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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

During the history taking and physical examination, several important diseases should be searched for before diagnosing essential hypertension. A critical investigation is repetitive abdominal auscultation for a bruit. In young patients with significant hypertension, coarctation of the aorta must be excluded by clinical examination. Investigations will especially be aimed at uncovering renal artery disease (relatively common) or a phaechromocytoma (relatively rare). The initial assessment must also diagnose associated diseases which will influence the type of therapy chose. Thus asthma and heart failure contraindicate beta-blockers, liver disease contraindicates methyldopa, severe depression contraindicates reserpine, methyldopa and beta-blockade, while diabetes or gout may be precipitated or aggravated by thiazide diuretics.
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PMID:Hypertension in general practice. Part I. Examination and investigation of a patient with hypertension. 744 97

The influence of the sympathetic nervous system on blood pressure control was impressively demonstrated in 1940 by bilateral excision of sympathetic nerve fibers. Thereafter, the first generation of drugs lowering blood pressure by central modulation of the sympathetic outflow through alpha 2-adrenoceptor for stimulation, such as alpha-methyldopa, guanabenz, clonidine, and guanfacine, were marketed. However, these compounds were often tolerated poorly, because they caused orthostatic hypotension, sedation, tachycardia or bradycardia, dry mouth, and reduced cardiac output. The mode of action of the second generation centrally acting antihypertensive drugs moxonidine and rilmenidine is different from that of the first generation compounds (e.g., clonidine). Contrary to clonidine, the newer drugs bind more selectively to I1-imidazoline receptors rather than to alpha 2-adrenoceptors where first-generation drugs act. The high affinity and selectivity of these two drugs for this recently discovered new receptor class make it possible to discriminate between I1-imidazoline receptor-mediated blood pressure lowering, on the one hand, and alpha 2-adrenoceptor-mediated side effects, on the other. Discrimination of the two effects was substantiated either by studies using moxonidine alone or in interaction experiments with I1-imidazoline receptor or alpha 2-adrenoceptor antagonists. The high selectivity of moxonidine at the I1-imidazoline receptor allows discrimination between alpha 2-adrenoceptors and I1-imidazoline receptors and is reflected in man by the relatively low incidence of adverse drug events during moxonidine treatment. Concentration of endazoline, a specific mediator of I1-imidazoline receptors, is elevated in some patients with essential hypertension. Modulation of I1-imidazoline receptors by moxonidine could be interpreted as antagonism with regard to the endogenous agonistic effect of the endogenous "transmitter" endazoline. On the other hand, moxonidine acted directly as an agonist at the putative I1-imidazoline receptor. Therefore, to clear the ground, characterization as well as physiological function of the mediator for imidazoline receptors seems essential. The therapeutic relevance of using drugs selective for I1-imidazoline receptors for blood pressure reduction in hypertensive patients is substantiated by the finding that in human rostral ventrolateral medulla (RVLM), which is essential in central blood pressure regulation, the relation between alpha 2-adrenoceptors and I1-imidazoline receptors is about one to ten (1:10). Reduction of a long-lasting sympathetic overdrive may avoid the deteriorating effects on the heart and peripheral circulation. These recent findings give a rational explanation for the very low incidence of sedation and the absence of respiratory depression, orthostatic hypotension, and rebound hypertension that banned the former central acting antihypertensive drugs from first-line treatment despite the advantages of central mediated blood pressure control.
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PMID:Why imidazoline receptor modulator in the treatment of hypertension? 767 85

