Search PubMed⌕ Search

Biomedical subjects

S G Sheps

Publications and source records attributed to S G Sheps.

At least 55 records · Page 3Linked to original sources
PubMed1990

Cost considerations of ambulatory blood pressure monitoring.

Automatic blood pressure monitoring has proved valuable in testing new antihypertensive drugs, providing greater precision at less cost. Results obtained by this method are better correlated with target-organ damage (e.g. left ventricular hypertrophy) than conventional office blood pressure measurements. A number of clinical conditions are better evaluated with ambulatory blood pressure monitoring than with conventional measurements, e.g. office (white coat) hypertension, episodic hypertension and intermittent hypertensive symptoms. An economic model suggests that appropriately constrained ambulatory blood pressure monitoring can be highly cost-effective in patients who are initially diagnosed as mildly hypertensive on the basis of repeated casual blood pressure measurements. Normative data are needed for populations by age, race, gender, body habitus and conditions such as pregnancy.

Antihypertensive Agents↗
PubMed1989

Clinical use of home and ambulatory blood pressure monitoring.

Blood pressure measurements made in the physician's office with a mercury-column sphygmomanometer traditionally have been the standard for diagnosis of hypertension and determination of the efficacy of antihypertensive agents. The utility of this measurement is limited, however, by the characteristic variability of blood pressure; office blood pressure readings are not always reliable indicators of pressures occurring throughout the course of the day. Therefore, blood pressure measurements performed by patients or family members at home and automatic ambulatory blood pressure monitoring are two supplementary methods used in the clinical management of hypertension. In this article, the role of these methods in the diagnosis of hypertension and other cardiovascular disorders as well as in the evaluation of the efficacy of antihypertensive therapy is addressed.

Antihypertensive Agents↗
PubMed1988

Correlation between verapamil plasma concentration and P-R prolongation in essential hypertension.

Plasma verapamil concentration was correlated with serial electrocardiographic P-R intervals in patients with essential hypertension receiving immediate-release (80 to 120 mg three times a day) or sustained-release (240 mg daily) verapamil. The mean P-R interval in 22 patients taking placebo and immediate-release verapamil was 0.18 second. The borderline first-degree atrioventricular block of three patients did not change during treatment. Plasma verapamil concentrations of patients with a P-R interval longer than 0.20 second and of those with a P-R interval of 0.20 second or less were 169 +/- 73 ng/mL and 63 +/- 8 ng/mL, respectively. Six patients taking sustained-release verapamil had a maximal mean P-R interval of 0.19 +/- 0.01 second during 24-hour ambulatory electrocardiographic monitoring. P-R intervals were 0.22 second or more in two patients, but they returned to normal by hour 7 for one and by hour 20 for the other patient. In summary, transient P-R prolongation occurred with oral verapamil therapy, but no patient, regardless of baseline P-R interval, developed high-grade atrioventricular block.

Delayed-Action Preparations↗
PubMed1988

Blood pressure load--a better determinant of hypertension.

Noninvasive ambulatory blood pressure monitoring was used to evaluate the diagnosis of hypertension in 168 untreated patients with essential hypertension. On the basis of overall office blood pressure--the mean of 12 measurements, 2 in each of three positions (supine, sitting, and standing) on 2 consecutive days--133 patients were diagnosed as having hypertension (diastolic blood pressure of 90 mm Hg or higher) and 35 as having borderline hypertension (diastolic blood pressure of less than 90 mm Hg). The mean blood pressures for those with hypertension and borderline hypertension were 149/99 and 135/87 mm Hg, respectively. The mean ambulatory diastolic blood pressure was 90 mm Hg or higher in 123 patients during awake hours and in 91 patients during 24 hours. The diastolic blood pressure loads (percentage of ambulatory diastolic blood pressures more than 90 mm Hg) in patients with hypertension and borderline hypertension, respectively, were 69% and 43% during awake hours and 59% and 35% during 24 hours. The systolic blood pressure loads (percentage of systolic readings more than 140 mm Hg) during awake and 24 hours were 56% and 48%, respectively, in patients with established hypertension and 31% and 26%, respectively, in those with borderline hypertension. Thus, ambulatory blood pressure monitoring and blood pressure load provide useful information for diagnosing hypertension.

Adult↗
PubMed1988

Carney's triad: guidelines for management.

