Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

During a 1-year period all Black patients admitted to two medical wards in the Johannesburg General Hospital were screened for malignant hypertension. Of the 62 patients eligible for inclusion in the study, 51 were thought to have essential malignant hypertension (hospital prevalence 2,2%). There was a striking absence of the cardiovascular and hypertensive risk factors usually described -- excessive smoking, alcohol consumption and obesity. The presenting features and complications were similar to those described in other series. Cardiac failure was present in 45% of the patients, neurological complications in 33%, and advanced renal failure in 47%. Twenty patients required dialysis. No evidence of ischaemic heart disease or atheromatous vascular disease was found. Red cell fragmentation was present in 25% of the patients. The hospital mortality rate was 25%. Only 24% of the patients had previously been diagnosed as having hypertension, although 43% had been examined by a doctor during the preceding 2 years. Of the patients discharged to the hypertension clinic, only 28% returned for short-term follow-up. Malignant hypertension is therefore a major medical and social problem in the Johannesburg Black community.
 ...
PMID:The malignant phase of essential hypertension in Johannesburg Blacks. A prospective study. 708 52

Nifedipine, the Ca++ antagonistic coronary vasodilator, was administered by oral, sublingual and enema routes. 1) In 6 severe hypertensive patients (systolic pressure greater than or equal to 200 mmHg, diastolic greater than or equal to 120 mmHg), nifedipine, administered orally, induced prompt and reliable fall of arterial pressure (systolic pressure: -28% of control level, diastolic: -27%). 2) In 10 patients with hypertensive emergencies, including malignant hypertension, intracranial bleeding, hypertensive encephalopathy and acute hypertensive heart failure, sublingual and enema administration of nifedipine were performed with excellent hypotensive efficacy. 3) Pressure began to fall within 5--15 min, 30 min and 30--60 min after sublingual (or dissolved), enema and oral (capsule), respectively, and reached its lowest levels in the next 10--20 min. The fall of pressure lasts for 2--4 hours. 4) In the combination of nifedipine with alpha-methyldopa, antihypertensive response in short-term was increased about +11% over nifedipine alone and lasted for 8 hours. In combination with beta-blocker (propranolol), hypotensive efficacy increased +39% over nifedipine alone, but the effective duration of this combination was the same as nifedipine alone. 5) Side effects, including dryness of the mouth and burning sensation in face and legs, were observed in few patients.
 ...
PMID:Treatment of severe hypertension and hypertensive emergency with nifedipine, a calcium antagonistic agent. 726 56

For Black patients in Johannesburg chronic haemodialysis has been associated with an extremely high mortality rate. A retrospective analysis has shown that the major factor contributing to this is the frequency of primary malignant hypertension, resulting in the death of patients from cardiac failure (sudden death and pulmonary oedema) and cerebrovascular accidents. Septic complications, tuberculosis and shunt complications also contributed to the high death rate. Possible measures to be taken to reduce this high mortality clearly emerge.
 ...
PMID:The mortality rate and causes of death in black patients on chronic haemodialysis. 742 3

To investigate age-related differences in malignant hypertension (MHT), we studied 38 elderly patients (18 males, 20 females; mean age 70.6 years, SD 4.6 years, range 65 to 84) and 277 younger patients (193 males, 84 females; mean age 46.4 years, SD 10.5, range 15 to 64) with MHT presenting 1965-93. Mean duration of known hypertension before presentation was greater in the elderly group (43.8 months vs. 23.1 months). The elderly group included 18 (47.4%) newly diagnosed hypertensives, compared to 160 (55.8%) in the younger group. At presentation, 19 (50.0%) elderly patients were receiving no antihypertensive drug therapy, whilst 18 (47.4%) were taking one or more drugs for hypertension. Presenting clinical features in elderly MHT patients included visual disturbance (9), headaches (2), headaches with visual disturbance (2), stroke (3), and heart failure (2). Six patients were asymptomatic. The commonest clinical complications were ischaemic heart disease (angina and myocardial infarction) (5), heart failure (4) and stroke (4). The majority (58%) of patients, however, had no vascular complications at presentation. Comparing elderly and younger MHT groups, there was no significant difference in presenting systolic blood pressures, although mean diastolic blood pressure was significantly greater in the younger group (mean 143.7 mmHg +/- 19.3 vs. 130.0 mmHg +/- 15.2; p < 0.0001). After a mean follow-up of 30.9 months (SD 37.1; range 1 to 123 months), 17 (44.7%) of the elderly patients were still alive, 15 were dead (39.5%) and six were lost to follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Malignant hypertension in the elderly. 758 78