Platelet and erythrocyte membrane Na+,K(+)-ATPase, Ca(2+)-ATPase and Mg(2+)-ATPase activities and platelet, erythrocyte and serum magnesium, calcium, sodium and potassium concentrations were determined in black (n = 52) and white (n = 24) essential hypertensive patients from the city of Johannesburg in South Africa. The hypertensive groups were matched for age and body mass with black (n = 52) and white (n = 26) normotensive controls. In the black group, platelet and erythrocyte membrane ATPase activities were significantly depressed in the hypertensive subjects. In the white group, there were no significant differences for any of the ATPases studied between the normotensive and hypertensive subjects. Platelet sodium and calcium were significantly increased and serum magnesium, serum potassium, platelet magnesium and erythrocyte magnesium significantly decreased in the black hypertensive group compared to the black normotensive group. In the white hypertensive patients, platelet sodium and calcium were significantly raised and platelet magnesium significantly decreased compared to the normotensive controls. In blacks, platelet magnesium and ATPase activity were negatively correlated with mean arterial pressure. Unlike whites, black hypertensives have widespread magnesium changes with associated cell membrane ATPase depression and cytosolic sodium and calcium accumulation. These results suggest possible racial differences in cellular cation regulation in essential hypertension.
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PMID:Racial differences in cell membrane ATPases and cellular cation content in urban South African normotensive and hypertensive subjects. 810 9

One hundred and one patients, 70 experimental and 31 controls, with a diagnosis of essential hypertension, were examined for the effects of group relaxation training and thermal biofeedback on blood pressure and on other psychophysiologic measures: heart rate, forehead muscle tension, finger temperature, depression, anxiety, plasma aldosterone, plasma renin activity, and plasma and urinary cortisol. Eighty percent of the participants were medicated. Treatment yielded a short-term success rate, defined as a decrease in mean arterial pressure of 5 mm Hg, of 49% in the experimental group. Other significant short-term changes included a reduction of forehead muscle tension, state anxiety, plasma aldosterone, and increased finger temperature. Follow-up measurements were made approximately 10 months after treatment in 36 patients, 51% of the treatment completers. Twenty of the 36 were short-term treatment failures, while 16 were treatment succeeders. Thirty-seven percent of the short-term succeeders continued to meet blood pressure criterion at follow-up. In short-term succeeders, continued practice of relaxation may influence long-term maintenance of decreased blood pressure. It is suggested that group relaxation training can be beneficial for short-term and long-term adjunctive treatment of essential hypertension in selected individuals.
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PMID:Effects of group relaxation training and thermal biofeedback on blood pressure and related physiological and psychological variables in essential hypertension. 816 64

Excessive blood pressure elevations during daily activities increase cardiovascular risk and may be related to individual differences in emotionality and expressive style. Emotional traits and ambulatory blood pressure were measured during a typical school day in 228 Black and White adolescents at risk of developing essential hypertension. Trait affect (depression, anger) predicted prevailing blood pressure levels; this association was moderated by gender, social setting (in classroom vs. with friends), and nonverbal expressive style. Relationships between emotion and blood pressure were not explained by obesity, smoking, or alcohol use. The uniform environment and regimen of the school made it possible to attribute variations in prevailing blood pressure to personality differences involving ways adolescents perceive and negotiate their social world.
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PMID:Negative affect, gender, and expressive style predict elevated ambulatory blood pressure in adolescents. 816 68

Thirty-five asymptomatic diabetic patients with non insulin-dependent diabetes and mild moderate essential hypertension (18 males and 17 females, mean age 60 +/- 6 years) underwent echocardiographic examination, followed by simultaneous ambulatory blood pressure and electrocardiographic monitorings. Three hundred and sixteen significant episodes of asymptomatic ST segment depression (at least 1 mm 80 msec after the J point, lasting more than 1 min) were recorded in 21 patients (60%) with a total duration of 5637 minutes. Patients with asymptomatic episodes of ST segment depression had significantly higher values of total cholesterol (p < 0.05), LDL cholesterol (p < 0.05), Glycosylated hemoglobin (p < 0.001), left ventricular mass index (p < 0.02), mean 24-hour systolic and diastolic ambulatory blood pressure (p < 0.001), systolic (p < 0.02) and diastolic (p < 0.01) ambulatory blood pressure variability and hypertensive peaks (p < 0.05), with respect to the rest of the study population. The number of ST segment depression episodes was significantly related to total cholesterol levels (r = 0.40, p < 0.05), LDL cholesterol levels (r = 0.36, p < 0.05) glycosylated hemoglobin levels (r = 0.50, p < 0.01), left ventricular mass index (r = 0.48, p < 0.01), ambulatory systolic (r = 0.43, p < 0.01) and diastolic (r = 0.51, p < 0.01) blood pressure variability and hypertensive peaks (r = 0.50, p < 0.01). Our data suggest that haemodynamic and metabolic factors could have a relevant role in high prevalence of SMI in asymptomatic diabetic patients with EH. The evidence of SMI in these patients warrants further diagnostic work-up and prognostic assessment.
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PMID:Prevalence of silent ST segment depression during long-term ambulatory electrocardiographic monitoring in asymptomatic diabetic patients with essential hypertension. 833 37

