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Biomedical subjects

M Alderman

Publications and source records attributed to M Alderman.

At least 19 recordsLinked to original sources
PubMed2006

Meeting report on the Bellagio Conference 'prevention of vascular diseases in the emerging world: An approach to global health equity'.

Representatives from five international organizations (International Society of Nephrology, World Heart Federation, International Diabetes Federation, International Atherosclerosis Federation, and International Society of Hypertension) participated in a strategic planning workshop in December 2005 in Bellagio, Italy sponsored by the Rockefeller Foundation. There were equal representatives from developed and developing countries. Global perspectives on diabetes and cardiovascular and renal diseases were presented, with special emphasis on China, India, Latin America, and Africa. The rationale and effectiveness of preventive measures were discussed. It was apparent that measures for primary prevention and early intervention for all the chronic vascular diseases are similar. The five organizations agreed that an integrated global approach to chronic vascular diseases is needed. They resolved to collaborate and work towards an integrated approach to chronic vascular diseases with the establishment of a 5-year plan for the prevention and treatment of chronic vascular diseases, including public advocacy, advising international and national agencies, and improving education and the practice of established approaches.

Chronic Disease↗
PubMed2004

[Serum uric acid--a cardiovasular risk factor?].

Serum uric acid represents an important, independent risk factor for cardiovascular and renal disease in patients with hypertension, heart failure, or diabetes. Elevated serum uric acid is highly predictive of mortality in patients with heart failure or coronary artery disease and of cardiovascular events in patients with diabetes. Although the mechanism(s) by which uric acid may play a pathogenetic role in cardiovascular disease is unclear, hyperuricemia is associated with deleterious effects on endothelial dysfunction, oxidative metabolism, platelet adhesiveness, hemrheology, and aggregation. Whether a reduction in uric acid impacts CV and renal disease remains to be determined. However, recent findings from LIFE in hypertensive patients with LVH suggest the possibility that a treatment-induced decrease in serum uric acid may indeed attenuate cardiovascular risk. Almost one third of the treatment benefit of a losartan-based versus atenolol-based therapy on the composite endpoint (death, myocardial infarction, or stroke) may be ascribed to differences in achieved serum uric acid levels. Clearly, randomized clinical trials are needed to investigate further the long-term cardioprotective benefits issue of reducing hyperuricemia in hypertensive patients.

Angiotensin II Type 1 Receptor Blockers↗
PubMed2001

Antihypertensive efficacy and safety of losartan alone and in combination with hydrochlorothiazide in adult African Americans with mild to moderate hypertension.

BACKGROUND: African Americans with hypertension, particularly those with more severe blood pressure elevations, are generally less responsive to monotherapy from any antihypertensive class. These patients usually require treatment with drugs from > or = 2 antihypertensive classes to achieve adequate blood pressure control. OBJECTIVE: The purpose of this study was to assess the antihypertensive efficacy and safety of losartan alone and in combination with hydrochlorothiazide (HCTZ) in African American adults with mild to moderate hypertension. METHODS: In this 12-week, multicenter, double-blind, randomized, parallel-group, placebo-controlled study, African American patients were randomized in a 3:3:1 ratio to I of 3 treatment groups: placebo, losartan monotherapy (50 to 150 mg), or losartan plus HCTZ (50/0 to 50/12.5 to 100/25 mg). Doses were titrated at weeks 4 and 8 if sitting diastolic blood pressure (SiDBP) was > or = 90 mm Hg. Safety was assessed by determining the incidence of clinical and laboratory Adverse events and evaluating mean changes in pulse, body weight, electrocardiographic parameters, and laboratory test results. RESULTS: A total of 440 patients were randomized-188 to placebo, 193 to losartan monotherapy, and 59 to losartan/HCTZ; 391 completed the study. At week 12, the response rate with losartan monotherapy was 45.8%, with a significant (P < or = 0.01) lowering in mean SiDBP by 6.6 mm Hg compared with placebo; the response rate with placebo was 27.2%, with a mean SiDBP reduction of 3.9 mm Hg. Sitting systolic blood pressure (SiSBP) was significantly lowered with losartan monotherapy, by 6.4 mm Hg, compared with placebo (reduction of 2.3 mm Hg). The response rate with losartan/ HCTZ was 62.7%, with reductions in SiSBP and SiDBP of 16.8 mm Hg and 10.8 mm Hg, respectively (P < or = 0.01 vs placebo and losartan monotherapy). The incidence of clinical adverse events was comparable in the 3 treatment groups. CONCLUSIONS: The results of this study suggest that in African American patients, losartan monotherapy was significantly more effective than placebo in lowering SiSBP and SiDBP. Moreover, the losartan/ HCTZ combination regimen resulted in significant and clinically meaningful additional reductions in SiSBP and SiDBP compared with losartan monotherapy or placebo. Losartan monotherapy and the losartan/HCTZ regimens were generally as well tolerated as placebo.

