Professor Of Clinical Medicine Research Articles

Angiotensin‐Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers: Is There a Difference in Response and Any Advantage to Using Them Together in the Treatment of Hypertension?

In April 2008, a panel was convened to discuss the effects of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in the treatment of hypertension and the possible added benefit of using these agents together. The panel was moderated by Marvin Moser, MD, Clinical Professor of Medicine at Yale University School of Medicine, and included Clive Rosendorff, MD, PhD, Professor of Medicine at Mount Sinai School of Medicine and William B. White, MD, Division Chief, Hypertension and Clinical Pharmacology and Professor, Calhoun Cardiology Center at the University of Connecticut Health Center, Farmington.

How to Treat Hypertension in Patients With Coronary Heart Disease disease.

Following a hypertension symposium in Los Angeles in October 2007, a panel was convened to discuss how to treat hypertension in patients with coronary artery disease or with evidence of multiple major risk factors for coronary heart disease. Marvin Moser, MD, Clinical Professor of Medicine at the Yale University School of Medicine, New Haven, CT, moderated the discussion. Jackson T. Wright Jr, MD, PhD, Professor of Medicine, Program Director of William T. Dahms Clinical Research, and Director of the Clinical Hypertension Program at Case Western Reserve University, Cleveland, OH; Ronald G. Victor, MD, Professor and Division Chief, Hypertension, University of Texas Southwestern Medical Center, Dallas, TX; and Joel Handler, MD, Hypertension Lead, Care Management Institute, Kaiser Permanente, Anaheim, CA, participated in the discussion.

Osteoporosis and the new absolute fracture risk algorithm

Dr Stuart Silverman was born in Chicago (IL, USA) and graduated from Princeton University (NJ, USA) cum laude in biology with an interest in art history. He received his MD from Johns Hopkins (MD, USA) in 1973. He was an intern and resident in the Boston University Hospital System (MA, USA) and was a rheumatology fellow at Boston University under Dr Alan Cohen. Following his rheumatology fellowship he was a Thorndike research fellow. He is board-certified in internal medicine, rheumatology and allergy-immunology, and has served as a lecturer in rheumatology at Tufts University, assistant professor at University of Pennsylvania (PA, USA) and is currently Clinical Professor of Medicine at University of California, Los Angeles (UCLA, CA, USA). He has served as acting chief of rheumatology at Greater Los Angeles VA Medical Center where he currently holds a research appointment. His clinical practice is based at Cedars-Sinai (CA, USA). Dr Silverman is medical director of the OMC Clinical Research Center, a non...

Evidence-based Health Policy Supports Single-Payer Health Insurance Reform

From the *Weill Cornell Medical College, New York, New York; and †SUNY Downstate Medical College, Brooklyn, New York. Reprints: Oliver Fein, MD, Professor of Clinical Medicine and Public Health, Weill Cornell Medical College, 445 East 69th Street, Suite 420, New York, NY 10021. E-mail: [email protected].

The Treatment of Hypertension in the Elderly

Following a hypertension symposium in San Francisco in September 2007, an expert panel was convened to discuss the treatment of hypertension in the elderly. Based on recent data, new recommendations may be indicated. The session was moderated by Marvin Moser, MD, Clinical Professor of Medicine at Yale University, New Haven, CT. Participants were William Cushman, MD, Professor of Preventive Medicine and Medicine at the University of Tennessee in Memphis, and Michael Ziegler, MD, Professor of Medicine, University of California at San Diego. The discussion was supported by Novartis Pharmaceuticals and Merck & Company, and each author received an honorarium from Novartis Pharmaceuticals and Merck & Company for time and effort spent participating in the discussion and reviewing the transcript for intellectual content before publication. The authors maintained full control of the discussion and the resulting content of this article.

Building your Babylon

Ron Bridges is the Head of the Division of Gastroenterology for the Calgary Health Region (CHR) and a Clinical Professor of Medicine at the University of Alberta. He has been actively involved in the development of the Forzani and MacPhail Colon Cancer Screening Centre (CCSC) at the University of Calgary, and has been the Medical Director for the centre during the formative planning and implementation stages.

Control of Blood Pressure: Does It Matter Which Agent You Use?

