bluuebunny/crossref_metadata_2025 huggingface dataset:
Macular pigment optical density at four retinal loci during 120 days of lutein supplementation
Authors: Wenzel Adam J. , Sheehan Joseph P. , Gerweck Catherine , Stringham James M. , Fuld Kenneth , Curran‐Celentano Joanne
Published: May 2007

Background:  Increased consumption of lutein and zeaxanthin has been shown to increase macular pigment optical density (MPOD) in some individuals. Most interventions either obtained infrequent measures of MPOD or measured MPOD at a single retinal locus.

Purpose:  The aim of this study was to measure acute changes in MPOD at four retinal loci during lutein intervention.

Methods:  For 120 days, three subjects consumed 30 mg of lutein and 2.7 mg of zeaxanthin supplement per day. MPOD was measured with heterochromatic flicker photometry at 20′, 30′, 60′ and 120′ eccentricity three or four times per week. High‐performance liquid chromatography was used to measure serum carotenoid concentrations in blood samples collected at baseline and at 30‐day intervals.

Results:  At the two most central loci, MPOD significantly increased in all three subjects with a mean change of approximately 0.09 log units at 20′ eccentricity and 0.08 log units at 30′ eccentricity. MPOD significantly increased in two subjects at 60′ eccentricity, and in one subject at 120′ eccentricity. The increases in MPOD appeared to be linear and continued after treatment was ended. In all three subjects, log sensitivity at the reference locus decreased linearly. Serum lutein and serum zeaxanthin increased from baseline, reaching peak concentrations after 30 days of supplementation.

Conclusion:  The changes in MPOD suggest that carotenoid deposition occurs linearly and may be biased towards the central retina. Further, carotenoid deposition may occur outside the central fovea in interventions with pharmacological doses of carotenoid, resulting in underestimations of psychophysical measures of MPOD.
An analysis of patients discharged from a hospital‐based glaucoma case‐finding clinic over a 3‐year period
Authors: Salmon Nicola J. , Terry H. P. , Farmery Andrew D. , Salmon John F.
Published: May 2007

Purpose:  To analyse the false positive referrals by community optometrists to a glaucoma case‐finding clinic over a 3‐year period.

Methods:  A retrospective study was undertaken of the 531 patients who were referred by community optometrists and discharged after their first visit to the glaucoma case‐finding clinic at the Oxford Eye Hospital between 2003 and 2005. The number of patients who were referred on the basis of one, two or three abnormal parameters was determined. The specific reason why the presumed abnormal parameter was considered normal by a glaucoma specialist was determined from the patients’ records.

Results:  The referral was based on only one presumed abnormal parameter in 65.5–74.3% of patients (minimum–maximum percentage per year, 2003–2005). Physiological cupping was present in 21.5–29.5%, asymmetrical cupping because of asymmetrical disc size in 6.4‐8.2% and asymmetrical cupping in the presence of similar disc size in 1.9–5.1%. An intraocular pressure (IOP) within the normal range was measured in 17.6–20.8% and an IOP between 22 and 25 mmHg in association with a central corneal thickness of >588 μm was found in a further 11.5–15.4%. In 11.5–16.1% of patients who were referred because of an abnormal visual field, no field defect was found when the test was repeated. A cause other than glaucoma was responsible for an abnormal visual field defect in 1.2–6%.

Conclusion:  This study identifies the factors responsible for false positive referrals to a hospital‐based glaucoma case‐finding clinic. By considering these factors and by combining test data, the number of unnecessary referrals could be reduced in the future.
Biodiversity Conservation and Productivity in Intensive Agricultural Systems
Authors: Omer Amani , Pascual Unai , Russell Noel P.
Published: May 2007

This paper explores the economic effects of biodiversity loss on marketable agricultural output for intensive agricultural systems, which require an increasing level of artificial capital inputs. A theoretical bio‐economic model is used to derive a hypothesis about the effect of the state of biodiversity on the optimal crop output both in the longer run and in the transitional path towards the steady‐state equilibrium. The hypothesised positive relationship between biodiversity stock and optimal levels of crop output is empirically tested using a stochastic production frontier approach, based on data from a panel of UK specialised cereal farms for the period 1989–2000. The results support the theoretical hypothesis. Increases in biodiversity can lead to a continual outward shift in the output frontier (although at a decreasing rate), controlling for the relevant set of labour and capital inputs. Agricultural transition towards biodiversity conservation may be consistent with an increase in crop output in already biodiversity‐poor modern agricultural landscapes.
Re‐evaluating the Harbinson Proposal – Prospects for the EU25: A Note
Authors: Philippidis G. , Hubbard L. J. , Renwick A.
Published: May 2007

