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Stephen T. Miller

Bio: Stephen T. Miller is an academic researcher from University of Tennessee Health Science Center. The author has contributed to research in topics: Blood pressure & Ambulatory blood pressure. The author has an hindex of 21, co-authored 50 publications receiving 2526 citations. Previous affiliations of Stephen T. Miller include University of Tennessee & Oklahoma State University Center for Health Sciences.

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Journal ArticleDOI
Paul K. Whelton, Lawrence J. Appel, Jeanne Charleston, Arlene Taylor Dalcin, Craig K. Ewart, Linda P. Fried, Delores Kaidy, Michael J. Klag, Shiriki K. Kumanyika, Lyn Steffen, W. Gordon Walker, Albert Oberman, Karen Counts, Heidi Hataway, James M. Raczynski, Neil Rappaport, Roland Weinsier, Nemat O. Borhani, Edmund Bernauer, Patricia A. Borhani, Carlos de la Cruz, Andrew Ertl, Doug Heustis, Marshall Lee, Wade Lovelace, Ellen O'Connor, Liz Peel, Carolyn Sugars, James O. Taylor, Beth Walker Corkery, Denis A. Evans, Mary Ellen Keough, Martha Clare Morris, Eleanor Pistorino, Frank M. Sacks, Mary Cameron, Sheila Corrigan, Nancy King Wright, William B. Applegate, Amy Brewer, Laretha Goodwin, Stephen T. Miller, Joseph T. Murphy, Judy Randle, Jay M. Sullivan, Norman L. Lasser, David M. Batey, Lee Dolan, Sheila Hamill, Pat Kennedy, Vera I. Lasser, Lewis H. Kuller, Arlene W. Caggiula, N. Carole Milas, Monica E. Yamamoto, Thomas M. Vogt, Merwyn R. Greenlick, Jack F. Hollis, Victor J. Stevens, Jerome D. Cohen, Mildred Mattfeldt-Beman, Connie Brinkmann, Katherine Roth, Lana Shepek, Charles H. Hennekens, Julie E. Buring, Nancy R. Cook, Ellie Danielson, Kim Eberlein, David Gordon, Patricia R. Hebert, Jean MacFadyen, Sherry L. Mayrent, Bernard Rosner, Suzanne Satterfield, Heather Tosteson, Martin Van Denburgh, Jeffrey A. Cutler, Erica Brittain, Marilyn Farrand, Peter G. Kaufmann, Ed Lakatos, Eva Obarzanek, John Belcher, Andrea Dommeyer, Ivan Mills, Peggy Neibling, Margo Woods, B.J. Kremen Goldman, Elaine Blethen 
04 Mar 1992-JAMA
TL;DR: Weight reduction is the most effective of the strategies tested for reducing blood pressure in normotensive persons, and sodium reduction is also effective.
Abstract: Objective. —To test the short-term feasibility and efficacy of seven nonpharmacologic interventions in persons with high normal diastolic blood pressure. Design. —Randomized control multicenter trials. Setting. —Volunteers recruited from the community, treated and followed up at special clinics. Participants. —Of 16821 screenees, 2182 men and women, aged 30 through 54 years, with diastolic blood pressure from 80 through 89 mm Hg were selected. Of these, 50 did not return for follow-up blood pressure measurements. Interventions. —Three life-style change groups (weight reduction, sodium reduction, and stress management) were each compared with unmasked nonintervention controls over 18 months. Four nutritional supplement groups (calcium, magnesium, potassium, and fish oil) were each compared singly, in double-blind fashion, with placebo controls over 6 months. Main Outcome Measures. —Primary: change in diastolic blood pressure from baseline to final follow-up, measured by blinded observers. Secondary: changes in systolic blood pressure and intervention compliance measures. Results. —Weight reduction intervention produced weight loss of 3.9 kg (P .05). Conclusions. —Weight reduction is the most effective of the strategies tested for reducing blood pressure in normotensive persons. Sodium reduction is also effective. The long-term effects of weight reduction and sodium reduction, alone and in combination, require further evaluation. (JAMA. 1992;267:1213-1220)

