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

Hypertension is quite common in the elderly population. Isolated systolic hypertension and diastolic hypertension are associated with cardiovascular complications. Like younger patients, the elderly may have labile hypertension. On the other hand, pseudohypertension, auscultatory gap, and postural hypotension are peculiar to the elderly. Obesity, atherosclerosis, arteriosclerosis, baroreceptor insensitivity, decline in renal function, physical inactivity, and insomnia are factors that can lead to or aggravate hypertension in older patients. Secondary hypertension should be suspected if elevated blood pressure first appears late in life or becomes resistant to previously adequate treatment. Spontaneous hypokalemia can indicate primary aldosteronism. Elevation in the serum creatinine level of a patient taking an angiotensin-converting enzyme (ACE) inhibitor suggests bilateral renovascular hypertension. The goal of antihypertensive therapy is to prevent morbidity, disability, and death from complications and to maintain quality of life. Psychosocial factors may play an important role in controlling hypertension. Nonpharmacologic treatment, such as weight loss, salt restriction, and exercise, should always be tried prior to and in conjunction with medical therapy. Antihypertensive drugs often cause side effects and should be prescribed with caution. Always start with a low dose and gradually increase it if necessary. All drugs that reduce blood pressure in the younger individual also work in the elderly. ACE inhibitors and calcium blockers are particularly useful because of their low incidence of adverse effects.
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PMID:Hypertension in elderly patients. The special concerns in this growing population. 154 24

There is some evidence that atherosclerosis and hypertension can already start in childhood or adolescence. For early detection in this age group, therefore regular blood pressure readings should be routine. Blood pressure in American and German children and adolescents is rising with age, in boys more than in girls; this phenomenon is not so striking in the Yanomamo-Indians. The frequency of hypertension in population studies of children and adolescents (systolic blood pressure above 139 mm Hg, diastolic blood pressure above 89 mm Hg) is 1-2% (fixed hypertension) vs. about 10% (labile hypertension).
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PMID:[Epidemiology of hypertension in childhood]. 666 51

The fatty acid pattern of serum triglycerides and FFA in normal untrained subjects, normotensive athletes, patients with labile and stable essential hypertension as well as in hypertensives with overweight and mild hypertriglyceridemia has been evaluated by gas liquid chromatography. The most striking differences revealed the linoleic acid in triglycerides being increased in athletes and in patients with labile hypertension in comparison with normotensive untrained controls and patients with stable hypertension. On the basis of these data an enhanced need of polyunsaturated fatty acids corresponding to probands with high physical activity has been assumed in patients with an early stage of essential hypertension. The differences of arachidonic acid were not so distinct. The results can be relevant with regard to the pathogenetic role of prostaglandin precursors in the development and course of essential hypertension and atherosclerosis.
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PMID:The fatty acid pattern of serum triglycerides and FFA in patients with essential hypertension of different stages, athletes, and normal subjects. 747 48

In this paper we present a case of a 60-year-old patient with labile hypertension, who was admitted to hospital because of unilateral exophthalmus and loss of vision of the left eye. During the hospitalization basic laboratory investigations, USG and NMR of orbits and arteriography of internal carotid arteries were carried out. Body temperature and arterial blood pressure were monitored. Leucocytosis and high values of arterial blood pressure in the early hours of the morning were found. Accessory investigations didn't explain the cause of exophthalmus. Repeated NMR of orbits showed image characteristic for retrobulbar haemorrhage in the left orbit. During the hospitalization hypotensive, anti-inflammatory and oedema-reducing treatment was administered, without surgical intervention. This case demonstrates that modern diagnostic investigations must be preceded by precise history taking concerning the early symptoms of the disease, its course and accompanying systemic diseases. Although spontaneous retrobulbar haemorrhages occur rarely, they must be taken into consideration in differential diagnosis of unilateral exophthalmus, especially in elderly patients with atherosclerosis and hypertension.
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PMID:[Unilateral exophthalmus in the course of spontaneous retrobulbar hemorrhage in a patient with arterial hypertension]. 934 Apr 22

