Browsing by Subject "Hypertension"
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Item Alpha and beta receptor blocking drugs in the treatment of hypertension(1978-01-12) Kaplan, Norman M.Item Arterial baroreceptors and related reflexes: their roles in health and disease(1980-05-29) Longhurst, John C.Item Automating Clinical Decision Support to Improve Pediatric Hypertension Identification: Evaluation of Diagnostic Validity and Computational Time of Two Algorithms(2017-01-17) Doney, Analise; Bowen, Michael; Adamson, Brian; Sanders, Joanne; Vertilus, Shawyntee; Menzies, Christopher; Gheen, Taylor; Bhat, Deepa; Fish, Jason; Skinner, Celette Sugg; Turer, Christy BolingHypertension (HTN) in children is underdiagnosed. This is concerning. Rates of HTN are increasing with the rise in childhood obesity. In children, diagnosis of HTN requires three discrete elevations in historical blood-pressure (BP) percentiles (%). Calculating BP% requires valid heights and ages that change from visit to visit, and BP%s are neither calculated nor stored in electronic health records (EHRs). Current methods used by providers to circumvent these challenges may contribute to under diagnosis of pediatric HTN. EHR-enabled algorithms may improve rates of HTN diagnosis by automating discovery of historical BP% elevations. The study aim was to determine whether an EHR-enabled algorithm to diagnose HTN is more diagnostically valid than methods currently used by providers. Data were from a retrospective cohort of 52,828 3-18 year-old children followed up to 6 years in primary care. The 1st algorithm, termed current-observation-carried backwards (COCB), identified the BP% threshold for HTN using current-visit height/age, and applied that threshold to historical visits to determine HTN (defined as 3 elevations in BP% ≥95). COCB imitated mental processes currently used by providers, because retrospectively calculating visit-specific thresholds during patient visits is not feasible. The 2nd algorithm, termed “smart data elements” (SDEs), exported historical-visit ages, heights, and BPs from the EHR into a database to calculate historical BP% thresholds for HTN—thus providing visit-specific BP%s. The 2nd algorithm is the ideal way to determine HTN. The study hypothesis was that the second/SDE algorithm would be more diagnostically valid than the first/COCB. Diagnostic validity for determining HTN was determined by calculating sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Descriptive statistics summarized diagnostic validity of the algorithms. Variation in diagnostic validity by height and body-mass-index percentile (BMI%) were explored. The sensitivity of COCB (vs. SDE) for detecting HTN was 82.2%. COCB’s specificity surpassed 99.8%. PPV and NPV were >95%. Diagnostic validity differed by height and BMI%: as height and BMI% increased, sensitivity increased and PPV decreased. Study data indicate that the current method used by many pediatricians to diagnose HTN (COCB) misses up to 1 in 5 children with HTN. Automating identification of three discrete BP% elevations using the SDE algorithm may improve rates of pediatric HTN diagnosis.Item Calcium antagonists in hypertension: physiological concepts and therapeutic use(1985-03-21) Ram, C. Venkata S.Item Cardiovascular Risk Factors Predict the Spatial Distribution of White Matter Hyperintensities(2014-02-04) Banerjee, Soham; King, Kevin; McColl, Roderick; Whittemore, Anthony; Hulsey, Keith; Peshock, Ronald M.PURPOSE: Increased volume of brain white matter hyperintensities (WMH) seen on MRI is associated with cardiovascular risk factors; however, WMH have also been attributed to normal aging. Recent studies have suggested that WMH in some brain regions are more strongly associated with specific risk factors. The purpose of this study was to create a map of every individual brain voxel that was significantly associated with risk factors (hypertension, diabetes, hyper-cholesterolemia) as compared to those without each risk factor. The aim of the study is to create a predictive model, which uses the WMH distribution to determine the associated underlying risk factor. METHODS: The MRI brain images used for analysis were obtained from 2066 participants in the Dallas Heart Study, a population based study. Each MRI brain was transformed onto a standard template that adjusts for participant variation in brain volume and shape, using the FSL SIENAX software. The participant's WMH distributions were then generated from their MRIs using an automated algorithm. For each risk factor, the subjects were divided into a case group and a control group. Each voxel of WMH was compared between the two groups using a two tailed nonparametric permutation test. A map of every voxel significantly associated with each risk factor was created. RESULTS: Of the total of 431891 voxels that comprise the distribution of WMH over the entire population, 26064 voxels (6%) were significantly associated with hypertension only. These hypertensive-associated voxels were prevalent anterior to the frontal horns of the lateral ventricles. Similarly, 22527 voxels (5%) were associated with diabetes only with a prevalence near the longitudinal cerebral fissure as well as lateral to the posterior horns of the lateral ventricles. 8088 voxels (2%) were associated with hyper-cholesterolemia only and were abundant posterior to the posterior horns of the lateral ventricles. 