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1
Anyiam, Helen. "Educating Staff Members in an Outpatient Clinic on Hypertension Management." Thesis, Walden University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10930842.
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An educational module on hypertension was created in response to the recurring pattern of patient visits with hypertension and an observed knowledge gap among nursing staff in an outpatient clinic located in the southern United States. The educational module was patterned after Joint National Committee-8 and American College of Cardiology guidelines involving patient lifestyle modification and provided clinic staff with information on hypertension diagnosis and self-management for use in patient education. The module was reviewed by a panel of 3 experts who approved it for appropriateness and clarity of content and made one minor recommendation for revision. The education materials were modified to meet the panel’s recommendations and subsequently presented to 5 nursing staff members. Pre- and postmodule questionnaires were provided to the staff to determine the extent of their learning from the education program. Pretest results indicated that staff lacked information on the guidelines for treatment of hypertension. Posttest results indicated that all 5 participants found the module information useful for staff to use in educating patients on self-management of hypertension. Providing nursing staff with current evidence-based practice guidelines can increase staff nurse knowledge on hypertension management. Educating nursing staff has the potential to effect positive social change by empowering staff and patients to improve health care outcomes by enabling staff to coach patients on hypertension management using up-to-date evidence-based practice guidelines.
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Pink, Nicole Catherine. "A Collaborative Hypertension Clinic Pilot Program in a Rural Primary Care." Diss., North Dakota State University, 2020. https://hdl.handle.net/10365/31879.
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In 2019, there were about seventy-million Americans with uncontrolled high blood pressure (BP) or hypertension (HTN) (Kitt, Fox, Tucker & McManus, 2019). Hypertension is the leading cause of preventable deaths worldwide (Stephen, Halcomb, McInnes, Batterham & Zwar, 2019). Uncontrolled HTN contributes to stroke, myocardial infarction, and renal failure, and is the most modifiable risk factor for heart disease and death (American Academy of Family Physicians [AAFP], 2019; Oparil & Schmider, 2015). Patients living in rural America have an increased prevalence of HTN and their access to preventative health services is lower (Buford, 2016; Caldwell, Ford, Wallace, Wang & Takahashi, 2016). The increased prevalence of HTN in rural communities does not positively correlate with optimized blood pressure control, which poses a gap in care (Buford, 2016). A multidisciplinary collaboration between registered nurses (RNs) and providers may improve patient outcomes (Ford et al., 2018). The implementation of a collaborative HTN Clinic in a rural setting had the potential to improve BP outcomes by increasing access to services.
The practice improvement project established a HTN Clinic as a collaborative effort between RNs and providers in a rural community. Providers and RNs were educated via modules regarding the protocol and participants took surveys before and after implementation to determine effectiveness and if the HTN Clinic should continue after conclusion of the practice improvement project. The HTN Clinic intervention implemented education for hypertensive patients with an emphasis on medication compliance and lifestyle modifications, as well as medication adjustments through nurse-led protocols.
Despite a short duration of implementation and evaluation, positive results were observed. All HTN Clinic patients had improvement in BP measures and were controlled by the end of the four-week implementation period. Overall, patient access, wait times for appointments, and BP measures for all hypertensive patients improved after implementation. The providers’ and nurses’ knowledge increased through completion of a detailed curriculum. The provider and RN surveys indicated support for continuing the HTN Clinic to improve HTN management and clinic providers felt that the HTN Clinic helped improve their time with patients and quality metrics.
3
Henriksson, Ann-Sofi, Martina Johansson, and Sofia Johnson. "Distriktssköterskans erfarenhet av att bedriva stödjande insatser vid en hypertonimottagning : En pilotstudie." Thesis, Högskolan i Halmstad, Sektionen för hälsa och samhälle (HOS), 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-24901.
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Hypertoni beskrivs vara en riskfaktor bland annat för hjärtkärlsjukdomar som tenderar att öka och patienter med hypertoni når i allt större utsträckning inte behandlingsmålen enligt Socialstyrelsens nationella riktlinjer. Tidigare studier har visat att distriktssköterskeledda hypertonimottagningar med strukturerade strategier har haft positiv effekt för patienter med hypertoni, men inte beskrivit vilka stödjande insatser som distriktssköterskorna utför. Syftet var att beskriva distriktssköterskans erfarenhet av att bedriva stödjande insatser vid en hypertonimottagning inom primärvården. Urvalet bestod av fyra distriktssköterskor som bedrev hypertonimottagning i primärvården. Materialet till pilotstudien samlades in via intervjuer. Kvalitativ innehållsanalys med induktiv ansats valdes som metod. I resultatet framkom att de stödjande insatserna utgjordes av distriktssköterskans förhållningssätt i bemötandet och att kunskap och färdighet utnyttjades i ett individbaserat mottagande. Genom att uppmärksamma och synliggöra hur de stödjande insatserna påverkar patienten kan hälsofrämjande metoder utvecklas ytterligare. Detta i sin tur skulle kunna leda till förslag på hur stödjande insatser som ämne skulle kunna implementeras i vårdutbildningar på alla nivåer med ännu större fokus på det holistiska synsättet på hälsa.Hypertension is increasing worldwide and it is a risk factor for cardiovascular disease. There are an increased frequency of patients with hypertension who do not reached treatment goals according to The National Board of Health and Welfare. Previous studies have shown that district nurse hypertension clinics with structured strategies have had a positive impact on patients with hypertension. However, these studies have not described the supportive interventions that district nurses´ perform. The aim of this study was to explore the district nurses´ experiences of doing supportive interventions at a hypertension clinic in primary care. The sample consisted of four district nurses who were carrying of hypertension clinic in primary care. The material for the pilot study was collected through interviews. Qualitative content analysis with an inductive approach was chosen as the method. The results showed that the supportive interventions consisted of standing for a supportive attitude in facing and using knowledge and skills in individualized reception. By paying attention to and make visible how the supportive interventions affect the patient can health-promoting methods be further developed. This in turn could lead to proposals for supporting efforts that topic could be implemented in nursing programs at all levels with greater focus on the holistic approach to health.
4
Chu, Wai-on. "The prevalence of cognitive impairment and dementia among hypertensive elderly as a whole and among different classes of anti-hypertensive drug users in a regional geriatric clinic in Hong Kong /." View the Table of Contents & Abstract, 2007. http://sunzi.lib.hku.hk/hkuto/record/B38348202.
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Chu, Wai-on, and 朱維安. "The prevalence of cognitive impairment and dementia among hypertensiveelderly as a whole and among different classes of anti-hypertensivedrug users in a regional geriatric clinic in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2007. http://hub.hku.hk/bib/B45011175.
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Tripathi, Dhiraj. "Clinical and haemodynamic studies in portal hypertension." Thesis, University of Edinburgh, 2005. http://hdl.handle.net/1842/30855.
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Over the last 20 years, there have been significant advances in the management of portal hypertension, with the introduction of drug therapy and the transjugular intrahepatic portosystemic stent-shunt (TIPSS). There are two aims of this thesis: 1. To study the haemodynamic effects of two novel vasocative agents on the portal and systemic circulations, and assess suitability for use in controlled clinical trials involving patients at risk of variceal bleeding: a. Carvedilol, a vasodilating non-cardioselective beta-blocker with α1 antagonism. The acute and chronic haemodynamic effects of this agent will be studied, with particular attention paid to patient tolerability. b. Losartan, an angiotensin II receptor antagonist. The chronic effects of this agent will be studied in patients with well compensated cirrhosis. 2. TIPSS has been used extensively in the management of portal hypertension, particularly variceal bleeding. Two studies will be presented in this thesis aimed at answering the following questions: a. Is TIPSS effective for the management of gastric variceal bleeding? This study will compare the efficacy of TIPPS for gastric and oesophageal variceal bleeding, and aim to correlate clinical outcomes with haemodynamic data. b. Is it necessary to continue portographic TIPSS surveillance indefinitely if variceal band ligation is combined with TIPSS for the prevention of oesophageal variceal rebleeding? This question will be explored in a randomised controlled trial comparing TIPSS alone with TIPSS plus variceal band ligation. This study will also address 2 drawbacks of TIPSS, namely the need for long-term portographic to ensure TIPSS patency and hepatic encephalopathy.
7
Bodey, Angela Rosamund. "A clinical and comparative study of canine hypertension." Thesis, Royal Veterinary College (University of London), 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.244138.
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Persson, Mats. "Bring hypertension guidelines into play : guideline-based decision support system for drug treatment of hypertension and epidemiological aspects of hypertension guidelines." Doctoral thesis, Umeå universitet, Allmänmedicin, 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-94105.
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Sephton_E_A. "Hypertension in Cape Town clothing industry clinics: Does treatment match risk?" Master's thesis, University of Cape Town, 2001. http://hdl.handle.net/11427/26511.
