The 2002 Official Patient's Sourcebook on High Blood Pressure

THE 2002 OFFICIAL PATIENT’S SOURCEBOOK on IGH LOOD RESSURE J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., ...

Author: James N. Parker | Philip M. Parker

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THE 2002 OFFICIAL PATIENT’S SOURCEBOOK

on

IGH LOOD RESSURE J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The 2002 Official Patient’s Sourcebook on High Blood Pressure: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83199-8 1. High Blood Pressure-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this sourcebook.

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Dedication To the healthcare professionals dedicating their time and efforts to the study of high blood pressure.

Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to high blood pressure. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.

Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.

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About ICON Health Publications In addition to high blood pressure, Official Patient’s Sourcebooks are available for the following related topics: ·

The Official Patient's Sourcebook on Binge Eating Disorder

·

The Official Patient's Sourcebook on Obesity

To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

Contents vii

Table of Contents INTRODUCTION ................................................................................................................................. 1 Overview ....................................................................................................................................... 1 Organization ................................................................................................................................. 3 Scope.............................................................................................................................................. 3 Moving Forward............................................................................................................................ 6 PART I: THE ESSENTIALS ............................................................................................................. 7 CHAPTER 1. THE ESSENTIALS ON HIGH BLOOD PRESSURE: GUIDELINES ....................................... 9 Overview ....................................................................................................................................... 9 What Is High Blood Pressure? .................................................................................................... 11 How Does High Blood Pressure Hurt My Kidneys? .................................................................. 12 How Will I Know Whether I Have High Blood Pressure? .......................................................... 12 How Will I Know Whether I Have Kidney Damage? ................................................................. 12 How Can I Prevent High Blood Pressure From Damaging My Kidneys? ................................. 13 Are There Medicines That Can Help?......................................................................................... 13 Risk for Kidney Failure Related to High Blood Pressure............................................................. 14 Hope through Research................................................................................................................ 14 For More Information.................................................................................................................. 14 More Guideline Sources .............................................................................................................. 15 Vocabulary Builder...................................................................................................................... 28 CHAPTER 2. SEEKING GUIDANCE ................................................................................................... 31 Overview ..................................................................................................................................... 31 Associations and High Blood Pressure........................................................................................ 31 Finding More Associations ......................................................................................................... 37 Finding Doctors........................................................................................................................... 39 Finding an Endocrinologist......................................................................................................... 40 Selecting Your Doctor ................................................................................................................. 41 Working with Your Doctor ......................................................................................................... 42 Broader Health-Related Resources .............................................................................................. 43 Vocabulary Builder...................................................................................................................... 43 CHAPTER 3. CLINICAL TRIALS AND HIGH BLOOD PRESSURE ....................................................... 47 Overview ..................................................................................................................................... 47 Recent Trials on High Blood Pressure......................................................................................... 50 Benefits and Risks........................................................................................................................ 62 Keeping Current on Clinical Trials ............................................................................................. 65 General References....................................................................................................................... 66 Vocabulary Builder...................................................................................................................... 67 PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL ........................... 69 CHAPTER 4. STUDIES ON HIGH BLOOD PRESSURE ......................................................................... 71 Overview ..................................................................................................................................... 71 The Combined Health Information Database .............................................................................. 71 Federally-Funded Research on High Blood Pressure................................................................... 78 E-Journals: PubMed Central ....................................................................................................... 94 The National Library of Medicine: PubMed................................................................................ 96 Vocabulary Builder...................................................................................................................... 97 CHAPTER 5. PATENTS ON HIGH BLOOD PRESSURE...................................................................... 103 Overview ................................................................................................................................... 103 Patents on High Blood Pressure................................................................................................ 104 Patent Applications on High Blood Pressure ............................................................................ 105 Keeping Current ........................................................................................................................ 105

viii Contents

Vocabulary Builder.................................................................................................................... 106 CHAPTER 6. BOOKS ON HIGH BLOOD PRESSURE ......................................................................... 107 Overview ................................................................................................................................... 107 Book Summaries: Federal Agencies ........................................................................................... 107 Book Summaries: Online Booksellers ........................................................................................ 112 The National Library of Medicine Book Index........................................................................... 116 Chapters on High Blood Pressure.............................................................................................. 119 Directories ................................................................................................................................. 128 General Home References .......................................................................................................... 131 Vocabulary Builder.................................................................................................................... 132 CHAPTER 7. MULTIMEDIA ON HIGH BLOOD PRESSURE .............................................................. 135 Overview ................................................................................................................................... 135 Video Recordings....................................................................................................................... 135 Bibliography: Multimedia on High Blood Pressure .................................................................. 144 Vocabulary Builder.................................................................................................................... 147 CHAPTER 8. PERIODICALS AND NEWS ON HIGH BLOOD PRESSURE ........................................... 149 Overview ................................................................................................................................... 149 News Services & Press Releases ................................................................................................ 149 Newsletters on High Blood Pressure ......................................................................................... 154 Newsletter Articles .................................................................................................................... 158 Academic Periodicals covering High Blood Pressure ................................................................ 162 Vocabulary Builder.................................................................................................................... 165 CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES .............................................................. 167 Overview ................................................................................................................................... 167 NIH Guidelines ......................................................................................................................... 167 NIH Databases .......................................................................................................................... 168 Other Commercial Databases .................................................................................................... 185 The Genome Project and High Blood Pressure.......................................................................... 186 Specialized References ............................................................................................................... 190 Vocabulary Builder.................................................................................................................... 191 CHAPTER 10. DISSERTATIONS ON HIGH BLOOD PRESSURE ......................................................... 193 Overview ................................................................................................................................... 193 Dissertations on High Blood Pressure....................................................................................... 193 Keeping Current ........................................................................................................................ 194 PART III. APPENDICES .............................................................................................................. 195 APPENDIX A. RESEARCHING YOUR MEDICATIONS ..................................................................... 197 Overview ................................................................................................................................... 197 Your Medications: The Basics ................................................................................................... 198 Learning More about Your Medications ................................................................................... 200 Commercial Databases............................................................................................................... 209 Contraindications and Interactions (Hidden Dangers)............................................................. 211 A Final Warning ....................................................................................................................... 212 General References..................................................................................................................... 212 Vocabulary Builder.................................................................................................................... 213 APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ............................................................... 217 Overview ................................................................................................................................... 217 What Is CAM? .......................................................................................................................... 217 What Are the Domains of Alternative Medicine? ..................................................................... 218 Can Alternatives Affect My Treatment?................................................................................... 221 Finding CAM References on High Blood Pressure ................................................................... 222 Additional Web Resources......................................................................................................... 233 General References..................................................................................................................... 296 Vocabulary Builder.................................................................................................................... 297

Contents

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APPENDIX C. RESEARCHING NUTRITION..................................................................................... 299 Overview ................................................................................................................................... 299 Food and Nutrition: General Principles .................................................................................... 300 Finding Studies on High Blood Pressure .................................................................................. 304 Federal Resources on Nutrition................................................................................................. 306 Additional Web Resources......................................................................................................... 306 Vocabulary Builder.................................................................................................................... 307 APPENDIX D. FINDING MEDICAL LIBRARIES ............................................................................... 309 Overview ................................................................................................................................... 309 Preparation ................................................................................................................................ 309 Finding a Local Medical Library ............................................................................................... 310 Medical Libraries Open to the Public ........................................................................................ 310 APPENDIX E. YOUR RIGHTS AND INSURANCE ............................................................................. 317 Overview ................................................................................................................................... 317 Your Rights as a Patient............................................................................................................ 317 Patient Responsibilities ............................................................................................................. 321 Choosing an Insurance Plan...................................................................................................... 322 Medicare and Medicaid ............................................................................................................. 324 NORD’s Medication Assistance Programs............................................................................... 327 Additional Resources................................................................................................................. 328 ONLINE GLOSSARIES ............................................................................................................... 329 Online Dictionary Directories................................................................................................... 337 HIGH BLOOD PRESSURE GLOSSARY .................................................................................. 339 General Dictionaries and Glossaries ......................................................................................... 359 INDEX.............................................................................................................................................. 361

Introduction

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INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don’t know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3

Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2

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High Blood Pressure

Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor’s offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The 2002 Official Patient’s Sourcebook on High Blood Pressure has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to high blood pressure, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on high blood pressure. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on high blood pressure should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on

Introduction

3

appropriate options is always up to the patient in consultation with their physician and healthcare providers.

Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching high blood pressure (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to high blood pressure. It also gives you sources of information that can help you find a doctor in your local area specializing in treating high blood pressure. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with high blood pressure. Part II moves on to advanced research dedicated to high blood pressure. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on high blood pressure. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with high blood pressure or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with high blood pressure. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with high blood pressure.

Scope While this sourcebook covers high blood pressure, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that high blood pressure is often considered a synonym or a condition closely related to the following: ·

Accelerated Hypertension

·

Arteriolar Nephrosclerosis

4

High Blood Pressure

·

Benign Hypertension

·

Benign Intracranial Hypertension

·

Chronic Hypertension

·

Essential Hypertension

·

Familial Hypertension

·

Familial Primary Pulmonary Hypertension

·

Genetic Hypertension

·

High Blood Pressure

·

Hypertension - Essential

·

Hypertension - Malignant

·

Hypertension - Renovascular

·

Hypertensive Crisis

·

Idiopathic Hypertension

·

Idiopathic Pulmonary Hypertension

·

Malignant Hypertension

·

Nephrosclerosis - Arteriolar

·

Pph

·

Pregnancy-induced Hypertension

·

Primary Obliterative Pulmonary Vascular Disease

·

Primary Pulmonary Hypertension

·

Primary Pulmonary Hypertension (pph)

·

Primary Pulmonary Vascular Disease

·

Pulmonary Arterial Hypertension, Secondary

·

Pulmonary Hypertension

·

Renal Hypertension

·

Secondary Pulmonary Hypertension

·

Severe Hypertension

·

Toxemia

·

Toxemia of Pregnancy

In addition to synonyms and related conditions, physicians may refer to high blood pressure using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most

Introduction

5

commonly used system of classification for the world’s illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for high blood pressure:4 ·

401.0 malignant hypertension

·

401.0 malignant hypertension due to renal artery stenosis

·

401.1 essential hypertension

·

401.1 essential hypertension, benign

·

405.01 malignant hypertension due to renal artery stenosis

·

405.01 malignant hypertension sec-ondary to renal artery stenosis

·

416.0 primary pulmonary hypertension

·

416.0 primary pulmonary hyperten-sion

·

416.8 secondary pulmonary hypertension

·

416.8 secondary pulmonary hyperten-sion

·

437.2 hypertensive encephalopathy

·

572.3 portal hypertension

·

642 hypertension complicating a pregnancy, childbirth, or puerperium

·

642 hypertension complicating preg-nancy

·

642.4 preeclampsia, mild

·

642.5 preeclampsia, severe

·

642.6 preeclampsia

·

642.9 unspecified hypertension complicating pregnancy, childbirth, or the puerperium

For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to high blood pressure. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.

4 This list is based on the official version of the World Health Organization’s 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”

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High Blood Pressure

Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson’s approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. Why “Internet age”? All too often, patients diagnosed with high blood pressure will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with high blood pressure is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of high blood pressure, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors

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PART I: THE ESSENTIALS

ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on high blood pressure. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your doctor or healthcare provider may have already explained the essentials of high blood pressure to you or even given you a pamphlet or brochure describing high blood pressure. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.

Guidelines

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CHAPTER 1. THE ESSENTIALS ON HIGH BLOOD PRESSURE: GUIDELINES Overview Official agencies, as well as federally-funded institutions supported by national grants, frequently publish a variety of guidelines on high blood pressure. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on high blood pressure can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on high blood pressure. Originally founded in 1887, the NIH is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.

5

Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.

10 High Blood Pressure

There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with high blood pressure and associated conditions: ·

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

·

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html

·

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

Among these, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is particularly noteworthy. The NIDDK’s mission is to conduct and support research on many of the most serious diseases affecting public health.6 The Institute supports much of the clinical research on the diseases of internal medicine and related subspecialty fields as well as many basic science disciplines. The NIDDK’s Division of Intramural Research encompasses the broad spectrum of metabolic diseases such as diabetes, inborn errors of metabolism, endocrine disorders, mineral metabolism, digestive diseases, nutrition, urology and renal disease, and hematology. Basic research studies include biochemistry, nutrition, pathology, histochemistry, chemistry, physical, chemical, and molecular biology, pharmacology, and toxicology. NIDDK extramural research is organized into divisions of program areas: ·

Division of Diabetes, Endocrinology, and Metabolic Diseases

·

Division of Digestive Diseases and Nutrition

·

Division of Kidney, Urologic, and Hematologic Diseases

The Division of Extramural Activities provides administrative support and overall coordination. A fifth division, the Division of Nutrition Research Coordination, coordinates government nutrition research efforts. The Institute supports basic and clinical research through investigator-initiated This paragraph has been adapted from the NIDDK: http://www.niddk.nih.gov/welcome/mission.htm. “Adapted” signifies that a passage is reproduced exactly or slightly edited for this book. 6

Guidelines 11

grants, program project and center grants, and career development and training awards. The Institute also supports research and development projects and large-scale clinical trials through contracts. The following patient guideline was recently published by the NIDDK on high blood pressure.

What Is High Blood Pressure?7 Blood pressure measures the force of blood against the walls of your blood vessels. Blood pressure that remains high over time is called hypertension. Extra fluid in your body increases the amount of fluid in your blood vessels and makes your blood pressure higher. Narrow or clogged blood vessels also raise blood pressure. If you have high blood pressure, see your doctor regularly. Your kidneys play a key role in keeping your blood pressure in a healthy range, and blood pressure, in turn, can affect the health of your kidneys. High blood pressure, also called hypertension, can damage the kidneys.

Hypertension can result from too much fluid in normal blood vessels or from normal fluid in narrow blood vessels.

Adapted from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): http://www.niddk.nih.gov/health/kidney/pubs/highblood/highblood.htm. 7

12 High Blood Pressure

How Does High Blood Pressure Hurt My Kidneys? High blood pressure makes your heart work harder and, over time, can damage blood vessels throughout your body. If the blood vessels in your kidneys are damaged, they may stop removing wastes and extra fluid from your body. The extra fluid in your blood vessels may then raise blood pressure even more. It’s a dangerous cycle. High blood pressure is one of the leading causes of kidney failure, also commonly called end-stage renal disease (ESRD). People with kidney failure must either receive a kidney transplant or go on dialysis. Every year, high blood pressure causes more than 15,000 new cases of kidney failure in the United States.

How Will I Know Whether I Have High Blood Pressure? Most people with high blood pressure have no symptoms. The only way to know whether your blood pressure is high is to have a health professional measure it. The result is expressed as two numbers. The top number, which is called the systolic pressure, represents the pressure when your heart is beating. The bottom number, which is called the diastolic pressure, shows the pressure when your heart is resting between beats. Your blood pressure is considered normal if it stays below 130/85 (expressed as “130 over 85”), but recent studies suggest that people with kidney disease should keep their blood pressure even lower.

How Will I Know Whether I Have Kidney Damage? Kidney damage, like hypertension, can be unnoticeable, detected only through medical tests. Blood tests will show whether your kidneys are removing wastes efficiently. Your doctor may refer to tests for serum creatinine and BUN, which stands for blood urea nitrogen. Having too much creatinine and urea nitrogen in your blood is a sign that you have kidney damage. Another sign is proteinuria, or protein in your urine. Proteinuria has also been shown to be associated with heart disease and damaged blood vessels. (For more information, see the NIDDK fact sheet on proteinuria.)

Guidelines 13

How Can I Prevent High Blood Pressure From Damaging My Kidneys? If you have kidney damage, you should keep your blood pressure well below 130/85. The National Heart, Lung, and Blood Institute (NHLBI), one of the National Institutes of Health (NIH), recommends that people with kidney disease use whatever therapy is necessary, including lifestyle changes and medicines, to keep their blood pressure at or below 130/85, or even below 125/75 when protein in the urine exceeds 1 gram per 24 hours.

How Can I Control My Blood Pressure? NHLBI has found that five lifestyle changes can help control blood pressure: ·

Maintain your weight at a level close to normal. Choose fruits, vegetables, grains, and low-fat dairy foods.

·

Limit your daily sodium (salt) intake to 2,000 milligrams or lower if you already have high blood pressure. Read nutrition labels on packaged foods to learn how much sodium is in one serving. Keep a sodium diary.

·

Get plenty of exercise, which means at least 30 minutes of moderate activity, such as walking, most days of the week.

·

Avoid consuming too much alcohol. Men should limit consumption to two drinks (two 12-ounce servings of beer or two 5-ounce servings of wine or two 1.5-ounce servings of “hard” liquor) a day. Women should have no more than a single serving on a given day because metabolic differences make women more susceptible to alcoholic liver disease.

·

Limit caffeine intake.

Are There Medicines That Can Help? Many people need medicine to control high blood pressure. A group of medications called ACE (angiotensin-converting enzyme) inhibitors lower blood pressure and have an added protective effect on the kidney in people with diabetes. Additional studies have shown that ACE inhibitors also reduce proteinuria and slow the progression of kidney damage in people who do not have diabetes. You may need to take a combination of two or more blood pressure medicines to reach 125/75.

14 High Blood Pressure

Risk for Kidney Failure Related to High Blood Pressure All racial groups have some risk of developing kidney failure from high blood pressure. African Americans, American Indians, and Alaska Natives, however, are more likely than whites to have high blood pressure and to develop kidney problems from it--even when their blood pressure is only mildly elevated. In fact, African Americans ages 25 to 44 are 20 times more likely than whites in the same age group to develop hypertension-related kidney failure. People with diabetes also have a substantially increased risk for developing kidney failure. People who are at risk both because of their race and because of diabetes should have early management of high blood pressure. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), also part of NIH, is sponsoring a study to find effective ways to prevent high blood pressure and kidney failure in African Americans.

Hope through Research In recent years, researchers have learned a great deal about kidney disease. NIDDK sponsors several programs aimed at understanding kidney failure and finding treatments to stop its progression. NIDDK’s Division of Kidney, Urologic, and Hematologic Diseases supports basic research into normal kidney function and the diseases that impair normal function at the cellular and molecular levels, including diabetes, high blood pressure, glomerulonephritis, and polycystic kidney disease.

For More Information For more information, contact: American Kidney Fund 6110 Executive Boulevard, Suite 1010 Rockville, MD 20852 Phone: 1-800-638-8299 or (301) 881-3052 Email: [email protected] Internet: www.akfinc.org

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National Heart, Lung, and Blood Institute Information Center P.O. Box 30105 Bethesda, MD 20824-0105 Phone: (301) 592-8573 Email: [email protected] Internet: www.nhlbi.nih.gov National Kidney Foundation 30 East 33rd Street New York, NY 10016 Phone: 1-800-622-9010 or (212) 889-2210 Email: [email protected] Internet: www.kidney.org National Kidney and Urologic Diseases Information Clearinghouse 3 Information Way Bethesda, MD 20892-3580 Email: [email protected] The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health under the U.S. Department of Health and Human Services. Established in 1987, the clearinghouse provides information about diseases of the kidneys and urologic system to people with kidney and urologic disorders and to their families, health care professionals, and the public. NKUDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about kidney and urologic diseases. Publications produced by the clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. This fact sheet was reviewed by Vito M. Campese, M.D., University of Southern California, and Matthew Weir, M.D., University of Maryland.

More Guideline Sources The guideline above on high blood pressure is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to high blood pressure. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with

16 High Blood Pressure

high blood pressure. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly.

Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.

The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on high blood pressure and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·

Your Podiatric Physician Talks About High Blood Pressure Source: Bethesda, MD: American Podiatric Medical Association. 1993. 4 p.

Contact: Available from American Podiatric Medical Association. 9312 Old Georgetown Road, Bethesda, MD 20814-1698. (800) 366-8227 or (301)

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581-9200. Fax (301) 530-2752. Website: www.apma.org. Price: Single copy free; bulk orders available at cost. Summary: This pamphlet provides people who have foot problems with information on high blood pressure. A podiatrist is concerned about hypertension and vascular disease, so he or she should know whether a patient has rheumatic heart disease, diabetes, ulceration, swollen feet, or burning feet. In addition, the pamphlet explains that a podiatrist assists in controlling high blood pressure by taking every patient's blood pressure on a routine basis; referring all patients who have high blood pressure to their physicians for evaluation, diagnosis, and treatment; and encouraging patients to adhere to treatment. ·

High Blood Pressure: What You Can Do Source: Santa Cruz, CA: ETR Associates. 2000. 15 p. Contact: Available from ETR Associates. P.O. Box 1830, Santa Cruz, CA 95061-1830. (800) 321-4407. Fax (800) 435-8433. Website: www.etr.org. Price: $1.00 plus shipping and handling; bulk orders available. Summary: This booklet focuses on steps people who have high blood pressure can take to manage this problem. The booklet explains what high blood pressure is and how blood pressure is measured. This is followed by a checklist of reasons people may have for managing their blood pressure and a checklist of steps people are already taking to lower their blood pressure. The booklet then offers tips for making an action plan, eating healthy foods, being active, losing weight, relaxing, quitting smoking, and limiting alcohol. The brochure also lists sources of additional information. 7 figures.

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About High Blood Pressure: Control, Risk, Lifestyle, Weight Source: Dallas, TX: American Heart Association. 1995. 17 p. Contact: Available from Channing L. Bete Company/American Heart Association Fulfillment Center. 200 State Road, South Deerfield, MA 01373-0200. (800) 611-6083. Fax (800) 499-6464. E-mail: [email protected]. Price: $7.50 for 50 copies. Summary: This booklet provides basic information about hypertension (high blood pressure). The booklet notes that adults have hypertension if their blood pressure remains above the threshold of 140 over 90. Approximately 90 percent of the cases of high blood pressure have no known causes. However, researchers have determined that some controllable risk factors for high blood pressure include obesity, excessive salt intake, excessive alcohol consumption, lack of exercise, and stress.

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Uncontrollable risk factors include race, heredity, and age. The booklet points out that an inactive lifestyle makes it easier for people to become overweight and therefore increases the chance of high blood pressure. High blood pressure has no symptoms, so adults should have a health care professional check their blood pressure at least once a year. Although high blood pressure cannot be cured, it can usually be controlled. When compared with people who have controlled high blood pressure, people with uncontrolled high blood pressure are on average three times more likely to develop coronary heart disease, six times more likely to develop congestive heart failure, and seven times more likely to have a stroke. Most treatments for high blood pressure involve a combination of diet, exercise, and medication. The booklet concludes with a list of related brochures available from the American Heart Association. ·

Living With High Blood Pressure and Diabetes Source: New York, NY: National Kidney Foundation. 1994. 6 p. Contact: Available from National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Price: Single copy free. Summary: This booklet provides general information for people with high blood pressure and diabetes. The booklet focuses on preventing the complications of these two diseases. Written in a question-and-answer format, it covers the following topics: a definition of high blood pressure and how it is measured; the causes of high blood pressure; how diabetes increases one's chances of developing high blood pressure; the interaction of blood pressure and diabetes; the symptoms of complications; risk factors and diagnostic screening tests for kidney disease; treatment options for high blood pressure; medications and their side effects; recommendations for self-care; and pregnancy in women with diabetes and high blood pressure. The booklet concludes with a list of the other materials in the Living With High Blood Pressure program.

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High Blood Pressure and its Effects on the Kidneys Source: Rockville, MD: American Kidney Fund. 1995. 4 p. Contact: Available from American Kidney Fund. 6110 Executive Boulevard, Suite 1010 Rockville, MD 20852. (800) 638-8299. Fax (301) 8810898. Price: Single copy free; additional copies $0.15 each plus shipping (as of 1995). Summary: This brochure explains the symptoms, causes, effects, and treatment of hypertension. The damage to the body caused by hypertension is explained, with particular emphasis on how

Guidelines 19

hypertension affects the kidneys. A list of factors that can aggravate hypertension is also given. ·

Living With High Blood Pressure: An Introduction Source: New York, NY: National Kidney Foundation. 1994. 5 p. Contact: Available from National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Price: Single copy free. Summary: This patient education booklet is the first in a series on living with high blood pressure. Designed for patients newly diagnosed with hypertension, the booklet answers basic questions in the areas of blood pressure measurement; the causes of hypertension; the complications associated with hypertension; treatment options; side effects attributable to hypertension medications; and the role of diet therapy. The brochure concludes with a list of the other resources in the Living With High Blood Pressure program. The brochure presents information in clear, easy-tounderstand language.

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Living With High Blood Pressure and Eating Healthy Source: New York, NY: National Kidney Foundation. 1994. 5 p. Contact: Available from National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Price: Single copy free. Summary: This patient education booklet is one of a series on living with high blood pressure. Designed for patients newly diagnosed with hypertension, the booklet gives general information about the role diet plays in treating high blood pressure. Written in question-and-answer format, the booklet covers topics including blood pressure measurement; the causes of hypertension; the complications associated with hypertension; treatment options; how weight loss and exercise can help control high blood pressure; dietary changes recommended for people with hypertension; limiting sodium intake; the effects of potassium and calcium on blood pressure; the importance of following medication guidelines, even while utilizing diet therapy; patients with diabetes; and patients with kidney function. The brochure concludes with a list of the other resources in the Living With High Blood Pressure program. The brochure presents information in clear, easy-to-understand language.

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Living With High Blood Pressure Over Time Source: New York, NY: National Kidney Foundation. 1994. 5 p. Contact: Available from National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Price: Single copy free.

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Summary: This patient education booklet is one of a series on living with high blood pressure. Designed for patients newly diagnosed with hypertension, the booklet gives general information about how high blood pressure may affect a person over time and about what patients can do to help prevent the complications of high blood pressure. Written in question-and-answer format, the booklet covers topics including the causes of hypertension; the complications associated with hypertension; difficult-to-control hypertension and how it is treated; the safety of hypertension medications over long periods of time; the impact of aging on blood pressure; treating hypertension in the elderly; the role of exercise programs, particularly for the older patient; the impact of hypertension on other medical problems, such as heart disease, diabetes, and kidney disease; the side effects of hypertension medication; and alleviating kidney function problems caused by hypertension. The brochure concludes with a list of the other resources in the Living With High Blood Pressure program. The brochure presents information in clear, easy-to-understand language. ·

Living With High Blood Pressure: The Role of the Family Source: New York, NY: National Kidney Foundation. 1994. 5 p. Contact: Available from National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Price: Single copy free. Summary: This patient education booklet is one of a series on living with high blood pressure. Designed for patients newly diagnosed with hypertension, the booklet offers suggestions about how the entire family can help the person with high blood pressure. Written in question and answer format, the booklet covers topics including a definition of hypertension and how it is measured; the causes of hypertension; how lifestyle changes can help to control high blood pressure; treatment options; how weight loss and exercise can help control high blood pressure and can be beneficial for the whole family; the importance of stopping smoking; the importance of following the prescribed drug therapy; interpersonal issues; and problems associated with high blood pressure, including heart attacks, strokes, or kidney disease. The brochure concludes with a list of the other resources in the Living With High Blood Pressure program. The brochure presents information in clear, easy-to-understand language.

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Living With High Blood Pressure and Reduced Kidney Function Source: New York, NY: National Kidney Foundation. 1994. 5 p.

Guidelines 21

Contact: Available from National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Price: Single copy free. Summary: This patient education booklet is one of a series on living with high blood pressure. Designed for patients newly diagnosed with hypertension, the booklet gives general information about how high blood pressure may harm the kidneys and offers suggestions about what patients can do to help keep their kidneys functioning. Written in question and answer format, the booklet covers topics including a definition of high blood pressure and how it is measured; the causes of hypertension; the complications associated with hypertension; treatment options; the impact of hypertension on the kidneys; keeping kidney damage from getting worse; diagnostic tests used to measure kidney function; the role of diet therapy; and treatments available to replace the kidneys, should they stop working completely. The brochure concludes with a list of the other resources in the Living With High Blood Pressure program. The brochure presents information in clear, easy-to-understand language. ·

Living with High Blood Pressure and Heart Disease Source: New York, NY: National Kidney Foundation, Inc. 1994. 6 p. Contact: Available from National Kidney Foundation. U.S. Materials Orders, 30 East 33rd Street, New York, NY 10016. (212) 889-2210. Fax (212) 689-9261. Price: $17.00 for 20 copies. Item number: 18-04. Summary: This booklet provides general information about high blood pressure (hypertension) and how readers can help prevent the complications of hypertension. Written in question and answer format, the booklet addresses topics including a definition of high blood pressure and how it is measured, how often blood pressure should be checked, why hypertension is a serious problem, how the heart is affected by hypertension, how to prevent hypertension-related heart disease, the risk factors for developing heart disease (age, family history, gender, cigarette smoking, high blood pressure, and high blood cholesterol), what to do if heart disease is already present, how to choose the right type of blood pressure medication, the interplay of high blood pressure medications and heart medications, the role of dietary cholesterol, and self care suggestions. The brochure concludes with a list of other informational booklets available from the National Kidney Foundation. The booklet emphasizes that, if high blood pressure is diagnosed, treated, and kept under control, its damaging effects, including those on the heart, can be prevented or reduced.

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·

Hypertension Source: Lenexa, KS: North American Transplant Coordinators Organization. 199x. 2 p. Contact: Available from North American Transplant Coordinators Organization. P.O. Box 15384, Lenexa, KS 66285-5384. (913) 492-3600. PRICE: $0.25. Summary: This brief brochure answers questions about hypertension (high blood pressure) commonly asked by patients undergoing kidney transplantation. Topics include a definition of blood pressure and hypertension; factors that contribute to hypertension, including obesity, eating too much salt, smoking, drinking alcohol, certain medications, psychological stress, gout, pregnancy, diabetes, heredity, and kidney disease; the complications of hypertension; the symptoms of hypertension (often there are none); and posttransplant changes in hypertension. The brochure concludes with a discussion of antihypertensive medications and other treatment options, including lifestyle changes. The brochure emphasizes that hypertension can cause the loss of a transplanted kidney, just as it can cause damage and loss of native kidneys. The brochure includes the address and telephone number of the North American Transplant Coordinators Organization.

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High Blood Pressure Prevention Month: May 1990 Source: Austin, TX, Texas Department of Health, Public Health Promotion Division, 1990. Contact: Texas Department of Health, Public Health Promotion Division, 1100 West 49th Street, Austin, TX 78756. (512) 458-7405. Summary: High Blood Pressure Month was the May 1990 topic for the Texas Pharmaceutical Association and Texas Department of Health, Joint Health Promotion Project. The High Blood Pressure Month information package for contains resources from the National High Blood Pressure Education Program and the American Heart Association on high blood pressure control. Additional materials from the Texas Department of Health include health risk appraisal sheets; pamphlets for the general public, Hispanic Americans, and African Americans; and information on weight, diet, lifestyle, and risk factors.

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National High Blood Pressure 12-Month Kit Source: Bethesda, MD, US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute, National High Blood Pressure Education

Guidelines 23

Program, 32-page resource materials guide, 37-page reproducible materials guide, and an evaluation and order form. 1988. Contact: US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute, National High Blood Pressure Education Program, Bethesda, MD 20892. (301) 951-3260. Summary: The National High Blood Pressure Education Program produced a kit for the 1988 National High Blood Pressure Month to assist participants in planning, promoting, implementing, and evaluating their hypertension education activities with a focus on lifelong adherence to therapy, including pharmacologic and nonpharmacologic approaches to hypertension control. The kit provides information about adherence; weight loss; exercise; reducing intake of sodium, fat, and calories; and other lifestyle changes to encourage cardiovascular health. The kit also stresses the importance of personal responsibility for controlling high blood pressure. The kit is divided into two separate booklets. Part one provides practical information for program planners and health professionals. It suggests ways to overcome barriers to health care among the medically underserved, promote high blood pressure control through the media and other community channels, and improve adherence to treatment among hypertensive patients. Part two provides reproducible materials suitable for distribution to professionals and consumers. These resources include handouts on nutrition, exercise, smoking, home blood pressure measurement devices, and the latest data on hypertension. A combined evaluation and order form is also included. ·

High Blood Pressure and Kidney Disease Source: Lexington, KY: Virgil Smirnow Associates. Health Quality, Inc. 1993. 18 p. Contact: Available from Health Information Library. P.O. Box 55109, Lexington, KY 40555. (606) 299-8475. Price: $1.95 each for 1-99 copies; plus shipping and handling. Summary: The purpose of this booklet is to provide general information to patients and to the public about the relationships between hypertension and kidney diseases. The booklet is not intended as a detailed description of hypertension and its management, but rather as an explanation of kidney impairment in which hypertension is a significant causative or resultant factor. Written in detailed, but layperson's language, the brochure provides a definition of hypertension and then discusses how blood pressure is measured; its causes; secondary hypertension; the prevalence of hypertension; the effects of hypertension;

24 High Blood Pressure

malignant hypertension; stepped care; how hypertension is controlled; the side effects of hypertension medications; the kidneys and hypertension; how hypertension affects the kidneys; diagnostic factors; the relationship between end-stage renal disease and hypertension; children and young people with hypertension; and how to avoid kidney damage from hypertension. The booklet concludes with an order form for the kidney series of booklets available from the Health Information Library. ·

Pulmonary Hypertension Source: Danvers, MA: Scleroderma Foundation. 1998. 6 p. Contact: Available from Scleroderma Foundation. 12 Kent Way, Suite 101, Byfield, MA 01922. (800) 722-4673 or (978) 463-5843. Fax (978) 4635809. E-mail: [email protected]. Website: www.scleroderma.org. Price: Single copy $1.00. Summary: This pamphlet for people with scleroderma uses a question and answer format to provide information about pulmonary artery hypertension. This type of high blood pressure involves the arteries that take blood from the right side of the heart to the lungs. The pamphlet describes the types of pulmonary artery hypertension that occur in scleroderma, including hypertension with or without scarring of the lung tissue. It also presents the symptoms of pulmonary artery hypertension, highlights the tests that might be conducted to diagnose pulmonary artery hypertension, explains the natural course of this condition in scleroderma, and discusses options for treating this type of hypertension. Pulmonary hypertension not related to scleroderma may be treated with oxygen therapy and anticoagulation therapy. Right-heart failure may be treated with various medications, including calcium channel blockers, diuretics, and an experimental drug known as prostacyclin. In addition, the pamphlet presents the mission of the Scleroderma Foundation.

The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “high blood pressure” or synonyms. The following was recently posted:

Guidelines 25

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National High Blood Pressure Education Program Working Group report on high blood pressure in pregnancy. Source: National Heart, Lung, and Blood Institute (U.S.)/National High Blood Pressure Education Program.; 1990 (revised 2000 Jul); 39 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 0704&sSearch_string=high+blood+pressure

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Sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Source: National Heart, Lung, and Blood Institute (U.S.)/National High Blood Pressure Education Program.; 1997 November; 33 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 0017&sSearch_string=high+blood+pressure Healthfinder™

Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·

Age Page - High Blood Pressure--A Common but Controllable Disorder Summary: This pamphlet provides basic facts about high blood pressure (hypertension)--what it is, how it is tested, what causes it, and how it can be treated, controled and prevented. Source: National Institute on Aging, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=36

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Blood Pressure Testing and Measurement Summary: Information about at-home high blood pressure monitoring. Source: American Heart Association http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=3826

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Controlling High Blood Pressure: A Woman's Guide Summary: Three out of every four women with high blood pressure know they have it. Yet fewer than one in three are controlling it. This easy-to-read guide tells women how to control their high blood pressure. Source: National Heart, Lung, and Blood Institute, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=717

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Facts About Heart Disease and Women: Preventing and Controlling High Blood Pressure Summary: If you have high blood pressure, you can control it with proper treatment. If you don't have high blood pressure now, you can take steps to prevent it from developing. Source: National Heart, Lung, and Blood Institute, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=242

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Facts About Lowering Blood Pressure Summary: This page links to consumer health information booklets that contain advice about how to maintain a healthy lifestyle and avoid the damaging effects of high blood pressure. Source: National Heart, Lung, and Blood Institute, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=2708

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High Blood Pressure Summary: The American Heart Association provides this site as a service to the general public. Users can get general information about high blood pressure risks, prevention and management. Source: American Heart Association http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=3827

Guidelines 27

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High Blood Pressure and Kidney Disease Summary: High blood pressure is one of the leading causes of kidney failure. This patient education fact sheet provides basic information about high blood pressure and kidney disease. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=2693

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High Blood Pressure Guidelines (JNC VI) Summary: This is an update of the previous guideline (JNC V, 1992), and contains important new information for clinicians. Source: National Heart, Lung, and Blood Institute, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=2610

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National High Blood Pressure Education Program Summary: The National High Blood Pressure Education Program (NHBPEP), established in 1972, is a cooperative effort among professional and voluntary health agencies, State health departments, and many community Source: National Heart, Lung, and Blood Institute, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=726

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Primary Pulmonary Hypertension (PPH) Summary: Answers your questions about unexplained elevated blood pressure in the pulmonary artery. This booklet covers the incidence, symptoms, cause, diagnosis, and treatment of the disease. Source: National Heart, Lung, and Blood Institute, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=1134

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The NIH Search Utility After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to high blood pressure. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.

Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

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drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html

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Family Village: http://www.familyvillage.wisc.edu/specific.htm

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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

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Med Help International: http://www.medhelp.org/HealthTopics/A.html

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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

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WebMDÒHealth: http://my.webmd.com/health_topics

Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter:

Guidelines 29

Antihypertensive: An agent that reduces high blood pressure. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Glomerulonephritis: A variety of nephritis characterized by inflammation of the capillary loops in the glomeruli of the kidney. It occurs in acute, subacute, and chronic forms and may be secondary to haemolytic streptococcal infection. Evidence also supports possible immune or autoimmune mechanisms. [EU] Gout: Hereditary metabolic disorder characterized by recurrent acute arthritis, hyperuricemia and deposition of sodium urate in and around the joints, sometimes with formation of uric acid calculi. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Heredity: 1. the genetic transmission of a particular quality or trait from parent to offspring. 2. the genetic constitution of an individual. [EU] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Liquor: 1. a liquid, especially an aqueous solution containing a medicinal substance. 2. a general term used in anatomical nomenclature for certain fluids of the body. [EU] Malignant: Tending to become progressively worse and to result in death. Having the properties of anaplasia, invasion, and metastasis; said of tumours. [EU] Nitrogen: An element with the atomic symbol N, atomic number 7, and

30 High Blood Pressure

atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Ulceration: 1. the formation or development of an ulcer. 2. an ulcer. [EU] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU]

Seeking Guidance 31

CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with high blood pressure. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.8 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with high blood pressure. The chapter ends with a discussion on how to find a doctor that is right for you.

Associations and High Blood Pressure As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of an illness can be as taxing as the physical side.9 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your condition can all Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 9 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 8

32 High Blood Pressure

influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. In addition to associations or groups that your doctor might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your insurance provider to find out if the cost will be covered): ·

American Society of Hypertension Address: American Society of Hypertension 515 Madison Avenue, Room 1212, New York, NY 10022 Telephone: (212) 644-0650 Toll-free: (800) 748-7274 Fax: (212) 644-0658 Email: [email protected] Web Site: http://www.ash-us.or Background: The American Society of Hypertension (ASH) is a not-forprofit organization dedicated to a clearer understanding, dissemination, and evaluation of the vast accumulation of data on high blood pressure (hypertension) and to provision of a separate forum for those involved in the study of management of hypertension. Established in 1985 by 17 world famous clinicians and scientists, ASH is now the largest U.S. organization devoted exclusively to hypertension and related cardiovascular diseases. Through the years, ASH has become a scientific organization on the cutting edge of education, research, and treatment strategies and has earned the respect of clinicians, scientists, industry, and government agencies. In addition, the organization conducts an annual four-day scientific meeting, presents several awards to young researchers, and holds regional meetings to provide practicing physicians and their staff with the latest and most comprehensive diagnostic and therapeutic options available in the treatment of hypertensive individuals. Consisting of 3,000 members, ASH publishes a monthly journal entitled 'American Journal of Hypertension,' has a member directory, and provides educational videos on the topic of hypertension. ASH can be reached at its web site on the Internet at http://www.ashus.org. Relevant area(s) of interest: High Blood Pressure, Hypertension

Seeking Guidance 33

·

Canadian Addison Society Address: Telephone: (519) 751-4472 Toll-free: (800) 748-7274 Fax: (519) 751-4473 Email: [email protected] Web Site: http://www.spin.nl/nvap0490.ht Background: The Canadian Addison Society (La Societe Canadienne d Addison) is a nonprofit voluntary agency dedicated to providing support and educational information to individuals affected by Addison s disease and their families. All Society staff members are volunteers. Addison s disease is a rare disorder characterized by chronic, usually progressive, insufficient functioning of the outer layer of the adrenal glands (adrenal cortex). Deficiencies of certain hormones manufactured by the adrenals (i.e., cortisol and aldosterone) result in abnormally low levels of sodium and chloride in the blood and body tissues as well as unusually high levels of potassium (electrolyte imbalance). Increased urinary output and abnormally low blood pressure (hypotension) can lead to extremely low levels of fluid in the body (dehydration). Other early symptoms of Addison s disease may include weakness, fatigue, loss of appetite (anorexia), and a darkened discoloration of scars, skin folds, and/or mucous membranes (hyperpigmentation). The Canadian Addison Society publishes a quarterly newsletter that includes information on national and international issues from support groups around the world; information on local support group activities is also included. In addition, the Society publishes an educational brochure on Addison s disease. The society has approximately 200 members and is itself a member of The Addison and Cushing International Federation. The Society s home page is located at http://www.spin.nl.nvap0490.htm.

·

Foundation for Pulmonary Hypertension, Inc Address: Foundation for Pulmonary Hypertension, Inc. P.O. Box 61540, New Orleans, LA 70161 Telephone: (504) 533-5888 Toll-free: (800) 748-7274 Fax: (504) 533- 244 Background: The Foundation for Pulmonary Hypertension is a national not-for-profit research organization that was established in 1984. Pulmonary Hypertension is a condition characterized by abnormally high blood pressure in the arteries that supply the lungs. Pulmonary Hypertension may be an isolated condition that may occur for unknown reasons (Primary Pulmonary Hypertension) or may occur due to or in

34 High Blood Pressure

association with other underlying disorders or conditions (Secondary Pulmonary Hypertension). The mission of the Foundation is to provide 'seed money' for pioneering research into the causes and treatments of Pulmonary Hypertension. The Foundation supports the development of clinical treatments for people with Primary and Secondary Pulmonary Hypertension and informs and educates affected individuals about their conditions. In some cases, the group make appropriate referrals for further evaluation and possible treatment. Educational materials distributed by the Foundation include a regular newsletter and fact sheets. Relevant area(s) of interest: PPH, Pulmonary Hypertension ·

JDF The Diabetes Research Foundation Address: JDF The Diabetes Research Foundation 89 Granton Avenue, Richmond Hill, Ontario, L4B 2N5, Canada Telephone: (905) 889- 4171 Toll-free: (800) 287-2533 Fax: (905) 889-4209 Email: [email protected] Web Site: http://www.jdfc.c Background: JDF The Diabetes Research Foundation is an international not-for- profit organization in Canada dedicated to raising funds to support and promote diabetes research. Diabetes is a chronic metabolic disorder that affects the body's ability to properly manufacture or utilize insulin, a hormone necessary for the body to transport food glucose into cells for energy. There are several types of diabetes including InsulinDependent Diabetes Mellitus, IDDM (also known as Juvenile Diabetes); Non-Insulin Dependent (Type II, also known as Adult-Onset Diabetes); and Gestational Diabetes. Established in 1974 and consisting of 14 chapters, JDF supports research advances in therapies to reduce the risk of diabetes- caused blindness, decrease the number of amputations due to diabetes, and control high blood pressure associated with diabetes; disease management practices that help maintain tight control of glucose levels to prevent or delay complications of diabetes; and practices that afford women with diabetes the opportunity for safe pregnancies and healthy children. JDF also supports advancements in methods to detect the earliest signs of diabetes; therapeutic treatments to prevent or delay the disease's onset; experimental techniques for programming cells from outside the pancreas to produce insulin; and research that has contributed to the increased understanding of transplantation immunology, which has helped to make transplantation of pancreatic tissue a reality. JDF publishes a quarterly magazine entitled 'Countdown

Seeking Guidance 35

Canada,' regularly produces 'Research News Updates,' and has a web site on the Internet at http://www.jdfc.ca. ·

Jeune Syndrome Info/Support Network Address: Telephone: (440) 246-1578 Email: [email protected] Web Site: http://geocities.com/HotSprings/Spa/9075 Background: The Jeune Syndrome Info/Support Network is a national not-for-profit volunteer support network for individuals and family members affected by Jeune syndrome. Jeune syndrome, also known as asphyxiating thoracic dystrophy (ATD), is a very rare genetic disorder affecting the development of the bone structure of the chest area. Asphyxiating thoracic dystrophy is characterized by insufficient growth of the rib cage (thorax) in newborns. The characteristic 'bell-shaped' chest cavity results in the inability of the infant to breathe properly. Lung infections, high blood pressure, pancreatic cysts and the growth of extra fingers and toes (polydactyly) may also occur. Individuals with Jeune syndrome may also have insufficient growth of the pelvic bones and shortened long bones of the arms and legs. Breathing and kidney problems are the most serious complications of this disorder. The Jeune Syndrome Info/Support Network, which was established in 1997, provides information and support through a self-titled newsletter, brochures and a site on the World Wide Web at http://www.geocities.com/HotSprings/Spa/9075/. The Network s mission is to link families affected by the disorder with one another and with medical professionals for the purpose of sharing information and emotional support.

·

National Hypertension Association, Inc Address: National Hypertension Association, Inc. 324 East 30th Street, New York, NY 10016 Telephone: (212) 889-3557 Toll-free: (800) 575-935 Fax: (212) 447-7032 Background: The National Hypertension Association, Inc. (NHA) is a not-for- profit organization dedicated to combating the chronic health problem of high blood pressure (hypertension) by developing, directing, and implementing effective programs to promote research, educate the public, and ensure prompt detection and effective treatment of hypertension. The NHA is committed to researching the causes of

36 High Blood Pressure

essential hypertension and enhancing the understanding of certain secondary types of hypertension through basic laboratory research studies, thereby improving treatment of these conditions; educating and alerting the public to the severe, life- threatening dangers of hypertension and informing physicians as well as medical students of the most current advances in its causes, diagnosis, treatment, and prevention; and detecting hypertension wherever it exists in the most economical and effective way and urging treatment if indicated. Established in 1977 by a group of concerned scientists, doctors, and philanthropists, NHA offers charitable blood pressure screening, provides work-site detection programs, and has a well-defined program of basic and clinical research to gain better insight into the causes of hypertension. Materials include brochures, pamphlets, a regular newsletter, reports, and information packets. Relevant area(s) of interest: Hypertension ·

Pre-Eclampsia Society Address: Pre-Eclampsia Society 17 South Avenue, Hullbridge, Essex, SS5 6HA, United Kingdom Telephone: (01702) 232533 Toll-free: (800) 748-7274 Email: None. Web Site: Non Background: The Pre-Eclampsia Society (PETS), an international not-forprofit organization, was founded in 1981 in the United Kingdom by an individual who experienced pre-eclampsia during her first pregnancy. The organization is dedicated to serving as a support and information society and is operated by those who themselves have experienced preeclampsia during pregnancy. Pre-eclampsia is a serious condition that may occur in females during the second half of pregnancy. The condition is characterized by high blood pressure (hypertension), abnormal fluid retention and associated swelling (edema), and the passage of abnormally increased levels of protein in the urine (proteinuria). Without appropriate treatment, pre-eclampsia may lead to eclampsia, which may be characterized by seizures, coma, and potentially life-threatening complications. The Pre-Eclampsia Society currently consists of approximately 400 members including individuals who have experienced pre- eclampsia in the past, those who are currently affected by the condition, medical professionals, and lay groups who have an interest in childbirth and pregnancy. The Society offers a variety of programs and services including a library lending service, regular updates on current research, and networking opportunities that promote the exchange of

Seeking Guidance 37

mutual support, information, and resources. In addition, the Society offers a variety of educational materials including brochures, pamphlets, reports, and a quarterly newsletter that contains members' letters and personal stories, members' questions and physicians' responses, and understandable information on pre-eclampsia. Relevant area(s) of interest: Toxemia of Pregnancy ·

Pulmonary Hypertension Association Address: Pulmonary Hypertension Association P.O. Box 463, Ambler, PA 19002 Telephone: (215) 591-9016 Toll-free: (800) 748-7274 Fax: (215) 542-5692 Email: [email protected] Web Site: http://www.phassociation.or Background: The Pulmonary Hypertension Association (PHA) is an international not- for-profit voluntary organization that provides educational information and fellowship to people with Primary or Secondary Pulmonary Hypertension. Pulmonary Hypertension is a condition characterized by abnormally high blood pressure in the arteries that supply the lungs. Pulmonary Hypertension may be an isolated condition that may occur for unknown reasons (Primary Pulmonary Hypertension) or may occur due to or in association with other underlying disorders or conditions (Secondary Pulmonary Hypertension). Established in 1992, the organization addresses issues pertinent to people with these disorders such as current research, early detection, orphan drug designations, organ donor awareness, and organ transplantation. The Association's activities include conducting international conferences on Pulmonary Hypertension; providing a networking service to help affected individuals contact one another by phone, through the mail or via the Internet; offering referrals; and publishing a quarterly newsletter entitled 'Pathlight.' The Pulmonary Hypertension Association also offers additional educational and support materials including fact sheets, booklets, and pamphlets. Relevant area(s) of interest: PPH, Pulmonary Hypertension

Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide

38 High Blood Pressure

different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for patient associations.

The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about high blood pressure. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.

DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “high blood pressure” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.

The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “high blood pressure”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “high blood pressure” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with high blood pressure. You should check back periodically with this database since it is updated every 3 months.

Seeking Guidance 39

The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option called “Organizational Database (ODB)” and type “high blood pressure” (or a synonym) in the search box.

Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective. The following Internet sites may be of particular interest: ·

Heart Care Cardiac Support Group (UK) http://www.heartcarecsg.co.uk

·

DENCATS Forum http://www.dencats.org/

·

High Blood Pressure Message Board http://www.healthboards.com/high-blood-pressure

Finding Doctors One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with high blood pressure must go through the process of selecting a physician. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:10 ·

If you are in a managed care plan, check the plan’s list of doctors first.

10

This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.

40 High Blood Pressure

·

Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals.

·

Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide.

·

Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide.

Additional steps you can take to locate doctors include the following: ·

Check with the associations listed earlier in this chapter.

·

Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors.

·

The American Board of Medical Specialties can tell you if your doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at 11 http://www.abms.org/newsearch.asp. You can also contact the ABMS by phone at 1-866-ASK-ABMS.

·

You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA’s Web site: http://www.amaassn.org/aps/amahg.htm.

Finding an Endocrinologist The American Association of Clinical Endocrinologists (AACE) sponsors a Physician Finder database located at http://www.aace.com/memsearch.php. Physician Finder allows you to search for endocrinologists who are members of the AACE by specialty, city, state, or country. According to the AACE: “Members of AACE are physicians with special education, training and interest in the practice of clinical endocrinology. These physicians devote a While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified. 11

Seeking Guidance 41

significant part of their career to the evaluation and management of patients with endocrine disease. All members of AACE are physicians (M.D. or D.O.) and a majority is certified by Boards recognized by the American Board of Medical Specialties. Members of AACE are recognized clinicians, educators and scientists, many of whom are affiliated with medical schools and universities. Members of AACE contribute on a regular and continuing basis to the scientific literature on endocrine diseases and conduct medical education programs on this subject.”12 If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.

Selecting Your Doctor13 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your health insurance plan and if he or she is taking new patients. If the doctor is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen physician. During the first visit you will have the opportunity to evaluate your doctor and to find out if you feel comfortable with him or her. Ask yourself, did the doctor: ·

Give me a chance to ask questions about high blood pressure?

·

Really listen to my questions?

·

Answer in terms I understood?

·

Show respect for me?

·

Ask me questions?

·

Make me feel comfortable?

·

Address the health problem(s) I came with?

·

Ask me my preferences about different kinds of treatments for high blood pressure?

·

Spend enough time with me?

Quotation taken from the AACE’s Web site: http://www.aace.com/memsearch.php. section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. 12

13 This

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Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.

Working with Your Doctor14 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·

You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.

·

It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.

·

Bring a “health history” list with you (and keep it up to date).

·

Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.

·

Tell your doctor about any natural or alternative medicines you are taking.

·

Bring other medical information, such as x-ray films, test results, and medical records.

·

Ask questions. If you don’t, your doctor will assume that you understood everything that was said.

·

Write down your questions before your visit. List the most important ones first to make sure that they are addressed.

·

Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.

·

Ask your doctor to draw pictures if you think that this would help you understand.

·

Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.

This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.

14

Seeking Guidance 43

·

Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.

·

Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.

·

After leaving the doctor’s office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.

By following these steps, you will enhance the relationship you will have with your physician.

Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:15 ·

Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html

·

Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html

·

Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html

Vocabulary Builder The following vocabulary builder provides definitions of words used in this chapter that have not been defined in previous chapters: Anorexia: Lack or loss of the appetite for food. [EU] Blindness: The inability to see or the loss or absence of perception of visual You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.

15

44 High Blood Pressure

stimuli. This condition may be the result of eye diseases; optic nerve diseases; optic chiasm diseases; or brain diseases affecting the visual pathways or occipital lobe. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Dehydration: The condition that results from excessive loss of body water. Called also anhydration, deaquation and hypohydration. [EU] Dystrophy: Any disorder arising from defective or faulty nutrition, especially the muscular dystrophies. [EU] Eclampsia: Convulsions and coma occurring in a pregnant or puerperal woman, associated with preeclampsia, i.e., with hypertension, edema, and/or proteinuria. [EU] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hyperpigmentation: Excessive pigmentation of the skin, usually as a result of increased melanization of the epidermis rather than as a result of an increased number of melanocytes. Etiology is varied and the condition may arise from exposure to light, chemicals or other substances, or from a primary metabolic imbalance. [NIH] Hypotension: Abnormally low blood pressure; seen in shock but not necessarily indicative of it. [EU]

Seeking Guidance 45

Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the islets of langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as EPILEPSY or "seizure disorder." [NIH] Toxemia: A generalized intoxication produced by toxins and other substances elaborated by an infectious agent. [NIH]

Clinical Trials 47

CHAPTER 3. CLINICAL TRIALS AND HIGH BLOOD PRESSURE Overview Very few medical conditions have a single treatment. The basic treatment guidelines that your physician has discussed with you, or those that you have found using the techniques discussed in Chapter 1, may provide you with all that you will require. For some patients, current treatments can be enhanced with new or innovative techniques currently under investigation. In this chapter, we will describe how clinical trials work and show you how to keep informed of trials concerning high blood pressure.

