34 results on '"Brent M Egan"'
Search Results
2. Cholesterol Control Among Uninsured Adults Did Not Improve From 2001‐2004 to 2009‐2012 as Disparities With Both Publicly and Privately Insured Adults Doubled
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Brent M. Egan, Jiexiang Li, Sara M. Sarasua, Robert A. Davis, Kevin A. Fiscella, Jonathan N. Tobin, Daniel W. Jones, and Angelo Sinopoli
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adult treatment panel‐3 ,cholesterol ,health disparities ,healthcare insurance ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundLow‐density lipoprotein cholesterol (LDL‐C) control is higher among insured than uninsured adults, but data on time trends and contributing factors are incomplete and important for improving health equity. Methods and ResultsAwareness, treatment, and control of elevated LDL‐C were compared among insured versus uninsured and publicly versus privately insured adults, aged 21 to 64 years, in National Health and Nutrition Examination Surveys from 2001 to 2004, 2005 to 2008, and 2009 to 2012 using Adult Treatment Panel‐3 criteria. Compared with insured adults, uninsured adults were younger; were more often minority; reported lower incomes, less education, and fewer healthcare encounters; and had lower awareness and treatment of elevated LDL‐C (P
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- 2017
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3. 2013 ACC/AHA Cholesterol Guideline and Implications for Healthy People 2020 Cardiovascular Disease Prevention Goals
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Brent M. Egan, Jiexiang Li, Kellee White, Douglas O. Fleming, Kenneth Connell, German T. Hernandez, Daniel W. Jones, Keith C. Ferdinand, and Angelo Sinopoli
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cardiovascular disease ,cholesterol ,epidemiology ,guideline ,primary prevention ,secondary prevention ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundHealthy People 2020 aim to reduce fatal atherosclerotic cardiovascular disease (ASCVD) by 20%, which translates into 310 000 fewer events annually assuming proportional reduction in fatal and nonfatal ASCVD. We estimated preventable ASCVD events by implementing the American College of Cardiology/American Heart Association (ACC/AHA) 2013 Cholesterol Guideline in all statin‐eligible adults. Absolute risk reduction (ARR) and number needed‐to‐treat (NNT) were calculated. Methods and ResultsNational Health and Nutrition Examination Survey data for 2007–2012 were analyzed for adults aged 21 to 79 years and extrapolated to the US population. Literature‐guided assumptions were used including (1) low‐density lipoprotein cholesterol falls 33% with moderate‐intensity statins and 51% with high‐intensity statins; (2) for each 39 mg/dL decline in low‐density lipoprotein cholesterol, 10‐year ASCVD10 risk would fall 21% when ASCVD10 risk was ≥20% and 33% when ASCVD10 risk was
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- 2016
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4. Nicotine replacement therapy sampling for smoking cessation within primary care: results from a pragmatic cluster randomized clinical trial
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Jennifer Dahne, K. Michael Cummings, Brent M. Egan, Elizabeth Garrett-Mayer, Kevin M. Gray, Matthew J. Carpenter, Robert A. Davis, and Amy E. Wahlquist
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Adult ,Male ,medicine.medical_specialty ,South Carolina ,Nicotine patch ,medicine.medical_treatment ,media_common.quotation_subject ,030508 substance abuse ,Medicine (miscellaneous) ,Context (language use) ,Article ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Behavior Therapy ,law ,Internal medicine ,Ambulatory Care ,Prevalence ,medicine ,Humans ,030212 general & internal medicine ,media_common ,Smokers ,Primary Health Care ,business.industry ,Odds ratio ,Middle Aged ,Abstinence ,Nicotine replacement therapy ,Tobacco Use Cessation Devices ,Clinical trial ,Psychiatry and Mental health ,Smoking cessation ,Female ,Smoking Cessation ,0305 other medical science ,business - Abstract
Background and aims Within the context of busy clinical settings, health-care providers need practical, evidence-based options to engage smokers in quitting. Sampling of nicotine replacement therapy [i.e. provision of nicotine replacement therapy (NRT starter kits)] is a brief, pragmatic strategy to address this need. We aimed to compare the effects of NRT sampling plus standard care (SC), relative to SC alone, provided by primary care providers during routine clinic visits. Design Cluster-randomized clinical trial. Setting Twenty-two primary care clinics in South Carolina, USA. Participants Adult smokers [n = 1245; 61% female, mean age = 50.7, standard deviation (SD) = 13.5] both motivated and unmotivated to quit, seen during routine clinical visit. Interventions were provider-delivered SC (n = 652, 12 clinics) cessation advice or SC + a 2-week supply of both nicotine patch and lozenge, with minimal instructions on use (n = 593; 10 clinics). Measurements The primary outcome was 7-day point prevalence smoking abstinence at 6-month follow-up, using intent-to-treat. Additional outcomes included NRT use and quit attempts, assessed at 1, 3 and 6 months following baseline. Findings Seven-day point prevalence abstinence rates were significantly higher in the NRT sampling group throughout follow-up, including at 6 months [12 versus 8%, odds ratio (OR) = 1.5, 95% confidence interval (CI) = 1.0-2.4]. NRT sampling increased prevalence of any use of NRT (65 versus 25%, OR = 5.8, 95% CI = 4.3-7.7), with higher prevalence of use at 6 months (25 versus 14%, OR = 2.0, 95% CI = 1.5-2.7). NRT sampling increased the rate of quit attempts in the initial month (24 versus 18%, OR = 1.5, 95% CI = 1.0-2.3) but had no significant effect on overall rate of quit attempts (48 versus 45%, OR = 1.2, 95% CI = 0.8-1.7). Conclusion Providing smokers with a free 2-week starter kit of nicotine replacement therapy increased quit attempts, use of stop smoking medications and smoking abstinence compared with standard care in a primary care setting.