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Background: The management of hypertension according to the patient' s absolute risk of cardiovascular disease. rather than their blood pressure in isolation from other risk factors, is now widely advocated because it targets treatment at those with most to gain. In South Africa blood pressure is traditionally managed according to the patient's level of blood pressure. Main Objective: To identify the proportion of traditionally treated hypertensive patients who may benefit from cessation or intensification of treatment as judged by a risk-based approach to their management. Design: A cross sectional descriptive survey of patients and their medical records with assessment of absolute risk of cardiovascular disease using Framingham risk equations. Setting: Eight Clothing Industry Health Benefit Fund clinics in Cape Town, South Africa. Participants: 382 women and men, predominantly coloured, attending for the treatment of hypertension Main outcome measure: The proportions of patients in whom the predicted risk of a cardiovascular event within 5 years is less than 10% and those in whom the risk within five years is greater than 20%. Results: 65% of participants (CI 60 - 70%) were at less than 10% risk of a cardiovascular event in the next 5 years and 19% (Cl 15-23%) were at more than 20% risk of a cardiovascular event despite current treatment. 5% (CI 3.2-7.9%) were at greater than 20% risk of a cardiovascular event in the next 5 years having no previous history of a cardiovascular event. 14% (CI 10-17%) were at greater than 20% risk of a cardiovascular event in the next 5 years because of a previous history of a cardiovascular event. 1.3% (CI 0.4-3%) were at less than 10% risk of a cardiovascular event within the next 5 years, despite having a systolic blood pressure over 170mmHg. Conclusion: Assessment of the cardiovascular risk of patients treated for hypertension identifies those patients at most and least risk. Resources could therefore be targeted at those with the most to gain from treatment and the unwanted side effects of antihypertensive medication avoided in those at low risk. Almost two thirds of patients currently being treated for hypertension were at less than 10% risk of developing a cardiovascular event within the next 5 years. A trial of medication reduction or cessation in this group is justified and the resources could be redirected at those 5% whose risk remains very high despite current levels of treatment.
10
Marsh, Wallace Arvie. "Calculating the mean effect size for hypertension clinical trials /." Digital version accessible at:, 1999. http://wwwlib.umi.com/cr/utexas/main.
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Hurcomb, Peter G. "The clinical assessment of systemic hypertension in optometric practice." Thesis, Aston University, 2003. http://publications.aston.ac.uk/14559/.
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This thesis sets out to examine in detail the condition of systemic hypertension (high Blood Pressure) in relation to optometric practice in the United Kingdom. Systemic hypertension, which is asymptomatic in the early stages, is diagnosed from the Blood Pressure (BP) measurement recorded by a sphygmomanometer and/or from the complications that have developed in target organs. Optometric practice based surveys revealed that diagnosed systemic hypertension was the most prevalent cardiovascular medical condition (20.5%). Measurement of BP of patients in this sample revealed that if an optometrist included sphygmomanometry into the sight examination then at least one patient each day would be referred for suspect systemic hypertension. Optometric opinion felt that the measurement of BP in optometric practice would advance the profession, being appreciated by both patients and General Practitioners (GPs), but was felt to be an unnecessary routine procedure. The present sight examination for the systemic hypertensive is similar to that of the normotensive patient, but may involve an altered fundus examination and a visual field test. The GPs were in favour of optometric BP measurement and a future role in the share care management of the systemic hypertensive. The application of a new pictorial grading scale for the grading of vascular changes associated with pre-malignant systemic hypertension was found to be both accurate and reliable. Clinical trial of the grading scale in optometric practice found positive correlations between BP and increasing severity of the retinal vascular features. The application of the pictorial grading scale to optometric practice and training the optometrist in the use of sphygmomanometry would improve the management of the systemic hypertensive patient in optometric practice. Future advances in image analysis hold substantial benefits for the detection and monitoring of subtle vascular changes associated with systemic hypertension.
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Draper, Taylor L. "Hypertension in older African Americans| Testing psychosocial mediators." Thesis, Loma Linda University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10194502.
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Objectives Past research has shown that low socioeconomic status (SES) and perceived discrimination are related to hypertension in African Americans. Past studies have used the Reserve Capacity Model (RCM; Gallo & Matthews, 2003; 2005; 2011) to understand these relationships which posits that stress can be mitigated by psychosocial resources which lead to healthy lifestyle behaviors predictive of cardiac health. However, few studies have examined the RCM resources to predict hypertension in African Americans and none have included discrimination as a stressor in the model. Methods We examined the mediational effects of RCM resources after low SES and discrimination experiences to predict health behavior (exercise) and hypertension in 1202 middle to older aged African Americans using structural equation modeling. Results Both low SES and perceived racial discrimination predicted a diagnosis of hypertension indirectly through levels of reserve capacity and exercise. Conclusions These findings provide support for the RCM as an explanatory framework for how social stressors affect health through modifiable psychosocial resources and health behaviors in middle to older aged African Americans.
13
Shobako, Naohisa. "Identification and characterization of a novel anti-hypertensive peptide derived from rice bran protein." Kyoto University, 2019. http://hdl.handle.net/2433/242924.
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Kyoto University (京都大学)0048
新制・課程博士
博士(農学)
甲第21973号
農博第2363号
新制||農||1071(附属図書館)
学位論文||R1||N5224(農学部図書室)
京都大学大学院農学研究科食品生物科学専攻
(主査)教授 井上 和生, 教授 谷 史人, 准教授 大日向 耕作
学位規則第4条第1項該当
14
Marley, John. "The conduct and management of large clinical trials in hypertension /." Title page, table of contents and abstract only, 1992. http://web4.library.adelaide.edu.au/theses/09MD/09mdm347.pdf.
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Thesis (M.D)--Dept. of Clinical and Experimental Pharmacology, University of Adelaide, 1993.Includes 4 published papers by the author as part of appendix 9. Includes bibliographical references (leaves 1-19 (second sequence)).
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Alharf, Adel Abdullah. "Prevalence of and clinical characteristics associated with microalbuminuria in hypertension." Thesis, University of Glasgow, 2012. http://theses.gla.ac.uk/3643/.
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Cardiovascular disease is the leading cause of mortality. As blood pressure is one of the most important risk factors for cardiovascular disease, effective management of hypertension is critical in reducing this risk. In addition to high blood pressure, however, several factors have been identified as predictors of future cardiovascular events. These include high cholesterol, cigarette smoking, obesity and diabetes. Taken together, these traditional risk factors do not entirely explain the risk. Thus, many novel risk factors have been proposed for risk prediction of cardiovascular disease. Microalbuminuria is one such factor. Microalbuminuria is defined as excretion of albumin in the urine above the normal level but less than gross proteinuria. As excretion of albumin exhibits high variability due to many confounders (such as urinary tract infection and strenuous exercise), diagnosis of microalbuminuria should be ideally based on screening of multiple samples using either 24-hour urine collection or first-morning voids. Much evidence suggests that microalbuminuria is a reflection of generalised endothelial dysfunction. This is supported by the observation that microalbuminuria is strongly associated with cardiovascular disease. My main aim was to study microalbuminuria in people with hypertension attending specialist clinics. Microalbuminuria has been investigated extensively in diabetes and in patients with renal disease. However, the available information on the association of microalbuminuria with hypertension has many limitations since many studies had small sample size, restricted population or were confounded by potential misdiagnosis of microalbuminuria by the use of single samples. This has led to uncertainty about the prevalence of microalbuminuria in hypertension, where reported prevalence ranges from 4.7% to 58%, and probable underestimation of its clinical significance. I addressed these issues by conducting a series of studies in 1059 hypertensive subjects attending the Glasgow Blood Pressure Clinic or the Aberdeen Hypertension Clinic. Each patient was invited to provide an early morning urine specimen for the assessment of albuminuria. Urinary tract infection was tested using urine strips and, where positive, samples were discarded. If the first sample showed increased albumin excretion, two further samples were requested. Albuminuria (microalbuminuria or gross proteinuria) was diagnosed when two out of the three samples showed increased albuminuria. Two definitions of microalbuminuria were used in the analysis, a conventional definition with the threshold used by most therapeutic guidelines and a new definition that accounts for low excretion of albumin. All patient information was obtained from case-records. In the first study, I showed that microalbuminuria by the conventional definition was present in 9.5% of non-diabetic hypertensive subjects without renal impairment. Another 10% of this cohort had microalbuminuria by the new definition. Compared with people with normal urinary albumin, individuals with microalbuminuria by both definitions (n= 786, after excluding those with diabetes or severe renal impairment) had significantly higher blood pressure, higher pulse pressure, increased levels of inflammatory markers, poorer renal function, higher triglycerides levels and used more cardiovascular drugs. In a second study, the association of microalbuminuria with clinical characteristics was investigated. Subjects with microalbuminuria had increased prevalence of risk factors / co-morbidities such as left ventricular hypertrophy (19.2% in normoalbuminuria versus 29.7% and 34.8% for microalbuminuria by the new and the conventional definitions, respectively), ECG abnormalities and cardiovascular disease. In addition, people with microalbuminuria had higher risk scores for subsequent cardiovascular events using two risk calculators, the Framingham and the Joint British Societies equations. In a subcohort with controlled blood pressure and without co-morbidities or risk, microalbuminuria (by combining the two definitions) was found in 14%. Compared with those with normoalbuminuria, subjects with microalbuminuria had higher blood pressure, poorer renal function, higher blood glucose and higher levels of inflammatory markers although the limited sample size precluded statistical significance. In a further study, the independent association of microalbuminuria with different risk factors was evaluated using multivariate testing. Systolic blood pressure, serum creatinine, left ventricular hypertrophy and fasting triglycerides were among factors linked with microalbuminuria. The risk of microalbuminuria increased in people with poorly controlled blood pressure. I also found that microalbuminuria was associated strongly with left ventricular hypertrophy [odds ratio 1.87 (95% CI, 1.12 - 3.12) for a composite of both definitions- the combined definition] and cardiovascular abnormalities [odds ratio 1.72 (95% CI, 1.05 - 2.80) for the combined definition]. In a fourth study, the reproducibility of microalbuminuria screening was investigated. I discovered that a large proportion of people who had increased urinary albumin excretion on first sample was categorised as normoalbuminuria based on the result of multiple samples (48% at the Glasgow Clinic and 41% at the Aberdeen Clinic). This indicates that even after controlling microalbuminuria confounders, multiple testing can be recommended for more accurate diagnosis. In the final study, I demonstrated that subjects with microalbuminuria by both definitions attending the Glasgow Blood Pressure Clinic had relatively high blood pressure and pulse pressure at first visit and subsequently. This finding indicates that subjects with microalbuminuria require particularly rigorous blood pressure management to achieve blood target blood pressure. Furthermore, individuals with microalbuminuria may be at risk for cardiovascular disease greater than that in those with normoalbuminuria since the eventual blood pressure remained higher in these subjects. Together with the observations that microalbuminuria is associated with clustering of cardiovascular risk factors, my finding support the importance of even small increase in urine albumin excretion as an indicator of eventual cardiovascular disease. In conclusion, microalbuminuria is found in one-fifth of subjects with essential hypertension. Although my investigation was observational, the large sample size, the use of multiple samples and allowance for the effects of potential confounders enhances the precision of the results. Moreover, subjects involved in this study represent a real hypertension population with few restrictions. My findings support the value of microalbuminuria as a tool to identify subjects at high risk for cardiovascular disease. Before routine screening can be recommended, these observations require confirmation in clinical trials and prospective studies with long-term follow up. Linkage of the records of the patients who participated in this series of studies with national morbidity and mortality statistics offers one approach with the potential to test the clinical relevance of my findings.