In this study, we use the Harbinson Proposal and July Framework to compare a ‘likely’ Doha scenario with a realistic baseline. The novelty of this study is that we focus exclusively on the trade‐led welfare impacts in selected EU member states. The important features of this note are the: (i) usage of the latest Global Trade Analysis Project (version 6) data; (ii) focus on EU25 regions incorporating all major Common Agricultural Policy instruments and reforms; and (iii) inclusion of binding tariff overhangs into the Harbinson tariff reductions. Results show the damping effects of tariff‐binding overhangs on welfare outcomes. This and other factors which limit the gains to liberalisation mean that the EU25 only realises 10% of its long‐run welfare gain potential, as defined by complete liberalisation.
The Utilisation of Trade Preferences for Developing Countries in the Agri‐food Sector
Authors: Bureau Jean‐Christophe , Chakir Raja , Gallezot Jacques
Published: May 2007

Both the European Union and the United States grant non‐reciprocal preferences to developing countries under the Generalised System of Preferences as well as under several regional schemes. The benefits of these preferences have recently been questioned. Several authors have pointed out the under‐utilisation of these preferences due to the constraints attached. There have been claims that rules of origin requirements and administrative costs, as well as uncertainty on eventual eligibility, have deterred exporters from using preferential regimes. We calculate various indicators of the utilisation of preferences in the agricultural, food and fisheries sector. We conclude that only a very small proportion of the imports eligible for these preferences is actually exported outside a preferential regime. The rate of utilisation is therefore high. However, the flow of imports from the poorest countries remains very limited in spite of rather generous tariff preferences, which leads to questions over the overall impact of the preferential agreements. In addition, preferential regimes overlap, and in such cases some regimes are systematically preferred to others. We use econometric estimates of the (latent) cost of using a given preference to explain why particular regimes are used. We focus on possible explanations, such as the cumulation rules (that restrict the use of materials originating from other countries), fixed administrative costs and differences in the preferential margin.
A Conjoint/Logit Analysis of Consumers’ Responses to Genetically Modified Tofu in Taiwan
Authors: Jan Man‐ser , Fu Tsu‐tan , Huang Chung L.
Published: May 2007

We use data collected from a consumer survey of face‐to‐face interviews to determine consumer demand for genetically modified (GM) tofu attributes in Taiwan. Conjoint analysis using logit models reveals that, on average, brand is the most important attribute in terms of influence on consumers’ preferences, followed by price, with GM content having the least influence. However, the analysis also reveals three distinct market segments for tofu. Apart from the largest segment (which reflects the average lack of concern about GM food), the remaining two segments are split according to their preference or antipathy towards GM tofu. This result suggests that GM labelling is helpful to Taiwanese tofu consumers.
Report of the Editor‐in‐Chief
Authors: Harvey David
Published: May 2007

2006 has been a year of consolidation for the Journal, as the first full year under editorial management at Newcastle using Manuscript Central by ©ScholarOne, and of the availability of our on‐line archive through Blackwell Synergy. We have made very substantial progress in reducing our turnround time during 2006, while our performance according to the citation impact factor for 2005 has also improved since the previous year. Submissions remain strong, though there may be signs that our rejection rate is increasing slightly. Plans are proceeding for the digitisation of our full archive since 1926 for inclusion in the on‐line archive.
On‐Farm Conservation of Rice Biodiversity in Nepal: A Simultaneous Estimation Approach
Authors: Dusen Eric Van , Gauchan D. , Smale M.
Published: May 2007

This paper presents an empirical case study about farmer management of rice genetic resources in two communities of Nepal, drawing on interdisciplinary, participatory research that involved farmers, rice geneticists and social scientists. The decision‐making process of farm households is modelled and estimated in order to provide information for the design of community‐based conservation programmes. A bivariate model with sample selection examines the simultaneous process of whether farmers decide to plant landraces or modern varieties, and whether the landraces they choose to plant constitute the genetic diversity of interest for future crop improvement. Findings show that the two landrace choices are affected by different social and economic factors, but in certain cases the decision processes are interrelated. Policies to promote the conservation of local rice diversity will need to take both processes into account.
Benefits of Antihypertensive Pharmacologic Therapy and Blood Pressure Reduction in Outcome Trials
Authors: Wang Ji‐Guang , Staessen Jan A.
Published: May 2007

In a quantitative overview of published trials, we investigated whether pharmacologic properties of antihypertensive drugs, as opposed to reduction in blood pressure, explain cardiovascular outcomes in hypertensive or high‐risk patients. We used meta‐regression to investigate the association between the odds ratios of outcome (experimental vs. reference treatment) and the corresponding blood pressure differences between study groups. Thus, we correlated odds ratios with between‐group differences in systolic pressure. We then compared odds ratios of benefit observed in recent trials with those predicted by meta‐regression on the basis of the differences in systolic pressure between randomized groups. Among nine actively‐controlled trials in hypertension, significant differences in systolic pressure (follow‐up minus baseline) between randomized groups (experimental minus reference) were observed in the ALLHAT, CAPPP, MIDAS, and NORDIL trials. Furthermore, the differences in achieved systolic and/or diastolic pressure between study groups were also significant in the hypertension trials and studies in high‐risk patients, which involved untreated control patients. The differences between the observed odds ratios and those predicted by meta‐regression did not reach statistical significance except for NORDIL and the single‐drug therapy subgroup of the PROGRESS trial. In NORDIL, the risk of stroke was lower on diltiazem than on the older drug classes despite a 3.1 mm Hg higher systolic pressure on the calcium channel blocker. In PROGRESS, perindopril alone reduced blood pressure by 5/3 mm Hg, but did not affect the incidence of all cardiovascular events or the recurrence of stroke. In conclusion, the finding that in the reviewed trials blood pressure reduction largely accounted for outcome emphasizes the desirability of tight blood pressure control. The hypothesis that blood pressure‐lowering medications might influence cardiovascular prognosis over and beyond their antihypertensive effect remains to a large extent unproved.
Treatment of Hypertension in African Americans and Latinos: The Effect of JNC VI on Urban Prescribing Practices
Authors: Henderson Sean O. , Bretsky Philip , DeQuattro Vincent , Henderson Brian E.
Published: May 2007

