Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

During the last 3 yr a large number of patients with renal artery stenosis have undergone attempted treatment of their stenosis by the technique termed percutaneous transluminal angioplasty or dilatation (PTD) using the balloon tipped catheter developed by Gruntiz. A number of publications have documented that this technique is reasonably safe and effective in renal artery lesions due to fibromuscular disease (FMD), atherosclerosis (AS), or prior surgery such as renal artery bypass or transplantation. Although initially many of the patients that were treated were felt to be poor surgical risks, many patients have now been treated who were excellent candidates for renal artery bypass. The cumulative experience argues that PTD should be the first treatment tried in any patient with significant renal artery stenosis causing hypertension. It should be noted that the cumulative experience is not based on any controlled trial and therefore may well be biased. Nevertheless, I will present this argument based on the published data and our own experience at Indiana University. This argument pertains to any patient with incomplete renal artery occlusion who has a functionally significant stenosis (determined by renal vein renin sampling) and who is a good surgical candidate. Those patients who are at high risk for major surgery will obviously be best treated by PTD or medical management. The argument has four major points: safety, effectiveness, cost analysis, and availability.
 ...
PMID:Percutaneous transluminal dilatation: the treatment of choice for renal artery stenosis causing hypertension. 646 Apr 40

The availability of pharmacologic agents has contributed to a reduction in the morbidity and mortality of hypertensive cardiovascular disease. However, antihypertensive agents are associated with changes that may adversely affect patients receiving therapy. Nutritional and metabolic consequences of antihypertensive therapy may be associated with enhanced atherosclerosis. The abnormalities in lipid metabolism, carbohydrate tolerance, and changes in the renin-angiotensin-aldosterone axis are reviewed. The mechanisms by which antihypertensive therapy causes these complications are unknown and their exact role in hypertensive cardiovascular disease remains to be elucidated. Appropriate selection of therapeutic agents and dietary manipulations may minimize the metabolic and nutritional consequences of antihypertensive therapy.
 ...
PMID:Metabolic consequences of antihypertensive therapy. 684 29

Four groups of New Zealand rabbits were used to study the effect of plasma renin activity (PRA) on atherogenesis. Control groups were fed normal rabbit chow (Group I) or chow supplemented with 0.25% cholesterol and 0.75% corn oil (Group II). The two-kidney--one-clip (2K-1C) hypertensive model was produced in 2 additional groups; Group III (normal diet) and Group IV (atherogenic diet). The latter 2 groups were subgrouped according to PRA levels. Each group was examined over a 7-month period. Group II became hyperlipidemic and developed extensive lipoidal vascular lesions. Mean arterial pressure remained normal throughout the experimental period; PRA fell below normal. Group III and Group IV rabbits developed sustained hypertension irrespective of circulating PRA. The atheromas of Group III were predominantly microscopic and fibromuscular; the extent of aortic and coronary artery involvement was independent of renin response. The most extensive and complicated atheromas were seen in the 2K-1C rabbits consuming the atherogenic diet (Group IV). The lesions were mostly lipoidal, although some were fibromuscular. These results demonstrated that cardiovascular lesions and atherogenesis were exacerbated in the 2K-1C rabbits on a high cholesterol diet; however, PRA was excluded as the cause.
Atherosclerosis
PMID:Renin as a risk factor for atherogenesis. Effects of hypercholesterolemia and two-kidney--one-clip hypertension in the rabbit. 700 7

1. These results show that elevated blood pressure and a hyperlipidemic diet exacerbate atherogenesis in the two kidney, one-clip hypertensive rabbit. Elevated PRA activity was not essential for the hypertension and did not exacerbate atherogenesis. 2. In addition, the experimentally induced, low renin state following DOC-saline did not result in a protective effect on cardiovascular lesions in rabbits fed an atherogenic diet when compared to normal renin controls. 3. Thus, in these experiments neither an increase in plasma renin accelerated atherogenesis, nor did a decrease in PRA slow the rate of production of atherosclerosis in the rabbit. 4. These observations lend no support to the thesis that renin is an independent risk factor when it is generated within the body in response to these stimuli. Indeed, it suggests that in this setting other factors, not PRA, are responsible for both hypertension in the two-kidney, one-clip rabbit and the arterial damage which occurs in this hypercholesterolemic model.
 ...
PMID:Is renin a risk factor? 702 26