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Freel, Ellen Marie. "Molecular and clinical studies of corticosteroid biosynthesis and regulation in hypertension." Thesis, University of Glasgow, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.437968.
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Miller, Deborah, and Nakia J. Woodward. "Clinical inquiries. Whom Should You Test for Secondary Causes of Hypertension?" Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/8810.
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Manafe, Naisa Abdul. "Characterization of severe and complicated hypertension in Mozambican adults." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/27971.
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Background and aims: Hypertension is a public health problem and a major reason for hospitalisation and death. In Mozambique, low levels of detection, treatment and control have been described. However, data on target-organ damage and associated clinical conditions is lacking. We therefore aimed at characterising the clinical profile of patients with severe hypertension, describing the pattern of target organ damage and determining the outcomes at 6-month follow-up. Methods: We designed a prospective descriptive cohort study to assess adult patients with severe hypertension defined according to the Joint National Committee VII guidelines. The study was conducted from July 2015 to May 2017 at Mavalane General Hospital in Maputo-Mozambique. Patients were characterized through physical examination, laboratory profile, electrocardiography, and echocardiography, and followed for six months to assess occurrence of complications such as hypertensive heart failure, stroke, renal failure, hospital admission and death. Data were analysed using SPSS software version 20.0. The study was approved by the National Bioethics Committee for Health of Mozambique. Results: We studied 116 subjects (111 [95.7%] black; women 81 [70%]). Women were slightly younger than men (mean 57 years vs 59 years); 18 (15.5%) patients were younger than 44 years. The risk profile of the studied population included obesity (46; 42.5%); dyslipidaemia (59; 54.1%); diabetes (10; 8.6%) and smoking (8; 6.9%). At baseline, mean values for systolic and diastolic blood pressure were 192.3 ± 23.6 and 104.2 ± 15.2, respectively. The most frequent target-organ damage were left atrial enlargement in 91 (88.3%) with atrial fibrillation in 9 (7.9%); left ventricular hypertrophy in 57 (50.4%); hypertensive retinopathy in 30 (26. 3%) and renal damage in 29 (25.7%) subjects. Major events during 6-month follow-up were hospitalisations (12; 10.3%) and death (10; 8.6%). Renal damage (4; 4.2%), stroke (4; 3.4%) and heart failure (2; 1.7%) were the most common complications occurring over the follow up period. Conclusion: Severe and complicated hypertension affects young people with higher incidence of obesity, diabetes and smoking than that found in general population. High occurrence of target organ damage is found at baseline, particularly heart damage, renal lesion and stroke. On follow up, severe hypertension is associated with high number of hospitalisations and high case-fatality rate. Moreover, renal damage, stroke and hypertensive heart disease were common complications on follow up. Further research is needed to understand the determinants of these poor outcomes.
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Kung, Kin-hang. "An audit on anti-hypertensive drug management amongst general out-patient clinics in New Territories West region." Click to view the E-thesis via HKUTO, 2004. http://sunzi.lib.hku.hk/hkuto/record/B31971878.
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Bonnecwe, Elaine Thelma. "Self care and patients with hypertension at primary health care clinics / Elaine Thelma Bonnecwe." Thesis, North-West University, 2012. http://hdl.handle.net/10394/8832.
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This study focuses on self care among patients with hypertension visiting primary health care clinics in the Naledi sub-district in the North-West Province. Hypertension is one of the chronic diseases that shorten the life expectancy of many people globally and remains the most common and rapid growing cardiovascular disease, affecting 20 million people in sub-Saharan Africa. Hypertension is one of the quadruple burdens of disease associated with risky lifestyle behaviours like unhealthy diets with excessive energy intakes, physical inactivity and tobacco use. Although taking the mentioned common modif iable factors and the fact that hypertension is a manageable condition into consideration, the reality remains that the hypertension.
A non-experimental, quantitative research was used to reach the aim of the study namely to identify and describe the self care abilities of patients diagnosed with hypertension, as well as explore and describe their knowledge and perceptions on hypertension. This was done by means of objectives to explore and describe self care abilities, knowledge and perceptions among patients diagnosed with hypertension; if there is an association between self care, knowledge and perception in relation to the level of education, age, income and time period and if there was association between self care and knowledge and perception of patients with hypertension visiting PHC clinics in Naledi sub-district in the North-W est Province.
A literature review was first conducted for a clear understanding of self care and hypertension. Thereafter a structured questionnaire, consisting of demographical information, and questions on self care, knowledge and perception among patients with hypertension, was employed. Trained field workers assisted in data collec tion. A number of 142 questionnaires were completed by patients visiting PHC clinics. The demographic data was first analysed with results shown in the frequency table. The exploratory factor analyses were done for data reduction on self care, knowledge and perception among patients with hypertension. Descriptive statistics and Cohen effect sizes for factors on self care, knowledge and perception in relation to the level of education, age, income and other chronic illnesses of patients diagnosed with hypertension, correlational descriptive statistics between self care and knowledge and perception were done.
The results revealed that patients with hypertension with low levels of education lack information with regard to hypertension. The higher the income of patients with hypertension, the better their self care abilities compared to those with low income. Patients who are English and Afrikaans speaking have more internal positive power and have better management abilities of hypertension than those who are Setswana speaking. Younger patients have more internal positive power, which declines with age. Those patients who are newly diagnosed with hypertension have more information on management abilities than those who have been diagnosed more than two years.
The conclusion regarding the relationship of self care and knowledge and perception of hypertension is that the patients diagnosed with hypertension need knowledge on hypertension in order to adhere to self care abilities. The more knowledge patients have the better they will be able to adhere to self care activities.Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.
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Haghighi, Maryam. "Correlation between COPD and pulmonary hypertension." Thesis, Uppsala University, Department of Medical Biochemistry and Microbiology, 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-6152.
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Chronic obstructive pulmonary disease (COPD) is in up to 90 % of all cases caused by
smoking. COPD often has negative effects on circulation, effects that first and foremost can be
observed as respiratory insufficiency. Reduced function of the right ventricle of the heart is
common in patients suffering from chronic obstructive pulmonary disease, especially if they
also have hypoxemi; insufficient levels of oxygen in blood or tissue. The incidence of this
cardiac complication reduces the survival time. It is possible in chronic obstructive pulmonary
disease that the pressure in the pulmonary circulation gradually increases resulting in
pulmonary hypertension followed by a slow adaptation of the right ventricle by hypertrophy of
the myocardium.
