Altace: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

LTACE A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2003 by ICON Group International, Inc. Copyright 2003 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Altace: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-83729-5 1. Altace-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on Altace. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON ALTACE ..................................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Altace ............................................................................................ 5 E-Journals: PubMed Central ......................................................................................................... 6 The National Library of Medicine: PubMed .................................................................................. 6 CHAPTER 2. NUTRITION AND ALTACE ........................................................................................... 23 Overview...................................................................................................................................... 23 Finding Nutrition Studies on Altace ........................................................................................... 23 Federal Resources on Nutrition ................................................................................................... 27 Additional Web Resources ........................................................................................................... 28 CHAPTER 3. CLINICAL TRIALS AND ALTACE ................................................................................. 29 Overview...................................................................................................................................... 29 Recent Trials on Altace ................................................................................................................ 29 Keeping Current on Clinical Trials ............................................................................................. 31 CHAPTER 4. BOOKS ON ALTACE ..................................................................................................... 33 Overview...................................................................................................................................... 33 The National Library of Medicine Book Index ............................................................................. 33 Chapters on Altace ....................................................................................................................... 33 CHAPTER 5. PERIODICALS AND NEWS ON ALTACE ....................................................................... 35 Overview...................................................................................................................................... 35 News Services and Press Releases................................................................................................ 35 Academic Periodicals covering Altace.......................................................................................... 37 CHAPTER 6. RESEARCHING MEDICATIONS .................................................................................... 39 Overview...................................................................................................................................... 39 U.S. Pharmacopeia....................................................................................................................... 39 Commercial Databases ................................................................................................................. 40 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 43 Overview...................................................................................................................................... 43 NIH Guidelines............................................................................................................................ 43 NIH Databases............................................................................................................................. 45 Other Commercial Databases....................................................................................................... 49 APPENDIX B. PATIENT RESOURCES ................................................................................................. 51 Overview...................................................................................................................................... 51 Patient Guideline Sources............................................................................................................ 51 Finding Associations.................................................................................................................... 53 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 55 Overview...................................................................................................................................... 55 Preparation................................................................................................................................... 55 Finding a Local Medical Library.................................................................................................. 55 Medical Libraries in the U.S. and Canada ................................................................................... 55 ONLINE GLOSSARIES.................................................................................................................. 61 Online Dictionary Directories ..................................................................................................... 61 ALTACE DICTIONARY................................................................................................................. 63 INDEX ................................................................................................................................................ 85

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with Altace is indexed in search engines, such as www.google.com or others, a nonsystematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about Altace, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to Altace, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on Altace. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to Altace, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on Altace. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON ALTACE Overview In this chapter, we will show you how to locate peer-reviewed references and studies on Altace.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and Altace, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “Altace” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Renal Insufficiency as a Predictor of Cariovascular Outcomes and the Impact of Ramipril: The Hope Randomized Trial Source: Annals of Internal Medicine. 134(8): 629-636. April 17, 2001. Contact: Available from American College of Physicians. American Society of Internal Medicine. 190 North Independence Mall West, Philadelphia, PA 19106-1572. Website: www.acponline.org. Summary: Severe kidney disease is known to increase the risk for heart (cardiac) disease, but it is not known whether mildly abnormal kidney function increases heart disease risk. This article summarizes the Heart Outcomes and Prevention Evaluation (HOPE) study that evaluated people at high risk for heart disease from many causes and considered the effects of ramipril (an ACE inhibitor used to lower blood pressure) on

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that risk. The study included 9,297 patients who received either ramipril or an inactive placebo pill and were then followed for 3.5 to 5.5 years. Because high blood pressure (hypertension) and diabetes can cause heart disease by themselves, patients with those disorders were analyzed separately. The primary outcomes studied were cardiac death, heart attack, or stroke. Outcomes of secondary interest were the total number of deaths, hospitalizations for heart failure, and performance of surgical procedures to increase blood flow to the heart. Mild kidney disease was present in 980 participants; these patients were compared to 8,307 patients with normal renal (kidney) function. Patients with renal insufficiency had a substantially increased risk for cardiovascular death (11.4 percent versus 6.6 percent), and total mortality (17.8 percent versus 10.6 percent), respectively. Ramipril substantially reduced the risk for bad outcomes in the patients with reduced kidney function. Ramipril produced no more adverse side effects than did placebo. The authors conclude that in patients with preexisting vascular disease or diabetes combined with an additional cardiovascular risk factor, mild renal insufficiency significantly increased the risk for subsequent cardiovascular events. Ramipril reduced cardiovascular risk without increasing adverse effects. •

Effect of Ramipril vs Amlodipine on Renal Outcomes in Hypertensive Nephrosclerosis: A Randomized Controlled Trial Source: JAMA. Journal of the American Medical Association. 285(21): 2719-2728. June 6, 2001. Summary: The incidence of end stage renal disease (ESRD) due to hypertension (high blood pressure) has increased in recent decades, but the optimal strategy for treatment of hypertension to prevent renal failure is unknown, especially among African Americans. This article reports on a study undertaken to compare the effects of an ACE (angiotensin converting enzyme) inhibitor (ramipril), a dihydropyridine calcium channel blocker (amlodipine), and a beta blocker (metoprolol) on hypertensive renal disease progression. Participants (n = 1,094) were randomly assigned to receive one of the three drugs, with other agents added to achieve 1 of 2 blood pressure goals. Among participants with a urinary protein to creatinine ratio of greater than 22, the ramipril group had a 36 percent slower mean decline in glomerular filtration rate (GFR, a measure of kidney function) over 3 years and a 48 percent reduced risk of the clinical end points versus the amlodipine group. In the entire cohort, there was no significant difference in mean GFR decline from baseline to 3 years between treatment groups. However, compared with the amlodipine group, after adjustment for baseline covariates, the ramipril group had a 38 percent reduced risk of clinical end points, a 36 percent slower mean decline in GFR after 3 months, and less proteinuria (protein in urine). The authors conclude that ramipril, compared with amlodipine, retards renal (kidney) disease progression in patients with hypertensive renal disease and proteinuria and may offer benefit to patients without proteinuria. 4 figures. 3 tables. 40 references.

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Ramipril and the Development of Diabetes Source: JAMA. Journal of the American Medical Association. 286(15): 1882-1885. October 17, 2001. Summary: Type 2 diabetes is a growing clinical and public health program. Preventive efforts related to lifestyle modification are not always successful; therefore, alternative prevention strategies need to be studied. This article reports on a study undertaken to investigate the effectiveness of ramipril, an ACE inhibitor, in preventing diabetes among high risk persons. The study used the randomized, controlled Heart Outcomes Prevention Evaluation trial of 5,720 patients older than 55 years without known diabetes

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but with vascular (blood vessel) disease who were followed up for a mean of 4.5 years. The study included 267 hospitals in 19 countries and was conducted between 1994 and 1999. Patients were randomly assigned to receive ramipril, up to 10 milligrams per day (n = 2,837) or placebo (n = 2,883). Diagnosis of diabetes determined from self report at follow up visits every 6 months. In the ramipril group, 102 individuals (3.6 percent) developed diabetes compared with 155 (5.4 percent) in the placebo group. Similar results were noted when different diagnostic criteria were used. These effects were also consistently seen in several subgroups examined. The authors conclude that ramipril is associated with lower rates of new diagnosis of diabetes in high risk individuals. 2 figures. 2 tables. 19 references.

Federally Funded Research on Altace The U.S. Government supports a variety of research studies relating to Altace. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to Altace. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore Altace. The following is typical of the type of information found when searching the CRISP database for Altace: •

Project Title: COMPARATIVE EFFECTS OF RAMIPRIL & LOSARTAN ON FIBRINOLYSIS Principal Investigator & Institution: Vaughan, Douglas E.; Chief, Division of Cardiovascular Medici; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2001; Project Start 01-DEC-2000; Project End 30-NOV-2001 Summary: We have hypothesized that an interaction between the renin-angiotensin system and fibrinolytic system could explain the beneficial effects of ACE inhibitors in reducing the incidence of myocardial infarction. The purpose of present study is to measure the effect of three commonly prescribed antihypertensive agents on fibrinolytic balance in hypertensive subjects who are at risk for increased PAI-1 antigen. The agents to be tested are the thiazide diuretic-hydrochlorthiazide, the ACE inhibitor-ramipril and the angiotensin receptor blocker-losartan. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “Altace” (or synonyms) into the search box. This search gives you access to fulltext articles. The following is a sample of items found for Altace in the PubMed Central database: •

No effects on myocardial ischaemia in patients with stable ischaemic heart disease after treatment with ramipril for 6 months. by Willenheimer R, Juul-Moller S, Forslund L, Erhardt L.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=56204

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Ramipril use in Canada: HOPE or HYPE? by Pilote L.; 2003 Mar 4; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=149251

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The striking effect of the Heart Outcomes Prevention Evaluation (HOPE) on ramipril prescribing in Ontario. by Tu K, Mamdani MM, Jacka RM, Forde NJ, Rothwell DM, Tu JV.; 2003 Mar 4; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=149247

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Use of ramipril in preventing stroke: double blind randomised trial. by Bosch J, Yusuf S, Pogue J, Sleight P, Lonn E, Rangoonwala B, Davies R, Ostergren J, Probstfield J.; 2002 Mar 23; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=99052

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with Altace, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “Altace” (or synonyms) into the 3 4

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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search box, and click “Go.” The following is the type of output you can expect from PubMed for Altace (hyperlinks lead to article summaries): •

A subdepressor low dose of ramipril lowers urinary protein excretion without increasing plasma potassium. Author(s): Keilani T, Danesh FR, Schlueter WA, Molteni A, Batlle D. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 1999 March; 33(3): 450-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10070908&dopt=Abstract

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Accelerated cholesteryl ester transfer in patients with essential hypertension and the effect of ramipril treatment. Author(s): Bagdade JD, Liu XQ, Buchanan WF, Hafner J, Rosenson R. Source: Atherosclerosis. 1998 September; 140(1): 167-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9733228&dopt=Abstract

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ACE inhibition with ramipril improves left ventricular function at rest and post exercise in patients with stable ischaemic heart disease and preserved left ventricular systolic function. Author(s): Willenheimer R, Rydberg E, Oberg L, Juul-Moller S, Erhardt L. Source: European Heart Journal. 1999 November; 20(22): 1647-56. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10543928&dopt=Abstract

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ACE inhibitors to prevent end-stage renal disease: when to start and why possibly never to stop: a post hoc analysis of the REIN trial results. Ramipril Efficacy in Nephropathy. Author(s): Ruggenenti P, Perna A, Remuzzi G; Gruppo Italiano di Studi Epidemiologici in Nefrologia. Source: Journal of the American Society of Nephrology : Jasn. 2001 December; 12(12): 2832-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11729254&dopt=Abstract

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Antianginal and anti-ischemic effects of nisoldipine and ramipril in patients with syndrome X. Author(s): Ozcelik F, Altun A, Ozbay G. Source: Clin Cardiol. 1999 May; 22(5): 361-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10326170&dopt=Abstract

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Antihypertensive efficacy and tolerability of once-daily sustained-release diltiazem alone and in combination with ramipril in hypertension. Author(s): Tuteja R, Swarup D, Saxena GN, Bhandari S, Sharma P. Source: J Assoc Physicians India. 1999 October; 47(10): 962-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10778687&dopt=Abstract

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Antihypertensive profiles with ascending dose combinations of ramipril and felodipine ER. Author(s): Scholze J, Bauer B, Massaro J. Source: Clinical and Experimental Hypertension (New York, N.Y. : 1993). 1999 November; 21(8): 1447-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10574423&dopt=Abstract

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Ask the doctor. Recently, I read that the ACE inhibitor ramipril is very good at preventing heart problems, particularly in people with diabetes. I'm diabetic, and for years I have been on a different ACE inhibitor (lisinopril). Should I be taking ramipril instead? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 2001 April; 11(8): 7-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11343399&dopt=Abstract

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Assessment of the effect of ramipril therapy on direct health care costs for first and recurrent strokes in high-risk cardiovascular patients using data from the Heart Outcomes Prevention Evaluation (HOPE) study. Author(s): Carroll CA, Coen MM, Rymer MM. Source: Clinical Therapeutics. 2003 April; 25(4): 1248-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12809971&dopt=Abstract

