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Biomedical subjects

W H Stewart

Publications and source records attributed to W H Stewart.

At least 19 recordsLinked to original sources
PubMed1992

24-hour efficacy of once-daily diltiazem in essential hypertension.

The safety and effectiveness of a once daily formulation of diltiazem hydrochloride (diltiazem CD) in the treatment of essential hypertension was assessed in a total of 127 patients with supine diastolic blood pressures (DBP) of 95 to 110 mmHg randomized to diltiazem CD (n = 61) or placebo (n = 66). Patients were titrated to doses of 120, 240, or 360 mg to achieve DBP reduction to less than 90 mmHg. At end study diltiazem CD changed trough supine SBP and DBP by -8.4 +/- 1.7 (p = 0.0009) and -8.6 +/- 1.1 mmHg (p = 0.0075), respectively. Heart rate was not significantly changed (-1.3 +/- 1.1 beats/min, p = 0.4362). The average dose of diltiazem CD was 268 mg with 69% achieving a clinical response. A subset of 47 patients underwent ambulatory blood pressure monitoring to assess the consistency of the effect over the full 24-h dosing interval. Diltiazem CD lowered DBP and SBP throughout the dosing interval. The overall side effect profile was similar to placebo. This study provides evidence of 24-h efficacy of this new, once daily formulation of diltiazem.

Adolescent↗
PubMed1990

An assessment of diltiazem and hydrochlorothiazide in hypertension. Application of factorial trial design to a multicenter clinical trial of combination therapy.

This multicenter, factorial-design trial assessed the safety and additive antihypertensive efficacy of a slow-release (SR) formulation of diltiazem hydrochloride given alone or in combination with hydrochlorothiazide for treatment of mild to moderate hypertension. After a 4- to 6-week placebo run-in period, 297 qualifying patients were randomized to receive placebo, 1 of 4 doses of diltiazem SR monotherapy, 1 of 3 doses of hydrochlorothiazide monotherapy, or 1 of 12 possible combinations of diltiazem SR and hydrochlorothiazide for 6 weeks. A dose-related reduction in blood pressure was demonstrated for each drug as monotherapy and for the two drugs in combination. Absolute blood pressures of patients who received combination therapy were lower by an overall mean of 3.0 mm Hg diastolic and 8.0 mm Hg systolic vs diltiazem SR used alone and 3.5 mm Hg diastolic and 4.0 mm Hg systolic vs hydrochlorothiazide used alone. At the largest doses used, 50% of patients achieved goal blood pressure while taking hydrochlorothiazide, 57% while taking diltiazem SR, and 75% while taking combination therapy. Combination therapy was well tolerated. This trial clearly demonstrates that diltiazem SR and hydrochlorothiazide have additive antihypertensive effects.

Adult↗
PubMed1988

Systolic blood pressure response in three subgroups of hypertensives treated with sustained-release diltiazem.

Data from a long-term, open-label diltiazem trial were analyzed to test the hypothesis that the magnitude of systolic blood pressure (SBP) response to diltiazem is dependent on pretreatment levels. The study design included a 2- to 4-week placebo period to establish stable qualifying pressures. Patients devoid of significant coexisting diseases with diastolic blood pressures (DBPs) greater than or equal to 95 mm Hg or SBPs greater than or equal to 160 mm Hg were titrated on sustained-release diltiazem (60-180 mg b.i.d.) over 2-6 weeks. Titration goals were greater than or equal to 10% drop in DBP or greater than or equal to 15% in SBP. Patients were followed up to 20 months. Based on pretreatment blood pressure, patients were divided into three subgroups: isolated systolic hypertension (ISH) (SBP/DBP; greater than or equal to 160/less than 95 mm Hg), isolated diastolic hypertension (IDH) (less than 160/greater than or equal to 95 mm Hg), and combined systolic and diastolic hypertension (CSDH) (greater than or equal to 160/ greater than or equal to 95 mm Hg). SBP changed significantly from baseline for all three groups. However, the percent reduction in SBP was significantly greater for patients with baseline SBP greater than or equal to 160 mm Hg when compared with patients with baseline SBP less than 160 mm Hg (-10.3 +/- 0.7% vs. -4.4 +/- 0.6%). In comparing the ISH and CSDH patient groups, the CSDH group required a larger diltiazem dose to achieve a SBP response similar to the ISH group. Diltiazem was well tolerated with only a 5% dropout due to adverse effects of therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1979

The use of government to protect and promote the health of the public through nutrition.

There are broad requirements for translation of scientific knowledge in nutrition to public policy through the legislative process. First, it requires an ability to take highly objective, highly specific, scientifically derived facts--the stuff of scientific knowledge--and translate them into legislation based on highly subjective, quite general, broadly perceived values. Another requirement is to keep the level of uncertainty to tolerable levels during consideration of a legislative proposal. Finally, the governmental action proposed must conform to the perception held at that particular time of the role of government in carrying out the law. Three examples of the use of government to protect and promote the health of the public through nutrition are given. They illustrate very well the trials and tribulations of the untidy process of translating scientific knowledge in nutrition to public policy. Governmental action to improve the health of the general public through dietary means has been much a part of this country's policies. The augmentation of purchasing power of the poor, the distribution of surplus commodities to the indigent, the provision of meals to school children and the elderly, etc., are examples of govermental action. There will be further use of government to protect and promote the health of the public through nutrition. A basic requirement is further understanding of the relationship between nutrients and health through good scientific work.

Government Agencies↗
PubMed1979

Distribution-free regression analysis of grouped survival data.

Methods based on regression models for logarithmic hazard functions, Cox models, are given for analysis of grouped and censored survival data. By making an approximation it is possible to obtain explicitly a maximum likelihood function involving only the regression parameters. This likelihood function is a convenient analog to Cox's partial likelihood for ungrouped data. The method is applied to data from a toxicological experiment.

Animals↗