South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 1993
Blood pressure at rest is not predictive of round-the-clock values. Blood pressure should therefo... more Blood pressure at rest is not predictive of round-the-clock values. Blood pressure should therefore be measured during effort to evaluate hypertension and its response to treatment. The effect of sustained-release verapamil (240 mg taken once a day) on blood pressure at rest and during isometric effort was therefore investigated. Overall, verapamil reduced blood pressure significantly in 41 of 45 hypertensive patients: the mean systolic blood pressure at rest (+/- SD) fell from 151 +/- 35 mmHg to 137 +/- 13 mmHg (P < 0.001) and the diastolic blood pressure from 97 +/- 21 mmHg to 83 +/- 7 mmHg (P < 0.001), while the systolic blood pressure during isometric effort fell from 186 +/- 23 mmHg to 156 +/- 13 mmHg (P < 0.001) and the diastolic blood pressure from 118 +/- 14 mmHg to 95 +/- 8 mmHg (P < 0.001). The simple, inexpensive handgrip method described is cost-effective and strongly recommended as an integral part of the evaluation of hypertensive patients. The combination ...
Currently, clinicians rely mostly on population-level treatment effects from RCTs, usually consid... more Currently, clinicians rely mostly on population-level treatment effects from RCTs, usually considering the treatment's benefits. This study proposes a process, focused on practical usability, for translating RCT data into personalized treatment recommendations that weighs benefits against harms and integrates subjective perceptions of relative severity. Intensive blood pressure treatment (IBPT) was selected as the test case to demonstrate the suggested process, which was divided into three phases: (1) Prediction models were developed using the Systolic Blood-Pressure Intervention Trial (SPRINT) data for benefits and adverse events of IBPT. The models were externally validated using retrospective Clalit Health Services (CHS) data; (2) Predicted risk reductions and increases from these models were used to create a yes/no IBPT recommendation by calculating a severity-weighted benefit-to-harm ratio; (3) Analysis outputs were summarized in a decision support tool. Based on the indivi...
Journal of the American College of Cardiology, 1998
Several prior studies have correlated cleat under.expanelon wlCh adverse long,term clinical outco... more Several prior studies have correlated cleat under.expanelon wlCh adverse long,term clinical outcome, To evaluate parameters related to s0vero stoat under.expansion (defined as minimum slant area [MSA] le~a than 5 mm~), motorized pullback IVU$ Images were analy~'od from 461 Palmaz.~¢hatz slants deployed in 389 native vessels (165 LAD, t03 RCA, ~9 LCX, 2 LM) and 72 t;aphenout~ vain graff~, for 4t4 patients enrolled In the AVID (Anglography Ve, Intravas(;ular ultrasound Directed coronary slant placement) study, fVUS
Objective: To examine whether co-administration of clopidogrel and omeprazole affects the clinica... more Objective: To examine whether co-administration of clopidogrel and omeprazole affects the clinical outcomes of clopidogrel treatment. Design and Methods: A retrospective cross-sectional study of 4078 patients after a percutaneous coronary intervention and stent implantation. Seven hundred twenty-three clopidogrel-treated patients who fulfilled the inclusion criteria of the study were included: 318 treated only with clopidogrel; 405 treated with clopidogrel and omeprazole (study group). The interaction between the drugs was examined in relation to adverse clinical outcomes such as all-cause mortality, Major Adverse Cardiovascular Events (MACE) and cardiac hospitalizations during one year. Results: No significant difference was detected between the groups regarding the primary outcomes of the study. Regression models adjusted to basic characteristics and clinical variables showed a significant association between the study group and the primary outcomes through interactions with speci...
In 1980, 87 male patients (age range 34-60 years), hospitalized after their first myocardial infa... more In 1980, 87 male patients (age range 34-60 years), hospitalized after their first myocardial infarction (MI), were asked why they believed they got the infarct and what would help them cope with it. In a multiple regression analysis, their causal attributions accounted for 15% of the explained variance in their physical, sexual, social and work functioning after 6 and 18 months, their level of education accounted for 25% and the severity of their infarct for 10%. This result was replicated in a cross-cultural study. A follow-up study shows that 12 years after the MI, the patients&#39; initial causal attributions still accounted for part of their rehabilitation and life expectancy. Of the original 87, 23 had died between 1980-1992 from cardiac causes and 50 male patients were located and re-interviewed at the Soroka ICCU, in 1992. This suggests a very low-risk post-MI sample. The only risk-factor, accounting for the difference between the surviving and the deceased patients, was the initial obesity of the latter. The functional capacity outcome of the survivors was accounted for by their age (24%) and initial causal attributions (26%). Also the initial causal attributions (5%) still accounted for the subjective perception of functioning among the survivors. These results suggest that the initial causal attributions may have created positive or negative self-fulfilling prophecies which had long-term consequences, especially in a low-risk, post-MI population, in which risk factors hardly effected long-term prognosis.