Carney's triad--gastric leiomyosarcoma, pulmonary chondroma, and extra-adrenal paraganglioma--is a syndrome that occurs primarily in young women. To date, 28 patients with at least two of these individually unusual or rare neoplasms have been described. This updated case report of one of the originally described patients with Carney's triad highlights several clinically important features of this unusual syndrome: (1) the multicentricity of both the paragangliomas and the epithelioid leiomyosarcomas, (2) the often indolent progression of metastatic leiomyosarcoma, (3) the potential for late recurrences, and (4) the importance of distinguishing intra-adrenal from periadrenal catecholamine-producing tumors (paragangliomas). Localization of paragangliomas is facilitated by two relatively new techniques--131I-metaiodobenzylguanidine scanning (a scintigraphic technique with high specificity for catecholamine-producing tumors) and two-dimensional echocardiography (which can noninvasively localize and demonstrate the anatomic relationships of aorticopulmonary paragangliomas). In patients with this syndrome, new or recurrent tumors frequently manifest after unusually long asymptomatic intervals. We outline an approach for continued follow-up of patients with one or more of the three neoplasms that constitute the syndrome. Rigorous long-term screening of these patients should not only lead to early recognition and resection of recurrent or new tumors but also enhance our understanding of this intriguing syndrome.

Adrenal Gland Neoplasms↗
PubMed1988

Antihypertensive efficacy of lisinopril. Ambulatory blood pressure monitoring.

Noninvasive automatic ambulatory blood pressure monitoring during 24 hours in eight patients with moderate hypertension was used to determine the blood pressure response to lisinopril, an angiotensin-converting enzyme inhibitor. Office, 24-hour ambulatory, awake ambulatory, and sleep ambulatory diastolic blood pressures were decreased from 108 +/- 3, 98 +/- 8, 101 +/- 7, and 87 +/- 14 mm Hg, respectively, at baseline to 83 +/- 4 (P less than or equal to 0.0001), 82 +/- 7 (P less than 0.0001), 84 +/- 7 (P less than 0.0001), and 73 +/- 9 mm Hg (P less than 0.005), respectively, after 20 weeks of lisinopril treatment (dose range, 40 to 80 mg once daily). The diastolic blood pressure loads (percentages of ambulatory diastolic blood pressures more than 90 mm Hg) during 24 hours and during awake hours were 74% +/- 19% and 83% +/- 15%, respectively, at baseline and 24% +/- 19% (P less than 0.0001) and 29% +/- 21% (P less than 0.0001), respectively, during treatment. Heart rate was not altered by lisinopril. In conclusion, lisinopril is an effective antihypertensive agent for the treatment of moderate hypertension, and ambulatory blood pressures and diastolic blood pressure loads are useful for evaluating therapy for hypertension.

Adult↗
PubMed1988

Diagnostic evaluation of pheochromocytoma.

Progress in the diagnostic evaluation of pheochromocytoma has taken place in biochemical studies and localization techniques. Measurement of fractionated catecholamines and their metabolites has been subjected to sensitivity and specificity assessment. Magnetic resonance imaging and isotopic imaging have led to much better localization of extra-adrenal tumors. Flow cytometry of the DNA of the tumor cells very likely indicates the malignant nature of the tumor.

Adrenal Gland Neoplasms↗
PubMed1987

Renovascular hypertension: a rare cardiovascular manifestation of the Ehlers-Danlos syndrome.

The association of the Ehlers-Danlos syndrome with many cardiovascular abnormalities is well known. To our knowledge, however, renovascular hypertension due to renal arterial aneurysms has not previously been reported in patients with this disease. We describe a patient with type IV Ehlers-Danlos syndrome who had multiple systemic and bilateral renal arterial aneurysms and hypertension. The hypertension could have been related to compression of renal tissue or arteries (or both) by the large aneurysms, associated stenoses, or small peripheral renal infarctions. A review of all patients in whom the Ehlers-Danlos syndrome had been diagnosed at our institution between 1967 and 1985 revealed that 4 of the 200 patients had hypertension. Three of these patients, and probably all four, had secondary causes of hypertension: Cushing's syndrome, renal insufficiency, or renovascular hypertension (in the present case). We conclude that hypertension is rare in patients with the Ehlers-Danlos syndrome and that, if present, it most likely is secondary hypertension. A thorough search for secondary causes of hypertension should be undertaken in these patients.

Adult↗
PubMed1987

Arterial fibromuscular dysplasia.

Fibromuscular dysplasia is a nonatherosclerotic, noninflammatory vascular disease that involves primarily the renal and internal carotid arteries and less often the vertebral, iliac, subclavian, and visceral arteries. Although its pathogenesis is not completely understood, humoral, mechanical, and genetic factors as well as mural ischemia may play a role. The natural history is relatively benign, with progression occurring in only a minority of the patients. Typical clinical manifestations are renovascular hypertension, stroke, subarachnoid hemorrhage, abdominal angina, or claudication of the legs or arms. In patients with symptoms, percutaneous transluminal angioplasty has emerged as the treatment of choice in most involved vascular beds.

Arterial Occlusive Diseases↗
PubMed1987

Antihypertensive efficacy of sustained-release verapamil.