What Is a Clinical Trial?16 Clinical trials involve the participation of people in medical research. Most medical research begins with studies in test tubes and on animals. Treatments that show promise in these early studies may then be tried with people. The only sure way to find out whether a new treatment is safe, effective, and better than other treatments for high blood pressure is to try it on patients in a clinical trial.

The discussion in this chapter has been adapted from the NIH and the NEI: www.nei.nih.gov/netrials/ctivr.htm.

16

48 High Blood Pressure

What Kinds of Clinical Trials Are There? Clinical trials are carried out in three phases: ·

Phase I. Researchers first conduct Phase I trials with small numbers of patients and healthy volunteers. If the new treatment is a medication, researchers also try to determine how much of it can be given safely.

·

Phase II. Researchers conduct Phase II trials in small numbers of patients to find out the effect of a new treatment on high blood pressure.

·

Phase III. Finally, researchers conduct Phase III trials to find out how new treatments for high blood pressure compare with standard treatments already being used. Phase III trials also help to determine if new treatments have any side effects. These trials--which may involve hundreds, perhaps thousands, of people--can also compare new treatments with no treatment. How Is a Clinical Trial Conducted?

Various organizations support clinical trials at medical centers, hospitals, universities, and doctors’ offices across the United States. The “principal investigator” is the researcher in charge of the study at each facility participating in the clinical trial. Most clinical trial researchers are medical doctors, academic researchers, and specialists. The “clinic coordinator” knows all about how the study works and makes all the arrangements for your visits. All doctors and researchers who take part in the study on high blood pressure carefully follow a detailed treatment plan called a protocol. This plan fully explains how the doctors will treat you in the study. The “protocol” ensures that all patients are treated in the same way, no matter where they receive care. Clinical trials are controlled. This means that researchers compare the effects of the new treatment with those of the standard treatment. In some cases, when no standard treatment exists, the new treatment is compared with no treatment. Patients who receive the new treatment are in the treatment group. Patients who receive a standard treatment or no treatment are in the “control” group. In some clinical trials, patients in the treatment group get a new medication while those in the control group get a placebo. A placebo is a harmless substance, a “dummy” pill, that has no effect on high blood pressure. In other clinical trials, where a new surgery or device (not a medicine) is being tested, patients in the control group may receive a “sham

Clinical Trials 49

treatment.” This treatment, like a placebo, has no effect on high blood pressure and does not harm patients. Researchers assign patients “randomly” to the treatment or control group. This is like flipping a coin to decide which patients are in each group. If you choose to participate in a clinical trial, you will not know which group you will be appointed to. The chance of any patient getting the new treatment is about 50 percent. You cannot request to receive the new treatment instead of the placebo or sham treatment. Often, you will not know until the study is over whether you have been in the treatment group or the control group. This is called a “masked” study. In some trials, neither doctors nor patients know who is getting which treatment. This is called a “double masked” study. These types of trials help to ensure that the perceptions of the patients or doctors will not affect the study results. Natural History Studies Unlike clinical trials in which patient volunteers may receive new treatments, natural history studies provide important information to researchers on how high blood pressure develops over time. A natural history study follows patient volunteers to see how factors such as age, sex, race, or family history might make some people more or less at risk for high blood pressure. A natural history study may also tell researchers if diet, lifestyle, or occupation affects how a disease or disorder develops and progresses. Results from these studies provide information that helps answer questions such as: How fast will a disease or disorder usually progress? How bad will the condition become? Will treatment be needed? What Is Expected of Patients in a Clinical Trial? Not everyone can take part in a clinical trial for a specific disease or disorder. Each study enrolls patients with certain features or eligibility criteria. These criteria may include the type and stage of disease or disorder, as well as, the age and previous treatment history of the patient. You or your doctor can contact the sponsoring organization to find out more about specific clinical trials and their eligibility criteria. If you are interested in joining a clinical trial, your doctor must contact one of the trial’s investigators and provide details about your diagnosis and medical history. If you participate in a clinical trial, you may be required to have a number of medical tests. You may also need to take medications and/or undergo

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surgery. Depending upon the treatment and the examination procedure, you may be required to receive inpatient hospital care. Or, you may have to return to the medical facility for follow-up examinations. These exams help find out how well the treatment is working. Follow-up studies can take months or years. However, the success of the clinical trial often depends on learning what happens to patients over a long period of time. Only patients who continue to return for follow-up examinations can provide this important long-term information.

Recent Trials on High Blood Pressure The National Institutes of Health and other organizations sponsor trials on various diseases and disorders. Because funding for research goes to the medical areas that show promising research opportunities, it is not possible for the NIH or others to sponsor clinical trials for every disease and disorder at all times. The following lists recent trials dedicated to high blood pressure.17 If the trial listed by the NIH is still recruiting, you may be eligible. If it is no longer recruiting or has been completed, then you can contact the sponsors to learn more about the study and, if published, the results. Further information on the trial is available at the Web site indicated. Please note that some trials may no longer be recruiting patients or are otherwise closed. Before contacting sponsors of a clinical trial, consult with your physician who can help you determine if you might benefit from participation. ·

Acupuncture and Hypertension Condition(s): Hypertension Study Status: This study is currently recruiting patients. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: Although traditional Chinese medicine advocates the use of acupuncture not only to induce analgesia but also to treat essential hypertension, acupuncture's postulated antihypertensive efficacy in humans has not been subjected to rigorous Western scientific testing. Before advocating acupuncture as an effective complementary/alternative medicine strategy for essential hypertension, it is necessary to demonstrate that the beneficial effects of acupuncture are scientifically robust, long-lasting, and explicable in terms of modern scientific mechanisms. In spontaneously hypertensive rats, acupuncturelike electrical stimulation of thinly myelinated (Group III) somatic afferents activates central endorphin (naloxone-sensitive) pathways that

17

These are listed at www.ClinicalTrials.gov.

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elicit long-lasting decreases in sympathetic nerve activity (SNA) and blood pressure. The ability to record SNA with microelectrodes in conscious humans provides a new opportunity to test this novel mechanistic hypothesis in patients undergoing electroacupuncture, a modification of the ancient technique that provides a quantifiable and reproducible stimulus to human skeletal muscle afferents. Using a randomized, double-blind placebo-controlled design, we will test the following major hypotheses: Electroacupuncture produces a long-lasting reduction in SNA, thereby providing a safe and effective complementary treatment of human hypertension. Given the enormous interest in acupuncture by our lay public, but the paucity of Western scientific data about its efficacy in cardiovascular disorders, our studies in normotensive and hypertensive humans should provide a conceptual framework for deciding whether to accept or reject the large body of Chinese (and Russian) literature advocating acupuncture as a safe and effective treatment of essential hypertension and other cardiovascular disorders (such as heart failure, and myocardial ischemia). Study Type: Interventional Contact(s): Texas; UT Southwestern, Dallas, Texas, 75390, United States; Recruiting; Richard C. Robinson, Ph.D. 214-648-5277 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00010478 ·

Hypertension: Prediction of Biofeedback Success Condition(s): Essential Hypertension Study Status: This study is currently recruiting patients. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: Hypertension, present in more than 50 million Americans, increases the risk of cardiovascular disease and its associated complications. More persons are turning to alternative medicine to deal with their health problems. Biofeedback may reduce blood pressure and/or allow the reduction of antihypertensive medications in some patients, while having no adverse effects. Yet biofeedback therapy is time-intensive and technician-intensive. Therefore, it is critical to be able to predict which patients with essential hypertension are most likely to lower his/her blood pressure using these techniques. This research proposes to test three different means of predicting whether a hypertensive subject will or will not be successful in lowering his/her blood pressure using biofeedback. Sixty hypertensive subjects will be studied over a three-year period. The results of this study will enable

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those caring for hypertensive persons to recommend biofeedback in an individualized way, thereby promoting adherence. Phase(s): Phase I Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00026065 ·

Magnetic Resonance Imaging for Evaluating Kidney Function Condition(s): Healthy; Renovascular Hypertension Study Status: This study is currently recruiting patients. Sponsor(s): Warren G Magnuson Clinical Center (CC) Purpose - Excerpt: This study will evaluate the usefulness of magnetic resonance imaging (MRI) as a tool for diagnosing renovascular hypertension (high blood pressure caused by narrowing of the arteries that feed the kidneys). Diagnosis of this condition currently requires expensive, inconvenient tests that carry some risk, and, as a result, some patients are never adequately evaluated. A simpler, less expensive procedure may improve diagnosis in this patient population. Patients with suspected renovascular hypertension and healthy volunteers may be eligible for this study. All candidates will be screened with a brief medical history and physical examination. In addition, patients will undergo a captopril renogram-a standard nuclear medicine study of kidney function. For this procedure, a small catheter (thin plastic tube) is placed in a vein and flushed with a sterile fluid. The patient receives an injection of a small amount of a radioactive substance called technetiumlabeled MAG3 and the kidney is scanned. After the scan, the patient drinks a glass of water mixed with a medicine called captopril (used to treat high blood pressure), and the scan is repeated an hour later. Blood pressure and heart rate are monitored frequently during the procedure. All patients and volunteers enrolled in the study then undergo MRI studies. A catheter placed in a vein is used to inject the contrast agent gadolinium chelate (a substance given routinely for MRI scans to brighten the images) and withdraw blood samples during the procedure. The patient or volunteer drinks water mixed with captopril. (Some volunteers will be given a placebo-an inactive substance-instead of the captopril.) Blood pressure and heart rate are monitored frequently. After about 1 hour, the MRI scan is begun. The patient or volunteer lies on a table inside the MRI machine-a cylinder containing a strong magnetic field. Flexible, padded sensors called MRI coils, which improve the image quality, are wrapped around the area to be scanned. Earplugs are used to

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muffle the loud thumping sounds the machine makes when the magnetic fields are switched. Kidney function is then evaluated during the following procedures: 1. MR BOLD (blood oxygen level dependent)Measures oxygenation of the kidneys; the patient or volunteer breathes room air through a special breathing device, then repeats the test while breathing carbogen, a mixture of 95% oxygen and 5% carbon dioxide, through the same device. 2. MR renography- Provides information about the impact of narrowed renal arteries on causing hypertension; the patient or volunteer receives an injection of gadolinium chelate and the kidneys are scanned. 3. MR angiography-Provides information about narrowing of the renal arteries; the patient or volunteer receives a second injection of gadolinium chelate and the kidneys and their arteries are scanned. The entire time in the MRI scanner is about 1 1/2 to 2 hours. The patient can speak with the technologist through an intercom system at all times during the study. The same tests and procedures, except for the MR angiography, will be repeated on another day. Study Type: Observational Contact(s): Maryland; Warren G. Magnuson Clinical Center (CC), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800-411-1222 [email protected]; TTY 1-866-411-1010 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00006173 ·

Nitric Oxide Therapy for Patients with Sickle Cell Anemia and Secondary Pulmonary Hypertension Condition(s): Sickle Cell Anemia; Pulmonary Hypertension Study Status: This study is currently recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: This study will test whether inhaling nitric oxide gas mixed with room air can improve pulmonary hypertension (high blood pressure in the lungs) in patients with sickle cell anemia. It is estimated that 20 to 30 percent of patients with sickle cell anemia have moderate to severe pulmonary hypertension, a disease complication associated with higher rates of illness and death. Patients with sickle cell disease 18 years of age or older may be eligible to participate in one or more parts of this three-stage study. Candidates will be screened with a medical history, physical examination, electrocardiogram, echocardiogram and blood tests. Those enrolled will undergo the following tests and procedures: Stage 1: Patients will be tested to determine the cause of pulmonary hypertension. They will have an echocardiogram (ultrasound study of the heart); a test for asthma, with measurement of arterial blood oxygen

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levels; oxygen breathing study with measurement of arterial blood oxygen levels; chest X-ray; computed tomography (CT) scans of the lung with and without contrast material; magnetic resonance imaging (MRI) of the heart; 6-minute walk to measure the distance covered in that time at a comfortable pace; night-hawks oxygen measurement while sleeping; and blood tests for HIV, hepatitis virus, lupus and arthritis and pregnancy. Stage 2: Patients who proceed with stage 2 will have a detailed MRI evaluation of the heart and will be admitted to the Clinical Center intensive care unit for the following procedure: A small intravenous (IV) catheter (plastic tube) is placed in the patient's arm and a longer tube, called a central line, in a deeper neck or leg vein. A long thin tube is then inserted through the vein into the heart and the lung artery to measure all blood pressures in the heart and lungs directly. The patients is then given oxygen to breathe for 2 hours, followed by infusion of prostacyclin, a blood pressure-lowering drug, for 2 hours; and finally inhaled nitric oxide for 2 hours. A small blood sample (3 tablespoons) of blood is drawn during the nitric oxide administration. Stage 3: Patients who participate in this stage of the study will remain in the ICU with the catheters in place for an additional 24 hours. During this time, they will breathe nitric oxide. Lung pressures will be measured every 4 hours and blood will be drawn every 8 hours. Patients will remain in the hospital for observation one more day. At home, they will continue to breathe nitric oxide continuously for 2 months, using a tank of gas that delivers the nitric oxide through tubes placed in the nose. They will be followed at the clinic weekly for blood tests and an echocardiogram. They will do a 6minute walk every 2 weeks. At the end of 2 months, patients will have a repeat MRI and measurement of heart and lung pressures. Patients who improve with nitric oxide therapy will have the option of continuing treatment. Phase(s): Phase I Study Type: Interventional Contact(s): Maryland; National Heart, Lung and Blood Institute (NHLBI), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800-411-1222 [email protected]; TTY 1-866-411-1010 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00023296 ·

Phase III Randomized Study of UT-15 in Patients with Primary Pulmonary Hypertension Condition(s): Pulmonary Hypertension Study Status: This study is currently recruiting patients.

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Sponsor(s): FDA Office of Orphan Products Development; United Therapeutics Purpose - Excerpt: Objectives: I. Determine the safety and efficacy of UT15 in patients with severe symptomatic primary pulmonary hypertension. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00004497 ·

Pulmonary Hypertension--Mechanisms and Family Registry Condition(s): Lung Diseases; Hypertension, pulmonary Study Status: This study is currently recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To establish a registry of primary pulmonary hypertension (PPH), a lethal disease which causes progressive obstruction of small pulmonary arteries and to investigate basic mechanisms of the disease. Study Type: Registry Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00005357

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Secondary Pulmonary Hypertension in Adults with Sickle Cell Anemia Condition(s): Pulmonary Hypertension; Sickle Cell Anemia Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Purpose - Excerpt: The purpose of this study is to determine how often people with sickle cell anemia develop pulmonary hypertension-a serious disease in which blood pressure in the artery to the lungs is elevated. Men and women 18 years of age and older with sickle cell anemia may be eligible for this study. Participants will undergo an evaluation at Howard University's Comprehensive Sickle Cell Center in Washington, D.C. or at the National Institutes of Health in Bethesda, Maryland. It will include the following: -medical history -physical examination -blood collection (no more than 50 ml., or about 1/3 cup) to confirm the diagnosis of sickle cell anemia, sickle cell trait or beta-thalassemia (Some blood will be stored for future research testing on sickle cell anemia.) -echocardiogram

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(ultrasound test of the heart) to check the pumping action of the heart and the rate at which blood travels through the tricuspid valve. Following this evaluation, a study nurse will contact participants twice a month for 2 months and then once every 3 months for the next 3 years for a telephone interview. The interview will include questions about general health and recent health-related events, such as hospitalizations or emergency room visits. Study Type: Observational Contact(s): Maryland; National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800-411-1222 [email protected]; TTY 1-866-411-1010 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00011648 ·

A Study to Prevent Complications of High Blood Pressure Caused by Hepatitis in Patients with Cirrhosis Condition(s): Hypertension, Portal; Liver Cirrhosis; Esophageal and Gastric Varices Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); Yale University Purpose - Excerpt: Objectives: I. Evaluate the efficacy of a certain drug in preventing intestinal complications in patients with cirrhosis and high blood pressure in the hepatic portal vein. II. Evaluate vein pressure measurements to predict the development of internal bleeding. Phase(s): Phase II Study Type: Interventional Contact(s): Robert J. Groszmann 203-937-3462; Connecticut; Yale University School of Medicine, New Haven, Connecticut, 06510, United States. Study chairs or principal investigators: Robert J. Groszmann, Study Chair; Yale University Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00004641

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Molecular Epidemiology of Essential Hypertension Condition(s): Cardiovascular Diseases; Heart Diseases; Coronary Disease; Hypertension Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI)

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Purpose - Excerpt: To localize individual genes, called blood pressure quantitative trait genes [BPQTGs], which influence blood pressure levels in the population-at- large, and to determine if these genes are able to predict the occurrence of essential hypertension or coronary artery disease. Study Type: Epidemiology Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00005377 ·

Safety and Efficacy of Sitaxsentan in the Treatment of Pulmonary Arterial Hypertension Condition(s): Pulmonary Hypertension Study Status: This study is no longer recruiting patients. Sponsor(s): ICOS-Texas Biotechnology; ICOS; Texas Biotechnology Corporation Purpose - Excerpt: This is a clinical research study designed to evaluate an investigational new medication called sitaxsentan for the treatment of pulmonary arterial hypertension (patients with NYHA functional class II, III or IV). The purpose of this study is to evaluate the safety and effectiveness of two different doses of sitaxsentan, compared to placebo (inactive treatment) for the treatment of pulmonary arterial hypertension. Patients who complete this trial may be eligible to take part in an extension trial (Protocol FPH01-X). Eligible patients who receive placebo in the 12-week study cross over to receive sitaxsentan for the extension trial. Phase(s): Phase II; Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00034307

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Treatment of Hypertension with Two Exercise Intensities Condition(s): Hypertension Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To determine whether exercise training can significantly replace medication as a treatment for mild essential hypertension. Phase(s): Phase III

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Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00004561 ·

Effects of Salt Intake on the Nervous Systems of Patients with SaltSensitive High Blood Pressure Condition(s): Hyperaldosteronism; Hypertension Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: Some patients with high blood pressure can experience an increase of blood pressure by 10 percent or more by taking in salt. These patients are referred to as having "salt-sensitive" (SS) hypertension. Previous studies conducted on patients with salt sensitive hypertension suggest that their portion of the nervous system responsible for maintaining normal blood pressure (autonomic nervous system) may respond differently to salt than patients with non-salt sensitive (NSS) hypertension. This study is designed to examine the response of the nervous system to high doses of salt in patients with salt-sensitive hypertension and patients with non-salt sensitive hypertension. Study Type: Observational Contact(s): Maryland; National Heart, Lung and Blood Institute (NHLBI), 9000 Rockville Pike Bethesda, Maryland, 20892, United States Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00001176

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End-organ Pathology in Childhood Essential Hypertension Condition(s): Cardiovascular Diseases; Heart Diseases; Hypertension Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To determine the distribution of left ventricular hypertrophy and retinal vascular abnormalities in children and adolescents with essential hypertension; to evaluate potential risk factors and the time sequence for the development of these end-organ complications in this population. Study Type: Epidemiology Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00005180

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Genetic and Environmental Determinants of Hypertension Condition(s): Cardiovascular Diseases; Heart Diseases; Hypertension Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To determine the pathophysiology of different types of essential hypertension by identifying the discrete effects of major genes and environmental variables as determinants of the subtypes of essential hypertension. Study Type: Epidemiology Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00005149

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Hypertension Detection and Follow-up Program (HDFP) Condition(s): Cardiovascular Diseases; Heart Diseases; Hypertension; Vascular Diseases Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To determine the effectiveness of systematic, sustained, antihypertensive therapy in reducing morbidity and mortality from hypertension in a wide spectrum of persons with elevated blood pressure in 14 communities. During its course, the trial also obtained a direct measure of the prevalence, severity, and treatment status of representative white and black populations with high blood pressure in these 14 communities, and obtained an estimate of the extent of attainable reduction of complications of high blood pressure by an organized screening and blood pressure management program. Phase(s): Phase III Study Type: Treatment, Prevention Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00000485

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Oral Calcium in Pregnant Women with Hypertension Condition(s): Cardiovascular Diseases; Heart Diseases; Hypertension; Pre-Eclampsia; Pregnancy Toxemias; Vascular Diseases Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI)

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Purpose - Excerpt: To determine of providing calcium supplementation to women with pre-existing hypertension reduces the level of blood pressure, requirement for antihypertensive drugs, and incidence of preeclampsia. Phase(s): Phase II Study Type: Prevention, Treatment Contact(s): August, Phyllis New York, New York, United States . Study chairs or principal investigators: August, Phyllis, Study Chair; Cornell University New York, New York, United States Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00000543 ·

Phase IV Study of Chronic Infusional Epoprostenol for Severe Primary Pulmonary Hypertension Condition(s): Hypertension, Pulmonary Study Status: This study is completed. Sponsor(s): National Center for Research Resources (NCRR); Baylor College of Medicine Purpose - Excerpt: Objectives: I. Provide epoprostenol (Flolan, prostaglandin I2) by chronic infusion to patients with severe primary pulmonary hypertension for whom no alternative therapy is available. II. Obtain additional safety information on continuous infusion epoprostenol. III. Obtain additional information on economic resource health consumption. Phase(s): Phase IV Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00004754

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Regulation of Placental Vascular Reactivity in Pregnancy-induced Hypertension Condition(s): Cardiovascular Diseases; Heart Diseases; Hypertension; Pregnancy Toxemias Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To elucidate the role of an imbalance in vasodilator prostacyclin (PGI2) and vasoconstrictor thromboxane (TxA2) in pregnancy-induced hypertension

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Study Type: Epidemiology Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00005208 ·

Sodium Transport: Genetics and Hypertension Condition(s): Cardiovascular Diseases; Heart Diseases; Hypertension Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: Originally, to determine whether genetic alterations in pathways of sodium ion transport in the red blood cells of children could predict their risk of developing primary hypertension in adulthood. In 1992, the objective was to determine the genetic basis of interindividual variation in the risk of essential hypertension in the population at large using the Rochester Family Heart Study. Study Type: Epidemiology Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00005166

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Treatment of Hypertension Condition(s): Cardiovascular Diseases; Heart Diseases; Hypertension; Vascular Diseases Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To determine whether the long-term treatment of essential hypertension without significant target organ disease materially influenced mortality and/or cardiovascular renal morbidity. Phase(s): Phase III Study Type: Treatment, Prevention Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00000484

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Urban African-American Community Hypertension Control Condition(s): Cardiovascular Diseases; Heart Diseases; Hypertension Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI)

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Purpose - Excerpt: To investigate whether a health education program, developed in partnership with the community and delivered by nurse supervised community health workers (CHWs), lowered high blood pressure (HBP) in inner city African American adults. Study Type: Demonstration and Education Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00005706

Benefits and Risks18 What Are the Benefits of Participating in a Clinical Trial? If you are interested in a clinical trial, it is important to realize that your participation can bring many benefits to you and society at large: ·

A new treatment could be more effective than the current treatment for high blood pressure. Although only half of the participants in a clinical trial receive the experimental treatment, if the new treatment is proved to be more effective and safer than the current treatment, then those patients who did not receive the new treatment during the clinical trial may be among the first to benefit from it when the study is over.

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If the treatment is effective, then it may improve health or prevent diseases or disorders.

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Clinical trial patients receive the highest quality of medical care. Experts watch them closely during the study and may continue to follow them after the study is over.

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People who take part in trials contribute to scientific discoveries that may help other people with high blood pressure. In cases where certain diseases or disorders run in families, your participation may lead to better care or prevention for your family members. The Informed Consent

Once you agree to take part in a clinical trial, you will be asked to sign an “informed consent.” This document explains a clinical trial’s risks and benefits, the researcher’s expectations of you, and your rights as a patient. This section has been adapted from ClinicalTrials.gov, a service of the National Institutes of Health: http://www.clinicaltrials.gov/ct/gui/c/a1r/info/whatis?JServSessionIdzone_ct=9jmun6f291. 18

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What Are the Risks? Clinical trials may involve risks as well as benefits. Whether or not a new treatment will work cannot be known ahead of time. There is always a chance that a new treatment may not work better than a standard treatment. There is also the possibility that it may be harmful. The treatment you receive may cause side effects that are serious enough to require medical attention.

How Is Patient Safety Protected? Clinical trials can raise fears of the unknown. Understanding the safeguards that protect patients can ease some of these fears. Before a clinical trial begins, researchers must get approval from their hospital’s Institutional Review Board (IRB), an advisory group that makes sure a clinical trial is designed to protect patient safety. During a clinical trial, doctors will closely watch you to see if the treatment is working and if you are experiencing any side effects. All the results are carefully recorded and reviewed. In many cases, experts from the Data and Safety Monitoring Committee carefully monitor each clinical trial and can recommend that a study be stopped at any time. You will only be asked to take part in a clinical trial as a volunteer giving informed consent.

What Are a Patient’s Rights in a Clinical Trial? If you are eligible for a clinical trial, you will be given information to help you decide whether or not you want to participate. As a patient, you have the right to: ·

Information on all known risks and benefits of the treatments in the study.

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Know how the researchers plan to carry out the study, for how long, and where.

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Know what is expected of you.

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Know any costs involved for you or your insurance provider.

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Know before any of your medical or personal information is shared with other researchers involved in the clinical trial.

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Talk openly with doctors and ask any questions.

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After you join a clinical trial, you have the right to: ·

Leave the study at any time. Participation is strictly voluntary. However, you should not enroll if you do not plan to complete the study.

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Receive any new information about the new treatment.

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Continue to ask questions and get answers.

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Maintain your privacy. Your name will not appear in any reports based on the study.

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Know whether you participated in the treatment group or the control group (once the study has been completed). What about Costs?

In some clinical trials, the research facility pays for treatment costs and other associated expenses. You or your insurance provider may have to pay for costs that are considered standard care. These things may include inpatient hospital care, laboratory and other tests, and medical procedures. You also may need to pay for travel between your home and the clinic. You should find out about costs before committing to participation in the trial. If you have health insurance, find out exactly what it will cover. If you don’t have health insurance, or if your insurance company will not cover your costs, talk to the clinic staff about other options for covering the cost of your care. What Should You Ask before Deciding to Join a Clinical Trial? Questions you should ask when thinking about joining a clinical trial include the following: ·

What is the purpose of the clinical trial?

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What are the standard treatments for high blood pressure? Why do researchers think the new treatment may be better? What is likely to happen to me with or without the new treatment?

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What tests and treatments will I need? Will I need surgery? Medication? Hospitalization?

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How long will the treatment last? How often will I have to come back for follow-up exams?

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What are the treatment’s possible benefits to my condition? What are the short- and long-term risks? What are the possible side effects?

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Will the treatment be uncomfortable? Will it make me feel sick? If so, for how long?

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How will my health be monitored?

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Where will I need to go for the clinical trial? How will I get there?

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How much will it cost to be in the study? What costs are covered by the study? How much will my health insurance cover?

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Will I be able to see my own doctor? Who will be in charge of my care?

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Will taking part in the study affect my daily life? Do I have time to participate?

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How do I feel about taking part in a clinical trial? Are there family members or friends who may benefit from my contributions to new medical knowledge?

Keeping Current on Clinical Trials Various government agencies maintain databases on trials. The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide patients, family members, and physicians with current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to their Web site (www.clinicaltrials.gov) and search by “high blood pressure” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: ·

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

General References The following references describe clinical trials and experimental medical research. They have been selected to ensure that they are likely to be available from your local or online bookseller or university medical library. These references are usually written for healthcare professionals, so you may consider consulting with a librarian or bookseller who might recommend a particular reference. The following includes some of the most readily available references (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·

A Guide to Patient Recruitment : Today’s Best Practices & Proven Strategies by Diana L. Anderson; Paperback - 350 pages (2001), CenterWatch, Inc.; ISBN: 1930624115; http://www.amazon.com/exec/obidos/ASIN/1930624115/icongroupinterna

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A Step-By-Step Guide to Clinical Trials by Marilyn Mulay, R.N., M.S., OCN; Spiral-bound - 143 pages Spiral edition (2001), Jones & Bartlett Pub; ISBN: 0763715697; http://www.amazon.com/exec/obidos/ASIN/0763715697/icongroupinterna

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The CenterWatch Directory of Drugs in Clinical Trials by CenterWatch; Paperback - 656 pages (2000), CenterWatch, Inc.; ISBN: 0967302935; http://www.amazon.com/exec/obidos/ASIN/0967302935/icongroupinterna

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The Complete Guide to Informed Consent in Clinical Trials by Terry Hartnett (Editor); Paperback - 164 pages (2000), PharmSource Information Services, Inc.; ISBN: 0970153309; http://www.amazon.com/exec/obidos/ASIN/0970153309/icongroupinterna

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Dictionary for Clinical Trials by Simon Day; Paperback - 228 pages (1999), John Wiley & Sons; ISBN: 0471985961; http://www.amazon.com/exec/obidos/ASIN/0471985961/icongroupinterna

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Extending Medicare Reimbursement in Clinical Trials by Institute of Medicine Staff (Editor), et al; Paperback 1st edition (2000), National Academy Press; ISBN: 0309068886; http://www.amazon.com/exec/obidos/ASIN/0309068886/icongroupinterna

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Handbook of Clinical Trials by Marcus Flather (Editor); Paperback (2001), Remedica Pub Ltd; ISBN: 1901346293; http://www.amazon.com/exec/obidos/ASIN/1901346293/icongroupinterna

Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Angiography: Radiography of blood vessels after injection of a contrast medium. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Captopril: A potent and specific inhibitor of peptidyl-dipeptidase A. It blocks the conversion of angiotensin I to angiotensin II, a vasoconstrictor and important regulator of arterial blood pressure. Captopril acts to suppress the renin-angiotensin system and inhibits pressure responses to exogenous angiotensin. [NIH] Catheter: A tubular, flexible, surgical instrument for withdrawing fluids from (or introducing fluids into) a cavity of the body, especially one for introduction into the bladder through the urethra for the withdraw of urine. [EU]

Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Electroacupuncture: A form of acupuncture using low frequency electrically stimulated needles to produce analgesia and anesthesia and to treat disease. [NIH]

Epoprostenol: A prostaglandin that is biosynthesized enzymatically from prostaglandin endoperoxides in human vascular tissue. It is a potent inhibitor of platelet aggregation. The sodium salt has been also used to treat primary pulmonary hypertension. [NIH] Gadolinium: Gadolinium. An element of the rare earth family of metals. It has the atomic symbol Gd, atomic number 64, and atomic weight 157.25. Its oxide is used in the control rods of some nuclear reactors. [NIH] Hypertrophy: Nutrition) the enlargement or overgrowth of an organ or part due to an increase in size of its constituent cells. [EU] Infusion: The therapeutic introduction of a fluid other than blood, as saline

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solution, solution, into a vein. [EU] Interindividual: Occurring between two or more individuals. [EU] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH]

Naloxone: A specific opiate antagonist that has no agonist activity. It is a competitive antagonist at mu, delta, and kappa opioid receptors. [NIH] Normotensive: 1. characterized by normal tone, tension, or pressure, as by normal blood pressure. 2. a person with normal blood pressure. [EU] Oxygenation: The process of supplying, treating, or mixing with oxygen. No:1245 - oxygenation the process of supplying, treating, or mixing with oxygen. [EU] Somatic: 1. pertaining to or characteristic of the soma or body. 2. pertaining to the body wall in contrast to the viscera. [EU] Sympathetic: 1. pertaining to, caused by, or exhibiting sympathy. 2. a sympathetic nerve or the sympathetic nervous system. [EU] Symptomatic: 1. pertaining to or of the nature of a symptom. 2. indicative (of a particular disease or disorder). 3. exhibiting the symptoms of a particular disease but having a different cause. 4. directed at the allying of symptoms, as symptomatic treatment. [EU] Technetium: The first artificially produced element and a radioactive fission product of uranium. The stablest isotope has a mass number 99 and is used diagnostically as a radioactive imaging agent. Technetium has the atomic symbol Tc, atomic number 43, and atomic weight 98.91. [NIH] Thalassemia: A group of hereditary hemolytic anemias in which there is decreased synthesis of one or more hemoglobin polypeptide chains. There are several genetic types with clinical pictures ranging from barely detectable hematologic abnormality to severe and fatal anemia. [NIH] Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography. [EU]

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PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL

ABOUT PART II In Part II, we introduce you to additional resources and advanced research on high blood pressure. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on high blood pressure. In Part II, as in Part I, our objective is not to interpret the latest advances on high blood pressure or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with high blood pressure is suggested.

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CHAPTER 4. STUDIES ON HIGH BLOOD PRESSURE Overview Every year, academic studies are published on high blood pressure or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on high blood pressure. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on high blood pressure and teach you how to keep current on new studies as they are published or undertaken by the scientific community.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and high blood pressure, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the

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format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “high blood pressure” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·

Bleeding Esophageal Varices: How to Treat This Dreaded Complication of Portal Hypertension Source: Postgraduate Medicine. 109(2): 75-76, 81-86, 89. February 2001. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Summary: Bleeding esophageal varices, one of the most feared complications of portal hypertension (high blood pressure in the liver venous system), contribute to the estimated 32,000 deaths annually attributed to cirrhosis (liver scarring). This article describes the care of patients with this complication. The authors stress that successful control requires knowledge of the pertinent anatomy, underlying pathophysiology of portal hypertension, and natural history of gastroesophageal varices. The authors discuss the various prophylactic (preventive) and therapeutic approaches to management, including pharmacologic agents (drug therapy), endoscopic sclerotherapy, and transjugular intrahepatic portosystemic shunt (TIPS). Nonselective beta blockers are the treatment of choice for prevention of the first bleeding episode. Active bleeding is managed with octreotide and endoscopic sclerotherapy. Goals in the management of active bleeding are hemodynamic resuscitation, prevention and treatment of complications, and control of bleeding. Complications related to bleeding or its treatment can substantially increase the risk of death in each episode. TIPS and shunt surgery are reserved for those in whom octreotide and endoscopic surgery have failed. Endoscopic band ligation (tying off) should be used for prevention of recurrent bleeding. If endoscopic band ligation fails, patients can be offered TIPS or surgical therapy; they should be evaluated for liver transplantation. 4 figures. 4 tables. 11 references.

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Treatment of Hypertension in Adult Patients with Diabetes Source: Diabetes Care. 25(1): 134-147. January 2002.

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Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: Hypertension (high blood pressure) is an extremely common comorbidity of diabetes, affecting 20 to 60 percent of people with diabetes. Hypertension is also a major risk factor for cardiovascular events, such as myocardial infarction and stroke, as well as for microvascular complications, such as retinopathy (eye disease) and nephropathy (kidney disease). This review article focuses on the treatment of hypertension in adult patients with diabetes. Recent studies have demonstrated the effectiveness of blood pressure treatment versus placebo in reducing complications of diabetes, helped to define the optimal level of blood pressure control, and compared treatment strategies based on different drug classes. The results of these studies support an aggressive approach to the diagnosis and treatment of hypertension in patients with diabetes in order to substantially reduce the incidence of both macrovascular and microvascular complications. Treatment decisions should be individualized based on the clinical characteristics of the patient, including comorbidities as well as tolerability, personal preference, and cost, especially for patients who must pay out of pocket for medications. Fixed dose combinations of many drugs are available and may help with compliance and be less expensive for patients with a prescription copayment. 2 tables. 117 references. ·

Diabetes and Hypertension: How Low Should You Go and with Which Drugs? Source: American Journal of Hypertension. 14(5 Part 2): 17S-26S. May 2001. Contact: Available from Elsevier Science. Customer Support Department, P.O. Box 945, New York, NY 10159-0945. (212) 633-3730 or (888) 437-4636. Fax (212) 633-3680. E-mail: [email protected]. Summary: Diabetes and hypertension (high blood pressure) are the most common causes of end stage renal disease (ESRD) in the United States. This article considers both experimental and clinical studies that have demonstrated the importance of more intensive control of systolic blood pressure (SBP) in delaying the progression of renal (kidney) disease, particularly in diabetic patients with macroproteinuria. Although traditional recommendations have suggested that reducing systolic levels to less than 140 mm Hg is appropriate, there is consistent evidence in clinical trials demonstrating that, in the presence of diabetes, macroproteinuria, and impaired renal function, reducing systolic levels

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to less than 125 mm Hg will result in a more successful attenuation of the rate of progression of renal disease. In addition, there is convincing evidence demonstrating that blockade of the renin angiotensin system, particularly with ACE inhibitors, results in an improved opportunity to delay progression of renal disease. Despite the advantages of ACE inhibitors, most patients will require three to five medications to achieve optimal levels of goal SBP to attenuate the rate of progression of renal disease. The author even concludes that in patients with diabetes, controlling blood pressure may be a more important predictor of delaying kidney disease (nephropathy) than is intensive glycemic (blood glucose) control. 5 figures. 5 tables. 42 references. ·

Hypertension and Diabetes: A Review Source: Practical Diabetology. 19(2): 36-40. June 2000. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Summary: This review article examines the prevalence and treatment of hypertension among people who have diabetes. Various studies suggest that hypertension is a complication of diabetes throughout the world and in all races and ethnic groups. A study conducted in the United States shows that diabetes increased the risk of hypertension among nonHispanic whites, non-Hispanic blacks, and Hispanics. Although various treatments have been studied for hypertension in diabetes, the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommended diuretics and beta blockers as the first line of treatment in general populations, and angiotensin converting enzyme (ACE) inhibitors in patients with diabetes. The Captopril Prevention Project found that ACE inhibitors or beta blockers plus diuretics were equally effective. Studies have also found aspirin to be effective. The United Kingdom Prospective Diabetes Study found that intensive blood pressure control led to decreases in total diabetes endpoints, diabetes related mortality, myocardial infarction, stroke, microalbuminuria, and congestive heart failure. Several studies have examined the role of calcium channel blockers (CCBs) for patients who have diabetes and hypertension. Although some studies have found beneficial results with CCBs, other evidence suggests that CCBs may not be the optimal agents for people who have diabetes. Although CCBs should not be used alone, they do have a role in combination with one or more of the primarily effective hypertensive agents. 28 references.

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High Blood Pressure and Diabetes Mellitus: Are All Antihypertensive Drugs Created Equal? Source: Archives of Internal Medicine. 160(16): 2447-2452. September 11, 2000. Contact: Available from American Medical Association. Subscriber Services Center, P.O. Box 10946, Chicago, IL 60610-0946. (800) 262-2350. Fax (312) 464-5831. E-mail: [email protected]. Summary: This article describes a study that analyzed available data to evaluate the efficacy of various antihypertensive agents in hypertensive patients with diabetes. A MEDLINE search of English language articles published until June 1999 was undertaken with the use of the terms diabetes mellitus,' hypertension,' blood pressure,' and therapy.' Pertinent articles cited in the identified reports were also reviewed. Included were only prospective randomized studies of more than 12 months' duration that evaluated the effect of drug treatment on morbidity and mortality in hypertensive patients with diabetes. The study also estimated the risk associated with the combination of diabetes and hypertension and the effect of treatment on morbidity and mortality. The study found that the coexistence of diabetes doubled the risk of cardiovascular events, cardiovascular mortality, and total mortality in hypertensive patients. Intensive blood pressure control to levels lower than 130/85 mm Hg was beneficial in hypertensive patients with diabetes. Diuretics, beta blockers, angiotensin converting enzyme inhibitors, and calcium antagonists were effective in reducing cardiovascular events in hypertensive patients with diabetes. In elderly patients with isolated systolic hypertension and diabetes, calcium antagonists reduced the rate of cardiac end points by 63 percent, stroke by 73 percent, and total mortality by 55 percent. In more than 60 percent of hypertensive patients with diabetes, combination therapy was required to control blood pressure. The article concludes that, in hypertensive patients with diabetes, intensive control of blood pressure to levels lower than 130/85 mm Hg reduces the risk of cardiovascular events. 6 tables. 47 references. (AA-M).

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Insulin Action is Associated with Endothelial Function in Hypertension and Type 2 Diabetes Source: Hypertension. 35(1 Part 2): 507-511. January 2000. Contact: Available from American Heart Association. 7272 Greenville Avenue, Dallas, TX 75231-4596. Summary: Insulin resistance (abnormally reduced insulin stimulated glucose uptake) and vascular endothelial (the cells that line the heart and blood vessels) dysfunction are both features of metabolic syndromes and

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cardiovascular (heart) disorders. This article reports on a study designed to understand the relations between insulin action and endothelial function in male patients with essential hypertension (high blood pressure; H group, n = 9) or type 2 diabetes (D group, n = 9) along with healthy control subjects (C group) matched for age, body mass index (BMI), and lipid profile. The groups were monitored for whole body insulin sensitivity (MCR) by the hyperinsulinemic clamp technique (day 1) and forearm vasoreactivity in response to insulin and glucose infusions (day two) and N monomethyl L arginine and norepinephrine (day 3). There were no significant differences among groups for these parameters. The authors conclude that their results support functional coupling between insulin action (both metabolic and vascular) and basal endothelial nitric oxide production in humans. In other words, insulin plays a key role in the maintenance of vascular endothelial function and inherited or acquired defects in insulin action lead to relative endothelial dysfunction as well as to insulin resistance. 5 figures. 1 table. 22 references. ·

Allopurinol Normalizes Endothelial Dysfunction in Type 2 Diabetics with Mild Hypertension Source: Hypertension. 35(3): 746-751. March 2000. Contact: Available from American Heart Association. 7272 Greenville Avenue, Dallas, TX 75231-4596. Summary: Treatment strategies against free radicals have mostly focused on the augmentation of antioxidant defenses (e.g., vitamins C and E). A novel approach is to prevent free radical generation by the enzyme system xanthine oxidase. This article reports on a study that examined whether the inhibition of xanthine oxidase with allopurinol can improve endothelial (the cells lining the heart, blood vessels and lymphatic system) function in subjects with type 2 diabetes and coexisting mild hypertension (high blood pressure) compared with control subjects of a similar age. The authors examined 23 subjects (11 patients with type 2 diabetes and 12 healthy age matched control subjects) in 2 parallel groups. The subjects were administered 300 milligrams allopurinol in a randomized, placebo controlled study in which both therapies were administered for 1 month. Results showed that allopurinol significantly increased the mean forearm blood flow response to acetylcholine by 30 percent but did not affect the nitroprusside response in patients with type 2 diabetes. There was no significant impact on either endothelium dependent or independent vascular responses in the age matched control subjects. Allopurinol improved endothelial function to near normal levels. Regarding markers of free radical activity, the level of

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malondialdehyde was significantly reduced in patients with type 2 diabetes but not in control subjects. 3 figures. 1 table. 41 references. ·

Reining In High Blood Pressure Source: Diabetes Self-Management. 16(6): 8, 10-12, 14. NovemberDecember 1999. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Summary: This article discusses the management of high blood pressure. People who have diabetes are more likely to develop hypertension and two to four times more likely to have a stroke or acute heart problems. Hypertension and diabetes are strong risk factors for the development of congestive heart failure. The blood pressure goal established by the American Diabetes Association for most people who have diabetes is blood pressure less than 130/85 millimeters of mercury. The top number represents the pressure in an artery during a contraction of the heart, and the bottom number represents the pressure in an artery between heartbeats. The higher the blood pressure, the greater the risk of stroke and heart, kidney, and eye disease. Many lifestyle habits can be modified to help lower blood pressure, including quitting smoking, losing weight, making dietary changes, restricting sodium, exercising, using relaxation techniques, consuming alcohol in moderation, and setting goals that are specific and attainable. In addition to making lifestyle changes, people who have diabetes and hypertension will also have to take one or more drugs daily to control their blood pressure. Many people who have diabetes and hypertension are treated with angiotensin converting enzyme inhibitors. The most important action that people who have diabetes and hypertension can take is to get involved in their care and treatment. One way to take an active role in managing hypertension is to take blood pressure measurements between doctor visits. The article includes information on the Dietary Approach to Stop Hypertension diet and drugs for treating high blood pressure.

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Hypertension and Diabetes Source: Practical Diabetology. 14(2): 14-16, 18-19. June 1995. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Summary: This review article addresses special concerns that arise in choosing therapy for patients with hypertension and diabetes. The authors present a rationale for choosing between the alternatives, with emphasis on the effect of medication on carbohydrate metabolism,

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atherosclerotic heart disease, and the complications of diabetes. Concerns covered include coronary artery disease, dyslipidemia, nephropathy, hypoglycemia, and neuropathy. Drug therapies discussed include diuretics, beta blockers, ACE inhibitors, calcium channel blockers, alpha1 blockers, and alpha-2 agonists. The authors relate their comments to the 1993 recommendations of the Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure (JNC-V). 1 table. 3 references. ·

Low Down on High Blood Pressure Source: Living Well With Diabetes. 7(1): 25-26. Winter 1992. Summary: This article focuses on preventing and controlling high blood pressure, with the end goal of preventing and controlling serious complications of diabetes, including stroke and heart, eye, and kidney problems. Topics include a definition of high blood pressure, how to prevent hypertension, how to control high blood pressure, and the role of lifestyle changes or medication. 2 tables. 2 references.

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High Blood Pressure and Diabetes: A Dangerous Combination Source: Clinical Diabetes. 14(4): 95. July-August 1996. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Reproducible. Summary: This fact sheet provides information about high blood pressure and diabetes. Topics include determining if high blood pressure is present; steps to take to lower hypertension without medication; the use of antihypertensive medications, including diuretics, beta blockers, vasodilators, alpha blockers, ACE inhibitors, and calcium channel blockers; and the side effects of some hypertensive medications. One chart lists the ranges of blood pressure readings from high normal to very severe hypertension. The fact sheet includes the toll-free number of the American Diabetes Association (800-342-2383).

Federally-Funded Research on High Blood Pressure The U.S. Government supports a variety of research studies relating to high blood pressure and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.19 CRISP Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services 19

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(Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally-funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to high blood pressure and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally-funded studies use animals or simulated models to explore high blood pressure and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for high blood pressure: ·

Project Title: Comprehensive High Blood Pressure Care In Young Urban Black Men Principal Investigator & Institution: Hill, Martha N.; Associate Professor, School Of; None; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2000; Project Start 0-JUN-1996; Project End 9-FEB2004 Summary: The main long term goal of this study is to improve the health care and health outcomes of young, hypertensive black men, the age-sexrace group which suffers disproportionately from premature high blood pressure (HBP) related morbidity and mortality. In an ongoing 24 month clinical trial, we have enrolled 309 black inner city hypertensive men, 2154 years of age. They have been randomized to two parallel arms to test the effectiveness of an educational, behavioral and pharmacological HBP control program, provided by a nurse practitioner (NP)-community health worker (CHW)- physician (MD) team (special intervention-SI), compared to usual medical care (UC). We have examined cardiovascular and renal abnormalities associated with HBP and identified barriers to HBP care and control. Preliminary results indicated that we have high rates of tracking and follow up (86% unadjusted; 97% adjusted) and have lowered both systolic and diastolic BP (DBP) in the SI group and DBP in the UC group. Over the first 12 months in the men (n=248) seen to date, BP changed from 146 to 136/99 to 90 mm Hg in the SI group and 145 to

Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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144/98 to 94 mm Hg in the UC group. The primary objective of this continuation proposal is to extend the trial for 36 additional months to maintain and further lower BP, and to reduce cardiovascular complications associated with HBP, such as left ventricular hypertrophy, diastolic and systolic dysfunction, central vascular stiffness, and renal impairment. We will also integrate ancillary studies of newly discovered genetic polymorphisms and their relationships to cardiac, arterial and renal structure and function as well as response to HBP treatment. We plan to build upon our innovative model, which integrates, basic, clinical and behavioral sciences with sound research principles and methodology. Our ongoing intervention includes educational counseling and treatment sessions with an NP-MD team (using an angiotensin receptor +/- diuretic), and telephone follow-up and 3 home visits by a CHW with the man and family members/friends who provide social support. In addition, we will document the cost of delivering the SI, an important step toward planning for cost-effectiveness and cost-utility analysis of the intervention. This study is significant because it: 1) is the only randomized longitudinal study we are aware of that specifically targets the understudied, vulnerable, population of black men who are at disproportionately high risk of the adverse consequences of uncontrolled HBP, 2) extends the care and evaluation of a well characterized cohort of young hypertensive black me, 3) builds upon innovative multidisciplinary tem intervention strategies and biologic science techniques over a total of five years, 4) it integrates ancillary studies of genetic risk factors and cost, and 5) it has the potential for impact through future generalizability and sustainability of effective strategies. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Korean American Elderly with High Blood Pressure Principal Investigator & Institution: Kim, Miyong T.; None; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001; Project Start 5-APR-2001; Project End 4-APR2003 Summary: The primary objective of this study is to develop and test an innovative self-help program for Korean American elderly (KAE) that is culturally sensitive, built on valid behavioral theory and principles, improves the control of high blood pressure (HBP), and enhance health related quality of life. Specifically, we focus on the self-help aspects of HBP control by empowering patients with greater knowledge about HBP, greater self- efficacy and enhancing self-care skills including general and HBP related problem-solving skills. We therefore propose to undertake a feasibility project to design and evaluate the efficacy of a

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self-help HBP control intervention program specifically designed for KAE with HBP. This self-help intervention will have three concurrently administered components: (1) a structured behavioral education intervention that focuses on fostering self-help skills in controlling HBP; (2) home BP monitoring with a telephone transmission system (HBPMT); and (3) interaction with a bilingual nurse who will facilitate effective communication between KAE with HBP and their care providers. Our specific aims are to: (1) develop and test a self-help protocol that specifies the process and content of the intervention for KAE with HBP; (2) enroll 40 KAE (greater than or equal to 60) with HBG in the self-help intervention program; (3) deliver the self-help program to the study participants; (4) measure the effect of the self-help intervention program on both primary outcome, BP reduction, and on secondary cognitive behavioral outcomes, including self-efficacy, problem-solving skills, and adherence to treatment recommendations; and (5) explore relevant methodological issues, which include evaluating the dose-response association with respect to the self-help education treatment strength, level of adherence necessary to induce the desirable changes in BP levels and psychological well-being. The outcome variables will be measured before the intervention and at 18 and 30 weeks after the start of the intervention. This plot investigation will allow us to examine the theoretical, logistical, and methodological issues prior to conducting a full-scale clinical trial in the next phase of this research program to improve health care outcomes in this vulnerable minority ethnic group. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Meditation for High Blood Pressure Principal Investigator & Institution: Lane, James D.; Psychiatry; Duke University Durham, Nc 27706 Timing: Fiscal Year 2001; Project Start 1-SEP-2001; Project End 1-AUG2004 Summary: (provided by applicant): High blood pressure is a major public health problem that affects nearly 25 percent of adults in the United States and contributes to increased risks of morbidity and mortality via cardiovascular and renal diseases. Although anti-hypertensive medications are often effective in the treatment of hypertension, nonpharmacological therapies are recognized as important first-line or adjunctive treatments for blood pressure management. A variety of relaxation and stress management techniques have been tested for their potential contributions to blood pressure control through stress reduction. Among these interventions, meditation training has shown the greatest promise as an adjunctive behavioral treatment for lowering

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blood pressure. This project investigates the effectiveness of a meditationtraining program for the reduction of blood pressure. The 3-year study is a randomized, controlled clinical trial involving 120 adult men and women with hypertension or high-normal blood pressure recruited from the community. After extended screening and baseline testing, participants will be assigned at random to receive the experimental meditation training program (N= 60), to receive a progressive muscle relaxation training program that serves as a placebo control (N = 30), or to continue with usual care (N= 30). Post-treatment testing will be conducted 1, 2, and 3 months after training begins. Treatment outcome will be assessed by changes in laboratory-based and 24-hour ambulatory measures of blood pressure from baseline to follow-up. In addition, the study will test whether stress-reduction is a plausible mechanism that can account for clinical outcomes, using measurements of treatment-related changes in neuroendocrine and subjective measures of stress. Finally, the study will investigate the characteristics of those who respond best to this treatment and determine whether those individuals who begin training with higher levels of stress and anxiety show greater improvements in blood pressure and measures of stress than those who begin with lower levels. Meditation training may be a cost-effective non-pharmacological treatment for the management of high blood pressure. The results of this trial will advance our understanding of the potential benefits of this behavioral intervention, the mechanisms through which it works, and the kind of person who will benefit most from it. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Principal Investigator & Institution: Vetroveck, George; ; Virginia Commonwealth University 901 W Franklin St Richmond, Va 23284 Timing: Fiscal Year 2000 Summary: A determination of effectiveness of three new blood pressurelowering drugs; lisinopril, amlodipine, and doxazocin as compared to the standard forms of treatment with diuretic drugs. An estimated 50 million people in the United States have elevated blood pressure or are taking medications for high blood pressure. There is known relationship between high blood pressure and coronary heart disease (CHD), but large-scale, randomized clinical trials in mild to moderately high blood pressure in largely middle-aged subjects failed to show that high blood pressure drug treatment reduces the occurrence of cardiac disease death or non-fatal myocardial infarction (the death of heart tissue due to lack of blood supply to the area). The primary hypothesis of this trial is that the

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combined incidence of fatal heart disease and non-fatal myocardial infarction will be lower in patients with high blood pressure who receive the three medications. The study will involve a population of men and women 55 years and older, all with at least one additional CHD risk factor besides high blood pressure, 55% of whom will be AfricanAmerican, a race more prone to high blood pressure. There will be a trial component to lower blood pressure and a trial component to lower cholesterol. Study drugs will be randomly assigned. Patients will be seen at four week intervals until a reasonably stable regimen with satisfactory blood pressure control has been achieved. Clinic visits will then take place every three months during the first year and every four months thereafter. Blood pressure will be taken at each visit. An electrocardiogram test will be given at visit two. Potassium levels will be checked at one month, one year, two years, four years, and at six years. Blood tests will be done as well as tests for creatinine serum., fasting cholesterol, and serum glucose. At every visit, a determination of compliance with study medications will be done. Quality of life will be discussed at the entry of the study and every year thereafter. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Blood Pressure Reduction and Insulin Sensitivity in Hypertension Principal Investigator & Institution: Raskin, Phillip; ; University of Texas Sw Med Ctr/Dallas Southwestern Medical Ctr/Dallas Dallas, Tx 75390 Timing: Fiscal Year 2001 Summary: Excess insulin production might be a factor leading to high blood pressure since it has been shown that insulin produces salt retention in the kidneys and increases the blood levels of adrenalin. It has also been suggested that decreased insulin sensitivity could be a consequence not a cause of hypertension. In order to evaluate if decreased insulin sensitivity is a consequence or a cause of high blood pressure investigators will study the effects of different hypotensive medications on insulin sensitivity. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket

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Project Title: Dopamine-3 Receptor Subtype and Hypertension Principal Investigator & Institution: Jose, Pedro A.; Professor; Pediatrics; Georgetown University 37Th and O Sts Nw Washington, Dc 20057 Timing: Fiscal Year 2000; Project Start 0-AUG-1997; Project End 1-JUL2001

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Summary: (Adapted from the application) Disruption of the D3dopamine receptor gene in mice is associated with diastolic hypertension and an impaired ability to excrete an acute NaCl load. The investigator will test the hypothesis that postsynaptic or extrasynaptic D3 receptors are involved in the regulation sodium transport, renal hemodynamics and renin release, variables that are abnormal in genetic hypertension. Presynaptic dopamine D3 receptors may function as autoreceptors regulating norepinephrine and dopamine release from nerve terminals. Thus, the hypothesis that an increased norepinephrine release in peripheral noradrenergic nerves (the renal nerves) occurs as a result of disruption of presynaptic dopamine D3 receptors will be tested. The first Specific Aim will determine the mechanism(s) causing the high blood pressure that occurs with the disruption of the D3 dopamine receptor gene in mice. Three hypotheses will be tested. After disruption of the D3 receptor gene high blood pressure could occurs due to: (a) decreased ability of the D3 receptor, functioning as an autoreceptor, to inhibit norepinephrine release in noradrenergic nerve terminals; (b) increased renin secretion because of a withdrawal of the inhibitory action of postor extrasynaptic D3 receptors on renin secretion; decreased synergism between D1, and D3 receptors impairing the ability to excrete a sodium load. 2. While disruption of the D3 receptor in mice produces high blood pressure, it is not known if a spontaneously occurring abnormal dopamine gene of the D3 class or its regulation causes genetic hypertension. The 2nd specific aim will determine if an abnormality of the D3 gene or its regulation exists in rats that develop hypertension spontaneously. Post- or extra-synaptic from pre-synaptic D3 gene expression and function will be distinguished by surgical/chemical unilateral renal denervation. If there are differences in D3 gene expression and/or function, then the D3 receptor gene will be sequenced and compared with the Wistar-Kyoto rat. The relevance of any changes in the D3 receptor function and gene expression in hypertension will be determined in F2 generation of SHR and WKY. The 3rd specific aim will test the hypothesis that the D3 dopamine receptor participates in the regulation of renin release by antagonizing the stimulatory effect of D1 receptors. Studies will be performed in isolated juxtaglomerular cells from WKY and SHR and mice lacking the D, or D3 dopamine receptor. These studies will determine the importance of the D3 receptor in the regulation of blood pressure and renal function in genetic hypertension. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket

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Project Title: Evaluation of Racial Differences in Aldosterone and Sodium Regulation Principal Investigator & Institution: Ripley, Betsy; Virginia Commonwealth University 901 W Franklin St Richmond, Va 23284 Timing: Fiscal Year 2000 Summary: An attempt to determine the racial differences in Aldosterone regulation as a contributing factor to salt sensitivity in hypertensive patients. High blood pressure is a major concern in the United States. It has been estimated that 43 million people have high blood pressure. An increased prevalence of hypertension in the black population was first noted 60 years ago. Since then, studies have attempted to study the mechanism for the increased risk. To date, the differences remain uncertain. Aldosterone is a steroid hormone produced in the adrenal cortex in the area of the kidneys. The major effects of aldosterone are to promote salt retention and potassium loss by the kidneys. It can have a similar effect on other tissues including the colon, sweat glands, and salivary glands. Studies have shown that black hypertensives and blacks with normal blood pressure excreted the sodium load more slowly and less completely than white subjects. Black patients also had a greater increase in blood pressure in response to salt loading. The aims of the study are: 1. To categorize black and white hypertension patients as salt sensitive using a saline loading/lasix diuresis protocol (increased urine output). 2. To analyze aldosterone regulation by saline loading in black and white patients. 3. To analyze day/night rhymicity of aldosterone and electrolyte excretion in black and white hypertensive patients at baseline, following saline loading, and following lasix diuresis. 4. To evaluate the role of dopamine using metoclopromide, a dopamine antagonist. 6. To evaluate the sensitivity of aldosterone secretion to oral potassium supplementation following lasix diuresis. The study will last for three weeks during which blood pressure medication will be stopped. Blood pressure will be monitored weekly. The first visit to the Clinical Research Center will take place one week after medication has been discontinued. Metoclopromide will be given intravenously and blood samples will be taken. The following week, a 24 hour urine will be collected and a special diet of controlled sodium and potassium will be given. The next day, there will be periodic urine collections from 8a.m. to 10 p.m. while the patient remains upright. On the third day, blood and urine will be taken and saline and furosemide, a medication that will increase the urine output, will be administered. On the fifth day, potassium chloride will be given and blood and urine samples will be taken. After the study, blood pressure medication will be continued. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket

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Project Title: Motivational Interviewing in Hypertensive African Americans Principal Investigator & Institution: Ogedegbe, Godwin O.; Medicine; Weill Medical College of Cornell Univ of Cornell University New York, Ny 10021 Timing: Fiscal Year 2001; Project Start 6-SEP-2001; Project End 1-AUG2005 Summary: (provided by investigator): In the United States, prevalence of high blood pressure in African-Americans is among the highest in the world. Prevalence of hypertension for non-Hispanic blacks age 20 and older is 50 percent higher than among non-Hispanic whites. AfricanAmericans develop high blood pressure at an earlier age and are more likely to have poorly controlled blood pressure. Blacks have a 1.8 times greater rate of fatal stroke, a 1.5 times greater rate of heart disease death and a 4.2 times greater rate of end-stage hypertension-related kidney disease than whites. Adherence with anti-hypertensive medications can help reduce risk of negative outcomes. Motivational interviewing is a promising patient-centered approach for improving treatment compliance. This technique consists of brief, patient-driven counseling sessions to facilitate initiation and maintenance of behavior change. This study will assess whether adherence can be enhanced through motivational interviewing, an integrated, multiple-component, and culturally-sensitive intervention. The proposed study is a longitudinal, randomized controlled trial of 190 poorly controlled hypertensive patients. Subjects will be recruited from a community-based primary care practice and randomly assigned to one of two conditions: non-supportive counseling or motivational interviewing. Patients in both arms will have 4 sessions of either non-supportive counseling or motivational interviewing at 3-month intervals after randomization. The primary outcome is medication adherence and the secondary outcomes are changes in systolic and diastolic blood pressure between baseline and one-year follow-up assessment. Changes in medication-adherence selfefficacy will also be measured. The long-term objective is to determine whether better adherence to prescribed medications can be achieved through motivational interviewing, leading to reduction in hypertensionrelated outcomes like end-stage renal disease, cardiovascular mortality and stroke among African-American patients with poorly controlled hypertension. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket

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Project Title: Mechanisms

Post-Exercise

Hypotension:

Central

Sites

and

Principal Investigator & Institution: Bonham, Ann C.; Professor; Internal Medicine; University of California Davis Davis, Ca 95616 Timing: Fiscal Year 2001; Project Start 7-MAR-2001; Project End 8-FEB2006 Summary: (Applicant's Abstract): Single bouts of exercise in hypertensive subjects can lead to a long-lasting decrease in sympathetic nerve activity that results in a post-exercise hypotension (PEH) which can normalize high blood pressure. PEH requires an intact baroreflex system; but, the gain of the system in regulating sympathetic nerve activity is reduced. Although the potential therapeutic benefits are appreciated, the mechanisms whereby exercise in hypertensive subjects leads to a persistent lowering of high blood pressure through a decreased central sympathetic output and at the same time to a reduced gain of baroreflex control of sympathetic output are unknown. The goal of this proposal is to resolve those mechanisms. Our data suggest that PEH and the reduced gain are mediated by exercise-induced changes in the central baroreflex network, specifically, in the nucleus tractus solitarius (NTS) where baroreceptor signals are first processed and at sympathetic cardiovascular neurons in the rostral ventrolateral medulla (RVLM), the sympathetic output pathway. We pose two Specific Hypotheses: 1. The underpinning of PEH is a decrease in the impulse activity of RVLM sympathetic cardiovascular neurons, a decrease mediated by: a) a tonic increase in the impulse activity of baroreceptor NTS neurons (increasing the tonic level of GABA release at GABAA receptors (GABAA-Rs) on RVLM neurons), and b) an upregulation of RVLM GABAA-RS (amplifying the efficacy of the tonic GABA inhibitory input to the RVLM neurons). 2. The reduced baroreflex gain originates in the NTS (such that for a given change in blood pressure and baroreceptor input, the corresponding change in NTS neuronal output (and hence dynamic GABA release in the RVLM) is reduced. The hypotheses will be tested by four aims using extracellular recording of NTS and RVLM neuronal activity in the central baroreflex network in vivo; patch-clamping in medullary slices containing NTS and RVLM neurons in the central network; and real-time RT-PCR from NTS and RVLM micropunches in spontaneously hypertensive rats (SHR). Aims 1-2 will resolve GABA mechanisms in the RVLM (GABA release and GABAA-R gene expression) mediating PEH and Aims 3-4 will address pre- and postsynaptic mechanisms in the NTS in mediating PEH and the reduced gain. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket

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Project Title: Prevention of Events with Angiotensin Converting Enzyme Inhibitors Principal Investigator & Institution: Vetrovec, George; ; Virginia Commonwealth University 901 W Franklin St Richmond, Va 23284 Timing: Fiscal Year 2000 Summary: A clinical trial to determine if trandolapril, a drug used to treat high blood pressure and heart failure, can also prevent heart attacks and death in patients with coronary heart disease (CHD). Coronary heart disease remains a major health problem in the United States. Major strides have been made in the management of acute infarct patients with the prompt use of aspirin, beta blockers, and regimens to restore the flow of blood to an effected area of the heart, which have resulted in major reductions in in-hospital deaths. Patients who have already experienced a myocardial infarction (the death of tissue in the heart due to the lack of blood flow to that area), continue to receive benefits of contemporary therapies and greater attention directed towards modification of the known risk factors. Some treatments of risk factors are the lowering of blood pressure and cholesterol, stoppage of smoking, and changing life style. In addition, there is strong, yet unproven rationale, that ACE inhibitor therapy (angiotensin converting enzyme [a form of hormone that causes the dilation of blood vessels and the contraction of smooth muscles]) are of proven value for patients with systemic high blood pressure and for therapy for congestive heart failure. The primary goal of this study is to test whether the addition of the ACE inhibitor trandolapril will reduce the incidence of cardiovascular death or nonfatal myocardial infarction in patients with cardiovascular heart disease, but with preserved left ventrical function. The subjects of this study will be men and women 50 years and older, with CHD and the ability of their hearts to pump blood must be normal to nearly normal. Subjects cannot have abnormal kidney function, high blood pressure, high blood potassium, or be pregnant. At entry to the study, height, weight, and blood pressure will be measured. Samples of blood and urine will be collected to measure risk factors. Health and medications will be discussed and a supply of trandolapril will be given. If there is no problem with the medication, patients will then be randomly assigned to receive either trandolapril or a placebo. Return visits to the CRC will be every six months for the duration of the study for updates of records and a new supply of the medication. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket

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Project Title: Psychosocial Factors and Ambulatory Blood Pressure Principal Investigator & Institution: Goldstein, Iris B.; None; University of California Los Angeles 405 Hilgard Ave Los Angeles, Ca 90024 Timing: Fiscal Year 2001; Project Start 1-AUG-1995; Project End 1-AUG2004 Summary: (investigator's abstract): Family history of hypertension is a primary predictor of high blood pressure in later life. The principal goal of this application is to determine how 24-hour ambulatory blood pressure distinguishes between individuals with different family histories: 2 hypertensive parents, 1 hypertensive parent, normotensive parents. The investigators will also examine effects of family history of blood pressure in combination with other factors linked to elevated blood pressure and hypertension: job strain, social support and personality traits (i.e., hostility, unexpressed anger, anxiety, defensiveness). Effects will be evaluated on a work day and an off work day in 192 men and women, aged 22-50 years, in a broad range of occupations. The investigators hypothesize that ambulatory blood pressure during waking and sleeping hours will be highest in offsprings of 2 hypertensive parents, somewhat elevated in those with 1 hypertensive parent, and lowest in those with normotensive parents. Predicted blood pressure elevations as a function of family history are expected to be greater in individuals with any of the following characteristics: high job strain, anxiety, hostility, defensiveness, or low anger-out. Also, the combination of a personality trait such as high hostility (or high anxiety, high defensiveness, or low anger-out), high job strain, and a family history of hypertension (particularly with 2 hypertensive parents) should lead to greater blood pressure magnifications. All predicted blood pressure effects are expected to be further elevated during work days, whereas the presence of high social support is expected to moderate blood pressure elevations. By sampling serum lipids, insulin, and glucose and daytime and nighttime urinary catecholamines and cortisol, the investigators will evaluate the role of insulin resistance and the sympathetic nervous system in family history. Investigating healthy men and women at risk for hypertension will help identify variables associated with high blood pressure before the disease is fully manifested and enable early intervention through diet and life-style changes. Since hypertension is predictive of future coronary heart disease, stroke, and renal disease, lowering the blood pressure for individuals at risk for hypertension can result in decreased morbidity and mortality rates. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket

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Project Title: Racism, Social Support, and Alcohol use and Blood Pressure in African Americans Principal Investigator & Institution: Robinson, Elwood L.; Professor; North Carolina Central University Durham, Nc 27707 Timing: Fiscal Year 2000 Summary: Two of the leading threats to american health are high blood pressure and alcohol-abuse. It is well documented that high blood pressure is linearly related to higher rates of certain forms of coronary heart disease (CHD) and stroke, and the relationship between hypertension and mortality is especially strong for African Americans. Moreover, African Americans alcoholics may run a greater risk than white alcoholics for blood pressure elevations as their drinking careers lengthen. Stressors, or the problems and pressures of life, have long been suspected as culprits linked to both hypertension and alcohol abuse. Racism has been reported to prevail as a primary stressor facing African Americans today. Several studies have described the potentially damaging social, economic, and political consequences of racism and its negative effects on individual well-being (Jaynes & Williams, 1989; Katz & Taylor, 1988; Schuman, Steeth, & Bobo, 1985). Recent studies from epidemiological literature have suggested that exposure to chronic stress of racism, prejudice, and discrimination may contribute to the disproportionately high rates of hypertension among African Americans. Social support has been purported to exert a buffering effect in ameliorating or attenuating the deleterious effects of stress on physical and mental health . Many epidemiological studies suggest that social support is related to reduced morbidity and mortality, particularly for cardiovascular disease. However, most of these studies have focused on white populations in the United States, Western Europe, and Scandinavia. This study proposes to investigate racism/discrimination, social support, alcohol use, and blood pressure in subjects that were drawn from a random sample survey of household residents in Erie county, New York. Overall, three waves of data are available for both cross-sectional and longitudinal data analysis. The specific aims are: (l) To examine the influence of racism on alcohol use and BP in African Americans; (2) To determine if social support buffers these relations and investigate the relation between social network measures and social support; and (3) To assess the effects of age, gender, and socioeconomic status on the above relations. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket

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Project Title: Synaptic Transmission in MREN Transgenic Rats Principal Investigator & Institution: Aileru, Azeez A.; ; Winston-Salem State University Winston-Salem, Nc 27102 Timing: Fiscal Year 2002; Project Start 1-AUG-1997; Project End 1-JUL2005 Summary: (provided by applicant): The broad, long-term objective of the proposed investigation is to understand the mechanisms by which high blood pressure produces profound changes in the physiology of autonomic synaptic transmission. Many studies suggest that hypertensive humans and animal models of hypertension exhibit increased peripheral sympathetic nervous system activity (SNA). Knowledge of the events that lead to elevated SNA and its significance in the genesis and maintenance of elevated blood pressure is rudimentary. It has been thought that increased SNA may originate primarily from the central nervous system. This is supported by the efficacy of certain centrally acting drugs, the impact of lesions in regions of the hypothalamus and brainstem involved in cardiovascular and electrolyte homeostasis and the effects of many centrally administered hormones on sympathetic outflow. In contrast, primary abnormalities in the function of the peripheral nervous system in hypertension are less well documented. The general approach is to monitor the activity-dependent changes in neuroplasticity of the superior cervical ganglia (SCG) and stellate ganglia (SG) isolated from hypertensive rat as well as monitoring the excitability of postganglionic neuron of acutely isolated ganglion cells and their responsiveness during sustained high blood pressure. Our hypotheses are that 1) hypertension induces modulation of synaptic efficacy in sympathetic ganglia, and 2) Angiotensin II (AnglI), either by long term actions at the ganglion or by increased activation of sympathetic nervous system (SNS) outflow from the central nervous system (CNS), contributes to the alterations in ganglionic function. In animal models of hypertension, dramatic changes can be observed in the electrophysiological behavior of sympathetic ganglion neurons ranging from alterations in the pattern of action potential activity recorded in postganglionic neurons to an enhanced efficacy of synaptic transmission. Our preliminary data reveal that two forms of synaptic plasticity, namely, post-tetanic (PTP) and long-term potentiation (LTP) in the SCG are profoundly affected during hypertensive states. This proposal uses electrophysiological techniques, receptor autoradiography techniques and neurotransmitter pharmacology in concert with genetic strains of hypertensive animals to learn how genesis and maintenance of high blood pressure alter the function of peripheral neural elements in autonomic ganglia.

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Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: TBC22351NA in Patients with Pulmonary Vascular Disease Principal Investigator & Institution: Barst, Robyn; ; Columbia University Health Sciences Ogc New York, Ny 10032 Timing: Fiscal Year 2000; Project Start 1-DEC-1977; Project End 0-NOV2004 Summary: The purpose of this study is to evaluate the safety and efficacy of TBC11251Na in patients with pulmonary arterial hypertension. Pulmonary arterial hypertension is a condition in which the blood pressure is abnormally high in the blood vessels that go from the heart to the lungs (the pulmonary arteries). The increased blood pressure in the lungs places a strain on the heart. The strain causes the heart to pump less blood into the lungs, causing shortness of breath, tiredness, and as heart failure develops, swelling in the feet and abdomen. Although the cause of this high blood pressure is unknown, previous studies have shown that endothelin (ET-1) is increased in patients with pulmonary arterial hypertension. Endothelin causes pulmonary vasoconstriction, e.g. closes the blood vessels in the lungs, thereby decreasing the blood pressure in the lungs. Previous studies demonstrated that continuous intravenous infusion of prostacyclin in patients with pulmonary arterial hypertension improved quality of life, improved survival and decreased the blood pressure in the lungs. Prostacyclin, subsequently, was approved by the Food and Drug Administration for long term treatment of pulmonary arterial hypertension. Unfortunately, chronic prostacyclin can only be given by continuous intravenous infusion 24 hours a day. Despite therapy with chronic continuous infusion of prostacyclin substantially improving survival and quality of life, this treatment is associated with significant risks due to the delivery system, including infection with subsequent hospitalizations. TBC11251Na, is a potent selective ETa receptor antagonist. The effects of endothelin are controlled by two different receptors: ETa and ETb. ETa receptors cause pulmonary vasoconstriction and ETb receptors cause pulmonary vasodilation. TBC11251Na is available in an oral preparation, in addition to an intravenous form. TBC11251Na is potentially capable of decreasing the high blood pressure in the lungs. Previous studies in patents with chronic heart failure and secondary pulmonary hypertension demonstrated that TBC11251Na lowers pulmonary arterial hypertension without any clinically significant side effects. Because of the potential for the therapeutic effect and an urgent need for an alternative effective treatment, the safety and efficacy of TBC11251Na will be evaluated in

Studies 93

patients with pulmonary arterial hypertension. The study design is to evaluate the effects of a single oral dose of TBC11251Na in patients with pulmonary arterial hypertension as well as the safety and efficacy of 12 weeks of therapy (in all patients who tolerate the single dose). The efficacy of TBC11251Na will be evaluated by assessing its effects on exercise, symptoms of pulmonary hypertension as well as measurements of pulmonary artery pressure. Prior to the study, TBC11251Na has been given to 48 healthy volunteers and 48 patients with congestive heart failure . Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Visual Adaptation Limits and Age-Related Disease Principal Investigator & Institution: Eisner, Alvin; Associate Professor; None; Oregon Health & Science University 3181 Sw Sam Jackson Park Rd Portland, or 97201 Timing: Fiscal Year 2000; Project Start 1-FEB-1999; Project End 1-JAN2003 Summary: The proposed research will determine the extent to which diseased visual systems can be pushed selectively beyond the limits of their effective adaptation capabilities so that their sensitivities become categorically different from normal. The emphasis will be on glaucomarelated visual dysfunction that cannot be attributed directly to the loss of optic nerve cells. This dysfunction involves adaptation processes that actively maintain visual response. It occurs for people who have a slight degree of glaucomatous optic neuropathy combined with high blood pressure, and could be due to either condition. The research will help clarify the relation between high blood pressure and glaucoma-related visual dysfunction. It will focus on how to exceed the limits of the visual system's adaptation capabilities so that subtle physiologic compromise can be amplified into large sensitivity changes. A major emphasis will concern the visual system's ability to maintain a stable effective operating range for resolving temporally modulated stimuli, i.e. for detecting flicker. Psychophysical tests of visual function after adaptation-field onset will be compared with clinical assessments of early glaucomatous damage. The prevalence of visual adaptation abnormalities will be examined for four clinically-defined groups of middle-age subjects: 1) glaucoma subjects with positive medical histories of high blood pressure, 2) glaucoma subjects with negative medical histories of high blood pressure, 3) non-glaucoma subjects with positive medical histories of high blood pressure and negative clinical histories of ocular hypertension, and 4) healthy normal subjects. Young healthy subjects will be tested also. The experiments will identify the types of processes that

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underlie flicker response abnormalities and will integrate a diverse set of existing results concerning suppression of flicker response under taxing adaptation conditions. The specific aims are 1) to determine whether people with high blood pressure have a higher-than-normal prevalence of visual dysfunction, 2) to determine how often foveal visual adaptation is abnormal for people who have high blood pressure but do not have glaucoma, and vice versa, 3) to determine whether certain subtypes or stages of glaucoma are associated with certain types of foveal adaptation abnormalities, 4) to identify the mechanisms by which glaucoma and/or high-blood-pressure alter foveal flicker response, and 5) to determine if the limits of the visual system's flicker-response operating-range can be specified as precisely at bright ambient light levels as they have been at dim ambient light levels. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket

E-Journals: PubMed Central20 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).21 Access to this growing archive of e-journals is free and unrestricted.22 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “high blood pressure” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for high blood pressure in the PubMed Central database: ·

Acute hemodynamic effects of inhaled nitric oxide, dobutamine and a combination of the two in patients with mild to moderate secondary pulmonary hypertension by Carmine D. Vizza, Giorgio Della Rocca, Di Angelo Roma, Carlo Iacoboni, Federico Pierconti, Federico Venuta, Erino Rendina, Giovanni Schmid, Paolo Pietropaoli, and Francesco Fedele; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=96124

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 21 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 22 The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 20

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Bone morphogenetic proteins, genetics and the pathophysiology of primary pulmonary hypertension by Mark De Caestecker and Barbara Meyrick; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=59576

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Chronic Control of High Blood Pressure in the Spontaneously Hypertensive Rat by Delivery of Angiotensin Type 1 Receptor Antisense by SN Iyer, D Lu, MJ Katovich, and MK Raizada; 1996 September 3 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=38537

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Contribution of parental blood pressures to association between low birth weight and adult high blood pressure: cross sectional study by Brian R Walker, Alex McConnachie, Joseph P Noon, David J Webb, and Graham C M Watt; 1998 March 14 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28489

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Defective G Protein Activation of the cAMP Pathway in Rat Kidney During Genetic Hypertension by C Chatziantoniou, X Ruan, and WJ Arendshorst; 1995 March 28 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=42331

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Dissection of a Quantitative Trait Locus for Genetic Hypertension on Rat Chromosome 10 by R Kreutz, N Hubner, MR James, M Bihoreau, D Gauguier, GM Lathrop, D Ganten, and K Lindpaintner; 1995 September 12 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=41050

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Endogenous Biosynthesis of Arachidonic Acid Epoxides in Humans: Increased Formation in Pregnancy-Induced Hypertension by F Catella, JA Lawson, DJ Fitzgerald, and GA FitzGerald; 1990 August 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=54435

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Gene Targeting Approaches to Complex Genetic Diseases: Atherosclerosis and Essential Hypertension by O Smithies and N Maeda; 1995 June 6 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=41675

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Genomic approaches to research in pulmonary hypertension by Mark W. Geraci, Bifeng Gao, Yasushi Hoshikawa, Michael E. Yeager, Rubin M. Tuder, and Norbert F. Voelkel; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=59578

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Nonlinear indicial response of complex nonstationary oscillations as pulmonary hypertension responding to step hypoxia by Wei Huang, Zheng Shen, Norden E. Huang, and Yuan Cheng Fung; 1999 March 2 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=26697

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Upregulation of nitric oxide synthase in mice with severe hypoxiainduced pulmonary hypertension by Karen A. Fagan, Brian Morrissey, Brian W. Fouty, Koichi Sato, Julie Wright. Harral, Kenneth G. Morris, Jr, Marloes Hoedt-Miller, Shanda Vidmar, Ivan F. McMurtry, and David M. Rodman; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=59521

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.23 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with high blood pressure, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “high blood pressure” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “high blood pressure” (hyperlinks lead to article summaries): ·

Comparison of glycoprotein components, tryptophan, lipid peroxidation and antioxidants in borderline and severe hypertension and myocardial infarction. Author(s): Srinivasan KN, Pugalendi KV, Sambandam G, Ramakrishna Rao M, Krishnan S, Menon VP.

PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

23

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Source: Clinica Chimica Acta; International Journal of Clinical Chemistry. 1998 July 28; 275(2): 197-203. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9721077&dopt=Abstract ·

Efficacy and safety of a therapeutic interchange from high-dose calcium channel blockers to a fixed-dose combination of amlodipine/benazepril in patients with moderate-to-severe hypertension. Author(s): Hilleman DE, Reyes AP, Wurdeman RL, Faulkner M. Source: Journal of Human Hypertension. 2001 August; 15(8): 559-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11494095&dopt=Abstract

Vocabulary Builder Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Allopurinol: A xanthine oxidase inhibitor that decreases uric acid production. [NIH] Antioxidant: One of many widely used synthetic or natural substances added to a product to prevent or delay its deterioration by action of oxygen in the air. Rubber, paints, vegetable oils, and prepared foods commonly contain antioxidants. [EU] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Arginine: An essential amino acid that is physiologically active in the Lform. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic

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processes of a living organism. [EU] Buffers: A chemical system that functions to control the levels of specific ions in solution. When the level of hydrogen ion in solution is controlled the system is called a pH buffer. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Cardiac: Pertaining to the heart. [EU] Carmine: Coloring matter from the insect Coccus cacti L. It is used in foods, pharmaceuticals, toiletries, etc., as a dye, and also has use as a microscopic stain and biological marker. [NIH] Catecholamines: A general class of ortho-dihydroxyphenylalkylamines derived from tyrosine. [NIH] Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. [NIH] Dobutamine: A beta-2 agonist catecholamine that has cardiac stimulant action without evoking vasoconstriction or tachycardia. It is proposed as a cardiotonic after myocardial infarction or open heart surgery. [NIH] Effusion: The escape of fluid into a part or tissue, as an exudation or a transudation. [EU] Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Endothelium: The layer of epithelial cells that lines the cavities of the heart and of the blood and lymph vessels, and the serous cavities of the body, originating from the mesoderm. [EU] Ethnopharmacology: The study of the actions and properties of drugs, usually derived from medicinal plants, indigenous to a population or ethnic group. [NIH] Furosemide: A sulfamyl saluretic and diuretic. It has a fast onset and short duration of action and is used in edema and chronic renal insufficiency. [NIH] GABA:

The most common inhibitory neurotransmitter in the central

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nervous system. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [NIH] Hemodynamics: The movements of the blood and the forces involved in systemic or regional blood circulation. [NIH] Homeostasis: A tendency to stability in the normal body states (internal environment) of the organism. It is achieved by a system of control mechanisms activated by negative feedback; e.g. a high level of carbon dioxide in extracellular fluid triggers increased pulmonary ventilation, which in turn causes a decrease in carbon dioxide concentration. [EU] Hypotensive: Characterized by or causing diminished tension or pressure, as abnormally low blood pressure. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Impotence: The inability to perform sexual intercourse. [NIH] Iris: The most anterior portion of the uveal layer, separating the anterior chamber from the posterior. It consists of two layers - the stroma and the pigmented epithelium. Color of the iris depends on the amount of melanin in the stroma on reflection from the pigmented epithelium. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Lisinopril: An orally active angiotensin-converting enzyme inhibitor that has been used in the treatment of hypertension and congestive heart failure. [NIH]

Lymphoma: Any neoplastic disorder of the lymphoid tissue, the term lymphoma often is used alone to denote malignant lymphoma. [EU] Malondialdehyde: The dialdehyde of malonic acid. [NIH] Medullary:

Pertaining to the marrow or to any medulla; resembling

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marrow. [EU] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Monocrotaline: A pyrrolizidine alkaloid and a toxic plant constituent that poisons livestock and humans through the ingestion of contaminated grains and other foods. The alkaloid causes pulmonary artery hypertension, right ventricular hypertrophy, and pathological changes in the pulmonary vasculature. Significant attenuation of the cardiopulmonary changes are noted after oral magnesium treatment. [NIH] Nephropathy: Disease of the kidneys. [EU] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A general term denoting functional disturbances and/or pathological changes in the peripheral nervous system. The etiology may be known e.g. arsenical n., diabetic n., ischemic n., traumatic n.) or unknown. Encephalopathy and myelopathy are corresponding terms relating to involvement of the brain and spinal cord, respectively. The term is also used to designate noninflammatory lesions in the peripheral nervous system, in contrast to inflammatory lesions (neuritis). [EU] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Nifedipine: A potent vasodilator agent with calcium antagonistic action. It is a useful anti-anginal agent that also lowers blood pressure. The use of nifedipine as a tocolytic is being investigated. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH]

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Nulliparous: Having never given birth to a viable infant. [EU] Octreotide: A potent, long-acting somatostatin octapeptide analog which has a wide range of physiological actions. It inhibits growth hormone secretion, is effective in the treatment of hormone-secreting tumors from various organs, and has beneficial effects in the management of many pathological states including diabetes mellitus, orthostatic hypertension, hyperinsulinism, hypergastrinemia, and small bowel fistula. [NIH] Paclitaxel: Antineoplastic agent isolated from the bark of the Pacific yew tree, Taxus brevifolia. Paclitaxel stabilizes microtubules in their polymerized form and thus mimics the action of the proto-oncogene proteins c-mos. [NIH] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Preeclampsia: A toxaemia of late pregnancy characterized by hypertension, edema, and proteinuria, when convulsions and coma are associated, it is called eclampsia. [EU] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]

Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Renin: An enzyme of the hydrolase class that catalyses cleavage of the leucine-leucine bond in angiotensin to generate angiotensin. 1. The enzyme is synthesized as inactive prorenin in the kidney and released into the blood in the active form in response to various metabolic stimuli. Not to be confused with rennin (chymosin). [EU] Resuscitation: The restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. [EU]

Retinopathy: 1. retinitis (= inflammation of the retina). 2. retinosis (= degenerative, noninflammatory condition of the retina). [EU] Saline: Salty; of the nature of a salt; containing a salt or salts. [EU]

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Sclerotherapy: Treatment of varicose veins, hemorrhoids, gastric and esophageal varices, and peptic ulcer hemorrhage by injection or infusion of chemical agents which cause localized thrombosis and eventual fibrosis and obliteration of the vessels. [NIH] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Shunt: 1. to turn to one side; to divert; to bypass. 2. a passage or anastomosis between two natural channels, especially between blood vessels. Such structures may be formed physiologically (e.g. to bypass a thrombosis) or they may be structural anomalies. 3. a surgically created anastomosis; also, the operation of forming a shunt. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [NIH] Tonic: 1. producing and restoring the normal tone. 2. characterized by continuous tension. 3. a term formerly used for a class of medicinal preparations believed to have the power of restoring normal tone to tissue. [EU]

Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Vasoconstriction: The diminution of the calibre of vessels, especially constriction of arterioles leading to decreased blood flow to a part. [EU] Verapamil: A calcium channel blocker that is a class IV anti-arrhythmia agent. [NIH] Withdrawal: 1. a pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) a substancespecific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU]

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CHAPTER 5. PATENTS ON HIGH BLOOD PRESSURE Overview You can learn about innovations relating to high blood pressure by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.24 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available to patients with high blood pressure within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available to patients with high blood pressure. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.

24Adapted

from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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Patents on High Blood Pressure By performing a patent search focusing on high blood pressure, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on high blood pressure: ·

Pharmaceutical composition for the treatment of high blood pressure Inventor(s): Becker; Reinhard (Wiesbaden, DE), Geiger; Rolf (Frankfurt am Main, DE), Henning; Rainer (Hattersheim am Main, DE), Teetz; Volker (Holheim am Taunus, DE), Urbach; Hansjorg (Kronberg/Taunus, DE) Assignee(s): Hoechst Aktiengesellschaft (Frankfurt am Main, DE) Patent Number: 5,256,687 Date filed: November 19, 1992 Abstract: The invention relates to a pharmaceutical composition comprising an angiotensin converting enzyme inhibitor (trandolpril or pamipril) and a loop diuretic (Furosemide or piretanide), and to their use for the treatment of high blood pressure. Excerpt(s): It is known that the high blood pressure of patients with essential hypertension can be reduced using inhibitors of angiotensin converting enzyme (ACE inhibitors), such as captoprit or enalapril (Therapiewoche 29 [1979] 7746; Lancet 2 [1981] 543-546). However, a certain percentage of patients with essential hypertension do not respond to substances of this type (Drug Devel. Eval. 4 [1980] 82-91). ... The combination of ACE inhibitors and loop diuretics effects a potent and persistent lowering of blood pressure and can thus be used for the treatment of high blood pressure of various etiologies. It is a particularly interesting fact that there is not an additive behavior of the actions of the two components; on the contrary, a synergistic effect is observed. In spontaneously hypertensive rats there is a lowering of blood pressure with the combination even when it contains doses of an ACE inhibitor, such as ramipril, which alone have no effect, when they are combined with doses of a loop diuretic, such as piretanide, which alone have no

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diuretic effect (subdiuretic doses). This shows that loop diuretics, in particular compounds of the abovementioned formula I, are able to stimulate the renin-angiotensin system without showing a diuretic and saturetic effect. No such effect is achieved with compounds of the hydrochlorothiazide type. ... For the reasons mentioned, the composition according to the invention is superior to the individual components for the treatment of high blood pressure, since it allows smaller doses of the components to be administered, and thus reduces any toxicological problems there may be. Web site: http://www.delphion.com/details?pn=US05256687__

Patent Applications on High Blood Pressure As of December 2000, U.S. patent applications are open to public viewing.25 Applications are patent requests which have yet to be granted (the process to achieve a patent can take several years).

Keeping Current In order to stay informed about patents and patent applications dealing with high blood pressure, you can access the U.S. Patent Office archive via the Internet at no cost to you. This archive is available at the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “high blood pressure” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on high blood pressure. You can also use this procedure to view pending patent applications concerning high blood pressure. Simply go back to the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.

25

This has been a common practice outside the United States prior to December 2000.

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Vocabulary Builder Enalapril: An angiotensin-converting enzyme inhibitor that is used to treat hypertension. [NIH] Hydrochlorothiazide: A thiazide diuretic often considered the prototypical member of this class. It reduces the reabsorption of electrolytes from the renal tubules. This results in increased excretion of water and electrolytes, including sodium, potassium, chloride, and magnesium. It has been used in the treatment of several disorders including edema, hypertension, diabetes insipidus, and hypoparathyroidism. [NIH] Ramipril: A long-acting angiotensin-converting enzyme inhibitor. It is a prodrug that is transformed in the liver to its active metabolite ramiprilat. [NIH]

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CHAPTER 6. BOOKS ON HIGH BLOOD PRESSURE Overview This chapter provides bibliographic book references relating to high blood pressure. You have many options to locate books on high blood pressure. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on high blood pressure include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go to http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “high blood pressure” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on high blood pressure:

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·

You Can Control Diabetes and High Blood Pressure: Self Care Handbook Source: South Deerfield, MA: Channing L. Bete Co., Inc. 2000. 31 p. Contact: Available from Channing L. Bete, Co., Inc. 200 State Road, South Deerfield, MA 01373-0200. (800) 628-7733. Fax (800) 499-6464. Price: $2.73 each; plus shipping and handling; quantity discounts available. Summary: This handbook provides people who have diabetes with self care advice for managing high blood pressure. The handbook begins with an explanation of diabetes and high blood pressure and the complications they can cause. Having both conditions puts a person at greater risk of stroke, coronary artery disease, heart failure, kidney disease, blindness, reduced circulation to the feet and legs, and nerve damage. The handbook then provides guidelines for monitoring blood glucose and blood pressure, setting weight and exercise goals, making other lifestyle changes to improve health, eating balanced meals and snacks, and managing their medications. The handbook includes charts and worksheets that help readers with managing their diabetes and high blood pressure. The handbook also stresses the importance of undergoing regular screenings, caring for one's emotional health, and seeking outside assistance when needed. The handbook includes a list of organizations that can answer questions about diabetes and high blood pressure.

·

Mayo Clinic on High Blood Pressure Source: New York, NY: Kensington Publishing. 1999. 180 p. Contact: Available from Mayo Clinic. 200 First Street, S.W., Rochester, MN 55905. (800) 291-1128 or (507) 284-2511. Fax (507) 284-0161. Website: www.mayo.edu. Price: $14.95 plus shipping and handling. ISBN: 1893005011. Summary: This book focuses on what people who have high blood pressure can do to better manage their blood pressure and keep it at a safe level. The book begins with a chapter that explains the basics of blood pressure, how high blood pressure develops, and why it can be harmful. This is followed by a chapter that identifies unmodifiable and modifiable risk factors for high blood pressure. Unmodifiable risk factors include race, age, family history, and gender. Modifiable risk factors include obesity, inactivity, tobacco use, sodium sensitivity, low potassium, excessive alcohol consumption, stress, chronic illness, high cholesterol, diabetes, sleep apnea, and heart failure. Other topics addressed in this chapter include secondary high blood pressure and ways of preventing high blood pressure. The third chapter focuses on the

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diagnosis and treatment of high blood pressure. Topics include measuring blood pressure, receiving a diagnosis, getting a medical evaluation, and deciding on treatment with either medication or lifestyle changes. Subsequent chapters discuss determining a healthy weight, losing weight, becoming more physically active, and eating well using the Dietary Approaches to Stop Hypertension (DASH) plan. The following chapters detail the effects of sodium, tobacco, alcohol, caffeine, and stress on blood pressure. Another chapter focuses on the mode of action and side effects of various medications used in controlling high blood pressure, including diuretics, beta blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, calcium antagonists, alpha blockers, central acting agents, and direct vasodilators. Remaining chapters examine factors unique to women, management of high blood pressure among specific populations and groups, treatment of difficultto-control high blood pressure, management of a hypertensive emergency, and home monitoring of blood pressure. The book also includes a week of menus based on the recommendations of the DASH eating plan. 17 figures. 2 tables. ·

Nephrology and Hypertension. 4th ed Source: Hagerstown, MD: Lippincott Williams and Wilkins. 1999. 368 p. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 714-2300. Fax (301) 8247390. Website: www.lww.com. Price: $26.95 plus shipping and handling. ISBN: 078172077X. Summary: Written by those who remember the information that was useful to them in their training, this book provides students, residents, and practitioners with basic clinical information on commonly encountered conditions in nephrology (kidney disease). Chapter 1 provides a brief overview of the structural and functional features of the kidney. Chapters 2 through 4 outline a practical approach to the functional and radiologic evaluation of the kidney, including the clinical indications for a kidney biopsy. Chapter 5 discusses the clinical significance of hematuria (blood in the urine) and identifies those clinical settings in which thorough evaluation is a necessity. In Chapter 6, the etiology, pathophysiology, and method of evaluation of proteinuria (protein in the urine) and the nephrotic syndrome are presented. Chapter 7 reviews diabetic nephropathy; then Chapter 8 discusses several forms of renal disease that are glomerular in type, including minimal change disease, focal segmental glomerulosclerosis, membranous glomerulonephritis, post infectious proliferative glomerulonephritis, and IgA nephropathy. Chapter 9 describes the various types of

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glomerulonephritis observed in patients with systemic lupus erythematosus (SLE). In Chapter 10, the problem of vasculitis is addressed in its many forms, including Wegener's granulomatosis, polyarteritis nodosa, and Schonlein Henoch purpura. Chapter 11 provides descriptions of the renal (kidney) manifestations of the thrombotic microangiopathies, progressive systemic sclerosis, multiple myeloma, and amyloidosis. Chapter 12 discusses tubulointerstitial nephritis, and Chapter 13 reviews the more frequently encountered familial and cystic forms of renal disease. Chapter 14 covers HIV infection and the kidney, including management of HIV infected patients with acute or chronic renal failure. The next section contains four chapters on disorders of water, electrolytes, and acid base regulation. In Chapter 19 renal stone disease is reviewed; Chapter 20 covers urinary tract infection (UTI). The next five chapters cover the diagnosis and management of hypertension (high blood pressure) and the use of diuretics in clinical practice. The last section covers diagnosis and management of renal failure; six chapters cover dialysis, patient care management, the role of nutrition in managing kidney failure, and drug therapy for acute and chronic renal failure. Each chapter concludes with a list of suggested readings, and the handbook concludes with a subject index. ·

Churches as an Avenue to High Blood Pressure Control Source: Bethesda, MD, US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute, National High Blood Pressure Education Program, 97 p., April 1987. Contact: US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute, National High Blood Pressure Education Program, Bethesda, MD 20892. NIH Publication no. 89-2725. Summary: Churches as an Avenue to High Blood Pressure Control is designed to assist health care professionals and leaders of churches, synagogues, and other religious institutions in establishing high blood pressure (HBP) control programs in their communities. The guide provides information on the development and implementation of such programs and presents readers with issues of concern, approaches to take, ways to expand and coordinate existing programs, and resources to contact for additional information and support. Chapter one provides an overview of HBP control programs based in religious institutions. Chapter two outlines the basic planning steps needed to establish a church-based HBP control program. Chapter three provides the program

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coordinator with information on implementing a screening event for HBP control. Chapter four discusses the followup components of a HBP control program, including patient tracking, monitoring, support, and education. Chapter five provides an overview of program evaluation with specific reference to church-based programs. Appendixes contain additional resources so that program planners and coordinators can locate the information, expertise, and support they need to make their church-based HBP control program a success. ·

Measuring Progress in High Blood Pressure Control: An Evaluation Handbook Source: Bethesda, MD, US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute, National High Blood Pressure Education Program, 57 p., September 1988. Contact: US Department of Health and Human Services, Public Health Service, National Institutes of Health, Bethesda, MD 20892. NIH Publication no. 88-2647. Summary: The National High Blood Pressure Education Program (NHBEP) developed Measuring Progress in High Blood Pressure Control in response to a perceived need for technical assistance in evaluating high blood pressure control programs. The guide is designed to assist program administrators in developing and using data that will improve their programs. The first chapter, Understanding Evaluation, covers concepts of program evaluation, purposes of high blood pressure control program evaluation, the decision to evaluate, and common misperceptions affecting evaluation efforts. The second chapter, Planning an Evaluation, discusses the evaluation process, the planning steps, cost effectiveness analysis, the role of the high blood pressure control program administrator, and use of a consultant service. The third chapter, Conducting an Evaluation, covers collecting and analyzing the data as well as ensuring confidentiality. The final chapter, Using Evaluation Results, provides examples of Using Indicators and discusses the use of evaluation results. The intended audience includes community program staff members who may or may not have formal training or experience in conducting evaluations.

·

Preeclampsia: The facts Source: New York: Oxford University Press. 1992. 197 pp.

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Contact: Available from Business Office, Oxford University Press, 2001 Evans Road, Cary, NC 27513. Telephone: (800) 451-7556 or (919) 677- 0977 / fax: (919) 677-1303. $29.95. Summary: This book is a comprehensive and easy-to-understand study of preeclampsia (pregnancy induced hypertension) written by a medical expert in the field and a medical journalist who herself had preeclampsia. Preeclampsia is the most common and the most potentially serious complication of pregnancy. High blood pressure, swelling, and the presence of protein in the urine are all forewarnings of preeclampsia, which can cause severe symptoms and danger to mother and fetus. The book was written in response to the lack of information for public consumption on the topic, and includes first-person accounts of the illness and symptoms.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes & Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). The following have been recently listed with online booksellers as relating to high blood pressure (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·

Chelation Can Cure: How to Reverse Heart Disease, Diabetes, Stroke, High Blood Pressure and Poor Circulation Without Drugs or Surgery by E. W. McDonagh (1983); ISBN: 0912815000; http://www.amazon.com/exec/obidos/ASIN/0912815000/icongroupin terna

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Control Your High Blood Pressure Cookbook by Cleaves M. Bennett, Chris Newport (1987); ISBN: 0385199198; http://www.amazon.com/exec/obidos/ASIN/0385199198/icongroupin terna

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Control Your High Blood Pressure Without Drugs by Cleaves M. Bennett, Charles Cameron (1984); ISBN: 0385189273; http://www.amazon.com/exec/obidos/ASIN/0385189273/icongroupin terna

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Controlling High Blood Pressure by Frans H.H. Leenan, R. Brian Haynes (1991); ISBN: 1559580879;

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http://www.amazon.com/exec/obidos/ASIN/1559580879/icongroupin terna ·

Controlling High Blood Pressure (1991); ISBN: 0914629875; http://www.amazon.com/exec/obidos/ASIN/0914629875/icongroupin terna

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Coping With High Blood Pressure by Sandy Sorrentino, Carl Hausman (1986); ISBN: 0934878765; http://www.amazon.com/exec/obidos/ASIN/0934878765/icongroupin terna

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Diet for a Strong Heart: Michio Kushi's MacRobiotic Dietary Guidelines for the Prevention of High Blood Pressure, Heart Attack, and Stroke by Michio Kushi, Alex Jack (Contributor) (1987); ISBN: 0312001207; http://www.amazon.com/exec/obidos/ASIN/0312001207/icongroupin terna

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Down With High Blood Pressure by R. Brian Haynes, Frans H.H. Leenen (Editor) (1991); ISBN: 0919959512; http://www.amazon.com/exec/obidos/ASIN/0919959512/icongroupin terna

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Exploring the Heart : Discoveries in Heart Disease and High Blood Pressure/08952 by Julius H. Comroe (1987); ISBN: 0393017087; http://www.amazon.com/exec/obidos/ASIN/0393017087/icongroupin terna

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Fact Book on Hypertension High Blood Pressure and Your Diet by Carlson Wade (1975); ISBN: 0879830956; http://www.amazon.com/exec/obidos/ASIN/0879830956/icongroupin terna

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High Blood Pressure by Ada P. Kahn (Editor) (1983); ISBN: 0809255995; http://www.amazon.com/exec/obidos/ASIN/0809255995/icongroupin terna

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High Blood Pressure by Leonard Mervyn (1983); ISBN: 0909911967; http://www.amazon.com/exec/obidos/ASIN/0909911967/icongroupin terna

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High Blood Pressure by Peter J. Lewis (1986); ISBN: 0443023018; http://www.amazon.com/exec/obidos/ASIN/0443023018/icongroupin terna

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High Blood Pressure (1987); ISBN: 0874340748; http://www.amazon.com/exec/obidos/ASIN/0874340748/icongroupin terna

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High Blood Pressure in Teenagers by David J. Gerrick (1978); ISBN: 0916750272; http://www.amazon.com/exec/obidos/ASIN/0916750272/icongroupin terna

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High Blood Pressure Special Diet Cookbook : Delicious Low-Salt Recipes That Are Calorie Controlled for Weight Reduction (Special Diet Cookbooks) by Maggie Pannell (1991); ISBN: 0722522363; http://www.amazon.com/exec/obidos/ASIN/0722522363/icongroupin terna

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High Blood Pressure, Cholesterol, and You by Harold C. Steele (1969); ISBN: 0873971019; http://www.amazon.com/exec/obidos/ASIN/0873971019/icongroupin terna

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High Blood Pressure: How to Live with It, How to Lower It by Martin Bates (1982); ISBN: 0133873811; http://www.amazon.com/exec/obidos/ASIN/0133873811/icongroupin terna

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High Blood Pressure: What Causes It, How to Tell If You Have It, How to Control It for a Longer Life by Frank A., Finnerty (1975); ISBN: 0679505121; http://www.amazon.com/exec/obidos/ASIN/0679505121/icongroupin terna

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High Blood Pressure: What It Means for You, and How to Control It by Kevin, Md. O'Malley (1982); ISBN: 0668053232; http://www.amazon.com/exec/obidos/ASIN/0668053232/icongroupin terna

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High Blood/Pressure by Michelle T. Clinton (1986); ISBN: 0931122414; http://www.amazon.com/exec/obidos/ASIN/0931122414/icongroupin terna

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How to Control High Blood Pressure Without Drugs by Robert L. Rowan (1987); ISBN: 0684183366; http://www.amazon.com/exec/obidos/ASIN/0684183366/icongroupin terna

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How to Live With You High Blood Pressure by William Alexander, Brams (1976); ISBN: 0668026952; http://www.amazon.com/exec/obidos/ASIN/0668026952/icongroupin terna

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Hypertension : Community Control of High Blood Pressure by Julian Tudor Hart (1988); ISBN: 0443031525;

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http://www.amazon.com/exec/obidos/ASIN/0443031525/icongroupin terna ·

Living With High Blood Pressure : The Hypertension Diet Cookbook by Joyce D. and Hunt, James C. Margie (1979); ISBN: 0801968550; http://www.amazon.com/exec/obidos/ASIN/0801968550/icongroupin terna

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Living With Your High Blood Pressure by William A. Brams (1977); ISBN: 0668042869; http://www.amazon.com/exec/obidos/ASIN/0668042869/icongroupin terna

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New Self Help: High Blood Pressure by Leon Chaitow (1986); ISBN: 072251221X; http://www.amazon.com/exec/obidos/ASIN/072251221X/icongroupi nterna

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Protect Your Lifeline : Fight High Blood Pressure (1981); ISBN: 9997490673; http://www.amazon.com/exec/obidos/ASIN/9997490673/icongroupin terna

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Speaking of High Blood Pressure : A Comprehensive Guide for Hypertensives and Their Partners by Hanns Peter Wolff (1979); ISBN: 0832622354; http://www.amazon.com/exec/obidos/ASIN/0832622354/icongroupin terna

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Stress and Relaxation: Self-Help Ways to Cope With Stress and Relieve Nervous Tension, Ulcers, Insomnia, Migraine, and High Blood Pressure by Jane. Madders (1980); ISBN: 0668046805; http://www.amazon.com/exec/obidos/ASIN/0668046805/icongroupin terna

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Strokes and Their Prevention: How to Avoid High Blood Pressure and Hardening of the Arteries. by Arthur, Ancowitz (1975); ISBN: 0442203306; http://www.amazon.com/exec/obidos/ASIN/0442203306/icongroupin terna

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The Complete Guide to Living with High Blood Pressure by Michael K. Rees (1988); ISBN: 0131593102; http://www.amazon.com/exec/obidos/ASIN/0131593102/icongroupin terna

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The Complete Guide to Living With High Blood Pressure (1988); ISBN: 0890431744;

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http://www.amazon.com/exec/obidos/ASIN/0890431744/icongroupin terna ·

The High Blood Pressure Book: A Guide for Patients and Their Families by Edward D. Freis (1979); ISBN: 0525124721; http://www.amazon.com/exec/obidos/ASIN/0525124721/icongroupin terna

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The K Factor : Reversing and Preventing High Blood Pressure Without Drugs by Richard, M.D. Ph.D. Moore, George, Ph.D. Webb (1986); ISBN: 0025861905; http://www.amazon.com/exec/obidos/ASIN/0025861905/icongroupin terna

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The Pill Book of High Blood Pressure by Bood and Drug Book Company (1985); ISBN: 0553244892; http://www.amazon.com/exec/obidos/ASIN/0553244892/icongroupin terna

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The Salt-Free Diet Book : To Help Avoid High Blood Pressure and Other Common Conditions by Graham MacGregor (1985); ISBN: 0668059729; http://www.amazon.com/exec/obidos/ASIN/0668059729/icongroupin terna

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The Sodium Counter : Including Calories : Your Long Life Guide to Help Avoid High Blood Pressure and Heart Problems (Long Life Guide Series) by Jacqueline Nagel (Editor) (1989); ISBN: 155785100X; http://www.amazon.com/exec/obidos/ASIN/155785100X/icongroupi nterna

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Understanding High Blood Pressure and Its Treatment by Richard A. Schacht (1987); ISBN: 0941827003; http://www.amazon.com/exec/obidos/ASIN/0941827003/icongroupin terna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “high blood pressure” (or synonyms) into the search box, and select “books only.” From

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there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:26 ·

ABC of hypertension. Author: Gareth Beevers, Gregory Y.H. Lip, Eoin O'Brien; Year: 2001; London: BMJ Books, 2001; ISBN: 0727915223 http://www.amazon.com/exec/obidos/ASIN/0727915223/icongroupin terna

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Acceptability and continuation of injectable Bangladesh. Author: H.H. Akhter; Year: 1981; 1981

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Analytical and preparative separation methods of biomacromolecules. Author: edited by Hassan Y. Aboul-Enein; Year: 1999; New York: Marcel Dekker, c1999; ISBN: 0824719964 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0824719964/icongroupin terna

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Arterial stiffness and pulse wave velocity: clinical application. Author: Roland Asmar; review committee Michael O'Rourke, Michel Safar; foreword by Michael O'Rourke; Year: 1999; Amsterdam; New York: Elsevier, 1999; ISBN: 2842991486 http://www.amazon.com/exec/obidos/ASIN/2842991486/icongroupin terna

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Autogenic-Feedback Training: a potential treatment for post-flight orthostatic intolerance in aerospace crews. Author: P.S. Cowings ... [et al.]; Year: 1993; Washington, DC: NASA Headquarters, 1993

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Bibliography of studies on target setting for family planning in India and studies on births averted. Author: A. Kumar; Year: 1971; Bombay, India, International Institute for Population Studies, 1971

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Blood pressure measurement devices: mercury and non-mercury. Author: Medical Devices Agency; Year: 2000; London: Department of Health, 2000

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Blood pressure monitoring in cardiovascular medicine and therapeutics. Author: edited by William B. White; foreword by Norman

contraceptives

in

In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

26

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M. Kaplan; Year: 2001; Totowa, N.J.: Humana Press, c2001; ISBN: 0896038408 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0896038408/icongroupin terna ·

Cardiovascular flow modelling and measurement with application to clinical medicine: based on the proceedings of a conference organized by the Institute on Mathematics and its Applications on cardiovascular flow modelling and measurement with application. Author: Asmar, R. (Roland); Year: 1999; Oxford: Clarendon Press, 1999; ISBN: 0198505205 http://www.amazon.com/exec/obidos/ASIN/0198505205/icongroupin terna

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Development of liquid chromatography-electrospray ionizationtandem mass spectrometry methods for determination of urinary metabolites of benzene in humans. Author: Assieh A. Melikian ... [et al.]; Year: 1999; Cambridge, MA: Health Effects Institute, [c1999]

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Developmental adaptations to gravity in animals. Author: A.R. Hargens; Year: 1991; Washington, DC: NASA Headquarters, 1991

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Ear pulse waveform parameters during the gradual onset centrifuge training profile. Author: M. Holewijn, J. van der Burgt, A. Kuijper; Year: 1999; [Soesterberg, Netherlands]: Aeromedisch Instituut, [1999]

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Effect of aerobic capacity on Lower Body Negative Pressure (LBNP) tolerance in females. Author: A.D. Moore, Jr., S.M. Fortney, S.F. Siconolfi; Year: 1993; Washington, DC: NASA Headquarters, 1993

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Fluid-loading solutions and plasma volume: Astro-ade and salt tablets with water. Author: S.M. Fortney ... [et al.]; Year: 1994; Washington, DC: NASA Headquarters, 1994

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Food analysis by HPLC. Author: edited by Leo M.L. Nollet; Year: 2000; New York: Marcel Dekker, c2000; ISBN: 082478460X (alk. paper) http://www.amazon.com/exec/obidos/ASIN/082478460X/icongroupi nterna

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Influence of estrogen content of oral contraceptives and consumption of sucrose on blood parameters [microform]. Author: K.E. Behall; Year: 1982; Ann Arbor, Michigan, University Microfilms International, 1982

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Low level progestogens. Author: J. Martinez-Manautou; Year: 1971; Control of human fertility. (Proceedings of the 15th Nobel Symposium, Sogergarn, Ladingo, Sweden, May 27-29, 1970.) New York, Wiley, 1971

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Multinational comparative clinical trial of long-acting injectable contraceptives: norethisterone enanthate given in two dosage regimens and depot-medroxyprogesterone acetate: final report. Author: Stewart, Joseph V., 1931-; Year: 1983; [1983]

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Neuro-cardiovascular regulation: from molecules to man. Author: edited by Mark W. Chapleau and François M. Abboud; Year: 2001; New York, N.Y.: New York Academy of Sciences, 2001; ISBN: 1573313440 (cloth: alk. paper) http://www.amazon.com/exec/obidos/ASIN/1573313440/icongroupin terna

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Oral contraceptives: advantages of orals outweigh disadvantages. Author: M. Potts ... [et al.]; Year: 1975; 1975

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Oral contraceptives and arterial disease. Author: B.V. Stadel; Year: 1982; 1982

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Ortho-Novum 7. Author: 7/7: a tri-phasic regimen; Year: 1984; Raritan, New Jersey, Ortho Pharmaceutical Corporation, 1984

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Pill. Author: J. Guillebaud; Year: 1983; London, Oxford Univ. Press, 1983

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Responses of women to orthostatic and exercise stresses. Author: G.W. Hoffler ... [et al.]; Year: 1990; Washington, DC: NASA Headquarters, 1990

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Sphygmomanometers, electronic, automatic. Author: ECRI; Year: 2000; Plymouth Meeting, PA: ECRI, c2000

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Summary report of STS 51-D medical investigations by Payload Specialist 2. Author: W.E. Thornton, T.P. Moore, N.M. Cintrón; Year: 1986; Houston, TX: NASA Johnson Space Center, 1986

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Triphasic oral contraceptive as hormone replacement therapy in perimenopausal women. Author: A.A. Shargil; Year: 1986; 1986

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Vasectomy and coronary heart disease: results of a long-term study. Final report. Author: E.B. Perrin ... [et al.]; Year: 1982; Seattle, Washington, Battelle Human Affairs Research Centers, 1982

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Vital signs and resuscitation. Author: Joseph V. Stewart; Year: 2001; Georgetown, TX, U.S.A.: Landes Bioscience, 2001; ISBN: 1570596719 (spiral)

Chapters on High Blood Pressure Frequently, high blood pressure will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with high blood pressure, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and high blood pressure using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you

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prefer, and the format option “Book Chapter.” By making these selections and typing in “high blood pressure” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on high blood pressure: ·

Portal Hypertension in Patients with Primary Biliary Cirrrhosis Source: in Lindor, K.D.; Heathcote, E.J.; Poupon, R., eds. Primary Biliary Cirrhosis: From Pathogenesis to Clinical Treatment. Boston, MA: Kluwer Academic Publishers. 1998. p. 87-91. Contact: Available from Kluwer Academic Publishers. Customer Service Deparment, P.O. Box 358, Accord Station, Hingham, MA 02018-0358. (781) 871-6600. Fax (781) 681-9045. E-mail: [email protected]. Website: www.wkap.nl. Summary: Primary biliary cirrhosis (PBC) is a chronic cholestasic (lack of bile flow) liver disease of unknown etiology (cause), although the association with a large number of autoimmune disorders suggests that the disease may be of autoimmune origin. The disease usually affects middle aged women and progresses from asymptomatic disease with only laboratory abnormalities to a severe cholestatic disease with deep jaundice, xanthomas (fatty tumors in the skin), portal hypertension (high blood pressure), and eventually liver failure. This chapter on portal hypertension (high blood pressure) is from a monograph that reprints papers from a conference held in November 1997 in Chicago, Illinois, on the clinical features (symptoms), pathogenesis, and treatment of PBC. Portal hypertension can result in the development of esophageal and gastric varices (enlarged veins or arteries) that, when of a large size, may bleed. Portal hypertension is increased venous pressure in the pathway of blood flow from the gastrointestinal tract and spleen to the liver; it is caused by compression or occlusion (blockage). The authors note that portal hypertension is not an uncommon finding in patients referred for the initial diagnosis of PBC, but it is also rarely severe. In patients not treated with UDCA (ursodeoxycholic acid), a progressive and slowly developing portal hypertension appears to occur with time. In patients treated with UDCA, progression of portal hypertension can be slowed during the first 2 years of treatment and, eventually, can be reversed after prolonged treatment. 8 references.

