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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Antihypertensive therapy was performed in 47 patients having severe or malignant hypertension. The duration of the survey was two years. A highly significant decrease in blood pressure was observed. The decrease was not dependent on the type of antihypertensive treatment. Renal function was reduced at the beginning of the treatment. The renal insufficiency partly or totally diminished in course of time. Coronary insufficiency was noted in 5 patients. Coronarography showed thrombotic atherosclerosis in only one patient. A significant increase in lipids, cholesterol and triglycerids was nearly constant. The meaning of such facts is discussed.
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PMID:[Medically treated severe arterial hypertension. Long term course]. 80 10

Ambulatory blood pressure monitoring can determine the average blood pressure level and the short- and long-term blood pressure variability (circadian rhythm). The circadian blood pressure rhythm appears to be mediated mainly by the circadian rhythm of the sympathetic tone which is linked to changes in physical and mental activity, e.g. the waking-sleeping cycle. A statistically significant circadian blood pressure rhythm was observed in approximately 80% of mild to moderate essential hypertensive patients as well as in normal subjects. However, in patients with Cushing's syndrome, under glucocorticoid treatment, or with hyperthyroidism, central and/or peripheral autonomic dysfunction (Shy-Drager syndrome, spinal cord injury, brainstem lesions, diabetic neuropathy, uremic neuropathy, etc), chronic renal failure, eclampsia, malignant hypertension, sleep apnea syndrome or systemic atherosclerosis, the normal circadian blood pressure rhythm appears to be eliminated or reversed, while in those with primary aldosteronism, renovascular hypertension, pheochromocytoma without paroxysmal hypertension, diabetes insipidus, acromegaly, hyperparathyroidism or hyperprolactinemia, the nocturnal blood pressure fall has been observed as in normal subjects. The alteration in the circadian blood pressure rhythm was observed with different pathophysiological conditions, although no specific pattern was observed for any condition. A disturbance in any part of the hierarchy of factors that regulate the circadian rhythm of sympathetic neural tone seems to disturb the circadian blood pressure rhythm. We conclude that ambulatory blood pressure monitoring is not critically important in the diagnosis of secondary hypertension although it does help in screening for secondary hypertension.
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PMID:Does ambulatory blood pressure monitoring improve the diagnosis of secondary hypertension? 208 1

The daily variation in blood pressure (circadian blood pressure rhythm) is characterized by a nocturnal fall and a diurnal rise. The circadian blood pressure rhythm seems to be mediated mainly by the circadian rhythm of sympathetic tone, linked to changes in physical and mental activities, e.g. the waking-sleeping cycle. Statistically significant circadian blood pressure rhythms have been confirmed in approximately 80% of mild to moderate essential hypertensive patients as well as in normal subjects. However, the normal pattern of circadian blood pressure rhythm is reversed in elderly people and in those with Cushing's syndrome, those undergoing glucocorticoid treatment, and those with hyperthyroidism, central and/or peripheral autonomic dysfunction (Shy-Drager syndrome, tetraplegia, diabetic or uremic neuropathy, etc), chronic renal failure, renal or cardiac transplantation, congestive heart failure, eclampsia, sleep apnea syndrome, malignant hypertension, systemic atherosclerosis and accelerated hypertensive organ damage. However, in those with primary aldosteronism, renovascular hypertension, pheochromocytoma without paroxysmal hypertension, or those with cardiac pacing, a nocturnal blood pressure fall is ordinarily observed. It may be that a fall in cardiac output rather than in peripheral resistance may be mainly responsible for the nocturnal fall in blood pressure. It also seems that a nocturnal heart rate fall is not responsible for it, since the nocturnal blood pressure fall remained unchanged in patients undergoing cardiac pacing and was disturbed in patients with Cushing's syndrome or hyperthyroidism in whom the circadian heart rate rhythm remained unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Circadian blood pressure variations under different pathophysiological conditions. 209 80

Hypertension can directly damage blood vessels, and leads to renal failure, intracranial bleeds, and lacunar infarctions. Of equal importance is the effect of hypertension on the development of atherosclerosis. Specific changes in both the microvasculature and macrovasculature vary depending on the degree and rapidity of blood pressure elevation. Changes in the intima and media can lead to significant narrowing of vessels and ischemia in various tissues. In addition, changes in small-resistance vessels contribute to changes in peripheral-vasculature resistance and thus affect blood pressure regulation. Treatment of moderate to severe elevation in blood pressure clearly results in a decrease in the incidence of stroke. However, evidence that treating mild hypertension reduces coronary events is less convincing. Antihypertensive therapy may result in partial regression of vascular changes, especially fibrinoid necrosis seen in malignant hypertension, but more work needs to be done to clearly define the roles of specific drugs in preventing or regressing hypertensive vascular disease.
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PMID:Vascular changes in hypertension. 330 5

