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Biomedical subjects

S G Sheps

Publications and source records attributed to S G Sheps.

At least 19 recordsLinked to original sources
PubMed2001

Martorell's hypertensive leg ulcer: case report and concise review of the literature.

Hypertensive leg ulcers (Martorell's ulcers) are a unique form of lower extremity ischaemic leg ulcer. First described by Martorell, and Hines and Farber in the 1940s, these ulcers are defined by pain disproportionate to the size of the ulcer, specific location on the lower extremity, female-to-male predominance, association with long-standing, often poorly, controlled hypertension, and healing response to specific antihypertensive agents. We present a case of Martorell's hypertensive ischaemic leg ulcer and a concise review of the 104 previous cases in the world's English literature. Hypertensive ischaemic leg ulcers will be more commonly recognised with a renewed appreciation of the existence of this clinical entity.

Aged↗
PubMed1999

Reflections on the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.

The editors of the Journal have asked us to review the background process to the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI), reflect on criticism, indicate where important changes occurred compared with its predecessor, and predict the purpose and content of the subsequent report.

Evaluation Studies as Topic↗
PubMed1999

Overview of JNC VI: new directions in the management of hypertension and cardiovascular risk.

Treatment recommendations for hypertension as outlined in the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) are constantly evolving and being refined as new information on the disease becomes evident. Uncontrolled hypertension is a major antecedent of stroke, heart failure, coronary heart disease, and end-stage renal disease. The increasing incidences of both cardiovascular and renal diseases fuel the need for improved control of hypertension. In fact, according to the National Health and Nutrition Examination Survey (NHANES), about 69% of Americans whose blood pressure is greater than 140/90 mm Hg are aware of it, about half are getting treatment for it, and only about one-quarter are adequately controlled. These observations fuel the need for improved patient management guidelines. JNC VI makes several changes from the previous JNC V to assist physicians in the diagnosis, treatment, and improved management of patients with hypertension. These changes include reporting adult blood pressure in two new ways, via staging and risk factor classification. A high-normal classification (systolic: 130 to 139 mm Hg, or diastolic: 85 to 89 mm Hg) is included in JNC VI because of the clinical importance of such blood pressure contributing to cardiovascular disease. Additionally, clinicians are advised to assign a patient to one of three risk categories that, in addition to hypertension stage, influence the decision to select antihypertensive drug therapy. Lifestyle modification is an important component at each stage. These and other changes and highlights of recent studies supporting the need for more intensive blood pressure control are discussed in this paper.

Adolescent↗
PubMed1999

A review of the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.

Hypertension is a major modifiable risk factor for cardiovascular diseases. After decades of improvement, population surveys demonstrate disturbing downward trends in the rates of awareness, treatment, and control of this disorder in recent years. Over this same time period, there has been a slight increase in the incidence of strokes, and a steady rise in the incidence of end-stage renal disease and the prevalence of congestive heart failure, conditions in which hypertension plays a prominent role. Results of recent studies support the possibility that lifestyle modifications may be effective for prevention of hypertension. Treatment of established hypertension involves lifestyle modifications and drug therapies designed to control blood pressure and reduce overall cardiovascular risk. Both threshold blood pressure levels for initiating drug therapy and goal blood pressure levels with treatment are individually determined based on the presence or absence of additional cardiovascular risk factors and hypertension target organ injury or clinical cardiovascular disease. Recent clinical trials support the value of lower goal blood pressures for patients with diabetes, heart failure, and renal disease. The presence or absence of comorbid conditions often determines specific drug choices. Diuretics and beta-blockers remain the drugs of choice in uncomplicated hypertension. Additional studies confirm the benefits of treating isolated systolic hypertension in the elderly. The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure provides a practical, evidence-based resource to help health care providers meet the public health challenges of preventing and controlling hypertension.

Antihypertensive Agents↗
PubMed1999

Detection and control of high blood pressure in the community : Do we need a wake-up call?

At the community level, the effect of national programs in increasing hypertension awareness, prevention, treatment, and control is unclear. This study evaluated the degree of detection and control of high blood pressure in a random population-based sample of Olmsted County, Minnesota, residents >/=45 years old, of whom 636 subjects among 1245 eligible residents agreed to participate. Home interview and home and office measurements of blood pressure were used to estimate awareness, treatment, and control rates for hypertension in the community. Mean blood pressures (+/-SD) were 138/80+/-20/12 mm Hg for men and 137/76+/-23/11 mm Hg for women. The overall prevalence of hypertension was 53%. The percentage of subjects with treated and controlled hypertension was 16.6%. Thirty-nine percent of subjects were unaware of their hypertension. Despite clinical trial evidence of reduced morbidity and mortality with antihypertensive therapy, recently reported national data suggest a leveling-off trend for treatment and control of hypertension. This population-based study supports these observations and suggests that at a community level, hypertension awareness and blood pressure control rates are suboptimal, presumably because of decreased attention to the detection and control of hypertension.

Aged↗
PubMed1999

[Comments on the 6th Report of the Joint American Committee on the Diagnosis and Treatment of Arterial Hypertension].

The new guidelines of the Joint American Committee for the diagnosis and treatment of high blood pressure emphasize the importance of improving the detection of the disease, and optimizing the treatment. The new classification of high blood pressure includes < 120/89 mmHg as optimum blood pressure goal, and for patients with diabetes or existing cardiac disease the blood pressure goal should be reduced to 130/85 mmHg. In this sense, the report also focuses on the need of accomplishing a diagnostic and therapeutic target of the global cardiovascular risk of the patient, taking into account other pathological situations.

Adolescent↗
PubMed1995

American National Standard for nonautomated sphygmomanometers. Summary report.