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Diabetes and Hypertension Source: in Johnstone, M.T. and Veves, A. Diabetes and Cardiovascular Disease. Totowa, NJ: The Humana Press, Inc. 2001. p. 123-129.

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Contact: Humana Press, Inc. 999 Riverview Dr., Suite 208 Totowa, NJ 07512. (973) 256-1699. Fax (973) 256-8341. E-mail: [email protected] Price: $125.00, plus shipping and handling. ISBN: 089603755X. Summary: With over ten million diagnosed patients and another five million undiagnosed, diabetes mellitus and its complications is a major public health problem that will assume epidemic proportions as the population grows older. This chapter on diabetes and hypertension is from a textbook that offers physicians practical knowledge about cardiovascular disease and diabetes. This chapter is in Part I, which focuses on pathophysiology, including the mechanisms and risk factors for diabetic cardiovascular disease. The author notes that many factors contribute to increased cardiovascular disease (CVD) in persons with diabetes. These factors include hypertension (high blood pressure), dyslipidemia (disordered levels of fats in the blood), platelet hyperactivity, endothelial (the cells lining the body cavity and cardiovascular system) abnormalities, as well as hyperglycemia (high blood glucose), microalbuminuria (protein in the urine), and hyperinsulinemia (high levels of insulin in the blood). The author discusses characteristics of hypertension in people with diabetes and then focuses on treatment goals in this population. The goal of hypertension treatment in persons with diabetes is to prevent hypertension-associated death and disability. The level of blood pressure and the diagnosis of hypertension should be based on multiple blood pressure measurements obtained in a standardized fashion on at least three occasions. Because of the tendency to orthostatic hypotension (abnormally low blood pressure upon standing), standing blood pressures should be measured at each office visit. Pharmacologic (drug) therapy should be initiated when lifestyle modifications do not lower blood pressure to less than 130 over 85 mmHg in people with diabetes. Combination therapy is usually necessary for adequate blood pressure control; therapy should include an ACE inhibitor for maximal benefits in protecting against cardiovascular disease as well as renal (kidney) disease. 1 figure. 1 table. 30 references. ·

Hypertension and Medical Nutrition Therapy Source: in Franz, M.J. and Bantle, J.P., eds. American Diabetes Association Guide to Medical Nutrition Therapy for Diabetes. Alexandria, VA: American Diabetes Association. 1999. p. 295-311. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 442-9742. Website: www.diabetes.org. Price: $39.95 for

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members; $49.95 for nonmembers; plus shipping and handling. ISBN: 158040006X. Order number 561601. Summary: This chapter focuses on the use of medical nutrition therapy (MNT) in treating hypertension in people with diabetes and presents the recommendations issued by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Numerous randomized, controlled clinical trials have provided strong evidence that lowering blood pressure reduces renal and other complications of diabetes. In the United Kingdom Prospective Diabetes Study, angiotensin converting enzyme (ACE) inhibitors and beta blockers were equally effective and beneficial in treating hypertension. ACE inhibitors may be preferable if albuminuria is present because they are renoprotective and because recent evidence suggests that they may also be cardioprotective. The final results of the Appropriate Blood Pressure Control in Diabetes Trial will provide evidence to judge the best medical treatment approach for individuals who have diabetes and hypertension. Extrapolating from more general studies, weight reduction appears to be the preferable treatment for hypertension in people who have diabetes. Although sodium restriction appears to be effective in lowering blood pressure in sodium sensitive people, severe sodium restriction can worsen lipids and insulin resistance, and present a possible cardiovascular risk. There is no evidence to support the supplemental use of fish oils, potassium, or calcium. The Dietary Approaches To Stop Hypertension Trial demonstrated that a diet high in fruits and vegetables, low in total and saturated fats and cholesterol, and high in whole grains, as well as being moderately low in sodium lowered blood pressure. 5 tables. 36 references. ·

Effects of Hypertension on the Kidney Source: in Schena, F.P., ed. Nephrology. New York, NY: McGraw-Hill, Inc. 2001. p. 349-354. Contact: Available from McGraw-Hill, Inc. Shoppenhangers Road, Maidenhead, Berkshire SL6 2QL. 44 (0)1628 502700. Fax: +44 (0)1628 635895 E-mail: [email protected]. Website: www.mcgrawhill.co.uk. Price: $79.95; plus shipping and handling. ISBN: 0077095251. Summary: Hypertension (high blood pressure) can cause renal (kidney) damage through two main mechanisms: those that involve the direct transmission of systemic hypertension to the body of the kidney and those that act indirectly on the kidney by inducing stenosis (narrowing of blood vessels) or occlusion (blockage) of preglomerular vessels and, in turn, ischemia (lack of blood flow) of the kidney. This chapter on the effects of hypertension on the kidney is from a book on nephrology (the

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study of the kidney and kidney diseases) designed for general practitioners and family care providers that offers strategies for the management of patients with renal (kidney) damage. Glomerular hypertension (high blood pressure in the capillaries of the filtering units of the kidney) may be present in diabetes mellitus, in primary renal diseases, and when renal mass is reduced. Elevated proteinuria (levels of protein in the urine) is the clinical sign of glomerular hypertension. On the other hand, patients with preglomerular vessel changes (such as stenosis) present a different clinical picture. The authors stress that the correct identification of the pathogenetic pathways (how the disease is developing) may help the practitioner to tailor the best treatment for his or her patients. In patients with glomerular hypertension, very strict control of blood pressure is mandatory, preferably with ACE inhibitors. In patients with preglomerular vessel changes, hypertension should be treated, but a careful control of serum creatinine is also mandatory, particularly when ACE inhibitors are used. Because kidney ischemia, not hypertensive stress, is the real problem, excessive reduction in blood pressure can harm the kidney organ. In these patients, the treatment of choice (when possible) is renal revascularization (surgery to bring additional blood vessels to the kidney). A patient care algorithm is provided. 1 figure. 2 tables. 15 references. ·

Hypertension in Dialysis Patients Source: in Lameire, N. and Mehta, R.L., eds. Complications of Dialysis. New York, NY: Marcel Dekker, Inc. 2000. p. 471-484. Contact: Available from Marcel Dekker, Inc. Cimarron Road, P.O. Box 5005, Monticello, NY 12701. (800) 228-1160 or (845) 796-1919. Fax (845) 796-1772. E-mail: [email protected]. International E-mail: [email protected]. Website: www.dekker.com. Price: $250.00 plus shipping and handling. ISBN: 0824788710. Summary: Arterial hypertension (high blood pressure) remains one of the major public health problems of industrialized nations, resulting in a great burden of morbidity (illness), mortality (death), and cost. For patients with end stage renal disease (ESRD), hypertension poses a particular problem, notably contribution to the high rates of cardiovascular disease and mortality experienced by dialysis patients. This chapter on hypertension in hemodialysis (HD) and peritoneal dialysis (PD) patients is from a book that offers a comprehensive, multidisciplinary resource for the nephrologist and caregiver providing dialysis, covering all aspects of dialysis therapies and their complications. In this chapter, the authors review the complicated subject of hypertension management for patients treated with HD or PD. The

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authors cover the measurement of blood pressure in dialysis patients; target blood pressure values; pathogenesis; the role of sodium and volume excess and the renin angiotensin axis; sympathetic activity; the role of erythropoietin; the role of divalent ions and parathyroid hormone; the vascular endothelium; and outcomes and treatment of hypertension in dialysis patients. Nonmedicinal treatments of hypertension can include aerobic exercise, control of salt and fluid intake, cessation of smoking, weight reduction, and avoidance of alcohol. The authors stress that the approach to the control of hypertension in dialysis patients should be multidisciplinary (medical, nursing, social work, and dietary). The mainstay of therapy for the control of hypertension in dialysis patients is adequate fluid removal. The use of antihypertensive medications is summarized in table format. 7 tables. 127 references. ·

Hypertension: Management Strategies Source: in Mandal, A.K. and Nahman, N.S., Jr., eds. Kidney Disease in Primary Care. Baltimore, MD: Williams and Wilkins. 1998. p. 133-147. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (800) 638-0672 or (410) 528-4223. Fax (800) 4478438 or (410) 528-8550. E-mail: [email protected]. Price: $39.95. ISBN: 0683300571. Summary: This chapter on hypertension (high blood pressure) is from a textbook that provides primary care physicians with practical approaches to common clinical problems of kidney diseases. The authors first provide background information about hypertension, including predisposing factors, the technique for blood pressure measurement, white coat hypertension, and pseudohypertension. The authors then discuss diagnostic considerations, including history, review of medications, physical examination, and laboratory evaluations; the causes of secondary hypertension; treatment, including nonpharmacologic approaches, medication selection based on populations, classes of antihypertensive medication, step therapy, and compliance issues; and how to manage refractory hypertension, including measuring sodium intake. The chapter concludes with a discussion of disability determination, the indications for referring a patient to a specialist, and the answers to a list of questions commonly asked by patients diagnosed with hypertension. The authors emphasize that patient compliance is essential to successful treatment of hypertension. 6 tables. 8 references.

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Renovascular Hypertension Source: in Mandal, A.K. and Nahman, N.S., Jr., eds. Kidney Disease in Primary Care. Baltimore, MD: Williams and Wilkins. 1998. p. 148-157. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (800) 638-0672 or (410) 528-4223. Fax (800) 4478438 or (410) 528-8550. E-mail: [email protected]. Price: $39.95. ISBN: 0683300571. Summary: This chapter on renovascular hypertension (a secondary form of high blood pressure resulting from renal artery stenosis, or RAS) is from a textbook that provides primary care physicians with practical approaches to common clinical problems of kidney diseases. The authors discuss the causes, including fibromuscular dysplasia and increased renal renin release; diagnostic considerations, including the patient history, physical examination, index of clinical suspicion, and confirmation of diagnosis; and treatment options, including renal artery angioplasty, surgical bypass procedures, and the medical management of documented renal artery stenosis. The chapter concludes with a discussion of the indications for referring a patient to a specialist and with the answers to a list of questions commonly asked by patients diagnosed with renovascular hypertension. The diagnosis of atherosclerotic RAS is usually considered in patients with difficult-to-control hypertension or in hypertensive patients with unexplained azotemia. The authors recommend renal artery angioplasty as firstline therapy in patients with atherosclerotic RAS. Medical management consists of good blood pressure control, preferably with antihypertensive drugs other than ACE inhibitors. ACE inhibitors should be avoided or used with great caution, as converting-enzyme drugs may further impair blood flow and worsen or precipitate azotemia. 2 figures. 4 tables. 6 references.

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Herbal Medications, Nutraceuticals, and Hypertension Source: in Miller, L.G. and Murray, W.J., eds. Herbal Medicinals: A Clinician's Guide. New York, NY: Pharmaceutical Products Press. 1998. p. 135-162. Contact: Available from Haworth Herbal Press. 10 Alice Street, Binghamton, NY 13904-1580. (800) HAWORTH. Fax (800) 895-0582. Email: [email protected]. Website: www.haworthpressinc.com. Price: $39.95 plus shipping and handling. ISBN: 0789004666. Summary: Hypertension (high blood pressure) is a common problem, for which numerous drug therapies and lifestyle changes are often prescribed. Many patients have elected to augment or substitute their

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allopathic therapies with herbal remedies, primarily to avoid the many known side effects of antihypertensive drugs. This chapter on herbal medicinals, nutraceuticals, and hypertension is from a clinician's guide to the use of herbal medicinals that uses a case based approach to lead readers through clinical considerations and the potential use of alternative medicines. The authors first briefly review some of the standard antihypertensive treatments, including their potential impact on quality of life. The case studies in this chapter describe licorice induced hypertension (licorice is found in smokeless tobacco); yohimbine to address erectile dysfunction (impotence); the use of garlic to treat hypertension; herbal diuretics (drugs that increase the rate of urine flow and the excretion of sodium); the negative impact of grapefruit juice and ginseng on blood pressure control; Chinese herbs for hypertension; and fish oil supplementation. One table lists herbs that may have an effect on blood pressure; another table summarizes information about herbs reviewed in this chapter. 7 tables. 117 references. ·

High Blood Pressure Source: in Gilroy, D.K., ed. Guide to a Man's Life. Emmaus, PA: Rodale Press. 1995. p. 11-13. Contact: Available from Rodale Press. 14 East Minor Street, Emmaus, PA 18098. (610) 967-8620. Price: Single copy free. Summary: This chapter on high blood pressure is from a booklet that presents the latest medical breakthroughs on common health risks that target men. The chapter presents a brief discussion of the problems caused by hypertension and then considers two recent advances in the treatment of hypertension: the use of beta blockers and the addition of high-potassium foods to the diet. The chapter then lists recommendations for lifestyle changes that can have a positive impact on the problem of hypertension. Suggestions cover topics including weight loss; sodium restrictions; alcohol consumptions; the role of calcium; avoiding isometrics; aerobic exercise; dietary changes, including the role of vegetarianism; monitoring blood pressure at home; psychological factors; and communication. The booklet is written in an informal, friendly style, with medical terms defined for the layperson.

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Renal Disease and Hypertension in Pregnancy Source: in Levine, D.Z. Care of the Renal Patient. Orlando, FL: W.B. Saunders Company. 1991. p. 85-96.

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Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 782-4479. Price: $46.95 plus shipping and handling. ISBN: 0721630561. Summary: This chapter, from a comprehensive medical textbook about the care of the renal patient, discusses renal disorders and hypertension in pregnant women. The authors first review the anatomic and physiologic changes in gestation and their clinical relevance to detecting and managing disease. A section on the kidneys is devoted to acute renal failure and chronic parenchymal diseases, including allograft recipients. A section on high blood pressure is primarily devoted to preeclampsia and essential hypertension. 2 figures. 5 tables. 11 references. ·

Hypertension: A Community Perspective Source: in Handbook of Black American Health: The Mosaic of Conditions, Issues, Policies, and Prospects. Livingston, I.L.; ed. Westport, CT, Greenwood Press, pp. 46-58, 1994. Contact: Greenwood Press, 88 Post Road West, Westport, CT 06881. Summary: Hypertension: A Community Perspective, a book chapter in Handbook of Black American Health: The Mosaic of Conditions, Issues, Policies, and Prospects, states that undetected and uncontrolled hypertension in blacks remains one of the most important health care challenges in the United States. The chapter (1) discusses the epidemiology of hypertension; (2) reviews causative and treatment factors, including individual and community level risk factors and effective interventions; (3) presents an urban case study of the East Baltimore (Maryland) experience; and (4) offers recommendations for primary and secondary high blood pressure prevention, improving detection, and community screening. The prevalence of high blood pressure is 30 percent higher in African Americans compared to whites (38 percent versus 29 percent); the higher prevalence persists when controlled for age, adiposity, and socioeconomic status. The chapter discusses the hypertension challenge primarily from the levels of the (1) individual (persons and their interactions with family, friends, and health care providers) and (2) community (geography; local institutions such as churches, schools, and work sites; and the health care delivery systems). The East Baltimore High Blood Pressure Control Program, which is conducted in an area that is 88 percent black, is a randomized community intervention trial of long-term, multiphasic high blood pressure research and educational intervention programs. In East Baltimore, 33 percent of the black population have high blood pressure, but less than half are on treatment and achieving blood pressure control. The solution to decreasing hypertension can be found in applying scientific knowledge

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about behavior, pathophysiology, and therapeutics to individuals and communities. Recommendations include (1) primary prevention efforts, such as the testing of family approaches to support and maintain lifestyle changes; (2) improved secondary prevention efforts; (3) accessible illness prevention and health promotion centers located in high-risk communities are needed; and (4) community-based screening of high-risk populations for new-onset high blood pressure.

Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to high blood pressure have been published that consolidate information across various sources. These too might be useful in gaining access to additional guidance on high blood pressure. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:27 ·

Hispanic: Sources of Spanish Language Health Materials Source: Washington, DC: Office of Minority Health Resource Center. October 1997. [15 p.]. Contact: Available from Office of Minority Health Resource Center. P.O. Box 37337, Washington, DC 20013-7337. (800) 444-6472. Website: www.omhrc.gov. PRICE: Single copy free. Summary: This chapter is from a bibliography that lists sources of health materials that are written specifically for the needs of certain ethnic groups. The bibliography includes five sections: African Americans, American Indians (including Alaska Natives), Asians, Hispanics, and Pacific Islanders. This chapter lists health materials specifically targeting different Hispanic populations, noting that culturally sensitive and universally appropriate Spanish language materials for this diverse population are difficult to obtain and some do not take culture, linguistics and other factors that may influence health behaviors into consideration. The listing includes sources of information for cancer, chemical

You will need to limit your search to “Directories” and high blood pressure using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find directories, use the drop boxes at the bottom of the search page where “You may refine your search by”. For publication date, select “All Years”, select language and the format option “Directory”. By making these selections and typing in “high blood pressure” (or synonyms) into the “For these words:” box, you will only receive results on directories dealing with high blood pressure. You should check back periodically with this database as it is updated every three months. 27

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dependency, diabetes, heart disease and stroke, infant mortality, kidney disease, high blood pressure, women's health, and health-associated risk factors. The chapter includes a brief introduction, a listing of subject topics covered, and the organizations or publishers that serve as sources for the health materials. Representative publications (including audiovisual materials) are listed and briefly annotated under each organization. Organizations included in the listing should be contacted directly to determine the cost and availability of bulk quantities and for permission to photocopy. ·

American Indian and Alaska Native: Sources of Health Materials Source: Washington, DC: Office of Minority Health Resource Center. October 1997. [6 p.]. Contact: Available from Office of Minority Health Resource Center. P.O. Box 37337, Washington, DC 20013-7337. (800) 444-6472. Website: www.omhrc.gov. PRICE: Single copy free. Summary: This chapter is from a bibliography that lists sources of health materials that are written specifically for the needs of certain ethnic groups. The bibliography includes five sections: African Americans, American Indians (including Alaska Natives), Asians, Hispanics, and Pacific Islanders. This chapter lists culturally sensitive printed health materials identified for American Indians by the Office of Minority Health Resource Center (OMH-RC). The listing includes sources of information for AIDS, cancer, child development, diabetes, high blood pressure, nutrition, and substance abuse. The chapter includes a brief introduction, a listing of subject topics covered, and the organizations or publishers that serve as sources for the health materials. Representative publications (including audiovisual materials) are listed and briefly annotated under each organization. Organizations included in the listing should be contacted directly to determine the cost and availability of bulk quantities and for permission to photocopy.

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Asian Language: Sources of Health Materials Source: Washington, DC: Office of Minority Health Resource Center. 199x. [11 p.]. Contact: Available from Office of Minority Health Resource Center. P.O. Box 37337, Washington, DC 20013-7337. (800) 444-6472. Website: www.omhrc.gov. PRICE: Single copy free. Summary: This directory lists sources identified by the Office of Minority Health Resource Center (OMH RC) that produce or distribute health promotion materials in various Asian languages. Materials concentrate

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on minority health priority areas and associated risk factors: cancer, cardiovascular diseases and stroke, chemical dependency, diabetes, infant mortality, homicide, suicide, and unintentional injury. Sources of AIDS information and educational materials are also included. Topics related to kidney and urologic diseases include AIDS, cultural awareness, high blood pressure (hypertension), lupus, men's health, nutrition, sexually transmitted diseases, and women's health. Sources are arranged alphabetically. Organization entries include organization name, address, telephone number, source title, and annotation. The primary languages in which the organization provides materials are noted. Organizations should be contacted directly to determine the cost and availability of bulk quantities or for permission to photocopy. ·

Directory of Cardiovascular Resources for Minority Populations Source: Bethesda, MD, US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute, 122 p., January 1989. Contact: US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute Education Programs Information Center, 4733 Bethesda Avenue, Suite 530, Bethesda, MD 20814. (301) 951-3260. Summary: The Directory of Cardiovascular Resources for Minority Populations contains detailed information on printed and audiovisual materials for cardiovascular education specifically designed for the four major minority populations of the U.S.: Blacks, Hispanics, American Indians, and Asians/Pacific Islanders. Materials were selected on the basis of suitability for public education; therefore, scholarly publications have not been included. The directory is designed for use by health professionals who provide services to minority populations but can also be used by health care providers serving the general public. The directory describes leaflets, pamphlets, booklets, books, posters, wallet cards, films, and videotapes that address high blood pressure, high blood cholesterol, and cigarette smoking, as well as other risk factors such as obesity, nutrition, and sedentary lifestyle. Each entry includes information on the language, target audience, grade level, producer, publication date, reproduction restrictions, format, content description, availability, and cost of the materials.

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Finding resources for Healthy Heart programs at work Source: Bethesda, MD: National Heart, Lung, and Blood Institute, U.S. Department of Health and Human Services. 1992. 92 pp.

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Contact: Available from Information Center, National Heart, Lung, and Blood Institute, National Institutes of Health, P.O. Box 30105, Bethesda, MD 20824-0105. Telephone: (301) 951-3260. (NIH Publication No. 92-737). Summary: This resource directory is designed to assist in developing worksite Healthy Heart programs for employees. Healthy Heart programs emphasize cardiovascular health which includes high blood pressure, high cholesterol, smoking, nutrition, weight control, and physical fitness. There are three sections. The first section suggests organizations, associations, and government agencies which can provide information and resources on developing workplace health promotion activities. Included in this section is a list of National Heart, Lung, and Blood Institute Cardiovascular Disease Liaisons for each state health department. The second section lists brochures, guides, manuals, booklets, video recordings, programs, services, and other resources available through organizations. The third section is an alphabetical listing of the organizations with their addresses and phone numbers.

General Home References In addition to references for high blood pressure, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · The 21st Century Complete Medical Guide to Obesity and Weight Control, Dieting, Nutrition, Fat, Meal Plans and Activities: Authoritative Federal Government Documents, Clinical References, and Practical Information for Patients and Physicians by PM Medical Health News; CD-ROM, 29289 pages (February 18, 2002), Progressive Management; ISBN: 1931828180; http://www.amazon.com/exec/obidos/ASIN/1931828180/icongroupinterna · A Complete Guide to Obesity Surgery: Everything You Need to Know About Weight Loss Surgery and How to Succeed by Bryan G. Woodward; Paperback (June 2001), Trafford; ISBN: 1552126641; http://www.amazon.com/exec/obidos/ASIN/1552126641/icongroupinterna · The Diet Alternative : With Study Guide by Diane Hampton; Paperback February 2002), Whitaker House; ISBN: 0883687216; http://www.amazon.com/exec/obidos/ASIN/0883687216/icongroupinterna · Fat No More: The Answer for the Dangerously Overweight by Norman B. Ackerman; Paperback: 250 pages; (August 1999), Prometheus Books;

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ISBN: 1573926922; http://www.amazon.com/exec/obidos/ASIN/1573926922/icongroupinterna · Understanding Obesity: The Five Medical Causes (Your Personal Health) by Dr. Lance Levy; Paperback: 200 pages; (August 5, 2000), Key Porter Books; ISBN: 1552094790; http://www.amazon.com/exec/obidos/ASIN/1552094790/icongroupinterna

Vocabulary Builder Aerobic: 1. having molecular oxygen present. 2. growing, living, or occurring in the presence of molecular oxygen. 3. requiring oxygen for respiration. [EU] Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH] Apnea: A transient absence of spontaneous respiration. [NIH] Asymptomatic: Showing or causing no symptoms. [EU] Azotemia: An excess of urea or other nitrogenous compounds in the blood. [EU]

Benzene: Toxic, volatile, flammable liquid hydrocarbon biproduct of coal distillation. It is used as an industrial solvent in paints, varnishes, lacquer thinners, gasoline, etc. Benzene causes central nervous system damage acutely and bone marrow damage chronically and is carcinogenic. It was formerly used as parasiticide. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Biliary: Pertaining to the bile, to the bile ducts, or to the gallbladder. [EU] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Dysplasia: Abnormality of development; in pathology, alteration in size, shape, and organization of adult cells. [EU] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other health-related event occurring in such outbreaks. [EU] Erythropoietin: Glycoprotein hormone, secreted chiefly by the kidney in the adult and the liver in the fetus, that acts on erythroid stem cells of the bone marrow to stimulate proliferation and differentiation. [NIH]

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Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Ionization: 1. any process by which a neutral atom gains or loses electrons, thus acquiring a net charge, as the dissociation of a substance in solution into ions or ion production by the passage of radioactive particles. 2. iontophoresis. [EU] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH] Metabolite: process. [EU]

Any substance produced by metabolism or by a metabolic

Myeloma: A tumour composed of cells of the type normally found in the bone marrow. [EU] Nephrology: A subspecialty of internal medicine concerned with the anatomy, physiology, and pathology of the kidney. [NIH] Parathyroid: 1. situated beside the thyroid gland. 2. one of the parathyroid glands. 3. a sterile preparation of the water-soluble principle(s) of the parathyroid glands, ad-ministered parenterally as an antihypocalcaemic, especially in the treatment of acute hypoparathyroidism with tetany. [EU] Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [NIH] Sedentary: 1. sitting habitually; of inactive habits. 2. pertaining to a sitting posture. [EU] Xanthoma: A tumour composed of lipid-laden foam cells, which are histiocytes containing cytoplasmic lipid material. Called also xanthelasma. [EU]

Yohimbine: A plant alkaloid with alpha-2-adrenergic blocking activity. Yohimbine has been used as a mydriatic and in the treatment of impotence. It is also alleged to be an aphrodisiac. [NIH]

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CHAPTER 7. MULTIMEDIA ON HIGH BLOOD PRESSURE Overview Information on high blood pressure can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on high blood pressure. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.

Video Recordings Most diseases do not have a video dedicated to them. If they do, they are often rather technical in nature. An excellent source of multimedia information on high blood pressure is the Combined Health Information Database. You will need to limit your search to “video recording” and “high blood pressure” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” By making these selections and typing “high blood pressure” (or synonyms) into the “For these words:” box, you will only receive results on video productions. The following is a typical result when searching for video recordings on high blood pressure:

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Noise Pollution Source: Princeton, NJ: Films for the Humanities and Sciences. 1988. (videocassette). Contact: Available from Films for the Humanities and Sciences. P.O. Box 2053, Princeton, NJ 08543. (800) 257-5126 or (609) 275-1400; Fax (609) 2753767. Price: $149.00 plus shipping and handling. Summary: This program looks at research into the impact of noise on health. Noise can cause high blood pressure, fetal damage, a loss of brain cells, and hearing damage. The program asserts that almost every type of occupation poses potential dangers from excessive noise. The program also focuses on the efforts of air craft manufacturers, airports, and residents in the path of low-flying planes to minimize noise or actually to cancel it out through the generation of anti-noise at selected sound frequencies (AA-M).

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Diagnosing Alpha 1 Antitrypsin Deficiency Source: Minneapolis, MN: Alpha 1 Association. 199x. (videocassette). Contact: Available from Alpha 1 Association. 8120 Penn Avenue, South, Suite 549, Minneapolis, MN 55431-1326. (800) 521-3025 or (612) 703-9979. Fax (612) 703-9977. E-mail: [email protected]. Website: www.alpha1.org. Price: $3.00 plus shipping and handling. Summary: This videotape program, narrated by Sandra Brandley, the Executive Director of the Alpha 1 National Association, reminds physicians of the symptoms and differential diagnosis of alpha 1 antitrypsin deficiency (A1AD or Alpha 1). The program features Dr. James Stoller, who describes the typical underdiagnosis of A1AD which is typical: the mean time until diagnosis is 7 years (from onset of symptoms) and the mean number of doctors consulted before diagnosis is 3.5. Alpha 1 is a relatively common genetic disorder that affects infants, children, and adults. It is the most common metabolic disorder that causes liver disease in infants and children; the disorder also causes cirrhosis and cancer of the liver in adults. Symptoms of A1AD deficiency in children include prolonged obstructive jaundice, low birth weight, mildly elevated liver enzymes, cholestasis, enlarged liver, abnormal bleeding, feeding difficulties, poor growth (or failure to thrive), and ascites (abnormal accumulation of fluids). In adults, the spectrum of liver disease associated with A1AD deficiency varies from mild to severe. Symptoms include chronic active hepatitis, cryptogenic cirrhosis (liver scarring of unknown cause), portal hypertension (high blood pressure in the portal vein of the liver), and hepatocellular carcinoma (liver cancer). A rare but telling symptom is panniculitis, a chronic inflammation of

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subcutaneous fat featuring ulcerated skin lesions on the torso. Dr. Stoller reminds viewers of the indications for A1AD screening: premature onset of moderate to severe chronic obstructive pulmonary disease (COPD) before age 50; predominant basilar emphysema; chronic bronchitis with airflow obstruction in a nonsmoker; bronchiectasis (irreversible dilation and destruction of the bronchial walls) without clear risk factors; development of unremitting asthma; family history of A1AD; cirrhosis without apparent risk factors; and family history of panniculitis. The program includes a chart of laboratory values and the risk of development of A1AD, and a series of interviews with patients about the interplay of early diagnosis and good quality of life. The program concludes with the contact information for the Alpha 1 National Association (800-521-3025). ·

Diabetes Home Video Guide: Skills for Self-Care Source: Timonium, MD: Milner-Fenwick. 2000. (videocassette). Contact: Available from Milner-Fenwick, Inc. 2125 Greenspring Drive, Timonium, MD 21093-3100. (800) 432-8433. Fax (410) 252-6316. Price: $350.00; bulk orders available; plus shipping and handling. Order number: HV-14. Summary: This videotape provides people who have diabetes with information on the basic skills needed to keep blood glucose in the target range and offers tips for incorporating these skills into daily life. Part one focuses on diabetes and related health concerns. One chapter in this segment of the tape explains how diabetes affects the body, what the long term complications are, and how to determine an appropriate blood glucose range. Another chapter examines related health concerns such as smoking, high blood cholesterol, high blood pressure, and excess body weight. Part two deals with blood glucose management, focusing on education, diet, exercise, monitoring, and medications. The chapter on education discusses the importance of education, the diabetes care team, and other resources. The chapter on nutrition provides nutrition guidelines and discusses other aspects of healthy eating. The chapter on exercise explains how to create an exercise plan. Other topics include doing aerobic and weight bearing exercises, keeping exercise fun and safe, and maintaining physical activity. The chapter on blood glucose monitoring focuses on laboratory testing, blood glucose self testing, and self testing techniques. Other topics include blood glucose records, medical emergencies, and equipment and supplies. The chapter on medications focuses on oral medications and insulin. Topics include insulin care, injection, and supplies; hypoglycemia; and medication tracking systems. Part three addresses the challenges of self management

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and offers strategies to help the viewer balance diabetes management with living. One chapter in this segment focuses on understanding the importance of pattern management, recognizing patterns, and adjusting a treatment plan. Another chapter deals with solving problems associated with sick days, dining out, unusual schedules, travel, special occasions, and holidays. A third chapter discusses lifestyle changes and emotions, focusing on incorporating change into daily life, managing emotions, handling sexual dysfunction and stress, dealing with close relationships, and finding support. The final chapter of the segment offers suggestions on maintaining good health, focusing on foot, skin, eye, and dental care; immunizations; and medical appointment and test scheduling. The video is accompanied by a foldout guide that provides an overview of diabetes self care skills. ·

Living with Diabetes: Making the Diagnosis Source: Madison, WI: University of Wisconsin Hospitals and Clinics, Department of Outreach Education. 1999. (videocassette). Contact: Available from University of Wisconsin Hospital and Clinics. Picture of Health, 702 North Blackhawk Avenue, Suite 215, Madison, WI 53705-3357. (800) 757-4354 or (608) 263-6510. Fax (608) 262-7172. Price: $19.95 plus shipping and handling; bulk copies available. Order number 071899A. Summary: This videotape, part of a series on living with diabetes, focuses on the diagnosis of diabetes. A moderator discusses the new criteria for the diagnosis and classification of diabetes, the rise in the incidence of diabetes, the symptoms of diabetes, and the prevention of diabetes with an endocrinologist. The videotape begins with a discussion of what diabetes is, how insulin works, the types of diabetes, and risk factors for diabetes. Type 1 diabetes, which was formerly known as insulin dependent diabetes, usually develops quickly, whereas type 2 diabetes, which was formerly known as noninsulin dependent diabetes, usually has a gradual onset. The symptoms of diabetes, which are generally the same regardless of the type, are related to high blood sugar. They include excessive urination and thirst, fatigue, hunger, weight loss, and blurred vision. Risk factors for type 1 diabetes include a genetic predisposition for developing the disease. Risk factors for type 2 diabetes include being overweight, sedentary, and over 45 years old; having a history of stillbirth or gestational diabetes; having high blood pressure and high cholesterol; being African American, Hispanic, or Native American; and having previously been identified with impaired glucose tolerance. The acute complications of diabetes include ketoacidosis, nonketotic hyperosmolar syndrome, and hypoglycemia. The chronic complications

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are divided into microvascular and macrovascular complications. Microvascular complications include retinopathy, neuropathy, and nephropathy. Macrovascular complications include heart attack, stroke, and peripheral vascular disease. Early diagnosis is important in preventing complications. Diagnosis is based on blood sugar levels obtained from a blood glucose test, a fasting plasma glucose test, or an oral glucose tolerance test. The risk of developing type 2 diabetes may be reduced by eating properly, maintaining an ideal weight, and exercising. The videotape includes a self test that viewers can take to assess their risk of developing type 2 diabetes. ·

Smoking and Diabetes Source: Los Angeles, CA: National Health Video, Inc. 1998. (videocassette). Contact: Available from National Health Video, Inc. 12021 Wilshire Blvd., Suite 550, Los Angeles, CA 90025. (800) 543-6803. Fax (310) 477-8198. Email: [email protected]. Price: $89.00 plus shipping and handling. Order number 272. Summary: This videotape provides people who have diabetes with information on the effect of smoking on the disease. Smoking has a greater adverse effect on people who have diabetes than on otherwise healthy smokers. For example, the risk of heart disease is 14 times higher in a person has diabetes and smokes. In addition, vasoconstriction can lead to blindness and severe peripheral neuropathy. Other adverse effects of smoking in a person with diabetes include increasing the risk of high blood pressure, stroke, respiratory disease, various cancers, and periodontal disease; impeding the control of infection; limiting joint mobility; and contributing to impotence. The video offers tips on quitting, including learning about smoking habits and using a substitute for smoking when a pattern is identified, setting a quitting date, and using nicotine replacement therapy. In addition, the video presents suggestions on avoiding postcessation weight gain.

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Diabetes and Alcohol Source: Los Angeles, CA: National Health Video, Inc. 1998. (videocassette). Contact: Available from National Health Video, Inc. 12021 Wilshire Blvd., Suite 550, Los Angeles, CA 90025. (800) 543-6803. Fax (310) 477-8198. Email: [email protected]. Price: $89.00 plus shipping and handling. Order number 304.

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Summary: This videotape provides people who have diabetes with information on the impact of alcohol consumption on diabetes management. Important information for patients includes what constitutes a drink of hard liquor, wine, and beer and how alcohol and diabetes interact. Alcohol can cause hypoglycemia, intensify insulin action, cause sleep disturbances, make weight management more difficult, use up vitamins and minerals or interfere with their absorption, kill liver cells, increase the symptoms of neuropathy, contribute to high blood pressure, and reduce the ability to think clearly. In addition, when consumed during pregnancy, alcohol can pose a danger to the fetus. ·

Strategies for the Prevention and Treatment of Macrovascular Complications of Type 2 Diabetes Source: Kansas City, MO: American Academy of Family Physicians. 1998. (videocassette). Contact: Available from American Academy of Family Physicians. 8880 Ward Parkway, Kansas City, MO 64114-2797. (800) 274-2237. Price: $17.95 for members; $25.00 for non-members, plus shipping and handling. Summary: The macrovascular (large blood vessel) complications of diabetes account for the majority of the morbidity (related illness) and mortality (death) associated with the disease. In particular, people with type 2 diabetes are at increased risk for cardiovascular disease, since they exhibit many independent risk factors for heart disease, including obesity, hypertension (high blood pressure), and dyslipidemia (disordered levels of fats in the blood). This continuing education program features a videocassette and study guide that discuss why people with diabetes are at increased risk for macrovascular complications and how to reduce the patient's risk of cardiovascular disease. Topics include hyperglycemia (high blood glucose levels) and cardiovascular disease, insulin resistance and cardiovascular disease, the benefits of improved glycemic control, recommended target glycemic goals, nonpharmacologic therapies for diabetes (diet, exercise, patient education), pharmacologic (drug) therapies for diabetes (insulin secretagogues, insulin sensitizers, alpha-glucosidase inhibitors, and insulin), determining the optimal drug treatment regimen for individual patients, and treating cardiovascular risk factors. The program recommends that patients should be seen quarterly or more often, depending upon the severity of their disease, and target goals for HbA1c (glycosylated hemoglobin, a measurement of blood glucose levels over time) and fasting blood glucose should be established at the initial visit and discussed directly with the patient. Patients should be reminded at every office visit that weight loss and regular exercise are the most

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important aspects of controlling their diabetes and reducing the risk of macrovascular disease. A sample patient education hand out is included in the study guide. Through this program, users can qualify for one credit hour of Continuing Medical Education (CME) in category 1; the appropriate posttest is provided. 5 figures. 14 tables. 15 references. ·

Diabetes and Heart Disease Source: Dallas, TX: American Heart Association. 1996. (videorecording). Contact: Available from Channing L. Bete Company/American Heart Association. Fulfillment Center, 200 State Road, South Deerfield, MA 01373-0200. (800) 611-6083. Fax (800) 499-6464. E-mail: [email protected]. Price: $39.00 plus shipping and handling. Summary: This video, which was developed by the American Heart Association, is intended to help people with diabetes become better informed about heart disease. The video points out that people who have diabetes have a increased risk of developing problems that involve the cardiovascular system. These problems include atherosclerosis (the build up of fatty acids in arteries) and hypertension (high blood pressure). High levels of glucose can damage arteries and increase the likelihood of hypertension and atherosclerosis. In some cases, hypertension may be controlled with changes in lifestyle, such as losing weight, reducing salt intake, and exercising. When lifestyle changes are insufficient to control hypertension, medication is used. The video notes that people must not treat hypertension with over the counter medicines or prescriptions from a friend because they may worsen diabetes or its related conditions. Many of the things that help to manage diabetes can also be effective in reducing the risk of heart disease. Self monitoring of blood glucose, eating healthfully, exercising, taking medication as needed, and educating oneself are each important. The video concludes that people with diabetes can successfully control blood glucose levels and significantly lower the risk of heart disease by making appropriate lifestyle changes and working with health care professionals. An accompanying brochure focuses on topics addressed in the video. The video is available in English or Spanish. (AA-M).

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Best of Living With Diabetes Television Video Series, Volume 1 Source: Vista, CA: CNBC. Lifetime. 1995. Contact: Available from Living with Diabetes. P.O. Box 2514, Vista, CA 92085-2514. (800) 433-2469. Price: $19.95 (as of 1995). Summary: In this videotape program, television medical correspondent Pat Gallagher narrates a compilation of the best of 100 episodes of the

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newsmagazine television show called Living With Diabetes. Produced by CNBC and Lifetime, the program explains the difference between insulindependent and noninsulin-dependent diabetes, and covers weight loss, exercise, cholesterol, high blood pressure, neuropathy, foot care, eye disease, kidney disease, and proper disposal of syringes. In addition, Terri Miller, a nurse and diabetes educator who has diabetes, shares practical tips on living with diabetes. (AA-M). ·

Barbershop Talk: Benny's Advice on Healthy Eating: A Nutrition Video for the Black Community Source: Southampton, PA: Dairy Council, Inc. 199x. (videocassette with leader's guide, participant cards, and education materials). Contact: Available from Dairy Council, Inc. 1225 Industrial Highway, Southampton, PA 18966-4010. (215) 322-0450. Price: $15 for video and all instructional materials. Video alone available for $12. Additional Leader's Guides and participant cards also available separately. Summary: This nutrition videotape on health targets black males. The videotape shows a group of African American men in an everyday setting talking about nutrition and health. Topics include high blood pressure, controlling dietary fats, lactose intolerance, the basic four food groups, soul food, and weight control. The packet includes the videotape, a leader's guide, 25 participant's cards, and Dairy Council education materials. The materials focus on the prevention of common health problems in this population, notably hypertension and diabetes.

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Choices: Options for Living with Kidney Failure Source: McGaw Park, IL: Baxter Healthcare Corporation. 1997 (videocassette). Contact: Available from community service section of Blockbuster video stores. Price: Free rental. Also available to health professionals from Baxter Healthcare Corporation. (888) 736-2543. 1620 Waukegan Road, McGaw Park, IL 60085. Summary: This videotape program helps viewers newly diagnosed with kidney failure to understand their treatment options and to make more informed choices for their own health care. The narrator reminds viewers that many members make up the health care team, but stresses that patients are the most important member of that team. The program reviews the functions of the kidneys, including clean the blood, make red blood cells, help maintain healthy bones and other bodily functions, balance body fluids and chemical levels, and retain valuable substances. Graphics demonstrate each of these functions. The narrator reviews the

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symptoms of kidney failure, and then real patients tell their own experiences of their movement into chronic kidney failure. The program outlines the common causes of chronic kidney failure, including diabetes, glomerulonephritis, hypertension (high blood pressure), polycystic kidney disease, and infections. The remainder of the program outlines each of the treatment options: hemodialysis, peritoneal dialysis, automated peritoneal dialysis (APD), and kidney transplantation. For each type, the program offers live footage of real patients using that treatment, drawings and graphics that demonstrate how the treatment works, and interviews with patients talking about how that treatment affects their lives. The program summarizes the reasons why each treatment option may be appropriate or inappropriate for a specific patient. The program concludes with a list of general guidelines that can help to reduce treatment side effects and with a list of associations to contact for more information. ·

Exercise: The Other Half of Weight Control Source: Bloomington, MN, Media Group Productions, 7-minute VHS videotape, 1984. Contact: Bloomington Heart and Health Program, 1900 West Old Shakopee Road, Bloomington, MN 55431. (612) 887-9603. Summary: Exercise: The Other Half of Weight Control is a videotape that stresses the importance of exercise in any weight-loss plan. The Minnesota Heart Health Program presents evidence for why diets won't work without exercise, and how to get the most out of an exercise program. Weight loss is a difficult balancing act between calorie intake and calorie output. The best way to increase your calorie output is through exercise. Some examples of the calories expended through exercise include (1) walking (300-400 kcal/hr), (2) swimming (400-500 kcal/hr), (3) biking (400-600 kcal/hr), (4) jogging (600-700 kcal/hr), and (5) cross-country skiing (600-800 kcal/hr). In contrast, sitting and other sedentary activities burn only 70-100 kcal/hr. Inactivity leads to high blood pressure, high cholesterol, obesity, and diabetes. There are many health benefits of exercise: (1) Exercise burns calories now and later; (2) exercise regulates the appetite; (3) exercise reduces fat and increases muscle tissue; and (4) exercise along with dieting leads to a 100 percent fat loss, whereas dieting without exercise leads to only a 60 percent fat loss and a 40 percent muscle tissue loss.

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Health Education Works! Source: Reston, VA, Association for the Advancement of Health Education, 16-minute VHS videotape.

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Contact: Association for the Advancement of Health Education, 1900 Association Drive, Reston, VA 22091. (703) 476-3437. Summary: Health Education Works! explains how health education efforts can be more effective by providing examples of success stories from four educational environments: School, community, clinic, and worksite. Health education in the school environment, whether it is targeted at a specific behavior like smoking or is comprehensive, has shown positive results. Programs like Project Prevent, The 3 R's and High Blood Pressure, Health Education Curriculum Guide, and Growing Healthy all demonstrate positive changes in health knowledge, attitudes, and practices in those who have taken them. Community health education has also shown success, and several program profiles have demonstrated positive health effects including (1) lowered teen pregnancy rates in a targeted, predominately black, low-income community; (2) measurable reductions in teen-related alcohol traffic fatalities (Maine's Project Graduation); (3) reductions in high blood pressure and mortality due to hypertension; and (4) increased physical health in persons with diabetes (the Zuni Diabetes Project). The video also reviews how clinical health education has had positive effects in 400 hypertension patients by stressing the importance of weight control, regular medical appointments, and efforts to maintain lower blood pressure. The program demonstrates that (1) carefully planned clinical health education can influence modifiable risk behavior, (2) such modifications are linked to premature mortality, and (3) similar positive effects can be achieved with minority populations. Worksite health promotion benefits both employees and employers. Employees benefit from a safer worksite environment and healthy lifestyle programs, while employers can realize various cost reduction benefits and higher productivity by promoting health at the worksite. A profile of Johnson and Johnson's comprehensive health program Live for Life shows substantial gains in employee health and employer cost savings in health-related benefit expenditures. The video concludes with some common elements found in all these successful health programs: (1) Careful planning, (2) a focus on the modified risk factors associated with health and daily task performance, (3) the use of multiple health promotion methods appropriate to the target group, (4) involvement of program participants in the planning and implementation stages, and (5) program delivery by competent and qualified personnel.

