ISSN:1062-4821    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1062-4821    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1062-4821    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1062-4821    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Abundant data confirm a role for sodium intake in human blood pressure and for the pathogenesis and treatment of some forms of hypertension. New information concerning mechanisms for the effect of salt on blood pressure, as well as the relationship between salt intake and the heart and kidneys, is reviewed

ISSN:1062-4821    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Clinical trials have demonstrated that antihypertensive therapy leads to the prevention of stroke, consistent with that predicted by epidemiological data. In contrast, in the same studies, the reduction in coronary artery disease events has been substantially less than predicted. Many possible explanations have been proposed to account for this shortfall in the reduction of disease produced by antihypertensive therapy. One suggestion has been that too great a fall in diastolic pressure during treatment actually increases the risk of myocardial infarction. A substantial body of data taken from clinical trials has consistently demonstrated a J-shaped association of diastolic pressure and coronary events. Some studies suggest that this J-shaped association is limited to those with coronary disease, and that the J-phenomenon is the result rather than the cause of atherosclerotic disease of the aorta. A prospective study is underway to resolve this issue. Meanwhile, the cautious physician is advised to seek a moderate decline in diastolic pressure to a level greater than 80mmHg.

ISSN:1062-4821    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The year 1995 has been an unsettling one in the history of the treatment of hypertension and ischemic heart disease. A fierce debate has sprung up about the safety of calcium antagonists, particularly the dihydropyridine nifedipine. A widely publicized case-control study showed that compared with diuretics and beta-blockers, short-acting calcium antagonists, when used in the treatment of hypertension, were associated with a higher risk of myocardial infarction, an effect which appeared to be dose related. A second study focused on clinical trials of nifedipine in patients primarily with acute myocardial ischemia syndromes. The meta-analysis showed an increased risk in the relative mortality rate of 1.16 associated with the use of short-acting nifedipine at doses of 80 mg/day or higher. The mechanisms responsible for these results were also discussed. Both publications were accompanied by editorials, and there were subsequently other commentaries published which pointed out weaknesses in the design, conduct, analysis and interpretation of the studies, and these have also been reviewed. Arising from this controversy, important questions have been raised which need to be addressed. First, are the data valid and are these drugs safe? If not, can the data be extrapolated from short-acting dihydropyridines, to the newer formulations and other sub-classes of calcium antagonists? Second, do these agents reduce cardiovascular morbidity and mortality? Finally, what are the alternatives to their use and the clinical implications? These studies have raised questions about safety, and there is little evidence to show any actual benefit on the incidence of cardiovascular events. For most patients there are clinically tested and proved therapeutic alternatives, i.e. diuretics and beta-blockers, and therefore the burden of proof must now be on those who primarily recommend the use of calcium antagonists. Recommendations and guidelines for treatment, where the primary goal is to reduce cardiovascular morbidity and mortality must be supported by adequate data.

ISSN:1062-4821    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Microalbuminuria is the presence of albumin above the normal but below the detectable range with the conventional urine dipstick methodology. Microalbuminuria is present in a variety of renal and non-renal diseases but only recently has its importance as a prognostic indicator been appreciated. It is an independent risk factor for renal mortality in patients with insulin-dependent diabetes mellitus and most probably for those with non-insulindependent diabetes mellitus. Moreover, it is associated with a four- to sixfold increase in cardiovascular mortality in diabetic subjects. Its role as a prognostic indicator in nondiabetic subjects is controversial. The available data suggest that it is not an independent risk factor in patients without diabetes, including hypertensive subjects. Moreover, in this latter group it appears to be simply a reflection of events that result in tissue injury from elevated arterial pressures rather than an initiator of injury. The converse may be true in the diabetic patient. A large body of data also exists to support the notion of early aggressive intervention to attenuate the rise of microalbuminuria with blood glucose control. In addition, agents such as angiotensin-converting enzyme inhibitors attenuate both the rise in microalbuminuria and progression of insulindependent diabetes mellitus nephropathy. Fewer but similar findings have been reported for subjects with noninsulin- dependent diabetes mellitus nephropathy. Thus, microalbuminuria should be assessed annually in all diabetic subjects. Routine screening for microalbuminuria in hypertensive non-diabetic subjects is not recommended at this time.

ISSN:1062-4821    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Substantial changes have occurred in the quality assurance and improvement programs conducted by the Health Care Financing Administration in the Medicare End-Stage Renal Disease Program. This review is a brief description of these changes and an introduction to the health policy, epidemiology, health services research, clinical nephrology, and statistical process control literature that is the basis for this initiative.

ISSN:1062-4821    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Effectiveness research, often called patient outcome research, is an evolving research discipline that attempts to provide information about the appropriate use of medical practices. This field of research uses epidemiological methods (observational and randomized controlled trials), analyses of variation and outcomes in medical practices, formal literature reviews and meta-analyses, quality of life measurement, decision analysis, patient preference assessment, patient satisfaction assessment, and economic and cost-effectiveness analysis. Several recent studies have applied a variety of these methods to provide data that will assist health professionals in the field of nephrology to make more informed clinical decisions. More of these studies are needed as new interventions are developed and tested in an environment where policy makers are asking how much value these interventions add and at what cost.

ISSN:1062-4821    

出版商:OVID    

年代:1996

数据来源: OVID