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Lisinopril is an blood pressure lisinopril inhibitor lisinopril and palpitations approved perindopril ramipril. All experimental procedures were previously reported in details.3WEB + , 7-9 Briefly, brains from adult albino Wistar rats 3-4 months, 300-380g ; were rapidly removed and placed into cold 20C ; artificial CSF ACSF ; . Transverse hippocampal slices 400 " ; were prepared with a McIlwain tissue slicer within 4 min of an animal decapitation. After standard recreating incubation at room temperature for 1.5 h in ACSF, slices were subjected to pharmacological treatment for 18-24 hrs ; with the human peptide A!1-40 0 and 0.33 "g ml [83 nM] in ACSF, see Ref. 3 ; and 0.3 "M mevinolin, 7, 10, 11 followed by washing for 3 min 5x ; in ACSF and extracellular field recording of evoked postsynaptic potentials fEPSP ; in stratum radiatum of CA1. Electrophysiological recording was performed as described.3, 5, 8 The tetanic stimulation was delivered at the stimulus intensity that yielded double compared to baseline responses ; EPSP amplitude. The input-stimulus output-response I O ; relationship and LTP were expressed as a fEPSP amplitude and slope change versus stimulus intensity and time, respectively. In selected experiments hippocampal slices were subjected to metabolic labeling with [14C]acetate to evaluate the synthesis of cholesterol and phospholipids.3 The data are presented as meanSEM. Nonparametric Mann-Whitney signed rank test was used for determining significant differences between experimental values. A probability of 0.05 one, for instance, lisinopril 25 mg.
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Mild-to-moderate hypertension. J Hum Hypertens 1999; 13: 657-64. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program SHEP ; . SHEP Co-operative Research Group. JAMA 1991; 265: 3255-64. MRC Trial of treatment of mild hypertension: principal results. Medical Research Council Working Party. Br Med J Clin Res Ed ; 1985; 291: 97-104. Five-year findings of the hypertension detection and follow-up program. I. Reduction in mortality of persons with high blood pressure, including mild hypertension. Hypertension Detection and Follow-up Program Cooperative Group. JAMA 1979; 242: 2562-71. Hansson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment HOT ; randomised trial. Lancet 1998; 351: 1755-62. Blood pressure, cholesterol, and stroke in eastern Asia. Eastern Stroke and Coronary Heart Disease Collaborative Research Group. Lancet 1998; 352: 1801-7. Culman J, Hartling S, von Heyer C, Rascher W, Unger T. Effects of irbesartan and losartan administered peripherally or centrally on vasopressin release, drinking response, and c-Fos expression in the rat brain. J Hypertens 1998; 16 Suppl 2 ; : S114. Brosnihan KB, Li P, Ferrario CM. Irbesartan but not candesartan blocks thromboxane A2-induced vasoconstriction in canine coronary arteries. Eur Heart J 1998; 19: 187. Kahan T, Malmqvist K, Edner M, Held C, Osbakken M. Rate and extent of left ventricular hypertrophy regression: a comparison of angiotensin II blockade with irbesartan and beta-blockade. J Coll Cardiol 1998; 31: 212A. Abst ; Kahan T. The importance of left ventricular hypertrophy in human hypertension. J Hypertens 1998; 16 Suppl 7 ; : S23-9. Richer-Giudicelli C, Fornes P, Cazaubon C, Nisato D, Giudicelli J-F. Effects of angiotensin II AT1 receptor blockade on survival, systemic and coronary hemodynamics and cardiac remodeling in post-ischemic heart failure in rats. Circulation 1997; 96 Suppl 8 ; : 644. Vijay N, Alhaddad IA, Marty Denny D, et al. Irbesartan compared with lisinopril in patients with mild to moderate heart failure. J Coll Cardiol 1998; 31: 68A. Abst ; Tonkon M, Awan N, Niazi I, et al. Irbesartan combined with conventional therapy, including angiotensin converting enzyme inhibitors, in heart failure. J Coll Cardiol 1998; 31: 188A. Abst ; Havranek EP, Thomas I, Smith WB, et al. Dose-related beneficial long-term hemodynamic and clinical efficacy or irbesartan in heart failure. Circulation 1997; 96: 452. Abst ; Pitt B, Segal R, Martinez FA, et al. Randomised trial of losartan. Objective: To assess 1-year persistence and adherence with monotherapy using the most commonly dispensed individual agent in 4 antihypertensive drug classes: hydrochlorothiazide HCTZ ; , amlodipine, lisinopril, or valsartan. Design: Retrospective, longitudinal analysis of