Gene/Protein Disease Symptom Drug Enzyme Compound
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221 patients with arterial hypertension were investigated as outpatients. 198 patients were found to have primary and 23 patients to have secondary hypertension. The results of urinary analysis were pathological in 25% of patients and renal function tests were abnormal in 20% of cases. Significant bacteriuria was recorded in 19% of urinary cultures. Intravenous pyelography showed true pathological findings in 12% of cases, false positive findings in 7% and false negative findings in 5%. Isotopic nephrograms showed true positive findings in 52%, false negative in 3% and 45% showed normal results. In 53% of patients angiography of the kidneys showed normal results, whilst this investigation proved pathological in 44% of cases and gave false negative results in 3% of patients. An additional search for coronary heart disease risk factors revealed that 73% of these hypertensive patients were overweight, 47% had hyperlipidaemia, 33% suffered from diabetes mellitus and nicotine abuse was present in 21% of cases. A relevant yet inexpensive screening programme for the investigation of hypertension is formulated on the basis of the results of this investigation.
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PMID:[The value of different investigation procedures in arterial hypertension (author's transl)]. 15 88

Although essential arterial hypertension is believed to have a strong genetic predisposition, the gene(s) responsible are unknown. The mechanisms underlying the regulation of blood pressure and experimental studies place the renin gene among the main candidate genes that need to be tested in humans. We tested the hypothesis of a linkage between the renin gene and essential hypertension using the affected sib pair method. Siblings (133 subjects, 52.1 +/- 10.9 years) from 57 families were selected for sustained hypertension (160.7 +/- 22.9/99.5 +/- 12.8 mmHg with 80% of patients under antihypertensive treatment), of early onset (40.7 +/- 12.0 years), in the absence of obesity, diabetes mellitus, and secondary hypertension. Eight renin haplotypes were generated from three diallelic renin restriction fragment length polymorphisms (RFLPs) (TaqI, HinfI, HindIII) located throughout the renin gene. The allelic concordance between the sib pairs was analyzed by identity by state relationships for 98 sib pairs (41 for 41 couples, 39 for 13 trios, 18 for 3 quartets). Allelic frequencies in the 57 hypertensive probands were similar to those observed among 102 hypertensive subjects studied previously. Six of eight possible haplotypes were observed, the informativity of the marker corresponded to 70% of heterozygosity. Allelic concordance for all sib pairs according to sibship size was not significantly different from that expected under the hypothesis of no linkage (t = 0.52, P = 0.15) reflecting only a small excess of renin alleles shared by the hypertensive sibs (1.44 +/- 0.6 vs 1.36 +/- 0.6). Likewise the linkage hypothesis was unsupported by weighted estimates to correct for possible bias due to large sibship size. Thus, the sib pair analysis suggests that the renin gene does not have a frequent role in the pathogenesis of essential hypertension; further more powerful linkage studies or other approaches will be needed to detect contributions at the renin locus to the heritability of essential hypertension.
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PMID:Sib pair linkage analysis of renin gene haplotypes in human essential hypertension. 134 86

To assess the cardiac characteristics and postoperative courses in patients with Cushing's syndrome, electrocardiography and echocardiography were performed to study 12 consecutive, unselected patients, and results were compared with those of essential hypertension and primary aldosteronism. Eleven patients had hypertension and 7 had diabetes mellitus. Before adrenalectomy, common electrocardiographic abnormalities consisted of high-voltage QRS complexes (10 patients) and negative T waves (7 patients). Echocardiograms showed left ventricular hypertrophy in 9 patients, and all the patients had evidence of asymmetric septal hypertrophy. In patients with left ventricular hypertrophy, the thickness of the interventricular septum ranged from 16 to 32 mm, whereas the ratio of the thickness of interventricular septum to that of the posterior wall ranged from 1.33 to 2.67. The interventricular septum in Cushing's syndrome was extremely thicker and asymmetric septal hypertrophy occurred more often than essential hypertension and primary aldosteronism. Nine patients could be followed up after operation. In these patients abnormal electrocardiographic findings had normalized, the thickness of interventricular septum had decreased and asymmetric septal hypertrophy had disappeared except in 1 patient. The reason why left ventricular hypertrophy in Cushing's syndrome is severe is still unknown. Because left ventricular hypertrophy is more severe and the frequency of asymmetric septal hypertrophy much greater in Cushing's syndrome than in essential and other secondary hypertension, it is thought that not only increased aortic pressure but excessive plasma cortisol may be etiologic factors in the progression of left ventricular hypertrophy in Cushing's syndrome.
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PMID:Cardiac characteristics and postoperative courses in Cushing's syndrome. 153 96