717 citations

Journal ArticleDOI
TL;DR: It is concluded that the treatment of selected elderly patients in a specialized geriatric rehabilitation unit improves function, decreases the risk of nursing home placement, and may reduce mortality.
Abstract: We conducted a randomized trial in a community rehabilitation hospital to determine the effect of treatment in a geriatric assessment unit on the physical function, institutionalization rate, and mortality of elderly patients. Functionally impaired elderly patients (mean age, 78.8 years) who were recovering from acute medical or surgical illnesses and were considered at risk for nursing home placement were randomly assigned either to the geriatric assessment unit (n = 78) or to a control group that received usual care (n = 77). The two groups were similar at entry and were stratified according to the perceived risk of an immediate nursing home placement. After six months, the patients treated in the geriatric assessment unit had significantly more functional improvement in three of eight basic self-care activities (P less than 0.05). Those in the lower-risk stratum had significantly more improvement in seven of eight self-care activities. Both six weeks and six months after randomization, significantly more patients treated in the geriatric assessment unit than controls (79 vs. 61 percent after six months) were residing in the community. During the year of follow-up, the control patients had more nursing home stays of six months or longer (10 vs. 3; P less than 0.05). However, there was no difference between the groups in the mean number of days spent in health care facilities (acute care hospital, nursing home, or rehabilitation hospital). Survival analysis showed a trend toward fewer deaths among the patients treated in the geriatric assessment unit, and mortality was significantly reduced in the patients considered to be at lower risk of immediate nursing home placement (P less than 0.05). We conclude that the treatment of selected elderly patients in a specialized geriatric rehabilitation unit improves function, decreases the risk of nursing home placement, and may reduce mortality. The beneficial effects on mortality and function appear greatest for patients at a moderate rather than high risk of nursing home placement.

370 citations

Journal ArticleDOI
TL;DR: It is concluded that decisions about patients' functional level should be based on performance testing, and patients' own ratings are most accurate, followed by family ratings.
Abstract: BACKGROUND. Important clinical decisions often hinge on patients' functional status. Previous studies have shown disagreement among sources of ratings of patients' functional status. This study compared patient self-ratings, family member ratings, and physician ratings of patient function to performance-based functional testing criteria. METHODS. Five activities of daily living of 73 older patients were studied at admission to a rehabilitation unit following discharge from an acute care community hospital. Data were collected from patients, family members, and physicians and were compared with performance-based function testing. RESULTS. Patient ratings were significantly more accurate than physician ratings for walking, transferring, and telephoning. Patients were significantly more accurate than family members for rating walking and telephoning, but patients were not significantly more accurate than family members or physicians for rating eating or dressing. CONCLUSIONS. We conclude that decisions about...

172 citations

Journal ArticleDOI
27 Feb 1987-JAMA
TL;DR: Older patients undergoing cataract surgery with intraocular lens implantation were associated with improved vision and improved objective function in most patients by four months after surgery, and these improvements were maintained at one year.
Abstract: We conducted a prospective study of 293 elderly patients undergoing cataract surgery with intraocular lens implantation to determine the impact of the surgery on vision and on subjective and objective measures of patient function Visual acuity in the surgical eye improved from a mean of 20/100 before surgery to 20/40 four months after surgery; improvement was maintained at one year Positive changes occurred in some subjective measures of patient function, such as reported activities of daily living and patient report of vision-dependent activities, but these changes were modest The most marked changes in patient function occurred in objective measures of function Mental status had improved not quite significantly at four months but significantly at one year Timed manual performance improved dramatically and significantly at four months and one year Cataract surgery was associated with improved vision and improved objective function in most patients by four months after surgery, and these improvements were maintained at one year ( JAMA 1987;257:1064-1066)

165 citations

Journal ArticleDOI
TL;DR: Examination of the prevalence and correlates of postural hypotension in a cohort of elderly persons with isolated systolic hypertension found a drop in syStolic blood pressure of ≥20 mm Hg was common.
Abstract: Objective The objective of this study was to examine the prevalence and correlates of postural hypotension (defined as a drop in systolic blood pressure of greater than or equal to 20 mm Hg) in a cohort of elderly persons with isolated systolic hypertension (ISH). Design Baseline cross-sectional analysis of the 4,736 persons randomized in the Systolic Hypertension in the Elderly Program (SHEP). Setting A randomized multi-center double-blind outpatient clinical trial of the impact of treating ISH. Participants Men and women age greater than or equal to 60 years with the systolic blood pressure (SBP) greater than or equal to 160 mm Hg and diastolic blood pressure (DBP) less than 90 mm Hg. Measures Medical histories were obtained using interviewer-administered, standardized clinical history forms. At entry into the study, seated and standing BP was measured by certified BP technicians using a random zero sphygmomanometer. Postural hypotension (PH) was assessed at 1 and 3 minutes after the participant arose from a seated position. Main results PH was found in 10.4% of participants at 1 minute and in 12.0% of participants at 3 minutes. 5.3% of participants demonstrated PH at both time intervals while 17.3% demonstrated PH at either or both of the time intervals. Factors significantly (P less than 0.05) associated with the presence of PH were higher mean SBP and a lower mean body mass index. Conclusions Somewhat different persons were defined as having PH based upon the 1 minute and 3 minute standing measures of BP, and prevalence estimates of PH can vary depending on whether one or more intervals of measurement are used. Cross-sectional data analysis indicated that PH, in healthy community-dwelling older persons with ISH, may not be associated with a history of disorders or problems usually thought to be related to PH. However, prospective data are needed to determine the prognostic significance of PH, and whether one or multiple measurements carry more significance.

