Nelly Gonzalez - Academia.edu (original) (raw)

Papers by Nelly Gonzalez

Research paper thumbnail of Use of Antihypertensive Agents with Particular Comorbid Problems

Clinics in Geriatric Medicine, 1989

The combination of the progressive age-related rise in blood pressure in Western societies and th... more The combination of the progressive age-related rise in blood pressure in Western societies and the rapidly increasing number of elderly persons has resulted in hypertension in the elderly population being a common medical problem. As the life expectancy of adults has gradually increased, the proportion of elderly with comorbid medical conditions has likewise increased. These comorbid conditions may potentially affect the timing and type of treatment of the various types of hypertension, which has centered around pharmacologic agents. Several classes of antihypertensive agents are available for effective reduction of blood pressure. Choice of agent(s) often depends on coexisting diseases to minimize adverse effects and potentially enhance beneficial therapeutic interactions. This article will review common medical conditions in elderly persons which may influence the choice of antihypertensive drug. This review is based on a literature search that used many excellent studies but also some that had substantial limitations including small sample size, inadequate blinding, no randomization, and no control groups. When possible, the results of rigorous clinical trials are emphasized.

Research paper thumbnail of α-Blockade and thiazide treatment of hypertension A double-blind randomized trial comparing doxazosin and hydrochlorothiazide

American Journal of Hypertension, 1996

This trial involved 107 patients in a two-group, parallel, double-blind, randomized study compari... more This trial involved 107 patients in a two-group, parallel, double-blind, randomized study comparing the diuretic, hydrochlorothiazide (HCTZ) (dose 25 to 50 mgf and the a1 antagonist, doxazosin (dose 2 to 16 mg). All randomized participants were followed for at least 1 year. Participants were recruited from the community. The study was carried out in four phases: Phase I-Baseline; Phase II-Monotherapy Titration; Phase III-Combination Therapy Titration; and Phase IV-Maintenance. The following measures were carried out: blood pressure, biochemistries, lipids/lipoproteins, quality of life, ambulatory electrocardiograms, echocardiograms, adverse experiences, and drug adherence. Both drugs were well tolerated, with only 4% taken off doxazosin and 7% off HCTZ. Adverse experiences were uncommon and mostly mild. Both drugs were effective in. managing hypertension over 1 year of therapy. There was no difference noted in terms of eff :rcy of blood pressure lowering between the two study drugs, nor was there any evidence of tolerance devdoping or of any serious adverse effects. Average final doses for drugs were 7.8 mg for doxazosin and 36 me For HCTZ. The rc-&ts show that, over the course of 1 year, both drugs significantly lowered systolic and diastolic pressures compared to baseline; doxazosin (-19 and-16 mm Hg); HffZ t-22 and 15 mm Hgf. Blood pressure lowe&g was not significantly different between drJgs. Sitting heart rate was not affected by drugs. Chqpges in quality of life measures were similar between groups. Echocardiographic mepsures at 1 year showed significant between-drug differences in change in left internal end systa\lc and diastolic dimensions and end systolic stress. Both doxazosin and HCTZ were effective drugs over 1 year for treating hypertension. Am J tippertens 1996;9:445-454

Research paper thumbnail of Sodium chloride raises blood pressure in normotensive subjects. The study of sodium and blood pressure

Hypertension, 1991

The effects of dietary sodium on blood pressure in normotensive adults is not well characterized.... more The effects of dietary sodium on blood pressure in normotensive adults is not well characterized. The Study of Sodium and Blood Pressure (SNaP) is a randomized, double-blind crossover trial using a placebo or 96 meq sodium in 4-week treatment periods separated by a 2-week washout period. Before capsule treatment periods, participants were instructed in a low sodium diet for 10 weeks to reduce urinary sodium excretion to less than 35 meq/8 hr. The low sodium diet was continued throughout the capsule treatment periods. Participants (n = 48; 47 white, 1 black) were 79% male and had an average age of 52 years, a body mass index of 27.6, and a baseline blood pressure of 131/84 mm Hg. Baseline overnight urinary sodium excretion was 51 meq/8 hr and 19 meq/8 hr after the low sodium diet run-in period, before the capsule treatment periods began. Resting, seated blood pressure was measured twice at each visit in a standard fashion. Differences between sodium and placebo treatment periods were...