The Association for the Advancement of Medical Instrumentation develops voluntary standards for medical devices so that manufacturers might provide information on their product and basic safety and performance criteria that should be considered in qualifying the instrument for clinical use. American National Standards are generated through a consensus process by committees of experts in research, development, and design from user, industry, and government communities. Draft standards are made available for public review and become American National Standards after review by the American National Standards Institute. This report is a summary of the American National Standard that establishes both the safety and performance requirements of pneumatic and other nonautomated sphygmomanometers (especially mercury gravity and aneroid sphygmomanometers) used in the indirect measurement of blood pressure. This standard was developed by a consensus panel from academia, industry, and government; it updates the previous standard approved by the American National Standards Institute in 1986. This summary report does not cover all of the provisions of the revised 1994 American National Standard, thus users, researchers, and instrument designers should refer to the standard for detailed requirements.

Blood Pressure Determination↗
PubMed1995

Newer antihypertensive drugs.

We review three new classes of antihypertensive drugs: imidazolines, monatepil, and neutral endopeptidase inhibitors. Imidazolines are a new generation of central acting drugs. Because of their greater affinity for imidazoline receptors rather than alpha 2-adrenoreceptors, they cause less fatigue and dry mouth than the older central acting drugs. Monatepil is a single drug with both calcium antagonist and peripheral alpha 1-antagonist properties. This agent not only lowers blood pressure but also lowers serum cholesterol, an effect mediated by its alpha-antagonism, and has anti-lipid peroxidation properties. Monatepil might become an effective antiatherosclerosis drug. Neutral endopeptidase inhibitors lower blood pressure by inhibiting the metabolism of atrial natriuretic peptide and other vasoactive peptides.

Antihypertensive Agents↗
PubMed1994

Management of patients with hypertension: a hypertension clinic model.

OBJECTIVE: To describe a successful system for managing outpatients with hypertension. DESIGN: The establishment of a Hypertension Clinic in the Division of Hypertension at the Mayo Clinic was reviewed. MATERIAL AND METHODS: The assignment of responsibilities in the use of a team approach was evaluated, and the various types of patients encountered were compared. RESULTS: Our experience has shown optimal control of hypertension in outpatients with use of a team approach, including hypertension medical specialists, nurses, dietitians, and nurse-educators. Patients also assume an active role in their own care, particularly for compliance with medications and recommended lifestyle changes, attendance at the Hypertension Clinic for follow-up monitoring, and reporting of symptoms or side effects of drugs. Individual goals are established, and patients are managed by the nurse-clinicians. The physician reviews each patient's course at regular intervals or as needed for specific situations. Short-term patients, long-term patients, and those undergoing liver transplantation have successfully participated in this type of a program. CONCLUSION: The team approach for management of outpatients with hypertension effectively provides a support system for prompt attention to any questions or medical problems that arise. With such an approach, decreased morbidity and mortality from hypertension and associated cardiovascular disease have been achieved.

Blood Pressure Monitoring, Ambulatory↗
PubMed1994

Current role of automated ambulatory blood pressure and self-measured blood pressure determinations in clinical practice.

OBJECTIVE: To discuss the clinical indications for use of automated indirect blood pressure measurement (ABPM) and self-monitoring of blood pressure. DESIGN: Available equipment, variations in blood pressure, and settings in which ABPM may be useful are reviewed. RESULTS: Measurement of blood pressure in the physician's office may not reflect the usual blood pressure in other nonmedical environments, such as at work, at home, or during sleep. Self-measurement of blood pressure at home and work and ABPM can provide this additional information. These procedures can be useful not only for determining the presence of office or "white-coat" hypertension but also for assessing patients with both borderline hypertension in the office and target organ damage, those with drug resistance, and cases of episodic hypertension or hypotension. ABPM can also be used to assess very abrupt changes in blood pressure (hypertension or hypotension) and changes in heart rate and blood pressure during sleep. An abbreviated (6-hour) ABPM can be used to confirm increased office blood pressure measurements. Thus, a 6-hour ABPM has the potential to decrease the misclassification of subjects with hypertension or normotension and to limit costs. CONCLUSION: Accurate self-monitored blood pressure measurements can be integrated with office blood pressure determinations to assist in the management of many patients with hypertension. Both ABPM and self-monitoring of blood pressure can improve blood pressure control and practice efficiencies.

Adult↗
PubMed1994

Short-term (six hour), ambulatory blood pressure monitoring.

The feasibility of substituting a shorter duration of ambulatory blood pressure monitoring (ABPM) for 24h ambulatory monitoring to evaluate increased office BP measurements was investigated by analysing the records of 126 normal volunteers and 168 mildly hypertensive patients receiving placebo, including 22 studied on two occasions two months apart. The value to be predicted was the long-term awake BP mean for an individual (usual BP). Among the subjects studied on two occasions, there were no systematic differences between the two occasions and there was reasonable correspondence between the hourly patterns. Estimated variance components were substituted in a formula for the standard error of prediction (SEP) of the usual awake mean BP, for various durations and frequencies of monitoring. The lower limit of the SEP was determined by the patient-by-occasion component of variance. As few as six hours of monitoring with two to three readings/hour achieved most of the gain in precision obtainable by going from single BP readings toward continuous measurement during an entire awake period. In the remaining subjects, the influence of the day rhythm of BP on short-term monitoring was examined by measuring the differences in means of 6h periods from the full awake mean BP for starting times from 7 am to 3 pm. Among normotensives and hypertensive patients with near normal office BP (< 144/< 96 mmHg), there was little difference due to starting time. There was, however, a slight positive bias in the more hypertensive subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