initial prescriptions during 2001 to 2002 from a nationwide administrative claims database representing 11 million covered lives in the United States. Measurements: Drug utilization following initiation. Cox proportional hazards regression models controlled for demographics, case-mix, and concomitant treatments. Results: Records for 60, 685 subjects were included: HCTZ n 18, 713 ; , amlodipine n 11, 520 ; , lisinopril n 21, 138 ; , or valsartan n 9314 ; . Over 1 year, 31% to 44% of subjects utilized no treatment for at least 60 days. Medication possession ratio MPR ; and adherence measures ranged from 73% to 90%. Valsartan was associated with significantly P .001 ; more favorable measures of persistence, length of therapy, time to discontinuation, MPR, and risk of discontinuation, compared with HCTZ, amlodipine, or lisinopril. The risk of discontinuation was 53%, 32%, and 14% greater for HCTZ, amlodipine, and lisinopril, respectively, versus valsartan all comparisons P .001 ; . Conclusion: Among antihypertensive agents studied, valsartan was associated with the most favorable utilization patterns. Health care providers and systems should evaluate the use of antihypertensive drugs within their populations to identify and manage treatment discontinuation. J Board Fam Med 2007; 20: 72 Hypertension is a common and eminently treatable risk factor for major cardiovascular events, including coronary heart disease and stroke.1 Cardiovascular disease is the leading cause of morbidity and mortality in developed nations, 2 and is expected to increase in worldwide importance during the next 20 to 50 years.3 The prevalence of hypertension.

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Garo H. Armen, PhD 50 ; was appointed a director of Elan in February 1994 and was appointed chairman of Elan in July 2002. He has been chairman and chief executive officer of Antigenics, Inc. ``Antigenics'' ; since its initial public offering in February 2000 and held the same positions in its predecessor, Antigenics, LLC since its formation in 1994. Previously, Dr Armen was with Dean Witter Reynolds as a senior vice president of research and with E.F. Hutton & Company as first vice president, research. Brendan E. Boushel 73 ; was appointed a director of Elan in January 1980. From 1966 until his retirement in 1994, Mr Boushel was a partner in the Irish law firm of T.T.L. Overend McCarron & Gibbons. Mr Boushel also holds a number of private company directorships. Laurence G. Crowley 66 ; was appointed a director of Elan in March 1996. He is governor chairman ; of the Bank of Ireland. He is presently chairman of PJ Carroll & Co. and is a director of a number of private companies. William F. Daniel 1 ; 51 ; was appointed a director of Elan in February 2003. He has served as the Company's secretary since December 2001, having joined Elan in March 1994 as group financial controller. In July 1996, he was appointed group vice president, finance, group controller and principal accounting officer. From 1990 to 1992, Mr Daniel was financial director of Xtravision, plc. Alan R. Gillespie, C.B.E. PhD 53 ; was appointed a director of Elan in March 1996. He is chairman of Ulster Bank Limited. From November 1999 until November 2002, he was chief executive officer of CDC Group, plc and was previously a managing director of Goldman Sachs International. Ann Maynard Gray 58 ; was appointed a director of Elan in February 2001. She was formerly president of Diversified Publishing Group of Capital Cities ABC, Inc. Ms Gray is a director of Duke Energy Corporation and The Phoenix Companies, Inc., and is a trustee of J.P. Morgan Funds. John Groom 65 ; was appointed a director of Elan in July 1996 and served as president and chief operating officer from then until his retirement in January 2001. Mr Groom was president, chief executive officer and director of Athena Neurosciences prior to its acquisition by Elan in 1996. Mr Groom serves on the boards of Ribozyme, Ligand, CV Therapeutics and Amarin and continues to serve Elan in an advisory capacity. Mr Groom is not standing for re-election at the forthcoming Annual General Meeting. Kieran McGowan 59 ; was appointed a director of Elan in December 1998. From 1990 until his retirement in December 1998, he was chief executive of IDA Ireland. He is a director of CRH, plc, Irish Life and Permanent, plc, United Drug, plc, Enterprise Ireland, An Post National Lottery Company