Specific Medication Classes Research Articles

Further Investigation of the Negative Association between Hypertension and Peripheral Neuropathy in the Elderly: An Oklahoma Physicians Resource/Research Network (OKPRN) Study

In a previous cross-sectional study of age-associated peripheral neuropathy (AAPN), we found that a history of hypertension was protective. The purpose of this study, conducted in the same cohort, was to investigate further this association in the same subjects and in a comparison group of older subjects with diabetes mellitus. Baseline data from 584 subjects involved in a longitudinal study of primary care patients 65 years of age and older, with no history of 10 medical conditions known to cause peripheral neuropathy, were analyzed for associations between peripheral neuropathy by examination and history of hypertension, number of antihypertensive medications, systolic blood pressure, diastolic blood pressure, pulse pressure, and orthostatic hypotension. In addition, we examined associations between neuropathy at baseline and use of specific classes of antihypertensive medications and non-steroidal anti-inflammatory agents (NSAIDs) in year 3. The analyses were repeated in 110 subjects with diabetes mellitus. History of hypertension, but not the other hypertension-related variables, was negatively associated (OR, 0.60; 95% CI: 0.40 to 0.90) with AAPN after controlling for age and body mass index (BMI). In 287 subjects evaluated in the 3rd year of the study, beta-blocking agents (OR, 3.56; 95% CI: 1.58 to 8.03) and NSAIDs (OR, 2.65; 95% CI: 1.37 to 5.10) were positively associated with AAPN. In subjects with diabetes mellitus, a history of hypertension was again protective, but current pulse pressure (OR, 1.03; 95% CI: 1.00 to 1.05) was a positive predictor of peripheral neuropathy. There were interesting interactions between pulse pressure and military service and pulse pressure and BMI in diabetic patients. The negative association between hypertension and AAPN remains unexplained. The positive association between pulse pressure and neuropathy in diabetic subjects supports findings from previous studies and suggests that AAPN and the neuropathy of diabetes may be distinct entities. The incidental finding of an association between NSAIDs and AAPN is concerning and should be investigated further.

Parametric neurocognitive task design: a pilot study of sustained attention in adolescents with bipolar disorder

BackgroundDisruption in attention is one of the core features of bipolar disorder (BP). Therefore, neurocognitive paradigms assessing brain function in response to tasks of increasing attentional difficulty may be useful to clarify the neurophysiology of bipolar disorder. The aim of this study was to obtain pilot performance data using a parametric task of sustained attention that might be useful as an experimental paradigm for future functional neuroimaging studies. We hypothesized that task performance would worsen as task difficulty increased in manic and euthymic bipolar and healthy subjects. Additionally, we hypothesized that the groups would exhibit a similar decline in task performance as level of task difficulty increased and that within each level of task difficulty there would be similar performance among groups. MethodsA novel parametric Continuous Performance Task-Identical Pairs (CPT-IP) version was administered to manic (N=10) and euthymic (N=10) adolescents with bipolar disorder and healthy controls (N=10). ResultsThere were no statistically significant group differences in task performance as measured by discriminability, percent correct, false positive hits, and reaction time. However, within each group, performance on all measures worsened with increased attentional difficulty (p<0.0001). There were no statistically significant task difficulty by group interactions. Furthermore, medication exposure and comorbid attention-deficit hyperactivity disorder were not associated with most measures of task performance. However, BP subjects who were treated with medications had slower task performance compared with BP subjects who were unmedicated. LimitationsLarger studies examining the effects of specific medication classes on task performance are necessary. ConclusionsThe results of this pilot study suggest that manic and euthymic BP patients do not exhibit attentional dysfunction as compared to healthy adolescents using a novel parametric version of the CPT-IP. Furthermore, our parametric CPT-IP version may be useful as a novel parametric neurocognitive paradigm for future functional neuroimaging studies of bipolar adolescents.

