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Biomedical subjects

N M Kaplan

Publications and source records attributed to N M Kaplan.

At least 19 recordsLinked to original sources
PubMed1992

Cardiac responses elicited by stimulation of loci within stellate ganglia of developing swine.

Stimulation with bipolar electrodes of specific loci in stellate ganglia elicited in anesthetized piglets, 1-4 weeks of age, alterations in cardiac function and aortic pressure. Responses were also elicited by chemical stimulation in specific loci of these ganglia. The probability of eliciting a cardiovascular response by stimulating loci in a stellate ganglion increased with increasing postnatal age. For instance, no responses were elicited when loci in the left stellate ganglia of 1-week-old piglets were stimulated. Significant heart rate responses were obtained only when loci in right stellate ganglia were stimulated. The number of ganglionic loci from which cardiovascular responses were obtained increased with increasing postnatal age. It is concluded that the capacity of stellate ganglion neurons to modulate the cardiovascular system matures during the first four weeks of life, heart rate being modulated primarily by neurons in the right stellate ganglion and inotropism by neurons in both stellate ganglia.

Aging↗
PubMed1992

Microalbuminuria: a risk factor for vascular and renal complications of hypertension.

The kidneys are not only involved in the development of hypertension, but they are also often damaged if the disease is not controlled. Microalbuminuria occurs early and is easily diagnosed. However, microalbuminuria is not detected on routine Albustix testing, which has a sensitivity limit of 300 mg/L. Urinary albumin excretion, therefore, should be routinely determined by radioimmunoassay or other techniques so that appropriate therapies can be instituted to prevent nephropathy.

Albuminuria↗
PubMed1992

The appropriate goals of antihypertensive therapy: neither too much nor too little.

Although the treatment of hypertension has increased markedly during the last decade, many patients have been left undertreated, including many of the disadvantaged, the elderly, and those at relatively high overall risk for cardiovascular disease. A rapidly growing number of patients, however, are being exposed to overtreatment with resultant interference with their quality of life and potential hazards to their health. These include patients who are diagnosed and treated without adequate documentation of the presence of persistent hypertension, patients who are not appropriately managed with nondrug therapies, and patients who are given inappropriate and overly aggressive drug therapies. Better recognition of the frequency and potential hazards of overtreatment is needed so that more appropriate goals of antihypertensive therapy can be established and maintained.

Antihypertensive Agents↗
PubMed1992

A new era in hypertension therapy. Protecting patients from premature cardiovascular disease.

Although the cause of hypertension in most patients is unknown, many patients have coexisting risk factors that may contribute to the disease. According to Dr Kaplan, the key to effective treatment is an individualized approach that maximizes blood pressure control by addressing each patient's profile of risk factors. In this article, he discusses various coronary risk factors and recommends appropriate drug and nondrug therapies.

Antihypertensive Agents↗
PubMed1992

The early morning rise in blood pressure is related mainly to ambulation.

The marked increase in cardiovascular events that occur in the early morning hours could be related to a significant rise in blood pressure at this time but there is uncertainty as to whether this rise in pressure occurs before, at, or after awakening. Automatic blood pressure and pulse measurements were taken twice on 15 normotensive subjects and three times on 11 untreated hypertensive subjects starting before the onset of sleep and at 10 min intervals for 1 h before and 60 to 90 min after awakening. In random order, all subjects either remained supine or immediately arose and ambulated on the first two occasions. The hypertensives had a third study involving ingestion of 10 mg nifedipine after awakening and remaining supine for the next 60 min. The blood pressure and pulse changed little before and after awakening if the subjects remained supine. They rose rapidly and significantly immediately upon arising. The rise in pressure upon arising was blunted by the prior ingestion of nifedipine. The early morning rise in blood pressure and pulse is mainly related to arising from bed. Possible ways to reduce the abrupt rise in blood pressure and the increase in cardiovascular events that occur after arising are suggested.

Adult↗
PubMed1992

Two faces of sympathetic nervous activity--hypotension and hypertension.

The sympathetic nervous system may play a pivotal role in the development of primary (essential) hypertension, and is almost always involved in the increasingly common occurrence of postural hypotension. This report reviews the recent evidence for and against stress-induced activation of sympathetic activity leading to a hyperkinetic circulation as an initiating mechanism for most hypertension. Then, attention is directed to the role of altered sympathetic nervous system responsiveness in the development of postural hypotension. Finally, therapy for this syndrome is reviewed.

Animals↗
PubMed1992

Nonpharmacologic treatment of hypertension.

A variety of lifestyle modifications will lower both the blood pressure and various other cardiovascular risk factors that are frequently present in patients with hypertension. Numerous recent studies document the overall efficacy of some (weight reduction, sodium restriction, physical activity, moderation of alcohol) and the relative lack of effect of others (stress management and calcium, magnesium, and fish oil supplements). In particular, the Trials of Hypertension Prevention, Phase I (a control trial funded by the National Heart, Lung, and Blood Institute) provides important new data on the ability of these various modalities to prevent the development of hypertension, an equally or even more important goal than the reduction of already-established disease.

Humans↗
PubMed1992

Blood pressure measurement and monitoring.

Recent developments in blood pressure measurement have emphasized recordings taken outside the physician's office. Such readings can recognize the spuriously high levels recorded in "white coat" hypertension. Nocturnal and early morning readings can detect silent complications and impending cardiovascular accidents.

Blood Pressure↗
PubMed1992

Effects of antihypertensive therapy on insulin resistance.

In view of the likely prohypertensive effects of hyperinsulinemia and the presence of insulin resistance in primary hypertension, the effects of various antihypertensive therapies on insulin sensitivity need to be identified. The evidence strongly supports major beneficial effects of weight reduction and aerobic exercise. Deleterious effects have been shown for diuretics and most beta-blockers, whereas probable beneficial effects have been seen with alpha-blockers, one angiotensin converting enzyme inhibitor, and various calcium entry blockers. Improvement of insulin sensitivity and reduction of plasma insulin levels are desirable attributes of antihypertensive therapy that should be more carefully considered in the future.

Adrenergic alpha-Antagonists↗
PubMed1992

Lipid intervention trials in primary prevention: a critical review.

On the basis of six randomized primary intervention trials, major changes in the diagnosis and treatment of relatively mild hypercholesterolemia have been strongly advocated. This paper examines the data from these six trials which show a significant reduction in morbidity and mortality from coronary heart disease but no decrease in overall mortality because of concomitant increases of cancer and violent deaths in the treated half. These adverse effects cannot be decisively proven to be related to the reduction in cholesterol levels but they also cannot be disregarded as biological or statistical quirks. In view of the limited positive evidence and the serious reservations about negative effects, caution is advised in the advocacy of more widespread therapy of all people with even minimal degrees of hypercholesterolemia. In particular, the limited effectiveness and the large expense of such broad therapy threaten to aggravate further the critical health care cost crisis.

Adult↗