To investigate a correlation between COPD and pulmonary hypertension COPD patients
were subjected to spirometry and ultrasound on heart.
Of 14 examined patients 5 had developed pulmonary hypertension. A correlation between
obstruction in the COPD- patients and an increase in left ventricular diameter was found.
DLCO (diffusion capacity) of the lungs is directly connected to PA (pulmonary arterial
pressure). The lower DLCO, the higher risk to develop pulmonary hypertension. However, we
could not find a significant correlation between COPD and pulmonary hypertension in this
study even if most patients had a decreased DLCO.
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Hallberg, Pär. "Pharmacogenomics of antihypertensive treatment & clinical pharmacological studies of digoxin treatment /." Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-5782.
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Shantsila, Alena. "Human hypertension : observations on autonomic nervous system control mechanisms and clinical associations." Thesis, University of Birmingham, 2016. http://etheses.bham.ac.uk//id/eprint/6756/.
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Introduction: Sympathetic nerve activity (SNA) undergoes physiological modulation by respiration but it remains unclear whether this process is altered by age and hypertension. Aims: To establish relationship between respiration and neural regulation of the cardiovascular system in aging and hypertension. Methods: Multiunit muscle SNA, BP, respiratory parameters and heart rate were recorded at rest in young and older healthy men and hypertensive patients, then repeated in hypertensive group after acute and long-term device-guided slow deep-breathing (SDB) training. Results: Muscle SNA was higher in older subjects but showed similar modulation by respiration in both age groups. In young acute SDB reduced SNA, with no effect on sympathetic and cardiac baroreflex sensitivity. The sympathoinhibition was not related to changes in baroreflex sensitivity, but it reflected increases in lung inflation afferent input and/or reduction in central respiratory-sympathetic coupling. Long-term SDB training inhibited muscle SNA in hypertensive patients and led to acute increase in heart rate variability and longer-term BP reduction. There were no changes in baroreflex sensitivity, cardiac structure/function or arterial stiffness in response to SDB training. Conclusions: The study provides new mechanistic insights into sympathetic regulatory pathways in hypertension and aging, which may help to establish anti-hypertensive strategy based on respiratory modulation.
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Rasmussen, Kelly. "The Impact of JNC-7 and New Clinical Studies on Antihypertensive Drug Prescribing." The University of Arizona, 2005. http://hdl.handle.net/10150/624769.
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Class of 2005 AbstractObjectives: The objectives of this study were to assess the number of antihypertensive prescriptions by therapeutic class including beta-blockers, calcium channel blockers (CCBs), diuretics, angiotensin-converting enzyme inhibitors (ACEIs), and angiotensin receptor blockers (ARBs), dispensed in the fiscal years 2002 through 2004. Methods: The project was a retrospective analysis of pharmacy data for medications used to treat hypertension from October 2002 through December 2004 (FY02 through the first quarter of FY05). Drug classes used to treat hypertension were obtained from the VA Integrated Service Network 18 (VISN 18). Within the drug classes, only drugs within the class having at least 100 prescriptions were included for the class. Rates of prescriptions dispensed by quarter over the three-year period of interest were obtained. Descriptive statistics were used to compare the before and after ALLHAT and JNC-7 time periods. Results: After the publication of The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), The Australian National Blood Pressure Study 2 (ANBP2), and Joint National Committee (JNC-7) guidelines, dihydropyridine CCB use declined to from 1.80% to 1.65% and non-dihydropyridine CCB use declined from 0.99% to 0.83% of all prescriptions from the first quarter 2002 to the first quarter 2004. In addition, after the publication of ALLHAT, hydrochlorothiazide use increased from 1.42% to 1.83% and ACE-inhibitor use increased from 4.26% to 4.79% of all prescriptions. Implications: The findings have several implications for encouraging our prescribing patterns to follow national guidelines and clinical studies more closely. Health care providers need to accept some responsibility through continuous education to be able to maintain appropriate therapy.
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Lees, K. R. "Studies of the clinical pharmacology of perindopril : A new inhibitor of angiotensin converting enzyme." Thesis, University of Glasgow, 1986. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.383183.
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Sanders, Gillian. "Therapeutic interventions in the management of hypertension : clinical studies in individuals and the community." Thesis, University of Newcastle Upon Tyne, 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.329166.
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Al-Shammari, Ayed M. H. M. "The role of clinical pharmacy in the treatment of hypertension in the State of Kuwait : an analysis of the current treatment of hypertension in Kuwait and the role of the clinical pharmacist in advancing treatment strategies." Thesis, University of Bradford, 2012. http://hdl.handle.net/10454/5483.
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The thesis investigated nicotine levels and their effects on hypertensive subjects and whether aspirin could be used in the treatment of hypertension to bring about not only an anti thrombotic effect but reduce the systemic blood pressure especially in those individuals who smoke cigarettes. The study, which also audits the use of aspirin, was conducted in Kuwait and so provides an insight of hypertensive patients very rarely considered in the literature The thesis begins in Chapter One with an extensive literature review which analyses the properties and problems that nicotine causes and its ability to cause hypertensive changes along with its multitude of other events. The physiological and pathological problems caused by nicotine are reviewed on the basis of its chemistry and pharmacological properties using a worldwide perspective rather than just focus on Kuwait. The second Chapter uses extensive analysis of the literature to determine the pharmacological properties of aspirin and its use in cardiovascular disease. The pharmacokinetics and therapeutic effects are presented with emphasis to its inhibitory effects on platelet activation which is central to the development of serious cardiovascular consequences such as stroke and myocardial infarction. The third Chapter returns to consider the literature in detail and why nicotine has specific effects on the cardiovascular system in terms of receptor stimulation and how aspirin may be able to reduce nicotine's cardiovascular effects and concludes with the Aims and Objectives of the thesis. The fourth Chapter investigates urinary nicotine levels in smokers from cigarettes available in Kuwait to indicate the actual levels which could be achieved by smokers in this study. This established that the levels would cause pharmacological effects demonstrating also the effects of passive smoking. The number of cigarettes smoked per day has an unpredictable effect on metabolism and urinary output of nicotine. The fifth Chapter is the major investigational section of the thesis and considers if aspirin ability to reduce cardiovascular effects, may be useful in terms of diastolic blood pressure and lipid levels in the 4 blood. The effects were suggestive that aspirin did reduce the blood pressure in hypertensive subjects but was not universal and was limited to those suffering from mild - moderate hypertension. It was determined that aspirin should be sued at the earliest age possible in these patients. The sixth Chapter involved a large scale trial of the effectiveness of aspirin treatment in hypertensive patients over a one year period in Kuwait. This used ambulatory blood pressure measurements to determine the effectiveness of daytime and nightime changes in blood pressure in patients with and without aspirin treatment. The overall conclusion was a reduced relative risk of suffering cardiovascular events in mild to moderate hypertension when aspirin (75mg/day) was administered. Specifically in smokers, aspirin lowers the systolic daytime BP and diastolic nightime BP. To support this work a comprehensive audit is provided of the use of the current use of aspirin in Kuwait hospitals.
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Hurdman, Judith. "The clinical spectrum and natural history of pulmonary hypertension in the modern treatment era." Thesis, University of Sheffield, 2015. http://etheses.whiterose.ac.uk/15205/.
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Pulmonary hypertension (PH) is a heterogeneous condition with classification based on shared pathophysiological characteristics. There is a paucity of literature reflecting the spectrum of disease across the 5 diagnostic groups encountered at a specialist referral centre in the era of the widespread availability of targeted pulmonary vascular therapy. The first part of this thesis focuses on the ASPIRE registry; a large registry of contemporary, consecutive, treatment-naïve patients identified at a specialist PH centre using a catheter-based approach. Uniquely, the ASPIRE registry compares the natural history of all forms of PH, providing new and novel insights into the natural history of rare groups such as pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension and more common but less well studied forms such as PH associated with left heart disease and lung disease where the role of targeted therapies is not clear. This registry demonstrates that outcomes and characteristics differ between and within PH diagnostic groups. In addition, the current system of diagnostic classification in PH has prognostic value even when adjusted for age and haemodynamic severity emphasizing the importance of systematic evaluation and precise classification. The second part of this thesis focuses on patients in group 3; pulmonary hypertension associated with lung disease, concentrating particularly on chronic obstructive pulmonary disease (COPD) and emphysema, the most common type of lung disease associated with PH. The characteristics of patients with severe PH associated with COPD (PH-COPD) differed from those with mild to moderate PH-COPD despite similar degrees of emphysema on CT scan. Survival in PH-COPD was poor and this study identified independent predictors of outcome. Patients with severe PH-COPD share certain characteristics with PAH such as the degree of haemodynamic severity and right ventricular impairment. This leads to the question of whether therapies frequently prescribed in PAH should be considered for this group. In the largest cohort yet studied, a minority of patients with severe PH-COPD demonstrated objective evidence of improvement with compassionate treatment with targeted pulmonary vascular therapies and where there was evidence of clinical benefit, patients demonstrated superior survival. This data suggests that further evaluation of targeted therapies is warranted in patients with severe PH-COPD. In conclusion, retrospective review of this cohort of patients has provided a detailed comparison of characteristics between and within PH diagnostic groups, assessed prognostic markers and provided insights into the effects of targeted pulmonary vascular treatment in severe PH-COPD. This underscores the importance of thorough assessment and accurate classification to ensure appropriate management and prudent use of costly therapies. This registry also provides detailed phenotypic information which may be helpful when defining entry criteria for clinical trials. The characterization of this patient cohort has also lead to a number of publications from collaborative projects in the Academic Unit of Radiology.
