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Biomedical subjects

A Chockalingam

Publications and source records attributed to A Chockalingam.

At least 55 records · Page 3Linked to original sources
PubMed1991

Treatment of mild-to-moderate hypertension: comparison between a calcium-channel blocker and a potassium-sparing diuretic.

In a multicenter study, 61 patients, 18-70 years of age, with mild-to-moderate hypertension [diastolic blood pressure (DBP) 95/114] completed a 28-week treatment. After initial placebo washout, patients were randomly allocated either to diltiazem or hydrochlorothiazide/triamterene. At the end of 12 weeks, the patients continued on the same medication if their goal blood pressure achieved (DBP less than 90; or 10 mm Hg below baseline). If not, the alternate agent was added (either diltiazem + hydrochlorothiazide/triamterene or hydrochlorothiazide/triamterene + diltiazem). At the end of 28 weeks, the intent-to-treat analysis showed that 90% on diltiazem alone, 73.7% on hydrochlorothiazide/triamterene alone, 71.4% on (diltiazem + hydrochlorothiazide/triamterene), and 57.1% on (hydrochlorothiazide/triamterene + diltiazem) achieved goal BP. End point mean values of BP and heart rate after adjusting for sex, baseline values, age, and weight showed no significant difference between groups. Forty-six percent on hydrochlorothiazide/triamterene alone and 24% on diltiazem alone reported one or more adverse events, possibly related to study medication. Patients with diltiazem as the first choice had better BP control than those on hydrochlorothiazide/triamterene alone (81.5% vs. 69.7%). Furthermore, among non-goal achievers at week 12, there was a greater response in the group when hydrochlorothiazide/triamterene was added to diltiazem than when diltiazem was added to hydrochlorothiazide/triamterene. This study suggests that in mild-to-moderate hypertension, diltiazem is better than hydrochlorothiazide/triamterene as first line therapy.

Adolescent↗
PubMed1991

Efficacy of once daily nitrendipine in mild hypertension: comparison with placebo.

A randomized, double-blind, parallel group study was carried out to compare the antihypertensive efficacy of nitrendipine with that of placebo in 80 mild hypertensives. The dose of nitrendipine was initially 10 mg once daily and was doubled to 20 mg once daily after four weeks in patients who responded poorly (33% of patients on nitrendipine and 49% of patients on placebo required doubling of dose). Blood pressure was assessed 20 to 24 h after dosing. Mean (+/- standard error) reductions in supine systolic and diastolic blood pressures for patients who completed 10 weeks of therapy were significantly greater for the nitrendipine group than for the placebo group (systolic blood pressure 18.1 +/- 2.7 mmHg versus 4.2 +/- 2.5, P less than 0.0001; and diastolic blood pressure 10.6 +/- 1.1 mmHg versus 6.6 +/- 1.3, P = 0.002). A comparison of mean reductions in standing systolic and diastolic blood pressures produced similar results. Goal of therapy (diastolic blood pressure no more than 90 mmHg or reduction of at least 10 mmHg) was achieved in 71% of nitrendipine-treated and 45% of placebo-treated patients (P less than 0.05). Nine of 80 patients randomized to therapy dropped out during treatment (nitrendipine: four adverse experiences and one moved from the area; placebo: two adverse experiences, and drug ineffective in two). Overall, the incidence of adverse experiences considered by the physician to be related to treatment was higher in the placebo group (32%) than in the nitrendipine group (23%). Only flushing had a higher incidence in the nitrendipine group; however, the overall incidence was low (9%).(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1991

Modification of cardiovascular risk factors in rural population of Newfoundland through nutritional counselling.

