Showing papers by "Nemat O. Borhani published in 1995"

Subclinical Disease as an Independent Risk Factor for Cardiovascular Disease

Abstract: Background The primary aim of the present study was to determine the relation between measures of subclinical cardiovascular disease and the incidence of clinical cardiovascular disease among 5201 adults 65 years of age or older who were participating in the Cardiovascular Health Study. Methods and Results A new method of classifying subclinical disease at baseline examination in the Cardiovascular Health Study included measures of ankle-brachial blood pressure, carotid artery stenosis and wall thickness, ECG and echocardiographic abnormalities, and positive response to the Rose Angina and Claudication Questionnaire. Participants were followed for an average of 2.39 years (maximum, 3 years). For participants without evidence of clinical cardiovascular disease at baseline, the presence of subclinical disease compared with no subclinical disease was associated with a significant increased risk of incident total coronary heart disease including CHD deaths and nonfatal MI and angina pectoris for both men and ...

Temporal patterns of antihypertensive medication use among older adults, 1989 through 1992. An effect of the major clinical trials on clinical practice?

Abstract: Objective. —To describe the changing patterns of antihypertensive medication use in the years immediately before and after the publication of the results of three major clinical trials of the treatment of hypertension in older adults. Design. —In this cohort study, adults 65 years or older were examined annually on four occasions between June 1989 and May 1992, and the use of antihypertensive medications was assessed by inventory at each visit. The four visits defined the boundaries of three study periods. For each study period, participants receiving antihypertensive therapy were either continuous users (n = 1667, 1643, and 1605, respectively) or starters (n = 157,142,120) of hypertensive therapy. The large clinical trials that convincingly proved the efficacy and safety of low-dose diuretic therapy in older adults were published during the latter parts of period 2 and the early parts of period 3. Results. —Among starters, the proportion initiating therapy on diuretics increased from 35.9% in period 2 to 47.5% in period 3, significantly so among women ( P =.04). The proportions initiating other drugs displayed no significant trends. Among continuous users, the use of diuretics, β-blockers, and vasodilators generally decreased over the 3-year period, while the use of calcium channel blockers and angiotensin-converting enzyme inhibitors increased significantly in each of the three periods ( P P =.03) to almost a complete halt during period 3 (0.2% decline). The rate of increase in the use of calcium channel blockers slowed significantly ( P =.01) between period 1 (+6.7%) and period 3 (+2.8%). Conclusions. —Although other factors such as cost may have been important, the temporal trends in antihypertensive drug therapy coincided in time with and may have reflected in part the influence of the major clinical trials on the patterns of clinical practice. ( JAMA . 1995;273:1436-1438)

Combinations of Potassium, Calcium, and Magnesium Supplements in Hypertension

Abstract: Dietary intakes of potassium, calcium, and magnesium have each been reported to lower blood pressure, but the extent of blood pressure reduction in epidemiological studies and clinical trials has tended to be small and inconsistent. We hypothesized that combinations of these mineral supplements would lower blood pressure and that the reductions would be greater than that usually reported in studies of each cation alone. One hundred twenty-five patients 82 men and 43 women) with untreated mild or borderline hypertension were randomly assigned to daily treatment with one of the following four regimens: 60 mmol potassium and 25 mmol (1000 mg) calcium, 60 mmol potassium and 15 mmol (360 mg) magnesium, calcium and magnesium, or placebo. Standardized clinic blood pressure measurements were obtained on 3 days at baseline and after 3 and 6 months of treatment. At baseline, systolic and diastolic blood pressures (mean +/- SD) were 139 +/- 12 and 90 +/- 4 mm Hg, respectively, and dietary intakes of potassium, calcium, and magnesium were 77 +/- 32, 19 +/- 13, and 12 +/- 52 mmol/d, respectively. The mean differences (with 95% confidence intervals) of the changes in systolic and diastolic blood pressures between the treatment and placebo groups were not significant: -0.7 (-4.3 to +2.9) and -0.4 (-2.9 to +2.1) for potassium and calcium, -1.3 (-4.4 to +1.8) and 0.4 (-2.5 to +3.3) for potassium and magnesium, and +2.1 (-1.8 to +6.0) and +2.2 (-1.0 to +5.4) for calcium and magnesium. In conclusion, this trial provides little evidence of an important role of combinations of cation supplements in the treatment of mild or borderline hypertension.

Hypertension in the elderly: correction and clarification.

Abstract: To the Editor. —I read with great interest the article by Dr Mulrow and colleagues.1I congratulate both the editors ofJAMAand the authors for bringing the results of this excellent work to the attention of the medical community. There is, however, an error and an oversight in the article. The legend to Figure 11(p1934)indicates that "HTN Coop" stands for "Hypertension Detection and Follow-up Program Cooperative Group." Yet the reference next to "HTN Coop" given in the body of Figure 1 is number 3. This is not one of the Hypertension Detection and Follow-up Program (HDFP) articles as they appear in the author's reference list (eg, references 4,31, and 48). Rather, their reference number 3 is an article from the Hypertension-Stroke Cooperative Study Group.2The question is whether the data in Figure 1 represent results from the HDFP or the Hypertension-Stroke Cooperative Study Group. Furthermore, in

Multicenter Isradipine Diuretic Atherosclerosis Study (Midas): Rationale, Design, and Description of Trial Patients

Abstract: Diseases caused by atherosclerosis, such as diseases of the heart, are the leading cause of death and disability. For example, in the United States diseases of the heart account for more than 36% of deaths each year. This is so despite the impressive decline in mortality from cardiovascular diseases reported in the United States in recent years. The number of premature deaths attributed to coronary heart disease exceeds 500,000 each year. The number of hospitalizations for acute myocardial infarction is more than 600,000 a year; this is more than one hospital admission every minute of each day throughout the year. In addition, there are many thousands of individuals who suffer from diseases caused by atherosclerosis which are in a stage considered “subclinical;” these people are not counted in the available statistics. Yet, they are just as vulnerable to premature death and disability as those who have overt clinical manifestation of the disease. With the advent of noninvasive diagnostic techniques, such as B-mode ultrasound, these “subclinical” stages of diseases caused by atherosclerosis can be easily identified in population studies. Indeed, this has been done, and the findings are not very encouraging. In a recent report from the Cardiovascular Health Study (CHS), a longitudinal study of 5,000 men and women over the age of 65 years, it was stated that more than 37% of the members of the cohort had evidence of subclinical atherosclerotic diseases, (e.g., common carotid wall thickness in the upper 80th percentile, or carotid artery stenosis of more than 25%), with no history or symptoms of any clinical manifestation of atherosclerosis [1].