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Biomedical subjects

N M Kaplan

Publications and source records attributed to N M Kaplan.

At least 37 records · Page 2Linked to original sources
PubMed2000

Angiotensin II-receptor blockers: will they replace angiotensin-converting enzyme inhibitors in the treatment of hypertension?

In the past few years, angiotensin II-receptor blockers have become available and are being heavily marketed and increasingly used. In various ways they differ from angiotensin-converting enzyme inhibitors (ACEIs). Until outcome data are available, they should continue to be used primarily in patients who should receive an ACEI but cannot tolerate the drug because of cough.

Angiotensin Receptor Antagonists↗
PubMed2000

The dietary guideline for sodium: should we shake it up? No.

The current US dietary guideline for sodium is a limit of 2.4 g/d or 6 g NaCl/d. This amount of sodium is far in excess of any physiologic need and is likely an essential though not by itself sufficient primary cause of hypertension as well as a contributor to many other cardiovascular and renal abnormalities. The evidence incriminating the current excessive consumption of sodium derives from epidemiologic, experimental, and interventional data, most of which support a threshold of approximately 100 mmol/d for the harmful effects of sodium to be expressed. Although the current recommendation may not be low enough to go below that threshold, it is an appropriate and attainable goal for now.

Animals↗
PubMed2000

Diuretics as a basis of antihypertensive therapy. An overview.

Diuretics have been, except for during a few recent years, the most commonly used therapy for hypertension. Although use of these agents fell significantly in the early 1990s, since then it has begun to increase again. Their recent return to popularity reflects 3 major factors: (i) recognition of the effectiveness of much lower dosages than previously used, thereby providing good antihypertensive activity with fewer adverse effects; (ii) the excellent reductions in morbidity and mortality achieved by low dosage diuretic-based therapy in multiple randomised controlled trials in elderly patients with hypertension; and (iii) the increasing recognition that some diuretic-induced shrinkage of effective blood volume is essential for the adequate treatment of many, if not most, patients with hypertension. Therefore, diuretics will probably continue to be the basis for antihypertensive therapy, and the indapamide sustained release 1.5 mg formulation provides all the essential characteristics of diuretic therapy.

Antihypertensive Agents↗
PubMed2000

A cardioprotective approach to the management of hypertension.

In view of the currently inadequate control of hypertension, multiple guidelines have recently been published to help improve the management of this increasingly common condition. In most regards these guidelines are in agreement, in particular as to the need for overall cardiovascular risk assessment, the selection of appropriate initial therapy, the need for long-acting formulations, and for a diuretic as part of most regimens.

Antihypertensive Agents↗
PubMed2000

Guidelines for the management of hypertension.

In Canada, as in all industrialized countries, hypertension is the most common indication for visits by adults to doctors, and is becoming even more prevalent largely as a consequence of two factors--the increasing age and the increasing obesity of the population. The control of hypertension in Canada and elsewhere is woefully inadequate. Recent guidelines from the United States and Canada emphasize similar principles designed to improve control. These include the assessment of overall cardiovascular risk, careful measurements of blood pressure, effective use of lifestyle modifications, targeted antihypertensive drug therapy and various manoeuvres to improve long term adherence to therapy. Cardiologists will play an increasingly important role in managing hypertension as a way to reduce the cardiovascular diseases that remain the leading causes of morbidity and mortality.

Adult↗
PubMed1999

Angiotensin II receptor antagonists in the treatment of hypertension.

The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VI) includes recommendations for the assessment of overall cardiovascular risk and the need for active antihypertensive drug therapy. Once the decision to initiate antihypertensive drug therapy has been made, JNC-VI recommends one of three paths for the choice of initial therapy: one path for patients with uncomplicated hypertension, another for those with well-defined indications for certain drugs and a third path for patients with various concomitant conditions in which one or another drug has favorable effects. At this time, the place for the newest class of antihypertensive drugs, the angiotensin II receptor antagonists, remains uncertain. Currently, they are considered reasonable alternatives for patients who have a compelling need for an angiotensin-converting enzyme (ACE) inhibitor but develop a cough while taking this medication. When data from ongoing trials become available, angiotensin II receptor antagonists may prove to be a good choice for initial therapy in many patients because of the favorable side effect profile of this class of drugs.

Algorithms↗
PubMed1999

Diuretics: correct use in hypertension.

The use of diuretics for the treatment of hypertension had fallen significantly from 1990 until 1997, when their use again began to increase. Their recent return to popularity reflects 3 major factors: (1) the recognition of the effectiveness of much lower doses than used previously, thereby providing good antihypertensive action with fewer side effects; (2) the excellent reductions in morbidity and mortality achieved by low-dose diuretic-based therapy in multiple, randomized controlled trials in elderly hypertensives; and (3) the increasing recognition that some diuretic-induced shrinkage of effective blood volume is essential for adequate treatment of many, if not most, hypertensives.

Controlled Clinical Trials as Topic↗
PubMed1998

Treatment of hypertension: insights from the JNC-VI report.

The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VI) provides updated guidelines for the treatment of hypertension. Antihypertensive drug therapy may be initiated either after a trial of lifestyle modifications or immediately after the diagnosis is made, depending on the patient's other cardiovascular risk factors and the presence of clinical cardiovascular disease. In general, therapy may begin with diuretics or beta-adrenergic blockers in patients under age 65, unless a concomitant condition warrants another, more tailored choice. Low dosages should be used initially, but if the blood pressure is not successfully reduced to 140/90 mm Hg or below, another drug should be added or should replace the initial choice. General principles of therapy include the use of once-a-day formulations and combination drugs as well as cost considerations.

Algorithms↗
PubMed1998

JNC VI guidelines.

Explore the source record for details and available documents.

Antihypertensive Agents↗
PubMed1998

Executive summaries on hypertension II. Choices of initial drug therapy.

Once the need for drug therapy has been determined, the JNC-6 report provides three pathways for the choice of therapy: for uncomplicated patients, a diuretic or beta-blocker; for patients with diabetic nephropathy, isolated systolic hypertension, congestive heart failure or systolic dysfunction after myocardial infarction, specific drugs are compellingly indicated; for other conditions, certain drugs that provide favorable effects are recommended. Whatever drug is chosen, long-acting preparations that provide 24-h coverage with one daily dose are recommended.

Journal Article↗
PubMed1998

Executive summaries on hypertension III. Managing difficult-to-treat hypertension.

Hypertension may be difficult to treat for multiple reasons. First some patients have pseudoresistance, displaying high pressure readings only in the physician's office from the "white coat" effect. Second, volume expansion, usually from inadequate diuretic therapy, is the most common reason for true resistance. A number of other mechanisms may be involved, which can usually be ascertained and overcome.

Journal Article↗