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Kalra, Lalit. "The effects of hypertension and hypertensive treatment on psychomotor performance." Thesis, King's College London (University of London), 1991. https://kclpure.kcl.ac.uk/portal/en/theses/the-effects-of-hypertension-and-hypertensive-treatment-on-psychomotor-performance(724a49ad-9e80-4a77-9a76-357cd0f6e277).html.
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Epstein, Christina (Christina Lynn). "An analytics approach to hypertension treatment." Thesis, Massachusetts Institute of Technology, 2014. http://hdl.handle.net/1721.1/91299.
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Thesis: S.M., Massachusetts Institute of Technology, Sloan School of Management, Operations Research Center, 2014.This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.
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Cataloged from student-submitted PDF version of thesis.
Includes bibliographical references (pages 67-68).
Hypertension is a major public health issue worldwide, affecting more than a third of the adult population and increasing the risk of myocardial infarction, heart failure, stroke, and kidney disease. Current clinical guidelines have yet to achieve consensus and continue to rely on expert opinion for recommendations lacking a sufficient evidence base. In practice, trial and error is typically required to discover a medication combination and dosage that works to control blood pressure for a given patient. We propose an analytics approach to hypertension treatment: applying visualization, predictive analytics methods, and optimization to existing electronic health record data to (1) find conjectures parallel and potentially orthogonal to guidelines, (2) hasten response time to therapy, and/or (3) optimize therapy selection. This thesis presents work toward these goals including data preprocessing and exploration, feature creation, the discovery of clinically-relevant clusters based on select blood pressure features, and three development spirals of predictive models and results.
by Christina Epstein.
S.M.
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Ali, Omar Farhan. "Statins as a treatment for pulmonary hypertension." Thesis, Imperial College London, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.521123.
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Francis, Bahaa. "Pharmacological treatment with tetrahydrobiopterin in pulmonary hypertension." Thesis, Imperial College London, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.530471.
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Hallberg, Pär. "Pharmacogenomics of antihypertensive treatment & clinical pharmacological studies of digoxin treatment /." Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-5782.
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Welsh, Tomas J. "The treatment of hypertension in people with dementia." Thesis, University of Nottingham, 2016. http://eprints.nottingham.ac.uk/33468/.
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Introduction: Current guidance on the treatment of high blood pressure provides the advice that co-pathology should be taken into account when treatment decisions are made, but does not specify the approach in people with dementia. A relationship between high blood pressure and dementia, all be it complex and variable over time, does exist, making dementia a relevant co-pathology in decisions around the treatment of hypertension. No trial evidence exists however to guide clinical decision making in this specific context and clinicians with theoretical concerns over adverse events or varying priorities may act differently while remaining within the scope of current guidance. To inform the design of potential future research examining the repercussions of different treatment approaches, the way high blood pressure is currently treated in people with dementia and the adverse events they experience need to be understood. Aims: This thesis reports research which set out to describe the treatment of high blood pressure in people with dementia and the adverse events that this population experienced over a six month period. Methods: (i) A systematic literature review of observational studies describing the treatment of hypertension in people with dementia was performed. (ii) A multicentre cohort study, the Hypertension IN Dementia (HIND) study, of 181 participants, recorded information on dependency in activities of daily living (ADLs), cognition, medication, diagnoses, and healthcare use. It provided a detailed description of the treatment of high blood pressure in the study population and the adverse events experienced over a 6 month period. Results: Literature review: The prevalence of hypertension in people with dementia was 45% (range 36%-84%), of whom 73% (range 48%-85%) were taking at least one antihypertensive. 55% of people with dementia achieved target blood pressure in the one study that reported this. The review found no studies that specifically set out to describe the treatment of high blood pressure in people with dementia in the UK. Cohort study: 181 participants were recruited from general practices and via memory clinics. The rate of recruitment was low (8%) in the GP arm, resulting in potential selection bias. The study population were mildly cognitively impaired (median MMSE 23 (IQR 18-26)), 56% were dependent for at least one ADL, had a median of 5 (IQR 3-7) diagnoses and were treated with a median of 7 (5-9) medications. High blood pressure was treated in 87% (95% CI 82% - 92%) and target blood pressure was achieved in 57% (95% CI 49% - 64%) of those on treatment, no different from the general population (87% (95% CI 85% - 89%) treated and 52% (95% CI 49% - 55%) achieving target). ACEi/ARBs were the most frequently prescribed antihypertensive class (55%), followed by calcium channel blockers (33%), beta-blockers (30%) and diuretics (21%). Diuretics were less likely to be prescribed than in the general population (21% (95% CI 15%-26%) vs 34% (95% CI 31% - 37%)). During 6 months follow up the study population reported 475 GP appointments, 65 hospital admissions, 214 falls, 1 myocardial infarction, 6 strokes and 8 deaths. Heart failure, stroke, recurrent falls, falls with fractures, death and GP appointments were more common in the study population than in benchmark populations. Conclusion: In conclusion in an area where clinicians were acting without a firm evidence base and where there were theoretical concerns around the potential side effects of antihypertensive use, clinicians treated hypertension in people with dementia much as they did in people without dementia. The same classes of antihypertensives were used to maintain blood pressure at a similar level to that achievable in the general population. Despite a potential selection bias that may have over recruited fitter and milder people with dementia than the overall population, the study population reported a higher level of cardiovascular events, recurrent falls, fractures and adverse symptomatology than those without dementia in benchmark populations. Although this finding could relate to reporting bias or a higher intrinsic cardiovascular risk it raises the possibility that the benefits of antihypertensive treatment are attenuated, while the risks are increased, in people with dementia with implications for the risk-benefit ratio in this population. Future specific research, using an approach that avoids selection bias, to explore the risk-benefit ratio of antihypertensive treatment in people with dementia is outlined and advice is provided to clinicians managing high blood pressure in people with dementia.
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Marriott, Helen Maria. "Pulmonary hypertension : susceptibility and treatment in rat models." Thesis, University of Sheffield, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.246988.
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Arigoni, Chiara. "Acute treatment of arterial hypertension with calcium antagonists /." [S.l : s.n.], 1986. http://www.ub.unibe.ch/content/bibliotheken_sammlungen/sondersammlungen/dissen_bestellformular/index_ger.html.
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Persson, Mats. "Bring hypertension guidelines into play : guideline-based decision support system for drug treatment of hypertension and epidemiological aspects of hypertension guidelines." Doctoral thesis, Umeå universitet, Allmänmedicin, 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-94105.
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Suen, Colin. "Novel Therapeutic Strategies for the Treatment of Pulmonary Arterial Hypertension." Thesis, Université d'Ottawa / University of Ottawa, 2017. http://hdl.handle.net/10393/36242.