Seventy-two patients, aged 6-69 years, were operated on because of presumed renovascular hypertension and subjected to follow-up studies for 4-60 months (mean 28). Unilateral renal artery stenosis was present in 47 patients. Surgery was followed by normalization of blood pressure (BP) in 28 and improvement in 7, whereas 12 showed no response. Sixteen were below the age of 40 and only one failed to respond to surgery. Peripheral venous plasma renin activity (PRA) was increased in 32 and urinary aldosterone elevated in 22 of 35 patients responding favourably to surgery. Renal vein PRA was higher from the kidney with the stenotic renal artery as compared to the contralateral side in all patients responding to surgery. Preoperative peripheral PRA difference was also found in 7 of 12 patients not responding to surgery. Preoperative peripheral PRA was increased in 26 of the patients becoming normotensive after surgery. In 20 of these patients normalization of BP was associated with a fall in peripheral PR. Twenty-five patients had bilateral renal artery stenosis. Four of them had severe hypertension, renal insufficiency and generalized atherosclerosis. They died in immediate connection with operation. Unilateral operation, performed in 11 of the remaining 21 patients, was followed by normalization of BP in 3 and no response in 8. Bilateral reconstructive surgery, performed in 10 patients, resulted in normotension in 2 and improvement in 7. Our studies indicate that determination of peripheral PRA and/or urinary aldosterone can serve as a useful prognostic indicator after surgery in hypertensive patients with renal artery stenosis.
 ...
PMID:Pre- and postoperative studies in 72 hypertensive patients with renal artery stenosis, with special reference to renin activity and aldosterone. 703 32

Sixteen consecutive patients with renovascular hypertension were treated by transluminal dilatation and observed during 6 - 39 months (mean 21.8 months). Poststenotic renal artery pressure increased (p less than 0.001) and the renal arteries were patent on angiograms taken immediately after dilatation. In 13 patients, angiography was repeated 2 - 9 months later; at that time the selective renal vein renin ratio had decreased (p less than 0.001). At the end of the follow-up, blood pressure was improved or normal in 14 cases. One of the eight patients with atherosclerosis was normotensive without treatment, compared with five of six patients with fibromuscular dysplasia (p less than 0.05). The results in two cases with vasculitis are uncertain. The four patients with relapses, one after intimal catheter dissection, were treated successfully by redilatation. Thus, renovascular hypertension can be improved by transluminal dilatation in patients with atherosclerosis and in patients with fibromuscular dysplasia with lasting success and a low morbidity rate.
 ...
PMID:Lasting improvement of renovascular hypertension by transluminal dilatation of atherosclerotic and nonatherosclerotic renal artery stenoses. A follow-up study. 703 92

Four groups of New Zealand rabbits were used to study the effect of suppressed plasma renin activity (PRA) on atherogenesis. Control groups were fed normal rabbit chow (Group I) or normal chow supplemented with 0.25% cholesterol--0.75% corn oil (Group III). Group II animals were fed normal chow and received periodic injections of 11-desoxycorticosterone (DOC)pivalate and 0.5% saline to drink, while Group IV animals were treated similarly except that they were also fed the atherogenic diet. Blood pressure and blood chemistry measurements were performed monthly over a 7-month period. The blood pressure was unaffected by either the diet or the DOC-saline treatment, however, the PRA was greatly reduced in the animals receiving DOC-saline (Groups II and IV). Similarly, plasma aldosterone was significantly (P less than 0.05) reduced in the DOC-saline-treated animals. No atheromata were observed in the animals consuming the regular diet, regardless of DOC-saline treatment. All of the animals fed the atherogenic diet showed extensive aortic atheromata. However, there was no difference in the lesion index between the animals with normal PRA levels (Group III) and those with suppressed PRA levels (Group IV). Likewise, microscopic evaluation of the aorta, coronary arteries, and renal arteries failed to show a consistent difference in the vascular involvement between animals of Groups III and IV. We therefore conclude that the suppression of PRA does not have a protective effect on atherogenesis in the cholesterol-fed normotensive rabbit.
Atherosclerosis
PMID:Renin as a risk factor for atherogenesis. Part 2. Effects of hypercholesterolemia and hyporeninemia in the rabbit. 703 15