Ltd., and a number of private companies. Kevin M. McIntyre, MD 67 ; was appointed a director of Elan in February 1984. He is an associate clinical professor of medicine at Harvard Medical School and has served as a consultant to the National Academy of Sciences. Kyran McLaughlin 59 ; was appointed a director of Elan in January 1998. Since 1985, he has been head of equities and corporate finance at Davy Stockbrokers, Ireland's largest stockbroker firm. He is a director of Ryanair Holdings, plc and is a director of a number of private companies. Many medications may cause changes increase or decrease ; in blood sugar, these include: alcohol containing beverages angiotensin converting enzyme inhibitors ace inhibitors ; , often used for high blood pressure or heart problems examples: captopril, enalapril, lisinopril ; antiretroviral protease inhibitors examples: indinavir, ritonavir, saquinavir ; aspirin and aspirin-like drugs baclofen beta-blockers, often used for high blood pressure or heart problems examples include atenolol, metoprolol, propranolol ; certain medicines used for mental depression, emotional, or psychotic disturbances chromium cisapride clonidine cyclosporine diazoxide disopyramide epinephrine female hormones, such as estrogens or progestins, birth control pills fibric acid derivatives, used to treat high cholesterol examples: fenofibrate and gemfibrozil ; glucagon growth hormone somatropin ; guanethidine isoniazid lithium metoclopramide male hormones or anabolic steroids medications to suppress appetite or for weight loss medicines for allergies, asthma, cold, or cough niacin nicotine including nicotine found in patches and gum ; octreotide pentamidine phenytoin quinolone antibiotics examples: ciprofloxacin, levofloxacin, ofloxacin ; some herbal dietary supplements steroid medicines such as prednisone or cortisone sulfonamides, medicines for infection examples: azulfidine, bactrim, gantrisin septra ; tacrolimus tegaserod thyroid hormones water pills diuretics ; tell your prescriber or health care professional about all other medicines you are taking, including non-prescription medicines, nutritional supplements, or herbal products and mesterolone.
`Controversy is the Lifeblood of Science' Sir George Pickering Almost 3 years ago, in the aftermath of the ALLHAT study, 2 the New York Times was carrying the headlines `Older way to treat hypertension found best'.3 ALLHAT, the largest study ever done, showed no difference in primary outcome coronary heart disease ; among the three treatment arms but seemed to favour chlorthalidone over amlodipine or lisinopril with regard to some secondary endpoints. Clearly, these headlines will need to be amended in view of the recent premature termination of the ASCOT trial.4 The primary objective of ASCOT was to compare the effects on fatal and non-fatal coronary heart disease of a so-called `conventional' treatment, i.e. a beta-blocker atenolol ; , combined, if needed, with a thiazide diuretic, to a more contemporary regimen of a calcium antagonist amlodipine ; and, if needed, an ACE-inhibitor perindopril ; . In a prospective randomized open-blinded endpoint design PROBE ; , a total of 19 000 patients were randomized to the two antihypertensive strategies. The study was launched in 1997 and stopped about 1 year before schedule because the contemporary treatment arm showed significant cardiovascular benefits when compared with the beta-blocker diuretic regimen. Specifically, when compared with atenolol thiazide, amlodipine perindopril resulted in a 15% reduction of allcause mortality, coronary events, and all cardiovascular events and procedures. Fatal and non-fatal stroke were reduced by 25%, as was cardiovascular mortality. Importantly, the risk of new onset diabetes was more than 30% lower with the contemporary treatment than with the traditional one. It seems unlikely that the small difference in blood pressure 2.9 1.8 mmHg ; between the two treatment arms would fully explain the observed benefits with amlodipine perindopril numbers based on preliminary presentation, for exact values see ASCOT-trial, ahead of print publication in Lancet.
03 04 - stroke risks stop study on estrogen chicago tribune - judy peres the national institutes of health has halted a large study on the long term effects of estrogen therapy in healthy women, officials announced tuesday, saying the hormone caused an increased risk of stroke and motrin.