The predictability of left ventricular function, short- and long-term prognosis, assessed by mean... more The predictability of left ventricular function, short- and long-term prognosis, assessed by means of two easily obtainable noninvasive markers, was prospectively studied in 110 consecutive patients undergoing thrombolytic therapy for acute myocardial infarction. Positive noninvasive markers were defined as follows: a) > 50% reduction in ST segment elevation within 120 min of initiating therapy, and b) early peak of creatine kinase (CK) activity < 12h after the start of thrombolysis. Seventy-five (68%) of the patients had two positive markers and are classified as the responder group. The nonresponder group consisted of 35 patients (32%) who had 0-1 positive markers. Left ventricular function was assessed 6-12 weeks after therapy by equilibrium radionuclide ventriculography. Left ventricular ejection fraction (LVEF) and survival rates at 1 month and 36 months were significantly higher in the responder group compared to the nonresponder group (54 +/- 12% vs. 43 +/- 11%, P < 0.05; 99% vs. 89%, P < 0.06; and 95% vs. 80%, P < 0.05 respectively). Thus, the combined analysis of two easily obtainable noninvasive markers can predict post-treatment preservation of left ventricular function and survival up to 36 months in patients with acute myocardial infarction undergoing thrombolytic therapy.
The study evaluates lipids profile changes during gestation in pregnancies with and without preec... more The study evaluates lipids profile changes during gestation in pregnancies with and without preeclampsia and/or gestational diabetes. STUDY DESIGN: Lipid profiles were assessed between year prior and after pregnancy in 9911 women without cardiovascular comorbidities. RESULTS: Lipid levels during gestation varied substantially with a nadir following conception and a peak at delivery. Compared to preconception levels total cholesterol levels increased from 164.4 mg/dL to 238.6 mg/dL and triglycerides (TGs) from 92.6 mg/dL to 238.4 mg/dL. The composite endpoint (gestational diabetes mellitus or preeclamp-sia) occurred in 1209 women (12.2%). Its prevalence increased with levels of TG-from 7.2% in the group with low TGs (Ͻ25th percentile adjusted for the gestational month) to 19.8% in the group with high TGs (Ͼ75th percentile), but was not associated with high-density lipoprotein levels. In multivariate analysis higher TGs levels, but not low high-density lipoprotein, were associated with the primary endpoint. CONCLUSION: Lipid levels change substantially during gestation. Abnormal levels of TGs are associated with pregnancy complications.
The ability to provide an accurate prognosis in an intensive care unit is of major importance. Nu... more The ability to provide an accurate prognosis in an intensive care unit is of major importance. Numerous risk scores have been developed to predict hospital mortality based on demographic, physiologic, and clinical data. These scores were universally developed in general medical or surgical intensive care units. Patients admitted to a cardiac care unit differ in many aspects from those admitted to general medical intensive care units. Few patients require mechanical ventilation and prolonged intensive care. Performance of risk scores developed for patients with acute myocardial infarction (AMI) in this subgroup is unknown. We prospectively studied 51 consecutive patients who were admitted to a cardiac care unit from September 2006 to March 2008 for AMI and received mechanical ventilation for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;24 hours. Acute Physiology and Chronic Health Evaluation II (APACHE II), Thrombolysis In Myocardial Infarction, and Global Registry of Acute Coronary Events risk scores were calculated for each patient. Mortality rates were extrapolated based on these 3 risk scores. Twenty-two of 51 patients (43%) died in hospital. Age, mean arterial pressure, urea, albumin, hemoglobin, need for vasopressors, and estimated glomerular filtration rate were predictive of mortality. APACHE II and Global Registry of Acute Coronary Events scores were higher in nonsurvivors but Thrombolysis In Myocardial Infarction risk score was not predictive of mortality. APACHE II score had the highest value for area under receiver operator characteristics curve for mortality prediction. In conclusion, patients with AMI requiring mechanical ventilation have a high mortality rate. This risk is predicted by co-morbidities better than by direct cardiac parameters. Consequently, conventional AMI risk scores do not perform well in this very sick population and the APACHE II score better predicts their short-term outcome.
