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Biomedical subjects

A Chockalingam

Publications and source records attributed to A Chockalingam.

65 records · Page 4Linked to original sources
PubMedDate not supplied

Estimation of subjective stress in acute myocardial infarction.

BACKGROUND AND AIMS: Mental stress is considered to be a precipitating factor in acute coronary events. We aimed to assess the association of subjective or 'perceived' mental stress with the occurrence of acute coronary events. SETTINGS AND DESIGN: Prospective case-control survey was carried out in a referral teaching hospital. SUBJECTS & METHODS: Consecutive patients with acute myocardial infarction and ST elevation on electrocardiogram who were admitted to the Coronary Care Unit of a referral teaching hospital were enrolled in the study as cases. Controls were unmatched and were enrolled from amongst patients with coronary artery disease who did not have recent acute coronary events. Subjective Stress Functional Classification (SS-FC) for the preceding 2-4 weeks was assessed and assigned four grades from I to IV as follows: I - baseline, II - more than usual but not affecting daily routine, III - significantly high stress affecting daily routine and IV - worst stress in life. STATISTICAL ANALYSIS: Proportions of different characteristics were compared using chi-square test with Yates continuity correction. Student's unpaired t test was applied for mean age. 'p' value of < 0.05 was considered statistically significant. RESULTS: SS-FC could be reliably (99%) and easily assessed. Eighty (53%) of the total 150 patients with acute MI reported 'high' levels of stress (stress class III and IV). This is in contrast to only 30 (20%) of 150 healthy controls reporting high stress for the same period (p value < 0.001). CONCLUSION: Patients with acute myocardial infarction report a higher subjective mental stress during 2 to 4 weeks preceding the acute coronary event.

Case-Control Studies↗
PubMedDate not supplied

Fish consumption and cardiovascular mortality in Canada: an inter-regional comparison.

There is growing evidence from both experimental and epidemiologic studies to suggest that regular fish consumption reduces the risk of cardiovascular disease in humans. However, a crude analysis of Canadian descriptive data does not support this hypothesis. Age-adjusted mortality from ischemic heart disease and cerebrovascular disease is actually higher in the Atlantic Provinces than in the Prairies where fish consumption is much lower. Possible reasons for this, including the importance of the type of fish consumed, and the effects of methods of preparation are discussed.

Adolescent↗
PubMedDate not supplied

The P-wave in the electrocardiogram of hypertensive patients before and after therapy.

P-wave areas in the electrocardiogram (ECG) of 51 patients with hypertension and of 53 normotensive controls were measured in lead V1 using a computerised planimeter. The total area (in mm2) of P-waves was significantly larger in hypertensives than in normotensives, i.e. males 0.59 vs 0.31; females 0.55 vs 0.26 (p less than .0001) respectively. With exception of one male, the P-waves in hypertensives were either negative or biphasic with terminal negativity. In part 2 of the study, P-wave areas of 84 hypertensives were measured prior to and five years after treatment. The patients had no previous antihypertensive therapy, a diastolic blood pressure (DBP) 90-104 mmHg at the onset of the study, no ECG signs of left ventricular hypertrophy (LVH), and DBP less than 85 mmHg at the end of the trial. After five years, the mean values of the P-wave areas (in mm2) decreased in white males from 0.67 to 0.36; in white females from 0.63 to 0.42; in black males from 0.97 to 0.56; and in black females from 0.80 to 0.46. We conclude that ECG P-wave area is significantly larger in untreated hypertensives compared with normotensives. In successfully treated hypertensives, the P-wave area returns to normal values.

Blood Pressure↗
PubMedDate not supplied

Errors in assessment of blood pressure: patient factors.

This article reviews patient-related factors affecting blood pressure measurement and provides the scientific rationale underlying current recommendations for the measurement of blood pressure in the evaluation of hypertension. Information is included on the magnitude of errors that can occur when the recommendations are not followed. A variety of factors relating to the patient's emotions, activity, bodily function and environment cause blood pressure to fluctuate throughout the day such that peak systolic and diastolic blood pressures are often twice as high as trough levels. Many physicians fail to account for these factors when assessing a patient's blood pressure. Errors in the classification and treatment of a patient's blood pressure and the finding of labile blood pressure can occur often when patients are not adequately prepared in advance of the blood pressure measurement.

Bias↗
PubMedDate not supplied

Errors in assessment of blood pressure: blood pressure measuring technique.

This article reviews the recommended techniques for accurate and reproducible blood pressure measurements. The scientific basis underlying current recommendations for blood pressure measurement is presented. Many of the current recommendations are not followed in ambulatory care clinics and this paper will show how measurement errors in excess of 15 mm Hg or more can occur. Many patients will be misclassified and treated inappropriately when errors in blood pressure measurement of this magnitude are made. Rigorous adherence to proper blood pressure measurement is necessary to evaluate a patient's risk of cardiovascular disease, and to assess the need or efficacy of antihypertensive therapy.