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Beneficial effects of ramipril on left ventricular end-diastolic and end-systolic volume indexes after uncomplicated invasive revascularization are associated with a reduction in cardiac events in patients with moderately impaired left ventricular function and no clinical heart failure. Author(s): Kjoller-Hansen L, Steffensen R, Grande P. Source: Journal of the American College of Cardiology. 2001 April; 37(5): 1214-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11300425&dopt=Abstract

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Beneficial impact of ramipril on left ventricular hypertrophy in normotensive nonalbuminuric NIDDM patients. Author(s): Lievre M, Marre M. Source: Diabetes Care. 1999 January; 22(1): 178-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10333928&dopt=Abstract

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Clinical implications for the Acute Infarction Ramipril Efficacy extension (AIREX) Study. Author(s): Spargias KS, Ball SG. Source: Int J Clin Pract Suppl. 1998 May; 94: 32-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9926443&dopt=Abstract

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Clinical trials report. The effect of Ramipril versus Amlodipine on renal outcomes in hypertension nephrosclerosis. Author(s): Vidt DG. Source: Current Hypertension Reports. 2001 October; 3(5): 379-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11551370&dopt=Abstract

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Comparative effects of ramipril on ambulatory and office blood pressures: a HOPE Substudy. Author(s): Svensson P, de Faire U, Sleight P, Yusuf S, Ostergren J. Source: Hypertension. 2001 December 1; 38(6): E28-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11751742&dopt=Abstract

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Conundrum of the HOPE study: time of taking ramipril may account for lack of relation between blood pressure and outcome. Author(s): Taylor R. Source: Bmj (Clinical Research Ed.). 2003 September 20; 327(7416): 681-2; Author Reply 682. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14509993&dopt=Abstract

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Cost effectiveness of ramipril in patients with non-diabetic nephropathy and hypertension: economic evaluation of Ramipril Efficacy in Nephropathy (REIN) Study for Germany from the perspective of statutory health insurance. Author(s): Schadlich PK, Brecht JG, Brunetti M, Pagano E, Rangoonwala B, Huppertz E. Source: Pharmacoeconomics. 2001; 19(5 Pt 1): 497-512. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11465309&dopt=Abstract

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Cost effectiveness of ramipril treatment for cardiovascular risk reduction. Author(s): Malik IS, Bhatia VK, Kooner JS. Source: Heart (British Cardiac Society). 2001 May; 85(5): 539-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11303006&dopt=Abstract

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Cost implications of the use of ramipril in high-risk patients based on the Heart Outcomes Prevention Evaluation (HOPE) study. Author(s): Lamy A, Yusuf S, Pogue J, Gafni A; Heart Outcomes Prevention Evaluation Investigators. Source: Circulation. 2003 February 25; 107(7): 960-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12600907&dopt=Abstract

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Cost-effectiveness analysis of ramipril in heart failure after myocardial infarction. Economic evaluation of the Acute Infarction Ramipril Efficacy (AIRE) study for Germany from the perspective of Statutory Health Insurance. Author(s): Schadlich PK, Huppertz E, Brecht JG. Source: Pharmacoeconomics. 1998 December; 14(6): 653-69. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10346417&dopt=Abstract

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Cost-effectiveness of the treatment of heart failure with ramipril: a Spanish analysis of the AIRE study. Author(s): Am Fam Physician. 2002 Aug 1;66(3):473 Source: European Journal of Heart Failure : Journal of the Working Group on Heart Failure of the European Society of Cardiology. 2002 August; 4(4): 553-8. /entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12182525

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Development of congestive heart failure in type 2 diabetic patients with microalbuminuria or proteinuria: observations from the DIABHYCAR (type 2 DIABetes, Hypertension, CArdiovascular Events and Ramipril) study. Author(s): Vaur L, Gueret P, Lievre M, Chabaud S, Passa P; DIABHYCAR Study Group (type 2 DIABetes, Hypertension, CARdiovascular Events and Ramipril) study. Source: Diabetes Care. 2003 March; 26(3): 855-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12610049&dopt=Abstract

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Don't keep that ACE (inhibitor) up your sleeve! Is ramipril effective for secondary prevention of cardiovascular disease and stroke? Author(s): Hammett DC, MacFadyen JC. Source: Can Fam Physician. 2000 April; 46(4): 821-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10790814&dopt=Abstract

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Economic impact of ramipril on hospitalization of high-risk cardiovascular patients. Author(s): Carroll CA, Coen MM, Piepho RW. Source: The Annals of Pharmacotherapy. 2003 March; 37(3): 327-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12639157&dopt=Abstract

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Effect of high dose ramipril with or without indomethacin on glomerular selectivity. Author(s): Pisoni R, Ruggenenti P, Sangalli F, Lepre MS, Remuzzi A, Remuzzi G. Source: Kidney International. 2002 September; 62(3): 1010-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12164885&dopt=Abstract

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Effect of long-term therapy with ramipril in high-risk women. Author(s): Lonn E, Roccaforte R, Yi Q, Dagenais G, Sleight P, Bosch J, Suhan P, Micks M, Probstfield J, Bernstein V, Yusuf S; HOPE Investigators. Heart Outcomes Prevention Evaluation. Source: Journal of the American College of Cardiology. 2002 August 21; 40(4): 693-702. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12204499&dopt=Abstract

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Effect of ramipril and vitamin E on atherosclerosis. Author(s): Iuliano L, Micheletta F, Violi F, Spagnoli LG. Source: Circulation. 2002 January 15; 105(2): E5-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11790713&dopt=Abstract

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Effect of ramipril in a patient with glycogen storage disease type I and nephroticrange proteinuria. Author(s): Pela I, Donati MA, Zammarchi E. Source: Journal of Inherited Metabolic Disease. 2001 November; 24(6): 681-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11768587&dopt=Abstract

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Effect of ramipril on ambulatory blood pressure and albuminuria in renal hypertension. Author(s): Soergel M, Verho M, Wuhl E, Gellermann J, Teichert L, Scharer K. Source: Pediatric Nephrology (Berlin, Germany). 2000 November; 15(1-2): 113-8. Erratum In: Pediatr Nephrol 2001 February; 16(2): 202. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11095026&dopt=Abstract

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Effect of ramipril on cardiovascular events in high-risk patients. Author(s): Gavras H. Source: The New England Journal of Medicine. 2000 July 6; 343(1): 65-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10896546&dopt=Abstract

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Effect of ramipril on cardiovascular events in high-risk patients. Author(s): Sharma AM, Pischon T, Engeli S. Source: The New England Journal of Medicine. 2000 July 6; 343(1): 65; Author Reply 66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10896545&dopt=Abstract

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Effect of ramipril on cardiovascular events in high-risk patients. Author(s): O'Rourke MF, Nichols WW. Source: The New England Journal of Medicine. 2000 July 6; 343(1): 64-5; Author Reply 66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10896544&dopt=Abstract

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Effect of ramipril on cardiovascular events in high-risk patients. Author(s): Weinsaft JW. Source: The New England Journal of Medicine. 2000 July 6; 343(1): 64; Author Reply 66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10896543&dopt=Abstract

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Effect of ramipril versus amlodipine on renal outcomes in hypertensive nephrosclerosis. Author(s): Flack JM. Source: Current Hypertension Reports. 2002 June; 4(3): 183-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12003698&dopt=Abstract

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Effect of ramipril vs amlodipine on renal outcomes in hypertensive nephrosclerosis: a randomized controlled trial. Author(s): Agodoa LY, Appel L, Bakris GL, Beck G, Bourgoignie J, Briggs JP, Charleston J, Cheek D, Cleveland W, Douglas JG, Douglas M, Dowie D, Faulkner M, Gabriel A, Gassman J, Greene T, Hall Y, Hebert L, Hiremath L, Jamerson K, Johnson CJ, Kopple J, Kusek J, Lash J, Lea J, Lewis JB, Lipkowitz M, Massry S, Middleton J, Miller ER 3rd, Norris K, O'Connor D, Ojo A, Phillips RA, Pogue V, Rahman M, Randall OS, Rostand S, Schulman G, Smith W, Thornley-Brown D, Tisher CC, Toto RD, Wright JT Jr, Xu S; African American Study of Kidney Disease and Hypertension (AASK) Study Group. Source: Jama : the Journal of the American Medical Association. 2001 June 6; 285(21): 2719-28. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11386927&dopt=Abstract

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Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. Author(s): Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Source: The New England Journal of Medicine. 2000 January 20; 342(3): 145-53. Erratum In: 2000 May 4; 342(18): 1376. N Engl J Med 2000 March 9; 342(10): 748. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10639539&dopt=Abstract

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Effects of ramipril and vitamin E on atherosclerosis: the study to evaluate carotid ultrasound changes in patients treated with ramipril and vitamin E (SECURE). Author(s): Lonn E, Yusuf S, Dzavik V, Doris C, Yi Q, Smith S, Moore-Cox A, Bosch J, Riley W, Teo K; SECURE Investigators. Source: Circulation. 2001 February 20; 103(7): 919-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11181464&dopt=Abstract

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Effects of ramipril in nondiabetic nephropathy: improved parameters of oxidatives stress and potential modulation of advanced glycation end products. Author(s): Sebekova K, Gazdikova K, Syrova D, Blazicek P, Schinzel R, Heidland A, Spustova V, Dzurik R. Source: Journal of Human Hypertension. 2003 April; 17(4): 265-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12692571&dopt=Abstract

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Effects of ramipril on coronary events in high-risk persons: results of the Heart Outcomes Prevention Evaluation Study. Author(s): Dagenais GR, Yusuf S, Bourassa MG, Yi Q, Bosch J, Lonn EM, Kouz S, Grover J; HOPE Investigators. Source: Circulation. 2001 July 31; 104(5): 522-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11479247&dopt=Abstract

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Effects of ramipril therapy on some components of insulin resistance syndrome in patients with essential hypertension. Author(s): Bojovic L, Micic D. Source: Med Pregl. 2002 July-August; 55(7-8): 286-92. English, Croatian. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12434673&dopt=Abstract

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HOPE for cardiovascular disease prevention with ACE-inhibitor ramipril. Heart Outcomes Prevention Evaluation. Author(s): Kleinert S. Source: Lancet. 1999 September 4; 354(9181): 841. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10485736&dopt=Abstract

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Impact of ramipril versus other angiotensin-converting enzyme inhibitors on outcome of unselected patients with ST-elevation acute myocardial infarction. Author(s): Wienbergen H, Schiele R, Gitt AK, Juenger C, Heer T, Meisenzahl C, Landgraf H, Bossaller C, Senges J; MITRA PLUS Study Group. Source: The American Journal of Cardiology. 2002 November 15; 90(10): 1045-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12423701&dopt=Abstract

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Impediment of the progressions of microalbuminuria and hyperlipidemia in normotensive type 2 diabetes by low-dose ramipril. Author(s): Vongterapak S, Dahlan W, Nakasatien S, Anuntakulnatee T, Suppanich M, Kittipoom W, Surasingchaidet C, Tamwiwat C, Tepkasetkul M, Bunnag P, Ongphiphadhanakul B, Rajatanavin R, Himathongkam T. Source: J Med Assoc Thai. 1998 September; 81(9): 671-81. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9737124&dopt=Abstract

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Influence of ramipril on the course of plasma thrombomodulin in patients with diabetes mellitus. Author(s): Borcea V, Morcos M, Isermann B, Henkels M, Ziegler S, Zumbach M, Amiral J, Langst KD, Seiz W, Ziegler R, Wahl P, Nawroth PP. Source: Vasa. Zeitschrift Fur Gefasskrankheiten. Journal for Vascular Diseases. 1999 August; 28(3): 172-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10483322&dopt=Abstract

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Liquid chromatography-mass spectrometry method for determination of ramipril and its active metabolite ramiprilat in human plasma. Author(s): Zhu Z, Vachareau A, Neirinck L. Source: Journal of Chromatography. B, Analytical Technologies in the Biomedical and Life Sciences. 2002 November 5; 779(2): 297-306. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12361743&dopt=Abstract

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Long-term angiotensin-converting enzyme inhibition with ramipril reduces thrombin generation in human hypertension. Author(s): Ekholm M, Wallen NH, Johnsson H, Eliasson K, Kahan T. Source: Clinical Science (London, England : 1979). 2002 August; 103(2): 151-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12149106&dopt=Abstract

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Long-term effects of ramipril and nitrendipine on albuminuria in hypertensive patients with type II diabetes and impaired renal function. Author(s): Fogari R, Zoppi A, Corradi L, Mugellini A, Lazzari P, Preti P, Lusardi P. Source: Journal of Human Hypertension. 1999 January; 13(1): 47-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9928752&dopt=Abstract

