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Article ; Online: Origins of a novel mobile health unit program to prevent cardiovascular disease in vulnerable communities.

Twiner, Michael J / Akcasu, Nora N / Foster, Bethany / Opara, Ijeoma Nnodim / Bauer, Samantha J / Korzeniewski, Steven J / Brook, Robert D / Levy, Phillip D

Journal of clinical hypertension (Greenwich, Conn.)

2024 Volume 26, Issue 4, Page(s) 448–450

MeSH term(s)	Humans ; Mobile Health Units ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/prevention & control ; Hypertension
Language	English
Publishing date	2024-03-19
Publishing country	United States
Document type	Letter
ZDB-ID	2077222-1
ISSN	1751-7176 ; 1524-6175
ISSN (online)	1751-7176
ISSN	1524-6175
DOI	10.1111/jch.14800
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Article: Nitroglycerin Use in the Emergency Department: Current Perspectives.

Twiner, Michael J / Hennessy, John / Wein, Rachel / Levy, Phillip D

Open access emergency medicine : OAEM

2022 Volume 14, Page(s) 327–333

Abstract: Nitroglycerin, a fast-acting vasodilator, is commonly used as a first-line agent for angina in the emergency department and to manage chest pain due to acute coronary syndromes. It is also a treatment option for other disease states such as acute heart ... ...

Abstract	Nitroglycerin, a fast-acting vasodilator, is commonly used as a first-line agent for angina in the emergency department and to manage chest pain due to acute coronary syndromes. It is also a treatment option for other disease states such as acute heart failure, pulmonary edema, and aortic dissection. Nitroglycerin is converted to nitric oxide, a potent vasodilator, in the body, leading to venodilation at lower dosages and arteriodilation at higher dosages that results in both preload and afterload reduction, respectively. Although nitroglycerin has historically been administered as a sublingual tablet and/or spray, it is often given intravenously in the emergency department as this enables titration to effect with predictable pharmacokinetics. In this review article, we outline the indications, mechanism of action, contraindications, and adverse effects of nitroglycerin as well as review relevant literature and make general recommendations regarding the use of nitroglycerin in the emergency department.
Language	English
Publishing date	2022-07-09
Publishing country	New Zealand
Document type	Journal Article ; Review
ZDB-ID	2520704-0
ISSN	1179-1500
ISSN	1179-1500
DOI	10.2147/OAEM.S340513
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Article ; Online: Linkage, Empowerment, and Access to Prevent Hypertension: A Novel Program to Prevent Hypertension and Reduce Cardiovascular Health Disparities in Detroit, Michigan.

Nnodim Opara, Ijeoma / Brook, Robert D / Twiner, Michael J / Dawood, Katee / Levy, Phillip D

American journal of hypertension

2023 Volume 36, Issue 5, Page(s) 264–272

Abstract: Background: Serious cardiovascular health disparities persist across the United States, disproportionately affecting Black communities. Mounting evidence supports negative social determinants of health (SDoH) as contributing factors to a higher ... ...