Black or African American↗
PubMed2001

Improving access to mammograms through community-based influenza clinics. A quasi-experimental study.

BACKGROUND: It is a national priority to increase breast-cancer screening among women aged > or = 50. Annual influenza clinics may represent an efficient setting in which to promote breast-cancer screening among older women. To our knowledge, this possibility has not previously been explored. OBJECTIVE: To examine whether offering women attending community-based influenza clinics the opportunity to receive a scheduling telephone call from a mammography facility will result in an increase in the number of mammograms performed over a 6-month period. METHODS: We used a quasi-experimental design with 6-month follow-up. A contemporaneous population-based survey provided a further control group for comparison. The sample group consisted of a total of 284 women attending nine community-based influenza clinics in a semirural county in Connecticut. All women were aged > or = 50 and reported no mammogram in the preceding 12 months. All women received informational literature on mammography. Experimental subjects were each asked if a radiology facility chosen by the subject could call her at home to schedule a mammogram. Mammograms performed were determined by hospital record for participants who received a scheduling call from a radiology facility, and by self-report for all other participants. RESULTS: Mammography use following access through influenza clinics was approximately twice that of women attending influenza clinics where access to mammography was not offered. Using three different assumptions regarding participants whose mammography status was unknown, the relative risks ranged between 1.6 and 2.1. For each assumption the results were statistically significant (chi(2)=8.51-12.2; p<0.001). CONCLUSIONS: Linking access to mammography at community-based influenza clinics can significantly increase the use of mammograms among women aged > or = 50. Further studies should seek to confirm these findings and determine the degree to which they can be replicated in a variety of communities. Enhancing preventive health practice through the bundling of services suggests a new strategy to exploit available interventions to improve health.

Community Health Services↗
PubMed1999

Uric acid in hypertension and cardiovascular disease.

Cardiovascular disease, and particularly coronary artery disease, remains the leading cause of mortality worldwide, despite recent substantial declines. Hypertension, long recognized as a risk factor for both stroke and myocardial infarction, is an important target for preventive intervention. However, effective hypotensive therapy produces incomplete cardioprotection, and most events that would have occurred in the natural state continue to occur among controlled hypertensive patients. Further progress in reducing the burden of cardiac disease will depend on early identification of risk in successfully treated hypertensive subjects and the development of preventive interventions that go beyond simple reduction of blood pressure. Recently, elevation of uric acid has been found to be associated with subsequent morbidity and mortality in the general population among patients with congestive heart failure, diabetes and hypertension. A prospective study in a large cohort of well controlled hypertensive subjects has revealed a strong, specific, stepwise, independent association of increasing serum uric acid and cardiac morbidity and mortality. Unanswered, however, is the question of whether uric acid is simply an associated phenomenon, or actually contributes to the occurrence of cardiac events.

Angiotensin Receptor Antagonists↗
PubMed1997

Urinary sodium excretion and myocardial infarction in hypertensive patients: a prospective cohort study.