Bibliography: Multimedia on High Blood Pressure The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer

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software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in high blood pressure (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on high blood pressure. For more information, follow the hyperlink indicated: ·

Arterial lines. Source: produced by Springhouse Corporation, with Blanchard-Healy Video Communications, Inc; Year: 1992; Format: Videorecording; Springhouse, PA: Springhouse Corp., c1992

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Avoiding mistakes in the diagnosis and management of hypertension. Source: Thomas D. Giles; Year: 1993; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, 1993

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Blood pressure : salt, slavery, and survival. Source: Marshfield Clinic, Saint Joseph's Hospital; a presentation of the Marshfield Video Network; Year: 1996; Format: Videorecording; Marshfield, WI: The Clinic, [1996]

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Blood pressure management. Source: Department of Postgraduate Medicine and Health Professions Education at the University of Michigan Medical Center, under contract with the Michigan Department of Public Health, Division of Chronic Disease, in cooperatio; Year: 1983; Format: Slide; [Ann Arbor, Mich.]: University of Michigan, c1983

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Carotid body hypersensitivity syndrome deinervation [videorecording]: journey into blood pressure control. Source: produced by Cine´-Med; Year: 1989; Format: I.e. denervation; Woodbury, Conn.: Cine´-Med, c1989

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Charge nurses approach to changes in vital signs. Source: QualityCare; Year: 1999; Format: Videorecording; North Hollywood, CA: QualityCare, c1999

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Coronary risk reduction in hypertensive patients. Source: [presented by] Marshfield Clinic, Saint Joseph's Hospital [and] Marshfield Medical Research Foundation; Year: 1991; Format: Videorecording; Marshfield, WI: Marshfield Regional Video Network, [1991]

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Evolution of the treatment of hypertension and a review of J & C number five [videorecording]. Source: the University of Texas Medical School at Houston; produced by UT-TV; Year: 1992; Format: I.e. JNC; Washington, D.C.: Distributed by Universal Health Associates, c1992

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Fundamentals of patient care, vital signs. Source: DAROX Interactive; Year: 1993; Format: Videorecording; La Jolla, CA: DAROX, 1993

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Hypertension : recent advances in diagnosis & management. Source: OMEN, Ohio Medical Education Network; Year: 1991; Format: Videorecording; [Columbus, Ohio]: Ohio State University, c1991

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Hypertension : the facts. Source: a presentation of Films for the Humanities & Sciences; Year: 2000; Format: Videorecording; Princeton, NJ: Films for the Humanities & Sciences, c2000

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Hypertension management : radical new paradigms. Source: Marshfield Clinic, Saint Joseph's Hospital; a presentation of the Marshfield Video Network; Year: 1998; Format: Videorecording; Marshfield, WI: The Network, c1998

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Measurement of blood pressure. Source: Francis Payne Bolton School of Nursing, Case Western Reserve University; Year: 1971; Format: Videorecording; [Cleveland, Ohio]: The University, c1971

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Measurement of the patient's blood pressure. Source: produced by the Department of Telecommunications; written and directed by John W. Sponaugle; Year: 1986; Format: Videorecording; Lewisburg, WV: J.W. Sponaugle, c1986

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Measuring blood pressure : identifying Korotkoff sounds. Source: Shared Care Productions; Year: 1990; Format: Videorecording; Rancho Palos Verdes, Calif.: Shared Care, c1990

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Measuring vital signs:. Source: [temperature, pulse, respiration, and blood pressure] / [presented by] Medcom; Year: 1997; Format: Videorecording; Cypress, CA: Medcom, c1997

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Measuring vital signs. Source: [presented by] Medcom; Year: 1997; Format: Videorecording; Cypress, CA: Medcom, c1997

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Noninvasive ambulatory blood pressure monitoring : current applications. Source: with Lawrence R. Krakoff; Year: 1987; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, 1987

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Obtaining vital signs. Source: Samuel Merritt College, Studio Three Productions; Year: 1997; Format: Videorecording; [Philadelphia, Pa.]: Lippincott, c1997

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Pediatric hypertension. Source: HSN, Hospital Satellite Network; Year: 1986; Format: Videorecording; Los Angeles, Calif.: The Network, c1986

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Pulse, blood pressure, and blood chemistry. Source: [presented by] Lawrence Educational Media; Year: 1995; Format: Videorecording; [Gainesville, Fla.]: Lawrence Educational Media, [c1995]

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Reflexes from the carotid bodies and sinuses in the dog. Source: [presented by] the U.S. Army; Year: 1948; Format: Motion picture; United States: Army, 1948

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Taking a blood pressure. Source: produced under the supervision of the Bureau of Aeronautics for the Bureau of Medicine and Surgery by Chicago Film Laboratory, Inc; Year: 1943; Format: Motion picture; United States: Navy Dept., [1943]

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Vital sign, blood pressure. Source: Intercollegiate Center for Nursing Education; a Learning Resources Unit production; Year: 1985; Format: Videorecording; Spokane, Wash.: I.C.N.E., c1985

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Vital signs : temperature, pulse, respiration, blood pressure. Source: [presented by] Fuld Institute for Technology in Nursing Education; Year: 1993; Format: Videorecording; Athens, Ohio: The Institute, c1993

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Vital signs : temperature, pulse, respiration, blood pressure. Source: prepared by Curriculum Development & Distance Education Department, Confederation College of Applied Arts & Technology; produced by the Confederation College of Applied Arts; Year: 1989; Format: Videorecording; [Thunder Bay, Ont.]: Confederation College, c1989

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Vital signs. Source: Mosby [and] Samuel Merritt College, Studio Three Productions; Year: 1993; Format: Videorecording; [St. Louis, Mo.]: Mosby, c1993

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Vital signs. Source: ICNE; a Learning Resources Unit production; Year: 1991; Format: Videorecording; [Spokane, Wash.]: ICNE, c1991

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Vital signs. Source: produced by American Safety Video Publishers, Inc; Year: 1990; Format: Videorecording; Naples, Fla.: ASVP, c1990

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Vital signs. Source: produced by Medcom/Trainex, Inc; Year: 1990; Format: Videorecording; Garden Grove, CA, USA: Medcom/Trainex, c1990

Vocabulary Builder Ascites: Effusion and accumulation of serous fluid in the abdominal cavity; called also abdominal or peritoneal dropsy, hydroperitonia, and hydrops abdominis. [EU] Bronchiectasis: Chronic dilatation of the bronchi marked by fetid breath and paroxysmal coughing, with the expectoration of mucopurulent matter. It may effect the tube uniformly (cylindric b.), or occur in irregular pockets (sacculated b.) or the dilated tubes may have terminal bulbous enlargements (fusiform b.). [EU] Carcinoma: A malignant new growth made up of epithelial cells tending to infiltrate the surrounding tissues and give rise to metastases. [EU]

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Cholestasis: Impairment of biliary flow at any level from the hepatocyte to Vater's ampulla. [NIH] Emphysema: A pathological accumulation of air in tissues or organs; applied especially to such a condition of the lungs. [EU] Hypersensitivity: A state of altered reactivity in which the body reacts with an exaggerated immune response to a foreign substance. Hypersensitivity reactions are classified as immediate or delayed, types I and IV, respectively, in the Gell and Coombs classification (q.v.) of immune responses. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Ketoacidosis: Acidosis accompanied by the accumulation of ketone bodies (ketosis) in the body tissues and fluids, as in diabetic acidosis. [EU] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Panniculitis: An inflammatory reaction of the subcutaneous fat, which may involve the connective tissue septa between the fat lobes, the septa lobules and vessels, or the fat lobules, characterized by the development of single or multiple cutaneous nodules. [EU]

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CHAPTER 8. PERIODICALS AND NEWS ON HIGH BLOOD PRESSURE Overview Keeping up on the news relating to high blood pressure can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on high blood pressure. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover high blood pressure beyond and including those which are published by patient associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.

News Services & Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on high blood pressure is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.

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PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “high blood pressure” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased. The following is typical of press releases that can be found on PR Newswire: ·

Results of a New Study Show That Irbesartan May Provide Additional Benefits For High Risk Patients With High Blood Pressure Summary: NEW YORK, May 16 /PRNewswire/ -- The results of a new study, which were presented today at the American Society of Hypertension 17th Annual Scientific Meeting (ASH), indicate that the high blood pressure medication irbesartan, may provide additional benefits for high risk patients with high blood pressure. The study evaluated patients at higher risk of cardiovascular events. According to the results of the study titled, "Irbesartan Reduces QT Dispersion in Hypertensive Patients with Left Ventricular Hypertrophy," irbesartan, an angiotensin II receptor antagonist (AIIRA) provided greater reductions in QT dispersion than atenolol, a member of another class of commonly prescribed high blood pressure medications called beta blockers. Increased QT dispersion can contribute to the development of lifethreatening arrhythmias and sudden cardiac death. "The results of this study are important because they provide us with additional information about the benefits of irbesartan when used to manage high risk patients with elevated blood pressure," said Thomas Kahan M.D., Karolinska Institute Danderyd Hospital, Division of Internal Medicine, Section of Cardiology, Stockholm, Sweden. "In addition to providing significant reductions in blood pressure, the results of this study demonstrate that irbesartan also contributes to reductions in QT dispersion. These reductions in QT dispersion may also help patients to reduce their risk of suffering the serious health consequences of heart arrhythmias and sudden cardiac death." QT dispersion is a measure of the synchronization of electrical activity of the heart. An increase in QT dispersion is a sign of desynchronized electrical functioning of the heart. An increase in QT dispersion often accompanies left ventricular hypertrophy (LVH), a condition in which

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the walls of the heart muscle thicken due to increased workload usually caused by longstanding high blood pressure. Increased QT dispersion can lead to life-threatening cardiac arrhythmias (a change in the rate and rhythm of the heartbeat) and cardiac death. A reduction in QT dispersion may therefore reduce the risk of such cardiovascular events. The study was designed to evaluate the effects of two hypertension treatments, irbesartan or atenolol, and their ability to reduce QT dispersion and left ventricular mass index (LVMI) -- a measure of LVH -in high risk patients with hypertension. In the study, 92 hypertensive patients with seated diastolic blood pressure between 95 and 115 mm Hg and LVH, were randomized to receive irbesartan 150 mg once daily or atenolol 50 mg once daily for 48 weeks. Study participants who received irbesartan had a greater reduction in QT dispersion at 12 weeks of treatment and this trend continued up to 48 weeks of treatment, compared to patients on atenolol (56 +/- 24 to 44 +/- 20 ms for irbesartan versus 48 +/- 20 to 53 +/- 20 ms for atenolol; p = 0.001). Greater reductions in LVMI were found in patients treated with irbesartan versus those in the atenolol group (-27 +/- 29 versus -18 +/- 21 g/m2, p=0.031), indicating a potential for reduction of cardiovascular events in the LVH patients who received irbesartan. The reduction in QT dispersion seen with irbesartan therapy was independent of changes in LVMI, blood pressure or heart rate. "The greater reduction in QT dispersion produced by irbesartan in this study may indicate a role for irbesartan in improving cardiovascular morbidity and mortality in this high risk hypertensive population," said Professor Kahan. "These results reinforce the beneficial effects of irbesartan beyond blood pressure lowering." Approximately four million people in the United States over the age of 55 years have hypertension and LVH and up to one-third of patients may die from a cardiac disease within five years of a LVH diagnosis. Karolinska Institutet (Institute) is a complete medical university that is responsible for 40 percent of all medical research performed at universities throughout Sweden. Through research training and information, the Institute contributes to improving human health. The research spans from basic research in molecular biology to public health science and care research. Danderyd University Hospital is one of four teaching and research hospitals within Karolinska Institutet. The Division of Internal Medicine is well recognized for cardiovascular and metabolic research.

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The study was supported by a grant from Bristol-Myers Squibb and Sanofi-Synthelabo. Irbesartan is known by the Avapro(R)/Aprovel(TM)/Karvea(TM).

following

trade

names:

Reuters The Reuters’ Medical News database can be very useful in exploring news archives relating to high blood pressure. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/frame2/arch.html and search by “high blood pressure” (or synonyms). The following was recently listed in this archive for high blood pressure: ·

Prevalence of high blood pressure increasing among US adults Source: Reuters Medical News Date: May 30, 2002 http://www.reuters.gov/archive/2002/05/30/professional/links/20020 530epid003.html

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High blood pressure increasing among US adults Source: Reuters Health eLine Date: May 30, 2002 http://www.reuters.gov/archive/2002/05/30/eline/links/20020530elin 018.html

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FDA approves new pill for high blood pressure Source: Reuters Health eLine Date: April 29, 2002 http://www.reuters.gov/archive/2002/04/29/eline/links/20020429elin 032.html

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No link seen between headache, high blood pressure Source: Reuters Health eLine Date: March 25, 2002 http://www.reuters.gov/archive/2002/03/25/eline/links/20020325elin 013.html

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Coffee drinking not linked to chronic hypertension Source: Reuters Health eLine Date: March 25, 2002 http://www.reuters.gov/archive/2002/03/25/eline/links/20020325elin 014.html

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High blood pressure tied to low testosterone Source: Reuters Health eLine Date: March 18, 2002 http://www.reuters.gov/archive/2002/03/18/eline/links/20020318elin 011.html

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High blood pressure awaits 9 out of 10 Americans Source: Reuters Health eLine Date: February 26, 2002 http://www.reuters.gov/archive/2002/02/26/eline/links/20020226elin 012.html

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Study suggests docs undertreat high blood pressure Source: Reuters Health eLine Date: February 25, 2002 http://www.reuters.gov/archive/2002/02/25/eline/links/20020225elin 014.html

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Negative association seen between dyslexia and familial high blood pressure Source: Reuters Medical News Date: January 07, 2002 http://www.reuters.gov/archive/2002/01/07/professional/links/20020 107epid003.html

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Many diabetics fail to control high blood pressure Source: Reuters Health eLine Date: January 01, 2002 http://www.reuters.gov/archive/2002/01/01/eline/links/20020101elin 023.html

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High-meat, low-carb diet in pregnancy linked to high blood pressure in offspring Source: Reuters Medical News Date: December 31, 2001 http://www.reuters.gov/archive/2001/12/31/professional/links/20011 231epid005.html

The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date

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at http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within their search engine.

Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name.

Internet Wire Internet Wire is more focused on technology than the other wires. To access this site, go to http://www.internetwire.com and use the “Search Archive” option. Type in “high blood pressure” (or synonyms). As this service is oriented to technology, you may wish to search for press releases covering diagnostic procedures or tests that you may have read about.

Search Engines Free-to-view news can also be found in the news section of your favorite search engines (see the health news page at Yahoo: http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “high blood pressure” (or synonyms). If you know the name of a company that is relevant to high blood pressure, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks.

BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “high blood pressure” (or synonyms).

Newsletters on High Blood Pressure Given their focus on current and relevant developments, newsletters are often more useful to patients than academic articles. You can find

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newsletters using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Your investigation must limit the search to “Newsletter” and “high blood pressure.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” By making these selections and typing in “high blood pressure” or synonyms into the “For these words:” box, you will only receive results on newsletters. The following list was generated using the options described above: ·

Kidney Failure in Sarcoidosis Source: Sarcoidosis Networking. 8(3): 3. 2000. Contact: Available from Sarcoid Network Association. Sarcoidosis Networking, 13925 80th Street East, Puyallup, WA 98372-3614. Email: [email protected]. Summary: Sarcoidosis is a chronic, progressive systemic granulomatous (causing lesions) disease of unknown cause (etiology), involving almost any organ or tissue, including the skin, lungs, lymph nodes, liver, spleen, eyes, and small bones of the hands or feet. This brief article, from a newsletter for patients with sarcoidosis, reviews the complications of kidney failure in sarcoidosis. Granulomatous infiltration of the kidney may be present in as many as 40 percent of patients with sarcoidosis, but it is rarely extensive enough to cause renal (kidney) dysfunction. The lesions are usually responsive to steroid therapy. Kidney failure has also been diagnosed in patients with sarcoidosis without the presence of lesions, possibly due to hypercalcemia (too much calcium in the blood), involvement of the glomerular filter system, and renal arteritis (inflammation of the arteries of the kidney), which may be associated with severe high blood pressure. It is recommended that all people with active sarcoidosis be screened for hypercalciuria (high levels of calcium in the urine). This may precede development of hypercalcemia, which should be treated. Glucocorticoids are the main choice of therapy and do seem to reduce levels of urinary calcium to normal within a few days. People with sarcoidosis may also have severe pain; the frequent use of pain medication can be another cause of kidney failure. People who take pain medication should ask their physicians to evaluate their kidneys on a regular basis. 9 references.

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Kidney Disease Source: Sarcoidosis Networking. 8(3): 2. May-June 2000.

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Contact: Available from Sarcoid Network Association. Sarcoidosis Networking, 13925 80th Street East, Puyallup, WA 98372-3614. Email: [email protected]. Summary: Sarcoidosis is a chronic, progressive systemic granulomatous (causing lesions) disease of unknown cause (etiology), involving almost any organ or tissue, including the skin, lungs, lymph nodes, liver, spleen, eyes, and small bones of the hands or feet. This brief article, from a newsletter for patients with sarcoidosis, reviews kidney disease, its types, diagnosis, and management. The article begins with a summary of the anatomy and function of the kidneys, which filter the blood (removing waste and excess body fluids), and maintain the balance of some essential nutrients helping to regulate blood pressure, red blood cells, and elements such as potassium and calcium. Without functioning kidneys, one cannot live without dialysis, the mechanical filtration of the blood. Kidneys fail for a variety of reasons, including trauma to the kidney, toxins, heart failure, obstruction (kidney stones), overuse of some medications, and diseases that invade the kidney, such as sarcoidosis. Diabetes and high blood pressure are the most common causes for loss of kidney function. Warning signs of kidney disease are high blood pressure (hypertension), blood or protein in the urine, creatinine level greater than 1.2 in women or 1.4 in men, more frequent urination (especially at night), difficult or painful urination, and puffy eyes or swelling of the hands or feet (especially in children). Loss of kidney function can produce symptoms including fatigue, weakness, nausea, vomiting, diarrhea or constipation, headaches, loss of appetite, increased edema (fluid retention), and fever or chills. Kidney failure is characterized as acute kidney failure, chronic kidney insufficiency, and chronic kidney failure. The need to put a person on dialysis depends upon the levels of creatinine and urea nitrogen in the blood and the evaluation of body parameters such as fluid status, and symptoms of toxicity. The author encourages readers to practice preventive measures which include drinking 8 to 10 glasses of water per day, preventing or treating diabetes and high blood pressure, avoiding tobacco, eating a well balanced diet, practicing good hygiene, treating wounds and infections, limiting exposure to heavy metals and toxic chemicals, and avoiding unnecessary over the counter drug use. ·

Physical Activity and Women's Health Source: Physical Activity and Fitness Research Digest. 2(5):1-8, March 1996. Summary: Physical Activity and Women's Health is a feature article from a newsletter on physical activity and fitness. The author presents the

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growing body of evidence for the beneficial relationships between physical activity (including exercise and physical fitness) and the major chronic diseases in women, with special references to race and ethnicity. The most current data on habitual physical activity are from the Behavioral Risk Factor Surveillance System, a state-based survey to collect self-reported information of adults. Only 27 percent of female respondents in 48 states and the District of Columbia reported participation in leisure-time physical activity in levels recommended by the Centers for Disease Control and the American College of Sports Medicine. Women, especially women of color, are more likely to be sedentary than men. In 1990, 4 of the 10 leading causes of death in American women are chronic diseases directly associated with modifiable behavioral factors including physical inactivity or sedentary lifestyle such as heart disease, various cancers, hypertension, stroke, and non-insulin-dependent diabetes mellitus. Controlling body fatness, another factor that relates to the increased risk of chronic diseases, also relates to inactivity. The author discusses major modifiable risk factors for cardiovascular diseases and their relation to physical inactivity including high blood cholesterol and high blood pressure. The author also states that habitual physical activity reduces the risk of hypertension in women, a risk factor for stroke, which is the leading cause of disability in American women. Increasing evidence also indicates that physical activity is associated with decreased overall cancer mortality and decreased incidence of specific types of cancers. Several studies in American women suggest that risk for breast cancer may be lowered in those who are habitually active. The author also cites studies indicating that regular physical activity has an important role in both treatment and prevention of non-insulin-dependent diabetes mellitus among women through its association with reduced body weight, and its independent effects on insulin sensitivity and glucose tolerance. Greater attention to prevention and treatment of obesity in minority populations may help to address critical health issues in American women. The author concludes that research and educational efforts must focus on conceptually-based programs in schools and communities that are culturally-sensitive and ethnic-specific. ·

Health Benefits of Physical Activity Source: Physical Activity and Fitness Research Digest. 1(1):1-8, February 1993. Summary: The Health Benefits of Physical Activity is a newsletter issue that provides a simple summary of the benefits of physical activity. Section one, Disease Prevention and Treatment, lists the diseases for

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which regular physical activity can reduce risk, either of getting the disease or of dying from it, and describes how exercise reduces risk for these diseases. Diseases that can be prevented through physical activity include (1) heart disease, (2) stroke, (3) vascular disease, (4) high blood pressure, (5) diabetes, (6) colon cancer, (7) obesity, (8) depression, (9) back pain, and (10) osteoporosis. Physical activity has been shown to have a significant beneficial health effect on individuals suffering from depression. Section two, Health Promotion, discusses the Healthy People 2000 report and its health goals. While physical activity's contribution to quality of life and a personal sense of well-being is more difficult to document than its contribution to prevention and treatment of disease, evidence suggests that humans were designed to be physically active and that physical activity has great potential for enhancing quality of life. Section three, Physical Fitness, examines the relationship between physical activity and physical fitness. Physical fitness has been linked to injury prevention and is often an important factor in the level of body fat, which can affect disease risk. Regular physical activity has positive benefits for both good health and adequate physical fitness.

Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” By making these selections, and typing in “high blood pressure” (or synonyms) into the “For these words:” box, you will only receive results on newsletter articles. You should check back periodically with this database as it is updated every 3 months. The following is a typical result when searching for newsletter articles on high blood pressure: ·

Kidney Failure: Early Detection Is Key Source: Mayo Clinic Health Letter. 18(10): 1-3. October 2000. Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 333-9037 or (303) 604-1465.

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Summary: This health information newsletter article describes the role of early detection in the adequate treatment of kidney failure. The author notes that kidney failure (the term for a decline in kidney function) is becoming more common because people are living longer with chronic illnesses that can harm their kidneys. To preserve kidney function, it is important to manage conditions that can affect the kidneys, as well as to recognize and treat kidney failure as early as possible. The article briefly reviews the anatomy and function of the kidneys, which not only filter out waste products but also regulate certain chemicals in the body, produce several important hormones (for manufacturing red blood cells), regulate blood pressure, and maintain bone calcium. The majority of people who need dialysis because of kidney failure have diabetes mellitus, hypertension (high blood pressure), or both. The symptoms of kidney failure may go unrecognized until substantial damage has occurred and kidney function is at just a small fraction of the normal level. The destruction of the filtering nephrons in the kidney can result in symptoms including a prolonged flulike illness, headaches, fatigue, itchiness over the entire body, a need to urinate less or more often, loss of appetite, and nausea and vomiting. When fewer nephrons are functioning, wastes and fluids accumulate in the blood. However, simple blood tests and urinalysis done during a routine exam may detect kidney failure even before symptoms show up. The article concludes by reminding readers of the importance of controlling high blood pressure in order to prevent or delay kidney failure, the need to control blood glucose (sugar) levels for people with diabetes, and the concept of maintaining adequate and healthy nutrition and fluid levels (including avoiding toxic drugs or herbal supplements). One sidebar reviews the most common tests of kidney function which check for creatinine, blood urea nitrogen (BUN), and proteinuria (protein in the urine). 2 figures. ·

Hypertension Drugs: They Can Treat More Than High Blood Pressure Source: Mayo Clinic Health Letter. 17(11): 5. November 1999. Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 333-9037 or (303) 604-1465. Summary: This health newsletter article reviews the drugs used to treat hypertension (high blood pressure). The author focuses on the additional benefits of these drugs. Not only do hypertension drugs help control elevated blood pressure, but some actually offer additional health benefits. These can include treating heart failure, diabetes, or symptoms resulting from an enlarged prostate. There are several types of hypertension drugs, and each type helps control elevated blood pressure in a different way. These include diuretics, beta blockers, angiotensin

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converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, calcium channel blockers, alpha blockers, and central acting agents (central adrenergic inhibitors). In choosing drug therapy to treat a specific patient's hypertension, the physician will consider age, overall health, other medications already being taken, and cost considerations. One table outlines the possible additional health benefits these drugs have beyond treating elevated blood pressure. 1 table. ·

Dialysis: Need for Artificial Kidney Treatment is Increasing Source: Mayo Clinic Health Letter. 15(2): 1-3. February 1997. Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 333-9037. Summary: This newsletter article reminds readers of the kidney's role in 'removing the garbage' from the body. The author explains how dialysis takes over the kidney's role. The author first describes how many different diseases or events can damage the kidneys and cause them to fail. Common conditions include diabetes, high blood pressure, and an inflammation of the kidneys called glomerulonephritis. The author goes on to describe hemodialysis and peritoneal dialysis. Hemodialysis removes waste and fluid by filtering the blood through an artificial kidney, called a dialyzer. Peritoneal dialysis uses the network of blood vessels in the abdominal cavity (the peritoneal membrane) to clean waste and excess fluid out of the body. The author concludes with a brief discussion on factors to consider when choosing a method of dialysis. Combined with medications and an appropriate diet, dialysis gives those with kidney failure a chance to live and enjoy life long after these organs have stopped working. 2 figures.

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Why Fat Migrates to Your Middle Source: Tufts University Health and Nutrition Letter. 18(7):6. September 2000. Contact: 10 High St., Suite 706, Boston, MA 02110. [email protected] www.healthletter.tufts.edu. Summary: A book by Dr. Pamela Peeke, Fight Fat After Forty, proposes that middle- age women gain weight around their waists because of emotional stress which causes the steady release of the stress hormone cortisol. According to Dr. Peeke, cortisol not only causes chronic overeating but also causes excess calories to be stored as fat deep in the abdomen. Although it is true that weight gain around the middle is a health problem because it contributes to high blood pressure and increased blood levels of cholesterol, there is still too little research to

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determine whether a hectic lifestyle has anything to do with abdominal weight gain. Human studies have found a rough link between fat stores in the abdomen and higher cortisol levels, but it is not clear whether the cortisol levels induce the laying down of abdominal fat or whether the greater levels of abdominal fat cause the rise in cortisol levels. Most researchers believe obesity is a complicated problem that involves not only an individual's stress level, but many other factors as well. The article notes that difficulties in coping with life's problems could never be singled out as the defining factor in a woman's eating style and body shape. Other theories on why many women gain weight around the middle as they enter midlife include having a sedentary lifestyle, a loss of muscle tissue due to aging, and a decline in estrogen levels. ·

Exploding the Myth: Weight Loss Makes You Healthier Source: Healthy Weight Journal. 13(1):4-6. January/February, 1999. Contact: Healthy Living Institute, 402 S. 14th St., Hettinger, ND 58639. (701) 567-2645. Summary: Ernsberger says that since weight loss is so difficult and the effects transitory, obese individuals should instead strive for a healthier lifestyle. By reducing the intake of saturated fats, exercising more, and consuming more fruits and vegetables, individuals may not lose as much weight, according to Ernsberger. However, he says, they will have lower cholesterol and blood sugar levels, as well as lower blood pressure. According to Ernsberger, since this is so, physicians should focus on a lower-fat diet, exercise and medication as treatments for high blood pressure, diabetes and high cholesterol. He says improvements in these conditions brought about by weight loss are temporary, and that weight loss attempts can actually be harmful by preventing the patient from pursuing other treatments.

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ARPKD: A Quick Review Source: PKD Progress. 16(3): 7. Summer 2001. Contact: Available from PKD Foundation. 4901 Main Street, Suite 200, Kansas City, MO 64112-2634. (800) 753-2873. E-mail: [email protected]. Summary: ARPKD (autosomal recessive polycystic kidney disease) primarily affects, the kidneys (always both) with progressive cysts and the liver with congenital hepatic fibrosis (CHF), which is malformation and progressive scarring of the bile duct system. This brief article reviews ARPKD, its diagnosis and treatment. The author notes that because of continually improved mechanical ventilation, neonate support, control of

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systemic and portal hypertension, management of ESRD, and transplantation, the ARPKD population is living longer into adulthood. Unfortunately, 30 to 50 percent of infants with ARPKD die at birthor shortly thereafter, usually as a result of underdeveloped lungs and pulmonary complications. Almost everyone with ARPKD is diagnosed during infancy or childhood; however, the first signs of the disease vary greatly. Approximately 30 percent of the infants experience failure-tothrive, although the exact cause is unknown. Hypertension (high blood pressure) is thought to be a factor in progression of renal deterioration, and without aggressive treatment, severe hypertension can be life threatening. The same inherited defect that affects the kidneys occurs in the liver, but the two organs react differently with great variability of onset and severity of clinical symptoms. Even for symptomatic individuals, synthetic liver function generally is preserved, as it usually continues to excrete, produce, and regulate hormones and chemicals normally.

Academic Periodicals covering High Blood Pressure Academic periodicals can be a highly technical yet valuable source of information on high blood pressure. We have compiled the following list of periodicals known to publish articles relating to high blood pressure and which are currently indexed within the National Library of Medicine’s PubMed database (follow hyperlinks to view more information, summaries, etc., for each). In addition to these sources, to keep current on articles written on high blood pressure published by any of the periodicals listed below, you can simply follow the hyperlink indicated or go to the following Web site: www.ncbi.nlm.nih.gov/pubmed. Type the periodical’s name into the search box to find the latest studies published. If you want complete details about the historical contents of a periodical, you can also visit http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/ you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.” The following is a sample of periodicals which publish articles on high blood pressure:

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Alternative Therapies in Health and Medicine. (Altern Ther Health Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Al ternative+Therapies+in+Health+and+Medicine&dispmax=20&dispstart= 0

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American Journal of Hypertension : Journal of the American Society of Hypertension. (Am J Hypertens) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=A merican+Journal+of+Hypertension+:+Journal+of+the+American+Society +of+Hypertension&dispmax=20&dispstart=0

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Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases. (Clin Microbiol Infect) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Cli nical+Microbiology+and+Infection+:+the+Official+Publication+of+the+E uropean+Society+of+Clinical+Microbiology+and+Infectious+Diseases&d ispmax=20&dispstart=0

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European Journal of Clinical Nutrition. (Eur J Clin Nutr) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Eu ropean+Journal+of+Clinical+Nutrition&dispmax=20&dispstart=0

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Harvard Heart Letter : from Harvard Medical School. (Harv Heart Lett) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ha rvard+Heart+Letter+:+from+Harvard+Medical+School&dispmax=20&di spstart=0

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Japanese Heart Journal. (Jpn Heart J) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ja panese+Heart+Journal&dispmax=20&dispstart=0

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Journal of Ethnopharmacology. (J Ethnopharmacol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Ethnopharmacology&dispmax=20&dispstart=0

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Journal of Human Hypertension. (J Hum Hypertens) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Human+Hypertension&dispmax=20&dispstart=0

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Journal of Hypertension. (J Hypertens) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Hypertension&dispmax=20&dispstart=0

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Journal of Toxicology and Environmental Health. Part B, Critical Reviews. (J Toxicol Environ Health B Crit Rev) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Toxicology+and+Environmental+Health.+Part+B,+Critical+Re views&dispmax=20&dispstart=0

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Phytotherapy Research : Ptr. (Phytother Res) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ph ytotherapy+Research+:+Ptr&dispmax=20&dispstart=0

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The American Journal of Emergency Medicine. (Am J Emerg Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+American+Journal+of+Emergency+Medicine&dispmax=20&dispstart= 0

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The American Journal of Medicine. (Am J Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+American+Journal+of+Medicine&dispmax=20&dispstart=0

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The American Journal of Physiology. (Am J Physiol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+American+Journal+of+Physiology&dispmax=20&dispstart=0

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The Australian & New Zealand Journal of Obstetrics & Gynaecology. (Aust N Z J Obstet Gynaecol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+Australian+&+New+Zealand+Journal+of+Obstetrics+&+Gynaecology &dispmax=20&dispstart=0

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The Journal of Family Practice. (J Fam Pract) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+Journal+of+Family+Practice&dispmax=20&dispstart=0

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Vocabulary Builder Antihistamine: A drug that counteracts the action of histamine. The antihistamines are of two types. The conventional ones, as those used in allergies, block the H1 histamine receptors, whereas the others block the H2 receptors. Called also antihistaminic. [EU] Arrhythmia: Any variation from the normal rhythm of the heart beat, including sinus arrhythmia, premature beat, heart block, atrial fibrillation, atrial flutter, pulsus alternans, and paroxysmal tachycardia. [EU] Arteriovenous: Both arterial and venous; pertaining to or affecting an artery and a vein. [EU] Atenolol: A cardioselective beta-adrenergic blocker possessing properties and potency similar to propranolol, but without a negative inotropic effect. [NIH]

Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU] Fistula: An abnormal passage or communication, usually between two internal organs, or leading from an internal organ to the surface of the body; frequently designated according to the organs or parts with which it communicates, as anovaginal, brochocutaneous, hepatopleural, pulmonoperitoneal, rectovaginal, urethrovaginal, and the like. Such passages are frequently created experimentally for the purpose of obtaining body secretions for physiologic study. [EU] Hydralazine: A direct-acting vasodilator that is used as an antihypertensive agent. [NIH] Hypercalcemia: Abnormally high level of calcium in the blood. [NIH] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Malformation: A morphologic defect resulting from an intrinsically abnormal developmental process. [EU] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Nephrons: The functional units of the kidney, consisting of the glomerulus and the attached tubule. [NIH] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Paralysis: Loss or impairment of motor function in a part due to lesion of the neural or muscular mechanism; also by analogy, impairment of sensory function (sensory paralysis). In addition to the types named below, paralysis

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is further distinguished as traumatic, syphilitic, toxic, etc., according to its cause; or as obturator, ulnar, etc., according to the nerve part, or muscle specially affected. [EU] Pilocarpine: A slowly hydrolyzed muscarinic agonist with no nicotinic effects. Pilocarpine is used as a miotic and in the treatment of glaucoma. [NIH] Polytetrafluoroethylene: Homopolymer of tetrafluoroethylene. Nonflammable, tough, inert plastic tubing or sheeting; used to line vessels, insulate, protect or lubricate apparatus; also as filter, coating for surgical implants or as prosthetic material. Synonyms: Fluoroflex; Fluoroplast; Ftoroplast; Halon; Polyfene; PTFE; Tetron. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Sarcoidosis: An idiopathic systemic inflammatory granulomatous disorder comprised of epithelioid and multinucleated giant cells with little necrosis. It usually invades the lungs with fibrosis and may also involve lymph nodes, skin, liver, spleen, eyes, phalangeal bones, and parotid glands. [NIH] Thrombectomy: Surgical removal of an obstructing clot or foreign material from a blood vessel at the point of its formation. Removal of a clot arising from a distant site is called embolectomy. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH] Ventilation: 1. in respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. in psychiatry, verbalization of one's emotional problems. [EU] Xerostomia: Dryness of the mouth from salivary gland dysfunction, as in Sjögren's syndrome. [EU]

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CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.

NIH Guidelines For the more common diseases, The National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.28 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:29 ·

Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

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Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 29 See http://www.nlm.nih.gov/databases/databases.html. 28

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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

While all of the above references may be of interest to physicians who study and treat high blood pressure, the following are particularly noteworthy.

The Combined Health Information Database A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information Package” and high blood pressure using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years,” select your preferred language, and the format option “Fact Sheet.” By making these selections and typing “high blood pressure” (or synonyms) into the “For these words:” box above, you will only receive results on fact sheets dealing with high blood pressure. The following is a sample result:

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National High Blood Pressure Education Program Working Group Report on Hypertension in Diabetes Source: Bethesda, MD: National Heart, Lung, and Blood Institute, National Institutes of Health. 1995. 26 p. Contact: Available from NHLBI Information Center. P.O. Box 30105, Bethesda, MD 20824-0105. (301) 251-1222. Fax (301) 251-1223. Price: $3.00; bulk discounts available. This publication is also available on the Internet at http://www.nhlbi.nih.gov/nhlbi/nhlbi.htm. Summary: This report is designed to increase awareness of the importance and implications of the problem of hypertension in persons with diabetes in community control programs; and to guide clinicians in their care of persons with the concomitant problems of hypertension and diabetes. Topics include definitions and diagnostic criteria; epidemiologic considerations; clinical trials; a guide to clinical evaluation; special considerations in patients with diabetes and hypertension, including kidney disease, secondary forms of hypertension, cardiovascular disease, cerebrovascular disease, diabetic retinopathy, hypertension with orthostatic hypotension, autonomic neuropathy, sexual dysfunction, lipid disorders, obesity, pregnancy, and children; treatment considerations, including lifestyle modifications, the pharmacologic treatment of hypertension, and drugs for managing hypertensive emergencies in patients with diabetes; and considerations in education, control, and maintenance. 3 figures. 116 references. (AA-M).

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Treatment of Hypertension: Insights from the JNC-VI Report Source: American Family Physician. 58(6): 1323-1330. October 15, 1998. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Summary: This article summarizes the recommendations of the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) which provided updated guidelines for the treatment of hypertension. Antihypertensive drug therapy may be initiated either after a trial of lifestyle modifications or immediately after the diagnosis is made, depending on the patient's other cardiovascular risk factors and the presence of clinical cardiovascular disease. In general, therapy may begin with diuretics or beta adrenergic blockers in patients under age 65, unless a concomitant condition warrants another, more tailored choice. Low dosages should be used initially, but if the blood pressure is not successfully reduced to 140 over 90 mm Hg or below, another drug

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should be added or should replace the initial choice. General principles of therapy include the use of once a day formulations and combination drugs as well as cost considerations. 1 figure. 3 tables. 11 references. (AAM). ·

Cyclosporine Source: Atlanta, GA: Arthritis Foundation. 1998. 6 p. Contact: Available from Arthritis Foundation. P.O. Box 1616, Alpharetta, GA 30009-1616. (800) 207-8633. Fax (credit card orders only) (770) 4429742. http://www.arthritis.org. Price: Single copy free from local Arthritis Foundation chapter (call 800-283-7800 for closest local chapter); bulk orders may be purchased from address above. Summary: This brochure for people with arthritis and related conditions uses a question and answer format to provide information on cyclosporine. This drug was originally developed to prevent organ rejection in transplant patients, but has been used experimentally for several years to treat arthritis-related diseases. One of a group of medications known as disease-modifying antirheumatic drugs, it can take several weeks or months to slow or possibly halt disease progression. These drugs can produce some serious side effects and complications, including high blood pressure, reduced kidney function, gum problems, fluid retention, increased hair growth, and loss of appetite. The brochure presents some tips on taking cyclosporine and provides information on the Arthritis Foundation.

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About Medications Source: Danvers, MA: Scleroderma Foundation. 1998. 12 p. Contact: Available from Scleroderma Foundation. 12 Kent Way, Suite 101, Byfield, MA 01922. (800) 722-4673 or (978) 463-5843. Fax (978) 4635809. E-mail: [email protected]. Website: www.scleroderma.org. Price: Single copy $1.00. Summary: This pamphlet for people with scleroderma provides information on medications used to treat some of the more common symptoms of systemic sclerosis. Information on each medication includes the goal of treatment, the basic mechanism of the medication, and the main side effects of the medication. Drugs identified include those for reducing joint and tendon pain, preventing Raynaud's phenomenon, treating diarrhea, relieving constipation, preventing heartburn, improving swallowing difficulty, treating digital ulcers, reducing skin itching, relieving dry mouth and eyes, controlling high blood pressure, relieving pericarditis, and treating reactive depression. In addition, the

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pamphlet presents some of the drugs under development for treating scleroderma and identifies other potential disease modifying treatments for scleroderma. ·

Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) Source: Rockville, MD: Lupus Foundation of America, Inc. 1997. 6 p. Contact: Available from Lupus Foundation of America, Inc. 1300 Piccard Drive, Suite 200, Rockville, MD 20850-4303. (800) 558-0121 or (301) 6709292. Website: www.lupus.org/lupus. Price: Available as part of a package of 21 different lupus-related brochures for $3.95 plus shipping and handling. Summary: This pamphlet for people with lupus discusses the use of nonsteroidal anti-inflammatory drugs (NSAIDs) to treat the pain and inflammation that commonly occur in patients with systemic lupus erythematosus. It identifies the types of NSAIDs, including aspirin and other salicylates, and explains the mechanism of action and use of NSAIDs. The pamphlet describes the common side effects of NSAID therapy, including stomach upset, headache, drowsiness, easy bruising, high blood pressure, and fluid retention. It highlights the uncommon side effects of NSAIDs, including abnormal liver tests, asthma, severe headache with neck stiffness, and skin rashes. The pamphlet also provides information on the Lupus Foundation of America.

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Acute Intermittent Porphyria (AIP) Source: Houston, TX: American Porphyria Foundation. 199x. 8 p. Contact: Available from American Porphyria Foundation. P.O. Box 22712, Houston, TX 77227-2712. (713) 266-9617. Fax (713) 871-1788. Website: www.enterprise.net/apf/. Price: Single copy free to members only ($30.00 membership fee); online version available for $5.00 access fee. Summary: This brochure for health professionals and people with acute intermittent porphyria (AIP) discusses the clinical features, diagnosis, and treatment of this rare inherited disease. Signs and symptoms usually occur intermittently and include abdominal pain, constipation, muscle weakness, arm and leg pain, insomnia, emotional difficulties, rapid pulse, and high blood pressure. Factors that may precipitate or exacerbate an attack are drugs such as barbiturates and sulfonamides, hormones, nutrition, environmental chemicals, alcoholic beverages, stress, and fatigue. Various blood and urine tests are central to the diagnosis, and initial treatment consists of stopping the patient from taking harmful drugs and providing a high intake of carbohydrates. Drugs that may be used to treat AIP include hematin and heme arginate, administered

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intravenously. Prognosis is usually good if the disease is recognized and treated before severe nerve damage has occurred. The brochure concludes with a list of general recommendations for people whose blood tests show low levels of porphobilinogen deaminase. ·

Alpha 1-Antitrypsin Deficiency Liver Disease Source: Minneapolis, MN: Alpha 1 Association. 2000. [4 p.]. Contact: Available from Alpha 1 Association. 8120 Penn Avenue, South, Suite 549, Minneapolis, MN 55431-1326. (800) 521-3025 or (612) 703-9979. Fax (612) 703-9977. E-mail: [email protected]. Website: www.alpha1.org. Price: $0.10 plus shipping and handling; bulk copies available. Summary: This brochure describes Alpha 1 antitrypsin deficiency (A1AD or Alpha 1), a genetic disorder that affects infants, children, and adults. It is the most common metabolic disorder that causes liver disease in infants and children; the disorder also causes cirrhosis and cancer of the liver in adults. The brochure reviews the functions of the liver, the causes of the deficiency, symptoms in children and adults, and treatment options. Alpha 1 antitrypsin (AAT) is a protein primarily manufactured in the liver and then released into the blood. The normal function of AAT is to protect body tissues from being damaged by neutrophil elastase, a protein found in white blood cells. The backup of abnormal AAT in the liver can cause liver damage. Symptoms of A1AD in children includes jaundice, low birth weight, mildly elevated liver enzymes, cholestasis, enlarged liver, abnormal bleeding, feeding difficulties, poor growth (or failure to thrive), and ascites (abnormal accumulation of fluids). In adults, the spectrum of liver disease associated with A1AD deficiency varies from mild to severe. Symptoms include chronic active hepatitis, cryptogenic cirrhosis (liver scarring of unknown cause), portal hypertension (high blood pressure in the portal vein of the liver), and hepatocellular carcinoma (liver cancer). Clinical care for all affected individuals largely involves supportive management for liver dysfunction and prevention of complications. For those who develop severe liver injury, liver transplantation is usually recommended. Proper nutrition is essential for everyone with A1AD. The brochure concludes with contact information for the Alpha 1 Association. 1 figure. 3 references.

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Food Labels: How to Use Them Source: Kalamazoo, MI: Hope Publications. 200x. [4 p.].

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Contact: Available from Hope Publications. 350 East Michigan Avenue, Suite 301, Kalamazoo, MI 49007-3851. (616) 343-0770. Website: hithope.com. Price: $0.59 each for 10-100 copies. Summary: This educational brochure offers information about food labels and how to use them to keep track of the calories and fat in daily diet choices. The brochure recommends that when readers shop for groceries, they should take time to compare the labels on the different brands of food to see if favorites are the healthiest choices. If not, readers are advised to consider making some changes. The bulk of the brochure features a copy of the Nutrition Facts label, with each part assigned a letter code; it then explains what information is contained in each part and how to incorporate that information into healthy diet choices. The sample food label is from a box of macaroni and cheese. The sections described include serving sizes, number of servings per container, total calories and other nutrients, percent daily value of some vitamins, and general information compared with standard diets (for example, a 2,000 calorie diet). The brochure also discusses the guidelines suggesting that no more than 30 percent of one's daily calories should come from fat. Also included are chart that lists health claims and what words can be used on the food label (for example, to make health claims about helping to prevent high blood pressure, the food must be low in sodium). The brochure is illustrated with simple cartoon line drawings. ·

Your Child and Prednisone: Answers to Parents' Questions About Prednisone Source: Valencia, CA: Children's Liver Association for Support Services (C.L.A.S.S.). 1996. 18 p. Contact: Available from Children's Liver Association for Support Services (C.L.A.S.S.). 26444 Emerald Dove Drive, Valencia, CA 91355. (877) 6798256 or (661) 255-0353. E-mail: [email protected]. Website: www.classkids.org. Price: Single copy free; available on the Internet at http://www.classkids.org/library/pred.htm. Summary: Prednisone is one of the most universally prescribe immunosuppressant drugs. It is used to prevent rejection after organ transplantation, and also to treat autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus (SLE), polymyositis, and others. This brochure educates parents about the use of prednisone in children. Written in question and answer format, the brochure covers the uses of prednisone, how the drug works, the use of newer immunosuppressant drugs such as cyclosporine and tacrolimus, administration and dosage of prednisone, the side effects, and weaning the patient off of it. Prednisone works by doing many things to the

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immune cells that fight infection and cause rejection; the result is that all inflammatory processes are slowed and weakened. By turning down the body's ability to produce inflammation, an organ transplant can survive longer. Prednisone is used to supplement the use of other anti-rejection drugs. Pretension is given orally, or by intravenous (IV) route. Side effects can include ulcers and abdominal pain, high blood pressure, weight gain, acne, cataracts, difficulty sleeping, brittle (easily broken) bones, high blood sugar and a tendency to develop diabetes, muscular weakness, excess hair growth, mood swings and personality changes, and slowed growth in children. The booklet concludes with a glossary of related terms. The brochure also offers a brief description of Children's Liver Association for Support Services (CLASS), a nonprofit organization dedicated to addressing the emotional, educational, and financial needs of families coping with childhood liver disease and transplantation. ·

5 Ways to Lower Blood Pressure Source: Santa Cruz, CA: ETR Associates. 2001. [4 p.]. Contact: Available from ETR Associates. P.O. Box 1830, Santa Cruz, CA 95061-1830. (800) 321-4407. Fax (800) 435-8433. Website: www.etr.org. Price: $1.00 plus shipping and handling; bulk orders available. Summary: This brochure presents ways people can lower their blood pressure. Healthy lifestyle choices can help lower high blood pressure. Lowering high blood pressure involves eating healthy foods and drinking water or caffeine free and sugar free drinks, being active, losing weight, taking prescription medication, quitting smoking, and limiting alcohol. The brochure also illustrates healthy serving sizes and presents a checklist of reasons for wanting to lower blood pressure. 3 figures.

·

Slowing Progressive Kidney Disease Self Care Handbook Source: South Deerfield, MA: Channing L. Bete Co., Inc. 2000. 31 p. Contact: Available from Channing L. Bete Co., Inc. 200 State Road, South Deerfield, MA 01373. (800) 628-7733. Fax (800) 499-6464. Website: www.channing-bete.com. Price: $2.73 each for 1-99 copies; discounts available for larger quantities. Order number 97571. Summary: This handbook provides people who have diabetes with information on slowing the progression of kidney disease. The kidneys clean blood, maintain healthy balances of fluids and nutrients, keep blood pressure at healthy levels, and keep bones healthy. Causes of kidney disease include diabetes, high blood pressure, inherited conditions, infection, medications, and use of alcohol or drugs. During the early stage of kidney disease, about one half of the nephrons have

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stopped working. In later stages, the number of nephrons that stop working keeps growing. By the time a person has reached end stage renal disease (ESRD), about nine in 10 nephrons have stopped working and a person needs dialysis or kidney transplantation to live. The handbook outlines the symptoms of kidney disease, describes some of the tests used to diagnose kidney disease, and identifies the functions of the members of a person's health care team. Another topic is the components of a treatment plan for kidney disease, including controlling other medical conditions, planning a proper diet, making other healthy changes, taking prescribed medications, and undergoing follow-up tests. In addition, the handbook discusses treatments for ESRD, including hemodialysis, continuous ambulatory peritoneal dialysis, continuous cycling peritoneal dialysis, and kidney transplantation. The handbook concludes by identifying sources of support and information. ·

Prevent Diabetes Problems: Keep Your Kidneys Healthy. [Evite los problemas de la diabetes: Mantenga los rinones sanos] Source: Bethesda, MD: National Diabetes Information Clearinghouse (NDIC), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health. 2000. 18 p. Contact: Available from National Diabetes Information Clearinghouse (NDIC). 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747 or (301) 654-3327. Fax (301) 907-8906. E-mail: [email protected]. Price: Single copy free. Summary: This illustrated booklet, written in nontechnical language, uses a question and answer format to provide people who have diabetes with information on preventing the kidney problems caused by diabetes. Diabetic nephropathy is the medical word for these problems. The kidneys rid the body of waste and extra fluid; however, high blood sugar and high blood pressure damage the glomeruli and allow protein to leak out of the kidneys into the urine. Damage can progress until the kidneys fail. A medication called an angiotensin converting enzyme inhibitor helps slow down kidney damage by keeping the kidneys from cleaning out too much protein. The booklet explains how a person can slow down or stop kidney damage, discusses annual screening for the presence of protein in the urine, and describes the use of hemodialysis and peritoneal dialysis in treating people whose kidneys have failed. The booklet also provides general tips for staying healthy. In addition, the booklet includes sources of information about diabetes and describes the activities of the National Diabetes Information Clearinghouse. Also available in Spanish.

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·

Executive Summary: Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, Stratification Source: New York, NY: National Kidney Foundation (NKF). 2001. 28 p. Contact: Available from National Kidney Foundation (NKF). 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Website: www.kidney.org. Price: Single copy free. Summary: This booklet highlights guidelines from the KDOQI (Kidney Disease Outcomes Quality Initiative) 2000 Update that establishes clinical practice guidelines to help improve outcomes for all individuals with kidney disease, from earliest kidney damage through the various stages of progression to kidney failure, when renalreplacement therapy becomes necessary. This booklet describes the activities and goals of the KDOQI Work Group on chronic kidney disease, the classification of chronic kidney disease (including the population at increased risk of developing chronic kidney disease), terminology and classification issues, the prevalence of chronic kidney disease in the United States, the review of evidence (including generalizability, the GFR or glomerular filtration rate range, results, methodological quality, and strength of evidence), and the future development of clinical guidelines. Fifteen guidelines are offered that cover the stages of chronic kidney disease, evaluation and treatment, individuals at increased risk of chronic kidney disease, the estimation of GFR, the assessment of proteinuria (protein in the urine), additional markers of chronic kidney disease, the association of level of GFR with hypertension (high blood pressure), the association of level of GFR with anemia, the association of level of GFR with nutritional status, bone disease and disorders of calcium and phosphorus metabolism, neuropathy (nerve disease), the association of level of GFR with indices of functioning and well being, factors associated with loss of kidney function in chronic kidney disease, the association of chronic kidney disease with diabetic complications, and the association of chronic kidney disease with cardiovascular disease. 2 figures. 8 references.

·

Polycystic Kidney Disease Source: Montreal, Quebec: Kidney Foundation of Canada. 199x. [4 p.]. Contact: Available from Kidney Foundation of Canada. 300-5165, rue Sherbrooke Ouest, Montreal, QC H4A 1T6. (514) 369-4806. Fax (514) 3692472. Website: www.kidney.ca. Price: Single copy free. Summary: This brochure answers questions that readers may have as they face a diagnosis of polycystic kidney disease (PKD), a disease in which cysts form in the kidneys. Polycystic kidneys become very large, have a bumpy surface, and contain many cysts. Pressure from the

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expanding cysts slowly damages the normal kidney tissue, eventually causing kidney failure. PKD is an inherited disease, and there are two types: autosomal dominant PKD, the most common inherited disease of the kidneys; and autosomal recessive PKD, which affects infants and young children. The brochure reviews the genetics of PKD and notes that adult PKD progresses very slowly, with few symptoms early in the disease. However, some symptoms should be watched for: high blood pressure, recurrent bladder or kidney infections, severe and recurrent headache, blood in the urine, pain, water retention, and kidney stones. One in six people with PKD will develop kidney failure but, early treatment of PKD symptoms can delay kidney failure. The brochure encourages people with PKD to meet with a genetic counselor before deciding about having children. It concludes with a brief description of the Kidney Foundation of Canada, including patient services and public education programs. 2 figures. ·

Taking Charge of Your Health: A Guide for African Americans at Risk for Kidney Disease Source: Cincinnati, OH: Kidney Foundation of Greater Cincinnati. 199x. Contact: Available from Kidney Foundation of Greater Cincinnati. 220 Victory Parkway, Suite 510, Cincinnati, OH 45206. (513) 961-8105. Fax (513) 961-8120. Price: Single copy free. Summary: This information packet provides a variety of health promotion materials, primarily on kidney disease, high blood pressure (hypertension), and organ donation, designed to educate African Americans about their particular health risks. The packet includes brochures on a medication aid program, urinary tract disorders (Scriptographic booklet, featuring simple cartoon drawings and nontechnical language), kidney dialysis and transplants (Scriptographic booklet), organ and tissue donation (Scriptographic booklet), treatment options for kidney failure, peritoneal dialysis (PD) catheter analysis, a general guide on kidney disease (from the American Kidney Fund, or AKF), facts about kidney stones, a guide for the dentist about the dialysis patient, central line access for hemodialysis, high blood pressure and kidney disease (a brochure specifically targeting African Americans), diabetes and kidney disease (also specifically targeting African Americans), and four brochures from the African American Health Education Program of the Kidney Foundation of Greater Cincinnati (covering the role of the kidneys, diabetes, high blood pressure, and the health program itself). The packet also includes fact sheets for people with kidney disease on getting the right amount of protein, limiting fluid, balancing calcium and phosphorus, and eating a safe amount of

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potassium. The materials are presented in a brightly colored folder, with basic information reiterated on the flaps of the folder. ·

Stay Young at Heart. New Edition Source: Bethesda, MD, National Heart, Lung, and Blood Institute, 11page program planner booklet, 52-page food service personnel booklet, 62-page consumer materials booklet, 1-page program enrollment form, 2page program kit information and order form, November 1994. Contact: National Heart, Lung, and Blood Institute Information Center, P.O. Box 30105, Bethesda, MD 20824. (301) 251-1222. NIH Publication Nos. 94-3648, 94-3648A, and 94-3648B. Summary: The National Heart, Lung, and Blood Institute (NHLBI) designed the Stay Young at Heart Program to provide heart-healthy food choices and cardiovascular information in the workplace and community settings. The purpose of this point-of-purchase nutrition education program is to help cafeterias, restaurants, schools, and other eating establishments to prepare and serve heart-healthy foods. All of the recipes follow the guidelines of the NHLBI's education programs and initiatives, including the National Cholesterol Education Program, NHLBI Obesity Education Initiative, and National High Blood Pressure Education Program. The recipes come in two versions: One for use in preparing foods in quantity and one for customers or clients to take and use at home. The program also provides heart-healthy nutrition education materials in a reproducible format for use in food service establishments and clinics, and with community groups. The program kit includes (1) a Stay Young at Heart Background report that describes the origins and evolution of the program; (2) a fact sheet on heart-healthy cooking tips and techniques for foodservice personnel; (3) 50 quantity recipes, including soups, entrees, vegetables, pasta, and desserts that combine good taste with good nutrition; (4) 14 reproducible consumer handouts; (5) 50 reproducible consumer recipe cards; and (6) reproducible newsletters and handouts.