We have tried to compare the proliferative responses seen in two vascular diseases: atherosclerosis and hypertension. Both diseases involve endothelial injury and proliferation, but our knowledge of this phenomenon is just beginning to emerge. In atherosclerosis the best evidence is that denudation does not occur in the normal young animal. Man, however, ages over a much longer time than our usual animal models, and the study of denudation during the chronic progression of atherosclerotic lesions remains to be done. We need to consider the possibility that repetitive, small lesions may occur at sites of endothelial turnover. We also need to know more about the possible role of nondenuding injuries, including death of endothelial cells in situ and the apparent increased stickiness of endothelial cells and monocytes during the early stages of hypercholesterolemia. The role of endothelial injury in hypertension also needs more study. We know that extensive denudation and thrombosis occur in small vessels subjected to high blood pressure. It is highly probable that release of PDGF occurs at these sites, possibly accounting for the characteristic hyperplasia seen in malignant hypertension. Whether this process is related to the more subtle changes in vessel wall mass seen in chronic hypertension remains unknown. Finally, there are remarkable differences in the proliferative behavior of the smooth muscle cells themselves in these two diseases. Hypertensive vascular disease is, in large part, a disease of the media. Atherosclerosis is characterized by intimal hyperplasia. Injury results in migration of smooth muscle cells from the media and cell division in the intima. It is possible to identify chemotactic factors using putative atherosclerosis risk factors or normal components of serum. This has already been done for one component of lesion formation, PDGF, and there is a report of a monocyte chemotactic factor released by smooth muscle cells. Factors released by other components of lesions may be of considerable interest. In contrast, changes in hypertension occur within a more orderly preservation of vessel wall structure. The wall thickens, but this occurs by increased synthesis of cell mass in the media. The cells themselves do not even divide, but they undergo a form of amitotic replication of their DNA.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Cellular proliferation in atherosclerosis and hypertension. 637 94

After some introductory remarks on the definition of the various forms of hypertension, a short description of the changes in arterial vessels associated with hypertension is given. Hypertension is by no means a prerequisite for atherosclerosis and arteriolosclerosis, but hypertension enhances such vascular changes. In malignant hypertension, typical fibrinoid arteriolonecroses occur. Hypertension leads to hypertrophy of the left ventricle through enlargement of individual muscle fibres, but numeric hyperplasia also occurs. At the same time, coronary atherosclerosis may be aggravated by systemic hypertension. Hypertrophy together with coronary sclerosis may result in various forms of ischemic heart disease among which myocardial infarction and its complications are the most important ones. There are intimate mutual interactions between hypertension and ischemic renal damages, the most important of which are briefly discussed. Again, many of these changes do not necessarily require hypertension as a prerequisite. Massive haemorrhage into the substance of the brain is usually associated with systemic arterial hypertension, but requires predisposing atherosclerosis and arteriolosclerosis: Walls of healthy arteries do not give way, however high the blood pressure may be.
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PMID:[Some pathologico-anatomic substrates of hypertensive lesions]. 686 18

Persistent inappropriate blood pressure elevation leads to the development of left ventricular hypertrophy, progressive atherosclerosis, and structural changes in the arterial tree. These changes result in clinical manifestations such as ischemic cardiac and cerebral events, congestive heart failure, renal failure, and peripheral vascular insufficiency. This article reviews the 5-year course of 439 patients with primary hypertension who were seen at a time (1946-1953) when potent antihypertensive therapy was not widely used. At the end of 5 years, 55% of the men (78 of 143) and 28% of the women (83 of 296) were dead. The principal causes of death were coronary insufficiency, congestive heart failure, cerebral infarction and hemorrhage, accelerated hypertension, renal failure, and dissecting aneurysm of the aorta. Coronary insufficiency and accelerated hypertension predominated in men, whereas women died principally of cerebral events and congestive heart failure. The 439 patients were stratified according to the level of their office blood pressure on the first visit, the severity of the changes in the optic fundi, the degree of left ventricular hypertrophy determined by electrocardiogram, cardiac enlargement determined by roentgenogram and their renal function, as measures of end-organ damage. Patients who had higher initial blood pressures showed more evidence of end-organ damage than patients with lower initial pressures. The higher the initial blood pressure or the more advanced the evidence of end-organ damage, the greater was the 5-year mortality. The mortality was particularly high in patients who had already sustained a clinical cardiovascular event before entry into the study and in those with malignant hypertension or gross cardiomegaly.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Retrospective and prospective research on hypertension-related end-organ damage. 760 71