331588 voxels (77%) were not associated with a risk factor. CONCLUSIONS: For hypertension, diabetes, and hyper-cholesterolemia, certain voxels were significantly associated with a risk factor, and maps of these voxels were created. Knowing the WMH distribution significantly associated with each risk factor will improve the specificity for evaluating patients for risk factor associated white matter injury. Importantly, this approach makes no a priori assumptions which divide the brain into functional regions or vascular territories.Item Cerebral circulation in hypertension(1984-08-23) Reed, William GaryItem The choice of therapy for mild hypertension(1981-04-30) Kaplan, Norman M.Item Clinical implications of impaired renal autoregulation(2000-10-12) Palmer, Biff F.Item [Combined efforts](1985-07-18) Anderson, Ron J.This Internal Medicine Grand Rounds protocol is comprised of three sections that follow the title page and the dedication and acknowledgements page. Each section has its own bibliography. All three sections were presented on the same date. Page numbers correspond to the digital page number displayed in the file.Item The deadly quadrangle: upper body obesity, glucose intolerance, hypertriglyceridemia and hypertension(1988-02-04) Kaplan, Norman M.Item Developing novel therapies in pulmonary arterial hypertension(2013-05-10) Chin, Kelly M.Item Difficult to treat hypertension(1994-04-07) Kaplan, Norman M.Item Disturbances in renal autoregulation and the susceptibility to hypertension-induced chronic kidney disease(2004-08-05) Palmer, Biff F.Item The Effect of Extracellular Volume Status on Intradialytic Hypertension(2014-02-04) Molina, Christopher; Van Buren, Peter; Toto, RobertBACKGROUND: lntradialytic hypertension (HTN), defined as an increase in systolic blood pressure (BP) >10 mmHg from pre to post-hemodialysis (HD),occurs regularly in approximately 15o/o of HD patients. Previous studieshave shown patients with intradialytic HTN display higher overall ambulatory BP and have higher mortality rates when compared to HD controls. As extracellular volume overload contributes to HTN in HD patients, it has been proposed that intradialytic HTN patients have increased extracellular volume. Still, atypical ambulatory BP patterns seen in intradialytic HTN patients suggest extracellular volume may not be a primary determinant of BP in this population. Thus, we hypothesize extracellular fluid volume will be similar in patients with intradialytic HTN and HD controls when adjusting for total body water. METHODS: ln a case control study we recruited hypertensive HD patients with pre HD systolic BP >140 mmHg or post HD systolic BP >130 mmHg. Case subjects with intradialytic HTN were defined as having systolic BP increases >10 mmHg from pre to post-HD. Control subjects were defined as having systolic BP decreases >10 mmHg from pre to post- HD. We obtained measurements of total body water, extracellular water, and intracellular water before and after HD in all subjects using multifrequency bioimpedance spectroscopy. We compared the ratio of extracellular water to total body water between groups using t-tests for pre and post dialysis measurements. RESULTS: Case subjects (n=4) had an average ambulatory systolic BP of 140 mmHg (20) and controls (n=4) had an average of 1a0 (9.8). Before dialysis, case subjects had a ratio of 0.49 (.03) vs. 0.a6 (.02) in controls (p=0.2). After dialysis, the ratio was 0.45 (0.03) in cases and .44 (0.01) in controls (p=0.4). DISCUSSION: The ratio of extracellular water to total body water was similar in subjects with intradialytic HTN both before and after HD compared to HD controls. While a larger sample size will be required to establish whether extracellular volume status is different in this patient population, the results of this study suggest increased extracellular volume is not a distinguishing feature of intradialytic HTN. Further etiologies for increased BP including excessive vascular resistance should be explored to explain the phenomenon of intradialytic hypertension.Item The Effects of Depression on Hypertension in Females with Military Sexual Trauma (MST)-Related PTSD(2016-05-18) Ali, Sania; Surís, Alina; Shivakumar, Geetha; Pai, Anushka; Dubois, ChelitaBACKGROUND: Posttraumatic stress disorder (PTSD) and depression have been linked with cardiovascular disease, specifically hypertension. Additionally, PTSD and major depression independently increase the likelihood of hypertension. Military sexual trauma (MST) is also associated with greater psychiatric and cardiovascular symptom severity. Comorbid depression and PTSD have an established relationship with hypertension; however, this association has yet to be studied in female veterans with MST-related PTSD. SUBJECTS: Data were used from baseline assessments of a recently published randomized clinical trial (RTC), with information from 113 female veterans with MST-related PTSD used for the present study. Only female veterans were included in the present study METHOD: A retrospective electronic chart review was conducted to determine the presence or absence of hypertension. Baseline diagnosis of comorbid major depressive disorder (Structured Clinical Interview for DSM-IV), and depression symptom severity (Beck Depression Inventory-II) were used in statistical analyses to examine the relationship between depression and hypertension in the sample. RESULTS: Neither comorbid major depressive disorder nor depression symptom severity were significant risk factors for hypertension in the sample. Subsequent exploratory analyses produced an expected finding that African American/Black race was associated with hypertension in our sample. DISCUSSION: Providers should be aware of the risk for hypertension in female veterans with MST-related PTSD who identify as African American regardless of the presence of comorbid depression or greater depressive symptom severity. Future researchers should expand upon our findings by examining the effect of age as well as comorbid physical health disorders (e.g., diabetes, hyperlipidemia) on hypertension in women with MST-related PTSD.Item The elderly woman with severe hypertension and renal insufficiency(1991-04-25) Jacobson, Harry R.Item The enigma of cyclosporine-induced hypertension(1989-10-26) Victor, Ronald G.Item Essential hypertension: natural history and results of treatment(1964-12-17) UnknownItem Ethnicity, hypertension, and the Dallas Heart Study(2003-07-17) Victor, Ronald G.