Abstract	Background: Serious cardiovascular health disparities persist across the United States, disproportionately affecting Black communities. Mounting evidence supports negative social determinants of health (SDoH) as contributing factors to a higher prevalence of hypertension along with lower control rates. Here, we describe a first-of-a-kind approach to reducing health disparities by focusing on preventing hypertension in Black adults with elevated blood pressure (BP) living in socially vulnerable communities. Methods and results: Linkage, Empowerment, and Access to Prevent Hypertension (LEAP-HTN) is part of the RESTORE (Addressing Social Determinants to Prevent Hypertension) health equity research network. The trial will test if a novel intervention reduces systolic BP (primary outcome) and prevents the onset of hypertension over 1 year versus usual care in 500 Black adults with elevated BP (systolic BP 120-129 mm Hg; diastolic BP <80 mm Hg) in Detroit, Michigan. LEAP-HTN leverages our groundbreaking platform using geospatial health and social vulnerability data to direct the deployment of mobile health units (MHUs) to communities of greatest need. All patients are referred to primary care providers. Trial participants in the active limb will receive additional collaborative care delivered remotely by community health workers using an innovative strategy termed pragmatic, personalized, adaptable approaches to lifestyle, and life circumstances (PAL2) which mitigates the impact of negative SDoH. Conclusions: LEAP-HTN aims to prevent hypertension by improving access and linkage to care while mitigating negative SDoH. This novel approach could represent a sustainable and scalable strategy to overcoming health disparities in socially vulnerable communities across the United States.
MeSH term(s)	Adult ; Humans ; Blood Pressure ; Hypertension/diagnosis ; Hypertension/epidemiology ; Hypertension/prevention & control ; Michigan/epidemiology ; United States/epidemiology
Language	English
Publishing date	2023-04-15
Publishing country	United States
Document type	Clinical Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	639383-4
ISSN	1941-7225 ; 1879-1905 ; 0895-7061
ISSN (online)	1941-7225 ; 1879-1905
ISSN	0895-7061
DOI	10.1093/ajh/hpad009
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Article ; Online: Ultra-high dose intravenous nitroglycerin in an ESRD patient with acutely decompensated heart failure.

Gyory, Michael / Abdallah, Samantha / Lagina, Anthony / Levy, Phillip D / Twiner, Michael J

Journal of the American College of Emergency Physicians open

2021 Volume 2, Issue 2, Page(s) e12387

Abstract: Acute cardiogenic pulmonary edema is a highly unstable and potentially lethal condition that is most commonly associated with markedly elevated blood pressure (BP). Use of nitrates, diuretics, and non-invasive positive pressure ventilatory support are ... ...

Abstract	Acute cardiogenic pulmonary edema is a highly unstable and potentially lethal condition that is most commonly associated with markedly elevated blood pressure (BP). Use of nitrates, diuretics, and non-invasive positive pressure ventilatory support are the mainstays of early intervention and stabilization. Use of high-dose bolus intravenous nitroglycerin, which causes both preload and afterload reduction, has shown significant promise in studies to date, reducing the need for endotracheal intubation (ETI) and intensive care unit admission. To date, the highest recorded total dose of nitroglycerin used during the initial stabilization of acute pulmonary edema has been 20 mg. Here, we describe a patient with end-stage renal disease who developed acute cardiogenic pulmonary edema and received a total of 59 mg nitroglycerin (56 mg push dose intravenous + 3 mg intravenous drip) over 41 minutes leading to successful stabilization and avoidance of ETI, facilitating rapid initiation of emergent hemodialysis.
Language	English
Publishing date	2021-03-02
Publishing country	United States
Document type	Case Reports
ISSN	2688-1152
ISSN (online)	2688-1152
DOI	10.1002/emp2.12387
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Article: Randomized Controlled Trial of a Novel Silicone Device for the Packing of Cutaneous Abscesses in the Emergency Department: A Pilot Study.

Brody, Aaron / Gallien, John / Reed, Brian / Hennessy, John / Twiner, Michael J / Marogil, Jerry

Open access emergency medicine : OAEM

2021 Volume 13, Page(s) 335–341

Abstract: Objective: Traditional treatment of abscesses in the emergency department includes packing with gauze; however, this can add pain and discomfort to the procedure and frequently involves a follow-up visit for packing removal. Alternatives to gauze ... ...