National trends in nonoperative care for nonspecific back pain

Background context Few empirical data are available that document changes in population-based rates for the evaluation and treatment of nonspecific back pain. Purpose To determine the extent of change in the pattern of outpatient evaluation and treatment of nonspecific low back pain in the United States between 1987 and 1997. Study design and setting The 1987 National Medical Expenditure Survey and the 1997 Medical Expenditure Panel Survey, two nationally representative surveys with similar sampling methods and questions, were used. Patient sample Noninstitutionalized adults in the United States. Outcome measures Changes in rates of any health service for nonspecific back pain and occurrence of provider-specific care and types of services provided. Changes in the prescription of specific medication classes (ie, nonsteroidal anti-inflammatory drugs [NSAIDs], muscle relaxants, nonnarcotic and narcotic analgesics) were also investigated. Results Overall rate for outpatient treatment for nonspecific back pain in the US population was relatively stable over the decade (4.48% in 1987, 4.53% in 1997, p = .85). Among those receiving care, the proportion receiving physician care increased from 64% in 1987 to 74% in 1997 (p<.001), whereas those obtaining care from physical therapists increased from 5% to 9% during the same time period (p<.01). The proportion of respondents receiving NSAIDs, muscle relaxants, nonnarcotic analgesics and narcotic analgesics remained stable. However, the mean number of patient visits in which these medications were prescribed increased from 2.0 to 3.9 over the decade (p<.001). The proportion of individuals receiving chiropractic care (p<.01) and X- rays (p<.001) were lower in 1997 than 1987. Conclusions The national pattern of health care for nonspecific low back pain observed in the present study serves as a basis for future investigations into the management of this major public health problem. Findings suggest that perhaps a duplication of care is partly responsible for the high degree of health care utilization in this population.

Psychopharmacology and Aggression

The authors used meta-analysis to determine the effect size for nonstimulant medications on symptoms of overt aggression-related behaviors in referred children and adolescents with serious emotional and behavioral disturbances.A review of the literature between 1970 and 2001 revealed 33 studies meeting exclusion/inclusion criteria and yielding 37 independent effects for neuroleptic, atypical antipsychotic, mood stabilizer, antidepressant, and adrenergic agents on symptoms of overt aggression.To acquire statistical power, two groups of medications were created and analyzed.The first group consisted of medications for more severely ill children and included neuroleptics, atypical antipsychotics, and mood stabilizers.The second group consisted of medications for less severely ill children and included antidepressants and adrenergic agents. Overall weighted mean effect sizes were moderate to large for overt aggression within a heterogeneous group of psychiatric disorders. Moderators of effect size included drug group, study design, and the interaction between drug group and study design.The results support the common clinical practice of including medications as part of a comprehensive psychoeducational treatment plan for some youth with maladaptive overt aggression within a variety of psychiatric disorders; however, not all referred youth respond to medication for overt aggression-related behavior, supporting the use of additional nonmedication interventions. Future pharmacological research should attempt to identify specific classes of psychiatric medications that are effective for specifically defined types of aggression in distinct psychiatric disorders.

Correlates of behavioral disturbances and pattern of psychotropic medication use in five skilled nursing facilities.

There are several treatment options for behavioral disturbances (BDs) in dementia. However, the choice of a specific psychotropic agent is directed by personal preferences and local community practice patterns. We examined the relationship between common clusters of BDs and the use of different classes of psychotropic agents in our community. A cross-sectional study of 430 long-term care residents from 5 nursing homes was undertaken. The Behavior Measurement Scale (BMS) was used to measure the frequency of BDs grouped in 4 categories. Residents with > 4 BD episodes in at least one category during a 2-week observation period were the behavior group and were considered to have clinically significant BDs. A sample of patients who had < 4 BDs in all BMS categories during the same observation period defined the nonbehavior group. A BD cluster was defined as > 4 BDs occurring in one or more BMS categories during the 2-week observation. Data on functional status, comorbidity, use of benzodiazepines, antidepressants, and neuroleptic agents were collected with chart review. The chi-square test was used to examine the correlation between variables. Clinically significant BDs were identified in 27.2% (117/430) of the residents in the sample. Five of 15 behavior clusters accounted for 73% of all clinically significant BDs. The 5 clusters were verbally nonaggressive behaviors (cluster 1, 20.5%), behaviors from all 4 categories (cluster 2, 17.9%), verbally and physically nonaggressive behaviors (cluster 3, 14.5%), physically nonaggressive behaviors (cluster 4, 12.8%), and verbally aggressive and nonaggressive behaviors (cluster 5, 7.7%). Cluster 5 had a negative correlation with functional impairment (P = .009). There was a significant correlation between cluster 2 and benzodiazepine use (P = .014). No other significant correlation was found between any of the 5 clusters and demographic variables, comorbidity status, and use of antidepressant or neuroleptic medications. Residents in the behavior group had higher impairment in self-feeding (P = .036) and bathing (P < .001) and were more likely to be treated with benzodiazepines (P = .004) and neuroleptic agents (P = .009) than residents in the nonbehavior group (n = 116). The higher use of neuroleptics and benzodiazepines in the behavior group compared with the nonbehavior group indicates that BDs are being identified for treatment, but the medications used may not be efficacious. The lack of association between specific classes of psychotropic medications and distinct behavior clusters indicates that clinicians are not using a standardized approach to target the neurochemical abnormalities that may underlie certain behavior clusters. Some behavior clusters correlate with impairment in specific activities of daily living categories such as bathing and feeding, making room for nonpharmacologic interventions.