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Cost, and the complexity of the treatment regimen including the pill burden ; substantially impact on patients' ability to adhere to a treatment regimen. Addressing the Barrier of Pill Burden A retrospective cohort study sought to determine predictors of adherence in patients receiving lipid-lowering and antihypertensive therapy.29 After adjustment for age, gender, and other potentially confounding variables, 3 factors emerged as important predictors of adherence: history of CHD or heart failure, reduced pill burden, and concurrent initiation of lipid-lowering and antihypertensive therapy. Other investigators conducted a retrospective analysis in 4953 managed care enrollees that provided evidence for initiating lipid-lowering. Lidocaine viscous.26 lidocaine prilocaine .26 LIDODERM.26 LIPITOR .24 LIPRAM .30 lisinopril .25 lisinopril hydrochlorothiazide . 24, 25 lithium carbonate .20 lithium carbonate ext-rel .20 lithium citrate syrup 8 mEq 5 mL .20 LOCOID lipocream 0.1% . 28, 33 loperamide .31 LOPROX gel .27 LOPROX shampoo .27 LORABID . 7 LOTEMAX .39 LOTREL . 23, 25 LOTRONEX .30 lovastatin .24 LOVENOX .21 loxapine .16 LUMIGAN.39 LUNESTA .43 LUPRON DEPOT .35 LUXIQ foam 0.12% . 28, 33 LYRICA. 8 LYSODREN.35 MACRODANTIN 25 mg. 8 MALARONE .15 mannitol.24 maprotiline .10 MARINOL.10 MARPLAN . 9 MATULANE.13 MAVIK .25 MAXAIR.42 MAXALT .12 MAXIPIME. 6 MEASLES VIRUS VACCINE LIVE ; .36 MEASLES, MUMPS, and RUBELLA VACCINES COMBINED ; .36 mebendazole .15 meclizine .10 MEDROL 2 mg, 16 mg, 32 mg .33 medroxyprogesterone acetate .34 medroxyprogesterone acetate 150 mg mL.34 mefloquine .15 MEGACE ES .34 and naprosyn.

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SCIENTIFIC CONCLUSIONS OVERALL SUMMARY OF THE SCIENTIFIC EVALUATION OF LISINOPRIL BIOCHEMIE AND ASSOCIATED NAMES SEE ANNEX I ; Lisinoprul is a highly specific, competitive inhibitor of angiotensin-I converting enzyme and therefore belongs to the group of drugs known as ACE inhibitors. Lisinopriil is indicated for the treatment of hypertension, heart failure, acute myocardial infarction and, in some EU Member States, incipient diabetic nephropathy. The MAH for Liwinopril Biochemie applied to the Reference Member State RMS ; for a variation through the Mutual Recognition Procedure to add an indication; "treatment of incipient nephropathy." The reference product, Zestril and associated names ; , does not have the same indications in all Member States due to divergent national decisions. In particular it is not authorised for the "treatment of incipient nephropathy" in Denmark which is the RMS for Losinopril Biochemie. The RMS would not accept an indication, which is not approved for the reference product, unless the MAH could submit sufficient clinical data of its own. Therefore the variation could not be granted. In the Netherlands, Zestril has the indication "incipient nephropathy in diabetes characterised by microalbuminuria." Since Lisinoprl Biochemie is claimed to be essentially similar to Zestril and will be used as a substitute, the Dutch Medicines Evaluation Board MEB ; is of the opinion that refusal of the variation could cause a safety issue and a risk to public health and therefore referred the issue to the CPMP. The CPMP considered the documentation provided by the MAH and came to the following conclusions: Efficacy The two pivotal trials which formed the supporting documentation for the proposed indication were Study 306 "EUCLID" Lancet 1997; 349: 1787-1792 ; and Study 298 "BRILLIANT" J Hum Hypertens 1996; 10: 185-192 ; Study 306 EURODIAB Controlled Trial of Lisinopril in Insulin Dependent Diabetes EUCLID ; This was a European multicentre randomised, double blind, parallel group, placebo controlled trial of llsinopril in "normotensive" insulin dependent diabetes mellitus IDDM ; patients. Five hundred and thirty patients were randomised to receive lisinopr8l n 265 ; or placebo n 265 ; . Only 13% of placebo patients and 17% of lisinopril patients had microalbuminuria AER 20-200 g min ; whereas 40% had been assumed for statistical power calculations. Lisinopril