, a recommendation may be made based on a consensus of experts. Guidelines are intended to apply to the clinical situation for all physicians without regard to specialty. Guidelines are intended to be flexible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care that are inflexible and rarely violated. Given the wide range of choices in any health care problem, the physician should select the course best suited to the individual patient and the clinical situation presented. These guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee. These guidelines are also approved by the governing boards of American College of Gastroenterology and Practice Parameters Committee. Expert opinion is solicited from the outset for the document. Guidelines are reviewed in depth by the committee, with participation from experienced clinicians and others in related fields. The final recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientific developments at a later time. The following guidelines are intended for adults and not for pediatric patients.     

Guidelines on acute infectious diarrhea in adults. The Practice Parameters Committee of the American College of Gastroenterology

Guidelines for clinical practice are intended to suggest preferable approaches to particular medical problems as established by the interpretation and collation of scientifically valid research, derived from an extensive review of published literature. When data are not available that will withstand objective scrutiny, a recommendation may be made based on a consensus of experts. Guidelines are intended to apply to the clinical situation for all physicians without regard to specialty. Guidelines are intended to be flexible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care that are inflexible and rarely violated. Given the wide range of choices in any health care problem, the physician should select the course best suited to the individual patient and the clinical situation presented. These guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee. These guidelines are also approved by the governing boards of the American Gastroenterology Association and the American Society of Gastrointestinal Endoscopy. Expert opinion is solicited from the outset for the document. Guidelines are reviewed in depth by the Committee, with participation from experienced clinicians and others in related fields. The final recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientific developments at a later time. The following guidelines are intended for adults and not for pediatric patients.     

Contributions to patient adherence: Is it time to share the blame?

Poor adherence to treatment is well recognized and contributes significantly to treatment failures in medical care. Studies examining contributing factors have focused predominantly on the patient. Studies examining provider influences have primarily examined communication styles or educational practices. M. R. DiMatteo et al (see record 1993-26883-001) show that other characteristics of the provider may influence patient behavior. Particularly interesting is the finding that baseline adherence predicts adherence 2 yrs later. Although this study opens the door to an examination of provider characteristics and their influence on patient behavior, care needs to be taken to avoid too rapid an acceptance of the discrete findings. The study used self-report by interview, a measure that can be significantly biased. However, this study provides future avenues to explore using more objective measures of patient adherence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mild hypertension]

The Norwegian Report on Evaluation and Treatment of Mild Hypertension and The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure were both published at the end of 1997. The prevalence of hypertension and the proportion of the total adult population on antihypertensive medication is about 20% and 10% respectively in both countries. In both reports patients are assessed and graded according to various risk factors for developing cardiovascular disease. However, in the American recommendations it seems that this will only have marginal impact on the number of persons with uncomplicated mild hypertension who will be recommended drug therapy. The Norwegian guidelines recommend drug therapy only where there is a minimum of 20% absolute risk (30% for the age group 60-69 years) of developing cardiovascular disease or of death within ten years. Drug therapy is not recommended for persons over 70 years with uncomplicated mild hypertension, whereas treatment is advised in cases of complicated mild hypertension. It is therefore estimated that drug therapy will be recommended for less than 50% of patients with uncomplicated mild hypertension, as opposed to almost 100% according to the American guidelines.