Diabetes Research and Clinical Practice, Dec 1, 2021
AIM Type 2 diabetes mellitus (T2DM) is a risk factor for mortality after acute myocardial infarct... more AIM Type 2 diabetes mellitus (T2DM) is a risk factor for mortality after acute myocardial infarction (AMI). We studied the impact of T2DM related to sex and age on post-AMI long-term mortality. METHODS A retrospective study included post-AMI patients. Data were obtained from electronic medical records. We defined the study groups by T2DM, stratified by age-sex. OUTCOME up-to-10 years post-discharge all-cause mortality. RESULTS 16,168 patients were analyzed, 40.3% had T2DM. Ten-year mortality rates were 50.3% with T2DM vs. 33.1% without T2DM, adjHR=1.622 (p<0.001). Females (adjHR=1.085, p=0.052) and increased age (adjHR=1.056 for one-year increase, p<0.001) were associated with a higher risk of mortality (borderline statistical significance for sex). The relationship between T2DM and mortality was stronger in females than in males at <50 and 60-69 years (p-for-interaction 0.025 and 0.009 respectively), but not for other age groups. CONCLUSIONS The study implies heterogeneity in the impact of T2DM on mortality of post-AMI patients, being greater among young patients, particularly females, and no significant impact in octogenarians. That implies that young women with T2DM should have advanced measures for early detection of coronary artery disease and tight control of cardiovascular risk factors to lower the propensity to develop AMI.
American Journal of Obstetrics and Gynecology, Nov 1, 2009
OBJECTIVE-The study evaluates lipids profile changes during gestation in pregnancies with and wit... more OBJECTIVE-The study evaluates lipids profile changes during gestation in pregnancies with and without preeclampsia and/or gestational diabetes. STUDY DESIGN-Lipid profiles were assessed between year prior and after pregnancy in 9911 women without cardiovascular comorbidities. RESULTS-Lipid levels during gestation varied substantially with a nadir following conception and a peak at delivery. Compared to preconception levels total cholesterol levels increased from 164.4 mg/dL to 238.6 mg/dL and triglycerides (TGs) from 92.6 mg/dL to 238.4 mg/dL. The composite endpoint (gestational diabetes mellitus or preeclampsia) occurred in 1209 women (12.2%). Its prevalence increased with levels of TG-from 7.2% in the group with low TGs (<25th percentile adjusted for the gestational month) to 19.8% in the group with high TGs (>75th percentile), but was not associated with high-density lipoprotein levels. In multivariate analysis higher TGs levels, but not low high-density lipoprotein, were associated with the primary endpoint. CONCLUSION-Lipid levels change substantially during gestation. Abnormal levels of TGs are associated with pregnancy complications.
Blood pressure at rest is not predictive of round-the-clock values. Blood pressure should therefo... more Blood pressure at rest is not predictive of round-the-clock values. Blood pressure should therefore be measured during effort to evaluate hypertension and its response to treatment. The effect of sustained-release verapamil (240 mg taken once a day) on blood pressure at rest and during isometric effort was therefore investigated. Overall, verapamil reduced blood pressure significantly in 41 of 45 hypertensive patients: the mean systolic blood pressure at rest (+/- SD) fell from 151 +/- 35 mmHg to 137 +/- 13 mmHg (P < 0.001) and the diastolic blood pressure from 97 +/- 21 mmHg to 83 +/- 7 mmHg (P < 0.001), while the systolic blood pressure during isometric effort fell from 186 +/- 23 mmHg to 156 +/- 13 mmHg (P < 0.001) and the diastolic blood pressure from 118 +/- 14 mmHg to 95 +/- 8 mmHg (P < 0.001). The simple, inexpensive handgrip method described is cost-effective and strongly recommended as an integral part of the evaluation of hypertensive patients. The combination of a drug to which compliance is good and a simple method of blood pressure evaluation should result in improved effectiveness of treatment in the long term.