In 1997, national recommendations for the treatment of hypertension were made in the form of the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). African American hypertensives are considered a special population with a higher prevalence of hypertension, and therefore, unique treatment needs. The study objective was to review medication use among an African American and Latino urban population in relation to the JNC recommendations. The study population was drawn from a preexisting cohort of African Americans and Latinos. Records were reviewed for self‐description of hypertension and the use of any antihypertensive medication in individuals less than 60 years of age. A small subgroup of individuals was separately reviewed for specific medications used to treat hypertension. There were 34,118 individuals in the cohort greater than 45 years of age and less than 60 years of age that qualified for review; 40% were African American and 60% were Latino. Of the 13,593 African Americans, 6387 (47%) were hypertensive. Of the 20,525 Latinos, 29% were hypertensive. Only 56% of all hypertensives were on some blood pressure medication (61 % of the African Americans and 48% of the Latinos). Within the subgroup of 550 individuals with detailed medication information (223 African Americans and 327 Latinos), calcium channel blockers and diuretics were the most frequently used medication among the African Americans and angiotensin‐converting enzyme inhibitors were the most frequently used medication among the Latinos. Beta blockers were used only 13% of the time. The authors concluded that in this cohort of hypertensive urban Latinos and African Americans, more than 40% of individuals were not being treated for hypertension and, despite the guidelines suggested in JNC VI, few individuals were being treated for their hypertension with diuretic monotherapy or β blockers as first‐choice drugs. Instead there was extensive use of calcium channel blockers and angiotensin‐converting enzyme inhibitors.
The Diagnosis and Management of Renovascular Disease: A Primary Care Perspective
Authors: Bloch Michael J. , Basile Jan
Published: May 2007

Renovascular disease is a complex disorder, the most common causes of which are fibromuscular dysplasia and atherosclerotic disease. It usually presents in one of three forms: asymptomatic renal artery stenosis, renovascular hypertension, or ischemic nephropathy. This complexity often makes diagnostic and management decisions difficult. This review will be presented in two parts. In Part I, the authors will discuss when to consider and how to go about making the diagnosis. In Part II (in a future issue of The JCH), the authors discuss the management of renovascular disease. The clinical index of suspicion remains paramount in setting the diagnostic strategy. Although it is subject to certain limitations, conventional contrast angiography is usually considered the gold standard in confirming the diagnosis. In addition, there are a number of available noninvasive tests that can aid in decision making. These tests can be divided into those that detect the anatomic presence of a stenosis and those that identify the functional consequences of the renal artery obstruction.

No one study is appropriate for every patient. A diagnostic algorithm is proposed at the conclusion of this review.
The Diagnosis and Management of Renovascular Disease: A Primary Care Perspective
Authors: Bloch Michael J. , Basile Jan
Published: May 2007

Renovascular disease is a complex disorder, most commonly caused by fibromuscular dysplasia and atherosclerotic disease. It usually presents in one of three forms: asymptomatic renal artery stenosis, renovascular hypertension, or ischemic nephropathy. This complexity may make diagnostic and management decisions difficult for the primary care physician. In Part I of this review (presented in the May/June 2003 issue of The JCH), the authors discussed when to consider and how to go about making a diagnosis of renovascular disease. In Part II, the authors review the management of this complex condition. There is a debate concerning the optimal treatment of patients with renovascular disease. Management options include medical, surgical, or percutaneous approaches (angioplasty and stenting). Generally in patients with fibromuscular disease, the results of surgery and percutaneous approaches appear superior. In patients with atherosclerotic disease, the data are less consistent, and there does appear to be a group of patients who will respond well to medical management. A potential management algorithm is presented.
Physician‐Nurse Team Approaches to Improve Blood Pressure Control
Authors: Norby Suzanne M. , Stroebel Robert J. , Canzanello Vincent J.
Published: May 2007