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Pulmonary arterial hypertension (PAH) is a progressive disease that results in increased pulmonary vasculature resistance, causing right ventricular (RV) remodeling, which eventually progresses into right heart failure and mortality. New and emerging therapeutic strategies involve regenerative approaches to repair the underlying vascular pathology using regenerative cell therapy and methods to alleviate RV dysfunction in the setting of fixed RV afterload. In the first section of the thesis, we investigated the role of EPC paracrine mechanisms in the treatment of PAH. We characterized the paracrine function of EPCs by demonstrating that EPC conditioned medium enhances endothelial cell migration, survival and angiogenesis in vitro. We further examined the role of secreted extracellular vesicles in the paracrine function of EPCs, which played a minor role in promoting wound healing. However, using the monocrotaline rat model of PAH, we did not demonstrate a consistent benefit on RV pressures or remodeling with EPCs or EPC conditioned medium. The lack of effect may be related to the advanced phenotype observed in our model of PAH.
Survival in severe pulmonary arterial hypertension (PAH) is related to the ability of the right ventricle (RV) to adapt to increased afterload. Therefore, we explored the effect of genetic background on right ventricular adaptation and survival in a rat model of severe (PAH). Compared to the conventional Sprague-Dawley rat strain, we observed high mortality in the Fischer SUHx model of severe PAH. This was related to a strain-dependent failure of RV adaptation, as evidenced by RV dilatation, RV contractile dysfunction, decreased cardiac ouptut and decreased exercise capacity. Further analysis by gene expression microarrays and fluorescence microangiography demonstrate that failure of RV adaptation is due at least in part due to lack of adequate microvascular angiogenesis in the hypertrophied RV. This work lays the foundation for the section on RV-specific therapy that follows.
Using the Fischer model of maladaptive RV remodeling, we tested whether cardiotrophin-1 (CT-1), a pro-angiogenic and cardioprotective cytokine, could improve RV adaptation. We demonstrated that as a rescue treatment, CT-1 reduced RV dilatation and function without influencing RV afterload, which suggests improved RV adaptation. These changes were associated with an increase in RV capillary density. As an early-stage preventative treatment, in addition to improving RV remodeling, CT-1 also reduced pulmonary pressures. These hemodynamic changes suggest that CT-1 may also have a direct impact on vascular tone or the underlying pulmonary vascular pathology.
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Addo, Juliet. "Detection, Treatment and Control of Hypertension Among Ghanaian Civil Servants." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.498935.
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Дудченко, Ірина Олександрівна, Ирина Александровна Дудченко, and Iryna Oleksandrivna Dudchenko. "Treatment of arterial hypertension on patients with thrombocytopenia: literature review." Thesis, Sumy State University, 2017. http://essuir.sumdu.edu.ua/handle/123456789/64798.
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Background. Thrombocytopenia is a common hematological problem. If a patient with thrombocytopenia has high level of blood pressure, this increases the risk of a hemorrhagic stroke or other life-treating bleeding. Literature sources also indicate that thrombocytopenia in some cases may be an adverse effect of antihypertensive treatment. Thus, it is very complicated to prescribe correct antihypertensive drug in patients with thrombocytopenia.
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Atkinson, Kathryn Jane. "Evaluation of novel diagnostic and therapeutic modalities for treatment of canine pulmonary hypertension." Diss., Columbia, Mo. : University of Missouri-Columbia, 2008. http://hdl.handle.net/10355/6068.
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Thesis (M.S.)--University of Missouri-Columbia, 2008."May 2008" The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Includes bibliographical references.
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鍾嘉怡 and Ka-yi Chung. "An evidence-based guideline : using progressive muscle relaxation exercise in maintaining optimal blood pressure for adult patients with hypertension." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193083.
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Hypertension is one of the most common chronic medical problems around the world and it is an important public health challenge. Hypertension can lead to cerebrovascular disease, ischemic heart disease, renal failure, myocardial infraction or stroke. According to the statistics from the Census and Statistics Department, it revealed that the ratio of people with known hypertension was about 11.0% in 2011/12. Exposure to stress has been evidenced by different studies as a risk factor for hypertension. Stress included occupational stress, stressful events from the social environment, and low socioeconomic status. Progressive muscle relaxation therapy plays an important role in controlling hypertension apart from the traditional management such as the use of medication or diet control.
Objective
The objectives of the translational nursing research are to develop an evidence- based guidelines for hypertension patients to maintain an optimal blood pressure level.
Methods
5 electronic databases including Medline (Ovid SP) (1950–Aug week 4 2012), Pubmed, ISI web of knowledge (1956- Aug 2012) , The PsycINFO database (1980- Aug 2012) and Cochrane Library (1950- Aug 2012) are used for systematic search of literature. Five suitable are identified while three studies are randomized controlled trials and two are quasi-experimental design. The 5 studies were summarized and a table of evidence is formed. The Scottish Intercollegiate Guidelines Network (SIGN) checklist was used for critical appraisal. The findings indicate that progressive muscle relaxation exercise has significant effects in maintaining optimal blood pressure for hypertension patients. In order to implement the evidence- based protocol, an implementation plan is developed. A pilot test is implemented before the full- scale implementation of innovation. An evaluation plan is developed in order to assess the effectiveness of the program.
Conclusion
There are all together 8 recommendations are made in this protocol which based on the 5 chosen studies. According to SIGN’s “Grades of Recommendation”, all 8 recommendations in the protocol are graded as “A”. The innovation is proposed to implemented at an outpatient clinic for the hypertension patients. The progressive muscle relaxation exercise would be last for 6 weeks, which is effective in maintaining optimal blood pressure in hypertension patients. In the views of the transferability of the evidences, the feasibility and the cost-effectiveness of the program, the proposed program is considered as rewarding to carry out at the outpatient clinic in Hong Kong.published_or_final_version
Nursing Studies
Master
Master of Nursing
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Toles, Chivon Latrice. "Home-based biofeedback-assisted breathing relaxation as treatment for hypertension in African Americans a pilot study /." [Pensacola, Fla.] : University of West Florida, 2009. http://purl.fcla.edu/fcla/etd/WFE0000195.
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Thesis (M.A.)--University of West Florida, 2009.Submitted to the Dept. of Psychology. Title from title page of source document. Document formatted into pages; contains 78 pages. Includes bibliographical references.
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Bakhit, Dana M. "The role of the renin-angiotensin system in responsiveness to captopril treatment." Thesis, University of Brighton, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.271977.
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Al-Shammari, Ayed M. H. M. "The role of clinical pharmacy in the treatment of hypertension in the State of Kuwait : an analysis of the current treatment of hypertension in Kuwait and the role of the clinical pharmacist in advancing treatment strategies." Thesis, University of Bradford, 2012. http://hdl.handle.net/10454/5483.