Until recently, there has been little evidence substantiating the belief that mental stress provokes myocardial infarction and stroke, and aggravates atherosclerosis. However, recent advances in methodology for demonstrating effects of stress are now beginning to build a foundation of evidence that supports those beliefs. In monkeys, social stress doubles coronary atherosclerosis, and increases coronary spasm, and treatment with oestrogen, which improves endothelial function, reduces coronary spasm in relation to stress. In human beings, mental stress provokes myocardial ischaemia, and haemodynamic responses to mental stress predict progression of left ventricular enlargement, and progression of carotid atherosclerosis. These findings suggest that it may not be safe to withhold treatment of high office pressures in patients with white coat hypertension. There is now some evidence that stress management in the form of individualized cognitive behavioural interventions reduces blood pressure. Further work is needed to determine whether it is safe to withhold treatment in white-coat syndrome, and whether stress management can reduce atherosclerosis and ischaemic events.
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PMID:Neurocardiology. Stress and atherosclerosis. 948 93

To investigate further the relationship between atherosclerotic vascular disease and blood pressure, and the phenomenon of white coat hypertension, we performed a cross-sectional study of patients referred for carotid Doppler scanning, to determine the relationship between ambulatory blood pressure monitoring (ABPM) and carotid atherosclerosis. We studied 79 patients (51 men, 28 women) undergoing Doppler ultrasound examination of the carotid arteries: 44 (56%) had evidence of carotid atherosclerosis on Doppler ultrasound examination ("disease group"), whilst 35 (44%) had normal carotid arteries ("controls"). "Adequate" ABPM recordings, defined by > 90% of recordings over the 24 h, were available in 51 patients (30 positive, 21 negative). There were no significant differences in mean daytime, mean night-time or mean 24 h ABPM recordings between those with and without carotid atherosclerosis. Mean manual clinic systolic blood pressure was significantly greater in those with carotid atherosclerosis than in controls (146.7 +/- 25.2 vs 131.1 +/- 35 mmHg, p < 0.005). In patients with carotid atherosclerosis, the first systolic blood pressure ABPM recording was not significantly different from the mean manual clinic recording (mean difference -1.5 mmHg, 95% confidence interval (CI) -7.9 to 4.8 mmHg). The initial diastolic blood pressure ABPM recording was significantly higher than the mean manual recording. Carotid atherosclerosis was identified in 53% of normotensive controls compared with 56% of white coat hypertensives and 75% of persistent hypertensives. One-third (9/27) of the patients with normal carotid arteries did not have nocturnal dipping ("non-dippers") compared with 50% (12/24) of the atherosclerotic patients. This study suggests that carotid atherosclerosis may be associated with white coat hypertension. Our study adds to the body of evidence that white coat hypertension is associated with end-organ damage and is not simply a benign disease. Such patients should be screened for other cardiovascular risk factors and should be monitored for the development of persistent hypertension.
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PMID:White coat hypertension and carotid atherosclerosis. 1059 90

Patients with essential arterial hypertension either have or do not have compelling reasons for specific drug classes. Patients lacking a compelling reason for a specific drug class are those without target organ damage (e.g. left ventricular hypertrophy, microalbuminuria, proteinuria, atherosclerosis) and without comorbidities. In these patients antihypertensive treatment can be initiated with Diuretics and perhaps Betablockers. Calciumantagonists, ACE-Inhibitors and Angiotensin II-Receptorenblockers (Sartans) are unlikely to be superior. However, adverse effects, patient preferences and antihypertensive efficacy of a drug in the particular individual ultimately determine the "choice" of the medication. In patients with a compelling reason for an individual drug class, i.e., in patients with target organ damage (e.g. left ventricular hypertrophy, microalbuminuria, proteinuria) or very high cardiovascular risk (e.g. Diabetes) Angiotensin II-Receptorblockers or ACE-Inhibitors should be used initially. In many hypertensives blood pressure will normalize in response to a combination therapy only. Usually, addition of a low dose thiazide to another drug class is the most beneficial combination. In most patients resistant to therapy, a 24-h-ambulatory blood pressure measurement to exclude white coat hypertension or a white coat component, evaluation of medication compliance, non-pharmacological measures and the tailored use of diuretics and other optimizations of therapy will lead to success.
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PMID:[Modern therapy of hypertension]. 1470 54