In order to determine the features that characterize refractory hypertension (RH), patients aged less than 65 years in a hypertension clinic were screened. Thirty-six patients on triple drug therapy with a supine diastolic blood pressure (DBP) of greater than or equal to 5 mmHg above an identified target pressure (90-100 mmHg), or a systolic blood pressure (SBP) greater than or equal to 170 mmHg for the last 6 months (greater than or equal to 3 measurements) underwent a thorough clinical investigation. The frequency of renal artery stenosis (RAS) in the RH patients was 30%. The non-RAS patients had a low occupational status, 76% being either manual workers or unskilled non-manual workers (reference group: 42%; P less than 0.01). They were more obese (body mass index (BMI) 28.8 vs. 25.8; P less than 0.01), and had a longer duration of hypertensive disease. RH patients had a higher prevalence of non-insulin-dependent diabetes mellitus (18 vs. 6%; P less than 0.05), and showed a higher prevalence of nervous complaints and mental distress (44% vs. 12%; P less than 0.001) and musculo-skeletal pain (39% vs. 7%: P less than 0.001). It is suggested that refractory hypertension should be investigated and treated bearing psychosocial factors in mind, concurrently with a screening for secondary hypertension.
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PMID:Characteristics of patients resistant to antihypertensive drug therapy. 204 Aug 68

In order to investigate the relationships between insulinemia and hypertension, fasting insulinemia has been assessed in 117 subjects: 69 normotensive subjects, 36 with essential hypertension, and 12 with renovascular hypertension, all untreated and newly diagnosed, classified in subgroups (euglycemic nonobese, euglycemic obese, with impaired glucose tolerance and with non-insulin-dependent diabetes mellitus). In the patients with essential hypertension fasting insulinemia was significantly higher than in normotensive subjects (P less than .0005). The patients with secondary hypertension and the normotensive subjects had similar fasting insulinemia values. In each subgroup fasting insulinemia was higher in hypertensive patients than among normotensive subjects (P less than .05). A significant correlation between fasting insulinemia and mean blood pressure has been found in patients with essential hypertension (r = 0.408, P less than .05), but not in patients with renovascular hypertension. Our data suggest a possible direct relationship between fasting insulinemia and blood pressure, especially in obese patients or patients with impaired glucose metabolism, and that increased blood pressure per se is not an insulin resistant state.
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PMID:Insulinemia and blood pressure. Relationships in patients with primary and secondary hypertension, and with or without glucose metabolism impairment. 219 8

Pathophysiology, outcome and some therapeutic problems of hypertension were described. Frequency of secondary hypertension and its underlying diseases in a hypertensive population greatly varied by study population. In the adult general population (Hisayama study) it was estimated to be 3.8%. Significance of various tests was evaluated in the diagnosis of renovascular hypertension and primary aldosteronism. Consideration of sodium balance in the evaluation was very necessary. The usefulness of captopril test was emphasized. Blood pressure was tended to decrease in upright posture and ambulation in cases with essential hypertension responding to acute sodium depletion by a significant reduction in blood pressure. In the observation of diurnal rhythm of urinary sodium excretion, the peak phase appeared about 3 hours earlier in essential hypertension than in normal control and 5 to 6 hours later in primary aldosteronism and Cushing syndrome. Sympathoadrenal function was activated in young borderline hypertensives but not in middle-aged ones. Outcome of hypertension accompanying diabetes mellitus was poor. Cardiovascular disease and renal failure occurred much frequently. Significance of hypertension as a risk factor of cardiovascular disease was described based on the data obtained through prospective epidemiological study (Hisayama Study). Hypertension was significantly correlated with stroke but not with myocardial infarction. Serum cholesterol level did not significantly correlate with both stroke and myocardial infarction. Reduction in stroke incidence in recent years was described in relation to the changes in risk factors of cardiovascular diseases. Pathophysiology and outcome of malignant hypertension (KW III-IV) were described in relation to underlying disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pathophysiology and outcome of hypertensive subjects. 389 32

We compared normal values for human venous norepinephrine (NE) and epinephrine (E) as reported in the literature with values determined in this laboratory and we measured and contrasted NE levels in patients with primary and secondary hypertension. Analysis of published data from many laboratories involving more than 800 supine, resting, healthy subjects indicated an average circulating level of venous NE of 260 pg/ml and of E, about 35 pg/ml. Supine levels of NE normally double when normal subjects stand for 5 min. This simple test provides one assessment of overall sympathetic nervous system integrity. Levels of catecholamines have been extensively studied in essential hypertension but much less so in secondary hypertension. Of the groups we studied with secondary hypertension (diabetes mellitus, primary hyperaldosteronism, polycystic kidney disease, chronic bilateral renal parenchymal disease, and unilateral renal arterial stenosis), only the group with renal parenchymal disease had supine NE levels significantly higher than the control group. Patients with essential hypertension and diabetes had a blunted increase in NE on standing. Plasma levels of NE do not reliably differentiate these groups of secondary hypertension from one another or from patients with primary hypertension.
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PMID:Plasma catecholamine levels in normal subjects and in patients with secondary hypertension. 669 Mar 38