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Haugen, Espen. "Pathophysiological role and clinical relevance of cytokines in hypertensive heart failure : a combined clinical and experimental study /." Göteborg : Department of Molecular and Clinical Medicine/Cardiology, Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska Academy, Göteborg University, 2007. http://hdl.handle.net/2077/7623.
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Redzuan, Adyani Md. "Sodium-dietary intake, awareness and clinical outcomes in treated hypertensive patients." Thesis, University of Glasgow, 2012. http://theses.gla.ac.uk/4418/.
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Kung, Kin-hang, and 龔健恆. "An audit on anti-hypertensive drug management amongst general out-patient clinics in New Territories West region." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2004. http://hub.hku.hk/bib/B31971878.
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Al, Shayban Dhfer Mahdi D. "Modelling the Clinical and Economic Outcomes of Variations in Intensity of Valsartan-Centric Regimens for Hypertension." Diss., The University of Arizona, 2015. http://hdl.handle.net/10150/556209.
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Purposes: The purpose of this study was threefold. First, to examine how both the effectiveness of valsartan centric regimens and the patient-related factors affect the control rates of the Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and combined SBP/DBP; specifically for Belgian patients with a history of failed or intolerant anti-hypertensive treatment. Secondly, to assess the effectiveness of valsartan treatment groups and the related factors concerning a patients' total cardiovascular risk (TCVR) residuals. Lastly, to attempt to estimate the cost avoidance factor associated with taking varying levels of valsartan treatment doses. Methodology: This research took the form of a secondary-data analysis study, focusing on the analysis of data collected primarily from seven prospective studies conducted between 2004 and 2009, covering different regimens of valsartan. The variants of valsartan doses given to patients included: valsartan monotherapy (80mg or 160 mg); a combination of valsartan with hydrochlorothiazide (HCTZ) (80 mg and 12.5mg, 160mg and 12.5 mg, or 160mg and 25mg); and a combination of valsartan with amlodipine (80mg and 5mg, 160mg and 5mg, or 160mg and 10mg). We applied Bailey's approach, using Kaplan-Meier curves to estimate the distribution of treatment intensity at which the target rates of SBP, DBP and SBP/DBP were achieved. The treatment intensity was calculated by dividing the daily dose prescribed to a patient by the maximum daily recommended dose of that particular drug variant. The outcomes provided by Bailey's approach included the control rates of SBP, DBP and combined SBP/DBP, in addition to the reduction in TCVR residuals. Another aspect of our methodology was the use of a simulation method to estimate the cost avoidance by using valsartan treatment groups. We used OCED data to compare health indicators between the US and Belgium in order to estimate the ratio enabling us to calculate the cost of hypertension per patient per year. This cost was then used in the simulation method to calculate the cost avoidance of using varying levels of the treatment intensity of valsartan regimens. Results: A total of 17,683 patients were included in this study, contributed to by 3,434 physician-investigators. The mean age of the population was 63.63 + 11.83 years, with a mean BMI of 28.45 + 3.13 kg/m^2 and 47.7% of the population was male and the vast majority of the total population was Caucasian (98%). As a baseline the total population who had controlled SBP, DBP and combined SBP/DBP were 1358, 5301 and 1091 respectively. The total population who were categorized as low added risk TCVR, moderate added risk TCVR, high added risk TCVR, and very high added risk TCVR were 192; 3,721; 3,888 and 9,362 respectively. Overall, there was a statistically significant increase in the proportion of patients with controlled SBP, DBP and combined SBP/DBP after 90 days of starting on valsartan-centric regimens (p<0.001). Both older age and the presence of diabetes were associated with a lower control rate of SBP, DBP and combined SBP/DBP (P<0.05). High adherence to valsartan-centric regimens was associated with an increase in the control rates of blood pressure. Substantial reductions in total cardiovascular risk, particularly in the very high added-risk category was observed 5,852 times (33.1%) (P<0.001) and an increase in the low added risk TCVR 3,331 times (18.9%) (p<0.001). The associated cost avoidance with varying levels of treatment intensity were dose related. The cost avoidance associated with the treatment intensity levels of 0.25, 0.5, 0.75, 1.0 and 1.5 were $261,164; $2,403,188; $6,384,142; $8,702,272 and $10,230,321, respectively. Conclusion: The different levels of the treatment intensity of valsartan-centric regimens were effective in increasing the control rates of SBP, DBP and combined SBP/DBP in the real practice for patients whose prior treatment failed. Not only did valsartan regimens improve the BP control rate, they also reduced the TCVR residuals. Additionally, substantial cost avoidance was found to be associated with the use of higher levels of treatment intensity. These results may support the idea that intensive anti-hypertensive treatment may be associated with higher clinical and economic benefits for both patients and payers. However, more research might be needed to validate our results and to address the questions of adverse effects that may be associated with intensive anti-hypertensive therapy and the economic consequences of treating any such effects.
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Johnston, Ian Hugh. "The pseudotumour syndrome : clinical and experimental studies of pseudotumour cerebri (benign intracranial hypertension) and related conditions." Thesis, University of Dundee, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.323162.
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Shepherd, Amy. "Characterising lymphocyte subpopulations and heat shock protein 70 expression in clinical and experimental pulmonary arterial hypertension." Thesis, University of Sheffield, 2012. http://etheses.whiterose.ac.uk/3743/.
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Pulmonary arterial hypertension (PAH) is fatal disease of the small pulmonary arteries which is characterised by medial hypertrophy causing an increase in pulmonary vascular resistance and pulmonary artery pressure resulting in right ventricular failure and death. The pathogenesis of PAH has not been fully elucidated to date and there is no current curable pharmacological treatment. Inflammation is thought to play an important role in the pathogenesis of PAH. The work undertaken in this thesis aimed to investigate the role of T cells in the pathogenesis of PAH by characterising lymphocyte subsets (T and B cell distribution) in treatment-naïve patients with PAH and animal models of disease. I found that the relative frequency of CD8+ cytotoxic T cells in treatment-naïve Scleroderma associated-PAH patients was significantly decreased compared to corresponding controls. A negative correlation was also noted between the relative frequency of CD4+ T cells and several clinical parameters. To investigate cause or effect of changes in T cell frequency, I examined a time course of the paigen diet-fed ApoE-/-/IL-1R1-/- mouse model of PAH, but noted no difference in circulating T cell subset distribution. CD4+ T cell depletion rendered these animals more susceptible to the development of PAH. Collectively, these findings suggest that subtypes of PAH are associated with distinct T cell profiles. Alterations in circulating T cell and B cell subsets in clinical PAH, particularly CD8+ T cells suggest a dysfunctional immune system which could contribute to disease pathogenesis. In experimental models, the propagation of disease progression by depletion of CD4+ T cells suggests an anti-inflammatory nature of these cells within this disease setting. Future studies are needed to fully understand the exact role that T cells play in the pathogenesis of PAH.
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Partha, Gautam. "Evaluating Outcomes Related to Hypertension in Toledo-Lucas County CareNet Patients." University of Toledo Health Science Campus / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=mco1333690615.
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Choski, Charvi, Kesheng Wang, Ying Liu, Olakunle Oni, Youssoufou Ouedraogo, and Shimin Zheng. "Effects of Buprenorphine and Methadone on Hypertension in Patients with Opioid Dependence: a Randomized Clinical Trial Study." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/326.
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Background: The misuse and addiction to opioids are one of the major health and social problem that is associated with an increase in morbidity and mortality. Both Buprenorphine (BUP) and Methadone (MET) are FDA-approved treatments for opioid dependence. This longitudinal study is to determine the effects of BUP and MET on hypertension in patients with opioid dependence using a Generalized Estimating Equation(GEE) Model. Methods: The data is from National Drug Abuse Treatment Clinical TrialsNetwork (CTN) protocol CTN-0027. This is a randomized study of 1,934 opioid dependence participants seeking treatment that followed for up to 32 weeks. A total of1,284 males and 631 females participated at the Baseline (visit1) of the study. At the endof 32 weeks (10 visits), 499 males and 243 female patients completed the study. Blood pressure of all the patients was checked at every visit beginning visit 1 to visit 10. For this analysis, the dependent variable was hypertension which was defined as having asystolic blood pressure higher than 140 mmHg and/or a diastolic blood pressure higher than 90 mmHg. These participants were randomly assigned to receive BUP (n= 740) or MET (n= 529). The GEE model with exchangeable correlation was used to determine the efficacy of both the drugs on hypertension. The analysis was performed using PROCGENMOD in SAS 9.4. Results: Time increased the odds of hypertension (adjusted odds ratio (aOR): 1.04, 95% confidence interval (CI): 1.02-1.06, pConclusion: Findings suggest that BUP had a slightly less chance of causing hypertension among patients with opioid dependence comparing with MET controlling for other risk factors, but neither one of Page 54 2017 Appalachian Student Research Forum them had any significant effect on hypertension among patients with opioid dependence. Further analysis will be essential to detect gender x treatment interaction.
