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Biomedical subjects

P Sleight

Publications and source records attributed to P Sleight.

299 records · Page 17Linked to original sources
PubMedDate not supplied

Beta blockade during and after myocardial infarction: an overview of the randomized trials.

Long-term beta blockade for perhaps a year or so following discharge after an MI is now of proven value, and for many such patients mortality reductions of about 25% can be achieved. No important differences are clearly apparent among the benefits of different beta blockers, although some are more convenient than others (or have slightly fewer side effects), and it appears that those with appreciable intrinsic sympathomimetic activity may confer less benefit. If monitored, the side effects of long-term therapy are not a major problem, as when they occur they are easily reversible by changing the beta blocker or by discontinuation of treatment. By contrast, although very early IV short-term beta blockade can definitely limit infarct size, more reliable information about the effects of such treatment on mortality will not be available until a large trial (ISIS) reports later this year, with data on some thousands of patients entered within less than 4 hours of the onset of pain. Our aim has been not only to review the 65-odd randomized beta blocker trials but also to demonstrate that when many randomized trials have all applied one general approach to treatment, it is often not appropriate to base inference on individual trial results. Although there will usually be important differences from one trial to another (in eligibility, treatment, end-point assessment, and so on), physicians who wish to decide whether to adopt a particular treatment policy should try to make their decision in the light of an overview of all these related randomized trials and not just a few particular trial results. Although most trials are too small to be individually reliable, this defect of size may be rectified by an overview of many trials, as long as appropriate statistical methods are used. Fortunately, robust statistical methods exist--based on direct, unweighted summation of one O-E value from each trial--that are simple for physicians to use and understand yet provide full statistical sensitivity. These methods allow combination of information from different trials while avoiding the unjustified direct comparison of patients in one trial with patients in another. (Moreover, they can be extended of such data that there is no real need for the introduction of any more complex statistical methods that might be more difficult for physicians to trust.) Their robustness, sensitivity, and avoidance of unnecessary complexity make these particular methods an important tool in trial overviews.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Blood-pressure reduction and cardiovascular risk in HOPE study.

In the Heart Outcomes Prevention Evaluation (HOPE) study, use of the angiotensin-converting-enzyme inhibitor ramipril was associated with a 22% relative risk reduction in cardiovascular death, myocardial infarction, or stroke, despite only a modest reduction in blood pressure (23.3 mm Hg systolic). To test the hypothesis that the benefits seen were not due to reduced blood pressure alone, we calculated blood-pressure-related risk estimates from the placebo group of the HOPE trial, and from earlier studies. We found that the benefits seen in HOPE were around three times greater than predicted from these calculations. In this well treated and largely normotensive population with coronary disease, but good left-ventricular function, the benefits from ramipril were additive to other proven therapies in normotensive patients and in those with higher baseline blood pressure.

Angiotensin-Converting Enzyme Inhibitors↗
PubMedDate not supplied

Is a slow pulse-rate a reliable sign of digitalis toxicity?

64 of 910 hospital patients taking digoxin had a ventricular rate of less than 60 beats/min. In only 6 out of 57 of those investigated further could a diagnosis of digoxin toxicity be made on clinical, electrocardiographic, and biochemical grounds. No reason for the slow heart-rate could be found in 42 patients. Excessive vagal effects of digoxin in resting subjects may cause the bradycardia found in these in patients in the absence of digitalis toxicity.

Adolescent↗
PubMedDate not supplied

Early rehabilitation after myocardial infarction.

129 men aged 60 years or less with a diagnosis of myocardial infarction were allocated to one of three programmes of management: normal treatment (control), exercise training, or extra advice. Outcome was evaluated after twelve weeks by exercise testing and standardised assessments of psychological state and social adjustment. There were no differences between the groups in psychological outcome, physical activity, or satisfaction with leisure or work. The "exercise" patients were more enthusiastic about their treatment and achieved higher work levels on exercise testing than the "advice" or "control" groups. Those who did not attend had a significantly worse outcome. At eighteen months the only significant findings were better outcomes, in terms of overall satisfaction, hours at work, and frequency of sexual intercourse, for the "advice" group. Exercise training increased confidence during exercise in the early stages of convalescence but the overall results show that rehabilitation is of little benefit to cardiac function, everyday life, or emotional state.

Adult↗
PubMedDate not supplied

Effects of long-term, once-daily administration of atenolol on ambulatory blood pressure of hypertensive patients.

We measured intraarterial, ambulatory blood pressure over a 24-h period in 12 subjects 24--63 years (mean 47.6) of age with newly diagnosed untreated hypertension. Measurements were performed both before and after 2--9 months of once-daily treatment with atenolol, a cardioselective beta-adrenoceptor antagonist. Significant reductions in arterial pressure (p less than 0.005) during treatment with atenolol (dose range 50--200 mg) were observed over the full 24-h period.

Adult↗
PubMedDate not supplied

Effect of rosary prayer and yoga mantras on autonomic cardiovascular rhythms: comparative study.

OBJECTIVE: To test whether rhythmic formulas such as the rosary and yoga mantras can synchronise and reinforce inherent cardiovascular rhythms and modify baroreflex sensitivity. DESIGN: Comparison of effects of recitation of the Ave Maria (in Latin) or of a mantra, during spontaneous and metronome controlled breathing, on breathing rate and on spontaneous oscillations in RR interval, and on blood pressure and cerebral circulation. SETTING: Florence and Pavia, Italy. PARTICIPANTS: 23 healthy adults. MAIN OUTCOME MEASURES: Breathing rate, regularity of breathing, baroreflex sensitivity, frequency of cardiovascular oscillations. RESULTS: Both prayer and mantra caused striking, powerful, and synchronous increases in existing cardiovascular rhythms when recited six times a minute. Baroreflex sensitivity also increased significantly, from 9.5 (SD 4.6) to 11.5 (4.9) ms/mm Hg, P<0.05. CONCLUSION: Rhythm formulas that involve breathing at six breaths per minute induce favourable psychological and possibly physiological effects.

Adult↗
PubMedDate not supplied

Involvement of the baroreceptor reflexes in the changes in blood pressure with sleep and mental arousal.

We have measured baroreflex sensitivity and blood pressure in 13 subjects during sleep and three stages of progressive mental arousal after waking. Baroreflex sensitivity was measured by correlating the increase in pulse interval with the increase in systolic pressure produced by an intravenous injection of 80 micrograms of phenylephrine. Blood pressure was measured directly from the brachial artery. During sleep, blood pressure fell and baroreflex sensitivity increased; with increasing mental arousal, blood pressure rose and baroreflex sensitivity decreased. These results suggest that baroreflex activity may be involved in the medium-term regulation of blood pressure during the day and night in addition to its recognized role in buffering acute changes in blood pressure.

Arousal↗
PubMedDate not supplied

When and how far should we lower blood pressure?

The accuracy of the diagnosis of mild or borderline hypertension is dubious. Perhaps up to one-third of such patients are wrongly categorized when more accurate measures are taken, largely because of the "defense" reaction. The recent trials of mild hypertension are discussed. Patients with a diastolic blood pressure in the range of 95 to 100 mm Hg should only begin treatment after careful assessment and consideration of other risk factors.

Blood Pressure↗