A panel was convened to discuss the question, "Is blood pressure lowering the sole determinant of outcome, or do specific drugs make a difference?" The panel was moderated by Marvin Moser, MD, Clinical Professor of Medicine at the Yale University School of Medicine, New Haven, CT. Panelists included Norman Kaplan, MD, Clinical Professor of Medicine at the University of Texas Southwestern Medical Center at Dallas, TX, and William Cushman, MD, Professor of Medicine at the University of Tennessee in Memphis, TN. The discussion was supported by Boehringer Ingelheim, and each author received an honorarium from Boehringer Ingelheim for time and effort spent participating in the discussion or reviewing the transcript for intellectual content before publication. The authors maintained full control of the discussion and the resulting content of this article.

T. Joseph Reeves, MD

It is with profound sadness that we report the passing of T. Joseph “Joe” Reeves on April 21, 2007. Likewise, we recount with great humility the exemplary career of this skilled clinician scientist and superb mentor, whose scholarly leadership contributed so substantively to advance the practice of cardiovascular medicine and the academic growth of the University of Alabama School of Medicine (UASOM) in Birmingham. Dr Reeves, a native of Waco, Tex, was born on April 22, 1923, to Thomas Jefferson Reeves and Ruth Scott Reeves, both of pioneer Texas families. After receiving his undergraduate education at Baylor University in Waco, he was inducted into the US Naval Reserve. He would return to active duty in the US Naval Reserve, serving as a medical officer and flight surgeon after his graduation from Baylor College of Medicine in 1946 and an internship at Parkland Memorial Hospital in Dallas. He completed his residency training in internal medicine at Parkland in 1951 and served as a Chief Resident in Medicine under Donald Seldin. Dr Reeves received his fellowship training in cardiology at UASOM under the mentorship of the late Tinsley R. Harrison, who also served as the first Chair of Medicine there and had an indelible impact on Dr Reeves’ clinical training and practice of medicine that became profound and long lasting. They were coauthors of a groundbreaking text entitled Principles and Problems of Ischemic Heart Disease , which appeared in 1968 (vide infra) when coronary care units were in their infancy and coronary angiography in the setting of an acute myocardial infarction was a rarity. When Dr Harrison suffered an acute myocardial infarction, it was none other than Joe Reeves who served as his mentor’s cardiologist. Dr Reeves was a pioneering faculty member of …

Microalbuminuria, Chronic Renal Disease, and the Effects of the Metabolic Syndrome on Cardiovascular Events

In March 2007, a panel discussion was held following a hypertension symposium in New York, New York. The panel was moderated by Marvin Moser, MD, Clinical Professor of Medicine at the Yale University School of Medicine, New Haven, Connecticut. Serving on the panel were James R. Sowers, MD, Professor of Medicine and Physiology at the University of Missouri, Columbia, Missouri, and Henry R. Black, MD, Clinical Professor of Medicine at the New York University School of Medicine, New York, New York. This expert panel discussion was supported by Novartis and each author received an honorarium from Novartis for time and effort spent participating in the discussion and reviewing the transcript for important intellectual content prior to publication. The authors maintained full control of the discussion and the resulting content of this article; Novartis had no input in the choice of topic, speakers, or content.

Interview with a Quality Leader: Bernard Rosof on the State of Medical Quality

Bernard Rosof, MD MACP, is senior vice president for corporate relations and health affairs at the North Shore-Long Island Jewish Health System and clinical professor of medicine at New York University School of Medicine. Before assuming a full-time hospital position, Rosof was in the private practice of internal medicine and gastroenterology for 29 years. He has chaired committees and task forces in New York and for the Institute of Medicine, National Quality Forum, the American Medical Association (AMA), and various specialty societies. He has achieved national recognition for his contributions in the areas of healthcare quality and clinical practice guidelines and is the current chair of the Physician Consortium for Performance Improvement convened by the AMA. He is a member of the editorial board of the American Journal of Medical Quality and chair of the committee on quality assurance in office based-surgery for the Commissioner of Health of New York State. Rosof is a former member of the board of directors of the National Alliance of Autism Research and was instrumental in the development of the North Shore-Long Island Jewish Health System's Center for Autism. He is a master of the American College of Physicians and chair emeritus and president emeritus of the Board of Regents of the American College of Physicians.