Abstract	Objective: Traditional treatment of abscesses in the emergency department includes packing with gauze; however, this can add pain and discomfort to the procedure and frequently involves a follow-up visit for packing removal. Alternatives to gauze packing have been proposed, but they may have disadvantages in the context of emergency care. The objective of this pilot study was to investigate the use of a novel silicone packing device - the Derma-Stent. Methods: This was a randomized controlled pilot study of 50 patients from two urban emergency departments with uncomplicated superficial abscesses. The primary outcome was the likelihood of self-removal of packing gauze versus the silicone device. Secondary outcome measures included subjective clinician and patient metrics, such as pain and ease of use. Results: Patients identified with simple cutaneous abscesses were randomized to intervention (packing with the novel silicone device, n=25) or standard care (gauze packing, n=25). Mean age was 36 years, 54% were female, and 96% identified as African American. Although it took longer to place, the silicone device (19.0 vs 15.3 minutes, Conclusion: This pilot randomized controlled trial compared the treatment of packing cutaneous abscesses with gauze versus using the silicone device. Limitations in the data prevent discussion on likelihood of self-removal. However, the silicone device was more likely to remain in place at day 3 follow-up and was equally effective to gauze packing in abscess reduction while also improving patient-reported pain scores. It did take longer to place the silicone device; however, physicians reported better ease of use and removal. This pilot study is encouraging for additional larger-scale trials that are required to further assess the utility of this device in the emergency department.
Language	English
Publishing date	2021-07-27
Publishing country	New Zealand
Document type	Case Reports ; Clinical Trial
ZDB-ID	2520704-0
ISSN	1179-1500
ISSN	1179-1500
DOI	10.2147/OAEM.S317713
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Article ; Online: Public Housing Resident Perspectives on Smoking, Barriers for Smoking Cessation, and Changes in Smoking Mandates.

Foster, Bethany / Ledgerwood, David M / Struble, Cara A / Fodor, Marina C / Jordan, Parada / Krishnan, Abhinav C / Turner, Beverly / Pearson, Claire / Twiner, Michael J / Levy, Phillip D

Inquiry : a journal of medical care organization, provision and financing

2022 Volume 59, Page(s) 469580221092814

Abstract: Background: Individuals from low-income groups report disproportionate rates of cigarette use, secondhand smoke (SHS) exposure with increased morbidity and mortality. Smoking bans in public housing have been enacted in attempt to reduce tobacco use and ... ...

Abstract	Background: Individuals from low-income groups report disproportionate rates of cigarette use, secondhand smoke (SHS) exposure with increased morbidity and mortality. Smoking bans in public housing have been enacted in attempt to reduce tobacco use and SHS exposure among lower income individuals. This study investigated the support needs of tobacco users living in two public housing complexes in Detroit, Michigan (USA), including their perspectives on smoking, resources and barriers for smoking cessation, and the impact of policy changes. Methods: This is a mixed-methods study, using a qualitative focus groups approach and a short survey, public housing residents interview data was analyzed to explore themes related to smoking-related issues. Specifically, six themes were assessed across four focus groups: (1) Quitting Smoking, (2) Current Smoking Cessation Resources, (3) Legal Mandates, (4) Education and Perceptions of Smoking, (5) Community Needs and Barriers, and (6) Medical Experiences. Results: There were 59 participants; the majority (39/42, 93%) of smokers reported at least one quit attempt. During the focus groups, several participants indicated a desire to quit smoking but reported barriers to smoking cessation, such as lack of access to medications, social triggers to continue smoking, and socioeconomic stressors. A number of suggestions were provided to improve smoking cessation resources, including support groups, graphic images of smoking-related diseased tissue, and better communication with health care providers. Conclusions: These findings demonstrate smoking bans in two public housing complexes can be effective yet are dependent upon a complex set of issues, including numerous barriers to care.
MeSH term(s)	Focus Groups ; Humans ; Public Housing ; Smoke-Free Policy ; Smoking/epidemiology ; Smoking Cessation/methods
Language	English
Publishing date	2022-04-11
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	42153-4
ISSN	1945-7243 ; 0046-9580
ISSN (online)	1945-7243
ISSN	0046-9580
DOI	10.1177/00469580221092814
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Article ; Online: Angiotensin-converting enzyme inhibitors increase anti-fibrotic biomarkers in African Americans with left ventricular hypertrophy.

A Romero, Cesar / Mathew, Shobi / Wasinski, Benjamin / Reed, Brian / Brody, Aaron / Dawood, Rachelle / Twiner, Michael J / McNaughton, Candace D / Fridman, Rafael / Flack, John M / Carretero, Oscar A / Levy, Phillip D

Journal of clinical hypertension (Greenwich, Conn.)