·

Heart Health Program Client Education Sheets Source: Olympia, WA, Department of Health, Heart Health Program, February 1992. Contact: Washington Department of Health, Office of Heart Disease and Cancer Prevention, 7211 Cleanwater Lane, MS: 7836, Olympia, WA 98504-7835. (360) 753-4311. Summary: The Washington State Department of Health has developed a set of photocopy ready masters of the 'Check It Out' client education card

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series. The cards, written at a fourth to sixth grade reading level and designed to be locally reproduced, are intended for use by health care professionals when counseling clients about their risk factors for heart disease. Eight sheets cover the following topics: Risk factors, cholesterol, high blood pressure, smoking, exercise, tips to lose weight, less stress, and a sheet for parents with high cholesterol. Each sheet offers suggestions and tips to clients for making healthy lifestyle changes in order to reduce the risk for heart disease. The photocopy ready masters will be updated periodically. ·

Choose Health, America Source: Bethesda, MD, the Program, 4 pieces in a folder, January 1987. Contact: National High Blood Pressure Education Program, 120/80 National Institutes of Health, Bethesda, MD 20892. Summary: The National High Blood Pressure Education Program (NHBPEP) of the National Institutes of Health (NIH) has prepared a kit designed to assist health professionals in planning, promoting, implementing, and evaluating hypertension education activities during National High Blood Pressure Month (May 1987) and throughout the year. The kit focuses on activities promoting lifelong adherence to therapy, including pharmacological and nonpharmacological approaches to hypertension control. Information is provided about weight loss; exercise; reducing intake of sodium, fat, and calories; and other lifestyle changes to encourage cardiovascular health. The theme, Choose Health, America, emphasizes the importance of personal responsibility in health management. The kit includes suggestions for working with the media and for reaching out to health professionals, patients and the public, and specific minority populations. A list of resources and a package of reproducible promotional and educational materials are provided.

·

NHLBI Workplace Initiative Kit Source: Bethesda, MD, US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute, (n.d.). Contact: National Heart, Lung, and Blood Institute, Information Center, 4733 Bethesda Avenue, Suite 530, Bethesda, MD 20814. (301) 951-3260. Summary: The National, Heart, Lung, and Blood Institute Workplace Initiative information package offers to health professionals and workers materials related to risk factors for cardiovascular and pulmonary disease, especially the three major modifiable risk factors: High blood pressure, high blood cholesterol, and cigarette smoking. Materials

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include (1) technical documents for health professionals, (2) guides for workplace program planners, (3) brochures and materials for workers, and (4) order forms for additional publications. Technical documents for professionals include the National Cholesterol Education Program Report of the Expert Panel on Population Strategies for Blood Cholesterol Reduction Executive Summary; Highlights of the Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults; the 1988 Report of the Joint National Committee Detection, Evaluation, and Treatment of High Blood Pressure; and Recommendations Regarding Public Screening for Measuring Blood Cholesterol. Guides for workplace program planners include A Resource Guide for Heart and Lung Health at the Workplace; Small Business Basics: Guidelines for Heart and Lung Health at the Workplace; Its Your Business: Smoking Policies for the Workplace; National Heart Lung and Blood Institute Demonstration Projects in Workplace High Blood Pressure Control; and Worksite Health Promotion and Human Resources: A Hard Look at the Data Program Summary. ·

Sources of Health Materials for African Americans, American IndianAlaska Natives, Asians, Hispanics, Pacific Islanders Source: Washington, DC: Office of Minority Health Resource Center. October 1997. 56 p. Contact: Available from Office of Minority Health Resource Center. P.O. Box 37337, Washington, DC 20013-7337. (800) 444-6472. Website: www.omhrc.gov. Price: Single copy free. Summary: This bibliography offers a listing of sources of health materials that are written specifically for the needs of certain ethnic groups. This bibliography includes five sections: African Americans, American Indians (including Alaska Natives), Asians, Hispanics, and Pacific Islanders. The first section concentrates on health materials identified by the Office of Minority Health Resource Center (OMH-RC) as specifically targeting African Americans and includes resources on nutrition, exercise, and AIDS educational materials. This section also includes cancer, chemical dependency, diabetes, heart disease and stroke, infant mortality, and the associated risk factors. The second section lists culturally sensitive printed health materials identified for American Indians and includes sources of information for AIDS, cancer, child development, diabetes, high blood pressure, nutrition, and substance abuse. The third section includes culturally sensitive health materials identified in various Asian languages and lists resources on nutrition, exercise, and AIDS education. The fourth section covers health materials specifically targeting different Hispanic populations, noting that

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culturally sensitive and universally appropriate Spanish language materials for this diverse population are difficult to obtain and some do not take culture, linguistics and other factors that may influence health behaviors into consideration. The final section lists sources that produce or distribute health promotion materials for Pacific Islander populations. The listing includes sources of information for AIDS, diabetes, hepatitis, sexually transmitted diseases, and thalassemia, as well as other health areas. Each of the five sections offers a brief introduction, a listing of subject topics covered, and the organizations or publishers that serve as sources for the health materials. Under each organization, some representative publications (including audiovisual materials) are listed and briefly annotated. ·

Working group report on high blood pressure in pregnancy (Rev. ed.) Source: Bethesda, MD: National Heart, Lung, and Blood Institute, U.S. Department of Health and Human Services. 2000. 39 pp. Summary: This report provides guidance to the practicing physician in 1) managing hypertensive patients who become pregnant and 2) managing pregnant patients who become hypertensive. This report updates the 1990 National High Blood Pressure Education Program Working Group Report on High Blood Pressure in Pregnancy. It expands on recommendations made in the 6th Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC v1). Sections of the report are devoted to classification of hypertensive disorders of pregnancy; pathology and pathophysiology; differential diagnoses; chronic hypertension in pregnancy; preeclampsia; postpartum counseling and followup; and recommendations for future research. The section on management of hypertension in pregnancy contains recommendations on diet, alcohol and tobacco use, and lactation.

·

Working group report on high blood pressure in pregnancy Source: Bethesda, MD: National Heart, Lung, and Blood Institute, U.S. Department of Health and Human Services. 1990. 39 pp. Contact: Available from High Blood Pressure Education Program, National Heart, Lung and Blood Institute Information Center, National Institutes of Health, 4733 Bethesda Avenue Suite 530, Bethesda, MD 20814. Telephone: (301) 951-3260. Single copies available at no charge. (NIH 90-3029). Summary: This report provides guidance to the practicing physician in 1) managing hypertensive patients who become pregnant and 2) managing

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pregnant patients who become hypertensive. The report expands on the recommendations of The 1988 Report on the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Sections of the report are devoted to classification of hypertensive disorders of pregnancy; epidemiological information; pathology and pathophysiology; differential diagnoses; management of conditions; remote prognoses; and blood pressure measurement protocol. The section on management of hypertension in pregnancy contains recommendations on diet, alcohol and tobacco use, and lactation.

The NLM Gateway30 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for many of NLM’s information resources or databases.31 One target audience for the Gateway is the Internet user who is new to NLM’s online resources and does not know what information is available or how best to search for it. This audience may include physicians and other healthcare providers, researchers, librarians, students, and, increasingly, patients, their families, and the public.32 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “high blood pressure” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category.

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 32 Other users may find the Gateway useful for an overall search of NLM’s information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 30 31

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Results Summary Category Items Found Journal Articles 61646 Books / Periodicals / Audio Visual 660 Consumer Health 1035 Meeting Abstracts 173 Other Collections 22 Total 63536

HSTAT33 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.34 HSTAT’s audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.35 Simply search by “high blood pressure” (or synonyms) at the following Web site: http://text.nlm.nih.gov. Coffee Break: Tutorials for Biologists36 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. To this end, we Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. The HSTAT URL is http://hstat.nlm.nih.gov/. 35 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force’s Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 36 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 33 34

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recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.37 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.38 This site has new articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access the Coffee Break Web site at http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

·

Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center’s MARS electronic medical record system; see the following Web site: http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.

·

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

·

MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical literature, and to explore relevant Web sites; see http://www.med.virginia.edu/~wmd4n/medweaver.html.

·

Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language generally used by caregivers into terms from formal, controlled vocabularies; see http://www.lexical.com/Metaphrase.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 38 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 37

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The Genome Project and High Blood Pressure With all the discussion in the press about the Human Genome Project, it is only natural that physicians, researchers, and patients want to know about how human genes relate to high blood pressure. In the following section, we will discuss databases and references used by physicians and scientists who work in this area.

Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).39 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. Go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html to search the database. Type “high blood pressure” (or synonyms) in the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. By following these links, especially the link titled “Database Links,” you will be exposed to numerous specialized databases that are largely used by the scientific community. These databases are overly technical and seldom used by the general public, but offer an abundance of information. The following is an example of the results you can obtain from the OMIM for high blood pressure: ·

Abdominal Obesity-metabolic Syndrome Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?605552

·

Adducin 1 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?102680

Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.

39

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·

Adducin 2 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?102681

·

Adenosine A2 Receptor Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?102776

·

Adrenal Hyperplasia, Congenital, due to Deficiency Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?202010

·

Adrenal Hyperplasia, Congenital, due to Deficiency Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?202110

·

Adrenal Hypoplasia, Congenital Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?300200

·

Angiotensin I Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?106150

·

Angiotensin I-converting Enzyme Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?106180

·

Angiotensin Receptor 1 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?106165

11-beta-hydroxylase

17-alpha-hydroxylase

Genes and Disease (NCBI - Map) The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to re-visit it from time to time. The following systems and associated disorders are addressed: ·

Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn’s disease, DiGeorge syndrome, familial Mediterranean fever,

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immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html ·

Metabolism: Food and energy. Examples: Adreno-leukodystrophy, Atherosclerosis, Best disease, Gaucher disease, Glucose galactose malabsorption, Gyrate atrophy, Juvenile onset diabetes, Obesity, Paroxysmal nocturnal hemoglobinuria, Phenylketonuria, Refsum disease, Tangier disease, Tay-Sachs disease. Web site: http://www.ncbi.nlm.nih.gov/disease/Metabolism.html

·

Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html

·

Signals: Cellular messages. Examples: Ataxia telangiectasia, Baldness, Cockayne syndrome, Glaucoma, SRY: sex determination, Tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html

·

Transporters: Pumps and channels. Examples: Cystic Fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html Entrez

Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·

PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed

·

Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide

·

Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein

·

Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure

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·

Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome

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PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset

·

OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM

·

Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy

·

Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books

·

ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

·

3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

·

NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/

To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=genom e, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” In the box next to “for,” enter “high blood pressure” (or synonyms) and click “Go.” Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database40 This online resource can be quite useful. It has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html you can also search across syndromes using an alphabetical index. You can also search at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html.

40

190 High Blood Pressure

The Genome Database41 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “high blood pressure” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms). This database is extremely technical as it was created for specialists. The articles are the results which are the most accessible to nonprofessionals and often listed under the heading “Citations.” The contact names are also accessible to non-professionals.

Specialized References The following books are specialized references written for professionals interested in high blood pressure (sorted alphabetically by title, hyperlinks provide rankings, information, and reviews at Amazon.com): · Evaluation & Management of Obesity by Daniel H. Bessesen, Robert F. Kushner; Paperback, 1st edition (December 15, 2001), Lippincott Williams & Wilkins Publishers; ISBN: 1560534699; http://www.amazon.com/exec/obidos/ASIN/1560534699/icongroupinterna · Handbook of Obesity Treatment by Thomas A. Wadden (Editor), Albert J. Stunkard (Editor); Hardcover: 624 pages, 3rd edition (January 9, 2002), Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html#mission.

41

Physician Guidelines and Databases 191

Guilford Press; ISBN: 1572307226; http://www.amazon.com/exec/obidos/ASIN/1572307226/icongroupinterna · Inborn Metabolic Diseases : Diagnosis and Treatment by J. Fernandes (Editor), et al; Hardcover, 3rd edition (August 2000), Springer Verlag; ISBN: 354065626X; http://www.amazon.com/exec/obidos/ASIN/354065626X/icongroupinterna

· Overweight and Weight Management: the Health Professional’s Guide to Understanding and Treatment by Sharron Dalton; Hardcover: 615 pages, 1st edition (January 15, 1997), Aspen Publishers, Inc.; ISBN: 0834206366; http://www.amazon.com/exec/obidos/ASIN/0834206366/icongroupinterna

Vocabulary Builder Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Cataract: An opacity, partial or complete, of one or both eyes, on or in the lens or capsule, especially an opacity impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape, location) or etiology (cause and time of occurrence). [EU] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU]

Concomitant: Accompanying; accessory; joined with another. [EU] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU] Hypoplasia: Incomplete development or underdevelopment of an organ or tissue. [EU] Immunosuppressant: An agent capable of suppressing immune responses. [EU]

Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Porphyria: A pathological state in man and some lower animals that is often due to genetic factors, is characterized by abnormalities of porphyrin metabolism, and results in the excretion of large quantities of porphyrins in the urine and in extreme sensitivity to light. [EU]

192 High Blood Pressure

Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH]

Salicylates: The salts, esters of salicylic acids, or salicylate esters of an organic acid. Some of these have analgesic, antipyretic, and antiinflammatory activities by inhibiting prostaglandin synthesis. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Tacrolimus: A macrolide isolated from the culture broth of a strain of Streptomyces tsukubaensis that has strong immunosuppressive activity in vivo and prevents the activation of T-lymphocytes in response to antigenic or mitogenic stimulation in vitro. [NIH]

Dissertations 193

CHAPTER 10. DISSERTATIONS ON HIGH BLOOD PRESSURE Overview University researchers are active in studying almost all known diseases. The result of research is often published in the form of Doctoral or Master’s dissertations. You should understand, therefore, that applied diagnostic procedures and/or therapies can take many years to develop after the thesis that proposed the new technique or approach was written. In this chapter, we will give you a bibliography on recent dissertations relating to high blood pressure. You can read about these in more detail using the Internet or your local medical library. We will also provide you with information on how to use the Internet to stay current on dissertations.

Dissertations on High Blood Pressure ProQuest Digital Dissertations is the largest archive of academic dissertations available. From this archive, we have compiled the following list covering dissertations devoted to high blood pressure. You will see that the information provided includes the dissertation’s title, its author, and the author’s institution. To read more about the following, simply use the Internet address indicated. The following covers recent dissertations dealing with high blood pressure: ·

A Brief Substance Abuse Intervention for Black Men with High Blood Pressure by Dennison, Cheryl Renee; Phd from The Johns Hopkins University, 2000, 271 pages http://wwwlib.umi.com/dissertations/fullcit/3006226

194 High Blood Pressure

·

A High Blood Pressure Education Program for Sixth Graders: Impact on Parents by Walker, Peter, Edd from University of Virginia, 1980, 207 pages http://wwwlib.umi.com/dissertations/fullcit/8102615

·

Anger and High Blood Pressure: Applicability of the State-trait Anger Expression Inventory to a Latino Medical Population by Martinez, Yvonne Robles; Psyd from California School of Professional Psychology Fresno, 2000, 55 pages http://wwwlib.umi.com/dissertations/fullcit/9994810

·

Medicinal Plant Use and High Blood Pressure on St. Kitts, West Indies. by Stevenson, David Richter, Phd from The Ohio State University, 1979, 143 pages http://wwwlib.umi.com/dissertations/fullcit/7922566

·

The Effects of a Selected Health Education Intervention upon the Compliance Behavior of Individuals Diagnosed As Having High Blood Pressure by Kardas, Edward Joseph, Phd from The Ohio State University, 1987, 137 pages http://wwwlib.umi.com/dissertations/fullcit/8717658

·

Worry, Stress and Family: Critical Signifiers of High Blood Pressure by Rural Dwelling African Americans by Boutain, Doris Marie; Phd from University of Washington, 2000, 168 pages http://wwwlib.umi.com/dissertations/fullcit/9975955

Keeping Current As previously mentioned, an effective way to stay current on dissertations dedicated to high blood pressure is to use the database called ProQuest Digital Dissertations via the Internet, located at the following Web address: http://wwwlib.umi.com/dissertations. The site allows you to freely access the last two years of citations and abstracts. Ask your medical librarian if the library has full and unlimited access to this database. From the library, you should be able to do more complete searches than with the limited 2-year access available to the general public.

195

PART III. APPENDICES

ABOUT PART III Part III is a collection of appendices on general medical topics which may be of interest to patients with high blood pressure and related conditions.

Researching Your Medications 197

APPENDIX A. RESEARCHING YOUR MEDICATIONS Overview There are a number of sources available on new or existing medications which could be prescribed to patients with high blood pressure. While a number of hard copy or CD-Rom resources are available to patients and physicians for research purposes, a more flexible method is to use Internetbased databases. In this chapter, we will begin with a general overview of medications. We will then proceed to outline official recommendations on how you should view your medications. You may also want to research medications that you are currently taking for other conditions as they may interact with medications for high blood pressure. Research can give you information on the side effects, interactions, and limitations of prescription drugs used in the treatment of high blood pressure. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

198 High Blood Pressure

Your Medications: The Basics42 The Agency for Health Care Research and Quality has published extremely useful guidelines on how you can best participate in the medication aspects of high blood pressure. Taking medicines is not always as simple as swallowing a pill. It can involve many steps and decisions each day. The AHCRQ recommends that patients with high blood pressure take part in treatment decisions. Do not be afraid to ask questions and talk about your concerns. By taking a moment to ask questions early, you may avoid problems later. Here are some points to cover each time a new medicine is prescribed: ·

Ask about all parts of your treatment, including diet changes, exercise, and medicines.

·

Ask about the risks and benefits of each medicine or other treatment you might receive.

·

Ask how often you or your doctor will check for side effects from a given medication.

Do not hesitate to ask what is important to you about your medicines. You may want a medicine with the fewest side effects, or the fewest doses to take each day. You may care most about cost, or how the medicine might affect how you live or work. Or, you may want the medicine your doctor believes will work the best. Telling your doctor will help him or her select the best treatment for you. Do not be afraid to “bother” your doctor with your concerns and questions about medications for high blood pressure. You can also talk to a nurse or a pharmacist. They can help you better understand your treatment plan. Feel free to bring a friend or family member with you when you visit your doctor. Talking over your options with someone you trust can help you make better choices, especially if you are not feeling well. Specifically, ask your doctor the following: ·

The name of the medicine and what it is supposed to do.

·

How and when to take the medicine, how much to take, and for how long.

·

What food, drinks, other medicines, or activities you should avoid while taking the medicine.

·

What side effects the medicine may have, and what to do if they occur.

42

This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.

Researching Your Medications 199

·

If you can get a refill, and how often.

·

About any terms or directions you do not understand.

·

What to do if you miss a dose.

·

If there is written information you can take home (most pharmacies have information sheets on your prescription medicines; some even offer large-print or Spanish versions).

Do not forget to tell your doctor about all the medicines you are currently taking (not just those for high blood pressure). This includes prescription medicines and the medicines that you buy over the counter. Then your doctor can avoid giving you a new medicine that may not work well with the medications you take now. When talking to your doctor, you may wish to prepare a list of medicines you currently take, the reason you take them, and how you take them. Be sure to include the following information for each: ·

Name of medicine

·

Reason taken

·

Dosage

·

Time(s) of day

Also include any over-the-counter medicines, such as: ·

Laxatives

·

Diet pills

·

Vitamins

·

Cold medicine

·

Aspirin or other pain, headache, or fever medicine

·

Cough medicine

·

Allergy relief medicine

·

Antacids

·

Sleeping pills

·

Others (include names)

200 High Blood Pressure

Learning More about Your Medications Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications your doctor has recommended for high blood pressure. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the “U.S. Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at www.usp.org. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database.43 While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopoeia. It is important to read the disclaimer by the United States Pharmacopoeia (http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using the information provided. Of course, we as editors cannot be certain as to what medications you are taking. Therefore, we have compiled a list of medications associated with the treatment of high blood pressure. Once again, due to space limitations, we only list a sample of medications and provide hyperlinks to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to high blood pressure:

Though cumbersome, the FDA database can be freely browsed at the following site: www.fda.gov/cder/da/da.htm.

43

Researching Your Medications 201

Amlodipine ·

Systemic - U.S. Brands: Norvasc http://www.nlm.nih.gov/medlineplus/druginfo/amlodipinesyste mic202670.html

Amlodipine and Benazepril ·

Systemic - U.S. Brands: Lotrel http://www.nlm.nih.gov/medlineplus/druginfo/amlodipineand benazeprilsystemi203634.html

Angiotensin-Converting Enzyme (Ace) Inhibitors ·

Systemic - U.S. Brands: Accupril; Aceon; Altace; Capoten; Lotensin; Mavik; Monopril; Prinivil; Univasc; Vasotec 4; Zestril http://www.nlm.nih.gov/medlineplus/druginfo/angiotensinconv ertingenzymeace202044.html

Angiotensin-Converting Hydrochlorothiazide ·

Enzyme

(Ace)

Inhibitors

and

Systemic - U.S. Brands: Accuretic; Capozide; Lotensin HCT; Prinzide; Uniretic; Vaseretic; Zestoretic http://www.nlm.nih.gov/medlineplus/druginfo/angiotensinconv ertingenzymeace202045.html

Antihistamines and Decongestants ·

Systemic - U.S. Brands: A.R.M. Maximum Strength Caplets; Actagen; Actifed; Actifed Allergy Nighttime Caplets 20; Alcomed; Alcomed 2-60; Allent; Allercon; Allerest Maximum Strength; Allerfrim; Allerphed; Amilon; Anamine; Anamine T.D.; Andec; Andec-TR; Aprodrine; Atrofed; Atrohi http://www.nlm.nih.gov/medlineplus/druginfo/antihistaminesa nddecongestants202061.html

Antihistamines, Decongestants, and Analgesics ·

Systemic - U.S. Brands: Aclophen; Actifed Cold & Sinus; Actifed Cold & Sinus Caplets; Actifed Sinus Nighttime; Actifed Sinus Nighttime Caplets; Alka-Seltzer Plus Allergy Medicine Liqui-Gels; Alka-Seltzer Plus Cold Medicine; Alka-Seltzer Plus Cold Medicine Liqui-Gels; Allerest http://www.nlm.nih.gov/medlineplus/druginfo/antihistaminesd econgestantsand202062.html

202 High Blood Pressure

Antihistamines, Decongestants, and Anticholinergics ·

Systemic - U.S. Brands: Note: http://www.nlm.nih.gov/medlineplus/druginfo/antihistaminesd econgestantsand202653.html

Beta-Adrenergic Blocking Agents ·

Systemic - U.S. Brands: Betapace; Blocadren; Cartrol; Corgard; Inderal; Inderal LA; Kerlone; Levatol; Lopressor; Normodyne; Sectral; Tenormin; Toprol-XL; Trandate; Visken; Zebeta http://www.nlm.nih.gov/medlineplus/druginfo/betaadrenergicb lockingagentssy202087.html

Beta-Adrenergic Blocking Agents and Thiazide Diuretics ·

Systemic - U.S. Brands: Corzide 40/5; Corzide 80/5; Inderide; Inderide LA; Lopressor HCT; Tenoretic 100; Tenoretic 50; Timolide 10-25; Ziac http://www.nlm.nih.gov/medlineplus/druginfo/betaadrenergicb lockingagentsan202088.html

Calcium Channel Blocking Agents ·

Systemic - U.S. Brands: Adalat; Adalat CC; Calan; Calan SR; Cardene; Cardizem; Cardizem CD; Cardizem SR; Dilacor-XR; DynaCirc; Isoptin; Isoptin SR; Nimotop; Plendil; Procardia; Procardia XL; Vascor; Verelan http://www.nlm.nih.gov/medlineplus/druginfo/calciumchannel blockingagentssy202107.html

Candesartan ·

Systemic - U.S. Brands: Atacand http://www.nlm.nih.gov/medlineplus/druginfo/candesartansyst emic203598.html

Carvedilol ·

Systemic - U.S. Brands: Coreg http://www.nlm.nih.gov/medlineplus/druginfo/carvedilolsyste mic203636.html

Clonidine ·

Systemic - U.S. Brands: Catapres; Catapres-TTS http://www.nlm.nih.gov/medlineplus/druginfo/clonidinesystem ic202152.html

Researching Your Medications 203

Clonidine and Chlorthalidone ·

Systemic - U.S. Brands: Combipres http://www.nlm.nih.gov/medlineplus/druginfo/clonidineandchl orthalidonesyst202153.html

Cyclosporine ·

Systemic - U.S. Brands: Neoral; Sandimmune; SangCya http://www.nlm.nih.gov/medlineplus/druginfo/cyclosporinesys temic202176.html

Decongestants and Analgesics ·

Systemic - U.S. Brands: Actifed Sinus Daytime; Actifed Sinus Daytime Caplets; Advil Cold and Sinus; Advil Cold and Sinus Caplets; Alka-Seltzer Plus Sinus Medicine; Allerest No-Drowsiness Caplets; Aspirin-Free Bayer Select Sinus Pain Relief Caplets; BC Cold Powder Non-Drowsy Fo http://www.nlm.nih.gov/medlineplus/druginfo/decongestantsa ndanalgesicssyst202184.html

Diuretics, Loop ·

Systemic - U.S. Brands: Bumex; Edecrin; Lasix; Myrosemide http://www.nlm.nih.gov/medlineplus/druginfo/diureticsloopsys temic202205.html

Diuretics, Potassium-Sparing ·

Systemic - U.S. Brands: Aldactone; Dyrenium; Midamor http://www.nlm.nih.gov/medlineplus/druginfo/diureticspotassi umsparingsyste202206.html

Diuretics, Potassium-Sparing, and Hydrochlorothiazide ·

Systemic - U.S. Brands: Aldactazide; Dyazide; Maxzide; Moduretic; Spirozide http://www.nlm.nih.gov/medlineplus/druginfo/diureticspotassi umsparingandhy202207.html

204 High Blood Pressure

Diuretics, Thiazide ·

Systemic - U.S. Brands: Aquatensen; Diucardin; Diulo; Diuril; Enduron; Esidrix; Hydro-chlor; Hydro-D; HydroDIURIL; Hydromox; Hygroton; Metahydrin; Microzide; Mykrox; Naqua; Naturetin; Oretic; Renese; Saluron; Thalitone; Trichlorex 10; Zaroxolyn http://www.nlm.nih.gov/medlineplus/druginfo/diureticsthiazid esystemic202208.html

Doxazosin ·

Systemic - U.S. Brands: Cardura http://www.nlm.nih.gov/medlineplus/druginfo/doxazosinsyste mic202629.html

Enalapril and Felodipine ·

Systemic - U.S. Brands: Lexxel http://www.nlm.nih.gov/medlineplus/druginfo/enalaprilandfelo dipinesystemic203638.html

Epoprostenol ·

Systemic - U.S. Brands: Flolan http://www.nlm.nih.gov/medlineplus/druginfo/epoprostenolsys temic203429.html

Eprosartan ·

Systemic - U.S. Brands: Teveten http://www.nlm.nih.gov/medlineplus/druginfo/eprosartansyste mic500044.html

Guanabenz ·

Systemic - U.S. Brands: Wytensin http://www.nlm.nih.gov/medlineplus/druginfo/guanabenzsyste mic202271.html

Guanadrel ·

Systemic - U.S. Brands: Hylorel http://www.nlm.nih.gov/medlineplus/druginfo/guanadrelsyste mic202272.html

Researching Your Medications 205

Guanethidine ·

Systemic - U.S. Brands: Ismelin http://www.nlm.nih.gov/medlineplus/druginfo/guanethidinesys temic202273.html

Guanfacine ·

Systemic - U.S. Brands: Tenex http://www.nlm.nih.gov/medlineplus/druginfo/guanfacinesyste mic202275.html

Headache Medicines, Ergot Derivative-Containing ·

Systemic - U.S. Brands: Cafergot; Cafertine; Cafetrate; D.H.E. 45; Ercaf; Ergo-Caff; Ergomar; Ergostat; Gotamine; Migergot; Wigraine http://www.nlm.nih.gov/medlineplus/druginfo/headachemedici nesergotderivati202216.html

Hydralazine and Hydrochlorothiazide ·

Systemic - U.S. Brands: Apresazide http://www.nlm.nih.gov/medlineplus/druginfo/hydralazineand hydrochlorothiaz202286.html

Indapamide ·

Systemic - U.S. Brands: Lozol http://www.nlm.nih.gov/medlineplus/druginfo/indapamidesyst emic202296.html

Irbesartan ·

Systemic - U.S. Brands: Avapro http://www.nlm.nih.gov/medlineplus/druginfo/irbesartansyste mic203379.html

Isoxsuprine ·

Systemic - U.S. Brands: Vasodilan http://www.nlm.nih.gov/medlineplus/druginfo/isoxsuprinesyst emic202310.html

206 High Blood Pressure

Laxatives ·

Oral - U.S. Brands: Afko-Lube; Afko-Lube Lax 40; Agoral Marshmallow; Agoral Raspberry; Alaxin; Alophen; Alphamul; Alramucil Orange; Alramucil Regular; Bilagog; Bilax; Bisac-Evac; Black-Draught; Black-Draught Lax-Senna; Carter's Little Pills; Cholac; Chronulac; Cillium; Cit http://www.nlm.nih.gov/medlineplus/druginfo/laxativesoral202 319.html

Losartan ·

Systemic - U.S. Brands: Cozaar http://www.nlm.nih.gov/medlineplus/druginfo/losartansystemi c202767.html

Losartan and Hydrochlorothiazide ·

Systemic - U.S. Brands: Hyzaar http://www.nlm.nih.gov/medlineplus/druginfo/losartanandhyd rochlorothiazide203639.html

Mecamylamine ·

Systemic - U.S. Brands: Inversine http://www.nlm.nih.gov/medlineplus/druginfo/mecamylamines ystemic202340.html

Methyldopa ·

Systemic - U.S. Brands: Aldomet http://www.nlm.nih.gov/medlineplus/druginfo/methyldopasyst emic202359.html

Methyldopa and Thiazide Diuretics ·

Systemic - U.S. Brands: Aldoclor; Aldoril http://www.nlm.nih.gov/medlineplus/druginfo/methyldopaand thiazidediuretics202360.html

Metyrosine ·

Systemic - U.S. Brands: Demser http://www.nlm.nih.gov/medlineplus/druginfo/metyrosinesyste mic202368.html

Researching Your Medications 207

Midodrine ·

Systemic - U.S. Brands: ProAmatine http://www.nlm.nih.gov/medlineplus/druginfo/midodrinesyste mic203640.html

Minoxidil ·

Systemic - U.S. Brands: Loniten http://www.nlm.nih.gov/medlineplus/druginfo/minoxidilsyste mic202373.html

Nisoldipine ·

Systemic - U.S. Brands: Sular http://www.nlm.nih.gov/medlineplus/druginfo/nisoldipinesyste mic203431.html

Phenoxybenzamine ·

Systemic - U.S. Brands: Dibenzyline http://www.nlm.nih.gov/medlineplus/druginfo/phenoxybenza minesystemic202458.html

Phenylephrine ·

Ophthalmic - U.S. Brands: Ak-Dilate; Ak-Nefrin; Dilatair; IPhrine; Mydfrin; Neofrin; Neo-Synephrine; Ocugestrin; Phenoptic http://www.nlm.nih.gov/medlineplus/druginfo/phenylephrineo phthalmic202461.html

Phenylpropanolamine ·

Systemic - U.S. Brands: Note:; Propagest; Thinz-Span http://www.nlm.nih.gov/medlineplus/druginfo/phenylpropanol aminesystemic202462.html

Potassium Supplements ·

Systemic - U.S. Brands: Cena-K; Effer-K; Gen-K; Glu-K; K+ 10; K+ Care; K+ Care ET; K-8; Kaochlor 10%; Kaochlor S-F 10%; Kaon; Kaon-Cl; Kaon-Cl 20% Liquid; Kaon-Cl-10; Kato; Kay Ciel; Kaylixir; K-Dur; K-Electrolyte; K-G Elixir; K-Ide; K-Lease; K-Lor; Klor-Con 10; Klor-Con 8; Kl http://www.nlm.nih.gov/medlineplus/druginfo/potassiumsuppl ementssystemic202473.html

208 High Blood Pressure

Prazosin ·

Systemic - U.S. Brands: Minipress http://www.nlm.nih.gov/medlineplus/druginfo/prazosinsystemi c202475.html

Prazosin and Polythiazide ·

Systemic - U.S. Brands: Minizide http://www.nlm.nih.gov/medlineplus/druginfo/prazosinandpol ythiazidesystemi202476.html

Rauwolfia Alkaloids ·

Systemic - U.S. Brands: Harmonyl; Raudixin; Rauval; Rauverid; Serpalan; Wolfina http://www.nlm.nih.gov/medlineplus/druginfo/rauwolfiaalkaloi dssystemic202503.html

Rauwolfia Alkaloids and Thiazide Diuretics ·

Systemic - U.S. Brands: Demi-Regroton; Diupres; Diurigen with Reserpine; Diutensen-R; Enduronyl; Enduronyl Forte; Oreticyl; Oreticyl Forte; Rauzide; Regroton http://www.nlm.nih.gov/medlineplus/druginfo/rauwolfiaalkaloi dsandthiazided202504.html

Reserpine, Hydralazine, and Hydrochlorothiazide ·

Systemic - U.S. Brands: Cam-Ap-Es; Cherapas; Ser-A-Gen; Seralazide; Ser-Ap-Es; Serpazide; Tri-Hydroserpine; Unipres http://www.nlm.nih.gov/medlineplus/druginfo/reserpinehydral azineandhydroch202506.html

Sibutramine ·

Systemic - U.S. Brands: Meridia http://www.nlm.nih.gov/medlineplus/druginfo/sibutraminesyst emic203725.html

Telmisartan ·

Systemic - U.S. Brands: Micardis http://www.nlm.nih.gov/medlineplus/druginfo/telmisartansyste mic203710.html

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Terazosin ·

Systemic - U.S. Brands: Hytrin http://www.nlm.nih.gov/medlineplus/druginfo/terazosinsystem ic202546.html

Torsemide ·

Systemic - U.S. Brands: Demadex http://www.nlm.nih.gov/medlineplus/druginfo/torsemidesyste mic202740.html

Trandolapril and Verapamil ·

Systemic - U.S. Brands: Tarka http://www.nlm.nih.gov/medlineplus/druginfo/trandolapriland verapamilsystem203641.html

Valsartan ·

Systemic - U.S. Brands: Diovan http://www.nlm.nih.gov/medlineplus/druginfo/valsartansystem ic203478.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. You may be able to access these sources from your local medical library or your doctor’s office.

Reuters Health Drug Database The Reuters Health Drug Database can be searched by keyword at the hyperlink: http://www.reutershealth.com/frame2/drug.html. The following medications are listed in the Reuters’ database as associated with high blood pressure (including those with contraindications):44 ·

44

Interferon Beta-1b (rIFN-B) http://www.reutershealth.com/atoz/html/Interferon_Beta-1b_(rIFNB).htm

Adapted from A to Z Drug Facts by Facts and Comparisons.

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·

Interferon Beta-1b(rIFN-B) http://www.reutershealth.com/atoz/html/Interferon_Beta-1b(rIFNB).htm

·

Interferon Gamma-1b http://www.reutershealth.com/atoz/html/Interferon_Gamma-1b.htm

·

Isotretinoin http://www.reutershealth.com/atoz/html/Isotretinoin.htm

·

Isotretinoin (13-cis-Retinoic Acid) http://www.reutershealth.com/atoz/html/Isotretinoin_(13-cisRetinoic_Acid).htm

·

Minocycline http://www.reutershealth.com/atoz/html/Minocycline.htm

·

Tetracycline HCl http://www.reutershealth.com/atoz/html/Tetracycline_HCl.htm

Mosby’s GenRx Mosby’s GenRx database (also available on CD-Rom and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Information in Mosby’s GenRx database can be obtained at the following hyperlink: http://www.genrx.com/Mosby/PhyGenRx/group.html.

Physicians Desk Reference The Physicians Desk Reference database (also available in CD-Rom and book format) is a full-text drug database. The database is searchable by brand name, generic name or by indication. It features multiple drug interactions reports. Information can be obtained at the following hyperlink: http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm. Other Web Sites A number of additional Web sites discuss drug information. As an example, you may like to look at www.drugs.com which reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. which allows users to

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download articles on various drugs and therapeutics for a nominal fee: http://www.medletter.com/.

Contraindications and Interactions (Hidden Dangers) Some of the medications mentioned in the previous discussions can be problematic for patients with high blood pressure--not because they are used in the treatment process, but because of contraindications, or side effects. Medications with contraindications are those that could react with drugs used to treat high blood pressure or potentially create deleterious side effects in patients with high blood pressure. You should ask your physician about any contraindications, especially as these might apply to other medications that you may be taking for common ailments. Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect. Drug interactions may make your medications less effective, cause unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you. Be sure to read the label every time you use a nonprescription or prescription drug, and take the time to learn about drug interactions. These precautions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense. Drug labels contain important information about ingredients, uses, warnings, and directions which you should take the time to read and understand. Labels also include warnings about possible drug interactions. Further, drug labels may change as new information becomes available. This is why it’s especially important to read the label every time you use a medication. When your doctor prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins, botanicals, minerals and herbals you take as well as the foods you eat. Ask your pharmacist for the package insert for each prescription drug you take. The package insert provides more information about potential drug interactions.

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A Final Warning At some point, you may hear of alternative medications from friends, relatives, or in the news media. Advertisements may suggest that certain alternative drugs can produce positive results for patients with high blood pressure. Exercise caution--some of these drugs may have fraudulent claims, and others may actually hurt you. The Food and Drug Administration (FDA) is the official U.S. agency charged with discovering which medications are likely to improve the health of patients with high blood pressure. The FDA warns patients to watch out for45: ·

Secret formulas (real scientists share what they know)

·

Amazing breakthroughs or miracle cures (real breakthroughs don’t happen very often; when they do, real scientists do not call them amazing or miracles)

·

Quick, painless, or guaranteed cures

·

If it sounds too good to be true, it probably isn’t true.

If you have any questions about any kind of medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

General References In addition to the resources provided earlier in this chapter, the following general references describe medications (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·

Complete Guide to Prescription and Nonprescription Drugs 2001 (Complete Guide to Prescription and Nonprescription Drugs, 2001) by H. Winter Griffith, Paperback 16th edition (2001), Medical Surveillance; ISBN: 0942447417; http://www.amazon.com/exec/obidos/ASIN/039952634X/icongroupinterna

·

The Essential Guide to Prescription Drugs, 2001 by James J. Rybacki, James W. Long; Paperback - 1274 pages (2001), Harper Resource; ISBN: 0060958162; http://www.amazon.com/exec/obidos/ASIN/0060958162/icongroupinterna

45

This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.

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·

Handbook of Commonly Prescribed Drugs by G. John Digregorio, Edward J. Barbieri; Paperback 16th edition (2001), Medical Surveillance; ISBN: 0942447417; http://www.amazon.com/exec/obidos/ASIN/0942447417/icongroupinterna

·

Johns Hopkins Complete Home Encyclopedia of Drugs 2nd ed. by Simeon Margolis (Ed.), Johns Hopkins; Hardcover - 835 pages (2000), Rebus; ISBN: 0929661583; http://www.amazon.com/exec/obidos/ASIN/0929661583/icongroupinterna

·

Medical Pocket Reference: Drugs 2002 by Springhouse Paperback 1st edition (2001), Lippincott Williams & Wilkins Publishers; ISBN: 1582550964; http://www.amazon.com/exec/obidos/ASIN/1582550964/icongroupinterna

·

PDR by Medical Economics Staff, Medical Economics Staff Hardcover 3506 pages 55th edition (2000), Medical Economics Company; ISBN: 1563633752; http://www.amazon.com/exec/obidos/ASIN/1563633752/icongroupinterna

·

Pharmacy Simplified: A Glossary of Terms by James Grogan; Paperback 432 pages, 1st edition (2001), Delmar Publishers; ISBN: 0766828581; http://www.amazon.com/exec/obidos/ASIN/0766828581/icongroupinterna

·

Physician Federal Desk Reference by Christine B. Fraizer; Paperback 2nd edition (2001), Medicode Inc; ISBN: 1563373971; http://www.amazon.com/exec/obidos/ASIN/1563373971/icongroupinterna

·

Physician’s Desk Reference Supplements Paperback - 300 pages, 53 edition (1999), ISBN: 1563632950; http://www.amazon.com/exec/obidos/ASIN/1563632950/icongroupinterna

Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Diuretics, Thiazide: Diuretics characterized as analogs of 1,2,4benzothiadiazine-1,1-dioxide. All have a common mechanism of action and differ primarily in the dose required to produce a given effect. They act directly on the kidney to increase the excretion of sodium chloride and water and also increase excretion of potassium ions. [NIH] Doxazosin: A selective alpha-1-adrenergic blocker that lowers serum cholesterol. It is also effective in the treatment of hypertension. [NIH]

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Gels: Colloids with a solid continuous phase and liquid as the dispersed phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting colloid is called a sol. [NIH] Guanabenz: An alpha-2 selective adrenergic agonist used as an antihypertensive agent. [NIH] Guanethidine: An antihypertensive agent that acts by inhibiting selectively transmission in post-ganglionic adrenergic nerves. It is believed to act mainly by preventing the release of norepinephrine at nerve endings and causes depletion of norepinephrine in peripheral sympathetic nerve terminals as well as in tissues. [NIH] Guanfacine: A centrally acting antihypertensive agent. The drug lowers both systolic and diastolic blood pressure by activating the central nervous system alpha-2 adrenoreceptors, which results in reduced sympathetic outflow leading to reduced vascular tone. Its adverse reactions include dry mouth, sedation, and constipation. [NIH] Indapamide: A sulfamyl diuretic with about 16x the effect of furosemide. It has also been shown to be an effective antihypertensive agent in the clinic. [NIH]

Isotretinoin: A topical dermatologic agent that is used in the treatment of acne vulgaris and several other skin diseases. The drug has teratogenic and other adverse effects. [NIH] Isoxsuprine: A beta-adrenergic agonist that causes direct relaxation of uterine and vascular smooth muscle. Its vasodilating actions are greater on the arteries supplying skeletal muscle than on those supplying skin. It is used in the treatment of peripheral vascular disease and in premature labor. [NIH]

Mecamylamine: A nicotinic antagonist that is well absorbed from the gastrointestinal tract and crosses the blood-brain barrier. Mecamylamine has been used as a ganglionic blocker in treating hypertension, but, like most ganglionic blockers, is more often used now as a research tool. [NIH] Methyldopa: An alpha-2 adrenergic agonist that has both central and peripheral nervous system effects. Its primary clinical use is as an antihypertensive agent. Before its alpha-adrenergic actions became clear, methyldopa was thought to act by inhibiting decarboxylation of DOPA leading to depletion of norepinephrine or by conversion to and release as the false transmitter alpha-methylnorepinephrine. [NIH] Midodrine: An ethanolamine derivative that is an adrenergic alpha agonist. It is used as a vasoconstrictor agent in the treatment of hypotension. [NIH] Minocycline: A semisynthetic antibiotic effective against tetracyclineresistant staphylococcus infections. [NIH] Phenoxybenzamine: An alpha-adrenergic anatagonist with long duration of

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action. It has been used to treat hypertension and as a peripheral vasodilator. [NIH]

Phenylephrine: An alpha-adrenergic agonist used as a mydriatic, nasal decongestant, and cardiotonic agent. [NIH] Phenylpropanolamine: A sympathomimetic that acts mainly by causing release of norepinephrine but also has direct agonist activity at some adrenergic receptors. It is most commonly used as a nasal vasoconstrictor and an appetite depressant. [NIH] Prazosin: A selective adrenergic alpha-1 antagonist used in the treatment of heart failure, hypertension, pheochromocytoma, Raynaud's syndrome, prostatic hypertrophy, and urinary retention. [NIH] Rauwolfia Alkaloids: Alkaloids from Rauwolfia serpentina Benth and other species. The prototype is reserpine, which is a depleter of catecholamines and serotonin from the sympathetic postganglionic fibers and brain areas. They have been used in hypertension and psychoses despite their wide range of potentially adverse effects. [NIH] Reserpine: An alkaloid found in the roots of Rauwolfia serpentina and R. vomitoria. Reserpine inhibits the uptake of norepinephrine into storage vesicles resulting in depletion of catecholamines and serotonin from central and peripheral axon terminals. It has been used as an antihypertensive and an antipsychotic as well as a research tool, but its adverse effects limit its clinical use. [NIH] Senna: Preparations of Cassia senna L. and C. angustifolia of the Leguminosae. They contain sennosides, which are anthraquinone type cathartics and are used in many different preparations as laxatives. [NIH] Synephrine: Sympathetic alpha-adrenergic agonist with actions like phenylephrine. It is used as a vasoconstrictor in circulatory failure, asthma, nasal congestion, and glaucoma. [NIH]

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APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your friends or doctor have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to high blood pressure. Finally, at the conclusion of this chapter, we will provide a list of readings on high blood pressure from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine’s (NCCAM) overview of complementary and alternative medicine.

What Is CAM?46 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and 46

Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.

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treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.

What Are the Domains of Alternative Medicine?47 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are

47

Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.

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practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India’s traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body’s defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.

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Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind’s capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.

Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine’s use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.

Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body’s systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues.

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Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient’s recovery and that healing is promoted when the body’s energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.

Can Alternatives Affect My Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your medical treatment. It becomes all the more important to speak with your doctor who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for patients of both genders and all ages.48

48

Adapted from http://www.4woman.gov/faq/alternative.htm.

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Is It Okay to Want Both Traditional and Alternative Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.

Finding CAM References on High Blood Pressure Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for high blood pressure. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required. The Combined Health Information Database For a targeted search, The Combined Health Information Database is a bibliographic database produced by health-related agencies of the Federal Government (mostly from the National Institutes of Health). This database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “high blood pressure” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: ·

Mainstreaming of Alternative Medicine Source: Consumer Report. 65(5): 17-25. May 2000.

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Summary: This magazine article presents findings from a survey of alternative and mainstream therapy use among more than 46,000 Consumer Reports readers. Respondents were asked to identify the 2 worst medical conditions they experienced in the past two years, what they did to treat them, and how they rated the results. This article presents the findings for allergies, arthritis, back pain, depression, headache, high blood pressure, high cholesterol, insomnia, prostate problems, and respiratory infections. It also presents ratings for general categories of alternative and mainstream treatments, and summarizes evidence for several popular herbal remedies and other supplements. Thirty-five percent of the survey respondents reported using alternative therapies, mainly for troublesome symptoms that did not respond to conventional treatments. Of the 65 percent who did not use alternative therapies, most said they were satisfied with standard medical treatments. Overall, 58 percent of medical conditions were treated with conventional treatments, 25 percent with both conventional and complementary therapies, 9 percent with alternatives only, and the remainder with over-the-counter drugs or lifestyle changes. For most conditions, the majority of respondents who tried alternatives found them very or somewhat helpful, but some popular treatments such as melatonin for insomnia and saw palmetto for prostate problems scored poorly. The article has 11 figures. ·

Alternative Medicine Sourcebook: A Realistic Evaluation of Alternative Healing Methods Source: Los Angeles: Lowell House. 1997. 260 p. Contact: Available from Lowell House, 2020 Avenue of the Stars, Suite 300, Los Angeles, CA 90067. 310-552-7555. $27.00. ISBN: 1565656261. Summary: This book examines homeopathy, bodywork, naturopathy, Chinese medicine, and movement therapies. It describes the strengths and weaknesses of alternative approaches; how to find qualified practitioners; how to integrate conventional and alternative medicine; and gives recommendations on what to do when suffering from various conditions such as anxiety, asthma, cancer, depression, fatigue, fibromyalgia, headaches, insomnia, pain, chronic illness, and high blood pressure. This book provides information on how to obtain health insurance coverage for alternative therapies. The annotated bibliography includes sections about general naturopathic methods, food supplements, herbs, dietary therapy, homeopathy, Chinese medicine, bodywork, and body-mind medicine. The subheadings in the bibliography are used again in a list of organizations. An index is included.

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·

Three Essential Oils for the Medicine Cabinet Source: Alternative Health Practitioner: The Journal of Complementary and Natural Care. 3(1): 11-15. Spring 1997. Summary: This article describes the properties and most common uses of three aromatherapy oils: lavender (Lavendula vera), tea tree (Melaleuca alternifolia) and peppermint (Mentha piperita). Lavender is described as a balancing oil and may be used as a sedative, an antibacterial agent, a tonic, astringent, or as a regulator of blood sugar and high blood pressure. Lavender is also reputed to relieve stress, fatigue, and depression. Tea tree oil is also called the 'oil of first aid' and may have antibacterial, antifungal, and antiviral properties. It can be used as a tonic, astringent, or stimulant. Peppermint, also known as the 'oil of digestion,' is used as a general tonic to refresh and invigorate the user while normalizing stomach and head conditions. This article provides guidelines for using essential oils through inhalation, compresses, bathing, and massage and gives instructions for measuring oils. This journal article contains 4 references.

·

Dr. Dean Ornish's Program for Reversing Heart Disease: The Only System Scientifically Proven to Reverse Heart Disease Without Drugs or Surgery Source: New York, NY: Ivy Books. 1995. 672 p. Contact: Available from Ivy Books. Random House, 201 East 50th Street, New York, NY 10022. (800) 726-0600; INTERNATIONAL: (212) 572-2620. Price: $6.99. ISBN: 0804110387. Summary: This book presents a research-based program for improving heart health through lifestyle change as an adjunct to conventional medical treatment. The foreword includes sections on new research findings about how healthy lifestyles improve heart conditions, how reversal of disease takes place, standards for measuring improvement, the need for drugs, and how practical the 'Opening Your Heart' program is. The Introduction explains the link among physical, emotional, and spiritual aspects of heart wellness. Part 1 orients the reader to making healthy lifestyle changes. Chapter 1 gives a history of heart disease and its treatment. Chapter 2 is a heart patient's anecdotal report of changing his attitude along with his health for the better. Chapter 3 describes the anatomy of the heart and the causes of heart ailments, including nicotine, poor diet, lack of exercise, emotional stress, and stimulants, as well as types of heart problems, from blocked circulation and high blood pressure to sudden cardiac death. Chapter 4 profiles how celebrities and average patients made healthy lifestyle and attitude changes. Chapter 5

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recounts the author's own background and life philosophy. Chapter 6 provides anecdotal evidence from program patients about how they learned to manage anger and chronic stress. Part 2 details the program. Chapter 7 discusses opening one's heart to your feelings and to inner peace through use of yogic exercises for stretching, relaxation, and breathing techniques. Chapters 8 through 12 discuss opening one's heart to interaction and support with others, the concept of a higher self, reversal and prevention diets, how to quit smoking, and how to exercise. Part 3 provides recipes and 21 days of menus. The book includes an epilogue, an appendix chart on nutrient analysis of common foods, bibliographic references, and subject index. ·

Your Body's Many Cries for Water. You Are Not Sick, You Are Thirsty! Don't Treat Thirst With Medications! 2nd ed Source: Vienna, VA: Global Health Solutions. 1995. 182 p. Contact: Available from Global Health Solutions. 8472 A Tyco Road, Vienna, VA 22182. (800) 759-3999. Price: $14.95. ISBN: 0962994235. Summary: This book discusses the role of water in health. The author suggests that most illness is the result of chronic thirst and that the current paradigm used in conventional medicine needs to be changed to overcome this problem. The book discusses water regulation at different stages of life, changes, and other important properties of water. Many conditions suggested as the result of chronic water deprivation include rheumatoid arthritis, neck pain, anginal pain, headaches, depression, high blood pressure and cholesterol, obesity, asthma, diabetes, and AIDS. The book suggests how to improve these conditions, how to change the health care system, and how much money may be saved by following this regimen. The book includes a bibliography; a record of correspondence between the author and various conventional medical associations, and a biography of the author.

·

Healing Power of Herbs: The Enlightened Person's Guide to the Wonders of Medicinal Plants. 2nd ed Source: Rocklin, CA: Prima Publishing. 1995. 410 p. Contact: Available from Prima Publishing. PO Box 1260BK, Rocklin, CA 95677. 916-786-0426. Price: $15.95. ISBN: 1559587008. Summary: This book is a consumer's guide to medicinal plants. It is organized into three sections. Section I, an introduction, discusses the regulation of herbal products in the United States and Europe, the history of herbal medicine, methods of preparing herbal products and expressing their strengths, and quality control issues. Section II, a materia medica,

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describes 37 medicinal plants including common food herbs and spices such as onion, garlic, ginger, and turmeric; herbal tonics such as Chinese or Korean ginseng, Siberian ginseng, and angelica; and herbal sedatives such as valerian and St. John's wort. The information includes key uses, a general description, chemical composition, history and folk use, pharmacology, clinical applications, dosage, toxicity, and references. Section III recommends herbal treatments for 34 common health conditions, including arthritis, asthma and hayfever, bladder infections, diabetes, herpes, high blood pressure, irritable bowel syndrome, menopause, and ulcers. The book includes a list of organizations and naturopathic medical schools, a glossary, and an index. ·

Visualization for Stress Reduction Source: Oakland, CA: New Harbinger Publications, Inc. 1992. (audiocassette). Contact: Available from New Harbinger Publications, Inc. 5674 Shattuck Avenue, Oakland, CA 94609. 800-748-6273, Fax: 510-652-5472. Price: $11.95. ISBN: 1879237172. Summary: This audiotape explains how to use visualization to relax and reduce stress. These skills may help relieve muscular tension, anxiety, insomnia, depression, fatigue, irritable bowel syndrome, muscle spasms, neck and back pain, and even high blood pressure. Side 1 provides the background information needed to prepare for using the visualization techniques. It discusses five topics: the physiology of relaxation, the nature of stress, preparing stress-reduction images, planning lifestyle changes, and composing appropriate affirmations. Side 2 presents the actual visualization instructions that should be listened to while lying down with the eyes closed. The visualization has four parts: muscle relaxation, breathing, imagery, and reinforcement of lifestyle changes.