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The thesis investigated nicotine levels and their effects on hypertensive subjects and whether aspirin could be used in the treatment of hypertension to bring about not only an anti thrombotic effect but reduce the systemic blood pressure especially in those individuals who smoke cigarettes. The study, which also audits the use of aspirin, was conducted in Kuwait and so provides an insight of hypertensive patients very rarely considered in the literature The thesis begins in Chapter One with an extensive literature review which analyses the properties and problems that nicotine causes and its ability to cause hypertensive changes along with its multitude of other events. The physiological and pathological problems caused by nicotine are reviewed on the basis of its chemistry and pharmacological properties using a worldwide perspective rather than just focus on Kuwait. The second Chapter uses extensive analysis of the literature to determine the pharmacological properties of aspirin and its use in cardiovascular disease. The pharmacokinetics and therapeutic effects are presented with emphasis to its inhibitory effects on platelet activation which is central to the development of serious cardiovascular consequences such as stroke and myocardial infarction. The third Chapter returns to consider the literature in detail and why nicotine has specific effects on the cardiovascular system in terms of receptor stimulation and how aspirin may be able to reduce nicotine's cardiovascular effects and concludes with the Aims and Objectives of the thesis. The fourth Chapter investigates urinary nicotine levels in smokers from cigarettes available in Kuwait to indicate the actual levels which could be achieved by smokers in this study. This established that the levels would cause pharmacological effects demonstrating also the effects of passive smoking. The number of cigarettes smoked per day has an unpredictable effect on metabolism and urinary output of nicotine. The fifth Chapter is the major investigational section of the thesis and considers if aspirin ability to reduce cardiovascular effects, may be useful in terms of diastolic blood pressure and lipid levels in the 4 blood. The effects were suggestive that aspirin did reduce the blood pressure in hypertensive subjects but was not universal and was limited to those suffering from mild - moderate hypertension. It was determined that aspirin should be sued at the earliest age possible in these patients. The sixth Chapter involved a large scale trial of the effectiveness of aspirin treatment in hypertensive patients over a one year period in Kuwait. This used ambulatory blood pressure measurements to determine the effectiveness of daytime and nightime changes in blood pressure in patients with and without aspirin treatment. The overall conclusion was a reduced relative risk of suffering cardiovascular events in mild to moderate hypertension when aspirin (75mg/day) was administered. Specifically in smokers, aspirin lowers the systolic daytime BP and diastolic nightime BP. To support this work a comprehensive audit is provided of the use of the current use of aspirin in Kuwait hospitals.
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McMurray, E. M. "Insulin action and hypertension : the effect of hyperaldosteronism and its treatment." Thesis, Queen's University Belfast, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.557964.
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Introduction There has been renewed interest in aldosterone, with evidence that those with primary hyperaldosteronism are at great risk of cardiovascular disease and have higher mortality rates than those with essential hypertension at a similar level. However, screening for primary hyperaldosteronism can be difficult. Aldosterone is also recognised to be a pro-inflammatory hormone, its effects resulting in vascular damage and cardiac fibrosis. Mortality benefits have been demonstrated in patients with heart failure, and post-M I with LV dysfunction following treatment with mineralocorticoid receptor antagonists. There is a link between aldosterone and hypertension and impaired insulin resistance. However evidence is lacking on the effect of eplerenone on insulin action. Methods Three studies are presented. In the first two studies salivary aldosterone is measured using a newly developed assay, initially in normotensive controls and then in a hypertensive cohort. The third study was a randomised, controlled, double-blind, crossover study, investigating the effects of the selective mineralocorticoid receptor antagonist Eplerenone on insulin action in a hypertensive cohort. Results Salivary aldosterone correlated well with serum aldosterone at 1200h in both the normotensive and hypertensive cohorts. Diurnal variation in salivary aldosterone concentration was also demonstrated in both cohorts. Treatment with eplerenone did not affect insulin sensitivity as assessed by a hyperinsulinaemic euglycaemic clamp. Conclusions Salivary aldosterone is a marker for serum aldosterone and varies across the day in both normotensive and hypertensive individuals. Eplerenone has a neutral effect on insulin action in man. Overall, these studies have addressed a number of practical issues concerning screening for primary hyperaldosteronism and shown a neutral effect of MR blockade on insulin action. These issues are highly relevant to current medical practice.
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Sephton_E_A. "Hypertension in Cape Town clothing industry clinics: Does treatment match risk?" Master's thesis, University of Cape Town, 2001. http://hdl.handle.net/11427/26511.
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Background: The management of hypertension according to the patient' s absolute risk of cardiovascular disease. rather than their blood pressure in isolation from other risk factors, is now widely advocated because it targets treatment at those with most to gain. In South Africa blood pressure is traditionally managed according to the patient's level of blood pressure. Main Objective: To identify the proportion of traditionally treated hypertensive patients who may benefit from cessation or intensification of treatment as judged by a risk-based approach to their management. Design: A cross sectional descriptive survey of patients and their medical records with assessment of absolute risk of cardiovascular disease using Framingham risk equations. Setting: Eight Clothing Industry Health Benefit Fund clinics in Cape Town, South Africa. Participants: 382 women and men, predominantly coloured, attending for the treatment of hypertension Main outcome measure: The proportions of patients in whom the predicted risk of a cardiovascular event within 5 years is less than 10% and those in whom the risk within five years is greater than 20%. Results: 65% of participants (CI 60 - 70%) were at less than 10% risk of a cardiovascular event in the next 5 years and 19% (Cl 15-23%) were at more than 20% risk of a cardiovascular event despite current treatment. 5% (CI 3.2-7.9%) were at greater than 20% risk of a cardiovascular event in the next 5 years having no previous history of a cardiovascular event. 14% (CI 10-17%) were at greater than 20% risk of a cardiovascular event in the next 5 years because of a previous history of a cardiovascular event. 1.3% (CI 0.4-3%) were at less than 10% risk of a cardiovascular event within the next 5 years, despite having a systolic blood pressure over 170mmHg. Conclusion: Assessment of the cardiovascular risk of patients treated for hypertension identifies those patients at most and least risk. Resources could therefore be targeted at those with the most to gain from treatment and the unwanted side effects of antihypertensive medication avoided in those at low risk. Almost two thirds of patients currently being treated for hypertension were at less than 10% risk of developing a cardiovascular event within the next 5 years. A trial of medication reduction or cessation in this group is justified and the resources could be redirected at those 5% whose risk remains very high despite current levels of treatment.
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Rosenqvist, Kerstin. "Transjugular intrahepatic portosystemic shunt in the treatment of symptomatic portal hypertension." Doctoral thesis, Uppsala universitet, Radiologi, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-321538.