Cardiovascular risk factor (CVRF) evaluation has been offered to the adult population of a rural area of Newfoundland. Out of 4,814 residents of the selected communities 522 persons volunteered for a screening examination. The assessed variables included medical history, blood pressure, total cholesterol, smoking and body mass index. The most frequent CVRF encountered had been hypercholesterolaemia, ascertained in 61% of all residents. Among the respondents 30% were smokers and 27% were hypertensives. A six-month intensive educational programme aimed at a cohort of 41 high risk individuals led to a significant decline of systolic blood pressure, body mass index and serum cholesterol. Although, after termination of the intervention programme six months later, the risk factor levels increased again, they have remained below the original values. The results of this pilot study led to a design of a major random clinical trial on non-pharmacological therapy to be implemented in the years 1990/1993.

Adult↗
PubMed1990

Accurate, reproducible measurement of blood pressure.

The diagnosis of mild hypertension and the treatment of hypertension require accurate measurement of blood pressure. Blood pressure readings are altered by various factors that influence the patient, the techniques used and the accuracy of the sphygmomanometer. The variability of readings can be reduced if informed patients prepare in advance by emptying their bladder and bowel, by avoiding over-the-counter vasoactive drugs the day of measurement and by avoiding exposure to cold, caffeine consumption, smoking and physical exertion within half an hour before measurement. The use of standardized techniques to measure blood pressure will help to avoid large systematic errors. Poor technique can account for differences in readings of more than 15 mm Hg and ultimately misdiagnosis. Most of the recommended procedures are simple and, when routinely incorporated into clinical practice, require little additional time. The equipment must be appropriate and in good condition. Physicians should have a suitable selection of cuff sizes readily available; the use of the correct cuff size is essential to minimize systematic errors in blood pressure measurement. Semiannual calibration of aneroid sphygmomanometers and annual inspection of mercury sphygmomanometers and blood pressure cuffs are recommended. We review the methods recommended for measuring blood pressure and discuss the factors known to produce large differences in blood pressure readings.

Adult↗
PubMed1990

Intersalt in Newfoundland and Labrador.

In Intersalt, positive relations between 24-hour urinary sodium and potassium excretion and blood pressure were observed in over 10,000 men and women in 52 centers around the world. Body mass index (BMI), alcohol intake and smoking showed different associations with blood pressure in various population groups. We investigated these variables in the 2 Canadian centers and could not confirm the sodium-potassium relationship. In a multiple stepwise regression analysis, BMI and alcohol had the strongest relation with blood pressure in men. Among the female participants, BMI and sodium were the most influential factors on systolic blood pressure. For diastolic blood pressure, BMI and smoking showed the strongest significance. Neither in men nor in women could the influence of high sodium and low potassium excretion on blood pressure be discerned.

Adult↗
PubMed1990

The Canadian consensus report on non-pharmacological approaches to the management of high blood pressure.

The Canadian Consensus Conference on Non-Pharmacological Approaches to the Management of High Blood Pressure reviewed in March, 1989 on its meeting in Halifax, Nova Scotia, data concerning the efficacy of eight interventional strategies used for controlling hypertension. These strategies were as follows: alcohol restriction, weight reduction, physical exercise, reduction of salt intake, relaxation/stress management, increase of potassium and calcium intake and combination of pharmacological and non-pharmacological management. The Panel of the Consensus Conference recommended as efficacious the following interventions: alcohol restriction for less than two standard drinks per day, reduction of excessive body weight, and reduction of salt intake. There is sufficient scientific evidence for recommending potassium rich diet for normotensives and hypertensive persons. The Panel also concluded that a combination of pharmacological and non-pharmacological management is an efficacious measure. The Panel at this point of time could not issue recommendations as to the value of relaxation/stress management, physical exercise and calcium intake.

Alcohol Drinking↗
PubMed1990

Canadian Consensus Conference on Nonpharmacological Approaches to the Management of High Blood Pressure: recommendations.