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- 2020
5. Insights on β-blockers for the treatment of hypertension: A survey of health care practitioners
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Mehul D. Patel, Brent M. Egan, John M. Flack, and Sofia Lombera
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medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Adrenergic beta-Antagonists ,Therapeutics ,030204 cardiovascular system & hematology ,Lower risk ,Physicians, Primary Care ,Nebivolol ,03 medical and health sciences ,Cardiologists ,0302 clinical medicine ,Heart Rate ,Surveys and Questionnaires ,Diabetes mellitus ,Health care ,Internal Medicine ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Formulary ,Carvedilol ,Antihypertensive Agents ,Aged ,Metoprolol ,Aged, 80 and over ,Original Paper ,business.industry ,Atenolol ,medicine.disease ,Black or African American ,Vasodilation ,Hypertension ,Practice Guidelines as Topic ,Emergency medicine ,Perception ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
A quantitative survey was completed by 103 primary care physicians (PCPs) and 59 cardiologists who regularly prescribed β-blockers to assess knowledge and use of this heterogeneous drug class for hypertension. More cardiologists than PCPs chose β-blockers as initial antihypertensive therapy (30% vs 17%, P < 0.01). Metoprolol and carvedilol were the most commonly prescribed β-blockers. Cardiologists rated "impact on energy" and "arterial vasodilation" as more important than PCPs (P < 0.05/
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- 2018
6. Measure Accurately, Act Rapidly, and Partner With Patients (MAP) improves hypertension control in medically underserved patients: Care Coordination Institute and American Medical Association Hypertension Control Project Pilot Study results
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Bijal Shah, Gregory Wozniak, Sean T. Bryan, Irfan M. Asif, Susan E. Sutherland, Robert A. Davis, Jianing Yang, Robert B. Hanlin, Brent M. Egan, and Michael Rakotz
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Adult ,Male ,medicine.medical_specialty ,hypertension ,Endocrinology, Diabetes and Metabolism ,Medically Underserved Area ,Pilot Projects ,030204 cardiovascular system & hematology ,Health Services Accessibility ,03 medical and health sciences ,0302 clinical medicine ,Outcome Assessment, Health Care ,Internal Medicine ,medicine ,Humans ,030212 general & internal medicine ,Antihypertensive Agents ,American Medical Association ,Aged ,health equity ,Therapeutic inertia ,Original Paper ,Hypertension control ,Medicaid ,business.industry ,blood pressure ,Blood Pressure Determination ,Middle Aged ,Clinical Management of Hypertension ,Quality Improvement ,United States ,Hypertension Control ,Blood pressure ,Pill ,Emergency medicine ,Female ,Patient Care ,Cardiology and Cardiovascular Medicine ,business - Abstract
Measure Accurately, Act Rapidly, and Partner With Patients (MAP) is an evidence‐based protocol implemented to improve hypertension control in a clinic for underserved patients (49.9% Medicaid and 50.2% black). Patients with hypertension seen during the year before intervention and with at least one visit during the 6‐month intervention (N = 714) were included. If initial attended blood pressure (BP; standard aneroid manometer) was ≥140/≥90 mm Hg, unattended automated office BP was measured in triplicate and averaged (Measure Accurately) using an Omron HEM‐907XL. When automated office BP was ≥140/≥90 mm Hg, Act Rapidly included intensification of antihypertensive medications, assessed by therapeutic inertia. Partner With Patients included BP self‐monitoring, reducing pill burden, and minimizing medication costs, which was assessed by systolic BP change per therapeutic intensification. Between baseline and the last study visit, BP control to
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- 2018
7. Antihypertensive Medication Persistence 1-Year Post-Stroke Hospitalization
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Edward C. Jauch, Robert J. Adams, Daniel T. Lackland, Wuwei Wayne Feng, David Bachman, Brent M. Egan, Bruce Ovbiagele, and Andrea D. Boan
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Male ,medicine.medical_specialty ,medicine.drug_class ,Endocrinology, Diabetes and Metabolism ,Medication Adherence ,Persistence (computer science) ,Internal medicine ,Internal Medicine ,medicine ,Humans ,Antihypertensive drug ,Stroke ,Antihypertensive Agents ,Aged ,business.industry ,Odds ratio ,Middle Aged ,medicine.disease ,Original Papers ,Comorbidity ,Confidence interval ,Hospitalization ,Clinical trial ,Regimen ,Hypertension ,Physical therapy ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
To optimize the translation of clinical trial evidence that antihypertensive treatment reduces recurrent stroke risk into clinical practice, it is important to assess the frequency of long-term antihypertensive drug persistence after stroke and identify the factors associated with low persistence. Structured telephone interviews to determine antihypertensive regimen persistence 1-year post-stroke hospitalization were conducted in 270 stroke survivors, of which 212 (78.5%) were discharged on antihypertensive therapy (two thirds on >1 drug class). Continued use of any antihypertensive agent at 1 year of follow-up was relatively high (87.3%); however, persistence on all or two or more drug classes prescribed at discharge was relatively low (38.7%). Continued use varied by drug class, with the highest rates among angiotensin-converting enzyme inhibitor (69.1%) and the lowest rates among diuretic (24.4%) users. Black patients (adjusted odds ratio, 0.35; 95% confidence interval, 0.16-0.78) and those with a high comorbidity burden (adjusted odds ratio , 0.39; 95% confidence interval, 0.18-0.86) were less likely to exhibit persistence on prescribed treatments 1-year post-stroke hospitalization. These results indicate the need for further study to identify appropriate persistence of antihypertensive therapies for secondary stroke prevention and to investigate reasons for racial disparities in persistence on prescribed treatments in a real-world clinical setting.
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- 2014
8. Formation of Community-Based Hypertension Practice Networks: Success, Obstacles, and Lessons Learned
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Richard A. Dart and Brent M. Egan
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South carolina ,Community based ,Knowledge management ,Quality management ,business.industry ,Endocrinology, Diabetes and Metabolism ,Community Networks ,Quality Improvement ,Article ,Variable (computer science) ,Hypertension ,Internal Medicine ,Key (cryptography) ,Humans ,Medicine ,Program development ,Community Health Services ,Program Development ,Quality of care ,Cardiology and Cardiovascular Medicine ,business - Abstract
Community-based practice networks for research and improving the quality of care are growing in size and number but have variable success rates. In this paper, the authors review recent efforts to initiate a community-based hypertension network modeled after the successful Outpatient Quality Improvement Network (O'QUIN) project, located at the Medical University of South Carolina. Key lessons learned and new directions to be explored are highlighted.