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Portal hypertension (PHT) is a condition with serious complications, such as variceal bleeding, refractory ascites and bowel ischemia. The cause of PHT may be pre-, intra- or post-hepatic. Initial treatment is pressure-reducing drugs and the treatment of acute symptoms. Ten patients presented with severe abdominal pain and acute portomesenteric venous thrombosis. Their response to systemic anticoagulation was insufficient. Treatment with primary continuous thrombolysis by a transhepatic or transjugular approach in four patients resulted in major complications, incomplete recanalization and a 75% survival rate. Treatment with repeated transjugular thrombectomy (TT) combined with the creation of a transjugular intrahepatic portosystemic shunt (TIPS) achieved near complete recanalization, prompt symptom relief and 100% survival in five patients treated with this method as the primary intervention. In one patient, treated with TT and TIPS secondary to surgical thrombectomy and bowel resection, the outcome was fatal. Nineteen patients with portal vein thrombosis presented with acute or threatening variceal bleeding or refractory ascites. TIPS was feasible in 16 of the 18 patients in whom it was attempted and symptom relief was achieved in the majority of them. In 14 patients with Budd-Chiari syndrome, 13 patients were treated with TIPS, four of them after previous liver vein angioplasty. The 5-year transplantation-free survival rate was 100% in patients treated with primary TIPS. In 131 patients with variceal bleeding treated with TIPS, the survival at 12 months in patients with and without cirrhosis was 70% and 100% respectively and in accordance with previous studies. A high Child-Pugh score prior to TIPS and severe HE within 12 months after TIPS was related to an increased mortality. The occurrence of HE after TIPS did not correlate with the PSG after TIPS. Re-bleeding within 12 months after TIPS occurred in 10 patients and was associated with TIPS dysfunction. In conclusion, endovascular intervention, mainly TIPS, seems to be safe and effective for treating patients with complications of PHT, regardless of the underlying cause of disease and site of venous blood flow obstruction. HE may occur more frequently after TIPS than medical and endoscopic treatment, but is often mild and easily treated. In selected patients with PHT, TIPS may improve survival.
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Wathen, Christopher George. "Studies of the cardiovascular effects of inotropic agents and vasodilators on the pulmonary and systemic circulation in man." Thesis, University of Edinburgh, 1988. http://hdl.handle.net/1842/27032.
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Duarte, Marli Teresinha Cassamassimo [UNESP]. "Estudo dos motivos do abandono do tratamento da hipertensão arterial: relato de usuários do CSE-Botucatu, 1995/1999." Universidade Estadual Paulista (UNESP), 2001. http://hdl.handle.net/11449/98505.
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duarte_mtc_me_botfm.pdf: 367548 bytes, checksum: 0bc9456e76ceee8e0aa601ea2566a701 (MD5)Objetivou-se, com este trabalho, identificar o abandono do seguimento médico em uma coorte de pacientes inscritos, em 1995, no atendimento ao hipertenso do Centro de Saúde-Escola (CSE) de Botucatu, no período de 1995 a 1999, e analisar os motivos de abandono do tratamento da hipertensão arterial relatados por esses pacientes. Estudaram-se 192 pacientes hipertensos, que compõem a coorte, tendo sido identificados, nesta, três grupos: grupo abandono (GAB), composto por 89 pacientes; grupo abandono-aderente (GAB/AD), composto por 41 pacientes, e grupo aderente (GAD), composto por 62 pacientes. A taxa de abandono observada foi de 46,4% e a de aderência de 53,6%. Os grupos foram caracterizados segundo as variáveis: sociodemográficas, relacionadas ao seguimento e tratamento no serviço de saúde, e doenças crônicas associadas. Na segunda parte do estudo, foram entrevistados 50 pacientes do GAB. A análise temática de conteúdo foi a técnica utilizada para tratamento das respostas dos entrevistados. A pesquisa indicou que a taxa de abandono do seguimento médico no CSE não pode ser generalizada como taxa de abandono de seguimento médico ou, ainda, como de abandono do tratamento da hipertensão, uma vez que se observou que mais da metade dos pacientes entrevistados estavam em acompanhamento médico para tratamento da hipertensão arterial em outros serviços de saúde e relataram diversas formas de cumprimento do tratamento medicamentoso e não-medicamentoso. Os motivos para o abandono do tratamento da hipertensão — considerando em separado os seus componentes...
The aim of this research is to identify the hypertension treatment dropout in a cohort assisted at a School Health Center (SHC), in Botucatu, from 1995 to 1999. This cohort (192 patients) was divided in to three groups: Dropout group – DG – (89 patients), dropout-compliant group – DCG – (41 patients) and compliant group – CG – (62 patients). The dropout rate was 46,4% and the compliance rate was 53,6%. The groups were studied according to these variables: socio-demographic, health service treatment and follow-up and chronic diseases comorbidity. Fifty DG patients were interviewed. Their answer were analyzed by content analysis. As more than half of the patients interviewed were being assisted at other health services the dropout rate at the SHC can not be considered as a treatment dropout. The causes of dropout - patient related problems, lack of symptons, better or normal arterial pressure, alcohol consumption – were the same if one considers each dropout component (medical treatment, changes in life style and health services follow-up) separetely. The lack of information about the medication and its side effects can be regarded as the main dropout causes of medical treatment. Moreover, it was observed that some health service features played an important rule in medical follow-up dropout.
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Powers, Jennifer Lynn. "Cellular and enzymatic studies with novel adrenergic analogs and effectors." Diss., Georgia Institute of Technology, 1993. http://hdl.handle.net/1853/30262.
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Mchowat, Jane. "Cardiovascular control by central beta-adrenoceptors in the rat." Thesis, University of Bath, 1987. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.380621.
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Guo, Huayang. "The development of a gene transfer approach for the treatment of hypertension /." [St. Lucia, Qld.], 2005. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe18895.pdf.
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Fowler, Ewan Douglas. "β1-adrenoceptor blockade treatment of right ventricular dysfunction caused by pulmonary hypertension." Thesis, University of Leeds, 2015. http://etheses.whiterose.ac.uk/11678/.
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Failure of the right ventricle (or ventricular) (RV) is the leading cause of death in patients with pulmonary arterial hypertension (PAH), however no treatments specifically target the failing RV. β1-adrenoceptor blockers (β-blockers, BB) reduce mortality in left heart failure but current clinical guidelines caution against their use in PAH. Recent studies suggest β-blockers may be beneficial in PAH however the mechanisms remain unknown. The present study sought to establish whether the β1- blocker metoprolol (10 mg/kg/day) improved survival and function in a rat model of PAH induced by monocrotaline (60 mg/kg, MCT), and to elucidate the mechanisms responsible. Daily metoprolol or placebo was administered 15 days post-monocrotaline injection. PAH resulted in severe RV hypertrophy, dysfunction and heart failure by median day 23 in placebo treated rats (FAIL), whereas metoprolol extended the median survival to day 31 (MCT+BB). RV function measured by echocardiography and catheterisation was severely impaired in FAIL, but was partially restored in MCT+BB on day 23±1. Metoprolol appeared to act primarily on the myocardium and not the vasculature. Contractile abnormalities in isolated FAIL RV cardiomyocytes included increased cell volume, negative force and Ca2+ transient response to faster pacing, increased stiffness to stretch and shorter resting sarcomere length. Reduced creatine kinase activity was found in FAIL; creatine kinase inhibition reproduced characteristics of FAIL in healthy cells, whereas exogeneous creatine kinase reversed the shorter sarcomere length in FAIL cells. Contractile and Ca2+ handling properties of MCT+BB cells were partially or fully restored relative to healthy cells. Capillary density was reduced in FAIL and partially restored in MCT+BB; computer modelling indicated fewer areas of hypoxia in MCT+BB RV. Assessment of FAIL RV mitochondria revealed reduced creatine-coupled respiration but no other detectable defects. Metoprolol improved survival, Ca2+-handling, contractility, oxygen delivery and diastolic properties of PAH rats. β-blockers represent a novel myocardium-specific therapy to target the failing RV in PAH.