The issue of nondrug treatment, either as a sole or an adjunct therapy in combination with a drug treatment for high blood pressure (BP), is controversial. In an attempt to resolve controversies and to arrive at a consensus, the Canadian Consensus Conference on Nonpharmacological Approaches to the Management of High Blood Pressure was convened in March 1989 in Halifax, Nova Scotia. State-of-the-art information on seven key nonpharmacological issues about body weight, alcohol, salt, potassium and calcium intake, physical exercise, and relaxation were reviewed, and a multidisciplinary consensus panel arrived at recommendations aimed at those members of the general public who are normotensive, those with high BP, health professionals, and, in some cases, the government and the food industry. This panel also suggested further studies in each of the topic areas.

Calcium, Dietary↗
PubMed1990

Canadian Consensus Conference on Nonpharmacological Approaches to the Management of High Blood Pressure: postconference initiatives.

Following the Canadian Consensus Conference on Nonpharmacological Approaches to the Management of High Blood Pressure. March 1989, the Coalition through its member organizations, launched a number of initiatives stemming from the conference. The Coalition achieved a unified document acceptable to all levels of the health profession for nonpharmacological approaches to hypertension, which will be the very first approach prior to treatment with drugs. The information dissemination was successfully carried out. With the cooperation of all member organizations the Coalition is hopeful of executing its future planned strategies for successful intervention of nonpharmacological approaches to the treatment of high blood pressure.

Education, Medical, Continuing↗
PubMed1990

Cardiovascular risk factors in Newfoundland population and modification of their level through nonpharmacological intervention.

In the rural area of Newfoundland, 522 residents volunteered for a cardiovascular risk factor evaluation. Medical history, blood pressure (BP), blood cholesterol, smoking, and body mass index were assessed. Seventy-five percent of the population had at least one of these risk factors. The most frequent condition had been hypercholesterolemia in 61% of respondents. An intensive 6-month educational program aimed at a group of 41 high-risk individuals led to a significant decline in systolic BP, diastolic BP, body mass index, and serum cholesterol. Although the risk factor levels increased again after termination of the intervention program 6 months later, they have remained below the original values. The results of this pilot study led to a design of a major random clinical trial on nonpharmacological therapy, to be implemented in the years 1990-1993.

Blood Pressure↗
PubMed1990

Clinical assessment of blood pressure.

This study was performed to determine the blood pressure measuring techniques and accuracy of sphygmomanometers used by physicians in ambulatory care clinics on the Avalon Peninsula of Newfoundland. Of the 114 participating physicians, no physician completely followed all the recommended BP measuring techniques of the American Heart Association. Almost all physicians supported the patient's arm at heart level to measure BP. Fewer physicians used the following recommended techniques; palpation to initially assess systolic BP (38%), measurement of BP in both arms (23%), an appropriate rate of cuff deflation (18%), measurement of BP in recommended patient positions (10%), the appropriate length of rest (4%) or use of a cuff of appropriate size (3%). Approximately 8% of mercury sphygmomanometers were out of calibration by at least 4 mmHg but none were out by more than 6 mmHg. Forty percent of aneroid sphygmomanometers were out of calibration by at least 4 mmHg and of these 30% were out by 10 mmHg or more. Mercury and aneroid sphygmomanometers were used by 60% of physicians. Aneroid sphygmomanometers were used exclusively by 34% of physicians, while 5% of physicians relied solely on mercury devices. Standardized techniques for BP measurement are not used and inaccurate sphygmomanometers are common; these factors may lead to misclassification of blood pressure and inappropriate treatment of patients.

Blood Pressure↗
PubMed1987

A comparison of the side effects of atenolol and propranolol in the treatment of patients with hypertension.

