Brent M Egan

..Identifying modifiable covariables that reduce demographic disparities in controlling type 2 diabetes could inform efforts to improve health equity...

..31-1.37]) or monotherapy (reference) with benefits in black and white patients. Greater use of single-pill combinations as initial therapy may improve hypertension control and cardiovascular outcomes in the first treatment year...

..Evidence suggests that this collaboration is facilitating application of evidence-based medicine and risk factor control...

..Hypertension is a major risk factor for cardiovascular disease and treatment and control of hypertension reduces risk. The Healthy People 2010 goal was to achieve blood pressure (BP) control in 50% of the US population...

..This commentary summarizes 13 peer-reviewed studies on dark chocolate and blood pressure and raises questions relevant to its future as an evidence-based lifestyle intervention...

..Reviewing the role of beta-blockers in several ancillary conditions should help illuminate various aspects of the complex progression of cardiovascular disease and clarify the drugs' various therapeutic benefits...

..Efforts to further identify the mechanisms and consequences of sympathetic dysfunction in the metabolic syndrome may provide insights for therapeutic advances to ameliorate the excess cardiovascular risk and adverse outcomes...

..65 ng/ml/h) indicates sodium-volume excess "V" hypertension, whereas values >or=0.65 indicate renin-angiotensin vasoconstriction excess "R" hypertension...

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..In the absence of a coordinated strategic plan, achieving this critically important goal for BP control is highly unlikely...

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..This paper reviews the protective role of beta blockade in the primary and secondary prevention of cardiovascular events and examines some of the potential barriers to appropriate beta blocker use in patients with compelling indications...

..Although insulin resistance and metabolic syndrome are often used synonymously, concordance is not established...

..To review outcomes of diabetic patients treated with losartan in two recent randomized, double-blind, clinical trials and compare outcomes to similar studies in diabetics...

..The results of this trial, when reported, should help to clarify the relative benefits of these different therapies...

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..A clearer definition of the specific reactive oxygen signaling pathways involved and interventions aimed at altering these pathways could lead to more rationale antioxidant therapy and improved outcomes...

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..The findings suggest that the application of evidence-based guidelines would improve health, avoid cost, and reduce racial disparities in health outcomes...

..BP in the range of 120 to 129/80 to 84 mm Hg is also associated with increased risk but roughly half of that of stage 2 prehypertension...

..Further research on the effects of selective changes of dietary sodium versus more global changes in diet composition on biochemical and hemodynamic variables could provide the basis for an even more effective public health policy...

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..A collaborative practice network is attainable that produces positive, sustainable, and growing impacts on cardiovascular and other chronic diseases...

..A better understanding of the signaling mechanisms by which NEFAs exert their vascular effects may facilitate novel and more effective therapeutic approaches to managing the cardiovascular risk factor cluster...

..Despite progress, many hypertensive patients remain uncontrolled. Defining characteristics of uncontrolled hypertensives may facilitate efforts to improve blood pressure control...

..The prevalence of high blood pressure (HBP), particularly isolated systolic hypertension, rises with age, whereas control rates decline...

..This review assesses whether controlling hypertension in 50% of all patients is the best we can do...

..The findings may have important implications for ethnic differences in the prevalence of hypertension and cardiovascular and renal disease...

..Diets high in fiber are associated with lower levels of inflammatory markers. This study examined the reduction in inflammation from a diet supplemented with fiber compared with a diet naturally high in fiber...

..91 (95% CI=0.77, 1.05), respectively. The results suggest that obesity is an independent risk factor in White people, and additional study of body size and disease progression is necessary in the assessment of racial disparities...

..In addition to lowering basal BP, angiotensin receptor blockade in patients with metabolic syndrome improves arterial compliance and reduces pressor reactivity to exercise...

..Understanding and addressing these disparities has the potential to incrementally improve hypertension control rates in the population...

..001). Conversion from prehypertension to hypertension is accelerated in blacks, which suggests that effective interventions in prehypertension could reduce racial disparities in prevalent hypertension...

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..The objective of this study was to determine whether daily fiber supplementation would reduce levels of inflammatory markers...

..These findings confirm the low rates of multiple risk factor control and highlight challenges of reaching evidence-based goals in primary care...

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..The data suggest provider prescribing patterns are not a major contributor to ethnic differences in BP control and outcomes in diabetic hypertensives...

..Ethnic differences in awareness, knowledge, and beliefs about hypertension may contribute to these disparities, but information is limited...

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..TI has a major impact on BP control in hypertensive subjects receiving regular care. Reducing TI is critical in attaining the Healthy People 2010 goal of controlling hypertension in 50% of all patients...

..Lifestyle interventions targeting multiple risk factors including BP may be the most effective prevention strategy...

..Multiple risk factor control was rare, especially among women and African Americans. It appears that programs to improve CV risk factor control using audit and feedback in primary care are feasible and instructive...

..Demographic differences in management of concomitant lipid disorders among hypertensive patients may contribute to health disparities...

..The findings are consistent with evidence that elevated BP in obese subjects may reflect an imbalance between antioxidant capacity and oxidative stress that is improved by the DASH-CD...

..This study examines the effect of age on the association of BMI to CVD in black and white women...

..Based on the sites examined, ethnic variations in important process and treatment indicators do not explain racial differences in cardiovascular and renal outcomes...