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Egwuagu-Ndubisi, Chinwe N. "Hardiness and Attitude on Hypertension Treatment Adherence Among Nigerian Health Care Workers." ScholarWorks, 2011. https://scholarworks.waldenu.edu/dissertations/965.
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Racial and ethnic minorities in the United States have higher rates of hypertension than European Americans. In this ethnographic study, 30 Nigerian immigrant health care workers with hypertension described their self-efficacy management of the disease to ascertain the relationship between health-related hardiness, individual attitudes on compliance, and medication adherence self-efficacy. Using a mixed methods designs comprised of survey tools and focus-group questionnaires, the research questions were focused on understanding attitudes and health practices within Nigerian culture that support self-efficacy management. The theoretical framework for this study is the social learning theory and the social cognitive theory postulated by Bandura. Content analysis of the focus group transcript revealed that all participants agreed that culture directly influences their self-efficacy practices. Interview responses generated 4 major themes in which the study participants expressed positive attitude towards adopted values including culture practices, faith, enculturation, and fear of medication effects. Cross tabulations of data from the survey tools showed no relationship between self-care management, attitude, and medication adherence. Factor analysis of the Health Related Hardiness (HRH) scale identified 6 constructs with a cumulative variance of 64.9%. Implication for positive social change include culturally specific health intervention programs that focus on the impact of culture on hypertension self-efficacy practices and self-care management.
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Martins, Renà Duarte. "Epidemiologic Study of Antihypertensive Terapeutic and its Effects on Lipoproteic Metabolism." Universidade Federal do CearÃ, 2002. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=347.
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FundaÃÃo de Amparo à Pesquisa do Estado do CearÃThe identification of patients with arterial hypertension, and the attitudes and practices related to individual cases of the condition, are fundamental to its control and to the prevention of associated complications. The dyslipidemia and hypertension are common and powerful risk factors for cardiovascular disease (CVD) and often coexist in the same individual. The diuretics and beta blockers affect the lipid profile and they can act synergistically, with dyslipidemia and hypertension, in terms of increased risk for CVD. We investigated the influence of hypertension and its treatment on circulating lipids. One hundred and sixty-nine individuals with aged between 32-87 years were studied. According to the results the population was predominantly women (72,6%), and the subjects had a mean blood pressure of 144,23  14,86 (mean  SD) for systolic pressure, and 90,45  9,91 for diastolic pressure. Hydrochlorothiazide (HCTZ), captopril (CPT) and propranolol (PPL) were the most prescribed drugs. Monotherapy was used in 33,53% of the patients, and CPT was the most prescribed drug. In association therapy (66,47%) the most used drug was HCTZ, specially in prescriptions associated to CPT. Propranolol was used proportionally more by women (p=0,01) and verapamil more by men (p=0,009), and the control of hypertension was significantly (p=0,04) more frequent in individuals being treated with monotherapy than in the subjects being treated with combination therapy. Patients taking HCTZ had significant effects in theirs lipid serum concentrations while that ones taking CPT and/or PPL have no expressive effects. The main associations which lead to lipid serum alterations were HCTZ+CPT and HCTZ+PPL. Theses results suggest that any therapy with includes HCTZ as an hypertensive drug, must be associated to a lipid monitoring process
A identificaÃÃo de pacientes com hipertensÃo arterial, as atitudes e as prÃticas face aos casos individuais sÃo determinantes para o controle da doenÃa e prevenÃÃo e para prevenÃÃo das complicaÃÃes associadas. Dislipidemia e hipertensÃo sÃo comuns e poderosos fatores de risco para doenÃas cardiovasculares e freqÃentemente coexistem num mesmo indivÃduo. Os diurÃticos e beta bloqueadores elevam o perfil lipÃdico e podem agir sinergicamente, com dislipidemia e hipertensÃo, na elevaÃÃo dos riscos para doenÃas cardÃacas. NÃs investigamos a influÃncia da hipertensÃo e seu tratamento sobre os lipÃdios circulantes. Foram estudados 169 indivÃduos, com idades entre 32 â 87 anos. De acordo com os resultados obtidos, a maioria da populaÃÃo foi composta por mulheres (72,6%), e a mÃdia de pressÃo era 144,23  14,86 (mÃdia  DP) para pressÃo sistÃlica e 90,45  9,91 para pressÃo diastÃlica. Hidroclorotiazida (HCTZ), captopril (CPT) e propranolol (PPL) foram as drogas mais prescritas. Monoterapia foi utilizada por 33,53% dos pacientes, e captopril foi a droga mais prescrita. Em associaÃÃo (66,47%) a droga mais prescrita foi HCTZ, principalmente associada com CPT. Propranolol foi predominantemente utilizada no sexo feminino (p= 0,01) e verapamil no sexo masculino (p=0,009), sendo que o controle da hipertensÃo foi significativamente (p=0,04) mais freqÃente nos indivÃduos tratados com monoterapia do que naqueles em uso de associaÃÃo. Pacientes em uso de hidroclorotiazida tiveram efeitos significantes sobre as concentraÃÃes sÃricas de lipÃdios, enquanto aqueles em uso de CPT e/ou PPL nÃo apresentaram efeitos expressivos. As principais associaÃÃes que elevaram lipÃdeos sÃricos foram HCTZ+CPT e HCTZ+PPL. Estes resultados sugerem que quando a terapÃutica antihipertensiva envolver o uso de HCTZ, a monitorizaÃÃo do perfil lipÃdico se faz necessÃria.
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Tao, Da, and 陶达. "An evaluation of the short-term impacts of a patient-centered computerized self-monitoring system among patients with type 2 diabetes and hypertension." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/209484.
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Consumer health information technologies (CHITs) are emerging as promising tools for delivering healthcare services and facilitating patient self-management of chronic diseases; however, the use of the CHITs is largely constrained by usability problems and unclear evidence on the effectiveness of the technologies. The ergonomics research team of The University of Hong Kong developed a patient-centered computerized self-monitoring system that appeared to be useful and easy to use; with the system, this thesis focuses on the examination of the short-term impacts of the technology on patient outcomes for diabetic and hypertensive patients.
The self-monitoring technology was designed using user-centered approaches and relevant human factors principles. Iterative usability evaluations were conducted to assess and improve the usability of the technology with 97 chronically ill patients. Also, using data from a larger randomized controlled trial (RCT) of technology-based disease self-management to improve patients’ outcomes, this thesis compared the short-term effects of the use of a computerized self-monitoring system to usual care using 63 patients with type 2 diabetes and hypertension for four weeks. Thirty-three patients were randomized into intervention group, whose disease care was supported by the self-monitoring system, while 30 patients into control group, who continued with their usual care. A pretest-posttest repeated measures design was employed to determine the effects of the technology on clinical, psychosocial, behavioral, usage, and technology perception outcomes over time. Measurements were obtained at baseline, and after 2 and 4 weeks.