Reduced-sodium diets are frequently recommended for hypertensive patients. To determine the relation of sodium intake to subsequent cardiovascular disease, 24-h urinary excretion of sodium, potassium, and creatinine and plasma renin activity (PRA) were measured in 2937 mildly and moderately hypertensive patients unmedicated for > or = 3-4 wk. Morbidity and mortality in these treated subjects were ascertained. Subjects were stratified by sex-specific quartiles of urinary sodium excretion; race, cardiovascular status, and blood pressure before and during treatment were similar for each stratum. Patients with lower urinary sodium excretion were thinner, excreted less potassium, and had higher PRA. During an average 3.8-y follow-up, 55 myocardial infarctions (MIs) occurred. Incidence of MIs and urinary sodium excretion were inversely associated in the total population and in males but not in females. In males, age- and race-adjusted MI incidence in the lowest compared with the highest quartile of urinary sodium excretion was 11.5 compared with 2.5 (RR: 4.3; 95% CI: 1.7, 10.6). No association was observed between mortality from causes other than cardiovascular disease (n = 11) and urinary sodium excretion. There was a significant linear trend in proportions of MI by quartile of urinary sodium excretion, with a breakpoint after the lowest quartile. In Cox multivariate analysis, the logarithm of PRA, age, systolic blood pressure, and cholesterol as continuous variables, as well as left ventricular hypertrophy and smoking, had a direct association and urinary sodium excretion an inverse, independent association (P = 0.036) with incidence of MI.

Cardiovascular Diseases↗
PubMed1996

Novel delivery system for verapamil designed to achieve maximal blood pressure control during the early morning.

Because the risk of cardiovascular events appears to be greatest in the early morning, this period is a time during which adequate blood pressure (BP) control appears to be most desirable. In this study, a controlled-onset extended-release system (COER-24) that delivers verapamil in a manner designed to achieve maximal levels of drug during the early morning surge in BP was compared with placebo. Ninety-five patients with mild to moderate hypertension were studied. Of this group, 49 patients (mean age 57.6 +/- 1.4 years; 35 men and 14 women) were randomized to take verapamil COER-24 240 mg at 10 PM, and 46 subjects (mean age 55.8 +/- 1.5 years; 29 men and 17 women) were randomized to take placebo. Ambulatory BP monitoring was performed after a 4-week initial placebo period and was repeated after 4 weeks of treatment with verapamil or placebo. Verapamil COER-24 resulted in significant (p < 0.001) decreases in mean whole-day systolic and diastolic BP (-8.2/-6.3 mm Hg; baseline 152/93.0 mm Hg) when compared with placebo (+0.3/-0.9 mm Hg; baseline 150.3/93.2 mm Hg). From 6 AM to noon, verapamil COER-24 resulted in a change in systolic and diastolic BP of -11.6/-9.0 mm Hg, which was significantly (p < 0.001) greater than the change that occurred with placebo (-0.5/-1.0 mm Hg) during the same period. In the last 4 hours of the dosing interval (6 PM to 10 PM), verapamil COER-24 caused significantly greater (p < 0.001) decreases in BP (-7.4/-4.8 mm Hg) than did placebo (+2.7/+1.0 mm Hg). These data demonstrate that the COER-24 system, when administered in the late evening, achieves maximal BP reduction during the early morning hours. Moreover, BP reductions were sustained throughout the 24-hour period.

Blood Pressure↗
PubMed1990

The relationship between 'job strain,' workplace diastolic blood pressure, and left ventricular mass index. Results of a case-control study.

To determine whether "job strain" (defined as high psychological demands and low decision latitude on the job) is associated with increased workplace diastolic blood pressure and the left ventricular mass index, we conducted a case-control study at seven urban work sites of 215 employed men aged 30 to 60 years without evidence of coronary heart disease. After comprehensive blood pressure screening of male employees (N = 2556) at the work site, 87 cases of hypertension and a random sample of 128 controls were studied. In a multiple logistic regression model, job strain was significantly related to hypertension, with an estimated odds ratio of 3.1, after adjusting for age, race, body-mass index, type A behavior, alcohol intake, smoking, work site, 24-hour urine sodium excretion, education, and physical demand level of the job. Controlling for the above variables in subjects aged 30 to 40 years with job strain, we found that the echocardiographically determined left ventricular mass index was, on average, 10.8 g/m2 greater than in subjects without job strain. We conclude that job strain may be a risk factor for both hypertension and structural changes of the heart in working men.