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- 2014
9. Elijah Saunders in Memoriam
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Brent M. Egan
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In Memoriam ,business.industry ,Endocrinology, Diabetes and Metabolism ,Cardiology ,Internal Medicine ,Humans ,Medicine ,History, 20th Century ,Cardiology and Cardiovascular Medicine ,business ,History, 21st Century ,Classics - Published
- 2015
10. Blood Pressure Reclassification in Adolescents Based on Repeat Clinic Blood Pressure Measurements
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Susan M. Hailpern, Lauren J. Becton, Brent M. Egan, and Ibrahim F. Shatat
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Male ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Endocrinology, Diabetes and Metabolism ,Blood Pressure ,Standard score ,Prehypertension ,Body Mass Index ,Cohort Studies ,Internal medicine ,Internal Medicine ,medicine ,Humans ,Nutrition survey ,skin and connective tissue diseases ,Retrospective Studies ,National health ,business.industry ,Reproducibility of Results ,Blood Pressure Determination ,Nutrition Surveys ,medicine.disease ,Original Papers ,Obesity ,United States ,C-Reactive Protein ,Blood pressure ,Hypertension ,Female ,sense organs ,Cardiology and Cardiovascular Medicine ,business ,Body mass index - Abstract
The common assumption is that blood pressure (BP) will decrease on subsequent readings. The objective of this study is to examine the prevalence and direction of BP classification change with repeat measurements and compare common clinical characteristics of groups of patients who do and do not have a change in BP classification. A nationally representative subsample of 1725 adolescents aged 13 to 18 years from the National Health and Nutrition Survey were analyzed. Three BP measurements were obtained. Patients were classified based on the first and the average of 3 BP measurements as having normal BP, hypertension, and/or prehypertension. Of the 1725 adolescents, 1569 (90.9%) maintained BP classification, 107 (6.2%) had a reduction in their classification, and 49 (2.9%) had an increase in their classification. Comparing the two groups that changed BP classification to the group without change, C‐reactive protein and body mass index (BMI) z score were significantly higher in the groups that had a change in BP classification (P=.02 and
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- 2013
11. Similar Blood Pressure Values Across Racial and Economic Groups: Baseline Data from a Group Randomized Clinical Trial
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Mark W. Vander Weg, Elizabeth A. Chrischilles, Dixie Ecklund, Brent M. Egan, Thomas Vaughn, Barry L. Carter, Christopher S. Coffey, Liz Uribe, Gail Ardery, Paul A. James, and Physicians to Improve Outcomes Now (Caption) trial investigators
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Male ,medicine.medical_specialty ,Time Factors ,Multivariate analysis ,Endocrinology, Diabetes and Metabolism ,Diastole ,Insurance Coverage ,Article ,law.invention ,Diabetes Complications ,Randomized controlled trial ,law ,Internal medicine ,Diabetes mellitus ,Internal Medicine ,medicine ,Cluster Analysis ,Humans ,Prospective Studies ,Prospective cohort study ,Aged ,Marital Status ,business.industry ,Age Factors ,Middle Aged ,medicine.disease ,United States ,Surgery ,Blood pressure ,Socioeconomic Factors ,Hypertension ,Kidney Failure, Chronic ,Marital status ,Female ,Cardiology and Cardiovascular Medicine ,business ,Kidney disease - Abstract
This paper examines baseline characteristics from a prospective, cluster-randomized trial in 32 primary care offices. Offices were first stratified by percentage of minorities and level of clinical pharmacy services and then randomized into 1 of 3 study groups. The only differences between randomized arms were for marital status (P=.03) and type of insurance coverage (P
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- 2013
12. Different Definitions of Prevalent Hypertension Impact: The Clinical Epidemiology of Hypertension and Attainment of Healthy People Goals
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Yumin Zhao and Brent M. Egan
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Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Diastole ,Blood Pressure ,Clinical epidemiology ,Article ,Diabetes mellitus ,Prevalence ,Internal Medicine ,Humans ,Medicine ,Antihypertensive Agents ,National health ,business.industry ,Extramural ,Middle Aged ,Nutrition Surveys ,medicine.disease ,United States ,Confidence interval ,Blood pressure ,Hypertension ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Prevalent hypertension in National Health and Nutrition Examination Surveys (NHANES) is traditionally defined as blood pressure (BP) ≥140 mm Hg systolic and/or ≥90 diastolic and/or currently taking antihypertensive medications. When estimating prevalent hypertension, American Heart Association (AHA) statistical updates include the traditional definition of hypertension (tHTN) and untreated individuals with nonhypertensive BP told twice that they were hypertensive (nontraditional [ntHTN]). The characteristics of ntHTN and their impact on the clinical epidemiology of hypertension and Healthy People prevention and control goals are undefined. NHANES 1999-2002, 2003-2006, and 2007-2010 were analyzed. The ntHTN group was younger and had less diabetes and lower BP than the tHTN group but higher BP than the normotensive group. When classifying ntHTN as hypertensive, prevalent hypertension increased approximately 3% and control 5% to 6% across NHANES periods. In 2007-2010, the Healthy People 2010 goal of controlling BP in 50% of all hypertensive patientss was attained when ntHTN was classified as hypertension (56.5% [95% confidence interval (CI), 54.2-58.7]) and nonhypertension (51.8% [95% CI, 49.6-53.9]). When including ntHTN in prevalent hypertension estimates, the Healthy People 2020 goal of controlling BP in 60% of hypertensive patients becomes more attainable, whereas reducing prevalent hypertension to 26.9% (31.8% [95% CI, 30.5-33.1]) vs 28.7% [95% CI, 27.5-30.0]) becomes more challenging.
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- 2012
13. Impact of the Number of Blood Pressure Measurements on Blood Pressure Classification in US Adults: NHANES 1999-2008
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Joel Handler, Brent M. Egan, and Yumin Zhao
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National health ,medicine.medical_specialty ,Pediatrics ,business.industry ,Endocrinology, Diabetes and Metabolism ,Diastole ,medicine.disease ,Logistic regression ,Comorbidity ,Prehypertension ,Blood pressure ,Internal medicine ,Diabetes mellitus ,Internal Medicine ,Cardiology ,medicine ,Hypertension diagnosis ,Cardiology and Cardiovascular Medicine ,business - Abstract
Clinical guidelines recommend averaging ≥ 2 blood pressure (BP) measurements on each visit. Only one BP is measured on many clinical visits, especially if the value is
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- 2012
14. Does Response of RAS Blockade on Serum K+ Levels Influence Its Glycemic-Mitigating Response When Combined With Hydrochlorothiazide?
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Dion H. Zappe, James R. Sowers, Prakash Deedwania, Rita Samuel, Das Purkayastha, and Brent M. Egan
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medicine.medical_specialty ,Glucose tolerance test ,medicine.diagnostic_test ,business.industry ,Endocrinology, Diabetes and Metabolism ,Potassium ,Insulin ,medicine.medical_treatment ,chemistry.chemical_element ,Endocrinology ,Postprandial ,Hydrochlorothiazide ,chemistry ,Valsartan ,Internal medicine ,Internal Medicine ,medicine ,Amlodipine ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug ,Glycemic - Abstract
J Clin Hypertens (Greenwich). 2012; 14:415–421. ©2012 Wiley Periodicals, Inc. The authors previously reported that addition of valsartan ameliorated the negative metabolic effects of hydrochlorothiazide in obese hypertensive patients through an enhanced postprandial insulin response. In this secondary analysis, the authors tested whether this enhanced insulin response to valsartan/hydrochlorothiazide was influenced by serum potassium levels, which were reduced to a lesser extent, when compared with amlodipine/hydrochlorothiazide. Results showed that the early insulin response with valsartan plus hydrochlorothiazide occurred regardless of serum potassium levels. Heightened insulin response was, however, not significantly different when patients with normal potassium (>3.9 mEq/L) at baseline and low potassium (≤3.9 mEq/L) at the end of the study were compared with the amlodipine/hydrochlorothiazide group. Despite the influence of serum potassium on insulin secretory response to a glucose challenge, the addition of valsartan maintained normoglycemia in patients given hydrochlorothiazide. Thus, the metabolic response to hydrochlorothiazide was improved with addition of valsartan through an enhanced insulin response that was not greatly affected by changes in potassium levels.