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Losartan versus ramipril in the treatment of postrenal transplant erythrocytosis. Author(s): Hortal L, Fernandez A, Vega N, Rodriguez JC, Losada A, Lorenzo M, Plaza C, Palop L. Source: Transplantation Proceedings. 1998 August; 30(5): 2127-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9723415&dopt=Abstract

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Low-dose ramipril reduces microalbuminuria in type 1 diabetic patients without hypertension: results of a randomized controlled trial. Author(s): O'Hare P, Bilbous R, Mitchell T, O' Callaghan CJ, Viberti GC; Ace-Inhibitor Trial to Lower Albuminuria in Normotensive Insulin-Dependent Subjects Study Group. Source: Diabetes Care. 2000 December; 23(12): 1823-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11128360&dopt=Abstract

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Mechanical vs intrinsic components in the improvement of brachial arterial compliance. Comparison of the effects of atenolol versus ramipril in hypertensive patients. Author(s): Armentano RL, Graf S, Ramirez AJ, Espinosa JD, Brandani L, Baglivo H, Sanchez R. Source: Medicina (B Aires). 2001; 61(5 Pt 1): 535-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11721319&dopt=Abstract

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Mixed-type inhibition of pulmonary angiotensin I-converting enzyme by captopril, enalaprilat and ramiprilat. Author(s): Baudin B, Beneteau-Burnat B. Source: J Enzyme Inhib. 1999; 14(6): 447-56. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10536878&dopt=Abstract

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Myalgia and arthralgia associated with enalapril and ramipril. Author(s): Peppers MP. Source: American Journal of Health-System Pharmacy : Ajhp : Official Journal of the American Society of Health-System Pharmacists. 1995 January 15; 52(2): 203-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12879551&dopt=Abstract

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Occupational UVA-induced allergic photodermatitis in a welder due to hydrochlorothiazide and ramipril. Author(s): Wagner SN, Welke F, Goos M. Source: Contact Dermatitis. 2000 October; 43(4): 245-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11011944&dopt=Abstract

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Oxidative stress in kidney transplant patients with calcineurin inhibitor-induced hypertension: effect of ramipril. Author(s): Calo LA, Davis PA, Giacon B, Pagnin E, Sartori M, Riegler P, Antonello A, Huber W, Semplicini A. Source: Journal of Cardiovascular Pharmacology. 2002 October; 40(4): 625-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12352326&dopt=Abstract

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Practice vs ambulatory blood pressure measurement under treatment with ramipril (PLUR Study): a randomised, prospective long-term study to evaluate the benefits of ABPM in patients on antihypertensive treatment. Author(s): Schrader J, Luders S, Zuchner C, Herbold M, Schrandt G. Source: Journal of Human Hypertension. 2000 July; 14(7): 435-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10918548&dopt=Abstract

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Preventing stroke with ramipril. Benefits were considerably overstated. Author(s): Wakeman AP, Wakeman JG. Source: Bmj (Clinical Research Ed.). 2002 August 24; 325(7361): 439. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12201279&dopt=Abstract

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Preventing stroke with ramipril. Presentation of data is misleading. Author(s): Parmar MS. Source: Bmj (Clinical Research Ed.). 2002 August 24; 325(7361): 439. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12201281&dopt=Abstract

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Preventing stroke with ramipril. Results should have been presented in ways that help practising clinicians. Author(s): Badrinath P. Source: Bmj (Clinical Research Ed.). 2002 August 24; 325(7361): 439. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12193364&dopt=Abstract

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Preventing stroke with ramipril. Superiority of particular class of antihypertensive agent remains to be shown. Author(s): Yudkin JS. Source: Bmj (Clinical Research Ed.). 2002 August 24; 325(7361): 439. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12201280&dopt=Abstract

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Preventing stroke with ramipril--authors' reply. Author(s): Yusuf S, Bosch J, Sleight P. Source: Bmj (Clinical Research Ed.). 2003 January 4; 326(7379): 52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12511474&dopt=Abstract

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Prospective randomized controlled multicenter trial on steroids plus ramipril in proteinuric IgA nephropathy. Author(s): Manno C, Gesualdo L, D'Altri C, Rossini M, Grandaliano G, Schena FP. Source: Journal of Nephrology. 2001 July-August; 14(4): 248-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11506246&dopt=Abstract

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Ramipril and cardiovascular risk reduction. Author(s): Nichols WW, Schuler B, O'Rourke MF. Source: Circulation. 2002 June 25; 105(25): E194-5; Author Reply E194-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12082006&dopt=Abstract

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Ramipril and risk of diabetes. Author(s): Shlossberg AH. Source: Jama : the Journal of the American Medical Association. 2002 January 9; 287(2): 186-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11779251&dopt=Abstract

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Ramipril and risk of diabetes. Author(s): Potyk DK. Source: Jama : the Journal of the American Medical Association. 2002 January 9; 287(2): 186; Author Reply 186-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11779250&dopt=Abstract

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Ramipril and the development of diabetes. Author(s): Yusuf S, Gerstein H, Hoogwerf B, Pogue J, Bosch J, Wolffenbuttel BH, Zinman B; HOPE Study Investigators. Source: Jama : the Journal of the American Medical Association. 2001 October 17; 286(15): 1882-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11597291&dopt=Abstract

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Ramipril for the prevention and treatment of cardiovascular disease. Author(s): Vuong AD, Annis LG. Source: The Annals of Pharmacotherapy. 2003 March; 37(3): 412-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12639174&dopt=Abstract

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Ramipril inhibits in vitro human mesangial cell proliferation and platelet-derived growth factor expression. Author(s): Grandaliano G, Ranieri E, Monno R, Gesualdo L, Schena F. Source: Experimental Nephrology. 1999 May-June; 7(3): 229-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10352363&dopt=Abstract

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Ramipril prior to thrombolysis attenuates the early increase of PAI-1 in patients with acute myocardial infarction. Author(s): Wagner A, Herkner H, Schreiber W, Bur A, Woisetschlager C, Stix G, Laggner AN, Hirschl MM. Source: Thrombosis and Haemostasis. 2002 August; 88(2): 180-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12195686&dopt=Abstract

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Ramipril prolongs life and is cost effective in chronic proteinuric nephropathies. Author(s): Ruggenenti P, Pagano E, Tammuzzo L, Benini R, Garattini L, Remuzzi G. Source: Kidney International. 2001 January; 59(1): 286-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11135082&dopt=Abstract

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Ramipril reduces QT dispersion in patients with acute myocardial infarction and heart failure. Author(s): Spargias KS, Lindsay SJ, Hall AS, Cowan JC, Ball SG. Source: The American Journal of Cardiology. 1999 March 15; 83(6): 969-71, A10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10190422&dopt=Abstract

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Ramipril study suggests drug may benefit broad group of patients. Author(s): Miller JL. Source: American Journal of Health-System Pharmacy : Ajhp : Official Journal of the American Society of Health-System Pharmacists. 1999 December 15; 56(24): 2504. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10613361&dopt=Abstract

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Ramipril treatment in a patient with glycogen storage disease I non-A. Author(s): Gianni ML, Bonvissuto M, Gallieni M, Testolin C, Racchi E, Riva E. Source: Journal of Inherited Metabolic Disease. 2002 October; 25(6): 515-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12555944&dopt=Abstract

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Ramipril use in Canada: HOPE or HYPE? Author(s): Pilote L. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2003 March 4; 168(5): 568-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12615751&dopt=Abstract

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Ramipril. Author(s): Smith WH, Ball SG. Source: Int J Clin Pract. 2000 May; 54(4): 255-60. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10912316&dopt=Abstract

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Ramipril: a review of its use in the prevention of cardiovascular outcomes. Author(s): Warner GT, Perry CM. Source: Drugs. 2002; 62(9): 1381-405. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12076194&dopt=Abstract

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Ramipril-associated hepatotoxicity. Author(s): Yeung E, Wong FS, Wanless IR, Shiota K, Guindi M, Joshi S, Gardiner G. Source: Archives of Pathology & Laboratory Medicine. 2003 November; 127(11): 1493-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14567716&dopt=Abstract

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Randomized, placebo-controlled trial of the angiotensin-converting enzyme inhibitor, ramipril, in patients with coronary or other occlusive arterial disease. PART-2 Collaborative Research Group. Prevention of Atherosclerosis with Ramipril. Author(s): MacMahon S, Sharpe N, Gamble G, Clague A, Mhurchu CN, Clark T, Hart H, Scott J, White H. Source: Journal of the American College of Cardiology. 2000 August; 36(2): 438-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10933355&dopt=Abstract

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Reduction of cardiovascular risk by regression of electrocardiographic markers of left ventricular hypertrophy by the angiotensin-converting enzyme inhibitor ramipril. Author(s): Mathew J, Sleight P, Lonn E, Johnstone D, Pogue J, Yi Q, Bosch J, Sussex B, Probstfield J, Yusuf S; Heart Outcomes Prevention Evaluation (HOPE) Investigators. Source: Circulation. 2001 October 2; 104(14): 1615-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11581138&dopt=Abstract

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REIN follow-up trial. Ramipril Efficacy in Nephropathy. Author(s): Montagnino G. Source: Lancet. 1998 December 19-26; 352(9145): 2021-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9872278&dopt=Abstract

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REIN follow-up trial. Ramipril Efficacy in Nephropathy. Author(s): Locatelli F, Del Vecchio L, Andrulli S. Source: Lancet. 1998 December 19-26; 352(9145): 2020-1; Author Reply 2021-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9872277&dopt=Abstract

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Renal function and requirement for dialysis in chronic nephropathy patients on longterm ramipril: REIN follow-up trial. Gruppo Italiano di Studi Epidemiologici in Nefrologia (GISEN). Ramipril Efficacy in Nephropathy. Author(s): Ruggenenti P, Perna A, Gherardi G, Gaspari F, Benini R, Remuzzi G. Source: Lancet. 1998 October 17; 352(9136): 1252-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9788454&dopt=Abstract

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Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril: the HOPE randomized trial. Author(s): Mann JF, Gerstein HC, Pogue J, Bosch J, Yusuf S. Source: Annals of Internal Medicine. 2001 April 17; 134(8): 629-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11304102&dopt=Abstract

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Renal insufficiency predicts cardiovascular disease in high-risk individuals: the benefit of ramipril in the HOPE study. Heart Outcomes and Prevention Evaluation. Author(s): Basile JN. Source: Journal of Clinical Hypertension (Greenwich, Conn.). 2001 July-August; 3(4): 256-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11498658&dopt=Abstract

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Response of serum total renin to ramipril and metoprolol in hypertensive patients. Author(s): Matinlauri IH, Vesalainen RK, Gronroos PE, Aalto M, Kantola IM, Irjala KM. Source: Scandinavian Journal of Clinical and Laboratory Investigation. 1998 December; 58(8): 655-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10088202&dopt=Abstract

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The Angiotensin Converting Enzyme Inhibition Post Revascularization Study (APRES). Effects of ramipril in patients with reduced left ventricular function. Rationale, design, methods, baseline characteristics and first-year experience. Author(s): Kjoller-Hansen L, Steffensen R, Grande P. Source: Scandinavian Cardiovascular Journal : Scj. 1998; 32(4): 225-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9802141&dopt=Abstract

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The antihypertensive efficacy and tolerability of a low dose combination of ramipril and felodipine ER in mild to moderate essential hypertension. Author(s): Bainbridge AD, Macfadyen RJ, Stark S, Lees KR, Reid JL. Source: British Journal of Clinical Pharmacology. 1993 October; 36(4): 323-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12959310&dopt=Abstract

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The CARE Study: a postmarketing evaluation of ramipril in 11,100 patients. The Clinical Altace Real-World Efficacy (CARE) Investigators. Author(s): Kaplan NM. Source: Clinical Therapeutics. 1996 July-August; 18(4): 658-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8879894&dopt=Abstract

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The cost-effectiveness of ramipril in the treatment of patients at high risk of cardiovascular events: a Swedish sub-study to the HOPE study. Author(s): Bjorholt I, Andersson FL, Kahan T, Ostergren J. Source: Journal of Internal Medicine. 2002 June; 251(6): 508-17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12028506&dopt=Abstract

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The effects of ramipril on sympathetic nervous system function in older patients with hypertension. Author(s): Lee CC, Sidani MA, Hogikyan RV, Supiano MA. Source: Clinical Pharmacology and Therapeutics. 1999 April; 65(4): 420-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10223780&dopt=Abstract

