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ucsd.edu
OBJECTIVES: Describe and evaluate an Internet-based approach to patient decision support using mathematical models that predict the probability of successful treatment on the basis of meta-analytic summaries of the mean and standard deviation of symptom response. DESIGN: An Internet-based decision support tool was developed to help patients with benign prostatic hypertrophy (BPH) determine whether they wanted to use alpha blockers. The Internet site incorporates a meta-analytic model of the results of randomized trials of the alpha blocker terazosin. The site describes alternative treatments for BPH and potential adverse effects of alpha blockers. The site then measures patients' current symptoms and desired level of symptom reduction. In response, the site computes and displays the probability of a patient's achieving his objective by means of terazosin or placebo treatment. SETTING: Self-identified BPH patients accessing the site over the Internet. MAIN OUTCOME MEASURES: Patients' perceptions of the usefulness of information. RESULTS: Over a three-month period, 191 patients who were over 50 years of age and who reported that they have BPH used the decision support tool. Respondents had a mean American Urological Association (AUA) score of 18.8 and a desired drop in symptoms of 10.1 AUA points. Patients had a 40 percent chance of achieving treatment goals with terazosin and a 20 percent chance with placebo. Patients found the information useful (93 percent), and most (71 percent) believed this type of information should be discussed before prescribing medications. CONCLUSIONS: Interactive meta-analytic summary models of the effects of pharmacologic treatments can help patients determine whether a treatment offers sufficient benefits to offset its risks.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10495100&dopt=Abstract
Am J Med. 1986 May 23;80(5B):68-72.
Long-term experience with terazosin for treatment of mild to moderate hypertension.
Mersey JH.
Two hundred twenty-six patients with mild to moderate hypertension were treated with terazosin in an open, multicenter study to determine the drug's long-term efficacy and safety. All patients had previously received terazosin in a short-term study; 66 patients entered from later short-term studies and had experienced a 7 mm Hg decrease in supine diastolic blood pressure in response to terazosin. Terazosin was administered once or twice daily either alone or in combination with a diuretic and/or a beta blocker. Supine systolic and diastolic blood pressures were significantly decreased from baseline during time intervals ending at 90, 180, 360, and 720 days of long-term therapy. No clinically significant trends were observed in pulse rate, clinical laboratory test results, physical examinations, or electrocardiograms. Patients had a tendency toward a slight weight gain. The most common adverse experiences attributed to terazosin monotherapy were dizziness and asthenia (9.7 percent and 6.6 percent, respectively). Adverse experiences were usually of mild or moderate severity. Of the 226 patients who underwent long-term therapy, 29 (13 percent) withdrew because of adverse experiences, and three (1 percent) withdrew because of uncontrolled blood pressure. This study demonstrates that terazosin is effective and safe for long-term treatment of hypertension.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2872810&dopt=Abstract
Am J Med. 1986 May 23;80(5B):77-81.
Overall safety of terazosin as an antihypertensive agent.
Sperzel WD, Glassman HN, Jordan DC, Luther RR.
The safety of terazosin, an effective agent for the treatment of hypertension, was assessed by analyzing data from 1,006 hypertensive patients who were enrolled in short-term and/or long-term studies. The total experience with terazosin in this article represents 422.5 patient-years. Changes in pulse rate measurements from pretreatment to posttreatment were not significantly different between the terazosin- and placebo-treated patients (-1.0 beat per minute for the terazosin group and -1.0 beat per minute for the placebo group, in the supine position). Dizziness, headache, and asthenia were the most commonly reported adverse experiences among all terazosin-treated patients, although the incidence of headache in placebo-controlled trials was not significantly different between the terazosin and placebo groups. As a whole, patients receiving terazosin had a tendency to gain small amounts of weight (2 pounds). In addition, there was a trend for slight decreases in hemoglobin, hematocrit, white blood cell count, total protein, and albumin levels in those patients who received terazosin, suggesting hemodilution. Overall, terazosin was shown to be safe in patients with mild to moderate essential hypertension.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2872812&dopt=Abstract
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