Therapy of Digestive Disorders

In the Preface, the authors make very clear his purpose for the work: “(R)ather than emphasizing specific classes of medication, endoscopic intervention, or surgical procedures, Therapy of Digestive Disorders was developed to provide practitioners with an authoritative and evidence-based yet practical approach to the optimal management of individuals with specific digestive disorders.” It is important to keep this in mind as one reads this book. The majority of contributors are gastroenterologists and are noted experts in their fields. The book is an excellent reference that completely discusses algorithms for disease treatment, differential diagnosis, and a thoughtful approach to patients with digestive disorders. The algorithms for treatment, specifically in the chapters on gastroesophageal reflux disease, Zollinger-Ellison syndrome, and primary sclerosing cholangitis are thoughtful and well done. Discussions include the use of modern technology such as laparoscopic interventions including cholecystectomy and Heller myotomy for achalasia, as well as laparoscopic evaluations of patients with carcinoma. The chapters on molecular targets in the therapy of acid-related disease and on Helicobacter pylori disorders are excellent. Additionally, the chapters on a variety of hepatic diseases in the section on liver problems are consistently outstanding. The weaknesses of this book are minor and don’t detract significantly from the overall value of the text; most of these criticisms are from the viewpoint of a practicing clinical gastrointestinal surgeon. In future editions, however, I would expect these weaknesses to be addressed. The chapters on pancreatic adenocarcinoma and cholangiocarcinoma are good, but could be expanded. There are two chapters on the work-up of jaundice in the pregnant patient and the neonatal patient, but a thoughtful defined discussion on obstructive jaundice in general would be nice. Additionally, the use of color, now appearing with increasing frequency in other texts, would have greatly enhanced some of the endoscopic pictures. The pictures of radiation proctitis and other pictures in the section on lower GI bleeding are of inferior quality. There is a wide variation of quality in the representation of CT and radionuclide scans throughout the text. Finally, the section on special situations in the treatment of gallstones was well conceived, but could have been expanded and been of more help to the practitioner. Overall, however, I am impressed with Dr. Wolfe’s efforts. The book’s price is more than reasonable for the broad array of information offered and the authoritative authorship. This work should be an important addition to the library of any practicing gastroenterologist or gastrointestinal surgeon.

Hypertension, Heart Rate, Use of Antihypertensives, and Incident Prostate Cancer

PURPOSE: Recent studies have reported conflicting results on a possible relationship between hypertension, heart rate, and prostate cancer. A model has been developed suggesting that high blood pressure and high heart rate may both be markers for increased central sympathetic nervous activity, which may result in androgen-mediated stimulation of prostate cancer growth. METHODS: In this study we examined the associations between hypertension, heart rate, use of antihypertensive medications, and incident prostate cancer in a cohort of 2442 men. Data from the Cardiovascular Health Study (CHS), an NHLBI-sponsored observational study of adults age 65 or older in four U.S. communities, were analyzed using Cox proportional hazards regression. Seated systolic and diastolic blood pressures were measured using a standardized protocol at the initial clinical examination and annually at follow-up visits. Medications data were transcribed by trained interviewers from prescription medication containers brought into the clinic by participants. RESULTS: A total of 209 cases of incident prostate cancer were identified from either an ICD-9 code of 185 in hospital medical records (n = 130) or by self-report from annual surveillance interviews (n = 79). An average of 5.6 years of follow-up was available for analyses. No associations between blood pressure measures at entry into the study and prostate cancer were found, although these results may have been affected by subsequent treatment of hypertension. An association between resting heart rate (HR) equal to or greater than 80 beats per minute and incident prostate cancer was found compared to men with a rate of less than 60 beats per minute (HR: 1.6, 95% confidence interval [CI]: 1.03–2.5). An inverse association was found between risk of incident prostate cancer and use of any antihypertensive medication (HR: 0.7, 95% CI: 0.5–0.9). A test of heterogeneity found no difference between use of the specific classes of antihypertensive medication and the association with prostate cancer risk. CONCLUSIONS: These data tend to support the hypothesized causal pathway between vascular disease markers and prostate cancer.