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 1993
Blood pressure at rest is not predictive of round-the-clock values. Blood pressure should therefo... more Blood pressure at rest is not predictive of round-the-clock values. Blood pressure should therefore be measured during effort to evaluate hypertension and its response to treatment. The effect of sustained-release verapamil (240 mg taken once a day) on blood pressure at rest and during isometric effort was therefore investigated. Overall, verapamil reduced blood pressure significantly in 41 of 45 hypertensive patients: the mean systolic blood pressure at rest (+/- SD) fell from 151 +/- 35 mmHg to 137 +/- 13 mmHg (P < 0.001) and the diastolic blood pressure from 97 +/- 21 mmHg to 83 +/- 7 mmHg (P < 0.001), while the systolic blood pressure during isometric effort fell from 186 +/- 23 mmHg to 156 +/- 13 mmHg (P < 0.001) and the diastolic blood pressure from 118 +/- 14 mmHg to 95 +/- 8 mmHg (P < 0.001). The simple, inexpensive handgrip method described is cost-effective and strongly recommended as an integral part of the evaluation of hypertensive patients. The combination ...
Currently, clinicians rely mostly on population-level treatment effects from RCTs, usually consid... more Currently, clinicians rely mostly on population-level treatment effects from RCTs, usually considering the treatment's benefits. This study proposes a process, focused on practical usability, for translating RCT data into personalized treatment recommendations that weighs benefits against harms and integrates subjective perceptions of relative severity. Intensive blood pressure treatment (IBPT) was selected as the test case to demonstrate the suggested process, which was divided into three phases: (1) Prediction models were developed using the Systolic Blood-Pressure Intervention Trial (SPRINT) data for benefits and adverse events of IBPT. The models were externally validated using retrospective Clalit Health Services (CHS) data; (2) Predicted risk reductions and increases from these models were used to create a yes/no IBPT recommendation by calculating a severity-weighted benefit-to-harm ratio; (3) Analysis outputs were summarized in a decision support tool. Based on the indivi...
Journal of the American College of Cardiology, 1998
Several prior studies have correlated cleat under.expanelon wlCh adverse long,term clinical outco... more Several prior studies have correlated cleat under.expanelon wlCh adverse long,term clinical outcome, To evaluate parameters related to s0vero stoat under.expansion (defined as minimum slant area [MSA] le~a than 5 mm~), motorized pullback IVU$ Images were analy~'od from 461 Palmaz.~¢hatz slants deployed in 389 native vessels (165 LAD, t03 RCA, ~9 LCX, 2 LM) and 72 t;aphenout~ vain graff~, for 4t4 patients enrolled In the AVID (Anglography Ve, Intravas(;ular ultrasound Directed coronary slant placement) study, fVUS
Objective: To examine whether co-administration of clopidogrel and omeprazole affects the clinica... more Objective: To examine whether co-administration of clopidogrel and omeprazole affects the clinical outcomes of clopidogrel treatment. Design and Methods: A retrospective cross-sectional study of 4078 patients after a percutaneous coronary intervention and stent implantation. Seven hundred twenty-three clopidogrel-treated patients who fulfilled the inclusion criteria of the study were included: 318 treated only with clopidogrel; 405 treated with clopidogrel and omeprazole (study group). The interaction between the drugs was examined in relation to adverse clinical outcomes such as all-cause mortality, Major Adverse Cardiovascular Events (MACE) and cardiac hospitalizations during one year. Results: No significant difference was detected between the groups regarding the primary outcomes of the study. Regression models adjusted to basic characteristics and clinical variables showed a significant association between the study group and the primary outcomes through interactions with speci...
In 1980, 87 male patients (age range 34-60 years), hospitalized after their first myocardial infa... more In 1980, 87 male patients (age range 34-60 years), hospitalized after their first myocardial infarction (MI), were asked why they believed they got the infarct and what would help them cope with it. In a multiple regression analysis, their causal attributions accounted for 15% of the explained variance in their physical, sexual, social and work functioning after 6 and 18 months, their level of education accounted for 25% and the severity of their infarct for 10%. This result was replicated in a cross-cultural study. A follow-up study shows that 12 years after the MI, the patients&#39; initial causal attributions still accounted for part of their rehabilitation and life expectancy. Of the original 87, 23 had died between 1980-1992 from cardiac causes and 50 male patients were located and re-interviewed at the Soroka ICCU, in 1992. This suggests a very low-risk post-MI sample. The only risk-factor, accounting for the difference between the surviving and the deceased patients, was the initial obesity of the latter. The functional capacity outcome of the survivors was accounted for by their age (24%) and initial causal attributions (26%). Also the initial causal attributions (5%) still accounted for the subjective perception of functioning among the survivors. These results suggest that the initial causal attributions may have created positive or negative self-fulfilling prophecies which had long-term consequences, especially in a low-risk, post-MI population, in which risk factors hardly effected long-term prognosis.