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Grünig, Ekkehard, Nicola Ehlken, Ardeschir Ghofrani, Gerd Staehler, F. Joachim Meyer, Jana Juenger, Christian F. Opitz, et al. "Effect of Exercise and Respiratory Training on Clinical Progression and Survival in Patients with Severe Chronic Pulmonary Hypertension." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-132537.
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Background: Even though specific agents for the treatment of patients with pulmonary hypertension (PH) are available, in PH patients, physical capacity and quality of life (QoL) are often restricted and survival is reduced. Objectives: This study prospectively investigated the long-term effects of respiratory and exercise training in patients with severe chronic PH regarding safety, time to clinical worsening and survival. Methods: Fifty-eight consecutive patients with severe PH on stable disease-targeted medication received exercise and respiratory training in hospital for 3 weeks and continued at home. They were prospectively followed for 24 ± 12 months. Primary endpoints were time to clinical worsening and survival. Adverse events and changes in the 6-min walking test, QoL, WHO functional class and gas exchange were secondary endpoints and were evaluated at baseline and at weeks 3 and 15. Results: All patients tolerated the exercise training well without severe adverse events. In week 15, 6-min walking test results were significantly improved compared to baseline (by 84 ± 49 m, p < 0.001), as well as QoL scores, WHO functional class (from 2.9 ± 0.5 to 2.6 ± 0.6, p < 0.01), peak oxygen consumption (from 12.5 ± 3.0 to 14.6 ± 3.9 ml/min/kg, p < 0.001), heart rate at rest (from 75 ± 12 to 61 ± 18 beats/min, p < 0.001) and maximal workload (from 65 ± 21 to 80 ± 25 W, p < 0.001). Survival at 1 and 2 years was 100 and 95%, respectively. Fifteen events occurred during the follow-up. Conclusion: This study indicates that exercise and respiratory training as add-on to medical treatment may improve exercise capacity and QoL, and that they have a good long-term safety in the described settingDieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich
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Grünig, Ekkehard, Nicola Ehlken, Ardeschir Ghofrani, Gerd Staehler, F. Joachim Meyer, Jana Juenger, Christian F. Opitz, et al. "Effect of Exercise and Respiratory Training on Clinical Progression and Survival in Patients with Severe Chronic Pulmonary Hypertension." Karger, 2011. https://tud.qucosa.de/id/qucosa%3A27461.
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Background: Even though specific agents for the treatment of patients with pulmonary hypertension (PH) are available, in PH patients, physical capacity and quality of life (QoL) are often restricted and survival is reduced.
Objectives: This study prospectively investigated the long-term effects of respiratory and exercise training in patients with severe chronic PH regarding safety, time to clinical worsening and survival.
Methods: Fifty-eight consecutive patients with severe PH on stable disease-targeted medication received exercise and respiratory training in hospital for 3 weeks and continued at home. They were prospectively followed for 24 ± 12 months. Primary endpoints were time to clinical worsening and survival. Adverse events and changes in the 6-min walking test, QoL, WHO functional class and gas exchange were secondary endpoints and were evaluated at baseline and at weeks 3 and 15.
Results: All patients tolerated the exercise training well without severe adverse events. In week 15, 6-min walking test results were significantly improved compared to baseline (by 84 ± 49 m, p < 0.001), as well as QoL scores, WHO functional class (from 2.9 ± 0.5 to 2.6 ± 0.6, p < 0.01), peak oxygen consumption (from 12.5 ± 3.0 to 14.6 ± 3.9 ml/min/kg, p < 0.001), heart rate at rest (from 75 ± 12 to 61 ± 18 beats/min, p < 0.001) and maximal workload (from 65 ± 21 to 80 ± 25 W, p < 0.001). Survival at 1 and 2 years was 100 and 95%, respectively. Fifteen events occurred during the follow-up.
Conclusion: This study indicates that exercise and respiratory training as add-on to medical treatment may improve exercise capacity and QoL, and that they have a good long-term safety in the described setting.Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.
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Gunnarsdóttir, Steingerður Anna /. "Liver cirrhosis : epidemiological and clinical aspects /." Göteborg : Section of Gastroenterology and Hepatology, Department of Internal Medicine, Sahlgrenska University Hospital, Göteborg University, 2008. http://hdl.handle.net/2077/10132.
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Jose, Arun. "Value of Baseline Cardiac Magnetic Resonance Imaging for Predicting Adverse Outcomes in Treatment-naive Pulmonary Hypertension Patients." University of Cincinnati / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1560866307524617.
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Jang, Sae, Rebecca R. Vanderpool, Reza Avazmohammadi, Eugene Lapshin, Timothy N. Bachman, Michael Sacks, and Marc A. Simon. "Biomechanical and Hemodynamic Measures of Right Ventricular Diastolic Function: Translating Tissue Biomechanics to Clinical Relevance." WILEY, 2017. http://hdl.handle.net/10150/626001.
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Background Right ventricular (RV) diastolic function has been associated with outcomes for patients with pulmonary hypertension; however, the relationship between biomechanics and hemodynamics in the right ventricle has not been studied. Methods and Results Rat models of RV pressure overload were obtained via pulmonary artery banding (PAB; control, n=7; PAB, n=5). At 3 weeks after banding, RV hemodynamics were measured using a conductance catheter. Biaxial mechanical properties of the RV free wall myocardium were obtained to extrapolate longitudinal and circumferential elastic modulus in low and high strain regions (E-1 and E-2, respectively). Hemodynamic analysis revealed significantly increased end-diastolic elastance (E-ed) in PAB (control: 55.1 mm Hg/mL [interquartile range: 44.785.4 mm Hg/mL]; PAB: 146.6 mm Hg/mL [interquartile range: 105.8155.0 mm Hg/mL]; P=0.010). Longitudinal E1 was increased in PAB (control: 7.2 kPa [interquartile range: 6.718.1 kPa]; PAB: 34.2 kPa [interquartile range: 18.144.6 kPa]; P=0.018), whereas there were no significant changes in longitudinal E-2 or circumferential E-1 and E-2. Last, wall stress was calculated from hemodynamic data by modeling the right ventricle as a sphere: (stress = Pressure x radius/2 x thickness Conclusions RV pressure overload in PAB rats resulted in an increase in diastolic myocardial stiffness reflected both hemodynamically, by an increase in E-ed, and biomechanically, by an increase in longitudinal E-1. Modest increases in tissue biomechanical stiffness are associated with large increases in E-ed. Hemodynamic measurements of RV diastolic function can be used to predict biomechanical changes in the myocardium.
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Katiya, Lulama Pearl. "An investigation on the effectiveness of lifestyle modification interventions for hypertensive patients in a public health clinic, in the Eastern Cape Province." Thesis, University of Fort Hare, 2014. http://hdl.handle.net/10353/d1021131.
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The continued increase in morbidity and mortality of hypertensive patients in Alice in the Eastern Cape Province, prompted the researcher to investigate the effectiveness of lifestyle modification intervention on hypertensive patients. High morbidity and mortality rates of hypertensive patients are occuring in spite of hypertensive patients being taught about lifestyle modification (De Haan, 2006:55). According to the fifth South African Guidelines (2011:60), hypertension is a global health burden affecting developed and developing countries including South Africa. In 2003, the South African District Health Statistics showed that in the Eastern Cape, 221 females over 15 years of age and 101 males over 15 years of age had moderate hypertension and 92 males over 15 years had severe hypertension. Hypertension is a `silent killer` because it seldom gives rise to any symptoms (De Haan, 2006:66). The objectives of the study were to: investigate the effectiveness of lifestyle modification intervention on hypertensive patients, and to determine the strategies used in order to ensure the effectiveness of lifestyle modification by hypertensive patients. The research question was: what is the level of effectiveness of lifestyle modification on hypertensive patients in Alice? A descriptive quantitative research design was used in this study. This design allowed the researcher to investigate the effectiveness of lifestyle modification of hypertensive patients in Alice area. A convenience sample was used to sample the target population for the study on the criteria and a total of 169 respondents served as a size of the sample. A pre-test of the tool was carried out on 16 participants to validate the tool before the actual data collection commenced. Ethical approval was obtained from University of Fort Hare, the Department of Health, as well as Victoria Hospital and clinics. Data were collected by means of self-administered questionnaires. The Statistical Package for Social Science (SPSS) version 21.0 software for windows reference was used to analyse the data. The results were presented in tables, graphs and pie charts. The results revealed that 77% (n=125) reported to know nothing about hypertension. Twenty three percent of the participants (n=37) knew about hypertension, they mentioned that it is when the heart has too much blood that is overloading the heart due to problems of the heart, then the blood flow through the heart is disturbed. Furthermore participants stated that it is important that every hypertensive patient engage in lifestyle modification. The study recommended that the Department of Health should emphasise the use of Hypertension Guidelines where all nurses in public clinics should be trained in educating and doing counselling to all hypertensive patients, including those who are pre-hypertensive that are visiting the clinics. Health education about risk factors and complications of hypertension must be done. All patients visiting public clinics must be educated regardless of their problems.