PMA8: DEVELOPMENT OF A CHRONIC DISEASE INDICATOR USING A MANAGED CARE POPULATION

OBJECTIVES: Accurate determination of disease prevalence in large patient populations is difficult. The objective of this research was to use pharmacy data to develop an index that estimates the presence and number of chronic diseases in a managed care population. METHODS: An expert panel evaluated 246 specific medication classes as to their likelihood to be indicative of a chronic disease. Those classes identified were then compared against medical records from two random samples of persons 18 years of age or older continuously enrolled for at least one year in a health maintenance organization. One sample was drawn from all eligible persons (n = 137), while the other sample was restricted to individuals 50 years of age or greater (n = 138). A cumulative number of chronic conditions was designated the chronic disease index (CDI). Sensitivity and specificity were calculated for those conditions with prevalence greater than 10% based upon medical record review. RESULTS: The expert panel designated 54 drug classes as containing medications used to treat chronic conditions. A total of 5640 medications were dispensed over a 1 year period for the 275 subjects. The average total number of chronic conditions via medical record review was 2.89 + 2.07, compared to 1.33 + 1.21 chronic conditions estimated by medication use. The CDI correlated well with the number of chronic conditions found via record review (r = 0.735, p < 0.0001). The specificity of pharmacy records to indicate the presence of hypertension, dyslipidemia, depression, and diabetes was 79.9%, 99.0%, 90.2%, and 99.6%, respectively. The sensitivity was 90.9%, 49.9%, 77.5%, and 62.2% for hypertension, dyslipidemia, depression, and diabetes, respectively. CONCLUSIONS: The CDI correlates well with documented chronic conditions. Pharmacy data can be useful in identifying persons with diagnoses of hypertension, dyslipidemia, depression, and diabetes.

Are asthma medications and management related to deaths from asthma?

There is controversy about the role of beta-agonists in asthma mortality, and the impact of asthma management plans remains unclear. We compared blood beta-agonist levels in patients dying from asthma with those in controls, and estimated the risks associated with specific classes of medication and patterns of management. We identified 89 asthma deaths and recruited 322 patients presenting to hospitals with acute asthma. A questionnaire was administered to the next of kin in 51 cases, and to 202 controls. Blood drawn from 35 cases and 229 controls was assayed for salbutamol. Smoking, drinking, and family problems were significantly more likely among the cases of asthma death than among the controls. The two groups were reasonably well matched with regard to markers of chronic asthma severity. Cases of asthma death were significantly less likely than controls to use a peak flow meter. Written action plans were associated with a 70% reduction in the risk of death. Use of nebulized bronchodilators or oral steroids was significantly more likely in cases of asthma death. Mean blood salbutamol concentrations were 2.5 times higher in cases of asthma. The use of oral steroids for an attack of asthma reduced the risk of death by 90%. More widespread adoption of written asthma management plans, with less reliance on beta-agonists and closer medical supervision, should reduce asthma mortality.

Clinical and economic impact of adverse drug reactions in hospitalized patients.

To identify the classes of drugs that most commonly cause adverse drug reactions (ADRs) and the characteristics of these ADRs and to determine the economic impact of ADRs on patients' length of stay and hospitalization costs. Data on ADRs from patients admitted to a hospital in New Jersey were collected, studied, and analyzed over a five-month period. To determine the economic impact of ADRs, patients who experienced ADRs during hospitalization were matched to controls. Each ADR was rated with regard to its severity, the patients' outcomes were determined, and specific classes of medications were identified as particularly causative of ADRs. A total of 196 patients experienced ADRs; 131 of these individuals were matched with 1338 patients who did not experience an ADR, based on their diagnosis-related group code. The leading causal drugs according to therapeutic class were antiinfective (17%), cardiovascular (17%), antineoplastic (15%), and analgesics/antiinflammatory agents (15%). The organ systems most often affected were gastrointestinal (24%), dermatologic (19%), and immune systems (15%). The mean length of stay per patient differed significantly between the ADR case group and matched control group (10.6 vs. 6.8 d; p = 0.003), as did the total hospitalization cost ($22775 vs. $17292; p = 0.025). Length of hospital stay and total hospitalization costs were significantly higher for patients experiencing ADRs than those who did not experience ADRs. ADR reporting systems in hospitals need to be changed and strengthened to decrease the incidence of avoidable reactions.