Adult↗
PubMed1988

A longitudinal study of urinary creatinine and creatinine clearance in normal subjects. Race, sex, and age differences.

The purpose of this study was to examine the variability of 24-hour urinary and serum creatinine levels and creatinine clearance in normal subjects and to develop nomograms for assessing the adequacy of 24-hour urine collections. The data were from a longitudinal research program examining biochemical, hormonal, and hemodynamic parameters in normal subjects. Bloods and 24-hour urine specimens were collected at yearly intervals from 144 people over 9 years, and from an additional 110 over 4 years. The subjects were originally distributed equally by sex, race (black, white), blood pressure (three groups within the normal range), and age (three groups). Men had 33% higher urine creatinines per weight than females (P less than 0.001). Because they only had 8% higher creatinine clearance per weight they also exhibited 21% higher serum creatinine. Blacks had 5% higher urine creatinine per weight than whites, perhaps reflecting greater muscle mass, but their serum creatinines were not different from those of whites, reflecting a 5% higher creatinine clearance by weight than whites (P less than 0.01). Interestingly, older black men (age greater than 60 years) had 12% lower urine creatinine/weight than younger black men (P less than 0.001). They also had 13% lower creatinine clearance by weight, resulting in no net difference in serum creatinine. The intraindividual variability in urine creatinine excretion averaged 15% and did not differ between blacks and whites and men and women. The within individual variability in serum creatinine and creatinine clearance averaged 14 and 20%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Renin relationship to sex, race and age in a normotensive population.

The relationship of renin activity to sex, race (black or white) and age (less than 50 or greater than or equal to 50 years of age) was examined in 236 normal subjects measure yearly for up to 9 years. There were 58 white women (34 less than 50 years, 24 greater than or equal 50 years), 66 white men (30 less than 50 years, 36 greater than or equal to 50 years), 57 black women (34 less than 50 years, 23 greater than or equal to 50 years) and 55 black men (34 less than 50 years, 21 greater than or equal to 50 years). The results showed men had higher mean renin activities than women, whites had higher activities than blacks and those of under 50 years had higher activities than those of over 50 years. However, the sex and race differences primarily occurred as a consequence of a lack of decline in renin activity with age among white men. The relationship with age as a continuous variable was weak (r = -0.21) and no relationship with age was found in 22 subjects with a least 7 years of data. No significant differences in urinary sodium excretion were observed between the groups. These results suggest that renin activity tends to be lower in older subjects and that differences in renin activity related to sex and race, while statistically significant, may not be physiologically important.

Age Factors↗
PubMed1985

Intermittent claudication: a double-blind crossover trial of pentoxifylline.

The influence of the xanthine derivative pentoxifylline ('Trental' or BL191; Hoechst-Roussel) on exercise tolerance was measured in 38 subjects with stable, severe to moderately severe, intermittent claudication who completed a randomised, double-blind, placebo controlled, cross-over clinical trial. Patients received placebo tablets or 400 mg slow-release pentoxifylline tablets ('Trental 400') twice a day for one week, followed by three times daily for seven weeks, and then crossed over to receive the alternate preparation for another eight weeks. Claudication distance and walking distance were measured on a treadmill before starting treatment and again at four-week intervals during the trial. At the same times, red blood cell filterability, plasma fibrinogen concentration and blood viscosity, resting and post-ischemic calf muscle blood flow, and the resting and post-exercise ankle/brachial systolic pressure ratio were also measured. In this study, the observed effects of pentoxifylline treatment were no greater than those of placebo, even though serum levels of pentoxifylline and its hydroxy-metabolite were within the anticipated range. This was shown by a 'therapeutic effect ratio' of 0.98 for treadmill claudication distance and 0.96 for treadmill walking distance after within-patient analysis at the end of the cross-over (where a ratio of 1.0 means the test drug and placebo effects are identical). These ratios have 95% confidence limits of 0.72-1.34 and 0.74-1.25, respectively.

Aged↗