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Duckworth, Susan Jacqueline. "Assessment and stratification of women with hypertension in the second half of pregnancy : a clinical, biochemical, economical and outcome evaluation." Thesis, King's College London (University of London), 2016. https://kclpure.kcl.ac.uk/portal/en/theses/assessment-and-stratification-of-women-with-hypertension-in-the-second-half-of-pregnancy-a-clinical-biochemical-economical-and-outcome-evaluation(78f2ca4c-0736-45d0-9e44-960c0b427e7d).html.
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Pre-eclampsia is a disease unique to pregnancy. Prevalence in the UK is between 5- 8% of pregnancies yet diagnosis remains challenging. The PELICAN study was a multi-centre, observational cohort study. The primary aim was to evaluate the diagnostic accuracy of plasma placental growth factor (PlGF) in the second half of pregnancy, in predicting the need for delivery for pre-eclampsia within 14 days of testing. 649 women presenting with suspected pre-eclampsia were recruited between January 2011 and February 2012, across seven consultant-led units within England and Ireland. Blood samples were taken at enrolment; PlGF measurements were performed but results blinded until the study was complete and diagnoses and pregnancy outcome known. A further 47 biomarkers were measured (using 57 assays) to evaluate whether the diagnostic potential of PlGF could be improved further. Using a pre-specified cut off of <5th centile, a low (>12pg/ml < 5th centile) or very low (<12pg/ml) PlGF concentration was shown to have high sensitivity (0.95 CI (0.89- 0.99) in women < 35 weeks’ gestation) to determine need for delivery within 14 days. When compared with other biologically plausible biomarkers, the area under the ROC curve for low or very low PlGF (0.87, standard error 0.03), was greater than all other commonly utilised tests either singly or in combination (range 0.58–0.76; p<0.001 for all comparisons). Data from 100 women were then used to perform a budget impact analysis. A hypothetical decision analytical model using data extracted from case note review and reference cost tariffs, suggested a mean cost saving associated with the PlGF test (in the PlGF plus management arm) of £35,087 (95% CI -£33,181 to -£36,992) per 1,000 women, equating to a saving of £582 (95% CI -£552 to -£613) per woman tested. PlGF testing could be used to risk-stratify women with suspected pre-eclampsia with the aim of improving pregnancy outcome.
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Liu, Lincoln. "Intergenerational effects of early life programming : the role of glucocorticoids and maternal obesity." Thesis, University of Edinburgh, 2011. http://hdl.handle.net/1842/9818.
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Hypertension and type two diabetes mellitus (Type 2 DM) are serious chronic illnesses that impact on the lives of millions of people around the world. Various epidemiological studies have shown a relationship between early life events such as intrauterine growth retardation (IUGR) resulting in low birth weight and the development of these chronic illnesses in adult life. To explain the link between these two events, it has been suggested that an ‘insult’ at a critical time point of development can ‘program’ alterations in gene expression, organ size, and cell number. This has been termed “the early life origins of disease’. There is also evidence that these programmed effects are not limited to the first generation but can also be passed to subsequent generations. With changes in lifestyle in modern society, the prevalence of obesity is increasing, in association with problems such as type 2 DM, hypertension, fatty liver, atherosclerosis and the metabolic syndrome. Obesity during pregnancy is linked to problems such as gestational diabetes, hypertension and early miscarriage as well as a higher risk of congenital malformations. Maternal obesity has also been recognised as one of the factors capable of ‘programming’ the offspring, increasing the risk of childhood and adult disorders such as obesity and hypertension. In this thesis I have used two animal models to explore the underlying mechanisms of programming and its intergenerational effects: i) a rat model of prenatal glucocorticoid over-exposure (the dexamethasone-programmed rat) and ii) a mouse model of obesity during pregnancy. Using the dexamethasone-programmed rat, I have shown that prenatal glucocorticoid overexposure reduces fetal and placental weight in the first generation (F1) offspring, in association with alterations in gene expression in placenta and liver. In addition, I have shown effects on fetal and placental weights and gene expression in the second generation (F2) offspring. The observed changes in gene expression in the F2 offspring differ from those in the first generation. Thus, although effects on fetal growth are seen in both generations, the underlying mechanisms appear to be different. We also observed marked parent of origin effects on fetal and placental growth and gene expression in the second generation. In the mouse model of maternal obesity, birth weight was decreased in the F1 offspring. At weaning, the offspring of obese mothers were heavier than controls, however this difference in weight was not persistent. At three months of age, F1 female offspring of obese mothers showed altered expression of hepatic genes important in lipid regulation and metabolism. More striking changes were seen in the F2 generation in which there was an effect of paternal exposure to maternal obesity to decrease birth weight. There were also parent of origin effects on organ weights and insulin levels at six months of age. These results provide evidence for the transmission of programming effects to a second generation in two different programming models and suggest that the mechanisms leading to these effects differ between generations.
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Alcantara, Roberta Vacari de 1977. "Evolução clinica, laboratorial, ultra-sonografica e endoscopica de pacientes com trombose de veia porta diagnosticada na faixa etaria pediatrica." [s.n.], 2007. http://repositorio.unicamp.br/jspui/handle/REPOSIP/309390.
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Orientador: Gabriel HesselDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: A trombose de veia porta (TVP) é uma importante causa de hipertensão portal na faixa etária pediátrica (FEP). As principais formas de apresentação clínica são hemorragia digestiva alta (HDA) e esplenomegalia. Há pouca informação sobre a evolução dessa doença em crianças. O objetivo desse estudo foi avaliar a evolução clínica, laboratorial, ultra-sonográfica e endoscópica de pacientes com TVP na FEP. Foi realizado um estudo descritivo e longitudinal de 51 pacientes com TVP sem doença hepática crônica associada acompanhados no Ambulatório de Hepatologia Pediátrica do Hospital de Clínicas da Faculdade de Ciências Médicas da Universidade Estadual de Campinas entre janeiro de 1986 e junho de 2006. Elaborou-se uma ficha de coleta de dados, a partir dos prontuários dos pacientes incluídos, que constou dos seguintes itens: identificação e avaliações clínica, laboratorial, ultra-sonográfica e endoscópica. Da avaliação laboratorial, foram obtidos os resultados dos seguintes exames: eritrograma, leucograma, contagem de plaquetas, RNI e R. Foram selecionados os resultados dos primeiros e últimos exames realizados, e os que foram coletados próximo ao ultra-som de abdome em que havia o resultado da dimensão do baço. A análise estatística foi descritiva para os indicadores clínicos e, para análise das variáveis, foram empregados os testes de McNemar, Mann-Whitney e coeficiente de correlação de Spearman. A análise de sobrevida dos pacientes foi realizada pelo método de Kaplan-Meier. Foi adotado nível de significância de 5%. HDA e esplenomegalia foram as principais formas de apresentação clínica que justificaram o encaminhamento para investigação, com freqüência de 66% e 22%, respectivamente. As medianas da idade do início dos sintomas foi de 3,7 anos e do tempo de seguimento foi de 4,8 anos. O fator de risco (FR) associado à TVP não foi identificado na maioria dos casos. Quando identificado, o mais freqüente foi o cateterismo umbilical (27,5%). A freqüência da HDA foi alta na admissão (66%) e na evolução (78%). A esplenomegalia já estava presente ao exame físico em 83,7% dos casos na admissão. A maioria dos pacientes apresentava níveis séricos de aminotransferases normais e alta freqüência de anemia, leucopenia e plaquetopenia. Com a evolução, observaram-se melhora da anemia e persistência da leucopenia e da plaquetopenia. A comparação entre a dimensão esplênica e a contagem de leucócitos, plaquetas e valores de R mostrou diferença estatística, sendo inversamente proporcional para o número de leucócitos e de plaquetas e diretamente proporcional para o R. Cinqüenta pacientes foram submetidos à endoscopia digestiva. Ao diagnóstico, 88% dos pacientes apresentavam varizes de esôfago (VE), 50% varizes gástricas (VG) e 22% gastropatia da hipertensão portal (GHP). As últimas endoscopias evidenciaram VE em 73%, VG em 60% e GHP em 41% dos pacientes. Escleroterapia e/ou ligadura de varizes esofágicas foram realizadas em 41 pacientes, sendo a maioria dos procedimentos realizados no primeiro semestre após o início da terapia endoscópica (p<0,001). Biliopatia portal foi diagnosticada em 4 pacientes. Três pacientes foram submetidos a shunt porto-sistêmico. Evolução para óbito ocorreu em 3 pacientes. Em conclusão, HDA, esplenomegalia e hiperesplenismo devem alertar o médico para o diagnóstico de TVP. A maioria dos casos permanece sem FR conhecido. O sangramento digestivo ocorreu na maior parte dos pacientes e motivou múltiplas transfusões. A doença apresenta baixa mortalidade, mas alta morbidade