Hypertension is an asymptomatic chronic disease that contributes to the development of serious health problems including coronary artery disease, chronic renal failure, and stroke. Despite published guidelines addressing goals for the treatment of hypertension, control rates (defined as a blood pressure <140/90 mm Hg) have not increased in recent years, and uncontrolled hypertension remains a serious public health issue. Both patient‐ and provider‐related factors contribute to these poor control rates, and new approaches to the management of hypertension must be sought. In this review, we describe unique physician‐nurse team approaches to improve the control of hypertension both in a subspecialty hypertension practice and in a primary care clinic setting. By implementing practice models that result in sustainable improvements in blood pressure control rates, the morbidity and mortality resulting from target organ damage and ensuing costs to society may be expected to decline as well.
Optimal Treatment of Hypertension and Cardiovascular Risk Reduction in African Americans: Treatment Approaches for Outpatients
Authors: Wright Jackson T. , Douglas Janice
Published: May 2007

African Americans have a higher prevalence and greater severity of hypertension compared with whites and therefore have a higher prevalence of many disease‐related complications, such as coronary heart disease, stroke, and end‐stage renal disease. Minorities have been, until recently, underrepresented in large clinical trials, leading to a lack of outcome data for these patient groups. However, accumulating data confirm the benefit of aggressive blood pressure‐lowering therapy in this population. These studies also show that most patients require combination therapy to achieve adequate blood pressure reduction, particularly high‐risk patient groups that have lower target blood pressure goals. All of the available antihypertensive agents are effective in African Americans. Recent studies suggest that regimens containing a thiazide‐type diuretic are unsurpassed in blood pressure lowering and prevention of major clinical complications, and they cost less. Thus, while other agents may be required for selected clinical indications or for blood pressure control, diuretics should be drugs of first choice or included in most antihypertensive regimens especially in African American hypertensives.
Results of the ALLHAT Trial: Is the Debate About Initial Antihypertensive Drug Therapy Over?
Authors: Moser Marvin
Published: May 2007

Results of the ALLHAT study have focused attention on the preferred approaches to the management of hypertension. Some of the conclusions of this trial have already been questioned. In this issue of The JCH, Marvin Moser, MD, and Michael A. Weber, MD, two of the senior editors, present their critiques of the ALLHAT results.
The Economic Impact of Hypertension
Authors: Elliott William J.
Published: May 2007

High blood pressure is the most common chronic medical problem prompting visits to primary health care providers, yet it is estimated that only 34% of the 50 million American adults with hypertension have their blood pressure controlled to a level of <140/90 mm Hg. Thus, about two thirds of Americans with hypertension are at increased risk for cardiovascular events. The medical, economic, and human costs of untreated and inadequately controlled high blood pressure are enormous. Adequate management of hypertension can be hampered by inadequacies in the diagnosis, treatment, and/or control of high blood pressure. Health care providers face many obstacles to achieving blood pressure control among their patients, including a limited ability to adequately lower blood pressure with monotherapy and a typical reluctance to increase therapy (either in dose or number of medications) to achieve blood pressure goals. Patients also face important challenges in adhering to multidrug regimens and accepting the need for therapeutic lifestyle changes. Nonetheless, the achievement of blood pressure goals is possible, and, most importantly, lowering blood pressure significantly reduces cardiovascular morbidity and mortality, as proved in clinical trials. The medical and human costs of treating preventable conditions such as stroke, heart failure, and end‐stage renal disease can be reduced by antihypertensive treatment. The recurrent and chronic morbidities associated with hypertension are costly to treat. Pharmacotherapy for hypertension therefore offers a substantial potential for cost savings. Pharmacoeconomic analyses regarding antihypertensive drug therapies, their costs, and the relevant reductions in health care expenditures are a useful framework for optimizing current strategies for hypertension management.
The Burden of Uncontrolled Hypertension: Morbidity and Mortality Associated With Disease Progression
Authors: Cushman William C.
Published: May 2007

Even small elevations above optimal blood pressure values (<120/80 mm Hg) increase the likelihood of developing hypertension (blood pressure 140/90 mm Hg) and incurring target organ damage. Until recently, the main emphasis in hypertension treatment had been lowering diastolic blood pressure; however, in the past decade, the important contributions of systolic hypertension, increased pulse pressure, and a blunted reduction in nocturnal blood pressure have been described. Primary hypertension arises from complex, interrelated pathologies. Among the contributors are genetic, environmental, metabolic, vascular, and endothelial factors. Signs of target organ damage herald a poorer prognosis and may present in the heart, blood vessels, kidneys, brain, or eyes. Later consequences include cardiac, cerebrovascular, vascular, and renal morbidities and death. The goal in treating hypertension is to prevent cardiovascular and renal complications. Thus, hypertensive patients with high‐normal blood pressure values may benefit from intensive lifestyle interventions to further reduce blood pressure. This is particularly true in patients with additional cardiovascular risk factors. Because of the complex nature of hypertension, it is not surprising that single antihypertensive agents normalize blood pressure for less than a majority of hypertensive patients. Using combination antihypertensive therapy consisting of agents from two or more different antihypertensive drug classes not only increases the likelihood of achieving the target blood pressure goal, but also offers the potential for greater protection against target organ damage by targeting separate pathologic mechanisms.
The Hypertension Management Program: Identifying Opportunities for Improvement
Authors: Maue Susan K. , Jackson James H. , Weiss Bruce A. , Rivo Marc L. , Jhaveri Vishu , Lennert Barbara
Published: May 2007