The antihypertensive effects of immediate-release (IR) verapamil were compared with those of sustained-release (SR) verapamil in 58 patients. After an open-label (IR verapamil) study, patients were randomized into a double-blind study to continue receiving the same dose of IR verapamil three times daily or an equivalent dose of SR verapamil (240 to 480 mg) once daily. Blood pressure decreased from 149/98 to 139/90 mmHg (p less than 0.01) with IR verapamil and from 150/98 to 136/88 mmHg (p less than 0.01) with SR verapamil. Ambulatory blood pressure monitoring showed a similar response for the two formulations. Diastolic pressure was less than 90 mmHg in approximately 67% of the IR verapamil group and 61% of the SR verapamil group. Mean trough plasma concentrations of verapamil were 70 and 59 ng/ml at 2 and 4 weeks, respectively, after treatment with IR verapamil; the corresponding values were 70 and 94 ng/ml for the SR verapamil group. SR verapamil administered once daily is an effective antihypertensive medication in a selected group of patients and could afford better compliance.

Blood Pressure↗
PubMed1987

Comparison of ketanserin and metoprolol in the treatment of essential hypertension.

Ketanserin, a serotonin receptor antagonist (S2), lowered blood pressure in patients with essential hypertension; at three months 72% (13/18) had a successful reduction in pressure. No marked orthostatic changes were noted. Older patients responded better when standing. Compared with metoprolol, ketanserin provided no significant difference in response at three months. With ketanserin, the heart rate was reduced only in the supine position, whereas it was reduced in the supine and standing positions with metoprolol. Response to ketanserin could not be predicted from baseline renin, aldosterone, or cortisol levels in blood, nor were there any changes in these factors or in plasma hydroxyindole levels with therapy. Ketanserin was generally well tolerated. Cholesterol values were significantly reduced with ketanserin, and there were no adverse hematologic or biochemical changes. Ketanserin should have a significant role in managing hypertension.

Blood Pressure↗
PubMed1986

Echocardiographic findings in pheochromocytoma.

M-mode and 2-dimensional echocardiography were used to study 26 consecutive, unselected patients with pheochromocytoma over a 3-year period. Only 1 patient had congestive heart failure; more than half had no cardiac symptoms or abnormalities. The most common (80% of patients) echocardiographic pattern was normal left ventricular (LV) mass with normal or even increased systolic performance. When LV mass was increased, LV systolic function was either normal or only borderline depressed in most of the patients. Patients with echocardiographic LV hypertrophy had symmetric thickening of ventricular walls; no case of asymmetric septal hypertrophy was found. There was no correlation between 24-hour urinary norepinephrine excretion and any of the echocardiographic variables studied. In some patients, increased LV wall thicknesses did not correlate with increased LV mass as calculated by the Woythaler echocardiographic method. Left atrial enlargement was not seen in any patient, including those with increased LV mass. The electrocardiogram and echocardiogram may be discordant: Electrocardiographic LV hypertrophy was seen in 6 patients, of whom 5 had normal echocardiographic LV mass. In patients with pheochromocytoma who have no cardiac symptoms or other clinical evidence of cardiac involvement, echocardiographic findings are usually normal.

Adrenal Gland Neoplasms↗
PubMed1986

Verapamil and 24-hour ambulatory blood pressure monitoring in essential hypertension.

The antihypertensive effects of oral regular and slow-release verapamil, a calcium-channel blocking agent, were evaluated in 22 patients with mild to moderate hypertension (sitting diastolic blood pressure [DBP] 95 to 112 mm Hg). The dose required to control blood pressure varied from 80 to 120 mg, 3 times a day. All patients received regular verapamil for a further 3 to 4 months, when systolic blood pressure (SBP) and DBP had risen from the end of the open-label phase. During a double-blind phase patients were randomly assigned to continue the same dose of regular verapamil, 3 times a day, or an equivalent daily dose of sustained-release verapamil (240 to 360 mg once a day). Seven of the 11 patients on regular and 3 of the 11 on sustained-release verapamil were also taking diuretics. This antihypertensive program was continued for at least 4 weeks. During the efficacy period, 24-hour ambulatory blood pressure monitoring was carried out. Mean 24-hour SBP and DBP were 133 +/- 20 and 89 +/- 13 mm Hg, respectively, on regular and 131 +/- 22 and 87 +/- 12 mm Hg, respectively, on sustained-release verapamil. There were no statistically significant differences noted between the 2 groups. Mean SBP and DBP varied similarly during awake and sleep hours with both formulations of verapamil. With regular verapamil, SBP was 139 +/- 18 and 124 +/- 20 mm Hg and DBP 92 +/- 11 and 84 +/- 13 mm Hg during awake and sleep hours, respectively; with sustained release, SBP was 138 +/- 21 and 122 +/- 22 mm Hg and DBP 92 +/- 10 and 80 +/- 10 mm Hg during awake and sleep hours, respectively. Heart rate fell during the entry period and continued during the entire study period. No other adverse effects were noted during the double-blind phase. In summary, verapamil is an effective antihypertensive medication and can be administered once a day as a sustained-release preparation; it is most useful in patients in whom adrenergic blocking drugs are indicated.