Antihypertensive Agents↗
PubMedDate not supplied

Errors in assessment of blood pressure: sphygmomanometers and blood pressure cuffs.

This article reviews the current recommendations on equipment when blood pressure is measured by sphygmomanometer. The scientific rationale underlying the current recommendations for selection and maintenance of blood pressure measuring equipment is presented. The errors that can occur when the recommendations are not followed are quantified whenever the data are available. Inadequate assessment and maintenance of equipment often lead to the use of faulty equipment, and as a result errors in the assessment of patients' blood pressure are likely to be common. If followed, the current guidelines for use and maintenance of equipment would remove most of the problems noted. Physicians must ensure that properly maintained and appropriate equipment is used to measure blood pressure.

Bias↗
PubMedDate not supplied

Guidelines for measurement of blood pressure, follow-up, and lifestyle counselling. Canadian Coalition for High Blood Pressure Prevention and Control.

As part of the Coalition's mandate to promote the prevention and control of high blood pressure in Canada, an interdisciplinary Workgroup was established to review and update the existing standards (1987) for blood pressure measurement and referral guidelines. The intent was to prepare a scientifically based document which contained practical guidelines for the measurement of blood pressure and criteria for follow-up, and one which promoted the concept of cardiovascular health in the assessment and interpretation of blood pressure readings. These guidelines were primarily developed to assist primary health care providers and/or clinicians to assess, monitor, counsel, refer, and develop treatment plans for adults-at-risk for high blood pressure or those with the confirmed diagnosis of hypertension. Readers are referred to The Canadian Hypertension Society Consensus Conference series (Canadian Medical Association Journal 1993) for specific guidelines on the evaluation, diagnosis, and treatment of hypertension. The document is divided into three sections: 1. Measurement of blood pressure 2. Criteria for follow-up 3. Guidelines for lifestyle counselling Each section cites the references used in developing the guidelines and where relevant, identifies other resources which can be used in clinical practice.

Adolescent↗
PubMedDate not supplied

Adherence to management of high blood pressure: recommendations of the Canadian Coalition for High Blood Pressure Prevention and Control.

Adherence or compliance, in the context of medical treatment, refers to how well a patient follows and sticks to the management plan developed with her/his health care provider, which may include pharmacologic agents as well as changes in lifestyle. Adherence is of great concern in asymptomatic conditions such as hypertension, where lack of control may have serious ramifications including end organ damage and premature mortality. To address this issue, the Canadian Coalition for High Blood Pressure Prevention and Control established a national Advisory Committee on Adherence to the Management of High Blood Pressure. The Advisory Committee consisted of 11 members from different disciplines of health care providers. The Committee reviewed all evidences to date and drew up four practical recommendations with respect to patient, provider and environment. Based on Canadian Task Force on Periodic Health Examination's guidelines, all four recommendations can be classified as 'level C' with a quality of evidence of II.

Canada↗
PubMedDate not supplied

Adherence to non-pharmacologic therapy for hypertension: problems and solutions.

The efficacy of a number of non-pharmacologic interventions in the therapy of primary hypertension has been firmly established. Most prominently, weight reduction, sodium restriction, and alcohol restriction have significant effects on lowering blood pressure. Increased physical activity contributes to management of hypertensive patients in a variety of ways: apart from having a direct impact on blood pressure level, it is an important supportive factor in a weight-reducing regime. The success in applying these non-pharmacologic measures in standard patient population is rather limited. A salient example is the lack of success in weight reduction. Reduction of sodium in the diet is somewhat more successful, however, the problem is that most of the salt intake is non-discretionary. Adherence to physical activity regimes is in the range of what has been observed in pharmacologic therapy. Research and experience in the past few years are providing a better understanding of the factors determining compliance with prescribed therapeutical regimes. Further research is needed to develop innovative strategies for providing efficacious non-pharmacologic measures to hypertensive patients.

Alcohol Drinking↗
PubMedDate not supplied

Adherence to pharmacologic management of hypertension.

Adherence to pharmacologic therapy of hypertension is low (in the range of 50-70%) and has important implications both for blood pressure control and cardiovascular complications. Based on a review of the literature using the levels of evidence grading technique, determinants of adherence to the pharmacologic therapy of hypertension have been assessed. Additionally, interventions to improve compliance were evaluated. Patient-centred, health care provider-centred and drug-specific factors have all been shown to affect adherence rates. We conclude that the extent of adherence to pharmacologic therapy is modifiable. Measurable improvements in adherence can be obtained from simplified medication regimens and a combination of behaviour strategies, including the tailoring of pill-taking to patients' daily habits and rituals, the advocacy of self-monitoring of pills and blood pressure, and the institution of reward systems.

Antihypertensive Agents↗