Research paper thumbnail of Use of Antihypertensive Agents with Particular Comorbid Problems

Clinics in Geriatric Medicine, 1989

The combination of the progressive age-related rise in blood pressure in Western societies and th... more The combination of the progressive age-related rise in blood pressure in Western societies and the rapidly increasing number of elderly persons has resulted in hypertension in the elderly population being a common medical problem. As the life expectancy of adults has gradually increased, the proportion of elderly with comorbid medical conditions has likewise increased. These comorbid conditions may potentially affect the timing and type of treatment of the various types of hypertension, which has centered around pharmacologic agents. Several classes of antihypertensive agents are available for effective reduction of blood pressure. Choice of agent(s) often depends on coexisting diseases to minimize adverse effects and potentially enhance beneficial therapeutic interactions. This article will review common medical conditions in elderly persons which may influence the choice of antihypertensive drug. This review is based on a literature search that used many excellent studies but also some that had substantial limitations including small sample size, inadequate blinding, no randomization, and no control groups. When possible, the results of rigorous clinical trials are emphasized.

Research paper thumbnail of α-Blockade and thiazide treatment of hypertension A double-blind randomized trial comparing doxazosin and hydrochlorothiazide

American Journal of Hypertension, 1996

This trial involved 107 patients in a two-group, parallel, double-blind, randomized study compari... more This trial involved 107 patients in a two-group, parallel, double-blind, randomized study comparing the diuretic, hydrochlorothiazide (HCTZ) (dose 25 to 50 mgf and the a1 antagonist, doxazosin (dose 2 to 16 mg). All randomized participants were followed for at least 1 year. Participants were recruited from the community. The study was carried out in four phases: Phase I-Baseline; Phase II-Monotherapy Titration; Phase III-Combination Therapy Titration; and Phase IV-Maintenance. The following measures were carried out: blood pressure, biochemistries, lipids/lipoproteins, quality of life, ambulatory electrocardiograms, echocardiograms, adverse experiences, and drug adherence. Both drugs were well tolerated, with only 4% taken off doxazosin and 7% off HCTZ. Adverse experiences were uncommon and mostly mild. Both drugs were effective in. managing hypertension over 1 year of therapy. There was no difference noted in terms of eff :rcy of blood pressure lowering between the two study drugs, nor was there any evidence of tolerance devdoping or of any serious adverse effects. Average final doses for drugs were 7.8 mg for doxazosin and 36 me For HCTZ. The rc-&ts show that, over the course of 1 year, both drugs significantly lowered systolic and diastolic pressures compared to baseline; doxazosin (-19 and-16 mm Hg); HffZ t-22 and 15 mm Hgf. Blood pressure lowe&g was not significantly different between drJgs. Sitting heart rate was not affected by drugs. Chqpges in quality of life measures were similar between groups. Echocardiographic mepsures at 1 year showed significant between-drug differences in change in left internal end systa\lc and diastolic dimensions and end systolic stress. Both doxazosin and HCTZ were effective drugs over 1 year for treating hypertension. Am J tippertens 1996;9:445-454

Research paper thumbnail of Sodium chloride raises blood pressure in normotensive subjects. The study of sodium and blood pressure

Hypertension, 1991

The effects of dietary sodium on blood pressure in normotensive adults is not well characterized.... more The effects of dietary sodium on blood pressure in normotensive adults is not well characterized. The Study of Sodium and Blood Pressure (SNaP) is a randomized, double-blind crossover trial using a placebo or 96 meq sodium in 4-week treatment periods separated by a 2-week washout period. Before capsule treatment periods, participants were instructed in a low sodium diet for 10 weeks to reduce urinary sodium excretion to less than 35 meq/8 hr. The low sodium diet was continued throughout the capsule treatment periods. Participants (n = 48; 47 white, 1 black) were 79% male and had an average age of 52 years, a body mass index of 27.6, and a baseline blood pressure of 131/84 mm Hg. Baseline overnight urinary sodium excretion was 51 meq/8 hr and 19 meq/8 hr after the low sodium diet run-in period, before the capsule treatment periods began. Resting, seated blood pressure was measured twice at each visit in a standard fashion. Differences between sodium and placebo treatment periods were...