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- 2012
15. Cocoa and Health
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Jennifer L. Donovan, Kelly Anne Holes-Lewis, Kenneth D. Chavin, and Brent M. Egan
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Toxicology ,Food consumption ,Nutrient intake ,Biology - Published
- 2011
16. Prevalence and management of hypertension in the inpatient setting: A systematic review
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R. Neal Axon, Brent M. Egan, and Laura K. Cousineau
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Pediatrics ,medicine.medical_specialty ,Leadership and Management ,MEDLINE ,Assessment and Diagnosis ,Epidemiology ,Prevalence ,medicine ,Humans ,cardiovascular diseases ,Risk factor ,Disease management (health) ,Care Planning ,Antihypertensive Agents ,Retrospective Studies ,business.industry ,Health Policy ,Disease Management ,Retrospective cohort study ,General Medicine ,Hospital medicine ,Hospitalization ,Blood pressure ,Hypertension ,Fundamentals and skills ,Observational study ,business - Abstract
BACKGROUND: Hypertension (HTN) is a major cardiovascular risk factor yet control rates remain suboptimal. Thus, improving recognition, treatment, and control of HTN by focusing on novel populations such as hospitalized patients is warranted. Current consensus guidelines do not address inpatient HTN, and little is known about HTN prevalence or patterns of care in this setting. METHODS: We conducted a systematic review of English-language studies published in 1976 or later that reported on HTN prevalence and care patterns among adult inpatients. We included MEDLINE-indexed randomized-controlled trials, meta-analyses, and observational studies that: (1) reported estimates of the prevalence of HTN in the inpatient setting, and (2) used HTN diagnosis or treatment as a primary focus. We excluded randomized, controlled trials that recorded measures of inpatient blood pressure but whose focus was not HTN. RESULTS: We identified 9 studies meeting inclusion criteria, and in those studies, HTN was highly prevalent among inpatients, ranging from 50.5% to 72%. Intensification of antihypertensive treatment was inconsistent, and 37% to 77% of hypertensive patients remained hypertensive at the time of discharge. Most patients with inpatient HTN continued to have elevated blood pressures at outpatient follow-up. CONCLUSIONS: Inpatient HTN is prevalent and a large percentage of those with this condition remain hypertensive at the time of discharge and at follow-up. The potential exists for improved recognition and treatment of newly diagnosed and known, but uncontrolled, HTN observed in the inpatient setting. Journal of Hospital Medicine 2011. © 2010 Society of Hospital Medicine.
- Published
- 2011
17. Office and Ambulatory Blood Pressure-Lowering Effects of Combination Valsartan/Hydrochlorothiazide vs Hydrochlorothiazide-Based Therapy in Obese, Hypertensive Patients
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James R. Sowers, Leopoldo Raij, Brent M. Egan, Dion H. Zappe, Das Purkayastha, and Rita Samuel
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education.field_of_study ,medicine.medical_specialty ,Ambulatory blood pressure ,business.industry ,Endocrinology, Diabetes and Metabolism ,Population ,Urology ,Blood pressure ,Hydrochlorothiazide ,Valsartan ,Ambulatory ,Internal Medicine ,Valsartan/hydrochlorothiazide ,Medicine ,Amlodipine ,Cardiology and Cardiovascular Medicine ,business ,education ,medicine.drug - Abstract
J Clin Hypertens (Greenwich). 2011;13:731–738. ©2011 Wiley Periodicals, Inc. The authors evaluated the blood pressure (BP)–lowering effects of combination valsartan/hydrochlorothiazide (HCTZ) vs amlodipine/HCTZ in a 16-week, double-blind, randomized, forced-titration study and ambulatory BP monitoring (ABPM) substudy involving centrally obese hypertensive patients 40 years and older. Patients were started on valsartan/HCTZ 160/12.5 mg or HCTZ 12.5 mg monotherapy, force-titrated at week 4 to valsartan/HCTZ 320/25 mg and HCTZ 25 mg, respectively. The HCTZ group initiated amlodipine 5 mg at week 8 and 10 mg at week 12. A subset of patients had 24-hour ABPM at baseline and weeks 8 and 16. At week 16 in the intent-to-treat population (n=401), valsartan/HCTZ and amlodipine/HCTZ lowered office systolic BP (−30.6 vs −28.3 mm Hg; P=.14). In the ABPM subgroup (n=111), valsartan/HCTZ was more effective than amlodipine/HCTZ in reducing 24-hour systolic BP (−20.6 vs −14.5 mm Hg; P=.011). In obese hypertensive patients, valsartan/HCTZ reduced office BP similar to amlodipine/HCTZ but lowered 24-hour systolic BP more. J Clin Hypertens (Greenwich). ****;**:**–**.
- Published
- 2011
18. Impacting Population Cardiovascular Health Through a Community-Based Practice Network: Update on an ASH-Supported Collaborative
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Yumin Zhao, Kim Seymour-Edwards, C. Shaun Wagner, Sheryl S. Mack, Marilyn Laken, John Dodson, Brent M. Egan, and Daniel T. Lackland
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Strategic planning ,medicine.medical_specialty ,education.field_of_study ,Quality management ,business.industry ,Endocrinology, Diabetes and Metabolism ,Population ,Comparative effectiveness research ,Alternative medicine ,Audit ,Disease ,Nursing ,Continuing medical education ,Internal Medicine ,medicine ,Cardiology and Cardiovascular Medicine ,business ,education ,Psychiatry - Abstract
The Hypertension Initiative began in 1999 to help transition South Carolina from a leader in cardiovascular disease (CVD) to a model of heart and vascular health. Goals were to reduce heart disease and stroke by 50% by promoting healthy lifestyles and access to effective care and medications. Continuing medical education was used to train providers, encourage physicians to become American Society of Hypertension (ASH)-certified hypertension specialists and recruit practices into the community-based practice network (CBPN). Practice data audit with provider specific feedback is a key quality improvement tool. With ASH support, the CBPN has grown to 197 practices with approximately 1.6 million patients (approximately 700,000 hypertensives). Clinical data are obtained from electronic health records and quarterly provider feedback reports are generated. Hypertension, hypercholesterolemia, and diabetes control rose and South Carolina's ranking improved from 51st to 35th in CVD mortality from 1995 to 2006. The Hypertension Initiative expanded to the Outpatient Quality Improvement Network (O'QUIN) to encompass comparative effectiveness research and other chronic diseases. Lessons learned include: trust enables success, addressing practice priorities powers participation, infrastructure support must be multilateral, and strategic planning identifies opportunities and pitfalls. A collaborative practice network is attainable that produces positive, sustainable, and growing impacts on cardiovascular and other chronic diseases.
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- 2011
19. Measuring the Impact of a Continuing Medical Education Program on Patient Blood Pressure
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Daniel T. Lackland, Dory Masters, Benjamin T. Allaire, Brent M. Egan, and Justin G. Trogdon
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Entire population ,medicine.medical_specialty ,business.industry ,Endocrinology, Diabetes and Metabolism ,Cardiovascular health ,education ,Psychological intervention ,Primary care ,Hypertension prevention ,Blood pressure ,Continuing medical education ,Internal Medicine ,Physical therapy ,Medicine ,Medical prescription ,Cardiology and Cardiovascular Medicine ,business - Abstract
J Clin Hypertens (Greenwich). 2011;13:517–522. ©2011 Wiley Periodicals, Inc. An increased focus on hypertension prevention and control, especially in high-risk populations, may have a substantial impact on cardiovascular health outcomes. A continuing medical education (CME) program trained primary care providers in evidence-based guidelines for hypertension prevention and control. This study evaluated its effectiveness in reducing patients’ blood pressure for the sessions occurring from 2003 to 2007. Using the Hypertension Initiative Database, 8183 patients of CME providers (CME patients) were paired with controls and changes in blood pressure, provider visits, prescription months, and the proportion of patients with blood pressure 140/90 mm Hg), the changes in blood pressure were similar in magnitude to those in the entire population. The CME program, by promoting evidence-based practice, improves patients’ blood pressure and could serve as a positive model for future hypertension interventions.
