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Query: UMLS:C0018099 (gout)
 5,192 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors presented the results of a 5-year follow-up of 50 gout patients who had been regularly (no less than 3-4 times a year) examined in outpatient clinics. Dispensary examinations of the patients resulted in a decrease in the level of uric acid and in the number of exacerbations of gouty arthritis, the reduction of the sizes of tophi or their disappearance. Regular examination and ultrasonic investigation made it possible to prevent in some cases attacks of urolithiasis, and to reduce 4-fold a disability time-period and to preserve working capacity in 96% of the patients. The study showed that in most of the patients with essential hypertension and coronary heart disease arterial pressure got stable and the number of angina attacks was on a decrease. The data obtained indicated a high efficacy and appropriateness of combined rehabilitation activities in gout patients.
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PMID:[Rehabilitation of patients with gout during outpatient follow-up]. 359

The antihypertensive effect and metabolic side effects of bendroflumethiazide have been compared with those of propranolol in two randomly selected groups, of 53 previously untreated middle-aged men during 6 years' treatment for mild to moderately severe essential hypertension. The blood pressure-reduction was the same in the two groups. During the follow-up 1 man in the bendroflumethiazide group and 3 in the propranolol group died while 2, 1 on each treatment, became diabetic. None had gout but serum urate increased in both groups. Glucose tolerance improved significantly in both groups during the first year and this improvement was sustained for the follow-up period. Serum potassium did not differ in the two groups during the first 5 years but during the sixth year it decreased in the diuretic group. Total potassium was, however, unchanged in both groups. These results indicate that the frequency of metabolic side effects during diuretic treatment of mild to moderately severe essential hypertension is low and has been grossly exaggerated. Since the antihypertensive effect and side effects were equal with both drugs, and since the diuretics are cheaper, they should be the drug of first choice in this type of hypertension.
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PMID:beta-blockers or diuretics in hypertension? A six year follow-up of blood pressure and metabolic side effects. 611 Sep 54

Traffice Noise and Hypertension. First communication: the question whether traffic noise could be a risk factor of essential hypertension was studied by means of interviews. In Bonn 931 inhabitants between 20 and 59 years of age, who lived either in streets with high (minimum: 9062 cars/day) or low (maximum: 1182 cars/day) traffic volumes were interviewed. While no differences were found in the frequencies of treatment of diabetes mellitus, gout, asthma and peptic ulcer, there was a difference in response to treatment of hypertension (p = 0.002); in the noisy area 22.8% and in the quiet area 14.6% of respondents stated that they were treated. Also in both male and females aged 29-39 years, there was a connection between hypertensive treatment and the duration of stay in the noisy area (p less than 0.05).
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PMID:[Traffic noise and the risk of hypertension. 1]. 677 26

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

Fifty-two middle-aged patients with essential hypertension were treated for five months with 25 mg mefruside as the only antihypertensive drug. Blood pressure, heart rate, fasting blood glucose, cholesterol, triglycerides, uric acid, electrolytes and weight were controlled regularly before and during treatment. Blood pressure normalized in 43 cases (82.7%). The decrease was more marked in the females and their maximal response appeared later. No significant changes were seen in cholesterol and triglycerides. Serum uric acid levels increased significantly in both sexes (p < 0.001) but no patient developed gout. A significant decrease (p < 0.001) in serum potassium was seen; only one male, with heredity for diabetes mellitus, showed a decreased glucose tolerance.
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PMID:Effects of mefruside treatment in hypertension. 744 7

The EDTA (calcium disodium edetate) lead mobilization test revealed lead as the probable cause of renal disease in industrial lead workers and in patients with gout or essential hypertension. The data reviewed here demonstrate persistence of lead nephropathy in the contemporary scene despite the introduction of modern industrial and environmental exposure standards. Renal function and biopsy studies showed that lead nephropathy is a chronic tubulointerstitial renal disease with modest proteinuria which frequently presents with hyperuricemia, gout and hypertension. Only evaluation of body lead stores by either the EDTA lead mobilization test or by x-ray fluorescence is helpful in diagnosing lead nephropathy. While chelation therapy is safe and helpful in reversing early lead nephropathy, the best treatment is prevention. These studies further raise the possibility that chronic environmental lead poisoning and associated renal disease and hypertension may be a more widespread problem than suspected. Assessment of the true extent of chronic lead poisoning requires large scale epidemiological studies.
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PMID:Lead nephropathy, gout, and hypertension. 847 50

Diuretics were used in most of the major trials that demonstrated that lowering the blood pressure reduced cardiovascular morbidity and mortality. Nevertheless in the second half of the eighties, there were misgivings about the widespread use of thiazide diuretics, driven in part by the relative failure of the large trials to reduce myocardial infarction-to the extent predicted by large scale epidemiological studies. There was much attention on metabolic side effects of thiazide diuretics including dyslipidaemia, glucose intolerance, hypokalaemia, hyperuricaemia, and then microalbuminuria particularly in diabetic subjects. These issues were current when JNC (IV) (1988) and the WHO-ISH guidelines (1989) were being written. Three major clinical trials SHEP, STOP and MRC published in the early nineties established that thiazide diuretics alone, or in combination with beta blockers, did reduce cardiovascular morbidity and mortality in elderly subjects with hypertension. All guidelines published since 1993 include diuretics among the first line drugs. Possibly the most important factor in the restoration of diuretics has been the use of progressively lower doses that minimise the metabolic side effects. Diuretics are effective as monotherapy in the treatment of mild essential hypertension and of isolated systolic hypertension in elderly subjects. They are very useful in combination with beta blockers or with ACE inhibitors. They should be avoided in patients with gout and should not be used as first line drugs in patients with diabetes. They should only be used with caution in young obese subjects with dyslipidaemia and increased risk of coronary artery disease, facing many decades of treatment for hypertension. However there is no doubt that diuretics are effective, cheap and have a central role in the control of hypertension in all communities around the world.
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PMID:[Role of diuretics in the treatment of hypertension: from large controlled trials to international guidelines]. 895 12

The association between increased serum urate and hypertension has been a subject of intense controversy. Extracellular uric acid drives uric acid deposition in gout, kidney stones, and possibly vascular calcification. Mendelian randomization studies, however, indicate that serum urate is likely not the causal factor in hypertension although it does increase the risk for sudden cardiac death and diabetic vascular disease. Nevertheless, experimental evidence strongly suggests that an increase in intracellular urate is a key factor in the pathogenesis of primary hypertension. Pilot clinical trials show beneficial effect of lowering serum urate in hyperuricemic individuals who are young, hypertensive, and have preserved kidney function. Some evidence suggest that activation of the renin-angiotensin system (RAS) occurs in hyperuricemia and blocking the RAS may mimic the effects of xanthine oxidase inhibitors. A reduction in intracellular urate may be achieved by lowering serum urate concentration or by suppressing intracellular urate production with dietary measures that include reducing sugar, fructose, and salt intake. We suggest that these elements in the western diet may play a major role in the pathogenesis of primary hypertension. Studies are necessary to better define the interrelation between uric acid concentrations inside and outside the cell. In addition, large-scale clinical trials are needed to determine if extracellular and intracellular urate reduction can provide benefit hypertension and cardiometabolic disease.
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PMID:Uric Acid and Hypertension: An Update With Recommendations. 3217 96


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