produced a 2.2 g min lower mean AER compared with placebo p 0.03 ; after 24 months of treatment and after adjustment for baseline AER and trial centre, as specified in the protocol. When adjusted for BP, the difference was reduced to 17.3% p 0.05 ; . The effect of lisinopril and placebo was further compared in patients who were normo-albuminuric AER 20 g min ; or microalbuminuric AER 20-200 g min ; at baseline. No significant difference between the treatment groups was found in the relative % difference in AER although there was a tendency in favour of lisinopril. When the treatment effect was stratified according to baseline AER using four categories: 5, 5- 10, and 20-200 g min, statistical difference was not reached in any of these categories. A separate analysis not predefined ; was performed after adjustment for baseline AER and centre, and only patients who attended the final visit were included in this analysis. At 24 months, the treatment difference in mean AER between lisinopril and placebo was 0.23 g min in patients who were normoalbuminuric at baseline p 0.6 ; , compared with a difference of 38.5 g min for patients who were microalbuminuric at baseline p 0.001 and propecia. Examiners Please Print Name ; 1 Day Time Telephone 2 Day Time Telephone OFFICE EQUIPMENT Except as specifically noted, all practitioners issued a permit shall demonstrate and maintain the following equipment. PLEASE CHECK IF EQUIPMENT PASSES INSPECTION AND LEAVE BLANK IF NOT. Portable gas delivery system capable of positive pressure ventilation; Equipment capable of administering 100% oxygen in all rooms operatory, recovery, examination, and reception Portable bag-mask ventilator ambu-bag Full face mask: adult; and pediatric; Nasal hood or cannula; Oral airways oropharyngeal airways ; : adult; and pediatric; Nasopharyngeal airways: adult; and pediatric. TRAMADOL HCL 50 MG TABLET RELAFEN 750 MG TABLET RELAFEN 750 MG TABLET VERAPAMIL 240 MG TABLET SA VERAPAMIL 240 MG TABLET SA LORATADINE 10 MG TABLET LORATADINE 10 MG TABLET LORATADINE 10 MG TABLET LORATADINE 10 MG TABLET AMBIEN 5 MG TABLET AMBIEN 5 MG TABLET DICLOFENAC POT 50 MG TABLET HYDROCODONE-APAP 10-325 MG TAB HYDROCODONE-APAP 10-325 MG TAB HYDROCODONE-APAP 10 325 TAB MOBIC 15 MG TABLET LESCOL 20 MG CAPSULE DIPYRIDAMOLE 25 MG TABLET CEFACLOR 250 MG CAPSULE PONSTEL 250 MG KAPSEALS PONSTEL 250 MG KAPSEALS PONSTEL 250 MG KAPSEALS LEXAPRO 10 MG TABLET DILTIAZEM HCL 180 MG CAP SA DILTIAZEM ER 240 MG CAPSULE DICLOFENAC POT 50 MG TABLET DICLOFENAC POT 50 MG TABLET ALLEGRA-D 12 HOUR TABLET ALLEGRA-D 12 HOUR TABLET TRIAZOLAM 0.25 MG TABLET TRIAZOLAM 0.125 MG TABLET AMBIEN 10 MG TABLET AMBIEN 10 MG TABLET AMBIEN 10 MG TABLET AMBIEN 10 MG TABLET NIFEDIPINE ER 30 MG TABLET LIPITOR 20 MG TABLET PRINIVIL 10 MG TABLET DIOVAN HCT 80-12.5 MG TABLET DIOVAN 160 MG TABLET CATAFLAM 50 MG TABLET CATAFLAM 50 MG TABLET CATAFLAM 50 MG TABLET CATAFLAM 50 MG TABLET DIOVAN HCT 160-25 MG TABLET CIPROFLOXACIN HCL 500 MG TAB CIPROFLOXACIN HCL 500 MG TAB CIPROFLOXACIN HCL 500 MG TAB CIPROFLOXACIN HCL 500 MG TAB CIPROFLOXACIN HCL 500 MG TAB CIPROFLOXACIN HCL 500 MG TAB CIPROFLOXACIN HCL 500 MG TAB CIPROFLOXACIN HCL 250 MG TAB CIPROFLOXACIN HCL 250 MG TAB CIPROFLOXACIN HCL 250 MG TAB DIOVAN 80 MG TABLET CIPROFLOXACIN HCL 750 MG TAB CELEXA 20 MG TABLET LEXAPRO 20 MG TABLET EFFEXOR 75 MG TABLET ASACOL 400 MG TABLET EC ANAPROX 275 MG TABLET ANAPROX 275 MG TABLET DIOVAN HCT 160 12.5 MG TAB LEVAQUIN 250 MG TABLET AMOX TR-K CLV 500-125 MG TAB AMOX TR-K CLV 500-125 MG TAB LORTAB 5 500 TABLET LORTAB 5 500 TABLET LORTAB 7.5 500 TABLET LORTAB 7.5 500 TABLET DARVOCET-N 100 TABLET DARVOCET-N 100 TABLET DARVOCET-N 100 TABLET TOPROL XL 50 MG TABLET SA GRIFULVIN V 500 MG TABLET LIPITOR 40 MG TABLET ACTOS 30 MG TABLET ALTACE 10 MG CAPSULE EFFEXOR XR 37.5 MG CAPSULE LIPITOR 10 MG TABLET PRAVACHOL 20 MG TABLET SEROQUEL 25 MG TABLET PRAVACHOL 40 MG TABLET ZOCOR 40 MG TABLET DIOVAN 320 MG TABLET LISINOPRIL-HCTZ 20-25 TAB LOVASTATIN 20 MG TABLET CITALOPRAM HBR 20 MG TABLET KEFLEX 250 MG CAPSULE KEFLEX 250 MG PULVULE KEFLEX 250 MG CAPSULE TALACEN CAPLET and soma.