The wide use of ABPM has resulted in greater appreciation of the circadian time structure of BP variability and its clinical relevance. It is now recognized that the day-night change in BP results from an interplay of circadian rhythms in neurohumoral mechanisms coupled with temporal patterns in physical activity and mental load. The composite effect and balance of these endogenous and exogenous cyclic phenomena give rise to elevated BP during diurnal activity and reduced BP during nighttime repose in both normotension and uncomplicated essential hypertension. The balance is frequently disturbed in complicated and secondary forms of hypertension causing gross alteration of the 24-hour BP profile. ABPM also reveals the efficiency of antihypertensive treatment throughout the 24 hours and as a function of drug administration time. The pharmacokinetics and/or pharmacodynamics of antihypertensive medications have been demonstrated to vary with ingestion time. Such time-dependencies arise from circadian rhythms in BP and underlying mechanisms. The effect of antihypertensive medications is not simply superimposed upon endogenous bioperiodicities. Rhythms in neurohumoral mechanisms of BP control may modulate treatment effect. Certain aspects of the shape of the 24-hour BP profile, such as the magnitude of the morning surge and nocturnal decrease, have been implicated as determinants of morbid and mortal cardiovascular events. One large clinical multicenter investigation, known as the CONVINCE (Controlled Onset Verapamil Investigation of Clinical Endpoints) trial, is aimed at assessing the impact (cardiovascular morbidity and mortality) of verapamil chronotherapy over standard diuretic or beta anatagonist treatment in hypertensive patients with at least one risk factor of coronary heart disease. ABPM will help ascertain to what extent depression of the morning surge in BP relates to reduction in cardiac morbidity and mortality in this as well as other such trials. In any event, the importance of ABPM and the indices derived from its application are just beginning to be appreciated and explored.
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PMID:Ambulatory blood pressure monitoring. Application to clinical medicine and antihypertension medication trials. 885 50

The study comprised 83 patients, mean (+/-SD) age 47 +/- 8 years, with essential hypertension. Systolic and diastolic blood pressure at inclusion were 171 +/- 16 and 110 +/- 7 mm Hg, respectively. Two small resistance arteries were dissected from a subcutaneous gluteal biopsy and mounted in an isometric small vessel myograph for measurement of the media:lumen ratio. Left ventricular mass (LVM) was estimated by echocardiography, and the occurrence of ventricular arrhythmias was assessed by ambulatory ECG for 48 h. Left ventricular hypertrophy (LVH) occurred in 67% of the patients. Systolic function was generally unimpaired. ST depression was found in 75%, and ventricular arrhythmias in 45%. Twenty-two patients had permanent ST depression, and they had also greater LVM and more frequent ventricular arrhythmias than those without permanent ST depression. The area under the ST trend curve of all significant ST depressions was correlated to the LVM (r = 0.42, p < 0.001). Patients with arrhythmias had significantly greater area under the ST trend curve of all significant ST depressions than patients without arrhythmias (p < 0.05). In patients with LVH and permanent ST depression, the media:lumen ratio of the peripheral vessels was greater than that of patients with LVH but without permanent ST depression (11.6 +/- 2.9 vs. 9.8 +/- 2.0, p < 0.01). This suggests that hypertensive structural changes similar to those observed in peripheral vessels might occur in the walls of myocardial resistance arteries.
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PMID:Myocardial ischemia and ventricular arrhythmias in relation to left ventricular mass and resistance artery structure. 909 13