To date, relatively few programs have been evaluated that were designed to affect the clinical practice patterns of primary care physicians who treat patients with hypertension. In particular, studies that have evaluated blood pressure control as a clinical outcome before and after an intervention are lacking. The Hypertension Management Program, developed by Applied Health Outcomes, is a quality improvement program designed to improve the medical management of hypertension in population based health care settings. This program is in the process of continuing to collect baseline data from health maintenance organizations, conducting physician‐focused interventions designed for improving clinical care, and collecting postintervention data between 6 and 12 months after the intervention is completed to determine its effect. The authors present the rationale for conducting large‐scale hypertension management programs that measure outcomes, as well as preliminary baseline and postintervention data from the Hypertension Management Program, based on a current database of more than 1.9 million individuals enrolled in eight health care plans.
Branch Retinal Vein Occlusion
Authors: Patel Milan R. , Prisant L. Michael , Marcus Dennis M.
Published: May 2007

The most common cause of branch retinal vein occlusion is hypertension. Since retinal arteries and veins share a common adventitial sheath, the thickened artery compresses a retinal vein causing an occlusion, resulting in a retinal hemorrhage. Most patients present in their 60s with unilateral involvement. The patient may be asymptomatic if the macula is not involved. Visual complications of branch retinal vein occlusion include macular edema, retinal ischemia, and retinal and iris neovascularization. Argon laser photocoagulation is beneficial in patients with macu‐Photographed by Michael S. Stanley, Ophthalmic Photographer lar edema. If neovascularization develops, laser treatment reduces secondary vitreous hemorrhage and/or neovascular glaucoma.
The ANBP2 and ALLHAT: Conflicting or Consistent?
Authors: Cutler Jeffrey A.
Published: May 2007

An ongoing debate during the past 2–3 months has centered on the results of two recent clinical trials in hypertension—the ALLHAT and ANBP2 trials. These apparently yielded different outcomes; in the American trial (ALLHAT), the use of a thiazide diuretic resulted in a better outcome with some cardiovascular end points compared to an ACE inhibitor. In the Australian trial (ANBP2), an ACE inhibitor was marginally (p=0.05) more effective in reducing end points than a diuretic (most of the benefit in men). In the following commentary, Dr. Jeffrey Cutler, the Senior Scientific Advisor to the Division of Epidemiology and Clinical Application of the National Heart, Lung, and Blood Institute, compares these two trials. Dr. Cutler has been involved in almost all of the major clinical hypertension trials in the United States over the last 20 years.—Marvin Moser, MD, Editor in Chief
Roundtable Discussion: Management of Hypertension in Diabetics
Authors: Moser Marvin , Sowers James , Giles Thomas
Published: May 2007

During the meeting of the American Society of Hypertension in New York, NY, in May 2003, there was an opportunity to discuss management of hypertension in diabetic patients. The discussion was moderated by Dr. Marvin Moser of the Yale University School of Medicine. Participants included Dr. James Sowers of the Downstate College of Medicine in New York City and Dr. Thomas Giles of the Louisiana State School of Medicine in New Orleans, two leading experts on the subject.
Hypertension in the Metabolic Syndrome and Diabetes: Pathogenesis, Clinical Studies, and Treatment
Authors: Izzo Joseph L.
Published: May 2007

The increasing prevalence of obesity, hypertension, and abnormal glucose metabolism is a major challenge to health care in industrialized societies. This brief review summarizes the mechanistic evidence and clinical studies related to the problem of hypertension in the metabolic syndrome and diabetes to allow clinicians to provide more effective and enlightened management of these common, interrelated problems.
Quality of Life Measured in a Practice‐Based Hypertension Trial of an Angiotensin Receptor Blocker
Authors: Weber Michael A. , Bakris George L. , Neutel Joel M. , Davidai Giora , Giles Thomas D.
Published: May 2007

Effectiveness of antihypertensive treatment depends not only on drugs that avoid or minimize symptomatic side effects but also on therapy that has a positive effect on quality of life. This study assessed the effect on quality of life of a contemporary agent (an angiotensin receptor blocker) and evaluated the validity and practicality of using a quality‐of‐life instrument in the practice‐based setting. A total of 2716 hypertensive patients, either untreated or on single‐agent therapy, were started on or switched to 40 mg telmisartan for 6 weeks; in patients whose blood pressures remained above 130/85 mm Hg after 2 weeks, the dose was increased to 80 mg for the remaining 4 weeks of treatment. Quality of life was measured by patient self‐administration of the Psychological General Well‐Being Index (GWBI) at baseline and at the end of the study. Sixty‐eight percent (n=1858) of patients treated with telmisartan fully completed both GWBI tests; the test score increased by 5.2±0.3 (p<0.0001) from 77.7±0.4. This improvement was observed across all six emotional and health subscales of the GWBI. White and black patients, those aged <65 or >65 years, and men and women had similar increases, though the baseline value in women was sharply lower (p<0.001) than in men. The GWBI rose more in patients whose blood pressure was controlled by treatment (<140/90 mm Hg) than in noncontrolled patients (6.1 vs. 4.1, p<0.0001); for all patients the decreases in systolic and diastolic blood pressures produced by telmisartan correlated significantly (p<0.001 for each) with the increases in the GWBI scores. Controlling blood pressure appears to be an important element in improving subjective health perceptions of hypertensive patients.
Rationale for Combination Therapy as Initial Treatment for Hypertension
Authors: Giles Thomas D.
Published: May 2007