- Published
- 2011
20. Comparative Efficacy of Aliskiren Monotherapy and Ramipril Monotherapy in Patients with Stage 2 Systolic Hypertension: Subgroup Analysis of a Double-blind, Active Comparator Trial
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Karl Andersen, Myron H. Weinberger, Brent M. Egan, Melanie Wright, Valentina Lukashevich, Christian M. Constance, and Deborah L. Keefe
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Pharmacology ,Ramipril ,medicine.medical_specialty ,Systolic hypertension ,business.industry ,medicine.drug_class ,Diastole ,Subgroup analysis ,General Medicine ,Aliskiren ,medicine.disease ,Renin inhibitor ,chemistry.chemical_compound ,Blood pressure ,chemistry ,Internal medicine ,ACE inhibitor ,medicine ,Cardiology ,Pharmacology (medical) ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Aliskiren is the first direct renin inhibitor approved for the treatment of hypertension. Blood pressure (BP) control in stage 2 hypertension with aliskiren monotherapy has not been reported. This was a post hoc analysis of the subgroup of patients with stage 2 systolic hypertension (baseline mean sitting systolic BP [msSBP]≥160 mmHg) who completed the 12-week monotherapy phase of a 6-month, double-blind, randomized study. A total of 175 patients were randomized to aliskiren 150 mg (n = 88) or ramipril 5 mg (n = 87) with optional up-titration to aliskiren 300 mg or ramipril 10 mg, respectively, at weeks 6 and 12. In the subgroup of patients with stage 2 systolic hypertension, aliskiren lowered msSBP and mean sitting diastolic BP (msDBP) by 22.3/12.7 mmHg from baseline to week 12; compared with a reduction of 18.1/10.2 mmHg with ramipril. The maximum BP reductions achieved with aliskiren were 60.0/34.0 mmHg (from a baseline of 172.7/107.3 mmHg). Aliskiren was noninferior (P < 0.0001) to ramipril for SBP reduction with nonsignificant superiority (P = 0.052), and superior (P = 0.043) to ramipril for DBP reduction. The proportion of patients who achieved BP control (
- Published
- 2010
21. An Evaluation of the Effects of an Angiotensin Receptor Blocker on Health-Related Quality of Life in Patients With High-Normal Blood Pressure (Prehypertension) in the Trial of Preventing Hypertension (TROPHY)
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Setareh A, Williams, Eric L, Michelson, Valerie A, Cain, Min, Yang, Shawna D, Nesbitt, Brent M, Egan, and Stevo, Julius
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Adult ,Male ,medicine.medical_specialty ,Angiotensin receptor ,Endocrinology, Diabetes and Metabolism ,Tetrazoles ,Placebo ,Prehypertension ,Placebos ,Double-Blind Method ,Quality of life ,Surveys and Questionnaires ,Internal medicine ,Internal Medicine ,medicine ,Humans ,Aged ,business.industry ,Incidence ,Incidence (epidemiology) ,Biphenyl Compounds ,Middle Aged ,Original Papers ,United States ,Candesartan ,Treatment Outcome ,Blood pressure ,Hypertension ,Quality of Life ,Physical therapy ,Benzimidazoles ,Female ,Cardiology and Cardiovascular Medicine ,business ,Angiotensin II Type 1 Receptor Blockers ,medicine.drug ,Biomedical sciences - Abstract
The Trial of Preventing Hypertension (TROPHY) demonstrated the feasibility of possibly reducing the incidence of hypertension with the angiotensin receptor blocker candesartan compared with placebo. The long-term benefits of pharmacologic therapy in high-normal blood pressure, or prehypertension are not known, and the long-term effect on health-related quality of life (HRQL) has not been determined. An analysis of covariance model was used to assess treatment differences from baseline in the HRQL scores using Short Form (SF)-36, and component measures at subsequent visits. Of the 809 randomized patients, 734 had both baseline and > or =1 HRQL follow-up assessment: 95% (379 of 397) of patients receiving candesartan and 91% (355 of 388) of patients receiving placebo. There were no statistically significant between-group differences in least-squares mean physical component survey and mental component survey scores or the individual scales at each scheduled visit relative to baseline values (P >.05). In TROPHY, patients with prehypertension had relatively high baseline HRQL, and HRQL was maintained with the angiotensin receptor blocker candesartan over both the 2-year treatment period and a total 4-year trial period.
- Published
- 2008
22. Combination Therapy With an Angiotensin-Converting Enzyme Inhibitor and a Calcium Channel Blocker
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Brent M. Egan
- Subjects
medicine.medical_specialty ,Combination therapy ,medicine.drug_class ,Systolic hypertension ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Angiotensin-Converting Enzyme Inhibitors ,Blood Pressure ,Calcium channel blocker ,Nephropathy ,Internal medicine ,Diabetes mellitus ,Internal Medicine ,Humans ,Medicine ,cardiovascular diseases ,Diuretics ,Clinical Trials as Topic ,Review Paper ,biology ,business.industry ,Angiotensin-converting enzyme ,Calcium Channel Blockers ,medicine.disease ,Blood pressure ,Endocrinology ,Cardiovascular Diseases ,Hypertension ,Cardiology ,biology.protein ,Drug Therapy, Combination ,Diuretic ,Cardiology and Cardiovascular Medicine ,business - Abstract
More than 1 medication is required in many hypertensive patients to reach blood pressure (BP) goals, and initial treatment with 2 agents has been recommended for patients whose BP level is >20/10 mm Hg above target. Diuretics reduce BP levels and the incidence of target organ complications and together with angiotensin‐converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers, which are recommended in patients with comorbid cardiovascular disease, nephropathy, or diabetes, are effective antihypertensive combinations. Calcium channel blockers (CCBs) are also effective antihypertensive agents, and evidence suggests that a CCB/ACEI combination is well tolerated and also decreases the risk of cardiovascular and renal disease. Some evidence suggests that this combination may improve endothelial function more than either agent alone, and its use could potentially lead to better cardiovascular outcomes than a diuretic/ACEI or diuretic/ARB combination. The ongoing Avoiding Cardiovascular Events Through Combination Therapy in Patients Living With Systolic Hypertension (ACCOMPLISH) trial compares these 2 effective combinations (ie, an ACEI/diuretic and ACEI/CCB) as initial treatment for reducing cardiovascular morbidity and mortality in older high‐risk hypertensive patients. The results of this trial, when reported, should help to clarify the relative benefits of these different therapies.