Parviz Lalezari: An Autobiography

Doctor Parviz Lalezari, currently a clinical professor of Medicine and Pathology at Albert Einstein College of Medicine in New York, describes highlights of his research career since 1958. He became the director of the blood bank at Montefiore Hospital in New York City in 1961, director of the Division of Immunohematology until 1996, and then until 2001, was President and chief executive officer of the Bergen Community Regional Blood Center in New Jersey. Doctor Lalezari was born in Iran in 1931, and after graduation from Medical School, he came to the United States in 1956. His initial research was on leukocyte antibodies. After modifying the available antibody detection techniques, he discovered that like hemolytic disease of the newborn and neonatal immune thrombocytopenia, fetal-maternal neutrophil incompatibility can cause neonatal neutropenia. He identified the targets of these antibodies and showed that they were expressed only on peripheral blood neutrophils. Doctor Lalezari also discovered that a common form of neutropenia in early childhood was caused by development of autoantibodies, which surprisingly were directed against the same neutrophil-specific antigens involved in fetal-maternal incompatibility. In 1959, a heparin-neutralizing drug (Polybrene) was introduced to be used after open-heart surgery. Lalezari discovered that Polybrene, a quaternary ammonium polymer, reacted with sialic acid molecules on the red blood cell (RBC) surface, causing the RBCs to aggregate. Later, realizing that the repelling forces generated by the RBC surface membrane charges were responsible for failure of the small IgG antibody molecules to agglutinate the RBCs, he used Polybrene to neutralize the RBC surface negative charge to allow the IgG antibody molecules to induce hemagglutination. This became The Polybrene test, which is to be used in RBC antibody detection.

The nonpharmacologic treatment of hypertension: how effective is it? An update.

Following a hypertension symposium in Los Angeles, CA, in October 2006, a panel was convened to update information about lifestyle changes or the nonpharmacologic treatment of hypertension. Dr Marvin Moser, Clinical Professor of Medicine at the Yale University School of Medicine, moderated the panel. Dr Stanley S. Franklin, Clinical Professor of Medicine and Associate Medical Director of the Heart Disease Prevention Program at the University of California, Irvine, and Dr Joel Handler, Director of the Orange County Kaiser-Permanente Hypertension Clinic and clinical hypertension leader of the Care Management Institute of Kaiser Permanente, participated in the discussion.

25th Princeton Conference on Cerebrovascular Disease

The 25th Princeton Conference on Cerebrovascular Disease was held in Portland, Oregon, from May 19th to the 20th, 2006. This was the 50th year of this biannual meeting first held from January 24th to the 26th, 1954, in Princeton, New Jersey. Jim Toole recalled that the location and month of the Conference were selected to be remote enough and the weather inhospitable enough to insure maximum, continuous involvement by the participants in the meeting. The first 11 meetings were held in Princeton. Irving Wright, Professor of Clinical Medicine at Cornell University Medical School, was the Chairman of the first Conference. He had introduced the use of coumadin into medicine and directed the first major trial on oral anticoagulation (in acute myocardial infarction). Wright noted that with “considerable difficulty” he was able to find 38 physicians and scientists with a …

Sickle Cell Disease and Pulmonary Hypertension: Addressing the Mixed Pathology and Special Considerations in Diagnosis and Treatment

This discussion was moderated by Evelyn M. Horn, MD, Associate Professor of Clinical Medicine and Director, Pulmonary Vascular Disease, Center for Advanced Cardiac Care, Columbia University Medical Center, New York, New York. Panel members included Harrison W. Farber, MD, Director, Pulmonary Hypertension Center, Boston Medical Center, Boston University School of Medicine; Mark Gladwin, MD, Chief, Vascular Medicine Branch, National Heart, Lung, and Blood Institute, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD; Myung H. Park, MD, Director, Pulmonary Vascular Disease Program, University of Maryland School of Medicine.

Charles Lightdale Editor for GI & Hepatology News

The editor of AGA’s new publication, the newspaper GI & Hepatology News, is Charles J. Lightdale, Professor of Clinical Medicine at the Columbia University College of Physicians and Surgeons in New York City, and Director of Clinical Research in the Division of Digestive and Liver Disease, Department of Medicine, at the New York-Presbyterian Hospital/Columbia University Medical Center.