2021 Volume 23, Issue 5, Page(s) 1008–1016

Abstract: Angiotensin-converting enzyme inhibitors (ACEi) are part of the indicated treatment in hypertensive African Americans. ACEi have blood pressure-independent effects that may make them preferred for certain patients. We aimed to evaluate the impact of ACEi ...

Abstract	Angiotensin-converting enzyme inhibitors (ACEi) are part of the indicated treatment in hypertensive African Americans. ACEi have blood pressure-independent effects that may make them preferred for certain patients. We aimed to evaluate the impact of ACEi on anti-fibrotic biomarkers in African American hypertensive patients with left ventricular hypertrophy (LVH). We conducted a post hoc analysis of a randomized controlled trial in which hypertensive African American patients with LVH and vitamin D deficiency were randomized to receive intensive antihypertensive therapy plus vitamin D supplementation or placebo. We selected patients who had detectable lisinopril (lisinopril group) in plasma using liquid-chromatography/mass spectrometry analysis and compared them to subjects who did not (comparison group) at the one-year follow-up. The pro-fibrotic marker type 1 procollagen C-terminal propeptide (PICP) and the anti-fibrotic markers matrix metalloproteinase-1 (MMP-1), tissue inhibitor of metalloproteinases 1 (TIMP-1), telopeptide of collagen type I (CITP), and N-acetyl-seryl-aspartyl-lysyl-proline (Ac-SDKP) peptide were measured. Sixty-six patients were included, and the mean age was 46.2 ± 8 years. No difference was observed in the number and intensity of antihypertensive medications prescribed in each group. Patients with detectable lisinopril had lower blood pressure than those in the comparison group. The anti-fibrotic markers Ac-SDKP, MMP-1, and MMP-1/TIMP-1 ratio were higher in patients with detectable ACEi (all p < .05). In a model adjusted for systolic blood pressure, MMP-1/TIMP-1 (p = .02) and Ac-SDKP (p < .001) levels were associated with lisinopril. We conclude that ACEi increase anti-fibrotic biomarkers in hypertensive African Americans with LVH, suggesting that they may offer added benefit over other agents in such patients.
MeSH term(s)	Adult ; African Americans ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Biomarkers ; Humans ; Hypertension/drug therapy ; Hypertrophy, Left Ventricular/drug therapy ; Middle Aged
Chemical Substances	Angiotensin-Converting Enzyme Inhibitors ; Biomarkers
Language	English
Publishing date	2021-03-10
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2077222-1
ISSN	1751-7176 ; 1524-6175
ISSN (online)	1751-7176
ISSN	1524-6175
DOI	10.1111/jch.14206
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Article ; Online: Does Vitamin D Provide Added Benefit to Antihypertensive Therapy in Reducing Left Ventricular Hypertrophy Determined by Cardiac Magnetic Resonance?

Levy, Phillip D / Twiner, Michael J / Brody, Aaron M / Dawood, Rachelle / Reed, Brian / Mango, LynnMarie / Gowland, Laura / Grandits, Greg / Svendsen, Kenneth / Haacke, Ewart Mark / Li, Tao / Zhang, Liying / McNaughton, Candace D / Flack, John M

American journal of hypertension

2022 Volume 36, Issue 1, Page(s) 50–62

Abstract: Background: Left ventricular hypertrophy (LVH) and vitamin D deficiency have been linked to hypertension (HTN) and cardiovascular disease, particularly in African Americans (AAs). Our objective was to determine if the addition of vitamin D to ... ...