In a 10-year period, 7200 of 19,000 black hypertensive adults in the University of Cincinnati Medical Center were referred to the Hypertension Service. In selected patients, intravenous urograms (1038) and renal arteriograms (238) were performed; 47 cases of renovascular hypertension (0.65% of the referred group and 0.25% of the entire sample) were identified. Atherosclerosis (32 patients) and fibromuscular dysplasia (11) were the most common causes of renal artery obstruction. Other lesions included traumatic thrombosis (2), Leriche syndrome (1), and postrenal transplant anastomotic thrombosis (1). Twenty-four patients were operated on (6 cured, 14 improved, 4 dead) and 23 treated medically (18 improved, 2 unimproved, 3 dead). Surgical mortality was 0. Follow-up exceeded 5 years in 25 patients. Extrarenal vascular lesions were found in 30 patients and accounted for six of seven deaths. Renal vein renin ratios greater than 1.5:1 (affected to unaffected side) predicted successful surgery in 14 patients, but eight of nine operated patients with ratios less than 1.5:1 also had favorable results. Factors in addition to renin assay were weighed before surgery was recommended. Since renovascular hypertension is rare in adult blacks, intensive investigation for this entity is justified only in patients with distinct suggestive findings. Treatment results in blacks are similar to those in white cohorts.
 ...
PMID:Renovascular hypertension in black patients. 704 Feb 33

Several published reports describe an abnormal circadian blood pressure profile in chronic renal failure subjects. Factors other than renal failure, including age, diagnosis of diabetes mellitus, autonomic dysfunction, and race, also may affect circadian blood pressure profiles. To further elucidate the relationship between renal function and circadian blood pressure variation, we compared day/night circadian blood pressure changes in three groups of male veteran hypertensive patients: group A, creatinine clearance (CC) > 80 mL/min, n = 20; group B, CC 20 to 80 mL/min, n = 19; and group C, CC < 20 mL/min, n = 14. We use postural changes in catecholamines, renin, and aldosterone as a measure of autonomic function. No significant difference in day/night percent change in systolic, diastolic, mean arterial pressure (MAP), or heart rate was seen by renal function group. Regression analysis using age, diagnosis of diabetes mellitus, postural hormonal changes, and creatinine clearance found race to be the only significant predictor of the day/night percent change in MAP (P < 0.05). Compared with whites, black subjects had higher nocturnal heart rates (P = 0.01); smaller day/night heart rate changes (P = 0.03); significantly higher diastolic blood pressure (P = 0.01); and a trend toward smaller day/night change in diastolic blood pressure (P = 0.06). In conclusion, renal function level does not influence day/night blood pressure changes. The blunting or reversal of the normal circadian blood pressure pattern seen in some chronic renal failure hypertensive subjects may be attributable to the association between chronic renal failure and cofactors associated with abnormal circadian blood pressure, including black race and possibly severity of atherosclerosis.
 ...
PMID:Circadian blood pressure variation versus renal function. 748 22

Vascular angiotensin plays an important role in the long-term regulation of the blood vessel function and structure. Angiotensin stimulates vascular smooth-muscle cell growth via the induction of protooncogene and autocrine growth factor gene expressions. In hypertension, atherosclerosis and restenosis, vascular angiotensin activity is increased and participates in the pathobiology of these vascular diseases. Experimental data demonstrate that angiotensin-converting enzyme inhibitors can prevent vascular hypertrophy of hypertension, attenuate atherosclerosis, and inhibit neointimal hyperplasia of restenosis. Taken together, the data show that pharmacologic blockade of the vascular renin-angiotensin system may result in vascular protection. Ongoing clinical trials (MERCATOR, QUIET) will address the relevance of these experimental observations in clinical therapy.
 ...
PMID:Vascular renin-angiotensin system and vascular protection. 750 45


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>