The iterative usability studies improved and verified the usability of the self-monitoring system for chronically ill patients. Results from the RCT showed that after four weeks, there were significant decreases in systolic blood pressure (p < 0.001) and diastolic blood pressure (p < 0.001), self-efficacy for managing chronic disease (p = 0.001), and adherence to treatment (p = 0.001) in the intervention group compared with the control group. Significant differences in favor of intervention group after four weeks were also documented for changes of several quality of life subscales (i.e., general health (p = 0.010), role physical (p = 0.001), role emotional (p = 0.002), bodily pain (p = 0.050), and physical component summary score (p = 0.005)), and perceived ease of use (p = 0.007). No significant difference was found between groups for fasting blood glucose (p = 0.687), perceived usefulness (p = 0.661), frequency of self-monitoring of blood pressure (p = 0.230) and self-monitoring of blood glucose (p = 0.993), and several other quality of life subscales over time.
The usability evaluation presented in this thesis report demonstrated that the method was effective and efficient in identifying potential usability problems at the early stage of system development for CHITs. The findings from the RCT indicated that the use of the human factored-engineered self-monitoring technology had short-term effectiveness in improving blood pressure control, self-efficacy for managing chronic disease, adherence to treatment, and quality of life for patients with type 2 diabetes and hypertension. A human factored-engineered self-management technology appears to be an effective tool in patient self-management of chronic diseases.published_or_final_version
Industrial and Manufacturing Systems Engineering
Doctoral
Doctor of Philosophy
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Kerari, Ali. "The Influence of Health Literacy, Hypertension-Specific Knowledge, Patient Activation, and Adherence to Hypertension Treatment Plans on Self-management and Blood Pressure Control in Saudi Adults with Hypertension." Case Western Reserve University School of Graduate Studies / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=case156354982307228.
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Bortel, Lucas Maria Aloysius Barbara Van. "Beyond the tension of hypertension focus on non-antihypertensive aspects of antihypertensive treatment /." Maastricht : Maastricht : Rijksuniversiteit Limburg ; University Library, Maastricht University [Host], 1993. http://arno.unimaas.nl/show.cgi?fid=5857.
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Hall, Eleanor M. "Social Ecology of Adherence to Hypertension Treatment in Latino Migrant and Seasonal Farmworkers." Digital Archive @ GSU, 2011. http://digitalarchive.gsu.edu/nursing_diss/26.
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The prevalence of hypertension (HTN) is high in Latinos (Latino/Latina) Americans due to social and ecological factors. Increased migration of Latino migrant/seasonal farmworkers (MSFW) to the U.S. augments the social, economic, environmental, and psychosocial factors associated with health and illness. Bronfenbrenner’s Ecological Systems Theory was used to guide this study. The purposes of this cross-sectional, correlational study were to explore Latino MSFWs’ adherence to HTN treatment (medication adherence, blood pressure [BP] self-care, and BP control) and to examine the influence of BP knowledge, perceived stress, acculturation, health literacy, and health care access (HCA) on adherence to HTN treatment.
A total of 45 Latino (mean age 45 + 9) MSFWs receiving HTN treatment participated in this study. Spanish and English questionnaires were available for participants to measure adherence to HTN treatment and the five independent variables. Analysis included correlations, t-tests, hierarchical multiple regression, and hierarchical logistic regression.
The majority of MSFWs were from Mexico, female (55.6%), had less than a 6th grade education. Most (82%) of the MSFWs had uncontrolled BP, and were not adherent to medications (42%), even with high BP knowledge scores (M = 6.5 ±1.3). MSFWs perceived a high level of stress (M = 16 + 6.9), low acculturation level (Anglo orientation: M = 2.9 + 0.9), and no employer-provided health insurance for personal illnesses or injuries (93%). Blood pressure knowledge, perceived stress, acculturation, health literacy, and HCA accounted for 49% of the variance in the BP self-care; however, only higher BP knowledge was a significant predictor of better BP self-care (p < .001). Furthermore, acculturation was a significant predictor of BP control (p < .01).
This study explored select determinants of adherence to HTN treatment in Latino MSFWs in a culturally informed way. Although BP self-care behaviors appeared to be a consequence of BP knowledge, this study found low medication adherence in Latino MSFWs and uncontrolled BP explained by the two predictors, acculturation and health literacy. Perceived stress and health care access did not influence the adherence to HTN treatment. MSFWs had poor BP control and HTN treatment adherence. A culturally appropriate educational program is needed to help the MSFWs adherence to HTN treatment.
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Lu, Changwu [Verfasser]. "Antifibrotic drugs: new candidates for the treatment of pulmonary arterial hypertension? / Changwu Lu." Gießen : Universitätsbibliothek, 2018. http://d-nb.info/1163533688/34.
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Greer, I. A. "The effect of anti-hypertensive agents on platelets, prostacylin and thromboxane and observations on prostacyclin and thromboxane in normal and hypertensive pregnancy." Thesis, University of Glasgow, 1985. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.380334.
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Anchala, Raghupathy. "Management of hypertension and prevention of cardiovascular diseases in India : the role of decision support systems." Thesis, University of Cambridge, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.648283.
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Somers, V. K. "The effects of exercise and physical training on cardiovascular control." Thesis, University of Oxford, 1986. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.375296.
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Kondowe, Greeves Burton Chianira. "An investigation of some of the mechanisms of action of angiotensin converting enzyme inhibitors." Thesis, Queen's University Belfast, 1986. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.254326.
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Waller, Patrick Charles. "Pharmacokinetics and antihypertensive effect of the serotonin antagonist ketanserin." Thesis, University of Sheffield, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.335054.
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Capewell, Simon. "Studies of the calcium antagonist felodipine in the treatment of hypertension and heart failure." Thesis, University of Newcastle Upon Tyne, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.330281.
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Singer, Donald Robert James. "Studies of the importance of atrial natriuretic peptides in physiology, pathophysiology and treatment in man." Thesis, University of Aberdeen, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.262349.
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In this thesis an attempt has been made to try to dissect out the relative importance of atrial natriuretic peptides (ANP) and the renin-angiotensin-aldosterone system in the control of sodium balance in normal man. At the same time the thesis examines the relevance of ANP in the pathophysiology of essential hypertension and cardiac transplantation and the potential therapeutic value of manipulating the ANP system. The studies described in this thesis were important in suggesting a dominant role of suppression of the renin-angiotensin-aldosterone system in permitting excretion of short term increases in intravenous or oral sodium intake. The permissive effects of suppression of angiotensin II or aldosterone for the excretion of an intravenous sodium load showed clear time differences, with suppression of angiotensin II important immediately but the response to suppression of aldosterone delayed. In contrast, there appears to be only a transient role for changes in circulating levels of ANP in the response to an intravenous sodium load and little evidence that changes in ANP release are important in responding to acute increases in dietary sodium intake in normal subjects. However, the sensing mechanism for ANP release is clearly activated by sustained changes in dietary sodium intake. Studies of prolonged dietary sodium alteration in normal subjects clear evidence for a role of ANP in the medium term regulation of sodium balance and further dietary studies suggested an important role for the ANP system in pathophysiology in essential hypertension and in cardiac transplant recipients.