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The HOPE study. Ramipril lowered cardiovascular risk, but vitamin E did not. Author(s): Hoogwerf BJ, Young JB. Source: Cleve Clin J Med. 2000 April; 67(4): 287-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10780101&dopt=Abstract

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The non-insulin-dependent diabetes, hypertension, microalbuminuria or proteinuria, cardiovascular events, and ramipril (DIABHYCAR) study: design, organization, and patient recruitment. DIABHYCAR Study Group. Author(s): Lievre M, Marre M, Chatellier G, Plouin P, Reglier J, Richardson L, Bugnard F, Vasmant D. Source: Controlled Clinical Trials. 2000 August; 21(4): 383-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10913814&dopt=Abstract

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The ongoing telmisartan alone and in combination with ramipril global endpoint trial program. Author(s): Unger T. Source: The American Journal of Cardiology. 2003 May 22; 91(10A): 28G-34G. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12781906&dopt=Abstract

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The prognostic significance of a history of systemic hypertension in patients randomised to either placebo or ramipril following acute myocardial infarction: evidence from the AIRE study. Acute Infarction Ramipril Efficacy. Author(s): Spargias K, Ball S, Hall A. Source: Journal of Human Hypertension. 1999 August; 13(8): 511-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10455471&dopt=Abstract

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The striking effect of the Heart Outcomes Prevention Evaluation (HOPE) on ramipril prescribing in Ontario. Author(s): Tu K, Mamdani MM, Jacka RM, Forde NJ, Rothwell DM, Tu JV. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2003 March 4; 168(5): 553-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12615747&dopt=Abstract

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The voltammetric study and determination of ramipril in dosage forms and biological fluids. Author(s): al-Majed AA, Belal F, Abadi A, al-Obaid AM. Source: Farmaco (Societa Chimica Italiana : 1989). 2000 March; 55(3): 233-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10919088&dopt=Abstract

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Tolerability of 10 mg of ramipril in normotensive Indian patients. Author(s): Oomman A, Ramachandran P. Source: Natl Med J India. 2002 July-August; 15(4): 244. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12296485&dopt=Abstract

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Treatment of arterial hypertension in the elderly with diltiazem vs ramipril. Author(s): Terranova R, Luca S. Source: Minerva Cardioangiol. 2000 June; 48(6): 183-96. English, Italian. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11048472&dopt=Abstract

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Treatment with ramipril improves systolic function even in patients with mild systolic dysfunction and symptoms of heart failure after acute myocardial infarction. Author(s): Kongstad-Rasmussen O, Blomstrand P, Broqvist M, Dahlstrom U, Wranne B. Source: Clin Cardiol. 1998 November; 21(11): 807-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9825192&dopt=Abstract

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Use of 7-fluoro-4-nitrobenzo-2-oxo-1,3-diazole (NBD-F) for the determination of ramipril in tablets and spiked human plasma. Author(s): Al-Majed AA, Al-Zehouri J. Source: Farmaco (Societa Chimica Italiana : 1989). 2001 April; 56(4): 291-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11421257&dopt=Abstract

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Use of ramipril in preventing stroke: double blind randomised trial. Author(s): Bosch J, Yusuf S, Pogue J, Sleight P, Lonn E, Rangoonwala B, Davies R, Ostergren J, Probstfield J; HOPE Investigators. Heart outcomes prevention evaluation. Source: Bmj (Clinical Research Ed.). 2002 March 23; 324(7339): 699-702. Summary for Patients In: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11909785&dopt=Abstract

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Voltammetric determination of benazepril and ramipril in dosage forms and biological fluids through nitrosation. Author(s): Belal F, Al-Zaagi IA, Abounassif MA. Source: J Aoac Int. 2001 January-February; 84(1): 1-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11234794&dopt=Abstract

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CHAPTER 2. NUTRITION AND ALTACE Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and Altace.

Finding Nutrition Studies on Altace The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “Altace” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “Altace” (or a synonym): •

A subdepressor low dose of ramipril lowers urinary protein excretion without increasing plasma potassium. Author(s): Northwestern University Medical School, VA Chicago Health Care System, Lakeside Division, IL 60611, USA. Source: Keilani, T Danesh, F R Schlueter, W A Molteni, A Batlle, D Am-J-Kidney-Dis. 1999 March; 33(3): 450-7 0272-6386

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Absence of interaction between ramipril, a new ACE-inhibitor, and phenprocoumon, an anticoagulant agent. Author(s): Clinical Research/Clinical Pharmacology, Hoechst AG, Frankfurt (M), Federal Republic of Germany. Source: Verho, M Malerczyk, V Grotsch, H Zenbil, I Pharmatherapeutica. 1989; 5(6): 3929 0308-051X

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Absence of nitrate tolerance after long-term treatment with ramipril: an endotheliumdependent mechanism. Author(s): Department of Cardiology, Erasme Hospital, Brussels, Belgium. Source: Berkenboom, G Fontaine, D Unger, P Baldassarre, S Preumont, N Fontaine, J JCardiovasc-Pharmacol. 1999 October; 34(4): 547-53 0160-2446

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Acute and chronic effects of ramipril and captopril in congestive heart failure. Author(s): Department of Pharmacology/Clinical Pharmacology, University of Groningen, The Netherlands. Source: de Graeff, P A Kingma, J H Viersma, J W Wesseling, H Lie, K I Int-J-Cardiol. 1989 April; 23(1): 59-67 0167-5273

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Acute hemodynamic and hormonal effects of ramipril in chronic congestive heart failure and comparison with captopril. Source: de Graeff, P A Kingma, J H Dunselman, P H Wesseling, H Lie, K I Am-J-Cardiol. 1987 April 24; 59(10): 164D-170D 0002-9149

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Acute hemodynamic, hormonal and electrolyte effects of ramipril in severe congestive heart failure. Source: Crozier, I G Ikram, H Nicholls, M G Jans, S Am-J-Cardiol. 1987 April 24; 59(10): 155D-163D 0002-9149

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An ACE inhibitor to coronary patients: ramipril reduces mortality according to HOPE trial. Source: Anonymous Prescrire-Int. 2001 April; 10(52): 62-3 1167-7422

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Comparative double-blind study of ramipril and captopril in mild to moderate essential hypertension. Source: Witte, P U Walter, U Am-J-Cardiol. 1987 April 24; 59(10): 115D-120D 0002-9149

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Comparative effects of the dual ACE-NEP inhibitor MDL-100,240 and ramipril on hypertension and cardiovascular disease in endogenous angiotensin II-dependent hypertension. Author(s): Department of Clinical and Experimental Medicine--Clinica Medica 4, University of Padova, University Hospital, Italy. [email protected] Source: Rossi, Gian Paolo Bova, Sergio Sacchetto, Alfredo Rizzoni, Damiano Agabiti Rosei, Enrico Neri, Giuliano Nussdorfer, Gastone G Pessina, Achille C Am-J-Hypertens. 2002 February; 15(2 Pt 1): 181-8 0895-7061

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Contribution of bradykinin to the beneficial effects of ramipril in the fructose-fed rat. Author(s): Chorley Hypertension Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel. Source: Erlich, Y Rosenthal, T J-Cardiovasc-Pharmacol. 1998 April; 31(4): 581-4 0160-2446

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Effect of long-term therapy with ramipril in high-risk women. Author(s): Department of Medicine, Division of Cardiology and Population Health Institute, McMaster University, Hamilton, Ontario, Canada. [email protected] Source: Lonn, E Roccaforte, R Yi, Q Dagenais, G Sleight, P Bosch, J Suhan, P Micks, M Probstfield, J Bernstein, V Yusuf, S J-Am-Coll-Cardiol. 2002 August 21; 40(4): 693-702 0735-1097

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Effect of ramipril versus amlodipine on renal outcomes in hypertensive nephrosclerosis. Source: Flack, John M Curr-Hypertens-Repage 2002 June; 4(3): 183-4 1522-6417

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Effect of ramiprilat or captopril on myocardial infarct size: assessment in canine models of ischemia alone and ischemia with reperfusion. Author(s): Department of Pharmacology, University of Michigan Medical School, Ann Arbor, USA. [email protected] Source: Black, S C Driscoll, E M Lucchesi, B R Pharmacology. 1998 July; 57(1): 35-46 0031-7012

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Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. Author(s): Canadian Cardiovascular Collaboration Project Office, Hamilton General Hospital, McMaster University, ON. [email protected] Source: Yusuf, S Sleight, P Pogue, J Bosch, J Davies, R Dagenais, G N-Engl-J-Med. 2000 January 20; 342(3): 145-53 0028-4793

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Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Heart Outcomes Prevention Evaluation Study Investigators. Source: Anonymous Lancet. 2000 January 22; 355(9200): 253-9 0140-6736

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Global and regional hemodynamic effects of ramipril in congestive heart failure. Author(s): Department of Cardiology, Princess Margaret Hospital, Christchurch, New Zealand. Source: Crozier, I G Ikram, H Nicholls, M G Jans, S J-Cardiovasc-Pharmacol. 1989 November; 14(5): 688-93 0160-2446

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Influence of age and dietary sodium on the cardiovascular and renal effects of ramipril in spontaneously hypertensive rats. Author(s): Department of Pharmacology and Toxicology, University of Helsinki, Finland. Source: Teravainen, T L Mervaala, E M Porsti, I Laakso, J Vapaatalo, H Karppanen, H Methods-Find-Exp-Clin-Pharmacol. 1997 June; 19(5): 311-21 0379-0355

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Influence of dietary salts on the cardiovascular effects of low-dose combination of ramipril and felodipine in spontaneously hypertensive rats. Author(s): Institute of Biomedicine, Department of Pharmacology and Toxicology, University of Helsinki, Finland. Source: Mervaala, E M Malmberg, L Teravainen, T L Laakso, J Vapaatalo, H Karppanen, H Br-J-Pharmacol. 1998 January; 123(2): 195-204 0007-1188

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Influence of ramipril on the course of plasma thrombomodulin in patients with diabetes mellitus. Author(s): Department of Internal Medicine I, University of Heidelberg, Germany. Source: Borcea, V Morcos, M Isermann, B Henkels, M Ziegler, S Zumbach, M Amiral, J Langst, K D Seiz, W Ziegler, R Wahl, P Nawroth, P P Vasa. 1999 August; 28(3): 172-80 0301-1526

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Inhibition of nitric oxide synthase prevents myocardial protection by ramiprilat. Author(s): Cardiovascular Diseases Research Unit, Upjohn Laboratories, Upjohn Company, Kalamazoo, Michigan. Source: Hartman, J C Kurc, G M Hullinger, T G Wall, T M Sheehy, R M Shebuski, R J JPharmacol-Exp-Ther. 1994 September; 270(3): 1071-6 0022-3565

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Local administration of ramiprilat is less effective than oral ramipril in preventing restenosis after balloon angioplasty in an animal model. Author(s): Department of Diagnostic Radiology, Eberhard-Karls-University, Tubingen, Germany. Source: Kalinowski, M Tepe, G Schieber, A Brehme, U Bruck, B Erley, C M Claussen, C D Duda, S H J-Vasc-Interv-Radiol. 1999 Nov-December; 10(10): 1397-404 1051-0443

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Long-term effects of ramipril and nitrendipine on albuminuria in hypertensive patients with type II diabetes and impaired renal function. Author(s): Department of Internal Medicine and Therapeutics, University of Pavia, Italy. Source: Fogari, R Zoppi, A Corradi, L Mugellini, A Lazzari, P Preti, P Lusardi, P J-HumHypertens. 1999 January; 13(1): 47-53 0950-9240

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More ACE inhibitors--quinapril, perindopril & ramipril. Source: Anonymous Drug-Ther-Bull. 1991 April 15; 29(8): 30-2 0012-6543

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Pharmacokinetics and pharmacodynamics of ramipril and piretanide administered alone and in combination. Author(s): Herz-Zentrum, Department of Clinical Pharmacology, Bad Krozingen, Germany. Source: Ruf, G Gera, S Luus, H G Trenk, D de la Rey, N Loffler, K Schulz, W Jahnchen, E Eur-J-Clin-Pharmacol. 1994; 46(6): 545-50 0031-6970

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Pharmacokinetics, converting enzyme inhibition and peripheral arterial hemodynamics of ramipril in healthy volunteers. Source: Thuillez, C Richer, C Giudicelli, J F Am-J-Cardiol. 1987 April 24; 59(10): 38D-44D 0002-9149