O C O Structural formula: Solutol HS 15 is polyethylene glycol 660 12-hydroxystearate The main components of the lipophilic part have the structure shown above; some of the hydroxy groups can be etherified with polyethylene glycol. Solutol HS 15 complies with the requirements of the German Pharmacopoeia monograph DAB ; for Macrogol-15 hydroxystearate. As a US-DMF Drug Master File ; was filed, the product became part of registered formulations in USA and Canada due to its outstanding properties.
12. Grundy SM, Howard B, Smith S Jr et al. Prevention conference VI: diabetes and cardiovascular disease: executive summary: conference proceeding for healthcare professionals from a special writing group of the American Heart Association. Circulation. 2002; 105: 22312239. Stamler J, Vaccaro O, Neaton JD et al. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care 1993; 16: 434444. Craeger M, Luscher T, Cosentino F et al. Diabetes and vascular disease. Pathophysiology, clinical consequence, and medical therapy: part I. Circulation 2003; 108: 15271532. Alpert JS, Thygesen K, Antman E et al. Myocardial infarction redefineda consensus document of the Joint European Society of Cardiology American College of Cardiology Committee for the redefinition of myocardial infarction. J Coll Cardiol 2000; 36: 959969. Zuanetti G, Latini R, Maggioni A et al. Effect of the ACE inhibitor lisinopril on mortality in diabetic patients with acute myocardial infarction. Data from the GISSI-3 Study. Circulation 1997; 96: 42394245. EUROASPIRE II Study Group. Lifestyle and risk factor management and use of drug therapies in coronary patients from 15 countries; principal results from EUROASPIRE II Euro Heart Survey Programme. Eur Heart J 2001; 22: 554572. Sowers JR, Haffner S. Treatment of cardiovascular and renal risk factors in the diabetic hypertensive. Hypertension 2002; 40: 781788. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. BMJ 1998; 317: 713720. Hansson L, Zanchetti A, Carruthers SG et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment HOT ; Randomized Trial. Lancet 1998; 351: 17551762. Gaede P, Vedel P, Larsen N et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 2003; 348: 383393. Mac Mahon S, Sharpe N, Gamble G et al. Randomized, placebo-controlled trial of the angiotensin converting enzyme inhibitor, ramipril, in patients with coronary or other occlusive vascular disease. J Coll Cardiol 2000; 36: 438443. Pitt B, O'Neill B, Feldman R et al. The QUinapril Ischemic Event Trial QUIET ; : evaluation of chronic ACE inhibitor therapy in patients with ischemic heart disease and preserved left ventricular function. J Cardiol 2001; 87: 10581063. Teo K, Burton J, Buller C et al. Long term effects of cholesterol lowering and angiotensin converting enzyme inhibition on coronary atherosclerosis: the Simvastatin enalapril Caoronary Atherosclerosis Trial SCAT ; . Circulation 2000; 102: 17481754. Blood Pressure Lowering Treatment Trialists' Collaboration. Effects of ACE inhibitorsm calcium antagonists, and other blood pressure lowering drugs: results of prospectively designed overviews of randomized trials. Lancet 2000; 355: 19551964. Staessen JA, Wang JG, Thijs L. Cardiovascular protection and blood pressure reduction: a meta-analysis. Lancet 2001; 358: 13051315. Candido R, Jandeleit-Dahm K, Cao Z et al. Prevention of accelerated atherosclerosis by angiotensin-converting enzyme inhibition in diabetic apolipoprotein E deficient mice. Circulation 2002; 106: 246253. Buus NH, Bttcher M, Jrgensen CG et al. Myocardial perfusion during long-term angiotensin-converting enzyme inhibition or b-blockade in patients with essential hypertenion. Hypertension 2004; 44: 465470. Zhuo J, Mendelsohn F, Ohishsi M. Perindopril alters vascular angiotensin-converting enzyme, AT1 receptor and nitric oxide synthase expression in patients with coronary artery disease. Hypertension 2002; 36: 200225. Vaughan D, Rouleau J, Ridker P et al. Effects of ramipril on plasma fibrinolytic balance in patients with acute anterior myocardial infarction. Circulation 1997; 96: 442447. Fogari R, Mugellini A, Zoppi A et al. Losartan and perindopril effects on plasma plasminogen activator inhibitor-1 and fibrinogen in hypertensive type 2 diabetic patients. J Hypertens 2002; 15: 316320. Marre M, Lievre M, Chatellier G et al. DIABHYCAR study investigators effects of low dose ramipril on cardiovascular and renal outcomes in patients with type 2 diabetes and raised excretion of urinary albumin: randomized, double blind, placebo controlled trial the DIABHYCAR study ; .BMJ 2004; 328: 495 and sonata and lisinopril.