Prehypertension-What Is It and Should It Be Treated?

In May 2006, a panel of experts was assembled during the meeting of the American Society of Hypertension, Inc to discuss the diagnosis and treatment of prehypertension. Is it a real entity? Does it pose a risk? Should it be treated entirely with lifestyle interventions or should some patients be placed on pharmacologic therapy? The panel was chaired by Dr Marvin Moser, Clinical Professor of Medicine at the Yale University School of Medicine, New Haven, CT, and Editor in Chief of The Journal of Clinical Hypertension. Panelists included Dr Thomas Giles, Professor of Medicine at Louisiana State University, New Orleans, LA; Dr Joseph Izzo, Jr, Professor of Medicine at SUNY Buffalo School of Medicine, Buffalo, NY; and Dr Henry Black, Roberts Professor of Preventive Medicine at the Rush University School of Medicine in Chicago, Chicago, IL.

The NCCN Clinical Practice Guidelines on Liver Cancer: Guidelines for All Settings?

Rodger J. Winn is the Editorin-Chief of JNCCN. He is Clinical Consultant at the National Quality Forum, and his past positions include Associate Professor of Clinical Medicine at The University of Texas M. D. Anderson Cancer Center. Dr. Winn received his medical degree from Jefferson Medical College of Philadelphia. His postgraduate training includes an internship and residency at Jefferson Medical College, and he also completed a medical oncology fellowship at Memorial Sloan-Kettering Cancer Center in New York. He is board certified in internal medicine and holds subspecialty certification in oncology. The NCCN Clinical Practice Guidelines on Liver Cancer: Guidelines for All Settings?

Prescription Opiate Medications

<p>Prescription opiate medications are controlled substances under United States law because of intrinsic characteristics that render them both medically useful and dangerously harmful to patients. However, the warnings derived from the experience and laws about the potential dangers and toxicity of prescription opiate medications were lost due to strong political pressure and aggressive pharmaceutical marketing directed toward physicians to prescribe them widely for all types of pain complaints and other conditions in clinical populations. Despite the pressure from the “pain movement” to rationalize away these medications’ biologically addictive qualities, we are witnessing epidemic proportions of addiction to prescription opiate medications at alarming rates in all clinical populations, with predictable adverse consequences.</p> <h4>ABOUT THE GUEST EDITOR</h4> <p>Norman S. Miller, MD, JD is clinical professor of medicine, Department of Medicine, Michigan State University, East Lansing, MI. He also has been professor of psychiatry and director of addiction medicine, Department of Psychiatry, Michigan State University. He has board certification in psychiatry, neurology, forensic psychiatry, and addiction psychiatry, and certification in addiction medicine.</p> <p>A graduate of the Howard University College of Medicine, Washington, DC, Dr. Miller served a residency in psychiatry at Johns Hopkins Medical School in Baltimore, MD, and a residency in neurology and fellowship in clinical pharmacology at the University of Minnesota, Minneapolis, MN. He also obtained a Juris Doctorate from the Michigan State University College of Law.</p> <p>Dr. Miller has published more than 250 articles in medical journals and edited or authored 11 medical texts. His current focus includes research and scholarly publications on prescription medication problems and providing expert testimony in medical legal medicine. He is also a member of the <cite>Psychiatric Annals</cite> Editorial Advisory Board.</p>

Resistant or Difficult‐to‐Treat Hypertension

Following a hypertension symposium in Los Angeles, CA, in October 2005, an expert panel discussion was held to discuss resistant hypertension. Are there patients whose blood pressures cannot be controlled? Do inappropriate uses of medications or drug combinations or, on the other hand, poor adherence on the part of patients, play a major role in resistance? Dr. Marvin Moser, Clinical Professor of Medicine at the Yale University School of Medicine, New Haven, CT, moderated the discussion. Participants on this panel included Dr. William Cushman of the University of Tennessee College of Medicine, Memphis, TN, and Dr. Joel Handler of the Kaiser Permanente Group in Anaheim, CA.