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Preservation of endothelial function by ramipril in rabbits on a long-term atherogenic diet. Author(s): Hoechst AG, Frankfurt/Main, Germany. Source: Becker, R H Wiemer, G Linz, W J-Cardiovasc-Pharmacol. 1991; 18 Suppl 2S110-5 0160-2446

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Ramipril and captopril in patients with heart failure: effects on hemodynamics and vasoconstrictor systems. Source: Manthey, J Osterziel, K J Rohrig, N Dietz, R Hackenthal, E Schmidt Gayk, H Kubler, W Am-J-Cardiol. 1987 April 24; 59(10): 171D-175D 0002-9149

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Ramipril reduces albuminuria in diabetic rats fed a high protein diet. Author(s): Department of Medicine, Austin Hospital, University of Melbourne, Heidelberg, Victoria, Australia. Source: O'Brien, R C Cooper, M E Allen, T J Jerums, G Clin-Exp-Pharmacol-Physiol. 1989 August; 16(8): 675-80 0305-1870

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Ramipril treatment alters Ca(2+) and K(+) channels in small mesenteric arteries from Wistar-Kyoto and spontaneously hypertensive rats. Author(s): Lankenau Institute for Medical Research, Jefferson Health System, Wynnewood, Pennsylvania 19096, USA. [email protected] Source: Cox, R H Lozinskaya, I Matsuda, K Dietz, N J Am-J-Hypertens. 2002 October; 15(10 Pt 1): 879-90 0895-7061

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Ramipril: a review of its use in the prevention of cardiovascular outcomes. Author(s): Adis International Limited, Auckland, New Zealand. [email protected] Source: Warner, Gregory T Perry, Caroline M Drugs. 2002; 62(9): 1381-405 0012-6667

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Ramipril-induced delayed myocardial protection against free radical injury involves bradykinin B2 receptor-NO pathway and protein synthesis. Author(s): Department of Pharmacology, Hunan Medical University, Changsha, P.R. China. Source: Jin, Z Q Chen, X Br-J-Pharmacol. 1998 October; 125(3): 556-62 0007-1188

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Salt blocks the renal benefits of ramipril in diabetic hypertensive rats. Author(s): University of Melbourne, Department of Medicine, Austin Hospital, Heidelberg, Victoria, Australia. Source: Fabris, B Jackson, B Johnston, C I Hypertension. 1991 April; 17(4): 497-503 0194911X

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The HOPE study. Ramipril lowered cardiovascular risk, but vitamin E did not. Author(s): Department of Endocrinology, Cleveland Clinic, OH 44195, USA. [email protected] Source: Hoogwerf, B J Young, J B Cleve-Clin-J-Med. 2000 April; 67(4): 287-93 0891-1150

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

The following is a specific Web list relating to Altace; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Minerals Angiotensin-Converting Enzyme (ACE) Inhibitors Source: Integrative Medicine Communications; www.drkoop.com Magnesium Source: Integrative Medicine Communications; www.drkoop.com Potassium Source: Healthnotes, Inc.; www.healthnotes.com Zinc Source: Healthnotes, Inc.; www.healthnotes.com

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CHAPTER 3. CLINICAL TRIALS AND ALTACE Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning Altace.

Recent Trials on Altace The following is a list of recent trials dedicated to Altace.8 Further information on a trial is available at the Web site indicated. •

Treatment of Pediatric Hypertension with Altace Trial Condition(s): Hypertension Study Status: This study is no longer recruiting patients. Sponsor(s): King Pharmaceuticals; Wyeth-Ayerst Research Purpose - Excerpt: Ramipril is an ACE inhibitor that has been marketed in the US for the treatment of hypertension since 1991. It has been shown to be effective in reducing both systolic and diastolic blood pressure in adults when used once daily. ACE inhibitors are frequently used to treat hypertension in children, however ramipril has not been extensively tested in children, and information regarding the efficacy and safety would therefore be of benefit to children. This study is designed to demonstrate the efficacy and safety of ramipril in the treatment of hypertension in children ages 6 through 16 years. Phase(s): Phase IV Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00044265

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These are listed at www.ClinicalTrials.gov.

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Effects of Angiotensin-Converting Enzyme Inhibitor (Ramipril) Therapy on Blood Vessel Inflammation Condition(s): Atherosclerosis; Coronary Disease; Vasculitis Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: This study will determine the effects of angiotensin-converting enzyme (ACE) inhibitor (trade name Ramipril) therapy on inflammation and stiffness of artery walls. These are two risk factors for developing atherosclerosis-deposits of fatty substances called plaques that can block the blood vessel, causing a heart attack or stroke. Studies of patients with coronary artery disease suggest that ACE inhibitor therapy reduces the risk of heart attack and heart failure. This study will examine the effects of this treatment on the artery walls and on levels of substances in the blood that indicate blood vessel inflammation. Patients between 40 and 75 years old with coronary artery disease caused by atherosclerosis may be eligible for this study. Candidates will be screened with a medical history, cardiovascular (heart and blood vessel) examination, electrocardiogram and blood tests. Those enrolled will be randomly assigned to take either an ACE inhibitor pill or a placebo (look-alike pill with no medicine) once a day for 3 months. No pills will be taken for the next month, and then participants will take the alternate pill for the next 3 months. That is, those who took ACE inhibitor for the first 3month period will take placebo for the second 3-month period and vice versa. Blood pressures will be taken at the NIH Clinical Center or by the patient's physician at the end of the first and second weeks of the study. At the end of 3 weeks, patients will return to the Clinical Center for a blood draw of 6 cc (1/2 teaspoon) to assess kidney function. In addition, at the end of each 3-month study period, patients will undergo the following procedures at the Clinical Center: 1. Fasting blood draw of 60 cc (2 ounces) to measure electrolytes (e.g., sodium and potassium) and blood markers for inflammation 2. Ultrasound (use of sound waves to create pictures) study of the carotid arteries (arteries in the neck leading to the brain)-An ultrasound probe is applied gently on the neck, and ultrasound pictures of the right and left carotid arteries are recorded on tape. Heart activity and blood pressure are monitored during the procedure with an electrocardiogram and blood pressure cuff. 3. Magnetic resonance imaging (MRI) of the carotid arteries-The patient lies on a table in a narrow cylinder (the MRI machine) containing a magnetic field. A flexible padded sensor called a MRI coil is placed over the neck area. Earplugs are placed in the ear to muffle the loud thumping sounds the machine makes when the magnetic fields are switched. During the second half of the exam, a contrast agent (gadolinium) is injected through an intravenous catheter (flexible tube placed in a vein) to brighten the images. The heart is monitored during the procedure with an electrocardiogram. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00005928

Clinical Trials 31

Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “Altace” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

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For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm

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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm

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For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm

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For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp

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For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm

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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/

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For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm

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For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm

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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm

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For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm

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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials

33

CHAPTER 4. BOOKS ON ALTACE Overview This chapter provides bibliographic book references relating to Altace. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on Altace include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “Altace” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:9 •

Likely mechanisms of ramipril in coronary artery disease Author: Drexler, H. (Helmut); Year: 2003; London: W.B. Saunders, c2003

Chapters on Altace In order to find chapters that specifically relate to Altace, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and Altace using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the 9

In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

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Altace

bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “Altace” (or synonyms) into the “For these words:” box.

35

CHAPTER 5. PERIODICALS AND NEWS ON ALTACE Overview In this chapter, we suggest a number of news sources and present various periodicals that cover Altace.

News Services and Press Releases One of the simplest ways of tracking press releases on Altace is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “Altace” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to Altace. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “Altace” (or synonyms). The following was recently listed in this archive for Altace: •

Skyepharma forms Altace licensing pact Source: Reuters Industry Breifing Date: May 19, 2003

•

King profit rises on Altace, Levoxyl Source: Reuters Industry Breifing Date: October 28, 2002

36

Altace

•

King says Altace patent secure, unchallenged Source: Reuters Industry Breifing Date: February 04, 2002

•

King to receive $50M from American Home Products under Altace co-promotion Source: Reuters Industry Breifing Date: October 10, 2000

•

King's Altace gets FDA approval for new indication Source: Reuters Industry Breifing Date: October 05, 2000

•

Strong Altace sales drive King Pharmaceuticals' second-quarter growth Source: Reuters Industry Breifing Date: July 25, 2000

•

American Home Products to co-promote King's Altace Source: Reuters Industry Breifing Date: June 26, 2000

•

FDA advisory panel recommends new uses for King's Altace Source: Reuters Industry Breifing Date: May 03, 2000

•

Parkdale resumes Fluogen production; seeks new Altace indications Source: Reuters Industry Breifing Date: April 17, 2000

•

Ramipril helps prevent heart attack in high-risk patients Source: Reuters Health eLine Date: January 20, 2000 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to

Periodicals and News

37

Market Wire’s home page at http://www.marketwire.com/mw/home, type “Altace” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “Altace” (or synonyms). If you know the name of a company that is relevant to Altace, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “Altace” (or synonyms).

Academic Periodicals covering Altace Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to Altace. In addition to these sources, you can search for articles covering Altace that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

39

CHAPTER 6. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for Altace. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with Altace. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The

40

Altace

following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to Altace: Angiotensin-Converting Enzyme (ACE) Inhibitors •

Systemic - U.S. Brands: Accupril; Aceon; Altace; Capoten; Lotensin; Mavik; Monopril; Prinivil; Univasc; Vasotec 4; Zestril http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202044.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/. PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

41

APPENDICES

43

APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute10: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

10

These publications are typically written by one or more of the various NIH Institutes.

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Altace

•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

Physician Resources

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.11 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:12 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

11

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 12 See http://www.nlm.nih.gov/databases/databases.html.

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Altace

•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html The Combined Health Information Database

A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to one of the following: Brochure/Pamphlet, Fact Sheet, or Information Package, and “Altace” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years.” Select your preferred language and the format option “Fact Sheet.” Type “Altace” (or synonyms) into the “For these words:” box. The following is a sample result: •

Renal Insufficiency as a Predictor of Cariovascular Outcomes and the Impact of Ramipril: The Hope Randomized Trial Source: Annals of Internal Medicine. 134(8): 629-636. April 17, 2001. Contact: Available from American College of Physicians. American Society of Internal Medicine. 190 North Independence Mall West, Philadelphia, PA 19106-1572. Website: www.acponline.org. Summary: Severe kidney disease is known to increase the risk for heart (cardiac) disease, but it is not known whether mildly abnormal kidney function increases heart disease risk. This article summarizes the Heart Outcomes and Prevention Evaluation (HOPE) study that evaluated people at high risk for heart disease from many causes and considered the effects of ramipril (an ACE inhibitor used to lower blood pressure) on that risk. The study included 9,297 patients who received either ramipril or an inactive placebo pill and were then followed for 3.5 to 5.5 years. Because high blood pressure (hypertension) and diabetes can cause heart disease by themselves, patients with those disorders were analyzed separately. The primary outcomes studied were cardiac death, heart attack, or stroke. Outcomes of secondary interest were the total number of deaths, hospitalizations for heart failure, and performance of surgical procedures to increase blood flow to the heart. Mild kidney disease was present in 980 participants; these patients were compared to 8,307 patients with normal renal (kidney) function. Patients with renal insufficiency had a substantially increased risk for cardiovascular death (11.4 percent versus 6.6 percent), and total mortality (17.8 percent versus 10.6 percent), respectively. Ramipril substantially reduced the risk for bad outcomes in the patients with reduced kidney function. Ramipril produced no more adverse side effects than did placebo. The authors conclude that in patients with preexisting vascular disease or diabetes combined with an additional cardiovascular risk factor, mild renal insufficiency significantly increased the risk for subsequent cardiovascular events. Ramipril reduced cardiovascular risk without increasing adverse effects.