One hundred cases of hypertensive complications due to irregular drug-therapy were studied in medicine units of Dhaka Medical College Hospital for the period of one year from February 7, 1989 to February 6, 1990. Among those stroke had headed the list (48%) manifesting in various ways e.g. cerebral haemorrhage with focal neurological signs--hemiplegia, hemiperesis, aphasia etc. Hypertension associated with varying degrees of cardiac ischaemias and heart failure was seen in 14% and 10% cases respectively. Highest incidence of complications was seen in 1-5 years after detection of hypertension with mean age of 55 +/- 18.70 years. Out of 48 cases of strokes, smoker were 41 (75.92%). Regarding reasons of noncompliance of drugs, personal carelessness was the prominent one (47%). Among the risk-factors for atherosclerosis family history tops the list (66%). Diabetes coexists with hypertension in 13% cases. Ocular complications were seen in 06% cases of malignant hypertension with variable retinal changes.
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PMID:Study of complications in hypertensive patients having irregular treatment. 803 Dec 88

New South African guidelines are proposed by the Hypertension Society of Southern Africa for the management of hypertension by primary health care services in South Africa. Specific South African guidelines are appropriate for hypertension, which is now recognised as one of the five major diseases that must be given priority by the new Government. Furthermore, patient participation and empowerment in blood pressure (BP) control become feasible through the new concept of lifestyle modification. This article gives the rationale underpinning these guidelines. The correct methods to measure blood pressure (BP), with patients sitting for 5 minutes, correct cuff-size and repeated readings, are emphasised to eliminate the 'white coat' effect and ensure accurate BP readings. The rationale for the overall management of all atherosclerosis-related risk factors is given, as are the principles of non-drug hypertension treatment and patient education. We emphasise that patients must understand hypertension to be a risk factor and not a disease. Patients should also be empowered to contribute to effective BP control. The justification for the chosen BP levels at which specific action is required by the primary health care team is given. The BP levels span the range from mild hypertension, requiring conservative treatment schedules, to possible malignant hypertension, which requires urgent management and referral to the appropriate level of care. The motivation for cost-effective antihypertensive drug therapy is provided. The recommended initiation of drug therapy is with effective, safe low-cost drugs. Suggested first-line therapy comprises lifestyle management and low-dose diuretics. The second-line drugs, in order of increasing price, are low-dose reserpine, or a beta-blocker, or a calcium blocker, or an ACE inhibitor. For third-line therapy hydralazine is chosen, or other second-line drugs could be added. Where possible, the examples of specific drugs given are those for which a generic is available, to ensure cost-containment. The motivation for drug choices for hypertension in special cases such as pregnancy, the elderly, blacks and patients with diabetes and renal disease is given. The management of malignant hypertension receives special attention.
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PMID:Rationale for the hypertension guidelines for primary care in South Africa. 860 Jun 5

NMR tomography (NMRT) of the brain and NMR angiography (NMRA) of the extra- and intracranial arteries were performed on the unit Magnetom 63 SP (1.5 T) Siemens in 13 healthy controls and 87 patients with cerebrovascular diseases initiated by arterial hypertension and atherosclerosis of major cerebral arteries. NMRA image of arterial impairment comprise curved extracranial arteries. NMRT picture of the brain was changed (extension of liquor spaces, small hyperintensive foci in the white matter) in mild and moderate hypertension. Frequency of these phenomena and their severity increase with growing severity of the disease reaching maximum in malignant hypertension. In atherosclerosis of the major cerebral arteries NMRT often detected strokes, for the most part ischemic. A direct relationship between the degree of arterial stenosis and incidence of the strokes was not found.
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PMID:[The clinical aspect of the joint use of magnetic resonance tomography of the brain and magnetic resonance angiography of the extra- and intracranial arteries in patients with arterial hypertension]. 900 7


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