149 citations


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TL;DR: This study provides a potential standardized definition for frailty in community-dwelling older adults and offers concurrent and predictive validity for the definition, and finds that there is an intermediate stage identifying those at high risk of frailty.
Abstract: Background: Frailty is considered highly prevalent in old age and to confer high risk for falls, disability, hospitalization, and mortality. Frailty has been considered synonymous with disability, comorbidity, and other characteristics, but it is recognized that it may have a biologic basis and be a distinct clinical syndrome. A standardized definition has not yet been established. Methods: To develop and operationalize a phenotype of frailty in older adults and assess concurrent and predictive validity, the study used data from the Cardiovascular Health Study. Participants were 5,317 men and women 65 years and older (4,735 from an original cohort recruited in 1989-90 and 582 from an African American cohort recruited in 1992-93). Both cohorts received almost identical baseline evaluations and 7 and 4 years of follow-up, respectively, with annual examinations and surveillance for outcomes including incident disease, hospitalization, falls, disability, and mortality. Results: Frailty was defined as a clinical syndrome in which three or more of the following criteria were present: unintentional weight loss (10 lbs in past year), self-reported exhaustion, weakness (grip strength), slow walking speed, and low physical activity. The overall prevalence of frailty in this community-dwelling population was 6.9%; it increased with age and was greater in women than men. Four-year incidence was 7.2%. Frailty was associated with being African American, having lower education and income, poorer health, and having higher rates of comorbid chronic diseases and disability. There was overlap, but not concordance, in the cooccurrence of frailty, comorbidity, and disability. This frailty phenotype was independently predictive (over 3 years) of incident falls, worsening mobility or ADL disability, hospitalization, and death, with hazard ratios ranging from 1.82 to 4.46, unadjusted, and 1.29-2.24, adjusted for a number of health, disease, and social characteristics predictive of 5-year mortality. Intermediate frailty status, as indicated by the presence of one or two criteria, showed intermediate risk of these outcomes as well as increased risk of becoming frail over 3-4 years of follow-up (odds ratios for incident frailty = 4.51 unadjusted and 2.63 adjusted for covariates, compared to those with no frailty criteria at baseline). Conclusions: This study provides a potential standardized definition for frailty in community-dwelling older adults and offers concurrent and predictive validity for the definition. It also finds that there is an intermediate stage identifying those at high risk of frailty. Finally, it provides evidence that frailty is not synonymous with either comorbidity or disability, but comorbidity is an etiologic risk factor for, and disability is an outcome of, frailty. This provides a potential basis for clinical assessment for those who are frail or at risk, and for future research to develop interventions for frailty based on a standardized ascertainment of frailty.

16,255 citations

Journal ArticleDOI
TL;DR: Evidence is presented that performance measures can validly characterize older persons across a broad spectrum of lower extremity function and that performance and self-report measures may complement each other in providing useful information about functional status.
Abstract: Background A short battery of physical performance tests was used to assess lower extremity function in more than 5,000 persons age 71 years and older in three communities. Methods Balance, gait, strength, and endurance were evaluated by examining ability to stand with the feet together in the side-by-side, semi-tandem, and tandem positions, time to walk 8 feet, and time to rise from a chair and return to the seated position 5 times. Results A wide distribution of performance was observed for each test. Each test and a summary performance scale, created by summing categorical rankings of performance on each test, were strongly associated with self-report of disability. Both self-report items and performance tests were independent predictors of short-term mortality and nursing home admission in multivariate analyses. However, evidence is presented that the performance tests provide information not available from self-report items. Of particular importance is the finding that in those at the high end of the functional spectrum, who reported almost no disability, the performance test scores distinguished a gradient of risk for mortality and nursing home admission. Additionally, within subgroups with identical self-report profiles, there were systematic differences in physical performance related to age and sex. Conclusion This study provides evidence that performance measures can validly characterize older persons across a broad spectrum of lower extremity function. Performance and self-report measures may complement each other in providing useful information about functional status.

7,417 citations

Journal ArticleDOI
TL;DR: Since 1980, the American College of Cardiology and American Heart Association have translated scientific evidence into clinical practice guidelines (guidelines) with recommendations to improve cardiovascular health.
Abstract: Since 1980, the American College of Cardiology (ACC) and American Heart Association (AHA) have translated scientific evidence into clinical practice guidelines (guidelines) with recommendations to improve cardiovascular health. In 2013, the National Heart, Lung, and Blood Institute (NHLBI) Advisory

4,604 citations