Abstract	Background: Left ventricular hypertrophy (LVH) and vitamin D deficiency have been linked to hypertension (HTN) and cardiovascular disease, particularly in African Americans (AAs). Our objective was to determine if the addition of vitamin D to antihypertensive therapy would lead to greater regression of LV mass index (LVMI) as determined by cardiac magnetic resonance (CMR) after 1 year in vitamin D deficient AA patients with uncontrolled HTN and LVH. Methods: This study was a randomized, double-blind, placebo-controlled, single-center study. AA patients with HTN (systolic blood pressure [BP] >160 mm Hg), increased LVMI, and vitamin D deficiency (<20 ng/ml) were randomized. All patients received antihypertensive therapy combined with biweekly 50,000 IU vitamin D3 (vitamin D group, n = 55) or placebo (placebo group, n = 58). Results: At 1 year, there were no statistical differences between the vitamin D and placebo groups in LVMI (-14.1 ± 14.6 vs. -16.9 ± 13.1 g/m2; P = 0.34) or systolic BP (-25.6 ± 32.1 vs. -25.7 ± 25.6 mm Hg; P = 0.99) reduction, respectively. Serum vitamin D levels increased significantly in the vitamin D group compared with placebo (12.7 ± 2.0 vs. 1.8 ± 8.2 ng/ml; P < 0.001). Conclusions: In this high-risk cohort of AAs we did not find an association between vitamin D supplementation and differential regression of LVMI or reduction in systolic BP. However, our study suffered from a small sample size with low statistical power precluding a definitive conclusion on the therapeutic benefit of vitamin D in such patients. Clinical trials registration: Trial Number NCT01360476. Full trial protocol is available from corresponding author.
MeSH term(s)	Humans ; Vitamin D ; Hypertrophy, Left Ventricular/diagnostic imaging ; Hypertrophy, Left Ventricular/drug therapy ; Hypertrophy, Left Ventricular/etiology ; Antihypertensive Agents/therapeutic use ; Antihypertensive Agents/pharmacology ; Hypertension/complications ; Hypertension/diagnosis ; Hypertension/drug therapy ; Vitamins/therapeutic use ; Blood Pressure ; Vitamin D Deficiency/complications ; Vitamin D Deficiency/diagnosis ; Vitamin D Deficiency/drug therapy ; Magnetic Resonance Spectroscopy
Chemical Substances	Vitamin D (1406-16-2) ; Antihypertensive Agents ; Vitamins
Language	English
Publishing date	2022-10-01
Publishing country	United States
Document type	Randomized Controlled Trial ; Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	639383-4
ISSN	1941-7225 ; 1879-1905 ; 0895-7061
ISSN (online)	1941-7225 ; 1879-1905
ISSN	0895-7061
DOI	10.1093/ajh/hpac096
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Article ; Online: Effect of Lower Blood Pressure Goals on Left Ventricular Structure and Function in Patients With Subclinical Hypertensive Heart Disease.

Levy, Phillip D / Burla, Michael J / Twiner, Michael J / Marinica, Alexander L / Mahn, James J / Reed, Brian / Brody, Aaron / Ehrman, Robert / Brodsky, Allie / Zhang, Yiying / Nasser, Samar A / Flack, John M

American journal of hypertension

2020 Volume 33, Issue 9, Page(s) 837–845

Abstract: Background: Subclinical hypertensive heart disease (SHHD) is a precursor to heart failure. Blood pressure (BP) reduction is an important component of secondary disease prevention in patients with SHHD. Treating patients with SHHD utilizing a more ... ...