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Component of MVRBC Q#5, ".under a doctor's care or had major surgery." induced donor recall of deferrable events that otherwise might have been overlooked. Exhibit 2 compares a single MVRBC question with two virtually identical questions on the UDHQ. In this case the MVRBC question applied to two distinctly different types of donors, red cells and platelets, having markedly different minimum required times between donations. Under MVRBC standard operating procedures SOPs ; , platelet donors require a minimum time interval between donations of 2 weeks while for red cell donors the minimum is 8 weeks. Since the same question is asked of both types of donors, numerous initial and final aberrant responses but few deferrals result from this usage. Staff comments evidence that virtually every aberrant response was the result of a platelet donor presenting to donate platelets within the acceptable minimum time interval not recognized by the question. The same result is likely from the UDHQ question. It would seem that the introduction of a second question specific to platelet donors, with both questions prefaced by such phrases as, "Whole blood donors, in the past 8 weeks.etc" or "Platelet donors, in the past 2 weeks.", would relieve staff of the necessity of reviewing and revising numerous initially aberrant responses that serve no purpose other than to reduce by one the number of questions in the interview. Exhibit 3 provides a comparison of an approach using a multiple number of specific questions to detect legitimate drug usage that is unacceptable for donation with one proposed for the UDHQ that employs an off-question list of such drugs. Specific questions on proscribed drug usage have the advantage of stimulating donor recall and staff inquiry into the specifics of donor drug usage at the cost of adding numerous interview questions to the questionnaire, the vast majority of which do not apply to most donors. Off listing of proscribed drugs, on the other hand, means that every donor must review the list of such drugs while answering only Yes No to the single question, have used or are now using one or more of the proscribed items. Other conditions being equal, the numbers of aberrant answers to the UDHQ question should approximate the cumulative results experienced by MVRBC. Staff and donor time saving through off-questionnaire listing of proscribed drugs, however, is unlikely since every donor must scan the list and every aberrant response to the UDHQ question must be followed by stepwise questioning by staff of the specifics of aberrant usage together with assessment of deferment requirements as set forth in the SOP supporting the UDHQ question. Thus, the issue here is: Are donors more or less likely to recall and admit to legitimate drug usage that is unacceptable for donation when presented with specific questions regarding each drug or when asked to scan and identify such drugs from a single extensive list? Conclusion. This preliminary study of health history interviews of MVRBC blood donors is limit in applicability to blood donors in general because of the under representation of new donors 7% versus a probable national average of 20% ; and it is suspected that the educational level and cultural behavior patterns of repeat donors at MVRBC are well above the national average thereby biasing study results. The study does raise questions, however, regarding the structure and content of some questions on the proposed UDHQ. It also suggests the need for a similar large-scale study of donor responses to the UDHQ, one more likely to identify comprehension and inclusion representativeness problems than previous methods. Such a large scale study conducted subsequent to FDA approval of the UDHQ with the understanding that if major shortcomings are found revision would follow seems the most rational approach for creation of a more effective and efficient questionnaire. Support: NHLBI HL072635 and the Scott County Iowa ; Regional Authority.

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