Physician Resources

•

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Effect of Ramipril vs Amlodipine on Renal Outcomes in Hypertensive Nephrosclerosis: A Randomized Controlled Trial Source: JAMA. Journal of the American Medical Association. 285(21): 2719-2728. June 6, 2001. Summary: The incidence of end stage renal disease (ESRD) due to hypertension (high blood pressure) has increased in recent decades, but the optimal strategy for treatment of hypertension to prevent renal failure is unknown, especially among African Americans. This article reports on a study undertaken to compare the effects of an ACE (angiotensin converting enzyme) inhibitor (ramipril), a dihydropyridine calcium channel blocker (amlodipine), and a beta blocker (metoprolol) on hypertensive renal disease progression. Participants (n = 1,094) were randomly assigned to receive one of the three drugs, with other agents added to achieve 1 of 2 blood pressure goals. Among participants with a urinary protein to creatinine ratio of greater than 22, the ramipril group had a 36 percent slower mean decline in glomerular filtration rate (GFR, a measure of kidney function) over 3 years and a 48 percent reduced risk of the clinical end points versus the amlodipine group. In the entire cohort, there was no significant difference in mean GFR decline from baseline to 3 years between treatment groups. However, compared with the amlodipine group, after adjustment for baseline covariates, the ramipril group had a 38 percent reduced risk of clinical end points, a 36 percent slower mean decline in GFR after 3 months, and less proteinuria (protein in urine). The authors conclude that ramipril, compared with amlodipine, retards renal (kidney) disease progression in patients with hypertensive renal disease and proteinuria and may offer benefit to patients without proteinuria. 4 figures. 3 tables. 40 references.

•

Ramipril and the Development of Diabetes Source: JAMA. Journal of the American Medical Association. 286(15): 1882-1885. October 17, 2001. Summary: Type 2 diabetes is a growing clinical and public health program. Preventive efforts related to lifestyle modification are not always successful; therefore, alternative prevention strategies need to be studied. This article reports on a study undertaken to investigate the effectiveness of ramipril, an ACE inhibitor, in preventing diabetes among high risk persons. The study used the randomized, controlled Heart Outcomes Prevention Evaluation trial of 5,720 patients older than 55 years without known diabetes but with vascular (blood vessel) disease who were followed up for a mean of 4.5 years. The study included 267 hospitals in 19 countries and was conducted between 1994 and 1999. Patients were randomly assigned to receive ramipril, up to 10 milligrams per day (n = 2,837) or placebo (n = 2,883). Diagnosis of diabetes determined from self report at follow up visits every 6 months. In the ramipril group, 102 individuals (3.6 percent) developed diabetes compared with 155 (5.4 percent) in the placebo group. Similar results were noted when different diagnostic criteria were used. These effects were also consistently seen in several subgroups examined. The authors conclude that ramipril is associated with lower rates of new diagnosis of diabetes in high risk individuals. 2 figures. 2 tables. 19 references.

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Altace

The NLM Gateway13 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.14 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “Altace” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 2 0 986 0 0 988

HSTAT15 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.16 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.17 Simply search by “Altace” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

Coffee Break: Tutorials for Biologists18 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI 13

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

14

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 15 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 16 17

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 18 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

Physician Resources

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staff.19 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.20 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

19

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 20 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

51

APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on Altace can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to Altace. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to Altace. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “Altace”:

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Altace

•

Other guides Heart Failure http://www.nlm.nih.gov/medlineplus/heartfailure.html Kidney Diseases http://www.nlm.nih.gov/medlineplus/kidneydiseases.html Kidney Failure and Dialysis http://www.nlm.nih.gov/medlineplus/kidneyfailureanddialysis.html

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The NIH Search Utility The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to Altace. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Patient Resources

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Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to Altace. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with Altace. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about Altace. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “Altace” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “Altace”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “Altace” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months.

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The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “Altace” (or a synonym) into the search box, and click “Submit Query.”

55

APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.21

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

21

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)22: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

22

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

Finding Medical Libraries

57

•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

Finding Medical Libraries

59

•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

61

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

63

ALTACE DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. ACE: Angiotensin-coverting enzyme. A drug used to decrease pressure inside blood vessels. [NIH]

Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adrenergic beta-Antagonists: Drugs that bind to but do not activate beta-adrenergic receptors thereby blocking the actions of beta-adrenergic agonists. Adrenergic betaantagonists are used for treatment of hypertension, cardiac arrythmias, angina pectoris, glaucoma, migraine headaches, and anxiety. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Albuminuria: More than normal amounts of a protein called albumin in the urine. Albuminuria may be a sign of kidney disease. [NIH]

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Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaline: Having the reactions of an alkali. [EU] Alprenolol: 1-((1-Methylethyl)amino)-3-(2-(2-propenyl)phenoxy)-2-propanol. Adrenergic beta-blocker used as an antihypertensive, anti-anginal, and anti-arrhythmic agent. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amlodipine: 2-((2-Aminoethoxy)methyl)-4-(2-chlorophenyl)-1,4-dihydro-6-methyl-3,5pyridinedicarboxylic acid 3-ethyl 5-methyl ester. A long-acting dihydropyridine calcium channel blocker. It is effective in the treatment of angina pectoris and hypertension. [NIH] Angina: Chest pain that originates in the heart. [NIH] Angina Pectoris: The symptom of paroxysmal pain consequent to myocardial ischemia usually of distinctive character, location and radiation, and provoked by a transient stressful situation during which the oxygen requirements of the myocardium exceed the capacity of the coronary circulation to supply it. [NIH] Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH] Angiotensin-Converting Enzyme Inhibitors: A class of drugs whose main indications are the treatment of hypertension and heart failure. They exert their hemodynamic effect mainly by inhibiting the renin-angiotensin system. They also modulate sympathetic nervous system activity and increase prostaglandin synthesis. They cause mainly vasodilation and mild natriuresis without affecting heart rate and contractility. [NIH] Angiotensinogen: An alpha-globulin of which a fragment of 14 amino acids is converted by renin to angiotensin I, the inactive precursor of angiotensin II. It is a member of the serpin superfamily. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble

Dictionary 65

substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antihypertensive: An agent that reduces high blood pressure. [EU] Antihypertensive Agents: Drugs used in the treatment of acute or chronic hypertension regardless of pharmacological mechanism. Among the antihypertensive agents are diuretics (especially diuretics, thiazide), adrenergic beta-antagonists, adrenergic alpha-antagonists, angiotensin-converting enzyme inhibitors, calcium channel blockers, ganglionic blockers, and vasodilator agents. [NIH] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arteriolar: Pertaining to or resembling arterioles. [EU] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arthralgia: Pain in the joint. [NIH] Arthrosis: A disease of a joint. [EU] Atenolol: A cardioselective beta-adrenergic blocker possessing properties and potency similar to propranolol, but without a negative inotropic effect. [NIH] Atherogenic: Causing the formation of plaque in the lining of the arteries. [NIH] Autacoids: A chemically diverse group of substances produced by various tissues in the body that cause slow contraction of smooth muscle; they have other intense but varied pharmacologic activities. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Beta blocker: A drug used to slow the heart rate and reduce pressure inside blood vessels. It also can regulate heart rhythm. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU]

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Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brachial: All the nerves from the arm are ripped from the spinal cord. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Calcineurin: A calcium- and calmodulin-binding protein present in highest concentrations in the central nervous system. Calcineurin is composed of two subunits. A catalytic subunit, calcineurin A, and a regulatory subunit, calcineurin B, with molecular weights of about 60 kD and 19 kD, respectively. Calcineurin has been shown to dephosphorylate a number of phosphoproteins including histones, myosin light chain, and the regulatory subunit of cAMP-dependent protein kinase. It is involved in the regulation of signal transduction and is the target of an important class of immunophilin-immunosuppressive drug complexes in T-lymphocytes that act by inhibiting T-cell activation. EC 3.1.3.-. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calcium channel blocker: A drug used to relax the blood vessel and heart muscle, causing pressure inside blood vessels to drop. It also can regulate heart rhythm. [NIH] Calcium Channel Blockers: A class of drugs that act by selective inhibition of calcium influx through cell membranes or on the release and binding of calcium in intracellular pools. Since they are inducers of vascular and other smooth muscle relaxation, they are used in the drug therapy of hypertension and cerebrovascular spasms, as myocardial protective agents,

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and in the relaxation of uterine spasms. [NIH] Calmodulin: A heat-stable, low-molecular-weight activator protein found mainly in the brain and heart. The binding of calcium ions to this protein allows this protein to bind to cyclic nucleotide phosphodiesterases and to adenyl cyclase with subsequent activation. Thereby this protein modulates cyclic AMP and cyclic GMP levels. [NIH] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Capillary Permeability: Property of blood capillary walls that allows for the selective exchange of substances. Small lipid-soluble molecules such as carbon dioxide and oxygen move freely by diffusion. Water and water-soluble molecules cannot pass through the endothelial walls and are dependent on microscopic pores. These pores show narrow areas (tight junctions) which may limit large molecule movement. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Captopril: A potent and specific inhibitor of peptidyl-dipeptidase A. It blocks the conversion of angiotensin I to angiotensin II, a vasoconstrictor and important regulator of arterial blood pressure. Captopril acts to suppress the renin-angiotensin system and inhibits pressure responses to exogenous angiotensin. [NIH] Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH] Cardioselective: Having greater activity on heart tissue than on other tissue. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Carotid Arteries: Either of the two principal arteries on both sides of the neck that supply blood to the head and neck; each divides into two branches, the internal carotid artery and the external carotid artery. [NIH] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Division: The fission of a cell. [NIH] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH]

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Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [NIH] Constriction: The act of constricting. [NIH] Contractility: Capacity for becoming short in response to a suitable stimulus. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Creatinine: A compound that is excreted from the body in urine. Creatinine levels are measured to monitor kidney function. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Diabetes Insipidus: A metabolic disorder due to disorders in the production or release of vasopressin. It is characterized by the chronic excretion of large amounts of low specific gravity urine and great thirst. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH]

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Diagnostic procedure: A method used to identify a disease. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diastole: Period of relaxation of the heart, especially the ventricles. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diastolic blood pressure: The minimum pressure that remains within the artery when the heart is at rest. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Dilatation: The act of dilating. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Diltiazem: A benzothiazepine derivative with vasodilating action due to its antagonism of the actions of the calcium ion in membrane functions. It is also teratogenic. [NIH] Dimethyl: A volatile metabolite of the amino acid methionine. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Diuretic: A drug that increases the production of urine. [NIH] Diuretics, Thiazide: Diuretics characterized as analogs of 1,2,4-benzothiadiazine-1,1dioxide. All have a common mechanism of action and differ primarily in the dose required to produce a given effect. They act directly on the kidney to increase the excretion of sodium chloride and water and also increase excretion of potassium ions. [NIH] Dosage Forms: Completed forms of the pharmaceutical preparation in which prescribed doses of medication are included. They are designed to resist action by gastric fluids, prevent vomiting and nausea, reduce or alleviate the undesirable taste and smells associated with oral administration, achieve a high concentration of drug at target site, or produce a delayed or long-acting drug effect. They include capsules, liniments, ointments, pharmaceutical solutions, powders, tablets, etc. [NIH] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is

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based on the results of a randomized control trial. [NIH] Electrocardiogram: Measurement of electrical activity during heartbeats. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Enalapril: An angiotensin-converting enzyme inhibitor that is used to treat hypertension. [NIH]

Enalaprilat: The active metabolite of enalapril and a potent intravenously administered angiotensin-converting enzyme inhibitor. It is an effective agent for the treatment of essential hypertension and has beneficial hemodynamic effects in heart failure. The drug produces renal vasodilation with an increase in sodium excretion. [NIH] Endarterectomy: Surgical excision, performed under general anesthesia, of the atheromatous tunica intima of an artery. When reconstruction of an artery is performed as an endovascular procedure through a catheter, it is called atherectomy. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium, Lymphatic: Unbroken cellular lining (intima) of the lymph vessels (e.g., the high endothelial lymphatic venules). It is more permeable than vascular endothelium, lacking selective absorption and functioning mainly to remove plasma proteins that have filtered through the capillaries into the tissue spaces. [NIH] Endothelium, Vascular: Single pavement layer of cells which line the luminal surface of the entire vascular system and regulate the transport of macromolecules and blood components from interstitium to lumen; this function has been most intensively studied in the blood capillaries. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extracellular: Outside a cell or cells. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH]

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Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Felodipine: A dihydropyridine calcium antagonist with positive inotropic effects. It lowers blood pressure by reducing peripheral vascular resistance through a highly selective action on smooth muscle in arteriolar resistance vessels. [NIH] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Fibrinolytic: Pertaining to, characterized by, or causing the dissolution of fibrin by enzymatic action [EU] Fold: A plication or doubling of various parts of the body. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fructose: A type of sugar found in many fruits and vegetables and in honey. Fructose is used to sweeten some diet foods. It is considered a nutritive sweetener because it has calories. [NIH] Gadolinium: An element of the rare earth family of metals. It has the atomic symbol Gd, atomic number 64, and atomic weight 157.25. Its oxide is used in the control rods of some nuclear reactors. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Ganglionic Blockers: Agents having as their major action the interruption of neural transmission at nicotinic receptors on postganglionic autonomic neurons. Because their actions are so broad, including blocking of sympathetic and parasympathetic systems, their therapeutic use has been largely supplanted by more specific drugs. They may still be used in the control of blood pressure in patients with acute dissecting aortic aneurysm and for the induction of hypotension in surgery. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glomerular Filtration Rate: The volume of water filtered out of plasma through glomerular capillary walls into Bowman's capsules per unit of time. It is considered to be equivalent to inulin clearance. [NIH] Glomerulus: A tiny set of looping blood vessels in the nephron where blood is filtered in the