Recent hypertension guidelines recommend initiating antihypertensive therapy with a combination of two or more agents in patients whose blood pressure exceeds their appropriate blood pressure goal by 20/10 mm Hg. This recommendation is based on the knowledge that the majority of patients with blood pressures of this magnitude will not achieve sufficient blood pressure reduction with monotherapy. Further, compared with high‐dose monotherapy, combination therapy is often associated with fewer adverse effects and, for this reason, may improve patient adherence. Bringing patients to blood pressure goal quickly is likely to improve clinical outcomes. This article discusses the rationale for using combination antihypertensive therapy as initial therapy for high blood pressure in selected patients and reviews data from a study of 364 high‐risk patients with Stage 2 hypertension in which a fixed‐dose combination product (amlodipine besylate/benazepril HCl) proved more successful as initial therapy than high‐dose monotherapy (amlodipine besylate) in reducing blood pressure.
Creating a Combination Antihypertensive Regimen: What Does the Research Show?
Authors: Weber Michael A.
Published: May 2007

Major randomized clinical trials have demonstrated unquestionable clinical benefits of lowering blood pressure without establishing superiority of any specific antihypertensive medication. Most notably, these trials have indicated that a majority of patients with hypertension will require more than one drug to control blood pressure. The recognition that many patients with hypertension should receive a combination of two agents as initial therapy is reflected in current hypertension guidelines, including the recently published consensus statement by the Hypertension in African Americans Working Group (HAAWG) and the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). In addition, there are some data that suggest that combination therapy may afford greater cardioprotection compared to monotherapy. For example, findings from A Lotrel Evaluation of Hypertensive Patients with Arterial Stiffness and Left Ventricular Hypertrophy (ALERT) indicated that low‐dose combined angiotensin‐converting enzyme inhibitor and calcium channel blocker antihypertensive treatment improved measures of cardiovascular structure and function compared with high‐dose monotherapy with either component. Intuitive clinical wisdom suggests that some combinations of antihypertensive agents may provide enhanced clinical benefits; however, clinical trial data have not established optimal combination regimens. Thus, a challenging task for investigators is to determine which combination therapy regimens will provide the greatest cardiovascular benefits for patients with hypertension. A trial that is now in progress, Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH), directly compares cardiovascular mortality and morbidity rates for two preselected, fixed‐dose combination therapies.
Who Should Be Treated With Combination Therapy as Initial Treatment for Hypertension?
Authors: Bakris George L.
Published: May 2007

There is currently consensus regarding the need to initiate antihypertensive therapy with a combination of two agents from different antihypertensive classes in selected patients. This consensus extends to the need to bring blood pressure to the appropriate level but has not been defined regarding optimal strategies for selection of combinations that may be most effective at reducing the morbidity and mortality associated with hypertension. Because of the heterogeneous nature of hypertension, there may be unique population‐specific strategies for selecting antihypertensive regimens. Appropriate combinations of antihypertensive agents are particularly relevant for patients with diabetes, renal disease, and isolated systolic hypertension as well as for African Americans with high‐risk hypertension. The antihypertensive regimen for high‐risk patients should be based on those agents for which the patient has compelling indications, with the addition of agents deemed most likely to bring the patient to the appropriate blood pressure goal as quickly as possible.
Combination Angiotensin‐Converting Enzyme Inhibitor and Angiotensin Receptor Blocker Therapy: Its Role in Clinical Practice
Authors: Sica Domenic A.
Published: May 2007

Angiotensin‐converting enzyme inhibitors and angiotensin receptor blockers are commonly prescribed for the management of hypertension. In addition, each of these drug classes has been shown to be effective in the treatment of congestive heart failure, proteinuric chronic kidney disease, and most recently the high‐cardiac‐risk profile patient. The individual success of each of these drug classes has fueled the theory that given together, the overall biologic effect of both would surpass that of either given alone. The foundation of this premise, although biologically plausible, has yet to be proven in a compelling enough fashion to support the everyday use of these two drug classes in combination. Additional clarifying studies are required to establish whether specific patient subsets exist that might benefit from such combination therapy.
Hypertension in Women: The Women Take Heart Project
Authors: Furumoto‐Dawson Alice A. , Pandey Dilip K. , Elliott William J. , Carlos F. Mendes de Leon , Al‐Hani Arfan J. , Hollenberg Steven , Camba Noel , Wicklund Roxanne , Black Henry R.
Published: May 2007

