The American journal of medicine
-
There are few studies devoted specifically to the epidemiology of older hypertensive patients, although some information has been obtained from broader trials in which either the study populations have become older or an older subgroup has been identified. Three areas have been addressed: the changes of blood pressure with age; the prevalence of hypertension in older persons; and the risks of elevated blood pressure in elderly patients. It has been found that blood pressure, especially systolic pressure, increases with age. ⋯ Older hypertensive patients' risks of cardiovascular complications and death are from two to five times that of normotensive persons. Treatment of diastolic hypertension in older patients can be expected to delay the onset of cardiovascular disease and improve the quality of life. Hopefully, this will prove to be true for isolated systolic hypertension as well.
-
Hypertension is a major health problem for patients over 65 years of age. Control of elevated blood pressure reduces cardiovascular morbidity and mortality rates among older hypertensive patients. Increased total peripheral vascular resistance is the primary hemodynamic abnormality in these patients. ⋯ The latter condition might be thought to favor blood pressure control with diuretics and impair the response to angiotensin-converting enzyme inhibitor therapy. However, recent studies with lisinopril, a new long-acting, nonsulfhydryl angiotensin-converting enzyme inhibitor, indicate that reductions in systolic and diastolic blood pressure in older hypertensive patients receiving either angiotensin-converting enzyme inhibitor or hydrochlorothiazide monotherapy were not significantly different. These data demonstrate that angiotensin-converting enzyme inhibitor monotherapy can effectively lower blood pressure in older hypertensive patients.
-
Pharyngitis, bronchitis, and pneumonia represent the most common respiratory tract infections. With a view to establishing effective management strategies, the origins of these illnesses and the diagnostic techniques that have been developed to discover them are reviewed. Therapeutic regimens with documented efficacy are outlined with emphasis on specific rather than empiric treatment. Although many respiratory tract pathogens remain exquisitely sensitive to penicillin, the emergence of resistant strains underscores the need for safe and effective alternative therapies.
-
Randomized Controlled Trial Clinical Trial
An attachable silver-impregnated cuff for prevention of infection with central venous catheters: a prospective randomized multicenter trial.
Percutaneously inserted central venous catheters are widely used. Catheter-related bacteremia or fungemia is the most frequent serious complication of these catheters. In an attempt to reduce the frequency of such infections, a subcutaneous cuff constructed of a biodegradable collagen matrix impregnated with bactericidal silver was developed. Our goal was to assess, in a multicenter clinical trial, the effectiveness of this cuff in preventing catheter-related infection. ⋯ This novel, silver-impregnated, attachable cuff can substantially reduce the incidence of catheter-related infection with most percutaneously inserted central venous catheters, can extend the time catheters can be left in place safely, and can prove cost-beneficial.
-
Comparative Study
Comparison between measured and fick-derived values of hemodynamic and oxymetric variables in patients with acute myocardial infarction.
Previous studies have compared the relationship between directly measured values for cardiac output, systemic oxygen consumption (VO2), and arteriovenous oxygen difference (D(A-v)O2) with those calculated by the Fick principle. However, the validity of Fick's principle in critically ill patients undergoing physiologic changes and pharmacologic interventions is unknown. The purpose of our study was to compare directly measured values for hemodynamic and oxymetric variables with those calculated by the Fick equation in patients with acute myocardial infarction, at baseline and after the hemodynamic changes produced by pharmacologic interventions. ⋯ In patients with acute myocardial infarction, cardiac output, VO2, and D(A-v)O2 indirectly calculated by the Fick principle are equivalent to directly measured values, despite the various degrees of hemodynamic dysfunction and the currently used therapeutic interventions.