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kidney. [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH] Glycogen Storage Disease: A group of inherited metabolic disorders involving the enzymes responsible for the synthesis and degradation of glycogen. In some patients, prominent liver involvement is presented. In others, more generalized storage of glycogen occurs, sometimes with prominent cardiac involvement. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Hemodynamics: The movements of the blood and the forces involved in systemic or regional blood circulation. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hepatotoxicity: How much damage a medicine or other substance does to the liver. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hydrochlorothiazide: A thiazide diuretic often considered the prototypical member of this class. It reduces the reabsorption of electrolytes from the renal tubules. This results in increased excretion of water and electrolytes, including sodium, potassium, chloride, and

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magnesium. It has been used in the treatment of several disorders including edema, hypertension, diabetes insipidus, and hypoparathyroidism. [NIH] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immunophilin: A drug for the treatment of Parkinson's disease. [NIH] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Indomethacin: A non-steroidal anti-inflammatory agent (NSAID) that inhibits the enzyme cyclooxygenase necessary for the formation of prostaglandins and other autacoids. It also inhibits the motility of polymorphonuclear leukocytes. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inotropic: Affecting the force or energy of muscular contractions. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Intracellular: Inside a cell. [NIH] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Inulin: A starch found in the tubers and roots of many plants. Since it is hydrolyzable to fructose, it is classified as a fructosan. It has been used in physiologic investigation for

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determination of the rate of glomerular function. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kallidin: A decapeptide bradykinin homolog produced by the action of tissue and glandular kallikreins on low-molecular-weight kininogen. It is a smooth-muscle stimulant and hypotensive agent that functions through vasodilatation. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Ligaments: Shiny, flexible bands of fibrous tissue connecting together articular extremities of bones. They are pliant, tough, and inextensile. [NIH] Lipid: Fat. [NIH] Lisinopril: An orally active angiotensin-converting enzyme inhibitor that has been used in the treatment of hypertension and congestive heart failure. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] McMaster: Index used to measure painful syndromes linked to arthrosis. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical

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Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mesenteric: Pertaining to the mesentery : a membranous fold attaching various organs to the body wall. [EU] Mesenteric Arteries: Arteries which arise from the abdominal aorta and distribute to most of the intestines. [NIH] Mesentery: A layer of the peritoneum which attaches the abdominal viscera to the abdominal wall and conveys their blood vessels and nerves. [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metoprolol: Adrenergic beta-1-blocking agent with no stimulatory action. It is less bound to plasma albumin than alprenolol and may be useful in angina pectoris, hypertension, or cardiac arrhythmias. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Motility: The ability to move spontaneously. [EU] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myosin: Chief protein in muscle and the main constituent of the thick filaments of muscle fibers. In conjunction with actin, it is responsible for the contraction and relaxation of muscles. [NIH] Natriuresis: The excretion of abnormal amounts of sodium in the urine. [EU] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United

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States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Nephropathy: Disease of the kidneys. [EU] Nephrosis: Descriptive histopathologic term for renal disease without an inflammatory component. [NIH] Nephrotic: Pertaining to, resembling, or caused by nephrosis. [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Nisoldipine: 1,4-Dihydro-2,6-dimethyl-4 (2-nitrophenyl)-3,5-pyridinedicarboxylic acid methyl 2-methylpropyl ester. Nisoldipine is a dihydropyridine calcium channel antagonist that acts as a potent arterial vasodilator and antihypertensive agent. It is also effective in patients with cardiac failure and angina. [NIH] Nitrendipine: Ethyl methyl 2,4-dihydro-2,6-dimethyl-4(3-nitrophenyl)-3,5pyridinedicarboxylate. A calcium channel blocker with marked vasodilator action. It is an effective antihypertensive agent and differs from other calcium channel blockers in that it does not reduce glomerular filtration rate and is mildly natriuretic, rather than sodium retentive. [NIH] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH]

Nitrosamines: A class of compounds that contain a -NH2 and a -NO radical. Many members of this group have carcinogenic and mutagenic properties. [NIH] Nitrosation: Conversion into nitroso compounds. An example is the reaction of nitrites with amino compounds to form carcinogenic N-nitrosamines. [NIH] Normotensive: 1. Characterized by normal tone, tension, or pressure, as by normal blood pressure. 2. A person with normal blood pressure. [EU] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior

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abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Particle: A tiny mass of material. [EU] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perindopril: An angiotensin-converting enzyme inhibitor. It is used in patients with hypertension and heart failure. [NIH] Pharmaceutical Solutions: Homogeneous liquid preparations that contain one or more chemical substances dissolved, i.e., molecularly dispersed, in a suitable solvent or mixture of mutually miscible solvents. For reasons of their ingredients, method of preparation, or use, they do not fall into another group of products. [NIH] Pharmacodynamics: The study of the biochemical and physiological effects of drugs and the mechanisms of their actions, including the correlation of actions and effects of drugs with their chemical structure; also, such effects on the actions of a particular drug or drugs. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenprocoumon: 3-(1-Phenylpropyl)-4-hydroxycoumarin. Long acting oral anticoagulant. It may cause diarrhea. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Photodermatitis: Dermatitis caused or elicited by exposure to ultraviolet light, may be phototoxic or photoallergic. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelet-Derived Growth Factor: Mitogenic peptide growth hormone carried in the alphagranules of platelets. It is released when platelets adhere to traumatized tissues. Connective tissue cells near the traumatized region respond by initiating the process of replication. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of

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muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Prodrug: A substance that gives rise to a pharmacologically active metabolite, although not itself active (i. e. an inactive precursor). [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Propranolol: A widely used non-cardioselective beta-adrenergic antagonist. Propranolol is used in the treatment or prevention of many disorders including acute myocardial infarction, arrhythmias, angina pectoris, hypertension, hypertensive emergencies, hyperthyroidism, migraine, pheochromocytoma, menopause, and anxiety. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to

Dictionary 79

recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteinuria: The presence of protein in the urine, indicating that the kidneys are not working properly. [NIH] Prothrombin: A plasma protein that is the inactive precursor of thrombin. It is converted to thrombin by a prothrombin activator complex consisting of factor Xa, factor V, phospholipid, and calcium ions. Deficiency of prothrombin leads to hypoprothrombinemia. [NIH]

Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Ramipril: A long-acting angiotensin-converting enzyme inhibitor. It is a prodrug that is transformed in the liver to its active metabolite ramiprilat. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Reabsorption: 1. The act or process of absorbing again, as the selective absorption by the kidneys of substances (glucose, proteins, sodium, etc.) already secreted into the renal tubules, and their return to the circulating blood. 2. Resorption. [EU] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Renin: An enzyme which is secreted by the kidney and is formed from prorenin in plasma and kidney. The enzyme cleaves the Leu-Leu bond in angiotensinogen to generate angiotensin I. EC 3.4.23.15. (Formerly EC 3.4.99.19). [NIH] Renin-Angiotensin System: A system consisting of renin, angiotensin-converting enzyme, and angiotensin II. Renin, an enzyme produced in the kidney, acts on angiotensinogen, an alpha-2 globulin produced by the liver, forming angiotensin I. The converting enzyme contained in the lung acts on angiotensin I in the plasma converting it to angiotensin II, the most powerful directly pressor substance known. It causes contraction of the arteriolar smooth muscle and has other indirect actions mediated through the adrenal cortex. [NIH] Reperfusion: Restoration of blood supply to tissue which is ischemic due to decrease in

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normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH] Reperfusion Injury: Functional, metabolic, or structural changes, including necrosis, in ischemic tissues thought to result from reperfusion to ischemic areas of the tissue. The most common instance is myocardial reperfusion injury. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Risk patient: Patient who is at risk, because of his/her behaviour or because of the type of person he/she is. [EU] Rods: One type of specialized light-sensitive cells (photoreceptors) in the retina that provide side vision and the ability to see objects in dim light (night vision). [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Serous: Having to do with serum, the clear liquid part of blood. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signal Transduction: The intercellular or intracellular transfer of information (biological activation/inhibition) through a signal pathway. In each signal transduction system, an activation/inhibition signal from a biologically active molecule (hormone, neurotransmitter) is mediated via the coupling of a receptor/enzyme to a second messenger system or to an ion channel. Signal transduction plays an important role in activating cellular functions, cell differentiation, and cell proliferation. Examples of signal transduction systems are the GABA-postsynaptic receptor-calcium ion channel system, the receptor-mediated T-cell activation pathway, and the receptor-mediated activation of phospholipases. Those coupled to membrane depolarization or intracellular release of calcium include the receptormediated activation of cytotoxic functions in granulocytes and the synaptic potentiation of protein kinase activation. Some signal transduction pathways may be part of larger signal transduction pathways; for example, protein kinase activation is part of the platelet activation signal pathway. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH]

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Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Steroids: Drugs used to relieve swelling and inflammation. [NIH] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Teratogenic: Tending to produce anomalies of formation, or teratism (= anomaly of formation or development : condition of a monster). [EU] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]

Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU]

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Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50 to 60 years. Obesity and possibly a genetic factor are usually present. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasodilation: Physiological dilation of the blood vessels without anatomic change. For dilation with anatomic change, dilatation, pathologic or aneurysm (or specific aneurysm) is used. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Ventricular Function: The hemodynamic and electrophysiological action of the ventricles. [NIH]

Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation

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occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH]

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INDEX A ACE, 3, 4, 5, 7, 8, 10, 13, 24, 26, 28, 29, 30, 46, 47, 63 Acetylcholine, 63, 76 Adjustment, 4, 47, 63 Adrenergic, 63, 64, 65, 75, 78 Adrenergic beta-Antagonists, 63, 65 Adverse Effect, 4, 46, 63, 80 Affinity, 63, 80 Age of Onset, 63, 82 Albumin, 63, 75 Albuminuria, 11, 14, 26, 63 Algorithms, 64, 66 Alkaline, 64, 66 Alprenolol, 64, 75 Alternative medicine, 36, 64 Amlodipine, 4, 9, 12, 25, 47, 64 Angina, 63, 64, 75, 76, 78 Angina Pectoris, 63, 64, 75, 78 Angioplasty, 26, 64 Angiotensin-Converting Enzyme Inhibitors, 13, 64, 65 Angiotensinogen, 64, 79 Animal model, 26, 64 Antagonism, 64, 69 Antibody, 63, 64 Anticoagulant, 24, 64, 77, 78 Antigen, 5, 63, 64 Antihypertensive, 5, 7, 8, 15, 16, 20, 64, 65, 76 Antihypertensive Agents, 5, 65 Anti-inflammatory, 65, 73 Aorta, 65, 75, 82 Arginine, 65, 76 Arterial, 14, 18, 21, 26, 65, 67, 73, 76, 79, 81 Arteries, 30, 65, 66, 67, 68, 75 Arteriolar, 65, 66, 71, 79 Arterioles, 65, 66, 67 Arthralgia, 15, 65 Arthrosis, 65, 74 Atenolol, 14, 65 Atherogenic, 26, 65 Autacoids, 65, 73 Autonomic, 63, 65, 71, 81 Autonomic Nervous System, 65, 81 B Bacteria, 65 Base, 65, 68, 74