- Published
- 2007
23. Cardiovascular Risk Factor Control in Communities?Update From the ASH Carolinas-Georgia Chapter, the Hypertension Initiative, and the Community Physicians' Network
- Author
-
Anekwe Onwuanyi, Daniel T. Lackland, Elizabeth Ofili, James W. Reed, Eni C. Okonofua, Jan Basile, Katharine H. Hendrix, Adefisayo Oduwole, Priscilla Igho-Pemu, Chamberlain I. Obialo, Shakaib U. Rehman, Alexander Quarshie, and Brent M. Egan
- Subjects
Male ,medicine.medical_specialty ,Georgia ,Quality management ,Referral ,Interprofessional Relations ,South Carolina ,Endocrinology, Diabetes and Metabolism ,MEDLINE ,Blood Pressure ,Health Promotion ,Community Networks ,Continuing medical education ,Nursing ,North Carolina ,Internal Medicine ,medicine ,Humans ,Societies, Medical ,Aged ,business.industry ,Public health ,Articles ,Middle Aged ,Risk factor (computing) ,Clinical trial ,Health promotion ,Family medicine ,Hypertension ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
The prevalence of hypertension dictates that blood pressure must be managed effectively in primary care. The American Society of Hypertension (ASH) regional chapters and clinical hypertension specialists represent a positive response by ASH to the growing problems of hypertension and metabolic syndrome-related risks and disease. To have a significant public health effect, the impact of clinical hypertension specialists must be leveraged. Key activities in the community include educating other providers locally, delivering care for complex referral patients, and fostering growth of a practice network with a central database in collaboration with academic partners. The database supports practice audit and feedback reports to enhance quality improvement, identify continuing medical education topics, and facilitate clinical trials to test new therapeutic and best-practice approaches to risk factor management. The ASH regional chapters serve as a forum for community and academic hypertension specialists to collaborate with like-minded individuals and organizations. The collaboration among the ASH Carolinas-Georgia chapter, the Hypertension Initiative, and the Community Physicians' Network provides a model for other ASH chapters and health delivery groups to partner in delivering continuing medical education programs focused on cardiovascular risk factor management, recruiting practices into the network, and developing and maintaining a centralized patient database. Evidence suggests that this collaboration is facilitating application of evidence-based medicine and risk factor control.
- Published
- 2006
24. The Effect of Extended-Release Metoprolol Succinate on C-Reactive Protein Levels in Persons With Hypertension
- Author
-
Brent M. Egan, Arch G. Mainous, Dana E. King, and Mark E. Geesey
- Subjects
Adult ,Male ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Metoprolol Succinate ,Adrenergic beta-Antagonists ,Pharmacotherapy ,Risk Factors ,Internal medicine ,Internal Medicine ,Humans ,Medicine ,Prospective Studies ,Risk factor ,Metoprolol ,biology ,business.industry ,C-reactive protein ,Articles ,Middle Aged ,C-Reactive Protein ,Blood pressure ,Endocrinology ,Delayed-Action Preparations ,Hypertension ,Multivariate Analysis ,biology.protein ,Female ,Extended release ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
The objective of this study was to determine whether 3 months of treatment with extended-release metoprolol succinate would reduce C-reactive protein (CRP) levels. Seventy-five patients aged 30-65 years with uncontrolled hypertension were treated with extended-release metoprolol at 25-50 mg, titrated up to 100-200 mg daily. CRP was evaluated at baseline and at 1 and 3 months. In the 61 hypertensive patients who completed the study, CRP decreased from 6.2+/-7.5 mg/L at baseline to 5.4+/-7.0 mg/L (p=0.03) at 1 month and showed no further change at 3 months (5.6+/-6.5 mg/L; p=0.13). The 13 patients who received 200 mg of extended-release metoprolol had a 32% decline in CRP from 7.0+/-9.0 mg/L to 4.8+/-6.6 mg/L (-2.2 mg/L) (p=0.005) over the 3-month period, whereas lower doses did not reduce CRP (p0.05). Age, race, sex, and change in blood pressure were not related to the reduction in CRP in multivariate analysis. If CRP evolves into a confirmed modifiable risk factor, a beta blocker such as metoprolol may be a useful addition to pharmacotherapy options.
- Published
- 2006
25. Alcohol Biomarker Screening in Medical and Surgical Settings
- Author
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Michael F. Fleming, Shaun A. Nguyen, Brent M. Egan, John D. Roache, A. M. Hoyumpa, Jan Basile, Tim Neumann, Claudia Spies, Kathryn Sullivan Dillie, Maryam Kashi, Peter M. Miller, Amy Webb, Raymond F. Anton, Martin A. Javors, and Francis E. Sharkey
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Medical screening ,Medicine (miscellaneous) ,Primary care ,Hepatitis C ,Toxicology ,medicine.disease ,Surgery ,Psychiatry and Mental health ,Internal medicine ,Predictive value of tests ,Liver biopsy ,Medicine ,Biomarker (medicine) ,In patient ,Steatohepatitis ,business - Abstract
This article highlights the proceedings of a symposium presented at the 28th Annual Meeting of the Research Society on Alcoholism in Santa Barbara, CA, on June 28, 2005, organized and chaired by Peter Miller. The presentations included (1) Screening for Alcohol Use Disorders in Surgical and Trauma Patients, presented by Claudia Spies; (2) Are Serum Levels of %CDT and GGT Related to Severity of Liver Biopsy Inflammation, Fibrosis, and Steatohepatitis in Patients with Hepatitis C? by Martin Javors; (3) Biochemical Alcohol Screening in the Treatment of Hypertension, presented by Peter Miller; and (4) The Cost-Effectiveness of a New Biomarker, CDT, in a Primary Care Sample, by Michael Fleming. Presentations were discussed by Raymond Anton.
- Published
- 2006
26. Platelet and White Blood Cell Counts Are Elevated in Patients With the Metabolic Syndrome
- Author
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Ammar Jesri, Eni C. Okonofua, and Brent M. Egan
- Subjects
Adult ,Blood Glucose ,Male ,medicine.medical_specialty ,Waist ,Endocrinology, Diabetes and Metabolism ,Blood Pressure ,Body Mass Index ,Leukocyte Count ,chemistry.chemical_compound ,Risk Factors ,Internal medicine ,White blood cell ,Internal Medicine ,medicine ,Humans ,Platelet ,Risk factor ,Triglycerides ,Metabolic Syndrome ,Platelet Count ,Cholesterol ,business.industry ,Cholesterol, HDL ,medicine.disease ,Original Papers ,Endocrinology ,medicine.anatomical_structure ,Blood pressure ,chemistry ,Hypertension ,Multivariate Analysis ,Female ,Insulin Resistance ,Metabolic syndrome ,Cardiology and Cardiovascular Medicine ,business ,Body mass index - Abstract
Platelet and white blood cell counts are higher among some insulin-resistant patients and may contribute to atherothromboembolic complications. Metabolic syndrome patients are insulin resistant, often hypertensive, and at high cardiovascular disease risk, yet the relationship of platelets to the metabolic syndrome is unknown. Platelet and white blood cell counts were obtained from 135 volunteers who had measurements of blood pressure, fasting triglycerides, high-density lipoprotein cholesterol, and glucose. A body mass index >30 kg/m2 served as a surrogate for increased waist circumference. Subjects were subdivided into three groups by the number of metabolic syndrome criteria, i.e., no metabolic syndrome risk factor (MS-0; n = 40), one or two metabolic syndrome risk factors (MS1-2; n = 61), and three to five metabolic syndrome risk factors (MS3-5; n = 34). Platelet counts were increased significantly from 226+/-8 to 257+/-8 and 276+/-10 (x10(3)/mm3) in the MS-0, MS1-2, and MS3-5 groups, respectively (p < 0.01), after adjustment for age, gender, ethnicity, total cholesterol, and low-density lipoprotein cholesterol. White blood cell counts were also increased across the three groups (5.4+/-0.2, 6.2+/-0.2, and 6.6+/-0.3 [x10(3)/mm3]; p < 0.01) after multivariate adjustment. Compared with patients with zero to two metabolic syndrome risk factors, metabolic syndrome patients have higher platelet and white blood counts, which may serve as markers of a prothrombotic and proinflammatory state and contributors to atherothromboembolic risk.