Hypertension is an important, modifiable risk for cardiovascular disease. The Women Take Heart study, a prospective, community‐based cohort study of risk factors for heart disease, provides an opportunity to examine prevalence, awareness, and control of hypertension specifically in women. In 1992, 5932 women, age 35 and older (mean age, 52.9; 86% white, 9% African American, 5% other) and free of active heart disease symptoms for 3 months, were recruited through Chicago area public announcements, and their baseline examination data analyzed. Overall, 47.6% were hypertensive (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg, or self‐report). Only 17.3% reported being hypertensive; in 63.2% of all hypertensive women, the hypertension was undetected or unacknowledged. Blood pressure was controlled to <140/90 mm Hg in 24.1% of self‐reported hypertensives. Results from this study and national surveys indicate that hypertension detection and control remain major public health challenges in preventing cardiovascular disease in older women.
Dispelling the Myth of “Aggressive” Antihypertensive Therapy
Authors: Ofili Elizabeth O.
Published: May 2007

Data from well designed randomized trials have proven the effectiveness of an intensive approach to hypertension management in reducing morbidity and mortality. Based on these data, guidelines recommend a blood pressure goal of <140/90 mm Hg in the general population, with lower goals for high‐risk patients. Clinical trials also show that most patients will require at least two antihypertensive agents to reach goal. Despite this evidence base, only about one third of individuals with hypertension receive sufficient therapy to attain a blood pressure of <140/90 mm Hg. Physicians may be reluctant to use multiple antihypertensive agents to achieve this goal because they may consider it to be “aggressive” and not always in the best interests of the patient, especially in those deemed at low risk. Such perceptions may be founded on several myths: 1) the approach demands a complex, time‐consuming titration‐to‐response strategy, during which the patient may be lost to follow‐up; 2) it increases the pill burden, which will decrease patient compliance; 3) it increases treatment‐related side effects; and 4) it is not cost‐effective. The availability of fixed‐dose combinations containing two antihypertensive agents should help to dispel these myths. Careful selection of efficacious, well tolerated, once‐daily, fixed‐dose combinations allows goal blood pressure to be achieved quickly in a broad range of patients and encourages patient concordance with therapy. Such formulations are also cost‐effective. Thus, reducing blood pressure using multiple drugs as fixed‐dose combinations is a strategy that recognizes the multiple pathophysiologic changes that lead to hypertension.
Hypertension—A Treatable Component of the Cardiometabolic Syndrome: Challenges for the Primary Care Physician
Authors: Manrique Camila M. , Lastra Guido , Palmer John , Stump Craig S. , Sowers James R.
Published: May 2007

Patients with the cardiometabolic syndrome (CMS) have an adverse cardiovascular risk factor profile, placing them at increased risk of stroke, coronary artery disease, chronic kidney disease, and type 2 diabetes mellitus. Although no specific treatments for CMS are available per se, prompt recognition and treatment of the individual components of the condition can prevent or delay the development of comorbidities. Primary care physicians are ideally positioned to identify patients with CMS and implement early intervention strategies. Hypertension contributes to many complications of CMS, and rigorous blood pressure control will help to delay or prevent endorgan vascular damage. Achieving blood pressure control to current guideline standards should be eagerly sought in the majority of patients through a combination of lifestyle modifications and appropriate pharmacologic therapy. Antihypertensive drug choice should be personalized, taking into account the CMS determinants present and any compelling indications for specific agents. As an initial approach, a thiazide diuretic is suitable for most cases of uncomplicated hypertension, although many patients will require additional antihypertensives from other classes to achieve their blood pressure goal. It is predicted that, due to the increase in unhealthy lifestyles, the prevalence of CMS will rise in the coming years. Therefore, by meeting the challenge of attaining and maintaining blood pressure control in patients with CMS, primary care physicians have the unique opportunity to markedly improve the health of the nation.
Oxcarbazepine—Efficacy and Tolerability During Treatment of Alcohol Withdrawal: A Double‐Blind, Randomized, Placebo‐Controlled Multicenter Pilot Study
Authors: Koethe Dagmar , Juelicher Antje , Nolden Brit M. , Braunwarth Wolf‐Dietrich , Klosterkötter Joachim , Niklewski Günter , Wodarz Norbert , Klatt Jan , Burtscheidt Wilhelm , Gaebel Wolfgang , Markus Leweke F.
Published: May 2007

Objective: Alcohol withdrawal syndrome (AWS) is a serious complication of alcohol dependence and often requires intensive medical treatment. Antiepileptic drugs (AEDs) have been shown to be as efficacious in the treatment of AWS in several controlled trials as benzodiazepines and superior to placebo in relieving alcohol withdrawal symptoms. Oxcarbazepine (OXC), a newer anticonvulsive drug, has a favorable safety profile over carbamazepine (CBZ) and other older AEDs due to its excellent efficacy and better side‐effect profile.

Methods: The efficacy and tolerability of OXC versus placebo were investigated in 50 inpatients during a 6‐day treatment of alcohol withdrawal in a 4‐site, double‐blind, randomized, placebo‐controlled pilot study. The amount of rescue medication of clomethiazole (CLO) capsules needed was chosen as the primary variable. The data were collected between May 2003 and September 2004.