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Mondzinger, Naomi Magdalena. "The knowledge of young adults on hypertension." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/71874.
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Thesis (MCur)--Stellenbosch University, 2012.ENGLISH ABSTRACT: Hypertension is on the increase among patients as found on the Routine Monthly Report (RMR) at Kayamandi Clinic. The staggering figures showed that the number of patients with hypertension between January 2009 until December 2009 was 5 754. It was further identified on the Routine Monthly Report (RMR) statistics that, more and more young adults between 18 and 40 years who are visiting the clinic for other health problems are diagnosed with hypertension and its complications. The incident rate of these young adults ranges between 151 and 340 per month. It is very alarming that some of them who are diagnosed with hypertension never return for further follow-up visits and are at risk of debilitating complications which are preventable in later life. The objectives of this study were to determine the knowledge young adult patients have of: • hypertension • the management of hypertension • the complications of hypertension. The study adopted a descriptive, exploratory design with a quantitative approach. The research question determines the research design or approach. In this case a broad overview is necessary of the knowledge young adults at Kayamandi Clinic have on the topic of hypertension. This then serves as a platform for further in-depth studies on this phenomenon. A yes/no scale was used to collect data. The questionnaire was designed in such a way that the participants could understand all the questions. The layout of the questionnaire was easy and the questions were straightforward. The questionnaires were written in English, Xhosa and Afrikaans. After the translation of the questionnaires, a second person scrutinized it for the correctness of the Xhosa translation. An interpreter assisted with the questionnaire in the Xhosa speaking community at the time of data collection, where a language barrier was anticipated. The Cronbach’s alpha test was used to test the reliability of the questionnaire. Informed consent was obtained from each participant. Permission was obtained from the University of Stellenbosch via the Health Research Ethical Committee ((HREC). Permission was also obtained from the Director: Department of Health, Western Cape Province and the authorities of the Cape Wine lands district. A statistician from the University of Stellenbosch was consulted regarding the data analysis and the interpretation of the data. Data was articulated in the form of frequency tables and histograms. The Spearman test was used to determine the correlation between variables. 10% of the participants used in the pilot study were from Cloetesville Clinic and 21% of the participants used for the main study were from Kayamandi Clinic, that is n=210 participants. The results of the study showed that for the n=172 participants that partook in the study, there was a correlation between complications and hypertension but no correlation on lifestyle management. Statistical associations were determined by using the Spearman test on a 95% confidence interval between various variables. The normal descriptive statistical analysis was completed. The implication of the results of this study is that high blood pressure can affect young and old people. Recommendations consist of on going health promotion and continuous education that include both old and young people.
AFRIKAANSE OPSOMMING: Hipertensie is aan die toeneem onder die pasiënte soos gevind in die maandelikse roetine-verslag.Die skokkende syfers soos gerapporteer in die maandelikse roetine-verslag,wys dat die aantal pasiënte met hipertensie by Kayamandi-kliniek van Januarie 2009 tot Desember 2009 was 5 754. Dit is verder geidentifiseer in die maandelikse roetine-verslag dat al hoe meer jong mense tussen die ouderdomsgroep van 18 to 40 jaar oud wat die kliniek vir ander siektetoestande besoek, met hipertensie en verwante komplikasies gediagnoseer word. Die voorkomssyfer van jongmense met hipertensie wissel tussen 151 tot 340 per maand. Dit is sorgwekkend dat sommige van die pasiënte nadat hulle met hipertensie gediagnoseer is, nie terugkeer na die kliniek vir verdere opvolgbesoeke nie en daardeur blootgestel word aan uitmêrgelende komplikasies in hul latere leeftyd wat voorkombaar is. Die doelwitte van die studie is om jong volwasse pasiënte se kennis vas te stel ten opsigte van: • hipertensie • die behandeling van hipertensie • die komplikasies van hipertensie. Die studie neem die vorm van ʼn beskrywende, verkennende ontwerp met ʼn kwantitatiewe benadering aan. Die navorsingsvraag bepaal die navorsingsontwerp of benaderring. In hierdie geval is ʼn breë oorsig nodig van die kennis van jong volwassenes by Kayamandi-kliniek oor die onderwerp aangaande hipertensie. Dit dien dan as basis vir verdere indringende studies rakende hierdie fenomeen. ʼn Ja/nee skaal is gebruik om data te versamel. Die vraelys is ontwerp op ʼn manier sodat die deelnemers dit kan verstaan. Die uitleg van die vraelys is eenvoudig en die vrae maklik. Die vraelys is geskryf in Engels,Xhosa en Afrikaans.Na die vertaling van die vraelys,is dit deur ʼn tweede person wat ook Xhosa magtig is nagegaan om die korrektheid van die vraelys te verseker. ʼn Tolk het gehelp met die vraelys ten tye van data-insamelling in die Xhosa- sprekende gemeenskap, waar taal ʼn moontlike probleem kon wees. Die Cronbach alpha- toets was gedoen om die betroubaarheid van die vraelys te toets. Ingeligte toestemming was verkry van elke deelnemer. Toestemming was verkry van die Universiteit deur middel van die Gesondheids Navorsings Etiese Kommitee (GNEK). Toestemming was ook verkry van die Direkteur: Departement van Gesondheid, Wes Kaap Provinsie en die owerhede van die Kaap Wynland streek. ʼn Statistiekus van die Universiteit van Stellenbosch was geraadpleeg aangaande die data analise. Data was geartikuleer in die vorm van frekwensies in tabelle en histogramme. Die Spearman-toets is gebruik om die korrelasie tussen variante vas te stel .10% van die deelnemers wat vir die loodprojek gebruik is, is van Cloetesville-kliniek. 21% van die deelnemers wat vir die hoofstudie gebruik is, is van die Kayamandi-kliniek , dus ʼn total van n=210 deelnemers. Die studie het bewys dat vir n=172 deelnemers wat aan die studie deelgeneem het, daar ʼn korrelasie tussen die komplikasies en die hipertensie toestand is, maar geen korrelasie met leefstylgewoontes is gevind nie. Statistiese assosiasies is bepaal deur gebruik te maak van die Spearman-toets op ʼn 95%-interval tussen verskeie variante. Die normale, beskrywende statistiese analise is voltooi. Die implikasie van die resultate van die studie, is dat hoë bloeddruk jonk en ouer mense affekteer. Aanbevelings dui op aanhoudende gesondheids promosies en voortdurende opvoeding wat jonk en ouer persone insluit.
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Hurdman, Judith. "The clinical spectrum and natural history of pulmonary hypertension in the modern treatment era." Thesis, University of Sheffield, 2015. http://etheses.whiterose.ac.uk/15205/.