- Published
- 2005
27. Ethnic Differences in the Treatment and Control of Hypertension in Patients With Diabetes
- Author
-
Daniel T. Lackland, Eni C. Okonofua, Jessica Flynn Riehle, Brent M. Egan, and Katherine H. Hendrix
- Subjects
Male ,medicine.medical_specialty ,Cross-sectional study ,Endocrinology, Diabetes and Metabolism ,Ethnic group ,White People ,Diabetes mellitus ,Internal medicine ,Diabetes Mellitus ,Internal Medicine ,medicine ,Humans ,In patient ,Medical prescription ,Aged ,business.industry ,Articles ,Middle Aged ,medicine.disease ,Black or African American ,Clinic visit ,Cross-Sectional Studies ,Logistic Models ,Blood pressure ,Hypertension ,Physical therapy ,Female ,Angiotensin Receptor Blockers ,Cardiology and Cardiovascular Medicine ,business - Abstract
Among diabetic hypertensive patients, ethnic differences in blood pressure control and outcomes have been attributed in part to greater reluctance of providers to prescribe combination antihypertensive regimens to African Americans than to Caucasians. African Americans purportedly receive fewer angiotensin‐converting enzyme inhibitors (ACEIs) and/or angiotensin receptor blockers (ARBs), which reduce target organ complications. To assess these issues, cross‐sectional data were analyzed from 19,864 diabetic hypertensives from 62 primary care clinics. Among diabetic hypertensives, African Americans (N=6230) were less likely than Caucasians (N=8041) to have blood pressure (BP) ≤130/80 mm Hg at their last clinic visit (23.1% [23.0%–23.2%] vs. 30.7% [30.6%–30.9%]) despite a greater number of prescriptions for antihypertensive medications (2.67 [2.63‐2.70] vs. 2.23 [2.20‐2.26]). African Americans were more likely than Caucasians to have an ACEI and/or ARB prescribed and to receive prescriptions for at least two antihypertensive medications that included an ACEI or ARB (64.1 % [63.8%–64.4%] vs. 53.1% [52.8%–53.4%]). Among diabetic hypertensives, African Americans are less likely than Caucasians to attain BP
- Published
- 2005
28. Elevation of C‐Reactive Protein in People With Prehypertension
- Author
-
Mark E. Geesey, Dana E. King, Brent M. Egan, and Arch G. Mainous
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,National Health and Nutrition Examination Survey ,Endocrinology, Diabetes and Metabolism ,Blood Pressure ,Prehypertension ,Diabetes mellitus ,Internal medicine ,Internal Medicine ,Humans ,Medicine ,Aged ,biology ,business.industry ,C-reactive protein ,Odds ratio ,Middle Aged ,Nutrition Surveys ,medicine.disease ,Original Papers ,United States ,Confidence interval ,Surgery ,C-Reactive Protein ,Blood pressure ,Hypertension ,biology.protein ,Female ,Cardiology and Cardiovascular Medicine ,business ,Body mass index ,Biomarkers - Abstract
The objective of this study was to determine the relationship of C‐reactive protein (CRP) and blood pressure (BP) across the range of BP categories including prehypertension. The Third National Health and Nutrition Examination Survey (NHANES III) data collected from 1988 to 1994 were analyzed. In unadjusted analyses, there was a step‐wise increase in the probability of elevated CRP across a wide range of BP categories. Prehypertensive participants had a higher prevalence of elevated CRP than normotensive people (27.4% vs. 19.8%; p
- Published
- 2004
29. Low Birth Weight as a Risk Factor for Hypertension
- Author
-
Pamela L. Ferguson, Daniel T. Lackland, and Brent M. Egan
- Subjects
Fetus ,Pediatrics ,medicine.medical_specialty ,business.industry ,Endocrinology, Diabetes and Metabolism ,Birth weight ,Blood Pressure ,Articles ,Disease ,Low birth weight ,Blood pressure ,Risk Factors ,Hypertension ,Internal Medicine ,Animals ,Birth Weight ,Humans ,Medicine ,Observational study ,Clinical significance ,medicine.symptom ,Risk factor ,Cardiology and Cardiovascular Medicine ,business ,Demography - Abstract
While the geographic and demographic disparities in the prevalence of hypertension have been recognized for decades, the reasons for these differences in disease risks remain unknown. The demographic and geographic patterns of hypertension are similar to those of low birth weight, giving support to the “Barker Hypothesis” which proposes a fetal origin of adult‐onset disease. In fact, ecologic and observational studies throughout the world have detected significant associations of low birth weight and increased risks of hypertension. Nonetheless, the mechanisms for the association have not been fully described and documented. With some supportive evidence, proposed mechanisms include reduced nephrogenesis with a higher threshold for pressure natriuresis and greater susceptibility to progressive renal disease, impaired development of the endothelium, and increased sensitivity to glucocorticoids. Still, considerable work needs to be done to explain the birth weight/blood pressure relationship. The findings to date and the clinical significance warrant continued research in this intriguing area of study.