It has been reported that since 1982 the incidence in persons with spinal cord injury (SCI) of hypertension is commoner than it is in the general population of the same age groups in Japan. In the current study, we examined outpatient morbidity rates and standardised outpatient morbidity ratios (SOMR) according to the site of injury, as well as blood pressure levels and history of disease, and compared the incidences with those for the general population. The subjects consisted of 195 men with SCI. All were engaged in light work at special centres while living with other persons at the centres. The mean age was 49.5 years old, and the average post-injury period was 17.9 years. With respect to the site of injury, 19 patients had had injuries at the level of C-T5, 24 at T6-T10, 139 at T11-L1, and 13 at L2 or lower. The SOMR (general population = 100) for hypertension was closely related to the site of injury, i.e. 0 at C-T5, 250 at T6-T10, 221 at T11-L1 and 308 at L2 or below. Among the patients treated with antihypertensive agents (41 persons), 17.1% were under treatment for renal diseases, 4.9% for diabetes, and 4.9% for hepatic disorders. In 68% of the SCI persons examined, however no disease (such as renal disease, diabetes mellitus, hepatic disease or endocrine abnormality) could be regarded as a cause of secondary hypertension. In addition, the survey revealed that the body weight of SCI persons was lower than that of the general populations.
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PMID:Morbidity rates of complications in persons with spinal cord injury according to the site of injury and with special reference to hypertension. 802 34

To study how the risk of cardiovascular disease changes with increasing levels of urinary albumin excretion (UAE), we prospectively studied a random sample of 120 49-year-old men with a wide range of blood pressures. Based on diastolic blood pressure (DBP), the subjects were divided into normotensives (DBP < 90 mm Hg; n = 21), borderline hypertensives (DBP 90 to 94 mm Hg; n = 30), mild hypertensives (DBP 95 to 104 mm Hg; n = 45) and moderate to severe hypertensives (DBP > 105 mm Hg; n = 24). None had been previously treated for hypertension or had secondary hypertension, diabetes mellitus, or other cardiovascular diseases at baseline. Heart and kidney function and metabolic and hormonal variables were with beta-blockade, diuretics, or hydralazine. The cardiovascular morbidity during 10 years of follow-up was studied. The hypertensives were treated with beta-blockade, diuretics, or hydralazine. The cardiovascular morbidity during 10 years of follow-up was studied. The 19 subjects who developed cardiovascular disease had significantly higher baseline UAE than the group that did not (median value 16.6 mg/24 h; range 3.5 to 73, and 9.7 mg/24 h, range 0 to 308, respectively). UAE correlated to systolic blood pressure (P = .0115) and DBP (P = .031), but not to smoking behavior or serum cholesterol. The risk of cardiovascular disease was associated with UAE and smoking independently of blood pressure (P = .001 and P = .015, respectively), and the risk increased continuously with increasing UAE. The initial UAE thus emerged as an efficient and independent predictor of cardiovascular disease in middle-aged hypertensive and normotensive men. UAE appeared to be a stronger predictor than blood pressure and serum cholesterol.
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PMID:Urinary albumin excretion--a predictor of risk of cardiovascular disease. A prospective 10-year follow-up of middle-aged nondiabetic normal and hypertensive men. 886 23

Obstructive sleep apnea (OSA) is a disorder in which there is repetitive collapse and closing of the pharynx during sleep. There is growing evidence to suggest that this disorder is a major cause of essential hypertension (EH) and that successful treatment of OSA can reduce the blood pressure (BP) significantly. In addition many other patients with EH have milder forms of sleep related breathing disorders (SRBD) like snoring, and upper airway resistance syndrome (UARS) which, while not as severe as OSA, may be severe enough to also cause systemic hypertension. We therefore propose a unifying hypothesis-that many patients with EH may have sleep related breathing disturbances (SRBD) and treatment of these disorders may improve the BP. SRBD could also explain many of the epidemiological, clinical, hereditary, biochemical, hematological and physiological characteristics seen in EH. In addition, many types of secondary hypertension (those caused by excessive alcohol intake, chronic renal failure, diabetes, hypothyroidism or acromegaly) have a higher than normal prevalence of OSA and OSA may contribute to the hypertension and organ damage found in these conditions as well. Thus SRBD may play an important role in the production of many cases of essential and secondary hypertension, and their early detection and treatment could reduce the hypertension and organ damage seen in these conditions.
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PMID:Essential and secondary hypertension and sleep-disordered breathing: a unifying hypothesis. 887 97


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