00/03312 A pattern-matching model for operator cognitive behaviors during accident conditions at a nuclear power plant

To reduce the rate of harmful adverse drug events (ADEs) of severity level D-I from a baseline peak of 0.24 ADE/1000 doses to 0.08 ADE/1000 doses.A hospital-wide, quasi-experimental time series quality improvement (QI) initiative to reduce ADEs was implemented. High-reliability concepts, microsystem-based multidisciplinary teams, and QI science methods were used. ADEs were detected through a combination of voluntary reporting, trigger tool analysis, reversal agent review, and pharmacy interventions. A multidisciplinary ADE Quality Collaborative focused on medication use processes, not on specific classes of medications. Effective interventions included huddles and an ADE prevention bundle.The rate of harmful ADEs initially increased by >65% because of increased error reporting, temporally associated with the implementation of a program focused on high reliability and an improved safety culture. The quarterly rate was 0.17 ADE/1000 dispensed doses in Q1 2010. By the end of Q2 2013, the rate had decreased by 76.5%, to 0.04 ADE/1000 dispensed doses (P < .001).Using an internal collaborative model and QI methodologies focused on medication use processes, harmful ADEs were reduced hospital-wide by 76.5%. The concurrent implementation of a high-reliability, safety-focused program was important as well.

00/03319 Internal reforming over nickel/zirconia anodes in SOFCS operating on methane: influence of anode formulation, pre-treatment and operating cond

To reduce the rate of harmful adverse drug events (ADEs) of severity level D-I from a baseline peak of 0.24 ADE/1000 doses to 0.08 ADE/1000 doses.A hospital-wide, quasi-experimental time series quality improvement (QI) initiative to reduce ADEs was implemented. High-reliability concepts, microsystem-based multidisciplinary teams, and QI science methods were used. ADEs were detected through a combination of voluntary reporting, trigger tool analysis, reversal agent review, and pharmacy interventions. A multidisciplinary ADE Quality Collaborative focused on medication use processes, not on specific classes of medications. Effective interventions included huddles and an ADE prevention bundle.The rate of harmful ADEs initially increased by >65% because of increased error reporting, temporally associated with the implementation of a program focused on high reliability and an improved safety culture. The quarterly rate was 0.17 ADE/1000 dispensed doses in Q1 2010. By the end of Q2 2013, the rate had decreased by 76.5%, to 0.04 ADE/1000 dispensed doses (P < .001).Using an internal collaborative model and QI methodologies focused on medication use processes, harmful ADEs were reduced hospital-wide by 76.5%. The concurrent implementation of a high-reliability, safety-focused program was important as well.

Psychopharmacology: An update for psychiatric home care (CE)

Psychopharmacology is a critical component of psychiatric home care. Nurses play an important role in medication management for patients who require this intervention. Knowledge of psychopharmacologic assessment, phases of psychopharmacologic treatment, psychobiology, and critical issues related to specific classes of medication is essential in developing a treatment plan with the patient and implementing it. Recent psychobiology research has indicated the importance of neurotransmitters, genetics, and the effect of the immune and endocrine systems. Critical issues related to anxiolytic medications, mood stabilizers, antidepressants, and antipsychotic (neuroleptic) medications are described.