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Pulmonary hypertension (PH) is a heterogeneous condition with classification based on shared pathophysiological characteristics. There is a paucity of literature reflecting the spectrum of disease across the 5 diagnostic groups encountered at a specialist referral centre in the era of the widespread availability of targeted pulmonary vascular therapy. The first part of this thesis focuses on the ASPIRE registry; a large registry of contemporary, consecutive, treatment-naïve patients identified at a specialist PH centre using a catheter-based approach. Uniquely, the ASPIRE registry compares the natural history of all forms of PH, providing new and novel insights into the natural history of rare groups such as pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension and more common but less well studied forms such as PH associated with left heart disease and lung disease where the role of targeted therapies is not clear. This registry demonstrates that outcomes and characteristics differ between and within PH diagnostic groups. In addition, the current system of diagnostic classification in PH has prognostic value even when adjusted for age and haemodynamic severity emphasizing the importance of systematic evaluation and precise classification. The second part of this thesis focuses on patients in group 3; pulmonary hypertension associated with lung disease, concentrating particularly on chronic obstructive pulmonary disease (COPD) and emphysema, the most common type of lung disease associated with PH. The characteristics of patients with severe PH associated with COPD (PH-COPD) differed from those with mild to moderate PH-COPD despite similar degrees of emphysema on CT scan. Survival in PH-COPD was poor and this study identified independent predictors of outcome. Patients with severe PH-COPD share certain characteristics with PAH such as the degree of haemodynamic severity and right ventricular impairment. This leads to the question of whether therapies frequently prescribed in PAH should be considered for this group. In the largest cohort yet studied, a minority of patients with severe PH-COPD demonstrated objective evidence of improvement with compassionate treatment with targeted pulmonary vascular therapies and where there was evidence of clinical benefit, patients demonstrated superior survival. This data suggests that further evaluation of targeted therapies is warranted in patients with severe PH-COPD. In conclusion, retrospective review of this cohort of patients has provided a detailed comparison of characteristics between and within PH diagnostic groups, assessed prognostic markers and provided insights into the effects of targeted pulmonary vascular treatment in severe PH-COPD. This underscores the importance of thorough assessment and accurate classification to ensure appropriate management and prudent use of costly therapies. This registry also provides detailed phenotypic information which may be helpful when defining entry criteria for clinical trials. The characterization of this patient cohort has also lead to a number of publications from collaborative projects in the Academic Unit of Radiology.
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Peeters, Andrea. "Primary open-angle glaucoma and ocular hypertension cost-effectiveness of early detection and treatment /." Maastricht : Maastricht : Universitaire Pers Maastricht ; University Library, Universiteit Maastricht [host], 2008. http://arno.unimaas.nl/show.cgi?did=12706.
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Losinsky, Rory. "Cognitive-behavioural treatment of essential hypertension in an urban Xhosa woman: a case study." Thesis, Rhodes University, 1991. http://hdl.handle.net/10962/d1002519.
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Essential hypertension has a complex and multiple biological, psychological and social aetiology and remains one of the most serious physical disorders affecting the Black population of South Africa today. Pharmacological treatment has been the predominant approach to blood pressure reduction, but considering that the greater part of essential hypertension has its origin in biobehavioural and cognitive functioning a non-pharmacological treatment approach to essential hypertension is receiving extensive interest both in research and therapeutic practice. This study attempted to implement a specific cognitive-behavioural treatment "package' which was tailored to the emergent aetiology in an urban Xhosa woman suffering from Mild hypertension who was on antihypertensive medication and to evaluate the treatment using a single case-study methodology. A combination of relaxation training and cognitive-behavioural modification was provided over a fifteen week period and evaluated both quantitatively and qualitatively. It was found that a combination of over-weight, occupational stress and anger could have contributed and/or caused the patient's hypertension. The results also show a significant reduction in blood pressure during the treatment phase as well as a reduction in weight, experienced anxiety and angry emotion, and by the end of the study the patient's blood pressure had been reduced to normal levels. Finally the feasibility of using such a treatment approach is discussed in relation to the South African context and the case study method is evaluated as a research tool in light of the findings.
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Xu, Wenxin. "Optimal Systolic Blood Pressure Target, Time-to-Intensification and Time-to-Follow-up in the Treatment of Hypertension." Thesis, Harvard University, 2014. http://etds.lib.harvard.edu/hms/admin/view/55.
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Objective:
I sought to determine the systolic intensification threshold, time-to-intensification and time-to-follow-up associated with the lowest risk of cardiovascular events or death in primary care patients with hypertension.
Methods:
A retrospective cohort study of 88,756 patients was performed. Systolic intensification threshold, time-to-intensification and time-to-follow-up were analyzed with respect to risk of acute cardiovascular event or death. The Cox model was adjusted for age, sex, smoking status, socioeconomic deprivation, history of diabetes, cardiovascular disease or CKD, Charlson Comorbidity Index, BMI, medication possession ratio, and baseline blood pressure.
Results:
During median follow-up of 37.4 months, 9,985 participants experienced acute cardiovascular event or death (11.3%). Systolic intensification thresholds of 130-150 mmHg were associated with no difference in risk, while higher thresholds were associated with progressively greater risk. Risk increased progressively from the lowest (0-1.4 months) to the highest quintile of time to medication intensification. The highest quintile of time to-follow-up (>2.7 months) was also associated with increased risk.
Conclusions:
Systolic intensification threshold higher than 150 mmHg, delays of greater than 1.4 months before medication intensification following systolic blood pressure elevation, and delays of greater than 2.7 months before blood pressure follow-up following medication intensification were associated with increased risk for acute cardiovascular events or death.
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Missouris, Constantinos Georgiou. "Atherosclerotic renal artery stenosis : new approaches in the assessment, diagnosis and treatment." Thesis, St George's, University of London, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.243459.
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Marley, John. "The conduct and management of large clinical trials in hypertension /." Title page, table of contents and abstract only, 1992. http://web4.library.adelaide.edu.au/theses/09MD/09mdm347.pdf.
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Thesis (M.D)--Dept. of Clinical and Experimental Pharmacology, University of Adelaide, 1993.Includes 4 published papers by the author as part of appendix 9. Includes bibliographical references (leaves 1-19 (second sequence)).
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Reed, Anna Katja. "The potential role for PPAR beta/delta agonists in the treatment of pulmonary arterial hypertension." Thesis, Imperial College London, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.540630.
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Pereira, Marta Sofia Ferreira. "Prevalence, awareness, treatment and control of hypertension: systematic review and original results from EPIPorto study." Master's thesis, Faculdade de Medicina da Universidade do Porto, 2008. http://hdl.handle.net/10216/21907.
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Pereira, Marta Sofia Ferreira. "Prevalence, awareness, treatment and control of hypertension: systematic review and original results from EPIPorto study." Dissertação, Faculdade de Medicina da Universidade do Porto, 2008. http://hdl.handle.net/10216/21907.
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