..07, P = NS). These observations indicate that elevating NEFAs acutely impairs BRS. The findings suggest that lipid abnormalities in obese hypertensives may contribute to elevated BP and increased cardiovascular events by impairing BRS...

..The objective of this study was to determine whether statin use was associated with better blood-pressure control in adults with hypertension and whether inflammation levels mediated this relationship...

..If CRP evolves into a confirmed modifiable risk factor, a beta blocker such as metoprolol may be a useful addition to pharmacotherapy options...

..20; 95% confidence interval, 1.02-1.41, respectively). CRP and BP are positively related across a wide range of BP categories. A substantial proportion of prehypertensive individuals have elevated CRP independent of multiple confounders...

..We aim to determine the risk of major cardiovascular events associated with blood pressure in the prehypertensive range in a longitudinal, population-based cohort...

..75). Primary care providers treat high-risk patients relatively aggressively; however, opportunities to forestall cardiovascular disease may be missed in hypertensive, dyslipidemic women whose LDL-C is often not measured and controlled...

..The observations raise the possibility that increased concentrations of NEFAs contribute to the cardiovascular risk factor cluster through oxidative-stress-sensitive mechanisms...

..Limitations in the methodology of different studies have reduced the value of the results to provide specific and reliable sodium intake levels essential for clinical and lifestyle guidelines...

..The adjustment in vascular compliance may be an important factor in determining overall BP response to NA...

..Current consensus guidelines do not address inpatient HTN, and little is known about HTN prevalence or patterns of care in this setting...

..Presentations were discussed by Raymond Anton...

..The Department of Veterans Affairs (VA) system, which provides access to health care and medications across ethnic and economic boundaries, may reduce disparities in BP control...

..Plasma renin activity also tended to increase more on the low salt diet in the high risk group. Ambulatory blood pressures were greater on the low than the high salt diet only in the high risk group.(ABSTRACT TRUNCATED AT 250 WORDS)..

..Whites appear to have greater reductions in risk factors than did Blacks. However, Lighten Up is reaching both Blacks and Whites with multiple cardiovascular risk factors, and short- and long-term improvements are being made...

..Continued study of the biological factors linking early development with later risk of hypertension-related diseases is important and may shed light on racial disparities in health outcomes. (c)2001 by Le Jacq Communications, Inc...

..Still, considerable work needs to be done to explain the birth weight/blood pressure relationship. The findings to date and the clinical significance warrant continued research in this intriguing area of study...

..Within the Southeast, South Carolina has unusually high rates of end-stage renal disease (ESRD) in young people, with more than 70% of cases attributed to hypertension and diabetes...

..Of the 133 participants, 70% attended half or more of the sessions, and several components of the risk factor cluster were favorably affected...

..Thus, a high priority should be given to the recognition, treatment, and control of systolic hypertension in the Southeast...

..An understanding of factors linking birthplace to risk for cerebrovascular mortality could facilitate efforts directed at stroke prevention...

..Further studies are required to determine whether this is true for the general population of patients with neurogenically mediated EHTN...

..58, 95% CI 1.02 to 2.44; fourth quartile 1.44, 95% CI 0.80 to 2.58). The findings suggest that inflammation may link dietary fiber and fat to cardiovascular disease...

..A routine search for excessive use of alcohol, along with brief interventions and monitoring, can have a major impact on reducing the prevalence of hypertension in the general population...

..05). These results suggest that higher plasma lipids combined with a greater pressor response to hyperlipidemia may contribute to the development of high BP in subjects with a family history of hypertension...

..The results suggest that LS-DASH decreases oxidative stress, improves vascular function and lowers blood pressure in SS but not SR volunteers...

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..The diurnal increases of systolic and diastolic blood pressure as well as heart rate and pressure-rate product were similar in all four groups.(ABSTRACT TRUNCATED AT 250 WORDS)..

..05). These data suggest that modest dietary sodium restriction in obese hypertensives does not adversely affect baseline blood pressure or lipids, but it does magnify their adverse lipid and hemodynamic response to fat loading...

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..Prehypertension is considered a precursor of stage 1 hypertension and a predictor of excessive cardiovascular risk. We investigated whether pharmacologic treatment of prehypertension prevents or postpones stage 1 hypertension...

..5 % (men) and >or=41.2% (women)...

..This report summarizes the impact of a standardized, evidence-based approach to managing high blood pressure and associated metabolic syndrome abnormalities that was developed and implemented by one Clinical Hypertension Specialist...

..Of concern, nearly half of men with normal BMI want to be heavier, while approximately 5/8 of overweight men are satisfied with being overweight or want to be heavier...

..The strong relationship between ESRD and physician density suggests that access to adequate treatment of diabetes and hypertension is of paramount importance for ESRD prevention, and has important public policy implications...

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..05). In TROPHY, patients with prehypertension had relatively high baseline HRQL, and HRQL was maintained with the angiotensin receptor blocker candesartan over both the 2-year treatment period and a total 4-year trial period...

..Compounds like EKODE, derived from linoleic acid, may affect adrenal steroid production in humans and mediate some of the deleterious effects of obesity and oxidative stress, especially in blacks...

..We believe the information generated by the proposed studies has the potential for elucidating biological mechanisms underlying obesity-associated hypertension and the potential for dietary anti-oxidants to modulate BP. ..

..The studies could provide a basis for longer-term clinical studies on NEFAs and BP regulation as well as basic experiments to elucidate signaling mechanisms. ..

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