Some Blood-Pressure Medication Linked to Lower Alzheimer's Rate

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessSome Blood-Pressure Medication Linked to Lower Alzheimer's RateAaron LevinAaron LevinSearch for more papers by this authorPublished Online:5 May 2006https://doi.org/10.1176/pn.41.9.0026High blood pressure may—or may not—increase risk of Alzheimer's disease, depending on who asks the question, and treating high blood pressure may—or may not—reduce that risk, depending on which drugs are used.Hypertension has been closely linked with vascular dementia and cognitive decline. Some studies have found that taking medicine to lower blood pressure reduces incidence of Alzheimer's disease, while others have found just the opposite.Most trials of antihypertensive drugs have indeed found that persons with high blood pressure test poorly for mental acuity, said hypertension expert Marvin Moser, M.D., a clinical professor of medicine at Yale and editor in chief of the Journal of Clinical Hypertension, in an interview.“ However, the relationship to Alzheimer's disease is very questionable.”Nevertheless, a three-year study of 3,217 elderly residents of Cache County, Utah, initially found that use of any antihypertensive medication at baseline was associated with lower incidence of Alzheimer's disease. However, it was later found that the advantage came only from potassium-sparing diuretics and not other antihypertensive medications. The study was published in the March 13 issue of Archives of Neurology.Use of antihypertensive medications was also linked to increased mortality—possibly because those who took these medications were sicker than those who didn't—although there was no increase in mortality for those taking potassium-sparing diuretics.Beginning in 1995, the investigators took DNA samples and interviewed the participants about risk and protective factors for dementia. They also completed a more extensive examination of an age-, sex-, and APOE genotype-weighted and stratified subsample of the group. Three years later they re-examined the participants to discover any incident cases of dementia.At each of the two stages of the study, the researchers asked about antihypertensive medications and cross-checked that information by inspecting medication vials. Antihypertensives were grouped into ACE inhibitors (used by 13.0 percent of the participants), beta blockers (11.5 percent), calcium channel blockers (14.9 percent), and diuretics (26.5 percent). Demographically, antihypertensive drug users were somewhat older and less educated and more likely to be female and have a history of stroke, high cholesterol, diabetes, or heart attack.Medication use was generally not associated with reduced risk of Alzheimer's disease with the exception of potassium-sparing diuretics. Use of these drugs by themselves produced an adjusted hazard ratio of 0.09. Since many persons with high blood pressure take more than one drug (18.2 percent in this study), the adjusted hazard ratio for all users of potassium-sparing diuretics was 0.26.Potassium-sparing diuretics, like triamterene, spironolactone, and amiloride hydrochloride, maintain levels of the element in the bloodstream, unlike loop or thiazide diuretics.Just how this class of drugs may cut the risk of Alzheimer's is not known. The authors noted that published reports suggest that low plasma potassium concentrations are variously associated with oxidative stress, inflammation, platelet aggression, and vasoconstriction, all of which can be linked to Alzheimer's disease pathogenesis. The blood pressure lowering action of the medications apparently did not play a role in the results.“There was variability in blood pressure by the type of antihypertensive medication being taken,” said study co-author Peter P. Zandi, Ph.D., an assistant professor in the Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health in Baltimore. “But we statistically controlled for current blood pressure in a subgroup of participants on which we had direct measures of blood pressure, and the results did not materially change, so the protective effect of these antihypertensive medications may be independent of their ability to control blood pressure.”A separate study published recently found that low serum potassium levels in women aged 46 to 60 were associated with low levels of amyloid-beta 42 in cerebrospinal fluid 24 years later. Other researchers have suggested that low cerebrospinal levels of amyloid-beta 42 corresponds to greater presence of the protein locked up in the brain in the form of the beta-amyloid plaques that characterize Alzheimer's disease.Still, Moser finds the Cache County study's results a bit puzzling.“ If the protective effect is caused by higher potassium levels, why don't we see the same effect in persons [in the study] who were taking angiotensin-converting enzyme inhibitors?” he said in an interview. ACE inhibitors also maintain potassium levels in the body and so should have a similar effect, he said.Zandi agreed that numerous questions remain. “Further study to clarify whether and how potassium-sparing diuretics may actually provide protection is clearly needed.”“Antihypertensive Medication Use and Incident Alzheimer Disease: The Cache County Study” is posted online at<http://archneur.ama-assn.org/cgi/content/full/63.5.noc60013v1>.▪ ISSUES NewArchived