Abstract	Background: Subclinical hypertensive heart disease (SHHD) is a precursor to heart failure. Blood pressure (BP) reduction is an important component of secondary disease prevention in patients with SHHD. Treating patients with SHHD utilizing a more intensive BP target (120/80 mm Hg), may lead to improved cardiac function but there has been limited study of this, particularly in African Americans (AAs). Methods: We conducted a single center, randomized controlled trial where subjects with uncontrolled, asymptomatic hypertension, and SHHD not managed by a primary care physician were randomized to standard (<140/90 mm Hg) or intensive (<120/80 mm Hg) BP therapy groups with quarterly follow-up for 12 months. The primary outcome was the differences of BP reduction between these 2 groups and the secondary outcome was the improvement in echocardiographic measures at 12 months. Results: Patients (95% AAs, 65% male, mean age 49.4) were randomized to the standard (n = 65) or the intensive (n = 58) BP therapy groups. Despite significant reductions in systolic BP (sBP) from baseline (-10.9 vs. -19.1 mm Hg, respectively) (P < 0.05), no significant differences were noted between intention-to-treat groups (P = 0.33) or the proportion with resolution of SHHD (P = 0.31). However, on post hoc analysis, achievement of a sBP <130 mm Hg was associated with significant reduction in indexed left ventricular mass (-6.91 gm/m2.7; P = 0.008) which remained significant on mixed effect modeling (P = 0.031). Conclusions: In post hoc analysis, sBP <130 mm Hg in predominantly AA patients with SHHD was associated with improved cardiac function and reverse remodeling and may help to explain preventative effects of lower BP goals. Clinical trials registration: Trial Number NCT00689819.
MeSH term(s)	Adult ; African Americans ; Antihypertensive Agents/therapeutic use ; Asymptomatic Diseases ; Echocardiography ; Female ; Heart Atria/diagnostic imaging ; Heart Atria/pathology ; Heart Ventricles/diagnostic imaging ; Heart Ventricles/pathology ; Humans ; Hypertension/drug therapy ; Hypertension/physiopathology ; Hypertrophy, Left Ventricular/diagnostic imaging ; Hypertrophy, Left Ventricular/etiology ; Hypertrophy, Left Ventricular/physiopathology ; Male ; Middle Aged ; Organ Size ; Patient Care Planning ; Treatment Outcome ; Ventricular Dysfunction, Left/diagnostic imaging ; Ventricular Dysfunction, Left/etiology ; Ventricular Dysfunction, Left/physiopathology ; Ventricular Function, Left
Chemical Substances	Antihypertensive Agents
Language	English
Publishing date	2020-07-01
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	639383-4
ISSN	1941-7225 ; 1879-1905 ; 0895-7061
ISSN (online)	1941-7225 ; 1879-1905
ISSN	0895-7061
DOI	10.1093/ajh/hpaa108
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Article ; Online: Structure-Activity Relationship Studies Using Natural and Synthetic Okadaic Acid/Dinophysistoxin Toxins.

Twiner, Michael J / Doucette, Gregory J / Pang, Yucheng / Fang, Chao / Forsyth, Craig J / Miles, Christopher O

Marine drugs

2016 Volume 14, Issue 11

Abstract: Okadaic acid (OA) and the closely related dinophysistoxins (DTXs) are algal toxins that accumulate in shellfish and are known serine/threonine protein phosphatase (ser/thr PP) inhibitors. Phosphatases are important modulators of enzyme activity and cell ... ...

Abstract	Okadaic acid (OA) and the closely related dinophysistoxins (DTXs) are algal toxins that accumulate in shellfish and are known serine/threonine protein phosphatase (ser/thr PP) inhibitors. Phosphatases are important modulators of enzyme activity and cell signaling pathways. However, the interactions between the OA/DTX toxins and phosphatases are not fully understood. This study sought to identify phosphatase targets and characterize their structure-activity relationships (SAR) with these algal toxins using a combination of phosphatase activity and cytotoxicity assays. Preliminary screening of 21 human and yeast phosphatases indicated that only three ser/thr PPs (PP2a, PP1, PP5) were inhibited by physiologically saturating concentrations of DTX2 (200 nM). SAR studies employed naturally-isolated OA, DTX1, and DTX2, which vary in degree and/or position of methylation, in addition to synthetic 2-
MeSH term(s)	Antineoplastic Agents/toxicity ; Cell Survival/drug effects ; Enzyme Inhibitors/chemistry ; Enzyme Inhibitors/pharmacology ; Eutrophication ; Humans ; Jurkat Cells ; Marine Toxins/chemistry ; Okadaic Acid/toxicity ; Phosphoprotein Phosphatases/antagonists & inhibitors ; Pyrans/toxicity ; Shellfish Poisoning ; Structure-Activity Relationship
Chemical Substances	Antineoplastic Agents ; Enzyme Inhibitors ; Marine Toxins ; Pyrans ; Okadaic Acid (1W21G5Q4N2) ; Phosphoprotein Phosphatases (EC 3.1.3.16) ; dinophysistoxin 2 (RH78DHY1JZ)
Language	English
Publishing date	2016-11-04
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2175190-0
ISSN	1660-3397 ; 1660-3397
ISSN (online)	1660-3397
ISSN	1660-3397
DOI	10.3390/md14110207
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