The predictability of left ventricular function, short- and long-term prognosis, assessed by mean... more The predictability of left ventricular function, short- and long-term prognosis, assessed by means of two easily obtainable noninvasive markers, was prospectively studied in 110 consecutive patients undergoing thrombolytic therapy for acute myocardial infarction. Positive noninvasive markers were defined as follows: a) > 50% reduction in ST segment elevation within 120 min of initiating therapy, and b) early peak of creatine kinase (CK) activity < 12h after the start of thrombolysis. Seventy-five (68%) of the patients had two positive markers and are classified as the responder group. The nonresponder group consisted of 35 patients (32%) who had 0-1 positive markers. Left ventricular function was assessed 6-12 weeks after therapy by equilibrium radionuclide ventriculography. Left ventricular ejection fraction (LVEF) and survival rates at 1 month and 36 months were significantly higher in the responder group compared to the nonresponder group (54 +/- 12% vs. 43 +/- 11%, P < 0.05; 99% vs. 89%, P < 0.06; and 95% vs. 80%, P < 0.05 respectively). Thus, the combined analysis of two easily obtainable noninvasive markers can predict post-treatment preservation of left ventricular function and survival up to 36 months in patients with acute myocardial infarction undergoing thrombolytic therapy.
The study evaluates lipids profile changes during gestation in pregnancies with and without preec... more The study evaluates lipids profile changes during gestation in pregnancies with and without preeclampsia and/or gestational diabetes. STUDY DESIGN: Lipid profiles were assessed between year prior and after pregnancy in 9911 women without cardiovascular comorbidities. RESULTS: Lipid levels during gestation varied substantially with a nadir following conception and a peak at delivery. Compared to preconception levels total cholesterol levels increased from 164.4 mg/dL to 238.6 mg/dL and triglycerides (TGs) from 92.6 mg/dL to 238.4 mg/dL. The composite endpoint (gestational diabetes mellitus or preeclamp-sia) occurred in 1209 women (12.2%). Its prevalence increased with levels of TG-from 7.2% in the group with low TGs (Ͻ25th percentile adjusted for the gestational month) to 19.8% in the group with high TGs (Ͼ75th percentile), but was not associated with high-density lipoprotein levels. In multivariate analysis higher TGs levels, but not low high-density lipoprotein, were associated with the primary endpoint. CONCLUSION: Lipid levels change substantially during gestation. Abnormal levels of TGs are associated with pregnancy complications.
The ability to provide an accurate prognosis in an intensive care unit is of major importance. Nu... more The ability to provide an accurate prognosis in an intensive care unit is of major importance. Numerous risk scores have been developed to predict hospital mortality based on demographic, physiologic, and clinical data. These scores were universally developed in general medical or surgical intensive care units. Patients admitted to a cardiac care unit differ in many aspects from those admitted to general medical intensive care units. Few patients require mechanical ventilation and prolonged intensive care. Performance of risk scores developed for patients with acute myocardial infarction (AMI) in this subgroup is unknown. We prospectively studied 51 consecutive patients who were admitted to a cardiac care unit from September 2006 to March 2008 for AMI and received mechanical ventilation for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;24 hours. Acute Physiology and Chronic Health Evaluation II (APACHE II), Thrombolysis In Myocardial Infarction, and Global Registry of Acute Coronary Events risk scores were calculated for each patient. Mortality rates were extrapolated based on these 3 risk scores. Twenty-two of 51 patients (43%) died in hospital. Age, mean arterial pressure, urea, albumin, hemoglobin, need for vasopressors, and estimated glomerular filtration rate were predictive of mortality. APACHE II and Global Registry of Acute Coronary Events scores were higher in nonsurvivors but Thrombolysis In Myocardial Infarction risk score was not predictive of mortality. APACHE II score had the highest value for area under receiver operator characteristics curve for mortality prediction. In conclusion, patients with AMI requiring mechanical ventilation have a high mortality rate. This risk is predicted by co-morbidities better than by direct cardiac parameters. Consequently, conventional AMI risk scores do not perform well in this very sick population and the APACHE II score better predicts their short-term outcome.