Results: No initial differences were found regarding sociodemographic data and alcohol‐related parameters, indicating successful randomization. No differences were found in the need for rescue medication CLO, decrease of withdrawal symptoms, or craving for alcohol between the OXC and the placebo group. Subjectively experienced side effects, normalization of vegetative parameters, craving, or improvement of psychopathological parameters were not different between the groups.

Conclusion: Despite the negative finding, which may be attributable to the design of the study, OXC still poses an interesting alternative to CBZ and other drugs because other studies have found it not only as efficient but also as having no addictive potential, while additionally possessing an anti‐craving effect. Therefore, well‐designed investigations with larger cohorts are required to further elucidate this issue.
Scaffolds for Hard Tissue Engineering by Ionotropic Gelation of Alginate–Influence of Selected Preparation Parameters
Authors: Dittrich R. , Tomandl G. , Despang F. , Bernhardt A. , Hanke Th. , Pompe W. , Gelinsky M.
Published: May 2007

Cylindrical constructs with parallel aligned pores were prepared by using ionotropic gelation of alginate/calcium phosphate hydroxyapatite (HAP) mixtures in regard to applications as scaffold for bone regeneration. The starting powder and stabilizing agents were characterized by measurement of electrosonic amplitude, particle size distribution, and specific surface. The shrinkage of the gels was investigated in dependence on the drying methods. The pore size relied on preparation conditions such as amount of HAP and concentrations of gelling agent or alginate sol. A wide field of pore sizes could be fabricated by varying the kind and concentration of additives. Micro computer tomography‐investigations of freeze dried scaffolds demonstrated the pore progression over a length of 4 mm. The pore dimension and structure were adequate for cell seeding and blood capillary ingrowth. Biocompatibility was proven by in vitro experiments with human mesenchymal stem cells by fluorescence microscopy. A high stability of the wet gels was maintained under cell culture conditions for a period of 3 weeks.
The independent contribution of neighborhood disadvantage and individual‐level socioeconomic position to self‐reported oral health: a multilevel analysis
Authors: Turrell Gavin , Sanders Anne E. , Slade Gary D. , Spencer A. John , Marcenes Wagner
Published: May 2007

Abstract – Objectives: To examine the association between neighborhood disadvantage and individual‐level socioeconomic position (SEP) and self‐reported oral health.

Methods: A population‐based cross‐sectional study conducted in 2003 among males and females aged 43–57 years. The sample comprised 2915 individuals and 60 neighborhoods and was selected using a stratified two‐stage cluster design. Data were collected using a mail survey (69.4% response rate). Neighborhood disadvantage was measured using a census‐based composite index, and individual‐level SEP was measured using education and household income. Oral health was indicated by self‐reports of the impact of oral conditions on quality of life (0 = none or minor, 1 = severe), self‐rated oral health (0 = excellent–good, 1 = fair/poor) and missing teeth (measured as a quantitative outcome). Data were analyzed using multilevel modeling.

Results: After adjusting for age, sex, education, and household income, residents of socioeconomically disadvantaged neighborhoods were significantly more likely than those in more advantaged neighborhoods to indicate negative impacts of oral conditions on quality of life, to assess their oral health as fair or poor, and to report greater tooth loss. In addition, respondents with low levels of education and those from a low income household reported poorer oral health for each outcome independent of neighborhood disadvantage.

Conclusions: The socioeconomic characteristics of neighborhoods are important for oral health over and above the socioeconomic characteristics of the people living in those neighborhoods. Policies and interventions to improve population oral health should be directed at the social, physical and infrastructural characteristics of places as well as individuals (i.e. the traditional target of intervention efforts).
Methodological assessment of behavioural problem dimensions in adults with dental fear
Authors: Elfström Magnus L. , Lundgren Jesper , Berggren Ulf
Published: May 2007

Abstract –  Objectives:  In the assessment and treatment of persons with dental fear, there may be other psychological/behavioural factors than fear itself and traditional measures of psychopathology that should be considered. Longitudinal natural history studies are needed to find such variables. The present study investigated whether the same behavioural problem dimensions (internalizing, externalizing, attention) found among children and adolescents with behaviour management problems and/or dental fear could also be found among severely fearful adult patients.

Methods:  The participants were 230 consecutive adult patients applying for treatment for severe dental anxiety at a specialized clinic. Patients completed a version of the Rutter behaviour questionnaire that was adapted for adults. Comparison data were the Hospital Anxiety and Depression scale and self‐rated anger evoked by dental fear. Background data, including dental fear, were also collected. Descriptive statistics, principal components analyses, group comparisons and correlations were calculated.

Results:  Of the three behaviour problems scales we adapted for adults, two (Internalizing and Attention) had acceptable psychometric properties and meaningful relations with the comparison variables. In contrast, the third problem scale (Externalizing) proved to have less satisfactory properties and relations, especially for men. Patients with severe phobia had higher levels of problem behaviours than patients with less severe phobia.

Conclusions:  Internalizing and Attention scales for adults seem promising for use in future prospective studies of the natural history of dental fear. The Externalizing scale, however, needs to be studied with a wider range of comparison variables and measures of social desirability.