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Creating Health: How to Wake Up the Body's Intelligence. Rev. ed Source: Wilmington, MA: Houghton-Mifflin Company. 1991. 205 p. Contact: Available from Houghton Mifflin Company. 181 Ballard Vale Street, Wilmington, MA 01887. (800) 225-3362. Price: $13.00 (Paperback). ISBN: 0395755158 (Paperback). Summary: This book provides a description of the mind/body connection within the context of Ayurvedic medicine. Health and disease topics discussed in detail include high blood pressure, cancer, cigarette smoking, chronic fatigue, stress, insomnia, depression, and the psychosocial connection. The brain chemistry of health, the problems of aging, and the positive and negative impulses of intelligence are

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discussed. The book reviews strategies for creating optimum health, including self-awareness, the importance of job satisfaction, channeling the unconscious mind, diet, wonder and belief, and having an open mind. These ideas are expanded in a section on moving towards a higher reality via mediation. Meditation techniques also are described. ·

Healing Herbs: The Ultimate Guide to the Curative Power of Nature's Medicines Source: Westminster, MD: Random House, Inc. 1991. 641 p. Contact: Available from Random House, Inc. 400 Hahn Road, Westminster, MD 21157. (800) 733-3000; Fax: (800) 659-2436. Price: $7.50 (Paperback). ISBN: 0553569880. Summary: This book profiles 100 of the most widely used medicinal plants, giving their scientific and popular names, which parts of the plant are used, tracing their history, folklore, and healing properties and summarizing the latest scientific research on the benefits of using herbs. The book provides information about: where to find herbs, how to take them, store them, prepare them, and how to grow them to safely harness the active ingredients. It also includes an alphabetical herb encyclopedia, and a guide to conditions and diseases including arthritis, burns, cancer, colds, ear infection, fever, high blood pressure, insomnia, migraine, motion sickness, stress, ulcers, and wound healing. A list of references from journals and periodicals are provided, as well as a list of books and an index.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine’s databases to allow patients to search for articles that specifically relate to high blood pressure and complementary medicine. To search the database, go to the following Web site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “high blood pressure” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine (CAM) that are related to high blood pressure: ·

24-hour blood pressure monitoring to evaluate the effects of nifedipine in pre-eclampsia and in chronic hypertension in pregnancy. Author(s): Benedetto C, Zonca M, Giarola M, Maula V, Chiarolini L, Carandente F.

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Source: Br J Obstet Gynaecol. 1997 June; 104(6): 682-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9197871&dopt=Abstract ·

A new physiological approach to control essential hypertension. Author(s): Selvamurthy W, Sridharan K, Ray US, Tiwary RS, Hegde KS, Radhakrishan U, Sinha KC. Source: Indian J Physiol Pharmacol. 1998 April; 42(2): 205-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10225047&dopt=Abstract

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Acute antihypertensive effects of calcium channel blockers are not affected by calcium supplementation in patients with essential hypertension. Author(s): Sato K, Dohi Y, Miyagawa K, Kojima M. Source: Japanese Heart Journal. 1998 May; 39(3): 347-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9711186&dopt=Abstract

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Acute pulmonary hypertension following paclitaxel in a patient with AIDS-related primary effusion lymphoma. Author(s): Cherifi S, Hermans P, De Wit S, Cantinieaux B, Clumeck N. Source: Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases. 2001 May; 7(5): 277-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11422257&dopt=Abstract

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Ask the doctor: I take a water pill for my high blood pressure, but just hate taking my potassium supplement - two teaspoons of a bitter liquid per day. Is there any better way to keep my potassium up? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 1999 August; 9(12): 8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10402355&dopt=Abstract

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Calcium supplementation in nulliparous women for the prevention of pregnancy-induced hypertension, preeclampsia and preterm birth: an Australian randomized trial. FRACOG and the ACT Study Group. Author(s): Crowther CA, Hiller JE, Pridmore B, Bryce R, Duggan P, Hague WM, Robinson JS.

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Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 1999 February; 39(1): 12-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10099740&dopt=Abstract ·

Calcium supplementation in patients with essential hypertension: assessment by office, home and ambulatory blood pressure. Author(s): Kawano Y, Yoshimi H, Matsuoka H, Takishita S, Omae T. Source: Journal of Hypertension. 1998 November; 16(11): 1693-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9856371&dopt=Abstract

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Chronic pulmonary hypertension--the monocrotaline model and involvement of the hemostatic system. Author(s): Schultze AE, Roth RA. Source: Journal of Toxicology and Environmental Health. Part B, Critical Reviews. 1998 October-December; 1(4): 271-346. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9776954&dopt=Abstract

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Chronotherapeutic delivery of verapamil in obese versus non-obese patients with essential hypertension. Author(s): White WB, Elliott WJ, Johnson MF, Black HR. Source: Journal of Human Hypertension. 2001 February; 15(2): 135-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11317194&dopt=Abstract

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Common Questions and Answers in the Management of Hypertension - Everyday Practice in Hypertension: Herbal Remedies for High Blood Pressure. Author(s): Townsend RR. Source: J Clin Hypertens (Greenwich). 2000 January; 2(1): 54-55. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11416627&dopt=Abstract

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Dietary fiber, psyllium, attenuates salt-accelerated hypertension in stroke-prone spontaneously hypertensive rats. Author(s): Obata K, Ikeda K, Yamasaki M, Yamori Y.

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Source: Journal of Hypertension. 1998 December; 16(12 Pt 2): 1959-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9886883&dopt=Abstract ·

Discourses of worry, stress, and high blood pressure in rural south Louisiana. Author(s): Boutain DM. Source: J Nurs Scholarsh. 2001; 33(3): 225-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11552548&dopt=Abstract

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Effect of red ginseng on blood pressure in patients with essential hypertension and white coat hypertension. Author(s): Han KH, Choe SC, Kim HS, Sohn DW, Nam KY, Oh BH, Lee MM, Park YB, Choi YS, Seo JD, Lee YW. Source: Am J Chin Med. 1998; 26(2): 199-209. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9799972&dopt=Abstract

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Effects of potassium supplementation on office, home, and 24-h blood pressure in patients with essential hypertension. Author(s): Kawano Y, Minami J, Takishita S, Omae T. Source: American Journal of Hypertension : Journal of the American Society of Hypertension. 1998 October; 11(10): 1141-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9799029&dopt=Abstract

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Effects of red ginseng upon vascular endothelial function in patients with essential hypertension. Author(s): Sung J, Han KH, Zo JH, Park HJ, Kim CH, Oh BH. Source: Am J Chin Med. 2000; 28(2): 205-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10999439&dopt=Abstract

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Factors that appear as obstacles to the control of high blood pressure. Author(s): Lang T. Source: Ethn Dis. 2000 Winter; 10(1): 125-30. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10764138&dopt=Abstract

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Garlic prevents hypoxic pulmonary hypertension in rats. Author(s): Fallon MB, Abrams GA, Abdel-Razek TT, Dai J, Chen SJ, Chen YF, Luo B, Oparil S, Ku DD. Source: The American Journal of Physiology. 1998 August; 275(2 Pt 1): L283-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9700088&dopt=Abstract

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Hypertensive crisis associated with St. John's Wort. Author(s): Patel S, Robinson R, Burk M. Source: The American Journal of Medicine. 2002 April 15; 112(6): 507-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11959071&dopt=Abstract

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Hypertensive crisis from herbal treatment of impotence. Author(s): Ruck B, Shih RD, Marcus SM. Source: The American Journal of Emergency Medicine. 1999 May; 17(3): 317-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10337904&dopt=Abstract

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Lay beliefs about high blood pressure in a low- to middle-income urban African-American community: an opportunity for improving hypertension control. Author(s): Wilson RP, Freeman A, Kazda MJ, Andrews TC, Berry L, Vaeth PA, Victor RG. Source: The American Journal of Medicine. 2002 January; 112(1): 26-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11812403&dopt=Abstract

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Lifestyle modifications to prevent and control hypertension. 7. Recommendations on stress management. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada. Author(s): Spence JD, Barnett PA, Linden W, Ramsden V, Taenzer P. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 1999 May 4; 160(9 Suppl): S46-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10333853&dopt=Abstract

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Non-pharmacological management of essential hypertension. Author(s): Anand MP. Source: J Indian Med Assoc. 1999 June; 97(6): 220-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10645695&dopt=Abstract

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Partners for two decades: AOA and the National High Blood Pressure Education Program. Author(s): Nickey WA, Lenfant C. Source: J Am Osteopath Assoc. 1998 March; 98(3): 153-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9558830&dopt=Abstract

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Pregnancy-induced hypertension: maternal and neonatal plasma lipidsoluble antioxidant levels and its relationship with fatty acid unsaturation. Author(s): Oostenbrug GS, Mensink RP, van Houwelingen AC, Al MD, Hornstra G. Source: European Journal of Clinical Nutrition. 1998 October; 52(10): 7549. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9805224&dopt=Abstract

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Promising hypotensive effect of hawthorn extract: a randomized double-blind pilot study of mild, essential hypertension. Author(s): Walker AF, Marakis G, Morris AP, Robinson PA. Source: Phytotherapy Research : Ptr. 2002 February; 16(1): 48-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11807965&dopt=Abstract

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The effect of sour tea (Hibiscus sabdariffa) on essential hypertension. Author(s): Haji Faraji M, Haji Tarkhani A. Source: Journal of Ethnopharmacology. 1999 June; 65(3): 231-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10404421&dopt=Abstract

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The inhibitory effects of Radix Astragali on hypoxic pulmonary hypertension of rats. Author(s): Xi S, Ruan Y, Liu Y, Zhang L, Si W.

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Source: Chin Med J (Engl). 1998 October; 111(10): 956-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11189248&dopt=Abstract ·

The mind/body link in essential hypertension: time for a new paradigm. Author(s): Mann SJ. Source: Alternative Therapies in Health and Medicine. 2000 March; 6(2): 39-45. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10710802&dopt=Abstract

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The treatment of adults with essential hypertension. Author(s): Dosh SA. Source: The Journal of Family Practice. 2002 January; 51(1): 74-80. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11927069&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.thedacare.org/healthnotes/

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Open Directory Project: http://dmoz.org/Health/Alternative/

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TPN.com: http://www.tnp.com/

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs

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WellNet: http://www.wellnet.ca/herbsa-c.htm

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html The following is a specific Web list relating to high blood pressure; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·

General Overview High Blood Pressure Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html

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Alternative Therapy Acupuncture Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Therapy/Acupuncture.htm Aromatherapy Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Aromat herapycm.html Ayurveda Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Ayurve dacm.html Ayurveda Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,672, 00.html Biofeedback Source: Integrative Medicine Communications; www.onemedicine.com

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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Biofeed backcm.html Biofeedback Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,675, 00.html Chiropractic Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Therapy/Chiropractic.htm Colon therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,682, 00.html Feldenkrais Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,695, 00.html Guided imagery Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,699, 00.html Homeopathy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,703, 00.html Hydrotherapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com

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Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,705, 00.html Hypnotherapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,706, 00.html Iridology Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,709, 00.html Meditation Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,717, 00.html Naturopathy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,722, 00.html Osteopathy Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Osteop athycm.html Prayer Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,728, 00.html Qigong Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com

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Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,729, 00.html Relaxation Techniques Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Relaxat ionTechniquescm.html Tai Chi Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/TaiChic m.html Tai chi Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,737, 00.html Traditional Chinese Medicine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Traditi onalChineseMedicinecm.html Yoga Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Yogac m.html Yoga Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,746, 00.html ·

Homeopathy

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Argentum nitricum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Argentum_ nitricum.htm Aurum metallicum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Aurum_met allicum.htm Belladonna Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Belladonna. htm Calcarea carbonica Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Calcarea_ca rbonica.htm Glonoinum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Glonoinum. htm Lachesis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Lachesis.ht m Natrum muriaticum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Natrum_mu riaticum.htm

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Nux vomica Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Nux_vomic a.htm Phosphorus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Phosphorus .htm Plumbum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Plumbum.h tm Sanguinaria Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Sanguinaria .htm ·

Herbs and Supplements 5-HTP Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Obesit ycc.html 5-HTP Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/5Hy droxytryptophan5HTPcs.html 5-Hydroxytryptophan (5-HTP) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/5Hy droxytryptophan5HTPcs.html

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Acanthopanax senticosus Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinsengSibe rianch.html Acebutolol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Acebutolol.htm Acebutolol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Achillea Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm Achillea millefolium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Yarrowch.ht ml ALA Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Alph aLinolenicAcidALAcs.html Alpha2-Adrenergic Agonists Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Cardio vascularMedicationsAlpha2AdrenergicAgonistscl.html Alpha-Linolenic Acid (ALA) Source: Integrative Medicine Communications; www.onemedicine.com

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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Alph aLinolenicAcidALAcs.html American Ginseng Alternative names: Panax quinquefolium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinsengAm ericanch.html Amiloride Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Amiloride.htm Amino Acids Overview Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Amino_Acids.htm Aminoglycosides Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Antibio ticMedicationsAminoglycosidescl.html Amlodipine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Amlodipine.htm Amlodipine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Andrographis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html

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Angelica sinensis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/DongQuaic h.html Angiotensin II Receptor Blockers Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Angiotensin_II_Blockers .htm Antidepressants Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Obesit ycc.html Anti-Inflammatory Drugs Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Antioxidants Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Preeclampsia.htm Antioxidants Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Antioxidants Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 04,00.html Apium graveolens Source: Integrative Medicine Communications; www.onemedicine.com

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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/CelerySeedc h.html Arctostaphylos uva ursi Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Uvaursich.h tml Arginine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Arginine.htm Arginine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm Arginine Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 05,00.html Asian Ginseng Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Ginseng_Asian.htm Asian Ginseng Alternative names: Panax ginseng Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinsengAsi anch.html Astragalus Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000101.html Atenolol Source: Integrative Medicine Communications; www.onemedicine.com

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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Athletic Performance Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Athletic_Performance .htm Baking soda Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,835, 00.html Bearberry Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Uvaursich.h tml Beargrape Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Uvaursich.h tml Benazepril Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Benazepril.htm Benazepril Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Beta-Adrenergic Blockers Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Beta_Blockers.htm

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Beta-Blockers Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Cardio vascularMedicationsBetaBlockerscl.html Beta-Carotene Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Beta-Carotene Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000104.html Betaxolol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Betaxolol.htm Black Cohosh Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000110.html Blue Cohosh Alternative names: Caulophyllum thalictroides Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Blue_Cohosh.htm Brahmi Alternative names: Centella asiatica , Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GotuKolach .html Butcher's broom Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com

246 High Blood Pressure

Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 10,00.html Caffeine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm Caffeine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Obesit ycc.html Calciferol Alternative names: Vitamin D Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/Inter actions/VitaminDcs.html Calciferol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minDcs.html Calcitrol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minDcs.html Calcitrol Alternative names: Vitamin D Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/Inter actions/VitaminDcs.html Candesartan Source: Healthnotes, Inc.; www.healthnotes.com

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Hyperlink: http://www.thedacare.org/healthnotes/Drug/Candesartan.htm Candesartan Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Capsaicin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Obesit ycc.html Captopril Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Captopril.htm Captopril Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Cardiac Glycosides Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Cardio vascularMedicationsCardiacGlycosidescl.html Carvedilol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Carvedilol.htm Celery Seed Alternative names: Apium graveolens Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/CelerySeedc h.html

248 High Blood Pressure

Centella Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GotuKolach .html Centella asiatica Alternative names: Centella asiatica , Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GotuKolach .html Chinese Angelica Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/DongQuaic h.html Chitosan Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Obesit ycc.html Chitosan Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 16,00.html Chlorothiazide Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm Chlorthalidone Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm

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Cholecalciferol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minDcs.html Cholecalciferol Alternative names: Vitamin D Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/Inter actions/VitaminDcs.html Cloves Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Coenzyme Q Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Coenzyme Q Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,768, 00.html Coenzyme Q10 Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Coenzyme_Q10.htm Coenzyme Q10 Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm Coenzyme Q10 Source: Integrative Medicine Communications; www.onemedicine.com

250 High Blood Pressure

Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Coen zymeQ10cs.html Coenzyme Q10 Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Coenzyme Q10 Alternative names: CoQ10 Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/Inter actions/CoenzymeQ10cs.html Coenzyme Q10 Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000293.html Coenzyme Q10 (CoQ10) Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000135.html Coleus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm Coleus forskohlii Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm Coleus forskohlii Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000136.html Conjugated linoleic acid Source: Integrative Medicine Communications; www.onemedicine.com

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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Obesit ycc.html CoQ10 Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm CoQ10 Alternative names: Coenzyme Q10 Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/Inter actions/CoenzymeQ10cs.html CoQ10 Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Coen zymeQ10cs.html CoQ10 Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000293.html Coumadin Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000293.html Cramp Bark Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Preecla mpsiacc.html Cyclosporine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Cyclosporine.htm Cysteine Source: Integrative Medicine Communications; www.onemedicine.com

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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Cyst einecs.html Cysteine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/Inter actions/Cysteinecs.html Dandelion Alternative names: Taraxacum officinale Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Dandelionc h.html Danggui Alternative names: Angelica sinensis, Chinese Angelica, Dang Gui, Danngui, Dong Qua, Tang Kuei, Tan Kue Bai zhi(Note: Dong quai should not be confused with Angelica root or Angelica seed.) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/DongQuaic h.html Dehydroepiandrosterone Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Obesit ycc.html Dehydroepiandrosterone (DHEA) Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/DHEA.htm Dehydroepiandrosterone (DHEA) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Dehy droepiandrosteroneDHEAcs.html

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DHEA Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Dehy droepiandrosteroneDHEAcs.html DHEA Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Obesit ycc.html Diltiazem Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Diltiazem.htm Diuretics Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Diuretics.htm Diuretics Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm Diuretics Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Docosahexaenoic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm Docosahexaenoic Acid Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html

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Docosahexaenoic Acid Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000293.html Dong Quai Alternative names: Angelica sinensis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Dong_Quai.htm Dong Quai Alternative names: Angelica sinensis, Chinese Angelica, Dang Gui, Danngui, Dong Qua, Tang Kuei, Tan Kue Bai zhi(Note: Dong quai should not be confused with Angelica root or Angelica seed.) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/DongQuaic h.html Dong quai (angelica) Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,774, 00.html Eicosapentaenoic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm Eicosapentaenoic Acid Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Eicosapentaenoic Acid Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000293.html Eicosapentaenoic Acid (EPA) Source: Integrative Medicine Communications; www.onemedicine.com

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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Eicos apentaenoicAcidEPAcs.html Eleuthero Alternative names: Eleutherococcus senticosus, Acanthopanax senticosus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Eleuthero.htm Eleuthero Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinsengSibe rianch.html Eleutherococcus senticosus Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinsengSibe rianch.html Enalapril Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm Enalapril Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Enalapril.htm Enalapril Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html EPA Source: Integrative Medicine Communications; www.onemedicine.com

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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Eicos apentaenoicAcidEPAcs.html Ephedra Alternative names: Ephedra sinica, Ephedra intermedia, Ephedra equisetina Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Ephedra.htm Ephedra Alternative names: Ephedra sinensis, Ma huang Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Ephedrach. html Ephedra Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Obesit ycc.html Ephedra Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000154.html Ephedra (Ma huang) Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,777, 00.html Ephedra sinensis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Ephedrach. html Epinephrine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm

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Erocalciferol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minDcs.html Erocalciferol Alternative names: Vitamin D Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/Inter actions/VitaminDcs.html Ethacrynic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm Felodipine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Felodipine.htm Felodipine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Fiber Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm Fiber Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Fiber.htm Fiber Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Obesit ycc.html

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Fibric Acid Derivatives Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Cholest erolLoweringMedicationsFibricAcidDerivativescl.html Flaxseed Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Forskolin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm Forskolin Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 25,00.html Furosemide Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm Furosemide Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Garcinia cambogia Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Obesit ycc.html Ginkgo Source: Integrative Medicine Communications; www.onemedicine.com

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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Ginkgo Biloba Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Ginkgo Biloba Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinkgoBilo bach.html Ginseng Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm Ginseng Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Ginseng (Panax) Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 29,00.html Ginseng, American Alternative names: Panax quinquefolium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinsengAm ericanch.html Ginseng, Asian Alternative names: Panax ginseng Source: Integrative Medicine Communications; www.onemedicine.com

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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinsengAsi anch.html Ginseng, Siberian Alternative names: Eleutherococcus senticosus, Acanthopanax senticosus, Eleuthero Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinsengSibe rianch.html Glucosamine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Glucosamine.htm Glutathione Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Glutathione.htm Glycyrrhiza glabra Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Licoricech.h tml Glycyrrhiza glabra Alternative names: Licorice Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsHerbs/Interactions /Licoricech.html Glycyrrhiza1 Alternative names: Licorice; Glycyrrhiza glabra L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Goldenseal Alternative names: Hydrastis canadensis Source: Integrative Medicine Communications; www.onemedicine.com

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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Goldensealc h.html Goldenseal Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,791, 00.html Gotu Kola Alternative names: Centella asiatica Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Gotu_Kola.htm Gotu Kola Alternative names: Centella asiatica , Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GotuKolach .html Green Tea Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Obesit ycc.html Guanfacine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Guanfacine.htm Gymnema Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Obesit ycc.html

262 High Blood Pressure

Gymnema sylvestre Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Obesit ycc.html Hawthorn Alternative names: Crataegus laevigata, Crataegus oxyacantha, Crataegus monogyna Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Hawthorn.htm Hawthorn Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm Hawthorn Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Preecla mpsiacc.html Hawthorn Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Hawthorn Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000293.html Hawthorn Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000178.html Hawthorn Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 35,00.html

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Herbal Medicine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm Herbal Medicine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Hibiscus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm Huperzine A Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000184.html Huperzine A Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 38,00.html Hydrastis canadensis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Goldensealc h.html Hydrochlorothiazide Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm Hydrocotyle Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GotuKolach .html

264 High Blood Pressure

Hydroxycitric Acid Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Obesit ycc.html Hypericum perforatum Alternative names: St. John's Wort Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsHerbs/Interactions /StJohnsWortch.html Hypericum perforatum Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/StJohnsWor tch.html Indapamide Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Indapamide.htm Indian Pennywort Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GotuKolach .html Indian Tobacco Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Preecla mpsiacc.html Inhalant, Systemic, and Topical Corticosteroids Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Antiinf lammatoryMedicationsInhalantSystemicandTopicalCorticosteroidscl.htm l

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Insulin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm Insulin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Preeclampsia.htm Insulin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Obesit ycc.html Insulin Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000293.html Irbesartan Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Irbesartan.htm Irbesartan Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Ispaghula Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Psyll iumcs.html Kava Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,798, 00.html

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Klamathweed Alternative names: St. John's Wort Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsHerbs/Interactions /StJohnsWortch.html Klamathweed Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/StJohnsWor tch.html Kola Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Korean Ginseng Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Kudzu Alternative names: Pueraria lobata Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Kudzu.htm Kudzu Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,858, 00.html Labetalol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Labetalol.htm L-Arginine Source: Healthnotes, Inc.; www.healthnotes.com

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Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm L-Glutamine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Obesit ycc.html Licorice Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Licorice Alternative names: Glycyrrhiza glabra, Spanish Licorice Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Licoricech.h tml Licorice Alternative names: Glycyrrhiza glabra Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsHerbs/Interactions /Licoricech.html Licorice Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000144.html Licorice Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,801, 00.html Lisinopril Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Lisinopril.htm

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Lisinopril Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Lobelia Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsj-l.htm Loop Diuretics Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Diureti csLoopDiureticscl.html Losartan Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Losartan.htm Losartan Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Ma huang Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Obesit ycc.html Ma huang Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Ephedrach. html Maidenhair Tree Source: Integrative Medicine Communications; www.onemedicine.com

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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinkgoBilo bach.html Maitake Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000203.html Marsh Pennywort Alternative names: Centella asiatica , Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GotuKolach .html Melatonin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Mela tonincs.html Melatonin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/Inter actions/Melatonincs.html Melatonin Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,804, 00.html Methyldopa Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Methyldopa.htm Metoprolol Source: Integrative Medicine Communications; www.onemedicine.com

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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Milk Thistle Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Preecla mpsiacc.html Miscellaneous Preparations Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Antaci dsMiscellaneousPreparationscl.html Mistletoe Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm Mistletoe Alternative names: Viscum album Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Mistletoe.htm Mistletoe Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,101 09,00.html Mixed Amphetamines Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Mixed_Amphetamines.h tm Moexipril Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Moexipril.htm

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Monophasic, Biphasic, and Triphasic Preparations Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/BirthC ontrolMedicationscl.html Nadolol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Nadolol.htm Nadolol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Naringin Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 89,00.html Nifedipine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Nifedipine.htm Nifedipine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Nonsteroidal Anti-Inflammatory Drugs Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Olive Leaf Alternative names: Olea europa Source: Healthnotes, Inc.; www.healthnotes.com

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Hyperlink: http://www.thedacare.org/healthnotes/Herb/Olive_Leaf.htm Olive Leaf Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm Oral Contraceptives Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Panax ginseng Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinsengAsi anch.html Panax quinquefolium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinsengAm ericanch.html Phenothiazine Derivatives Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Psycho therapeuticMedicationsPhenothiazineDerivativescl.html Phentermine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Obesit ycc.html Phenylpropanolamine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Obesit ycc.html

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Phosphorus Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Phos phoruscs.html Plantago isphagula Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Psyll iumcs.html Propranolol Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000293.html Psyllium Alternative names: Plantago ovata, Plantago ispaghula Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Psyllium.htm Psyllium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Obesit ycc.html Psyllium Alternative names: Ispaghula,Plantago isphagula Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Psyll iumcs.html Quinapril Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Quinapril.htm Ramipril Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Ramipril.htm

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Red Pepper Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Obesit ycc.html Reishi Alternative names: Ganoderma lucidum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Reishi.htm Reishi Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm Ribes Alternative names: Black Currant; Ribes nigrum L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Siberian Ginseng Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm Siberian Ginseng Alternative names: Eleutherococcus senticosus, Acanthopanax senticosus, Eleuthero Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinsengSibe rianch.html Siberian ginseng Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,821, 00.html Sibutramine Source: Integrative Medicine Communications; www.onemedicine.com

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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Obesit ycc.html Soluble fiber Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Obesit ycc.html Spanish Licorice Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Licoricech.h tml Spanish Licorice Alternative names: Licorice Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsHerbs/Interactions /Licoricech.html St. John's Wort Alternative names: Hypericum perforatum, Klamathweed Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/StJohnsWor tch.html St. John's Wort Alternative names: Hypericum perforatum Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsHerbs/Interactions /StJohnsWortch.html Sulfonylureas Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Antidia beticMedicationsSulfonylureascl.html

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Tang Kuei Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/DongQuaic h.html Taraxacum officinale Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Dandelionc h.html Taurine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Taurine.htm Taurine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm Taurine Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000196.html Taurine Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 59,00.html Thiazide Diuretics Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Thiazide_Diuretics.htm Thiazide Diuretics Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Diureti csThiazideDiureticscl.html

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Thioxanthene Derivatives Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Psycho therapeuticMedicationsThioxantheneDerivativescl.html Torsemide Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm Trental Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000293.html Triamterene Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Triamterene.htm Tricyclic Antidepressants Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Obesit ycc.html Tricyclic Antidepressants (TCAs) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Antide pressantMedicationsTCAscl.html Triotann-S Pediatric Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/TriotannS_Pediatric.htm Tyrosine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Tyro sinecs.html

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Uncaria asian Alternative names: Asian species; Uncaria sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Uva ursi Alternative names: Arctostaphylos uva-ursi Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Uva_Ursi.htm Uva Ursi Alternative names: Arctostaphylos uva ursi, Bearberry, Beargrape Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Uvaursich.h tml Valsartan Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Valsartan.htm Valsartan Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Vasodilators Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Cardio vascularMedicationsVasodilatorscl.html Verapamil Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Verapamil.htm Yarrow Alternative names: Achillea millefolium, Milfoil Source: Integrative Medicine Communications; www.onemedicine.com

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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Yarrowch.ht ml Yohimbe Alternative names: Pausinystalia yohimbe Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Yohimbe.htm Yohimbe Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000251.html Yohimbe Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,830, 00.html ·

Related Conditions Allergic Reaction, Anaphylaxis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Anaph ylaxiscc.html Allergic Reaction, Angioedema Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Angioe demacc.html Allergies Alternative names: Hay Fever Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000258.html Alzheimer's Disease Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Alzhei mersDiseasecc.html

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Alzheimer's Disease, Non-Alzheimer's Dementia, and Normal AgeRelated Memory Loss Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000259.html Amenorrhea Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ameno rrheacc.html Anaphylaxis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Anaph ylaxiscc.html Angina Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Angina.htm Angina Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Angina cc.html Angioedema Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Angioe demacc.html Arteries, Hardening of Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Athero sclerosiscc.html Arteriosclerosis Source: Integrative Medicine Communications; www.onemedicine.com

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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Athero sclerosiscc.html Asthma Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Asthm acc.html Asthma Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Atherosclerosis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Athero sclerosiscc.html Atherosclerosis and Heart Disease Prevention Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000263.html Benign Prostatic Hyperplasia Alternative names: Prostate Enlargement Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Bites and Stings, Insect Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/InsectB itesandStingscc.html Blood Pressure, High Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Blood Sugar, Low Source: Integrative Medicine Communications; www.onemedicine.com

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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypog lycemiacc.html Bone Marrow Disorders Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Myelo proliferativeDisorderscc.html Bronchitis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Bronch itiscc.html Candidiasis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Candid iasiscc.html Cardiac Arrhythmia Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Cardiac_Arrhythmia. htm Cardiovascular Disease Overview Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Cardiovascular_Dise ase.htm Chickenpox and Shingles Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Herpes ZosterandVaricellaVirusescc.html Cholesterol, High Source: Integrative Medicine Communications; www.onemedicine.com

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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hyperc holesterolemiacc.html Chronic Fatigue Syndrome Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Chroni cFatigueSyndromecc.html Chronic Myelogenous Leukemia Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Myelo proliferativeDisorderscc.html Cold Sores Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Herpes SimplexViruscc.html Congestive Heart Failure Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Congestive_Heart.htm Congestive Heart Failure Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Conges tiveHeartFailurecc.html Constipation Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Consti pationcc.html Coronary Artery Disease Source: Integrative Medicine Communications; www.onemedicine.com

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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Athero sclerosiscc.html Depression Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Depres sioncc.html Diabetes Mellitus Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Dysphagia Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Dysph agiacc.html Erythema Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/SkinDi sordersErythemacc.html Fainting Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Faintin gcc.html Fatigue, Chronic Syndrome Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Chroni cFatigueSyndromecc.html Gastritis Source: Integrative Medicine Communications; www.onemedicine.com

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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastriti scc.html Gastroesophageal Reflux Disease Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastro esophagealRefluxDiseasecc.html Gestational Hypertension Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gestational_Hyperte nsion.htm Glaucoma Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Glauco macc.html Gout Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gout.htm Gout Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Goutcc .html Hair Growth, Excessive Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hirsuti smcc.html Headache, Migraine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Heada cheMigrainecc.html

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Heart Attack Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Heart_Attack.htm Heart Attack Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Myoca rdialInfarctioncc.html Heart Failure, Congestive Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Conges tiveHeartFailurecc.html Heart Infection, Pericarditis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pericar ditiscc.html Heartburn Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastro esophagealRefluxDiseasecc.html Hepatitis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Hepatitis, Viral Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hepati tisViralcc.html Herpes Simplex Virus Source: Integrative Medicine Communications; www.onemedicine.com

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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Herpes SimplexViruscc.html Herpes Zoster and Varicella Viruses Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Herpes ZosterandVaricellaVirusescc.html High Cholesterol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/High_Cholesterol.htm High Cholesterol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hyperc holesterolemiacc.html High Cholesterol Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000278.html Hirsuitism Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hirsuti smcc.html HIV and AIDS Support Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/HIV_Support.htm Hypercholesterolemia Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hyperc holesterolemiacc.html

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Hyperparathyroidism Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hyper parathyroidismPrimarycc.html Hyperthyroidism Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert hyroidismcc.html Hypoglycemia Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypog lycemiacc.html Hypothyroidism Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypot hyroidismcc.html Indigestion, Heartburn, and Low Stomach Acidity Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Indigestion.htm Insect Bites and Stings Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/InsectB itesandStingscc.html Insulin Resistance Syndrome Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Insulin_Resistance_S yndrome.htm Low Blood Sugar Source: Integrative Medicine Communications; www.onemedicine.com

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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypog lycemiacc.html Macular Degeneration Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Macular_Degeneratio n.htm Macular Degeneration Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000257.html Menopausal Symptoms (Other Than Osteoporosis) Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000276.html Menstruation, Absence of Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ameno rrheacc.html Migraine Headache Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Heada cheMigrainecc.html Mitral Valve Prolapse Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Mitral_Valve_Prolaps e.htm Myelofibrosis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Myelo proliferativeDisorderscc.html

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Myeloproliferative Disorders Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Myelo proliferativeDisorderscc.html Myocardial Infarction Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Myoca rdialInfarctioncc.html Obesity Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Obesit ycc.html Parathyroid, Overactive Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hyper parathyroidismPrimarycc.html Parkinson's Disease Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Parkin sonsDiseasecc.html Peptic Ulcer Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Peptic Ulcercc.html Pericarditis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pericar ditiscc.html

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Pharyngitis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pharyn gitiscc.html Polycythemia Vera Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Myelo proliferativeDisorderscc.html Preeclampsia Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Preeclampsia.htm Preeclampsia Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Preecla mpsiacc.html Pregnancy and Postpartum Support Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Pregnancy.htm Pulmonary Edema Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pulmo naryEdemacc.html Reiter's Syndrome Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Reiters Syndromecc.html Respiratory Infection, Bronchitis Source: Integrative Medicine Communications; www.onemedicine.com

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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Bronch itiscc.html Retinopathy Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Retinopathy.htm Sarcoidosis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Sarcoid osiscc.html Scleroderma Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Sclerod ermacc.html Shingles and Chickenpox Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Herpes ZosterandVaricellaVirusescc.html Shock Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Shockc c.html Sinus Infection Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Sinusit iscc.html Sinusitis Source: Integrative Medicine Communications; www.onemedicine.com

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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Sinusit iscc.html Skin Disorders, Erythema Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/SkinDi sordersErythemacc.html Sleep Apnea Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/SleepA pneacc.html Sore Throat Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pharyn gitiscc.html Stings and Bites, Insect Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/InsectB itesandStingscc.html Stomach Inflammation Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastriti scc.html Stroke Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Stroke.htm Stroke, Transient Source: Integrative Medicine Communications; www.onemedicine.com

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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Stroke Transientcc.html Swallowing, Difficulty Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Dysph agiacc.html Syncope Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Faintin gcc.html Tendinitis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Tendin itiscc.html Throat, Sore Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pharyn gitiscc.html Thrombocytosis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Myelo proliferativeDisorderscc.html Thyroid, Overactive Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert hyroidismcc.html Thyroid, Underactive Source: Integrative Medicine Communications; www.onemedicine.com

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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypot hyroidismcc.html TIAs Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Stroke Transientcc.html Transient Ischemic Attacks Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Stroke Transientcc.html Ulcer, Peptic Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Peptic Ulcercc.html Varicella and Herpes Zoster Viruses Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Herpes ZosterandVaricellaVirusescc.html Warts Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Wartsc c.html Yeast Infection Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Candid iasiscc.html

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General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Alternative Medicine for Dummies by James Dillard (Author); Audio Cassette, Abridged edition (1998), Harper Audio; ISBN: 0694520659; http://www.amazon.com/exec/obidos/ASIN/0694520659/icongroupinterna ·

Complementary and Alternative Medicine Secrets by W. Kohatsu (Editor); Hardcover (2001), Hanley & Belfus; ISBN: 1560534400; http://www.amazon.com/exec/obidos/ASIN/1560534400/icongroupinterna

·

Dictionary of Alternative Medicine by J. C. Segen; Paperback-2nd edition (2001), Appleton & Lange; ISBN: 0838516211; http://www.amazon.com/exec/obidos/ASIN/0838516211/icongroupinterna

·

Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating by Walter C. Willett, MD, et al; Hardcover - 352 pages (2001), Simon & Schuster; ISBN: 0684863375; http://www.amazon.com/exec/obidos/ASIN/0684863375/icongroupinterna

· Encyclopedia of Natural Medicine, Revised 2nd Edition by Michael T. Murray, Joseph E. Pizzorno; Paperback - 960 pages, 2nd Rev edition (1997), Prima Publishing; ISBN: 0761511571; http://www.amazon.com/exec/obidos/ASIN/0761511571/icongroupinterna ·

Integrative Medicine: An Introduction to the Art & Science of Healing by Andrew Weil (Author); Audio Cassette, Unabridged edition (2001), Sounds True; ISBN: 1564558541; http://www.amazon.com/exec/obidos/ASIN/1564558541/icongroupinterna

·

New Encyclopedia of Herbs & Their Uses by Deni Bown; Hardcover - 448 pages, Revised edition (2001), DK Publishing; ISBN: 078948031X; http://www.amazon.com/exec/obidos/ASIN/078948031X/icongroupinterna

· Textbook of Complementary and Alternative Medicine by Wayne B. Jonas; Hardcover (2003), Lippincott, Williams & Wilkins; ISBN: 0683044370; http://www.amazon.com/exec/obidos/ASIN/0683044370/icongroupinterna

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For additional information on complementary and alternative medicine, ask your doctor or write to: National Institutes of Health National Center for Complementary and Alternative Medicine Clearinghouse P. O. Box 8218 Silver Spring, MD 20907-8218

Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antifungal: Destructive to fungi, or suppressing their reproduction or growth; effective against fungal infections. [EU] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Inhalation: The drawing of air or other substances into the lungs. [EU] Menopause: Cessation of menstruation in the human female, occurring usually around the age of 50. [EU] Sedative: 1. allaying activity and excitement. 2. an agent that allays excitement. [EU] Stimulant: 1. producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. an agent or remedy that produces stimulation. [EU] Valerian: Valeriana officinale, an ancient, sedative herb of the large family Valerianaceae. The roots were formerly used to treat hysterias and other neurotic states and are presently used to treat sleep disorders. [NIH]

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APPENDIX C. RESEARCHING NUTRITION Overview Since the time of Hippocrates, doctors have understood the importance of diet and nutrition to patients’ health and well-being. Since then, they have accumulated an impressive archive of studies and knowledge dedicated to this subject. Based on their experience, doctors and healthcare providers may recommend particular dietary supplements to patients with high blood pressure. Any dietary recommendation is based on a patient’s age, body mass, gender, lifestyle, eating habits, food preferences, and health condition. It is therefore likely that different patients with high blood pressure may be given different recommendations. Some recommendations may be directly related to high blood pressure, while others may be more related to the patient’s general health. These recommendations, themselves, may differ from what official sources recommend for the average person. In this chapter we will begin by briefly reviewing the essentials of diet and nutrition that will broadly frame more detailed discussions of high blood pressure. We will then show you how to find studies dedicated specifically to nutrition and high blood pressure.

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Food and Nutrition: General Principles What Are Essential Foods? Food is generally viewed by official sources as consisting of six basic elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and (6) minerals. Consuming a combination of these elements is considered to be a healthy diet: ·

Fluids are essential to human life as 80-percent of the body is composed of water. Water is lost via urination, sweating, diarrhea, vomiting, diuretics (drugs that increase urination), caffeine, and physical exertion.

·

Carbohydrates are the main source for human energy (thermoregulation) and the bulk of typical diets. They are mostly classified as being either simple or complex. Simple carbohydrates include sugars which are often consumed in the form of cookies, candies, or cakes. Complex carbohydrates consist of starches and dietary fibers. Starches are consumed in the form of pastas, breads, potatoes, rice, and other foods. Soluble fibers can be eaten in the form of certain vegetables, fruits, oats, and legumes. Insoluble fibers include brown rice, whole grains, certain fruits, wheat bran and legumes.

·

Proteins are eaten to build and repair human tissues. Some foods that are high in protein are also high in fat and calories. Food sources for protein include nuts, meat, fish, cheese, and other dairy products.

·

Fats are consumed for both energy and the absorption of certain vitamins. There are many types of fats, with many general publications recommending the intake of unsaturated fats or those low in cholesterol.

Vitamins and minerals are fundamental to human health, growth, and, in some cases, disease prevention. Most are consumed in your diet (exceptions being vitamins K and D which are produced by intestinal bacteria and sunlight on the skin, respectively). Each vitamin and mineral plays a different role in health. The following outlines essential vitamins: ·

Vitamin A is important to the health of your eyes, hair, bones, and skin; sources of vitamin A include foods such as eggs, carrots, and cantaloupe.

·

Vitamin B1, also known as thiamine, is important for your nervous system and energy production; food sources for thiamine include meat, peas, fortified cereals, bread, and whole grains.

·

Vitamin B2, also known as riboflavin, is important for your nervous system and muscles, but is also involved in the release of proteins from

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nutrients; food sources for riboflavin include dairy products, leafy vegetables, meat, and eggs. ·

Vitamin B3, also known as niacin, is important for healthy skin and helps the body use energy; food sources for niacin include peas, peanuts, fish, and whole grains

·

Vitamin B6, also known as pyridoxine, is important for the regulation of cells in the nervous system and is vital for blood formation; food sources for pyridoxine include bananas, whole grains, meat, and fish.

·

Vitamin B12 is vital for a healthy nervous system and for the growth of red blood cells in bone marrow; food sources for vitamin B12 include yeast, milk, fish, eggs, and meat.

·

Vitamin C allows the body’s immune system to fight various diseases, strengthens body tissue, and improves the body’s use of iron; food sources for vitamin C include a wide variety of fruits and vegetables.

·

Vitamin D helps the body absorb calcium which strengthens bones and teeth; food sources for vitamin D include oily fish and dairy products.

·

Vitamin E can help protect certain organs and tissues from various degenerative diseases; food sources for vitamin E include margarine, vegetables, eggs, and fish.

·

Vitamin K is essential for bone formation and blood clotting; common food sources for vitamin K include leafy green vegetables.

·

Folic Acid maintains healthy cells and blood and, when taken by a pregnant woman, can prevent her fetus from developing neural tube defects; food sources for folic acid include nuts, fortified breads, leafy green vegetables, and whole grains.

It should be noted that one can overdose on certain vitamins which become toxic if consumed in excess (e.g. vitamin A, D, E and K). Like vitamins, minerals are chemicals that are required by the body to remain in good health. Because the human body does not manufacture these chemicals internally, we obtain them from food and other dietary sources. The more important minerals include: ·

Calcium is needed for healthy bones, teeth, and muscles, but also helps the nervous system function; food sources for calcium include dry beans, peas, eggs, and dairy products.

·

Chromium is helpful in regulating sugar levels in blood; food sources for chromium include egg yolks, raw sugar, cheese, nuts, beets, whole grains, and meat.

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·

Fluoride is used by the body to help prevent tooth decay and to reinforce bone strength; sources of fluoride include drinking water and certain brands of toothpaste.

·

Iodine helps regulate the body’s use of energy by synthesizing into the hormone thyroxine; food sources include leafy green vegetables, nuts, egg yolks, and red meat.

·

Iron helps maintain muscles and the formation of red blood cells and certain proteins; food sources for iron include meat, dairy products, eggs, and leafy green vegetables.

·

Magnesium is important for the production of DNA, as well as for healthy teeth, bones, muscles, and nerves; food sources for magnesium include dried fruit, dark green vegetables, nuts, and seafood.

·

Phosphorous is used by the body to work with calcium to form bones and teeth; food sources for phosphorous include eggs, meat, cereals, and dairy products.

·

Selenium primarily helps maintain normal heart and liver functions; food sources for selenium include wholegrain cereals, fish, meat, and dairy products.

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Zinc helps wounds heal, the formation of sperm, and encourage rapid growth and energy; food sources include dried beans, shellfish, eggs, and nuts.

The United States government periodically publishes recommended diets and consumption levels of the various elements of food. Again, your doctor may encourage deviations from the average official recommendation based on your specific condition. To learn more about basic dietary guidelines, visit the Web site: http://www.health.gov/dietaryguidelines/. Based on these guidelines, many foods are required to list the nutrition levels on the food’s packaging. Labeling Requirements are listed at the following site maintained by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government recommends that consumers become familiar with the following abbreviations before reading FDA literature:49 ·

DVs (Daily Values): A new dietary reference term that will appear on the food label. It is made up of two sets of references, DRVs and RDIs.

·

DRVs (Daily Reference Values): A set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium.

49

Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.

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·

RDIs (Reference Daily Intakes): A set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. The name “RDI” replaces the term “U.S. RDA.”

·

RDAs (Recommended Dietary Allowances): A set of estimated nutrient allowances established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge. What Are Dietary Supplements?50

Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail. Dietary supplements are provided in many forms including tablets, capsules, powders, gel-tabs, extracts, and liquids. Historically in the United States, the most prevalent type of dietary supplement was a multivitamin/mineral tablet or capsule that was available in pharmacies, either by prescription or “over the counter.” Supplements containing strictly herbal preparations were less widely available. Currently in the United States, a wide array of supplement products are available, including vitamin, mineral, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin. The Office of Dietary Supplements (ODS) of the National Institutes of Health is the official agency of the United States which has the expressed goal of acquiring “new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.”51 According to the ODS, dietary supplements can have an important impact on the prevention and management of disease and on the maintenance of health.52 The ODS notes that considerable research on the effects of dietary supplements has been conducted in Asia and Europe where the use of plant products, in particular, has a long tradition. However, the This discussion has been adapted from the NIH: http://ods.od.nih.gov/whatare/whatare.html. 51 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920, Fax: (301) 480-1845, E-mail: [email protected]. 52 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health and Education Act defines dietary supplements as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” 50

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overwhelming majority of supplements have not been studied scientifically. To explore the role of dietary supplements in the improvement of health care, the ODS plans, organizes, and supports conferences, workshops, and symposia on scientific topics related to dietary supplements. The ODS often works in conjunction with other NIH Institutes and Centers, other government agencies, professional organizations, and public advocacy groups. To learn more about official information on dietary supplements, visit the ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact: The Office of Dietary Supplements National Institutes of Health Building 31, Room 1B29 31 Center Drive, MSC 2086 Bethesda, Maryland 20892-2086 Tel: (301) 435-2920 Fax: (301) 480-1845 E-mail: [email protected]

Finding Studies on High Blood Pressure The NIH maintains an office dedicated to patient nutrition and diet. The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.53 IBIDS is available to the public free of charge through the ODS Internet page: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We recommend that you start with the Consumer Database. While you may not find references for the topics that are of most interest to you, check back periodically as this database is frequently updated. More studies can be Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

53

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found by searching the Full IBIDS Database. Healthcare professionals and researchers generally use the third option, which lists peer-reviewed citations. In all cases, we suggest that you take advantage of the “Advanced Search” option that allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “high blood pressure” (or synonyms) into the search box. To narrow the search, you can also select the “Title” field. The following is a typical result when searching for recently indexed consumer information on high blood pressure: ·

High blood pressure. Lifestyle changes replace drugs for some. Source: Anonymous Harv-Health-Lett. 1998 May; 23(7): 5 1052-1577

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Lowering the risk for high blood pressure. Source: Aftergood, L. Alfin Slater, R.B. Tufts-Univ-Diet-Nutr-Lett. New York, N.Y. : Tufts University Diet and Nutrition Letter. May 1987. volume 5 (3) page 3-6. 0747-4105

·

Not only salt, but calcium and fish oils affect high blood pressure. Source: Mendoza, T.G. Environ-Nutr. New York, N.Y. : Environmental Nutrition, Inc. November 1988. volume 11 (11) page 1, 6. 0893-4452

·

Tackling high blood pressure. Source: Nutr-Action-Health-Lett. Washington, D.C. : Center for Science in the Public Interest. May 1989. volume 16 (4) page 1, 5-7. charts. 0199-5510

The following information is typical of that found when using the “Full IBIDS Database” when searching using “high blood pressure” (or a synonym): ·

High blood pressure medicinal plant use and arterial pressure change. Source: Stevenson, D.R. Plants in indigenous medicine & diet : biobehavioral approaches / edited by Nina L. Etkin. Bedford Hills, N.Y. : Redgrave, c1986. page 252-265. ISBN: 0913178020

·

Licorice and high blood pressure. Source: Tufts-Univ-Diet-Nutr-Lett. New York, N.Y. : Tufts University Diet and Nutrition Letter. May 1986. volume 4 (3) page 7-8.

·

Tackling high blood pressure. Source: Nutr-Action-Health-Lett. Washington, D.C. : Center for Science in the Public Interest. May 1989. volume 16 (4) page 1, 5-7. charts. 0199-5510

·

What can I eat if my doctor tells me I have: osteroprosis? high blood pressure? high blood cholesterol? diabetes. Source: Struempler, B. Circ-HE-Ala-Coop-Ext-Serv-Auburn-Univolume Auburn, Ala. : The Service. August 1992. (691) 6 page 0571-8392

306 High Blood Pressure

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

·

The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

·

The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

·

The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

·

The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

·

Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

·

Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

·

Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

·

Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

·

Google: http://directory.google.com/Top/Health/Nutrition/

·

Healthnotes: http://www.thedacare.org/healthnotes/

·

Open Directory Project: http://dmoz.org/Health/Nutrition/

Researching Nutrition 307

·

Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

·

WebMDÒHealth: http://my.webmd.com/nutrition

·

WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html

Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]

Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH]

Finding Medical Libraries 309

APPENDIX D. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM’s interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.54

54

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

310 High Blood Pressure

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):55 ·

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

·

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM

·

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

·

California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html

·

California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html

·

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

·

California: Gateway Health Library (Sutter Gould Medical Foundation)

·

California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/

55

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

Finding Medical Libraries 311

·

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

·

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

·

California: San José PlaneTree Health Library, http://planetreesanjose.org/

·

California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html

·

California: University of California, Davis. Health Sciences Libraries

·

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html

·

California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/

·

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm

·

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

·

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

·

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml

·

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm

·

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html

·

Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

·

Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp

·

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/

312 High Blood Pressure

·

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm

·

Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html

·

Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/

·

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm

·

Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/

·

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/

·

Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/

·

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm

·

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html

·

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm

·

Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/

·

Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library

·

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10

·

Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html

·

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

·

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml

Finding Medical Libraries 313

·

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

·

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

·

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html

·

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

·

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp

·

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital), http://www.southcoast.org/library/

·

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

·

Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/

·

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

·

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

·

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

·

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm

·

Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html

·

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41

314 High Blood Pressure

·

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

·

National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

·

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

·

Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm

·

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

·

New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm

·

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm

·

New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/

·

New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

·

New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/

·

New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html

·

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

·

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

·

Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp

Finding Medical Libraries 315

·

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/

·

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/

·

Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml

·

Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html

·

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html

·

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

·

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp

·

Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm

·

Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/

·

South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm

·

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

·

Texas: Matustik Family Resource Center (Cook Children’s Health Care System), http://www.cookchildrens.com/Matustik_Library.html

·

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

·

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/

Your Rights and Insurance 317

APPENDIX E. YOUR RIGHTS AND INSURANCE Overview Any patient with high blood pressure faces a series of issues related more to the healthcare industry than to the medical condition itself. This appendix covers two important topics in this regard: your rights and responsibilities as a patient, and how to get the most out of your medical insurance plan.

Your Rights as a Patient The President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has created the following summary of your rights as a patient.56 Information Disclosure Consumers have the right to receive accurate, easily understood information. Some consumers require assistance in making informed decisions about health plans, health professionals, and healthcare facilities. Such information includes: ·

Health plans. Covered benefits, cost-sharing, and procedures for resolving complaints, licensure, certification, and accreditation status, comparable measures of quality and consumer satisfaction, provider network composition, the procedures that govern access to specialists and emergency services, and care management information.

56Adapted

from Consumer Bill of Rights and Responsibilities: http://www.hcqualitycommission.gov/press/cbor.html#head1.

318 High Blood Pressure

·

Health professionals. Education, board certification, and recertification, years of practice, experience performing certain procedures, and comparable measures of quality and consumer satisfaction.

·

Healthcare facilities. Experience in performing certain procedures and services, accreditation status, comparable measures of quality, worker, and consumer satisfaction, and procedures for resolving complaints.

·

Consumer assistance programs. Programs must be carefully structured to promote consumer confidence and to work cooperatively with health plans, providers, payers, and regulators. Desirable characteristics of such programs are sponsorship that ensures accountability to the interests of consumers and stable, adequate funding.

Choice of Providers and Plans Consumers have the right to a choice of healthcare providers that is sufficient to ensure access to appropriate high-quality healthcare. To ensure such choice, the Commission recommends the following: ·

Provider network adequacy. All health plan networks should provide access to sufficient numbers and types of providers to assure that all covered services will be accessible without unreasonable delay -including access to emergency services 24 hours a day and 7 days a week. If a health plan has an insufficient number or type of providers to provide a covered benefit with the appropriate degree of specialization, the plan should ensure that the consumer obtains the benefit outside the network at no greater cost than if the benefit were obtained from participating providers.

·

Women’s health services. Women should be able to choose a qualified provider offered by a plan -- such as gynecologists, certified nurse midwives, and other qualified healthcare providers -- for the provision of covered care necessary to provide routine and preventative women’s healthcare services.

·

Access to specialists. Consumers with complex or serious medical conditions who require frequent specialty care should have direct access to a qualified specialist of their choice within a plan’s network of providers. Authorizations, when required, should be for an adequate number of direct access visits under an approved treatment plan.

·

Transitional care. Consumers who are undergoing a course of treatment for a chronic or disabling condition (or who are in the second or third trimester of a pregnancy) at the time they involuntarily change health

Your Rights and Insurance 319

plans or at a time when a provider is terminated by a plan for other than cause should be able to continue seeing their current specialty providers for up to 90 days (or through completion of postpartum care) to allow for transition of care. ·

Choice of health plans. Public and private group purchasers should, wherever feasible, offer consumers a choice of high-quality health insurance plans.

Access to Emergency Services Consumers have the right to access emergency healthcare services when and where the need arises. Health plans should provide payment when a consumer presents to an emergency department with acute symptoms of sufficient severity--including severe pain--such that a “prudent layperson” could reasonably expect the absence of medical attention to result in placing that consumer’s health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.

Participation in Treatment Decisions Consumers have the right and responsibility to fully participate in all decisions related to their healthcare. Consumers who are unable to fully participate in treatment decisions have the right to be represented by parents, guardians, family members, or other conservators. Physicians and other health professionals should: ·

Provide patients with sufficient information and opportunity to decide among treatment options consistent with the informed consent process.

·

Discuss all treatment options with a patient in a culturally competent manner, including the option of no treatment at all.

·

Ensure that persons with disabilities have effective communications with members of the health system in making such decisions.

·

Discuss all current treatments a consumer may be undergoing.

·

Discuss all risks, nontreatment.

·

Give patients the opportunity to refuse treatment and to express preferences about future treatment decisions.

benefits,

and

consequences

to

treatment

or

320 High Blood Pressure

·

Discuss the use of advance directives -- both living wills and durable powers of attorney for healthcare -- with patients and their designated family members.

·

Abide by the decisions made by their patients and/or their designated representatives consistent with the informed consent process.

Health plans, health providers, and healthcare facilities should: ·

Disclose to consumers factors -- such as methods of compensation, ownership of or interest in healthcare facilities, or matters of conscience -that could influence advice or treatment decisions.

·

Assure that provider contracts do not contain any so-called “gag clauses” or other contractual mechanisms that restrict healthcare providers’ ability to communicate with and advise patients about medically necessary treatment options.

·

Be prohibited from penalizing or seeking retribution against healthcare professionals or other health workers for advocating on behalf of their patients.

Respect and Nondiscrimination Consumers have the right to considerate, respectful care from all members of the healthcare industry at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality healthcare system. To assure that right, the Commission recommends the following: ·

Consumers must not be discriminated against in the delivery of healthcare services consistent with the benefits covered in their policy, or as required by law, based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.