A single-blind study was conducted in 52 hypertensive patients, aged 25 to 68 years, to compare the side effects of an equally effective antihypertensive regimen of propranolol and atenolol. All patients had a history of side effects with beta-blocker therapy. Patients were treated with propranolol 40 to 160 mg bid for 8 weeks, followed by atenolol 50 to 100 mg given once daily for 8 weeks, and then rechallenged with the required dosage of propranolol for 8 weeks. Mean systolic and diastolic blood pressures were controlled during all three treatment phases. Side effects showed a definite trend toward improvement during the atenolol treatment phase. CNS side effects, in particular, showed significantly (P less than .05) reduced severity scores and overall incidence rates during the atenolol treatment phase. In conclusion, this study showed that at equally effective antihypertensive dosages the hydrophilic beta blocker atenolol produced significantly fewer CNS side effects than the lipophilic beta blocker propranolol.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Achieving cardiovascular health through continuing interprofessional development.

In order to achieve cardiovascular health for all Canadians, the ACHIC (Achieving Cardiovascular Health in Canada) partnership advocates that health promotion for healthy lifestyles be incorporated into practice, and that the consistent messages and professional skills required to motivate patients and the public be acquired through interprofessional education and development. Professional education specialists are essential members of health care promotion teams with expertise to develop educational interventions that impact behaviours of health professionals and subsequent patient outcomes. Continuing medical education (CME) is in evolution to continuing professional development (CPD), and then to continuing inter-professional development (CID). Providers of health promotion, public health, and health care can work with health educators to complete the cascade of learning, change in practice, and improvement in patient outcomes. The Canadian health care system can empower Canadians to achieve cardiovascular health, the most important health challenge in the 21st century.

Behavior Therapy↗
PubMedDate not supplied

From death and disability to patient empowerment: an interprofessional partnership to achieve cardiovascular health in Canada.

This paper proposes a paradigm shift in health care from a focus on death and disability to one on health empowerment resulting in improved cardiovascular lifestyles for all Canadians. It describes a national interprofessional initiative to achieve this new vision in the area of cardiovascular health promotion. Achieving Cardiovascular Health in Canada (ACHIC) is a partnership of health professional associations and other health advocate groups whose vision is to promote optimal cardiovascular health (including cerebrovascular health) for all Canadians through interprofessional partnership initiatives and support systems. ACHIC's objectives are to: 1) identify system barriers and supports to cardiovascular health; 2) develop strategies that will have a positive impact on the practices of health professionals/educators in the promotion of cardiovascular health; 3) develop an interprofessional national approach to support strategies to achieve cardiovascular health in Canada; and 4) support the development and delivery of consistent, evidence-based messages by health professionals/educators for promotion of cardiovascular health.

Canada↗
PubMedDate not supplied

LDL molecular size as risk factor in coronary artery disease.

Sera of 65 fasting human subjects--32 patients with coronary artery disease (CAD) aged 42-80 years and 33 healthy individuals--were tested for determination of nine lipid-related laboratory parameters, including protein-enriched LDL (low density lipoprotein cholesterol (LDL apo B) which is proportional to the amount of cholesterol per LDL particle. Three of the investigated parameters: protein-enriched LDL, HDL cholesterol and apo B level differed significantly in the two groups (corrected P < 0.001, P < 0.009 and P < 0.009, respectively). Discriminant analysis revealed that protein-enriched LDL, LDL cholesterol, apo B and fasting triglyceride levels, but not HDL cholesterol, were the major discriminating factors for CAD in this study. Pearson correlation coefficients were calculated to describe the association between this size-related parameter and those which in both groups seem to be most strongly associated with it: apo B/A-I ratio (i), triglyceride (ii) and LDL/HDL ratio (iii). The analysis was done separately in the two groups. In the patients with CAD the influence of these three parameters were less decisive in the determination of the protein-enriched LDL than in the controls (corr. coeff.: (i) -0.155 vs -0.358; (ii) -0.624 vs -0.791; (iii) -0163 vs -0.471). In healthy volunteers the size-reducing effect of the same parameters was more profound, and at high values of LDL/HDL ratio, apo B/apo A-I ratio and triglyceride no distinction in LDL particle size can be made any longer between CAD patients and controls. Thus the improvement of the atherogenic profile does not seem to result in the reduction of risk for CAD in terms of LDL size and composition.

Adult↗