- Published
- 2003
30. Moderate Sodium Restriction Enhances the Pressor Response to Hyperlipidemia in Obese, Hypertensive Patients
- Author
-
Miloš P. Stojiljković, Heno Ferreira Lopes, Brent M. Egan, Theodore L. Goodfriend, and Da Zhang
- Subjects
Adult ,Male ,medicine.medical_specialty ,Haemodynamic response ,Endocrinology, Diabetes and Metabolism ,Sodium ,medicine.medical_treatment ,chemistry.chemical_element ,Hyperlipidemias ,Pressoreceptors ,Reference Values ,Internal medicine ,Hyperlipidemia ,Internal Medicine ,medicine ,Humans ,Obesity ,Prospective Studies ,Probability ,business.industry ,Insulin ,Hemodynamics ,Blood Pressure Determination ,Articles ,Heparin ,Diet, Sodium-Restricted ,Middle Aged ,medicine.disease ,Treatment Outcome ,Blood pressure ,Endocrinology ,medicine.anatomical_structure ,Mean blood pressure ,chemistry ,Case-Control Studies ,Hypertension ,Linear Models ,Vascular resistance ,Female ,Cardiology and Cardiovascular Medicine ,business ,Blood Chemical Analysis ,medicine.drug - Abstract
The effect of dietary sodium restriction on insulin, lipids, and blood pressure has been controversial. Evidence suggests that adverse short-term effects in response to very low-salt diets do not persist long-term with modest sodium restriction. In this study, the effects of modest dietary sodium restriction (60 and 120 mmol sodium) were measured for 3 weeks in 12 lean normotensives and 10 obese hypertensives. Blood pressure, plasma lipids, and the pressor response to an infusion of Intralipid and heparin were obtained. In contrast to previous reports concerning very low-salt diets, obese hypertensives did not manifest a pressor response or an adverse lipid effect with moderate salt restriction. Obese hypertensives were not more salt-sensitive than lean normotensives and did not manifest a different hemodynamic response to 4-hour infusion of Intralipid and heparin while on the 120-mmol/day salt diet. During the 60-mmol/day salt diet, however, plasma triglycerides increased more in obese than in lean volunteers during the Intralipid and heparin infusion (398+/-38 vs. 264+/-18 mg/dL; p
- Published
- 2002
31. Health Care Improvement and Cost Reduction Opportunities in Hypertensive Medicaid Beneficiaries
- Author
-
Daniel T. Lackland, Nelson Gunter, Lisa Beardon, Blake Williams, Brent M. Egan, and Aunyika Tocharoen
- Subjects
Male ,medicine.medical_specialty ,Cost Control ,Quality Assurance, Health Care ,South Carolina ,Endocrinology, Diabetes and Metabolism ,Disease ,Health outcomes ,Health care ,Internal Medicine ,medicine ,Humans ,Myocardial infarction ,Medical prescription ,Intensive care medicine ,Socioeconomic status ,Medicaid ,business.industry ,Articles ,Middle Aged ,medicine.disease ,Hospitalization ,Cardiovascular Diseases ,Heart failure ,Hypertension ,Emergency medicine ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Hypertension and its complications are more frequent and occur about a decade earlier in life among high-risk groups, especially in the Southeast. Moreover, socioeconomic status is inversely related to hypertension and cardiovascular complications. Low-income, young and middle-aged adults living in the Southeast may be at especially high risk. Data on inpatient admissions among hypertensive Medicaid beneficiaries living in this region may provide insights on the burden of hypertension-related disease and on opportunities for successful intervention. A study of hospitalization rates and costs among 44,440 hypertensive Medicaid beneficiaries in South Carolina from 1993-1996 showed that 16,883 (38%) were continuously enrolled in Medicaid. Of this group, 63% were African American and 74% were women. Among the continuously enrolled patients, 7637, or about 45%, were hospitalized during the 4-year period. These 7637 individuals accounted for 20,698 hospital admissions, i.e., 2.7 admissions per person, over the 4-year interval. Nearly two thirds of the hospitalizations included a cardiovascular or renal diagnosis. Hospital claims paid reached nearly $90 million for the 7637 hypertensive Medicaid recipients during the 4-year period. Among patients discharged from the hospital with congestive heart failure, 33% filled a prescription for an angiotensin-converting enzyme inhibitor within 90 days; 13% of patients discharged with an acute myocardial infarction filled a prescription for a beta blocker within 90 days. The data confirm that hypertensive Medicaid beneficiaries in the Southeast are hospitalized at high rates. Cardiovascular and renal morbidity account for the majority of the inpatient admissions. The findings suggest that the application of evidence-based guidelines would improve health, avoid cost, and reduce racial disparities in health outcomes.
- Published
- 2001
32. Challenges and Risks in Attaining the Systolic Blood Pressure Goal of <130 mm Hg in All Diabetic Patients
- Author
-
Brent M. Egan
- Subjects
medicine.medical_specialty ,Systole ,business.industry ,Endocrinology, Diabetes and Metabolism ,Blood Pressure ,Original Papers ,Prehypertension ,Pulse pressure ,Diabetes Complications ,Blood pressure ,Diastole ,Internal medicine ,Hypertension ,Internal Medicine ,medicine ,Cardiology ,Humans ,Cardiology and Cardiovascular Medicine ,business ,Antihypertensive Agents - Abstract
The authors assessed the practicality and results of forced titrating of blood pressure to
- Published
- 2006
33. Low Birth Weight Contributes to the Excess Prevalence of End-Stage Renal Disease in African Americans
- Author
-
Holly E. Syddall, Daniel T. Lackland, Brent M. Egan, and Z. Joyce Fan
- Subjects
Adult ,Male ,Gerontology ,Endocrinology, Diabetes and Metabolism ,Birth weight ,Black People ,Disease ,Risk Assessment ,White People ,End stage renal disease ,Prevalence ,Internal Medicine ,Humans ,Medicine ,Stroke ,Aged ,Retrospective Studies ,Fetus ,business.industry ,Infant, Newborn ,Retrospective cohort study ,Articles ,Infant, Low Birth Weight ,Middle Aged ,medicine.disease ,Epidemiologic Studies ,Low birth weight ,Hypertension ,Kidney Failure, Chronic ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Risk assessment ,Demography - Abstract
The risk of hypertension and related target organ damage is much greater in African Americans than in Caucasians. The risk of hypertensive end-stage renal disease is approximately five-fold higher in African Americans. Many studies have shown that low birth weight is strongly associated with increased risk of hypertension, stroke, and myocardial infarction. However, until recently the relationship between birth weight and hypertension-related diseases was not clearly established in African Americans. Moreover, it was also unclear if low birth weight in humans heightened the risk for end-stage renal disease. This is a critical gap in the literature, since low birth weight occurs at twice the rate in African Americans as among Caucasians. We identified a significant relationship between end-stage renal disease and low birth weight in both African Americans and Caucasians. Given the higher rates of low birth weight in African Americans, differences in fetal development may, therefore, contribute to the racial disparity in end-stage renal disease. Continued study of the biological factors linking early development with later risk of hypertension-related diseases is important and may shed light on racial disparities in health outcomes. (c)2001 by Le Jacq Communications, Inc.
- Published
- 2001
34. Acute physical and mental stress resulted in an increase in fatty acids, norepinephrine, and hemodynamic changes in normal individuals: A possible pathophysiological mechanism for hypertension—Pilot study
- Author
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Josiane Motta e Motta, Ludmila Neves Souza, Bianca Bassetto Vieira, Humberto Delle, Fernanda Marciano Consolim‐Colombo, Brent M. Egan, and Heno Ferreira Lopes
- Subjects
catecholamines ,fatty acids ,hemodynamic response ,insulin ,mental stress ,metabolism ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Hypertension is often associated with metabolic changes. The sustained increase in sympathetic activity is related to increased blood pressure and metabolic changes. Environmental stimuli may be related to increased sympathetic activity, blood pressure, and metabolic changes, especially in genetically predisposed individuals. The aim of this study was to evaluate the response of fatty acids to physical and mental stress in healthy volunteers and the hemodynamic, hormonal, and metabolic implications of these stimuli. Fifteen healthy individuals with a mean age of 31 ± 7 years, of both sexes, were evaluated. They were assessed at baseline and after combined physical and mental stress (isometric exercise test, Stroop color test). Blood samples were collected at baseline and after stimulation for glucose, insulin, fatty acid, and catecholamine levels. Blood pressure, heart rate, cardiac output, systemic vascular resistance, and distensibility of the large and small arteries were analyzed. The data obtained at baseline and after stimuli were from the same individual, being the control itself. Compared to baseline, after physical and mental stress there was a statistically significant increase (p
- Published
- 2021
- Full Text
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