Beta blocker, 4, 47, 65 Biochemical, 65, 77 Biotechnology, 6, 33, 36, 45, 66 Bladder, 66, 82 Blood Coagulation, 66, 81 Blood pressure, 3, 4, 9, 11, 15, 30, 46, 47, 65, 66, 67, 71, 73, 75, 76, 80 Blood vessel, 5, 30, 47, 63, 65, 66, 67, 70, 71, 74, 75, 80, 81, 82 Body Fluids, 66, 80 Bowel, 66, 69 Bowel Movement, 66, 69 Brachial, 14, 66 Bradykinin, 25, 27, 66, 74, 76 Branch, 59, 66, 70, 77, 79, 81 C Calcineurin, 15, 66 Calcium, 4, 47, 64, 65, 66, 67, 69, 71, 76, 79, 80 Calcium channel blocker, 4, 47, 64, 65, 66, 76 Calcium Channel Blockers, 65, 66, 76 Calmodulin, 66, 67 Capillary, 66, 67, 71, 82 Capillary Permeability, 66, 67 Capsules, 67, 69, 71 Captopril, 15, 24, 25, 26, 67 Carcinogenic, 67, 76 Cardiac, 3, 8, 9, 46, 63, 67, 72, 75, 76 Cardioselective, 65, 67, 78 Cardiovascular, 4, 5, 8, 9, 10, 11, 12, 13, 15, 16, 17, 18, 19, 20, 24, 25, 26, 27, 30, 46, 67 Cardiovascular disease, 10, 13, 17, 19, 24, 67 Carotid Arteries, 30, 67 Catheterization, 64, 67 Cell, 17, 65, 66, 67, 70, 73, 74, 76, 77, 78, 79, 80, 81 Cell Division, 65, 67 Cell proliferation, 17, 67, 80 Central Nervous System, 63, 65, 66, 67, 71 Cerebrovascular, 66, 67 Chronic, 17, 19, 24, 65, 67, 68, 69, 70, 74 Clinical trial, 5, 9, 29, 31, 45, 67, 79 Cloning, 66, 68 Cofactor, 68, 78, 81 Computational Biology, 45, 68 Congestive heart failure, 10, 24, 25, 68, 74

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Constriction, 68, 74 Contractility, 64, 68 Contraindications, ii, 68 Coronary, 13, 18, 24, 30, 33, 64, 67, 68, 75 Coronary heart disease, 67, 68 Coronary Thrombosis, 68, 75 Cortex, 68, 79 Creatinine, 4, 47, 68 Curative, 68, 81 Cyclic, 67, 68, 72, 76, 78 D Databases, Bibliographic, 45, 68 Delivery of Health Care, 68, 72 Density, 68, 81 Diabetes Insipidus, 68, 73 Diabetes Mellitus, 13, 25, 26, 68, 72 Diagnostic procedure, 37, 69 Diarrhea, 69, 77 Diastole, 69 Diastolic, 8, 29, 69, 73 Diastolic blood pressure, 29, 69 Digestive system, 31, 69 Dilatation, 64, 69, 78, 82 Dilation, 66, 69, 82 Diltiazem, 7, 21, 69 Dimethyl, 69, 76 Direct, iii, 8, 39, 69, 79 Disease Progression, 4, 47, 69 Diuretic, 5, 69, 72 Diuretics, Thiazide, 65, 69 Dosage Forms, 21, 22, 69 Drive, ii, vi, 23, 36, 69 Drug Interactions, 40, 69 Drug Tolerance, 69, 81 E Edema, 69, 73, 74 Efficacy, 7, 8, 9, 10, 19, 20, 21, 29, 69 Electrocardiogram, 30, 70 Electrolyte, 24, 70, 78, 80 Electrophysiological, 70, 82 Enalapril, 15, 70 Enalaprilat, 15, 70 Endarterectomy, 64, 70 Endothelial cell, 70, 81 Endothelium, 24, 70, 76 Endothelium, Lymphatic, 70 Endothelium, Vascular, 70 Endothelium-derived, 70, 76 End-stage renal, 7, 70 Environmental Health, 44, 46, 70 Enzymatic, 66, 70, 71 Epithelium, 70

Esophagus, 69, 70, 81 Exogenous, 67, 70, 82 Extracellular, 70, 80 F Family Planning, 45, 70 Fatigue, 71, 72 Felodipine, 8, 20, 25, 71 Fibrin, 66, 71, 81 Fibrinogen, 71, 81 Fibrinolytic, 5, 71 Fold, 71, 75 Forearm, 66, 71 Fructose, 25, 71, 73 G Gadolinium, 30, 71 Gallbladder, 69, 71 Ganglia, 63, 71, 81 Ganglionic Blockers, 65, 71 Gas, 71, 76 Gastric, 69, 71 Gastrointestinal, 66, 71, 81 Gene, 33, 66, 71 Glomerular, 4, 10, 47, 71, 74, 76, 79 Glomerular Filtration Rate, 4, 47, 71, 76 Glomerulus, 71 Glucose, 68, 72, 73, 79 Glucose Intolerance, 68, 72 Glycogen, 11, 18, 72 Glycogen Storage Disease, 11, 18, 72 Glycoprotein, 71, 72, 81 Governing Board, 72, 78 Growth, 36, 64, 67, 72, 77 Guanylate Cyclase, 72, 76 H Health Care Costs, 8, 72 Health Expenditures, 72 Heart attack, 4, 30, 36, 46, 67, 72 Heart failure, 4, 8, 10, 17, 21, 26, 30, 46, 64, 70, 72, 77 Hemodynamics, 26, 72 Hemorrhage, 72, 81 Hepatotoxicity, 18, 72 Heredity, 71, 72 Hormonal, 24, 72 Hormone, 72, 73, 77, 80 Hydrochlorothiazide, 15, 72 Hyperlipidemia, 13, 73 Hypertrophy, 8, 18, 73 I Id, 28, 52, 58, 60, 73 Immune response, 64, 73, 81 Immunophilin, 66, 73

Index 87

Immunosuppressive, 66, 73 Impairment, 73, 75 In vitro, 17, 73 In vivo, 73 Incision, 73, 74 Indicative, 73, 77, 82 Indomethacin, 10, 73 Infarction, 8, 10, 21, 73, 80 Inflammation, 30, 63, 65, 73, 81 Inotropic, 65, 71, 73 Insulin, 13, 14, 20, 73, 82 Insulin-dependent diabetes mellitus, 73 Interstitial, 73, 79 Intestines, 71, 73, 75 Intracellular, 66, 73, 76, 77, 78, 80 Intravenous, 30, 73 Intrinsic, 14, 63, 73 Inulin, 71, 73 Invasive, 8, 74 Ions, 65, 67, 69, 70, 74, 79 Ischemia, 25, 64, 74, 80 J Joint, 65, 74 K Kallidin, 66, 74 Kb, 44, 74 Kidney Disease, 3, 7, 12, 31, 44, 46, 52, 63, 74 Kidney Failure, 52, 70, 74 L Large Intestine, 69, 73, 74, 79 Leukocytes, 73, 74 Library Services, 58, 74 Ligaments, 68, 74 Lipid, 67, 73, 74 Lisinopril, 8, 74 Liver, 63, 69, 71, 72, 74, 79 Lymph, 70, 74 Lymphocyte, 65, 74 M McMaster, 25, 74 MEDLINE, 45, 74 Membrane, 69, 75, 80 Mental Disorders, 32, 75 Mental Health, iv, 5, 32, 44, 48, 75, 79 Mesenteric, 27, 75 Mesenteric Arteries, 27, 75 Mesentery, 75 Metabolic disorder, 68, 72, 75 Metabolite, 14, 69, 70, 75, 78, 79 Metoprolol, 4, 19, 47, 75 MI, 61, 75

Modification, 4, 47, 75 Molecular, 45, 49, 66, 67, 68, 71, 74, 75 Molecule, 65, 67, 70, 75, 79, 80 Monitor, 68, 75, 76 Motility, 73, 75 Myocardial infarction, 5, 10, 13, 17, 21, 68, 75, 78 Myocardium, 64, 75 Myosin, 66, 75 N Natriuresis, 64, 75 Nausea, 69, 75, 82 NCI, 1, 31, 43, 75 Necrosis, 73, 75, 76, 80 Need, 3, 4, 33, 46, 47, 53, 72, 76, 81 Nephropathy, 7, 9, 12, 16, 19, 74, 76 Nephrosis, 76 Nephrotic, 11, 76 Neurons, 71, 76, 81 Nisoldipine, 7, 76 Nitrendipine, 14, 26, 76 Nitric Oxide, 26, 76 Nitrosamines, 76 Nitrosation, 22, 76 Normotensive, 8, 13, 14, 21, 76 Nuclear, 71, 76 O Ointments, 69, 76 P Palliative, 76, 81 Pancreas, 69, 73, 76 Particle, 77, 81 Pathologic, 68, 77, 82 Peptide, 77, 79 Perindopril, 26, 77 Pharmaceutical Solutions, 69, 77 Pharmacodynamics, 26, 77 Pharmacologic, 65, 77, 82 Phenprocoumon, 24, 77 Phosphorus, 66, 77 Photodermatitis, 15, 77 Physiologic, 73, 77, 78, 79 Plaque, 64, 65, 77 Plasma, 7, 13, 14, 21, 24, 26, 63, 70, 71, 72, 74, 75, 77, 79 Platelet Aggregation, 76, 77 Platelet-Derived Growth Factor, 17, 77 Platelets, 76, 77 Polysaccharide, 65, 77 Potassium, 7, 24, 28, 30, 69, 72, 77 Practice Guidelines, 48, 78 Probe, 30, 78

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Altace

Prodrug, 78, 79 Progression, 4, 47, 64, 78 Progressive, 69, 72, 76, 78, 79 Propranolol, 65, 78 Prostaglandin, 64, 78 Prostaglandins A, 73, 78 Protein C, 63, 78 Protein S, 27, 33, 66, 78 Proteins, 65, 70, 75, 77, 79, 80, 82 Proteinuria, 4, 10, 11, 20, 47, 79 Prothrombin, 79, 81 Public Health, 4, 47, 48, 79 Public Policy, 45, 79 Publishing, 6, 79 Pulmonary, 15, 66, 74, 79, 82 Pulmonary Artery, 66, 79, 82 R Randomized, 3, 4, 12, 14, 16, 18, 19, 46, 47, 70, 79 Reabsorption, 72, 79 Receptor, 5, 27, 65, 79, 80 Rectum, 66, 69, 71, 74, 79 Refer, 1, 79 Regimen, 69, 79 Renal failure, 4, 47, 79 Renin, 5, 19, 64, 67, 79 Renin-Angiotensin System, 5, 64, 67, 79 Reperfusion, 25, 79, 80 Reperfusion Injury, 80 Risk factor, 4, 30, 46, 80 Risk patient, 9, 11, 12, 25, 36, 80 Rods, 71, 80 S Salivary, 69, 80 Salivary glands, 69, 80 Screening, 67, 80 Sensor, 30, 80 Serous, 70, 80 Serum, 19, 63, 80 Side effect, 4, 39, 46, 63, 80, 82 Signal Transduction, 66, 80 Smooth muscle, 65, 66, 71, 79, 80, 81 Sodium, 25, 30, 69, 70, 72, 75, 76, 79, 80 Sound wave, 30, 81 Specialist, 53, 69, 81 Spinal cord, 66, 67, 81 Steroids, 16, 81

Stimulus, 68, 69, 81 Stomach, 69, 70, 71, 72, 73, 75, 81 Stress, 12, 15, 65, 75, 81 Stroke, 4, 6, 10, 15, 16, 22, 30, 32, 44, 46, 67, 81 Substance P, 75, 81 Sympathetic Nervous System, 20, 64, 65, 81 Systemic, 21, 40, 65, 66, 72, 81 Systolic, 7, 8, 21, 29, 73, 81 T Teratogenic, 69, 81 Therapeutics, 8, 20, 26, 40, 81 Threshold, 73, 81 Thrombin, 14, 71, 77, 78, 79, 81 Thrombomodulin, 13, 26, 78, 81 Thrombosis, 17, 79, 81 Tissue, 65, 67, 69, 70, 71, 73, 74, 75, 76, 77, 79, 80, 81 Tolerance, 24, 72, 81 Toxic, iv, 82 Toxicity, 69, 82 Toxicology, 25, 46, 82 Toxins, 65, 82 Transfection, 66, 82 Type 2 diabetes, 4, 13, 47, 82 U Unconscious, 73, 82 Uremia, 74, 79, 82 Urethra, 82 Urinary, 4, 7, 24, 47, 82 Urine, 4, 47, 63, 66, 68, 69, 75, 79, 82 V Vascular, 4, 5, 13, 46, 47, 66, 70, 71, 73, 76, 82 Vasodilation, 64, 70, 82 Vasodilator, 65, 66, 76, 82 Vein, 30, 73, 76, 82 Venous, 79, 82 Ventricle, 79, 81, 82 Ventricular, 7, 8, 18, 19, 82 Ventricular Function, 7, 8, 19, 82 Venules, 66, 67, 70, 82 Veterinary Medicine, 45, 82 Vitro, 82 X Xenograft, 64, 83

Index 89

90

Altace

Index 91

92

Altace