·

Consumers eligible for coverage under the terms and conditions of a health plan or program, or as required by law, must not be discriminated against in marketing and enrollment practices based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment. Confidentiality of Health Information

Consumers have the right to communicate with healthcare providers in confidence and to have the confidentiality of their individually identifiable

Your Rights and Insurance 321

healthcare information protected. Consumers also have the right to review and copy their own medical records and request amendments to their records. Complaints and Appeals Consumers have the right to a fair and efficient process for resolving differences with their health plans, healthcare providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review. A free copy of the Patient’s Bill of Rights is available from the American Hospital Association.57

Patient Responsibilities Treatment is a two-way street between you and your healthcare providers. To underscore the importance of finance in modern healthcare as well as your responsibility for the financial aspects of your care, the President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has proposed that patients understand the following “Consumer Responsibilities.”58 In a healthcare system that protects consumers’ rights, it is reasonable to expect and encourage consumers to assume certain responsibilities. Greater individual involvement by the consumer in his or her care increases the likelihood of achieving the best outcome and helps support a quality-oriented, cost-conscious environment. Such responsibilities include: ·

Take responsibility for maximizing healthy habits such as exercising, not smoking, and eating a healthy diet.

·

Work collaboratively with healthcare providers in developing and carrying out agreed-upon treatment plans.

·

Disclose relevant information and clearly communicate wants and needs.

·

Use your health insurance plan’s internal complaint and appeal processes to address your concerns.

·

Avoid knowingly spreading disease.

To order your free copy of the Patient’s Bill of Rights, telephone 312-422-3000 or visit the American Hospital Association’s Web site: http://www.aha.org. Click on “Resource Center,” go to “Search” at bottom of page, and then type in “Patient’s Bill of Rights.” The Patient’s Bill of Rights is also available from Fax on Demand, at 312-422-2020, document number 471124. 58 Adapted from http://www.hcqualitycommission.gov/press/cbor.html#head1. 57

322 High Blood Pressure

·

Recognize the reality of risks, the limits of the medical science, and the human fallibility of the healthcare professional.

·

Be aware of a healthcare provider’s obligation to be reasonably efficient and equitable in providing care to other patients and the community.

·

Become knowledgeable about your health plan’s coverage and options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions.

·

Show respect for other patients and health workers.

·

Make a good-faith effort to meet financial obligations.

·

Abide by administrative and operational procedures of health plans, healthcare providers, and Government health benefit programs.

Choosing an Insurance Plan There are a number of official government agencies that help consumers understand their healthcare insurance choices.59 The U.S. Department of Labor, in particular, recommends ten ways to make your health benefits choices work best for you.60 1. Your options are important. There are many different types of health benefit plans. Find out which one your employer offers, then check out the plan, or plans, offered. Your employer’s human resource office, the health plan administrator, or your union can provide information to help you match your needs and preferences with the available plans. The more information you have, the better your healthcare decisions will be. 2. Reviewing the benefits available. Do the plans offered cover preventive care, well-baby care, vision or dental care? Are there deductibles? Answers to these questions can help determine the out-of-pocket expenses you may face. Matching your needs and those of your family members will result in the best possible benefits. Cheapest may not always be best. Your goal is high quality health benefits.

More information about quality across programs is provided at the following AHRQ Web site: http://www.ahrq.gov/consumer/qntascii/qnthplan.htm. 60 Adapted from the Department of Labor: http://www.dol.gov/dol/pwba/public/pubs/health/top10-text.html. 59

Your Rights and Insurance 323

3. Look for quality. The quality of healthcare services varies, but quality can be measured. You should consider the quality of healthcare in deciding among the healthcare plans or options available to you. Not all health plans, doctors, hospitals and other providers give the highest quality care. Fortunately, there is quality information you can use right now to help you compare your healthcare choices. Find out how you can measure quality. Consult the U.S. Department of Health and Human Services publication “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer. 4. Your plan’s summary plan description (SPD) provides a wealth of information. Your health plan administrator can provide you with a copy of your plan’s SPD. It outlines your benefits and your legal rights under the Employee Retirement Income Security Act (ERISA), the federal law that protects your health benefits. It should contain information about the coverage of dependents, what services will require a co-pay, and the circumstances under which your employer can change or terminate a health benefits plan. Save the SPD and all other health plan brochures and documents, along with memos or correspondence from your employer relating to health benefits. 5. Assess your benefit coverage as your family status changes. Marriage, divorce, childbirth or adoption, and the death of a spouse are all life events that may signal a need to change your health benefits. You, your spouse and dependent children may be eligible for a special enrollment period under provisions of the Health Insurance Portability and Accountability Act (HIPAA). Even without life-changing events, the information provided by your employer should tell you how you can change benefits or switch plans, if more than one plan is offered. If your spouse’s employer also offers a health benefits package, consider coordinating both plans for maximum coverage. 6. Changing jobs and other life events can affect your health benefits. Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), you, your covered spouse, and your dependent children may be eligible to purchase extended health coverage under your employer’s plan if you lose your job, change employers, get divorced, or upon occurrence of certain other events. Coverage can range from 18 to 36 months depending on your situation. COBRA applies to most employers with 20 or more workers and requires your plan to notify you of your rights. Most plans require eligible individuals to make their COBRA election within 60 days of the plan’s notice. Be sure to follow up with your plan sponsor if you don’t receive notice, and make sure you respond within the allotted time.

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7. HIPAA can also help if you are changing jobs, particularly if you have a medical condition. HIPAA generally limits pre-existing condition exclusions to a maximum of 12 months (18 months for late enrollees). HIPAA also requires this maximum period to be reduced by the length of time you had prior “creditable coverage.” You should receive a certificate documenting your prior creditable coverage from your old plan when coverage ends. 8. Plan for retirement. Before you retire, find out what health benefits, if any, extend to you and your spouse during your retirement years. Consult with your employer’s human resources office, your union, the plan administrator, and check your SPD. Make sure there is no conflicting information among these sources about the benefits you will receive or the circumstances under which they can change or be eliminated. With this information in hand, you can make other important choices, like finding out if you are eligible for Medicare and Medigap insurance coverage. 9. Know how to file an appeal if your health benefits claim is denied. Understand how your plan handles grievances and where to make appeals of the plan’s decisions. Keep records and copies of correspondence. Check your health benefits package and your SPD to determine who is responsible for handling problems with benefit claims. Contact PWBA for customer service assistance if you are unable to obtain a response to your complaint. 10. You can take steps to improve the quality of the healthcare and the health benefits you receive. Look for and use things like Quality Reports and Accreditation Reports whenever you can. Quality reports may contain consumer ratings -- how satisfied consumers are with the doctors in their plan, for instance-- and clinical performance measures -- how well a healthcare organization prevents and treats illness. Accreditation reports provide information on how accredited organizations meet national standards, and often include clinical performance measures. Look for these quality measures whenever possible. Consult “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer.

Medicare and Medicaid Illness strikes both rich and poor families. For low-income families, Medicaid is available to defer the costs of treatment. The Health Care Financing Administration (HCFA) administers Medicare, the nation’s largest health insurance program, which covers 39 million Americans. In the following pages, you will learn the basics about Medicare insurance as well as useful

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contact information on how to find more in-depth information about Medicaid.61

Who is Eligible for Medicare? Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. You might also qualify for coverage if you are under age 65 but have a disability or EndStage Renal disease (permanent kidney failure requiring dialysis or transplant). Here are some simple guidelines: You can get Part A at age 65 without having to pay premiums if: ·

You are already receiving retirement benefits from Social Security or the Railroad Retirement Board.

·

You are eligible to receive Social Security or Railroad benefits but have not yet filed for them.

·

You or your spouse had Medicare-covered government employment.

If you are under 65, you can get Part A without having to pay premiums if: ·

You have received Social Security or Railroad Retirement Board disability benefit for 24 months.

·

You are a kidney dialysis or kidney transplant patient.

Medicare has two parts: ·

Part A (Hospital Insurance). Most people do not have to pay for Part A.

·

Part B (Medical Insurance). Most people pay monthly for Part B. Part A (Hospital Insurance)

Helps Pay For: Inpatient hospital care, care in critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas) and skilled nursing facilities, hospice care, and some home healthcare.

This section has been adapted from the Official U.S. Site for Medicare Information: http://www.medicare.gov/Basics/Overview.asp.

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Cost: Most people get Part A automatically when they turn age 65. You do not have to pay a monthly payment called a premium for Part A because you or a spouse paid Medicare taxes while you were working. If you (or your spouse) did not pay Medicare taxes while you were working and you are age 65 or older, you still may be able to buy Part A. If you are not sure you have Part A, look on your red, white, and blue Medicare card. It will show “Hospital Part A” on the lower left corner of the card. You can also call the Social Security Administration toll free at 1-800-772-1213 or call your local Social Security office for more information about buying Part A. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Fiscal Intermediary about Part A bills and services. The phone number for the Fiscal Intermediary office in your area can be obtained from the following Web site: http://www.medicare.gov/Contacts/home.asp. Part B (Medical Insurance) Helps Pay For: Doctors, services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home healthcare. Part B helps pay for covered services and supplies when they are medically necessary. Cost: As of 2001, you pay the Medicare Part B premium of $50.00 per month. In some cases this amount may be higher if you did not choose Part B when you first became eligible at age 65. The cost of Part B may go up 10% for each 12-month period that you were eligible for Part B but declined coverage, except in special cases. You will have to pay the extra 10% cost for the rest of your life. Enrolling in Part B is your choice. You can sign up for Part B anytime during a 7-month period that begins 3 months before you turn 65. Visit your local Social Security office, or call the Social Security Administration at 1-800-7721213 to sign up. If you choose to enroll in Part B, the premium is usually taken out of your monthly Social Security, Railroad Retirement, or Civil Service Retirement payment. If you do not receive any of the above payments, Medicare sends you a bill for your part B premium every 3 months. You should receive your Medicare premium bill in the mail by the 10th of the month. If you do not, call the Social Security Administration at 1800-772-1213, or your local Social Security office. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Medicare carrier about bills and services. The

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phone number for the Medicare carrier in your area can be found at the following Web site: http://www.medicare.gov/Contacts/home.asp. You may have choices in how you get your healthcare including the Original Medicare Plan, Medicare Managed Care Plans (like HMOs), and Medicare Private Fee-for-Service Plans.

Medicaid Medicaid is a joint federal and state program that helps pay medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state. People on Medicaid may also get coverage for nursing home care and outpatient prescription drugs which are not covered by Medicare. You can find more information about Medicaid on the HCFA.gov Web site at http://www.hcfa.gov/medicaid/medicaid.htm. States also have programs that pay some or all of Medicare’s premiums and may also pay Medicare deductibles and coinsurance for certain people who have Medicare and a low income. To qualify, you must have: ·

Part A (Hospital Insurance),

·

Assets, such as bank accounts, stocks, and bonds that are not more than $4,000 for a single person, or $6,000 for a couple, and

·

A monthly income that is below certain limits.

For more information on these programs, look at the Medicare Savings Programs brochure, http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Langua ge=English&Type=Pub&PubID=10126. There are also Prescription Drug Assistance Programs available. Find information on these programs which offer discounts or free medications to individuals in need at http://www.medicare.gov/Prescription/Home.asp.

NORD’s Medication Assistance Programs Finally, the National Organization for Rare Disorders, Inc. (NORD) administers medication programs sponsored by humanitarian-minded pharmaceutical and biotechnology companies to help uninsured or underinsured individuals secure life-saving or life-sustaining drugs.62 NORD Adapted from NORD: http://www.rarediseases.org/cgibin/nord/progserv#patient?id=rPIzL9oD&mv_pc=30.

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programs ensure that certain vital drugs are available “to those individuals whose income is too high to qualify for Medicaid but too low to pay for their prescribed medications.” The program has standards for fairness, equity, and unbiased eligibility. It currently covers some 14 programs for nine pharmaceutical companies. NORD also offers early access programs for investigational new drugs (IND) under the approved “Treatment INDs” programs of the Food and Drug Administration (FDA). In these programs, a limited number of individuals can receive investigational drugs that have yet to be approved by the FDA. These programs are generally designed for rare diseases or disorders. For more information, visit www.rarediseases.org.

Additional Resources In addition to the references already listed in this chapter, you may need more information on health insurance, hospitals, or the healthcare system in general. The NIH has set up an excellent guidance Web site that addresses these and other issues. Topics include:63 ·

Health Insurance: http://www.nlm.nih.gov/medlineplus/healthinsurance.html

·

Health Statistics: http://www.nlm.nih.gov/medlineplus/healthstatistics.html

·

HMO and Managed Care: http://www.nlm.nih.gov/medlineplus/managedcare.html

·

Hospice Care: http://www.nlm.nih.gov/medlineplus/hospicecare.html

·

Medicaid: http://www.nlm.nih.gov/medlineplus/medicaid.html

·

Medicare: http://www.nlm.nih.gov/medlineplus/medicare.html

·

Nursing Homes and Long-term Care: http://www.nlm.nih.gov/medlineplus/nursinghomes.html

·

Patient’s Rights, Confidentiality, Informed Consent, Ombudsman Programs, Privacy and Patient Issues: http://www.nlm.nih.gov/medlineplus/patientissues.html

You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

·

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

·

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

·

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

·

On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/

·

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

·

Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html

Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia Web site address is http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a) and drkoop.com (http://www.drkoop.com/). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to high blood pressure and keep them on file. The NIH, in particular, suggests that patients with high blood pressure visit the following Web sites in the ADAM Medical Encyclopedia:

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·

Basic Guidelines for High Blood Pressure Essential hypertension Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000153.htm Malignant hypertension (arteriolar nephrosclerosis) Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000491.htm Primary pulmonary hypertension Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000112.htm

·

Signs & Symptoms for High Blood Pressure Anxiety Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Blindness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003040.htm Blood in the urine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003138.htm Blurred vision Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003029.htm Change in mental status Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003205.htm Chest pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003079.htm

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Coma Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003202.htm Confused Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003205.htm Confusion Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003205.htm Cough Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003072.htm Coughing up blood Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003073.htm Decreased alertness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003202.htm Decreased urinary output Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003147.htm Dizziness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003093.htm Edema Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003103.htm Fainting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003092.htm

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Fatigue Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Headache Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003024.htm Hematuria Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003138.htm High blood pressure Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003082.htm Hyperventilation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003071.htm Lethargic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Lightheadedness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003092.htm Loss of vision Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003040.htm Nausea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Numbness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm

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Overweight Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003101.htm Pale skin Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003244.htm Perspiration Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003218.htm Restlessness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003212.htm Seizure Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003200.htm Seizures Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003200.htm Shortness of breath Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003075.htm Sleepy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003208.htm Stuporous Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003202.htm Swelling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003103.htm

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Tiredness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Visual changes Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003029.htm Vomiting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Weakness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003174.htm Weight loss Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003107.htm ·

Diagnostics and Tests for High Blood Pressure Aldosterone Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003704.htm Arterial blood gas analysis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003855.htm Blood pressure Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003398.htm BUN Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003474.htm Cardiac catheterization Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003419.htm

Online Glossaries 335

Chest X-ray Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003804.htm Creatinine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003475.htm Diastolic blood pressure Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003398.htm ECG Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003868.htm Echocardiogram Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003869.htm Lung scan Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003824.htm Pulmonary arteriogram Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003813.htm Renin Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003698.htm Urinalysis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003579.htm Urinary casts Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003586.htm ·

Nutrition for High Blood Pressure

336 High Blood Pressure

Protein Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002467.htm ·

Surgery and Procedures for High Blood Pressure Heart-lung transplantation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003004.htm

·

Background Topics for High Blood Pressure Acute Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002215.htm Enzyme Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002353.htm Exercise Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001941.htm Hormone levels Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003445.htm Incidence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002387.htm Intravenous Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002383.htm Physical examination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002274.htm

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Renal Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002289.htm Respiratory Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002290.htm Retina Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002291.htm Vascular disorders Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000147.htm

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

·

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

·

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

·

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

Glossary 339

HIGH BLOOD PRESSURE GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acne: An inflammatory disease of the pilosebaceous unit, the specific type usually being indicated by a modifying term; frequently used alone to designate common acne, or acne vulgaris. [EU] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH]

Aerobic: 1. having molecular oxygen present. 2. growing, living, or occurring in the presence of molecular oxygen. 3. requiring oxygen for respiration. [EU] Allopurinol: A xanthine oxidase inhibitor that decreases uric acid production. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anginal: Pertaining to or characteristic of angina. [EU] Angiography: Radiography of blood vessels after injection of a contrast medium. [NIH] Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as

340 High Blood Pressure

simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH] Anorexia: Lack or loss of the appetite for food. [EU] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Antifungal: Destructive to fungi, or suppressing their reproduction or growth; effective against fungal infections. [EU] Antihistamine: A drug that counteracts the action of histamine. The antihistamines are of two types. The conventional ones, as those used in allergies, block the H1 histamine receptors, whereas the others block the H2 receptors. Called also antihistaminic. [EU] Antihypertensive: An agent that reduces high blood pressure. [EU] Antioxidant: One of many widely used synthetic or natural substances added to a product to prevent or delay its deterioration by action of oxygen in the air. Rubber, paints, vegetable oils, and prepared foods commonly contain antioxidants. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Apnea: A transient absence of spontaneous respiration. [NIH] Arginine: An essential amino acid that is physiologically active in the Lform. [NIH] Arrhythmia: Any variation from the normal rhythm of the heart beat, including sinus arrhythmia, premature beat, heart block, atrial fibrillation, atrial flutter, pulsus alternans, and paroxysmal tachycardia. [EU] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arteriolar: Pertaining to or resembling arterioles. [EU] Arteriovenous: Both arterial and venous; pertaining to or affecting an artery and a vein. [EU] Ascites: Effusion and accumulation of serous fluid in the abdominal cavity;

Glossary 341

called also abdominal or peritoneal dropsy, hydroperitonia, and hydrops abdominis. [EU] Astringent: Causing contraction, usually locally after topical application. [EU] Asymptomatic: Showing or causing no symptoms. [EU] Atenolol: A cardioselective beta-adrenergic blocker possessing properties and potency similar to propranolol, but without a negative inotropic effect. [NIH]

Autonomic: Self-controlling; functionally independent. [EU] Azotemia: An excess of urea or other nitrogenous compounds in the blood. [EU]

Benzene: Toxic, volatile, flammable liquid hydrocarbon biproduct of coal distillation. It is used as an industrial solvent in paints, varnishes, lacquer thinners, gasoline, etc. Benzene causes central nervous system damage acutely and bone marrow damage chronically and is carcinogenic. It was formerly used as parasiticide. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Biliary: Pertaining to the bile, to the bile ducts, or to the gallbladder. [EU] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Blindness: The inability to see or the loss or absence of perception of visual stimuli. this condition may be the result of eye diseases; optic nerve diseases; optic chiasm diseases; or brain diseases affecting the visual pathways or occipital lobe. [NIH] Bronchiectasis: Chronic dilatation of the bronchi marked by fetid breath and paroxysmal coughing, with the expectoration of mucopurulent matter. It may effect the tube uniformly (cylindric b.), or occur in irregular pockets (sacculated b.) or the dilated tubes may have terminal bulbous enlargements (fusiform b.). [EU] Buffers: A chemical system that functions to control the levels of specific ions in solution. When the level of hydrogen ion in solution is controlled the system is called a pH buffer. [NIH] Calcification: The process by which organic tissue becomes hardened by a deposit of calcium salts within its substance. [EU] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH]

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Captopril: A potent and specific inhibitor of peptidyl-dipeptidase A. It blocks the conversion of angiotensin I to angiotensin II, a vasoconstrictor and important regulator of arterial blood pressure. Captopril acts to suppress the renin-angiotensin system and inhibits pressure responses to exogenous angiotensin. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Carcinoma: A malignant new growth made up of epithelial cells tending to infiltrate the surrounding tissues and give rise to metastases. [EU] Cardiology: The study of the heart, its physiology, and its functions. [NIH] Carmine: Coloring matter from the insect Coccus cacti L. It is used in foods, pharmaceuticals, toiletries, etc., as a dye, and also has use as a microscopic stain and biological marker. [NIH] Cataract: An opacity, partial or complete, of one or both eyes, on or in the lens or capsule, especially an opacity impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape, location) or etiology (cause and time of occurrence). [EU] Catecholamines: A general class of ortho-dihydroxyphenylalkylamines derived from tyrosine. [NIH] Catheter: A tubular, flexible, surgical instrument for withdrawing fluids from (or introducing fluids into) a cavity of the body, especially one for introduction into the bladder through the urethra for the withdraw of urine. [EU]

Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chronic: Persisting over a long period of time. [EU] Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. [NIH]

Glossary 343

Confusion: Disturbed orientation in regard to time, place, or person, sometimes accompanied by disordered consciousness. [EU] Contraceptive: conception. [EU]

An agent that diminishes the likelihood of or prevents

Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Curative: Tending to overcome disease and promote recovery. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water. Called also anhydration, deaquation and hypohydration. [EU] Deprivation: Loss or absence of parts, organs, powers, or things that are needed. [EU] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Diuresis: Increased excretion of urine. [EU] Diuretics, Thiazide: Diuretics characterized as analogs of 1,2,4benzothiadiazine-1,1-dioxide. All have a common mechanism of action and differ primarily in the dose required to produce a given effect. They act directly on the kidney to increase the excretion of sodium chloride and water and also increase excretion of potassium ions. [NIH] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dobutamine: A beta-2 agonist catecholamine that has cardiac stimulant action without evoking vasoconstriction or tachycardia. It is proposed as a cardiotonic after myocardial infarction or open heart surgery. [NIH] Doxazosin: A selective alpha-1-adrenergic blocker that lowers serum cholesterol. It is also effective in the treatment of hypertension. [NIH] Dysplasia: Abnormality of development; in pathology, alteration in size, shape, and organization of adult cells. [EU] Dystrophy: Any disorder arising from defective or faulty nutrition, especially the muscular dystrophies. [EU] Eclampsia: Convulsions and coma occurring in a pregnant or puerperal woman, associated with preeclampsia, i.e., with hypertension, edema, and/or proteinuria. [EU]

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Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effusion: The escape of fluid into a part or tissue, as an exudation or a transudation. [EU] Electroacupuncture: A form of acupuncture using low frequency electrically stimulated needles to produce analgesia and anesthesia and to treat disease. [NIH]

Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Emphysema: A pathological accumulation of air in tissues or organs; applied especially to such a condition of the lungs. [EU] Enalapril: An angiotensin-converting enzyme inhibitor that is used to treat hypertension. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endothelium: The layer of epithelial cells that lines the cavities of the heart and of the blood and lymph vessels, and the serous cavities of the body, originating from the mesoderm. [EU] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other health-related event occurring in such outbreaks. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Epoprostenol: A prostaglandin that is biosynthesized enzymatically from prostaglandin endoperoxides in human vascular tissue. It is a potent inhibitor of platelet aggregation. The sodium salt has been also used to treat primary pulmonary hypertension. [NIH] Erythropoietin: Glycoprotein hormone, secreted chiefly by the kidney in the adult and the liver in the fetus, that acts on erythroid stem cells of the bone marrow to stimulate proliferation and differentiation. [NIH] Ethnopharmacology:

The study of the actions and properties of drugs,

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usually derived from medicinal plants, indigenous to a population or ethnic group. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU] Fistula: An abnormal passage or communication, usually between two internal organs, or leading from an internal organ to the surface of the body; frequently designated according to the organs or parts with which it communicates, as anovaginal, brochocutaneous, hepatopleural, pulmonoperitoneal, rectovaginal, urethrovaginal, and the like. Such passages are frequently created experimentally for the purpose of obtaining body secretions for physiologic study. [EU] Folklore: The common orally transmitted traditions, myths, festivals, songs, superstitions, and stories of all peoples. [NIH] Furosemide: A sulfamyl saluretic and diuretic. It has a fast onset and short duration of action and is used in edema and chronic renal insufficiency. [NIH] GABA: The most common inhibitory neurotransmitter in the central nervous system. [NIH] Gadolinium: Gadolinium. An element of the rare earth family of metals. It has the atomic symbol Gd, atomic number 64, and atomic weight 157.25. Its oxide is used in the control rods of some nuclear reactors. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Gels: Colloids with a solid continuous phase and liquid as the dispersed phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting colloid is called a sol. [NIH] Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [NIH] Glomerulonephritis: A variety of nephritis characterized by inflammation of the capillary loops in the glomeruli of the kidney. It occurs in acute, subacute, and chronic forms and may be secondary to haemolytic streptococcal infection. Evidence also supports possible immune or autoimmune mechanisms. [EU] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the

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normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Gout: Hereditary metabolic disorder characterized by recurrent acute arthritis, hyperuricemia and deposition of sodium urate in and around the joints, sometimes with formation of uric acid calculi. [NIH] Guanabenz: An alpha-2 selective adrenergic agonist used as an antihypertensive agent. [NIH] Guanethidine: An antihypertensive agent that acts by inhibiting selectively transmission in post-ganglionic adrenergic nerves. It is believed to act mainly by preventing the release of norepinephrine at nerve endings and causes depletion of norepinephrine in peripheral sympathetic nerve terminals as well as in tissues. [NIH] Guanfacine: A centrally acting antihypertensive agent. The drug lowers both systolic and diastolic blood pressure by activating the central nervous system alpha-2 adrenoreceptors, which results in reduced sympathetic outflow leading to reduced vascular tone. Its adverse reactions include dry mouth, sedation, and constipation. [NIH] Habitual: Of the nature of a habit; according to habit; established by or repeated by force of habit, customary. [EU] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Heart-Lung Transplantation: The simultaneous, or near simultaneous, transference of heart and lungs from one human or animal to another. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hemodynamics: The movements of the blood and the forces involved in systemic or regional blood circulation. [NIH] Heredity: 1. the genetic transmission of a particular quality or trait from parent to offspring. 2. the genetic constitution of an individual. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Homeostasis: A tendency to stability in the normal body states (internal environment) of the organism. It is achieved by a system of control mechanisms activated by negative feedback; e.g. a high level of carbon

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dioxide in extracellular fluid triggers increased pulmonary ventilation, which in turn causes a decrease in carbon dioxide concentration. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hydralazine: A direct-acting vasodilator that is used as an antihypertensive agent. [NIH] Hydrochlorothiazide: A thiazide diuretic often considered the prototypical member of this class. It reduces the reabsorption of electrolytes from the renal tubules. This results in increased excretion of water and electrolytes, including sodium, potassium, chloride, and magnesium. It has been used in the treatment of several disorders including edema, hypertension, diabetes insipidus, and hypoparathyroidism. [NIH] Hyperaldosteronism: Aldosteronism. [EU] Hypercalcemia: Abnormally high level of calcium in the blood. [NIH] Hyperpigmentation: Excessive pigmentation of the skin, usually as a result of increased melanization of the epidermis rather than as a result of an increased number of melanocytes. Etiology is varied and the condition may arise from exposure to light, chemicals or other substances, or from a primary metabolic imbalance. [NIH] Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU] Hypersensitivity: A state of altered reactivity in which the body reacts with an exaggerated immune response to a foreign substance. Hypersensitivity reactions are classified as immediate or delayed, types I and IV, respectively, in the Gell and Coombs classification (q.v.) of immune responses. [EU] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Hypertrophy: Nutrition) the enlargement or overgrowth of an organ or part due to an increase in size of its constituent cells. [EU] Hyperventilation: A state in which there is an increased amount of air entering the pulmonary alveoli (increased alveolar ventilation), resulting in reduction of carbon dioxide tension and eventually leading to alkalosis. [EU] Hypoplasia: Incomplete development or underdevelopment of an organ or

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tissue. [EU] Hypotension: Abnormally low blood pressure; seen in shock but not necessarily indicative of it. [EU] Hypotensive: Characterized by or causing diminished tension or pressure, as abnormally low blood pressure. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Immunosuppressant: An agent capable of suppressing immune responses. [EU]

Indapamide: A sulfamyl diuretic with about 16x the effect of furosemide. It has also been shown to be an effective antihypertensive agent in the clinic. [NIH]

Infarction: 1. the formation of an infarct. 2. an infarct. [EU] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Infusion: The therapeutic introduction of a fluid other than blood, as saline solution, solution, into a vein. [EU] Inhalation: The drawing of air or other substances into the lungs. [EU] Insomnia: Inability to sleep; abnormal wakefulness. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]

Ionization: 1. any process by which a neutral atom gains or loses electrons, thus acquiring a net charge, as the dissociation of a substance in solution into ions or ion production by the passage of radioactive particles. 2. iontophoresis. [EU] Iris: The most anterior portion of the uveal layer, separating the anterior

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chamber from the posterior. It consists of two layers - the stroma and the pigmented epithelium. Color of the iris depends on the amount of melanin in the stroma on reflection from the pigmented epithelium. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Isotretinoin: A topical dermatologic agent that is used in the treatment of acne vulgaris and several other skin diseases. The drug has teratogenic and other adverse effects. [NIH] Isoxsuprine: A beta-adrenergic agonist that causes direct relaxation of uterine and vascular smooth muscle. Its vasodilating actions are greater on the arteries supplying skeletal muscle than on those supplying skin. It is used in the treatment of peripheral vascular disease and in premature labor. [NIH]

Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH] Ketoacidosis: Acidosis accompanied by the accumulation of ketone bodies (ketosis) in the body tissues and fluids, as in diabetic acidosis. [EU] Lactation: The period of the secretion of milk. [EU] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Lisinopril: An orally active angiotensin-converting enzyme inhibitor that has been used in the treatment of hypertension and congestive heart failure. [NIH]

Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH]

Lymphoma: Any neoplastic disorder of the lymphoid tissue, the term lymphoma often is used alone to denote malignant lymphoma. [EU] Malformation: A morphologic defect resulting from an intrinsically abnormal developmental process. [EU] Malignant: Tending to become progressively worse and to result in death.

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Having the properties of anaplasia, invasion, and metastasis; said of tumours. [EU] Malondialdehyde: The dialdehyde of malonic acid. [NIH] Mecamylamine: A nicotinic antagonist that is well absorbed from the gastrointestinal tract and crosses the blood-brain barrier. Mecamylamine has been used as a ganglionic blocker in treating hypertension, but, like most ganglionic blockers, is more often used now as a research tool. [NIH] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Menopause: Cessation of menstruation in the human female, occurring usually around the age of 50. [EU] Metabolite: process. [EU]

Any substance produced by metabolism or by a metabolic

Methyldopa: An alpha-2 adrenergic agonist that has both central and peripheral nervous system effects. Its primary clinical use is as an antihypertensive agent. Before its alpha-adrenergic actions became clear, methyldopa was thought to act by inhibiting decarboxylation of DOPA leading to depletion of norepinephrine or by conversion to and release as the false transmitter alpha-methylnorepinephrine. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Midodrine: An ethanolamine derivative that is an adrenergic alpha agonist. It is used as a vasoconstrictor agent in the treatment of hypotension. [NIH] Minocycline: A semisynthetic antibiotic effective against tetracyclineresistant staphylococcus infections. [NIH] Monocrotaline: A pyrrolizidine alkaloid and a toxic plant constituent that poisons livestock and humans through the ingestion of contaminated grains and other foods. The alkaloid causes pulmonary artery hypertension, right ventricular hypertrophy, and pathological changes in the pulmonary vasculature. Significant attenuation of the cardiopulmonary changes are noted after oral magnesium treatment. [NIH] Myeloma: A tumour composed of cells of the type normally found in the bone marrow. [EU] Naloxone: A specific opiate antagonist that has no agonist activity. It is a competitive antagonist at mu, delta, and kappa opioid receptors. [NIH] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Neonatal: Pertaining to the first four weeks after birth. [EU] Nephrology:

A subspecialty of internal medicine concerned with the

Glossary 351

anatomy, physiology, and pathology of the kidney. [NIH] Nephrons: The functional units of the kidney, consisting of the glomerulus and the attached tubule. [NIH] Nephropathy: Disease of the kidneys. [EU] Nephrotic: Pertaining to, resembling, or caused by nephrosis. [EU] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A general term denoting functional disturbances and/or pathological changes in the peripheral nervous system. The etiology may be known e.g. arsenical n., diabetic n., ischemic n., traumatic n.) or unknown. Encephalopathy and myelopathy are corresponding terms relating to involvement of the brain and spinal cord, respectively. The term is also used to designate noninflammatory lesions in the peripheral nervous system, in contrast to inflammatory lesions (neuritis). [EU] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrophil: Having an affinity for neutral dyes. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nifedipine: A potent vasodilator agent with calcium antagonistic action. It is a useful anti-anginal agent that also lowers blood pressure. The use of nifedipine as a tocolytic is being investigated. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and

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atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Normotensive: 1. characterized by normal tone, tension, or pressure, as by normal blood pressure. 2. a person with normal blood pressure. [EU] Nulliparous: Having never given birth to a viable infant. [EU] Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium. [NIH] Octreotide: A potent, long-acting somatostatin octapeptide analog which has a wide range of physiological actions. It inhibits growth hormone secretion, is effective in the treatment of hormone-secreting tumors from various organs, and has beneficial effects in the management of many pathological states including diabetes mellitus, orthostatic hypertension, hyperinsulinism, hypergastrinemia, and small bowel fistula. [NIH] Orthostatic: Pertaining to or caused by standing erect. [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Oxygenation: The process of supplying, treating, or mixing with oxygen. No:1245 - oxygenation the process of supplying, treating, or mixing with oxygen. [EU] Paclitaxel: Antineoplastic agent isolated from the bark of the Pacific yew tree, Taxus brevifolia. Paclitaxel stabilizes microtubules in their polymerized form and thus mimics the action of the proto-oncogene proteins c-mos. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the islets of langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Panniculitis: An inflammatory reaction of the subcutaneous fat, which may involve the connective tissue septa between the fat lobes, the septa lobules and vessels, or the fat lobules, characterized by the development of single or multiple cutaneous nodules. [EU]

Glossary 353

Paralysis: Loss or impairment of motor function in a part due to lesion of the neural or muscular mechanism; also by analogy, impairment of sensory function (sensory paralysis). In addition to the types named below, paralysis is further distinguished as traumatic, syphilitic, toxic, etc., according to its cause; or as obturator, ulnar, etc., according to the nerve part, or muscle specially affected. [EU] Parathyroid: 1. situated beside the thyroid gland. 2. one of the parathyroid glands. 3. a sterile preparation of the water-soluble principle(s) of the parathyroid glands, ad-ministered parenterally as an antihypocalcaemic, especially in the treatment of acute hypoparathyroidism with tetany. [EU] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pericarditis: Inflammation of the pericardium. [EU] Perspiration: Sweating; the functional secretion of sweat. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenoxybenzamine: An alpha-adrenergic anatagonist with long duration of action. It has been used to treat hypertension and as a peripheral vasodilator. [NIH]

Phenylephrine: An alpha-adrenergic agonist used as a mydriatic, nasal decongestant, and cardiotonic agent. [NIH] Phenylpropanolamine: A sympathomimetic that acts mainly by causing release of norepinephrine but also has direct agonist activity at some adrenergic receptors. It is most commonly used as a nasal vasoconstrictor and an appetite depressant. [NIH] Pilocarpine: A slowly hydrolyzed muscarinic agonist with no nicotinic effects. Pilocarpine is used as a miotic and in the treatment of glaucoma. [NIH] Polytetrafluoroethylene: Homopolymer of tetrafluoroethylene. Nonflammable, tough, inert plastic tubing or sheeting; used to line vessels, insulate, protect or lubricate apparatus; also as filter, coating for surgical implants or as prosthetic material. Synonyms: Fluoroflex; Fluoroplast; Ftoroplast; Halon; Polyfene; PTFE; Tetron. [NIH] Porphyria: A pathological state in man and some lower animals that is often due to genetic factors, is characterized by abnormalities of porphyrin metabolism, and results in the excretion of large quantities of porphyrins in the urine and in extreme sensitivity to light. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong

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electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Prazosin: A selective adrenergic alpha-1 antagonist used in the treatment of heart failure, hypertension, pheochromocytoma, Raynaud's syndrome, prostatic hypertrophy, and urinary retention. [NIH] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH]

Preeclampsia: A toxaemia of late pregnancy characterized by hypertension, edema, and proteinuria, when convulsions and coma are associated, it is called eclampsia. [EU] Prejudice: A preconceived judgment made without adequate evidence and not easily alterable by presentation of contrary evidence. [NIH] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Progestogen: A term applied to any substance possessing progestational activity. [EU] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]

Pulmonary: Pertaining to the lungs. [EU] Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [NIH] Ramipril: A long-acting angiotensin-converting enzyme inhibitor. It is a prodrug that is transformed in the liver to its active metabolite ramiprilat. [NIH]

Rauwolfia Alkaloids: Alkaloids from Rauwolfia serpentina Benth and other species. The prototype is reserpine, which is a depleter of catecholamines and serotonin from the sympathetic postganglionic fibers and brain areas.

Glossary 355

They have been used in hypertension and psychoses despite their wide range of potentially adverse effects. [NIH] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Refractory: Not readily yielding to treatment. [EU] Renin: An enzyme of the hydrolase class that catalyses cleavage of the leucine-leucine bond in angiotensin to generate angiotensin. 1. The enzyme is synthesized as inactive prorenin in the kidney and released into the blood in the active form in response to various metabolic stimuli. Not to be confused with rennin (chymosin). [EU] Renovascular: Of or pertaining to the blood vessels of the kidneys. [EU] Reserpine: An alkaloid found in the roots of Rauwolfia serpentina and R. vomitoria. Reserpine inhibits the uptake of norepinephrine into storage vesicles resulting in depletion of catecholamines and serotonin from central and peripheral axon terminals. It has been used as an antihypertensive and an antipsychotic as well as a research tool, but its adverse effects limit its clinical use. [NIH] Respiratory: Pertaining to respiration. [EU] Resuscitation: The restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. [EU]

Retinopathy: 1. retinitis (= inflammation of the retina). 2. retinosis (= degenerative, noninflammatory condition of the retina). [EU] Rheumatoid: Resembling rheumatism. [EU] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Salicylates: The salts, esters of salicylic acids, or salicylate esters of an organic acid. Some of these have analgesic, antipyretic, and antiinflammatory activities by inhibiting prostaglandin synthesis. [NIH] Sarcoidosis: An idiopathic systemic inflammatory granulomatous disorder comprised of epithelioid and multinucleated giant cells with little necrosis. It usually invades the lungs with fibrosis and may also involve lymph nodes, skin, liver, spleen, eyes, phalangeal bones, and parotid glands. [NIH]

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Sclerotherapy: Treatment of varicose veins, hemorrhoids, gastric and esophageal varices, and peptic ulcer hemorrhage by injection or infusion of chemical agents which cause localized thrombosis and eventual fibrosis and obliteration of the vessels. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as EPILEPSY or "seizure disorder." [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Senna: Preparations of Cassia senna L. and C. angustifolia of the Leguminosae. They contain sennosides, which are anthraquinone type cathartics and are used in many different preparations as laxatives. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Shunt: 1. to turn to one side; to divert; to bypass. 2. a passage or anastomosis between two natural channels, especially between blood vessels. Such structures may be formed physiologically (e.g. to bypass a thrombosis) or they may be structural anomalies. 3. a surgically created anastomosis; also, the operation of forming a shunt. [EU] Somatic: 1. pertaining to or characteristic of the soma or body. 2. pertaining to the body wall in contrast to the viscera. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Spices: The dried seeds, bark, root, stems, buds, leaves, or fruit of aromatic plants used to season food. [NIH] Stenosis: Narrowing or stricture of a duct or canal. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU]

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Stimulant: 1. producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. an agent or remedy that produces stimulation. [EU] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [NIH] Symptomatic: 1. pertaining to or of the nature of a symptom. 2. indicative (of a particular disease or disorder). 3. exhibiting the symptoms of a particular disease but having a different cause. 4. directed at the allying of symptoms, as symptomatic treatment. [EU] Synephrine: Sympathetic alpha-adrenergic agonist with actions like phenylephrine. It is used as a vasoconstrictor in circulatory failure, asthma, nasal congestion, and glaucoma. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent. [EU]

Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tacrolimus: A macrolide isolated from the culture broth of a strain of Streptomyces tsukubaensis that has strong immunosuppressive activity in vivo and prevents the activation of T-lymphocytes in response to antigenic or mitogenic stimulation in vitro. [NIH] Technetium: The first artificially produced element and a radioactive fission product of uranium. The stablest isotope has a mass number 99 and is used diagnostically as a radioactive imaging agent. Technetium has the atomic symbol Tc, atomic number 43, and atomic weight 98.91. [NIH] Thalassemia: A group of hereditary hemolytic anemias in which there is decreased synthesis of one or more hemoglobin polypeptide chains. There are several genetic types with clinical pictures ranging from barely detectable hematologic abnormality to severe and fatal anemia. [NIH] Thrombectomy: Surgical removal of an obstructing clot or foreign material from a blood vessel at the point of its formation. Removal of a clot arising from a distant site is called embolectomy. [NIH] Thrombosis: The formation, development, or presence of a thrombus. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography.

358 High Blood Pressure

Tonic: 1. producing and restoring the normal tone. 2. characterized by continuous tension. 3. a term formerly used for a class of medicinal preparations believed to have the power of restoring normal tone to tissue. [EU]

Toxemia: A generalized intoxication produced by toxins and other substances elaborated by an infectious agent. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Valerian: Valeriana officinale, an ancient, sedative herb of the large family Valerianaceae. The roots were formerly used to treat hysterias and other neurotic states and are presently used to treat sleep disorders. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasculitis: Inflammation of a vessel, angiitis. [EU] Vasoconstriction: The diminution of the calibre of vessels, especially constriction of arterioles leading to decreased blood flow to a part. [EU] Veins: The vessels carrying blood toward the heart. [NIH]

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Ventilation: 1. in respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. in psychiatry, verbalization of one's emotional problems. [EU] Ventricular: Pertaining to a ventricle. [EU] Verapamil: A calcium channel blocker that is a class IV anti-arrhythmia agent. [NIH] Withdrawal: 1. a pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) a substancespecific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Xanthoma: A tumour composed of lipid-laden foam cells, which are histiocytes containing cytoplasmic lipid material. Called also xanthelasma. [EU]

Xerostomia: Dryness of the mouth from salivary gland dysfunction, as in Sjögren's syndrome. [EU] Yohimbine: A plant alkaloid with alpha-2-adrenergic blocking activity. Yohimbine has been used as a mydriatic and in the treatment of impotence. It is also alleged to be an aphrodisiac. [NIH]

General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·

Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna

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Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg, M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna

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A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinterna

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Dorland’s Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna

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Dorland’s Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna

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Dorland’s Pocket Medical Dictionary (Dorland’s Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna /103-4193558-7304618

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Melloni’s Illustrated Medical Dictionary (Melloni’s Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna

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Stedman’s Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna

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Stedman’s Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN: 068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupinterna

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Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co, ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna

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INDEX A Abdomen .......92, 160, 165, 192, 350, 357 Abdominal.....45, 147, 160, 161, 172, 175, 340, 352 Acetylcholine .........................76, 100, 351 Acne ............................175, 214, 339, 349 Adenosine....................................191, 339 Adolescence ........................101, 339, 353 Adverse ..51, 80, 139, 214, 215, 346, 349, 355 Aerobic ........................118, 124, 126, 137 Allopurinol..............................................76 Anemia ..............53, 55, 68, 177, 188, 357 Anginal.................................100, 225, 351 Angiography ..........................................53 Angioplasty ..........................................125 Anorexia ................................................33 Antibacterial...........................30, 224, 356 Antifungal.............................................224 Antihypertensive .....22, 50, 51, 59, 60, 75, 78, 124, 125, 126, 165, 214, 215, 228, 346, 347, 348, 350, 355 Antioxidant.....................................76, 232 Antiviral ................................................224 Anxiety.............................82, 89, 223, 226 Apnea ..................................................108 Arginine .................................................76 Arrhythmia ...................102, 165, 340, 359 Arterial ......29, 30, 53, 57, 67, 80, 92, 119, 165, 305, 340, 342, 347, 357 Arteries .....24, 29, 33, 37, 52, 55, 92, 120, 141, 155, 214, 340, 343, 349 Arteriolar ..............................................330 Ascites .........................................136, 173 Astringent ............................................224 Asymptomatic ......................................120 Atenolol........................................150, 151 Autonomic..58, 91, 97, 100, 170, 339, 352 Azotemia..............................................125 B Benzene ................................99, 118, 349 Bile......102, 120, 132, 133, 161, 341, 349, 356 Biliary...........................................120, 148 Blindness ...............34, 108, 139, 191, 342 Bronchial..............................................137 Bronchiectasis .....................................137 Bronchitis .............................................137 Buffers ...................................................90 C Capsules..............................................303

Captopril................................................ 52 Carbohydrate .................. 44, 77, 302, 346 Carcinoma................................... 136, 173 Cardiac....... 75, 80, 82, 98, 101, 102, 150, 151, 224, 343, 355, 356 Cataract ...................................... 191, 342 Catecholamines ............ 89, 215, 354, 355 Catheter .................................. 52, 54, 178 Cerebrovascular ................................. 170 Cervical ................................................. 91 Cholestasis ................................. 136, 173 Cirrhosis.................. 56, 72, 120, 136, 173 Comorbidity........................................... 73 Concomitant........................................ 170 Constipation ........ 156, 171, 172, 214, 346 Contraceptive...................................... 119 Coronary .. 18, 57, 78, 82, 88, 89, 90, 108, 119 Cortex ............................................. 33, 85 Curative....................................... 307, 351 D Degenerative ...................... 101, 301, 355 Dehydration........................................... 33 Diarrhea .............................. 156, 171, 300 Diastolic 12, 29, 79, 84, 86, 151, 214, 346, 347 Digestion ............................. 192, 224, 357 Diuresis ................................................. 85 Dobutamine........................................... 94 Dysplasia .................................... 125, 188 Dystrophy...................................... 35, 188 E Eclampsia ............... 36, 60, 101, 227, 354 Edema...... 36, 44, 98, 101, 106, 156, 343, 345, 347, 354 Effusion ............................................... 228 Electroacupuncture............................... 51 Electrolyte ................... 30, 33, 85, 91, 354 Electrophysiological .............................. 91 Emphysema ........................................ 137 Enalapril .............................................. 104 Endocrinology ....................................... 40 Endothelium .................................. 76, 124 Enzyme ...... 13, 29, 74, 75, 76, 77, 88, 99, 101, 104, 106, 109, 122, 125, 160, 176, 344, 349, 354, 355 Epidemic ............................................. 121 Epidemiological............................. 90, 183 Epoprostenol......................................... 60 Erythropoietin...................................... 124 Extracellular ............................ 87, 99, 347

F Fatal.............................68, 82, 86, 88, 357 Fatigue....33, 97, 138, 156, 159, 172, 223, 224, 226, 340 Fibrosis ..67, 102, 161, 166, 342, 355, 356 Fistula ..........................101, 133, 345, 352 Folklore................................................227 Furosemide............................85, 214, 348 G Gadolinium ............................................52 Ganglia ....................................91, 97, 339 Gels .............................................214, 345 Ginseng ...............................126, 226, 230 Glomerulonephritis ........14, 109, 143, 160 Glucose ....34, 44, 45, 74, 75, 83, 89, 108, 121, 137, 138, 140, 141, 157, 159, 345, 348 Gout .......................................................22 H Habitual ...............................................157 Heartburn.............................................171 Hematology ...........................................10 Hematuria ............................................109 Hemodynamics......................................84 Hepatic ..........................................56, 161 Hepatitis.........................54, 136, 173, 182 Hepatocellular..............................136, 173 Heredity ...........................................18, 22 Herpes .................................226, 297, 346 Homeostasis..........................................91 Homicide..............................................130 Hormones .......33, 91, 101, 102, 159, 162, 172, 355, 356 Hunger .................................................138 Hydrochlorothiazide.............................105 Hypercalcemia.....................................155 Hyperpigmentation ................................33 Hypersensitivity ...................................145 Hypertrophy ....58, 80, 100, 150, 215, 350, 354 Hypotension.....33, 87, 121, 170, 214, 350 Hypotensive...................................83, 232 I Immunization .................................30, 356 Immunosuppressant ............................174 Impotence............126, 133, 139, 231, 359 Infarction..........73, 74, 82, 88, 96, 98, 343 Infiltration .............................................155 Inflammation ...29, 67, 101, 136, 155, 160, 172, 175, 342, 345, 355 Infusion ......................54, 60, 92, 102, 356 Inhalation .............................................224 Insomnia ......................172, 223, 226, 227 Insulin .....34, 44, 45, 75, 83, 89, 121, 122, 137, 138, 140, 142, 157, 346, 348 Interindividual ........................................61

Intermittent .......................................... 172 Intestinal........................................ 56, 300 Intravenous ............................. 54, 92, 175 Ionization............................................. 118 Iris ................................................. 99, 349 Ischemia........................................ 51, 122 J Jaundice.............................. 120, 136, 173 K Ketoacidosis ....................................... 138 L Lactation ..................................... 182, 183 Lesion ......................................... 165, 353 Lethal .................................................... 55 Ligation ................................................. 72 Lipid .. 45, 76, 96, 133, 170, 232, 348, 359 Liquor ............................................ 13, 140 Lisinopril................................................ 82 Lupus .................... 54, 110, 130, 172, 174 Lymphoma ............................ 99, 228, 349 M Malformation ....................................... 161 Malignant ............ 5, 24, 99, 147, 342, 349 Malondialdehyde................................... 77 Medullary .............................................. 87 Menopause ......................................... 226 Metabolite ........................... 106, 303, 354 Methyldopa ................................. 214, 350 Mobility................................................ 139 Molecular ...... 10, 14, 101, 132, 151, 166, 168, 185, 186, 339, 355, 358 Monocrotaline ..................................... 229 Myeloma ............................................. 110 N Naloxone............................................... 50 Nausea........................................ 156, 159 Neonatal.............................................. 232 Nephrology.................................. 109, 122 Nephrons .................................... 159, 175 Nephropathy ..... 73, 74, 78, 109, 139, 176 Nephrotic............................................. 109 Neural ........................... 91, 165, 301, 353 Neuronal ............................................... 87 Neurons .... 87, 91, 99, 100, 148, 345, 351 Neuropathy .... 78, 93, 139, 140, 142, 170, 177 Neurotransmitter ...... 91, 97, 98, 100, 191, 339, 345, 351, 352 Neutrophil............................................ 173 Niacin .................................................. 301 Nicotine ....................................... 139, 224 Nifedipine ............................ 100, 227, 351 Nitrogen ................................ 12, 156, 159 Norepinephrine ...... 76, 84, 100, 214, 215, 346, 350, 351, 355 Normotensive.................................. 51, 89

Glossary 363

Nulliparous...........................................228 O Octreotide ..............................................72 Ocular ....................................................93 Optic ........................................93, 99, 348 Oral .......85, 92, 100, 118, 119, 137, 139, 307, 341, 350 Orthostatic ...101, 117, 119, 121, 170, 352 Overdose .............................................301 Oxygenation ............................53, 68, 352 P Paclitaxel .............................................228 Pancreas .................................34, 45, 348 Panniculitis ..........................................136 Paralysis ......................................165, 353 Parathyroid ..........................124, 133, 353 Pelvic .....................................35, 166, 354 Pericarditis...........................................171 Pharmacologic...23, 30, 72, 140, 170, 358 Porphyria .............................................172 Potassium...19, 33, 85, 88, 106, 108, 122, 126, 156, 179, 213, 228, 230, 302, 343, 347 Predisposition ......................................138 Prednisone ..........................................174 Preeclampsia....5, 44, 112, 127, 182, 228, 343 Prejudice................................................90 Presynaptic............................84, 100, 351 Progressive.......33, 55, 82, 110, 120, 155, 156, 161 Prostate .......................................159, 223 Proteins ...................30, 95, 300, 302, 352 Pulmonary ....5, 24, 27, 53, 55, 57, 60, 67, 92, 94, 95, 96, 99, 100, 137, 162, 180, 228, 229, 231, 232, 330, 344, 347, 350 Purpura ................................................110 R Ramipril ...............................................104 Receptor ......80, 84, 91, 92, 109, 150, 160 Renin .......................74, 84, 105, 124, 125 Renovascular.................................52, 125 Respiratory ..................139, 166, 223, 359 Resuscitation .................................72, 119 Retinopathy ...........................73, 139, 170 Rheumatoid .................................174, 225 Riboflavin.............................................300 S Salicylates ...........................................172 Saline.......................................67, 85, 348 Sarcoidosis ..................................155, 156 Sclerotherapy ........................................72 Secretion ......84, 85, 101, 102, 349, 352, 353 Sedative...............................224, 297, 358 Sedentary ............130, 138, 143, 157, 161

Seizures .................................. 36, 45, 356 Selenium ............................................. 302 Senna.......................................... 215, 356 Serum . 12, 30, 83, 89, 123, 213, 343, 356 Shunt..................................... 72, 102, 356 Skeletal ................................. 51, 214, 349 Somatic ......................................... 50, 339 Spectrum......................... 10, 59, 136, 173 Spices ................................................. 226 Stenosis .................................. 5, 122, 125 Steroid........................... 85, 101, 155, 355 Stimulant ............................... 98, 224, 343 Stomach...................... 133, 172, 224, 345 Suicide ................................................ 130 Surgical ...... 30, 67, 72, 84, 125, 166, 342, 352, 353, 358 Symptomatic ................... 55, 68, 162, 357 Synergistic .......................................... 104 Systolic... 12, 29, 73, 75, 79, 86, 214, 346, 347 T Tacrolimus .......................................... 174 Thalassemia.................................. 55, 182 Thermoregulation................................ 300 Thoracic ................................................ 35 Thrombosis ................................. 102, 356 Thyroxine ............................................ 302 Tomography.......................................... 54 Tonic ............................................. 87, 224 Toxicity........................................ 156, 226 Toxicology..................................... 10, 169 Transplantation .. 22, 34, 37, 72, 143, 162, 173, 174, 176, 336 Tricyclic ............................................... 340 Tryptophan............................................ 96 U Ulceration.............................................. 17 Urinalysis ............................ 159, 166, 358 Urinary ..... 30, 33, 89, 110, 118, 155, 178, 215, 331, 354, 358 Urology.................................................. 10 V Valerian............................................... 226 Vascular . 17, 58, 67, 75, 76, 80, 124, 139, 158, 214, 230, 344, 346, 349 Vasculitis............................................. 110 Vasoconstriction ............. 92, 98, 139, 343 Vegetarianism ..................................... 126 Veins ................................... 102, 120, 356 Ventilation ............. 99, 161, 166, 347, 359 Ventricular....... 58, 80, 100, 150, 151, 350 Verapamil............................................ 229 W Withdrawal ............................................ 84 Y Yohimbine ........................................... 126

Glossary 365