Diabetes Research and Clinical Practice, Dec 1, 2021
AIM Type 2 diabetes mellitus (T2DM) is a risk factor for mortality after acute myocardial infarct... more AIM Type 2 diabetes mellitus (T2DM) is a risk factor for mortality after acute myocardial infarction (AMI). We studied the impact of T2DM related to sex and age on post-AMI long-term mortality. METHODS A retrospective study included post-AMI patients. Data were obtained from electronic medical records. We defined the study groups by T2DM, stratified by age-sex. OUTCOME up-to-10 years post-discharge all-cause mortality. RESULTS 16,168 patients were analyzed, 40.3% had T2DM. Ten-year mortality rates were 50.3% with T2DM vs. 33.1% without T2DM, adjHR=1.622 (p<0.001). Females (adjHR=1.085, p=0.052) and increased age (adjHR=1.056 for one-year increase, p<0.001) were associated with a higher risk of mortality (borderline statistical significance for sex). The relationship between T2DM and mortality was stronger in females than in males at <50 and 60-69 years (p-for-interaction 0.025 and 0.009 respectively), but not for other age groups. CONCLUSIONS The study implies heterogeneity in the impact of T2DM on mortality of post-AMI patients, being greater among young patients, particularly females, and no significant impact in octogenarians. That implies that young women with T2DM should have advanced measures for early detection of coronary artery disease and tight control of cardiovascular risk factors to lower the propensity to develop AMI.
American Journal of Obstetrics and Gynecology, Nov 1, 2009
OBJECTIVE-The study evaluates lipids profile changes during gestation in pregnancies with and wit... more OBJECTIVE-The study evaluates lipids profile changes during gestation in pregnancies with and without preeclampsia and/or gestational diabetes. STUDY DESIGN-Lipid profiles were assessed between year prior and after pregnancy in 9911 women without cardiovascular comorbidities. RESULTS-Lipid levels during gestation varied substantially with a nadir following conception and a peak at delivery. Compared to preconception levels total cholesterol levels increased from 164.4 mg/dL to 238.6 mg/dL and triglycerides (TGs) from 92.6 mg/dL to 238.4 mg/dL. The composite endpoint (gestational diabetes mellitus or preeclampsia) occurred in 1209 women (12.2%). Its prevalence increased with levels of TG-from 7.2% in the group with low TGs (<25th percentile adjusted for the gestational month) to 19.8% in the group with high TGs (>75th percentile), but was not associated with high-density lipoprotein levels. In multivariate analysis higher TGs levels, but not low high-density lipoprotein, were associated with the primary endpoint. CONCLUSION-Lipid levels change substantially during gestation. Abnormal levels of TGs are associated with pregnancy complications.
Blood pressure at rest is not predictive of round-the-clock values. Blood pressure should therefo... more Blood pressure at rest is not predictive of round-the-clock values. Blood pressure should therefore be measured during effort to evaluate hypertension and its response to treatment. The effect of sustained-release verapamil (240 mg taken once a day) on blood pressure at rest and during isometric effort was therefore investigated. Overall, verapamil reduced blood pressure significantly in 41 of 45 hypertensive patients: the mean systolic blood pressure at rest (+/- SD) fell from 151 +/- 35 mmHg to 137 +/- 13 mmHg (P < 0.001) and the diastolic blood pressure from 97 +/- 21 mmHg to 83 +/- 7 mmHg (P < 0.001), while the systolic blood pressure during isometric effort fell from 186 +/- 23 mmHg to 156 +/- 13 mmHg (P < 0.001) and the diastolic blood pressure from 118 +/- 14 mmHg to 95 +/- 8 mmHg (P < 0.001). The simple, inexpensive handgrip method described is cost-effective and strongly recommended as an integral part of the evaluation of hypertensive patients. The combination of a drug to which compliance is good and a simple method of blood pressure evaluation should result in improved effectiveness of treatment in the long term.
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Papers by Harel Gilutz