Oxidative stress in sustained hypertension was shown with several biochemical parameters. Oxidized low-density lipoprotein (oxLDL) plays an important role during the atherosclerosis process and paraoxonase (PON1) can significantly inhibit lipid peroxidation. Serum PON1 activity, oxLDL and malondialdehyde (MDA) concentrations and their relationship with serum lipid parameters and systolic and diastolic blood pressures (SBP and DBP) were determined in subjects with white coat hypertension (WCH), sustained hypertension (HT) and normotension (NT). The study group consisted of a total of 86 subjects, 30 with WCH (14 male, 16 female subjects), 30 with HT (13 male, 17 female subjects) and 26 with NT (12 male, 14 female subjects). Both white coat hypertensive and hypertensive subjects had significantly higher levels of MDA than normotensives (P<0.026 and P<0.001, respectively). The oxLDL level of the HT group was significantly higher than the NT group (P<0.023). The WCH group had an oxLDL level similar to both hypertensive and normotensive groups. HT and WCH groups had significantly lower PON1 levels than the normotensive group (P<0.001). oxLDL correlated with MDA positively (P=0.008), and PON1 negatively (P=0.008). A negative correlation between MDA and PON1 (P=0.014) was detected. MDA correlated positively with both SBP and DBP (P=0.001), while PON1 correlated with both of them negatively (P=0.01 and P=0.008, respectively). OxLDL correlated with diastolic blood pressure positively (P=0.008). Our data demonstrate that oxidative stress increase in WCH is associated with a decrease in PON1 activity. The reduction in PON1 activity may be one of the factors leading to an increase in oxidative status in WCH.
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PMID:Oxidative stress in white coat hypertension; role of paraoxonase. 1498 79

Prevalence of pediatric hypertension has increased with the onset of obesity epidemic. Early detection and treatment of childhood hypertension is important due to its link with atherosclerosis in adult life. Accurate measurement of blood pressure is the key for the management and physicians should make effort to rule out the possibility of anxiety associated and white coat hypertension before the final diagnosis of hypertension. Secondary hypertension is more common in children as compared to adults but essential hypertension is also common in older children and adolescents. The younger children with severe hypertension are more likely to have secondary hypertension. Non-pharmacologic treatment should be tried before instituting the pharmacologic treatment, unless patient is symptomatic and has severe hypertension.
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PMID:Management of childhood hypertension: a guide for primary care physicians. 1719 Apr 13

The aim of the present study was to determine if there is any association between white coat hypertension (WCH) and body mass index. The study was performed in two phases. In the first phase, we studied consecutive underweight patients, while in the second phase, age-matched consecutive normal weight, overweight, and obese cases were studied. Although we detected 61 cases in the underweight group with a mean age of 24.1 years, we could only detect 12 age-matched cases in the obesity group, and thus the obesity group was not used for comparison. When we looked at the prevalences of sustained normotension (NT), WCH, and HT in the groups, there were gradual and significant increases in the prevalences of WCH in addition to the gradual and significant decreases in the sustained NT from the underweight towards the normal weight and overweight groups. Eventually, only 31.5% of the overweight group had sustained NT, even though the mean age of the cases was very young. Due to the gradually increased prevalence of WCH from the underweight towards the normal weight and overweight groups, parallel to the already known increasing prevalences of HT, type 2 diabetes mellitus, hyperbetalipoproteinemia, dyslipidemia, and coronary heart disease and the very low prevalence of sustained NT among the overweight cases even in the early decades here, WCH should preferentially be accepted as an alarming sign of excess weight and many associated disorders in the future, rather than just being considered a predisposing factor of HT or atherosclerosis alone.
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PMID:Prevalence of white coat hypertension in underweight and overweight subjects. 1799 70


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