Showing papers by "Henry R. Black published in 1991"

Resistant hypertension in a tertiary care clinic.

Abstract: Study Objective. To determine the prevalence of resis tant hypertension in a tertiary care facility, the frequency of its various causes, and the results of treatment. Design. Review of clinic records of all patients seen for the first time between January 1, 1986, and December 31, 1988. Methods. Patients meeting criteria for resistant hyper tension were examined for appropriateness of their medical regimen, presence of secondary causes of hypertension, noncompliance, interfering substances, drug interactions, office resistance (elevated blood pressure in the office only while receiving treatment), and other potential causes of resistance. Results. Of the 436 charts reviewed, 91 were those of patients who met criteria for resistant hypertension and were seen more than once. The most common cause was a suboptimal medical regimen (39 patients), fol lowed by medication intolerance (13 patients), previously undiagnosed secondary hypertension (10 patients), noncompliance (nine patients), psychiatric causes (seven pa tients), office resistance (two patients), an interfering substance (two patients), and drug interaction (one pa tient). Blood pressure control, defined as diastolic blood pressure of 90 mm Hg or less and systolic blood pressure of 140 mm Hg or less for patients aged 50 years or less ( 60 years), was achieved in 48 (53%) of those 91 patients. Another 10 had significant improvement in their blood pressure (>=15% decrease in diastolic blood pressure). Of patients whose blood pres sure was controlled after they had been on a suboptimal regimen, the two most frequently used therapeutic strat egies were to add (50%) or modify (24%) diuretic ther apy or to add (50%) or increase the dose of (12%) a newer drug, either a calcium entry blocker or angiotensin-converting enzyme inhibitor. Conclusion. We conclude that resistant hypertension is common in a tertiary care facility and that a subopti mal regimen is the most common reason. Furthermore, in the majority of these patients, the elevated blood pressures can be controlled or significantly improved. (Arch Intern Med. 1991;151:1786-1792)

Drug treatment of hypertension in patients with diabetes mellitus.

Abstract: Patients with diabetes mellitus have an increased prevalence of hypertension and its vascular consequences, including coronary and cerebrovascular disease. Drug treatment of hypertension in diabetic subjects is fraught with potential difficulties, including the altered efficacy of medications, the increased risk of side effects, and the possibility of worsening glycemic control and increasing serum lipid levels. Despite these difficulties, treatment is an important part of reducing morbidity and mortality from vascular events. Antihypertensive therapy may also have the potential to prevent or retard the development of diabetic nephropathy. In this article, we discuss the efficacy and metabolic and nonmetabolic side effects of the various classes of antihypertensive agents in patients with diabetes mellitus and suggest a stepped-care approach to the drug treatment of patients with hypertension and diabetes.

Part 6: Baseline physical examination findings

Abstract: Presented are results of the physical examinations performed on the participants randomized into the Systolic Hypertension in the Elderly Program (SHEP). Included are data on 4,226 of the total cohort of 4,736 (89.1%). Randomized participants not included were examined, but at least one element of the physical examination was not recorded. All centers performed the physical examinations in a standardized fashion (see Methods). Data are presented by age (in 5 -year increments), by race (black or white), by systolic blood pressure (SBP) at randomization (by 10-mm Hg intervals), and by whether participants were on medication when initially screened for SHEP. The actual numbers and percentages or the means and standard deviations are given in each table. In addition to the data presented in detail, other findings not directly pertinent to the cardiovascular system are noted and summarized at the end.