To clarify psychological factors related to white coat hypertension, we examined personality characteristics of patients with mild essential hypertension by psychological testing. Patients with essential hypertension were taught to measure their own blood pressure (BP) with a semi-automatic oscillometric BP measuring device and were asked to measure BP at home in the sitting position before going to sleep. The duration of the study was 8 wk. Patients were defined as "white coat" hypertensive patients (WCHT) (n = 49) if home systolic BP was 135 mmHg or less and home diastolic BP was 85 mmHg or less, and as "sustained" hypertensive patients (SHT) (n = 53) if home systolic BP was 140 mmHg or more or home diastolic BP was 90 mmHg or more. All the patients underwent the following psychometric tests: self-rating questionnaire for depression, MMPI alexithymia scale, type A behavior pattern check list, general health questionnaire (GHQ), and egogram check list. WCHT did not differ from SHT in the scores for depression, alexithymia, type A behavior pattern, or GHQ. However, WCHT showed an abnormal pattern on egograms, as compared with SHT. On egograms, SHT showed a normal hill-shaped pattern with a peak in "nurturing parent (NP)", and "free child (FC)" was higher than "adapted child (AC)" in both genders. In contrast, WCHT showed significantly lower FC and significantly higher AC than SHT, and AC was higher than FC in both genders. These findings suggested that WCHT tend to suppress their own emotions and become over-adaptive to their surroundings, as compared with SHT.
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PMID:Personality characteristics of patients with "white coat" hypertension. 922 Feb 73

Quality of life with the selective beta1-blocker bisoprolol and the calcium channel blocker nifedipine as a retard formulation was compared in patients with essential hypertension. A multicenter randomized, double-blind, two-way, crossover study design was used. After a placebo run-in period (4-6 weeks), during which all antihypertensive therapy was withdrawn, 82 patients were randomized. During the active treatment periods (8 weeks each), patients received either bisoprolol once daily or nifedipine retard twice daily, using the double-dummy technique. A washout period (4-6 weeks) separated the treatment periods. Data at baseline (at randomization) and at the end of each treatment period were compared. Seventy-five patients completed the study. Blood pressure (168 +/- 2/103 +/- 1 mmHg) decreased (p < 0.001) similarly with bisoprolol (153 +/- 2/90 +/- 1 mmHg) and nifedipine (154 +/- 2/90 +/- 1 mmHg). Compared with baseline values, none of the quality of life variables investigated changed during bisoprolol or nifedipine retard use. Neither in the intention-to-treat nor the efficacy analysis were differences between bisoprolol and nifedipine found in quality of life variables, such as the Health Status Index, somatic symptoms, anxiety, depression, total psychiatric morbidity, cognitive symptoms, and hostility score. Only in the efficacy analysis did Health Status Index tend to be better (p = 0.055) during nifedipine intake when compared with bisoprolol. This trend was not present in the intention-to-treat analysis. The number of dropouts during bisoprolol (n = 2) and nifedipine (n = 3) treatment, and the number of patients reporting side effects (21% and 16%, respectively) did not differ (p = 0.64) between both treatments. It can be concluded that at equipotent antihypertensive dosages, an 8-week treatment period with the selective beta1-blocker bisoprolol or the calcium antagonist nifedipine as a retard formulation does not result in any difference in quality of life variables. It is not clear whether the trend of Health Status Index to become better during nifedipine intake, which was only found in the efficacy analysis and not in the intention-to-treat analysis, is of clinical relevance.
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PMID:Quality of life comparison between bisoprolol and nifedipine retard in hypertension. 931 Feb 75


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