Development of a Chronic Disease Indicator Score Using a Veterans Affairs Medical Center Medication Database

Objective: Develop a chronic disease index that approximates the number of chronic diseases a patient has using a medication database. Methods: An expert panel determined whether specific medication classes could be indicative of a chronic disease. Those classes identified were incorporated into a computer program and then used to screen the medication records of 246 randomly selected patients to estimate the number of chronic diseases present in each patient. This number was designated as the chronic disease index (CDI). The CDI was then validated against chart review. The CDI and a measure of disease severity, the chronic disease score (CDS) also were compared. The sensitivity and specificity of the computer program was analyzed for seven common chronic diseases. Results: The expert panel designated 54 drug classes containing medications used to treat chronic diseases. The CDI correlated moderately with the number of chronic diseases found via chart review ( r = 0.65; P = 0.001) and highly with the CDS ( r = 0.81; P = 0.001). The index predicted the presence of three common diseases with a sensitivity of ≥75%, and of six common diseases with a specificity of ≥75%. Conclusions: The CDI correlates moderately well with the actual number of chronic disease states present. This tool may be useful for researchers when trying to identify patients with specific diseases and also for risk adjustment.

Cardiovascular Drugs

HomeCirculationVol. 97, No. 5Cardiovascular Drugs Free AccessOtherPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toFree AccessOtherPDF/EPUBCardiovascular Drugs Review of Mechanisms and Clinical Applications Dan Roden and James T. Willerson Dan RodenDan Roden Search for more papers by this author and James T. WillersonJames T. Willerson Search for more papers by this author Originally published10 Feb 1998https://doi.org/10.1161/01.CIR.97.5.415Circulation. 1998;97:415In this issue and continuing on a monthly basis, Circulation will review basic mechanisms and clinical applications of the most important and relevant cardiovascular medications used to treat cardiovascular diseases in humans. Experienced physicians, knowledgeable about specific classes of medications, will contribute comprehensive reviews providing the interested reader with detailed information concerning cardiovascular medications used in the treatment of patients with selected cardiovascular problems. These reviews will identify indications, patient benefits, side effects, and possible interactions with other medications. Dr Dan Roden will serve as the Section Editor of this new series. The majority of the reviews will be invited ones, but we are also willing to consider reviews submitted by the readership of Circulation. We believe that this new series will be useful to physicians who care for patients with cardiovascular diseases. Previous Back to top Next FiguresReferencesRelatedDetails February 10, 1998Vol 97, Issue 5Article InformationMetrics Copyright © 1998 by American Heart Associationhttps://doi.org/10.1161/01.CIR.97.5.415 Originally publishedFebruary 10, 1998 PDF download Advertisement

Health status and hypertension: A population-based study

We describe the relation between self-reported hypertension and measures of health-related quality of life (HRQOL) in a community-dwelling population. In a cross-sectional study, 1430 randomly selected adults, aged 45 to 89 years, were interviewed to obtain a medical history and health status measures, including the SF-36 questionnaire, the Quality of Well Being (QWB) index, and time trade-off (TTO) assessments. A total of 519 participants reported being affected by hypertension (HTN group). The HTN group, compared to the No HTN group, had significantly lower age-adjusted health status scores measured by the General Health (GH) scale of the SF-36 and by TTO, with differences between groups for each measure comprising approximately 5% of the total scale. HTNs also had a significant decline in general health status measures associated with increasing numbers of antihypertensive medications but not with specific classes of medications. We conclude that hypertension and hypertension drug therapy are associated with clinically meaningful decreases in reported health status.

National High Blood Pressure Education Program Working Group Report on Hypertension in the Elderly. National High Blood Pressure Education Program Working Group.

Raised blood pressures in the elderly and the increased prevalence of hypertension in this population are not benign occurrences and should not be viewed as a normal or inevitable consequence of aging. In fact, the relation of systolic and diastolic blood pressures to cardiovascular events is generally more pronounced in people aged 65 years and older when compared with those aged 35 to 64. The relative risk of cardiovascular disease is greater among the elderly at every level of blood pressure. Furthermore, the absolute likelihood that an older individual will have a cardiovascular event is substantially greater than for someone younger, reflecting the increased prevalence of other cardiovascular disease risk factors in this age group. Thus, equivalent blood pressure reduction is likely to produce a greater benefit in the elderly than in younger patients at every level of blood pressure. This report, an update of the 1985 Working Group Report on Hypertension in the Elderly, has two aims: to guide clinicians in their care of elderly patients with hypertension and to assist health care professionals participating in high blood pressure control programs that serve the elderly. The role of lifestyle modifications--weight loss, dietary sodium restriction, alcohol reduction, and exercise--as definitive or adjunctive therapy to drug treatment is discussed. In addition, the report reviews the relative advantages and disadvantages of the specific classes of antihypertensive medications.