Administration, Oral↗
PubMed1986

Antihypertensive efficacy of pinacidil--automatic ambulatory blood pressure monitoring.

Forty-three patients with mild essential hypertension were randomized into two double-blind studies: pinacidil vs. placebo or pinacidil vs. hydralazine. Pinacidil (62 +/- 18 mg/day) decreased office systolic and diastolic blood pressures from 145 to 137 mm Hg and from 98 to 89 mm Hg, respectively, after 6 weeks of therapy. Similarly, hydralazine (128 +/- 28 mg/day) reduced supine systolic blood pressure from 140 to 134 mm Hg and supine diastolic blood pressure from 93 mm Hg to 84 mm Hg. Significant tachycardia was not noted with either drug. Ambulatory blood pressure was monitored for 24 h during the placebo-washout and efficacy phases with both pinacidil and hydralazine. Mean 24-h blood pressure was 128 systolic and 81 diastolic with pinacidil and 121 systolic and 76 diastolic with hydralazine. Reduction in awake hypertensive diastolic blood pressure was significant for both pinacidil and hydralazine. Normal sleep diastolic blood pressure was not reduced by pinacidil but was reduced by hydralazine. Side-effects with both drugs included edema, headache, and palpitations. These data demonstrate that pinacidil is as effective an antihypertensive agent as hydralazine.

Adult↗
PubMed1986

Pharmacodynamics of midodrine, an antihypotensive agent.

Midodrine is an orally active adrenergic agonist useful in the treatment of hypotension. We have investigated the pharmacodynamics of its active metabolite after oral midodrine therapy in nine patients with severe orthostatic hypotension. Peak plasma levels of the metabolite were reached in 60 to 90 minutes and ranged from 25 to 56 ng/ml. The mean values for distribution volume, plasma clearance, and t1/2 were 4.0 L/kg, 23 ml/min/kg, and 2.1 hours, respectively. Heart rate increased after 5 to 10 mg doses and the increases were statistically significant (P less than 0.05) at 120 minutes. An apparent increase in blood pressure was not statistically significant. The patients said that they felt better.

Administration, Oral↗
PubMed1986

Efficacy of sustained-release verapamil: automatic ambulatory blood pressure monitoring.

The potential antihypertensive effect of sustained-release (SR) verapamil was compared to immediate-release (IR) verapamil in a group of patients with essential hypertension. All patients were withdrawn from their previous antihypertensive medication(s) and were entered into an open-label IR verapamil study (dose varying from 80 to 120 mg TID). Patients were subsequently randomized in a double-blind fashion to continue the same dose of IR verapamil or an equivalent dose of SR verapamil. Automatic ambulatory blood pressure recordings were carried out with a Del Mar Avionics PIII Unit in eight patients who were randomized into the SR group. An initial 24-hour recording was performed on the IR verapamil group during the open-label phase and repeated following treatment with SR verapamil. Mean 24-hour systolic blood pressure (SPB) and diastolic blood pressure (DBP) were 143 +/- 18 mmHg and 89 +/- 6 mmHg, respectively, on IR verapamil and 142 +/- 22 and 90 +/- 6 mmHg, respectively, on SR verapamil. There were no statistically significant differences noted between the two groups. Mean SBP and DBP varied similarly during waking and sleeping periods with IR and SR verapamil: With IR verapamil, SBP was 139 +/- 18 and 124 +/- 20 mmHg and DBP was 92 +/- 11 and 84 +/- 13 mmHg during waking and sleeping hours, respectively; with SR verapamil, SBP was 138 +/- 21 and 122 +/- 22 mmHg and DBP 92 +/- 10 and 80 +/- 10 mmHg during waking and sleeping hours, respectively. DBP was less than or equal to 90 mmHg in approximately 70% and 60% of patients in the IR verapamil and SR verapamil groups, respectively. Trough plasma levels of 92 +/- 44 and 67 +/- 32 ng/ml were measured by HPLC, 2 and 4 weeks, respectively, after treatment with IR verapamil. During a similar time interval, SR verapamil revealed plasma levels of 64 +/- 59 and 92 +/- 57 ng/ml, respectively. No correlation between change in DBP and plasma level of verapamil was demonstrated. No significant change in heart rate was observed during the 4-week period. In summary, verapamil is an effective antihypertensive medication and can be administered once a day as a slow-releasing preparation; it is most useful in patients in whom adrenergic blocking drugs are indicated.

Adult↗