Abstract: The aim of this study was to analyze clinical, laboratory, ultrasonographic and endoscopic data of PVT in children. We comprised 51 children who had PVT diagnosed between January 1986 and January 2006. All of them were selected from the record of patients admitted to the Hepatology Pediatric Outpatient Clinic of the University of Campinas Teaching Hospital (Unicamp), city of Campinas, state of São Paulo, Brazil. The information obtained from the patients¿ charts included their clinical, laboratory, ultrasonographic and endoscopic data. The following values were included in the laboratory evaluation: hemoglobin, white blood cell and platelet counts, INR and R values. The first and last results of these exams were selected, as well as those exams performed next to an abdominal ultrasonography in which the spleen dimension was available. The clinical data were obtained from descriptive statistical analysis. The Mann-Whitney and McNemar tests and Spearman¿s rank correlation coefficient were used for variable data. Kaplan-Meier¿s method was used in order to determine patient¿s life expectancy. A p-value of <0.05 was considered signif icant. Initial manifestations included gastrointestinal bleeding and splenomegaly, seen in 66% and 22% of the patients, respectively, with a median age of 3.7 years old. The patients were followed for a median time of 4.8 years. The etiologic factor for PVT was not available in most patients and umbilical catheterization was identified in 27.5% of all cases. Sixty percent of the patients presented with GI bleeding at the first medical evaluation and 78% of them had presented GI bleeding at the last one. Splenomegaly was the most frequent sign at physical examination, occurring in 83.7% of the children at presentation. Most patients had normal liver enzymes, but low levels of hemoglobin, leukocytes and platelet counts were commonly seen. The last evaluation showed persistent leucopenia and low platelet count. The correlation between the spleen dimension and the white blood cell count, platelet count and R was statistically significant. Fifty patients underwent upper gastrointestinal endoscopy. At first evaluation, 88% of the patients presented with esophageal varices, 50% with gastric varices and 22% with portal hypertensive gastropathy. The last endoscopies showed esophageal varices in 73%, gastric varices in 60% e portal hypertensive gastropathy in 41%. Forty-one patients underwent sclerotherapy and/or esophageal ligation, most of whom during the first 6-month period after they were initiated (p < 0.001). Portal biliopathy occurred in four patients. Shunt surgery was performed in three patients. Three patients died. In conclusion: Gastrointestinal bleeding, splenomegaly and hypersplenism should alert physicians to PVT. The etiologic factor related to PVT remains uncertain in most cases. The majority of patients experienced gastrointestinal bleeding and many blood transfusions. Therefore, PVT seems to cause little mortality but high morbidity
Mestrado
Pediatria
Mestre em Saude da Criança e do Adolescente
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Darling, Chad E. "Hypertensive Acute Decompensated Heart Failure Presentations: On the Decline? : A Master's Thesis." eScholarship@UMMS, 2007. http://escholarship.umassmed.edu/gsbs_diss/720.
Full textAbstract:
Background: The initial systolic blood pressure (SBP) in patients with acute heart failure (AHF) can be used as a guide when choosing specific pharmacologic treatments by helping identify the underlying type of HF (e.g., HF with preserved ejection fraction). Clinical experience and research data from our medical center suggests that AHF with elevated SBP may be presenting less frequently than in the past. This may call into question the utility of initial SBP as a clinical guide. The goal of this Master’s Thesis is to test the hypothesis that the frequency of AHF patients with a SBP>160mmhg has declined over time.
Methods: This observational study compares data from 4 cohorts of adult patients admitted with AHF in central MA. Data were obtained from a contemporary (2011-2013) study of patients with AHF as well as from the 1995, 2000, 2006 Worcester Heart Failure Study (WHFS) cohorts. The Framingham criteria the diagnostic criterion for AHF. The main outcome was the proportion of patients with AHF with a SBP > 160 mmHg who presented in each of the 4 study cohorts and was examined by multivariate logistic regression.
Results: 2,366 patients comprised the study population. The average age was 77 years, 55% were female, 94% white, and 75% had prior HF. In 1995 33.6% of AHF patients had a SBP >160 mmHg compared to 19.5% in 2011-2013 (p160 mmHg in 2006 (0.64, (0.42-0.96)) and 2011-13 (0.46, (0.28-0.74)).
Conclusion: The proportion of patients with AHF and an initial SBP >160 mmHg has significantly declined over time. This may warrant a reexamination of the utility of SBP to inform diagnosis and treatment in patients with AHF.
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Darling, Chad E. "Hypertensive Acute Decompensated Heart Failure Presentations: On the Decline? : A Master's Thesis." eScholarship@UMMS, 2014. https://escholarship.umassmed.edu/gsbs_diss/720.
Full textAbstract:
Background: The initial systolic blood pressure (SBP) in patients with acute heart failure (AHF) can be used as a guide when choosing specific pharmacologic treatments by helping identify the underlying type of HF (e.g., HF with preserved ejection fraction). Clinical experience and research data from our medical center suggests that AHF with elevated SBP may be presenting less frequently than in the past. This may call into question the utility of initial SBP as a clinical guide. The goal of this Master’s Thesis is to test the hypothesis that the frequency of AHF patients with a SBP>160mmhg has declined over time.
Methods: This observational study compares data from 4 cohorts of adult patients admitted with AHF in central MA. Data were obtained from a contemporary (2011-2013) study of patients with AHF as well as from the 1995, 2000, 2006 Worcester Heart Failure Study (WHFS) cohorts. The Framingham criteria the diagnostic criterion for AHF. The main outcome was the proportion of patients with AHF with a SBP > 160 mmHg who presented in each of the 4 study cohorts and was examined by multivariate logistic regression.
Results: 2,366 patients comprised the study population. The average age was 77 years, 55% were female, 94% white, and 75% had prior HF. In 1995 33.6% of AHF patients had a SBP >160 mmHg compared to 19.5% in 2011-2013 (p160 mmHg in 2006 (0.64, (0.42-0.96)) and 2011-13 (0.46, (0.28-0.74)).
Conclusion: The proportion of patients with AHF and an initial SBP >160 mmHg has significantly declined over time. This may warrant a reexamination of the utility of SBP to inform diagnosis and treatment in patients with AHF.
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Florea, Elena V. "Prediction of clinical events in elderly using sensor data a case study on pulse pressure /." Diss., Columbia, Mo. : University of Missouri-Columbia, 2009. http://hdl.handle.net/10355/6588.
Full textAbstract:
Thesis (M.S.)--University of Missouri-Columbia, 2009.The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. "May 2009" Includes bibliographical references.
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Rhinehart, Jaylyn Durham. "Clinical Evaluation of Echocardiographic Variability in Estimating Pulmonary Artery Pressure and Pulmonary Vascular Resistance in Dogs." The Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1460723584.
Full text
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Dokun-Mowete, Christine Adekemi. "Using Multi-Theory Model to Predict Low Salt Intake - Nigerian Adults with Hypertension." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4279.
Full textAbstract:
Hypertension is a chronic non-communicable disease and a major risk factor for cardiovascular diseases, renal malfunction, disability, and premature death. One of the public health recommendations for the management of hypertension is the reduction of sodium/salt intake. There is need to develop and implement new evidence-based theoretical interventions to initiate and sustain behavior change in health education and promotion. Therefore, the quantitative cross-sectional method and design was used to investigate the adequacy of multi-theory model (MTM) constructs for the initiation and the sustenance of low sodium/salt intake behavior in hypertensive Nigerian adults. In addition, the impact of the MTM (initiation) constructs on actual salt/sodium intake was evaluated to validate self-reported behavior. A convenience sample of 149 consenting Nigerian adults with hypertension and of ages 20 to 60 years, self -administered the valid and reliable 39-item MTM instrument. The findings of confirmatory factor analysis showed construct validity of subscales for the initiation and sustenance model. All items loading for the two models were significant, p < 0.001. Multivariate regression analysis revealed 40.6% of the variance in initiating the consumption of low salt diets explained by advantages outweighing disadvantages, behavioral confidence, and changes in physical environment. About 41.8 % of the variance to sustain the intake of low salt diet was explained by emotional transformation, practice for change, and changes in social environment. The results justified the predictive role of MTM and adequacy of its utility to build evidence-based health education programs and interventions to address the health need of people with hypertension and contribute to social change in the country.