Hypertensive crises are now uncommon in developed countries, and few doctors will have experience in their management. A review of the drugs used by clinicians in Scotland suggests considerable diversity in approach but broadly follows the best advice that is available in the literature. For emergencies such as hypertensive encephalopathy and hypertension associated with aortic dissection in which irreversible damage would occur within hours if left untreated, patients should probably be admitted to Intensive Care Units and be given nitroprusside. Similarly nitroprusside or nitroglycerin would be appropriate choice for hypertension that is complicated by acute left ventricular failure. By contrast if the risk to the patient is measured in days rather than hours then oral therapy will be quite sufficient. Atenolol or nifedipine retard can safely be given as initial treatment for uncomplicated malignant hypertension, and nifedipine retard can be used for the milder cases of encephalopathy or heart failure. The use of sublingual drugs in the management of hypertensive emergencies and urgencies cannot be recommended as the fall in blood pressure is both unpredictable and uncontrolled with the consequent and unacceptable risk of organ ischaemia.
 ...
PMID:Management of hypertensive crises. 760 39

Hypertensive therapy based on diuretics is time-honored. Thiazides represent the most commonly used class of diuretics for uncomplicated hypertension because of economic motivations, their tolerance and efficacy both as monotherapy and in combined treatment with other agents. Clinical studies using diuretics and beta-blockers reported that thiazide treatment prevents the development of malignant hypertension, renal and heart failure, hypertensive retinopathy, and reduces in five years overall mortality of 33%, cardiovascular mortality of 41%, fatal and non-fatal cerebrovascular events of 51% and the risk of coronary events of 15%. The less than expected risk reduction of cardiovascular disease raised many concerns about the possibility of adverse biochemical changes of thiazides through their effects on lipids, electrolytes and glucose metabolism. However, the real clinical significance of these metabolic effects remains actually uncertain and needs further investigation. The treatment of the hypertensive patient cannot be adequately managed using a merely adjunctive step-care criterium. Hypertensive subjects have different haemodynamic, metabolic and endocrine disorders and a tailored treatment should consider the different activities of the various agents as monotherapy or in association in the single patient.
 ...
PMID:[The role of diuretics in antihypertensive therapy]. 779 57

Thirty of 118 cases of childhood onset systemic lupus erythematosus collected in the Parisian area had an unfavorable outcome. Thirteen patients evolved to end-stage renal failure. Seven survived with renal substitution therapy, and 6 other patients subsequently died. Most had diffuse proliferative glomerulonephritis, the pattern of glomerular disease classically responsible for end-stage renal failure. Three patients had membranous nephropathy with segmental lesions, a form of glomerulonephritis whose severe prognosis should be emphasized. In another patient, end-stage renal failure was precipitated by thrombotic microangiopathy. Seventeen other patients died and in most, the causes of death were multiple. In 7, death could be attributed to complications secondary to an infection and in 4 other cases to SLE exacerbation with severe organ involvement. Two patients died suddenly, another showed cardiac failure and another had malignant hypertension. Of the remaining 2 patients, one suffered anticoagulant therapy complications after treatment for renal artery stenosis and the second, an urothelial carcinoma. Unfavorable evolutions were high among patients coming from French departments and territories, and among North African patients. One may speculate that poor outcome is associated with ethnic characteristics or with socioeconomic factors. However, the problem of compliance with treatment is clearly an extremely important factor in the prognosis. Both end-stage renal failure and death were in some of our cases precipitated by treatment interruption, indicating an insufficient understanding of the importance of treatment in this chronic disease.
 ...
PMID:Unfavorable outcomes (end-stage renal failure/death) in childhood onset systemic lupus erythematosus. A multicenter study in Paris and its environs. 795 30

One hundred cases of hypertensive complications due to irregular drug-therapy were studied in medicine units of Dhaka Medical College Hospital for the period of one year from February 7, 1989 to February 6, 1990. Among those stroke had headed the list (48%) manifesting in various ways e.g. cerebral haemorrhage with focal neurological signs--hemiplegia, hemiperesis, aphasia etc. Hypertension associated with varying degrees of cardiac ischaemias and heart failure was seen in 14% and 10% cases respectively. Highest incidence of complications was seen in 1-5 years after detection of hypertension with mean age of 55 +/- 18.70 years. Out of 48 cases of strokes, smoker were 41 (75.92%). Regarding reasons of noncompliance of drugs, personal carelessness was the prominent one (47%). Among the risk-factors for atherosclerosis family history tops the list (66%). Diabetes coexists with hypertension in 13% cases. Ocular complications were seen in 06% cases of malignant hypertension with variable retinal changes.
 ...
PMID:Study of complications in hypertensive patients having irregular treatment. 803 Dec 88

The levels of plasma arginine-vasopressin (AVP) in 80 patients with essential hypertension were measured, and its impact on the disease and its clinical significance were studied. The results showed that: (1) The levels of plasma AVP in patients with essential hypertension were significantly higher than that in normotensive subjects (P < 0.001). It dropped to normal level after antihypertensive drugs. (2) The concentrations of plasma AVP in both hypertensive subjects and normotensive subjects were not correlated with age and sex (P < 0.05). (3) The concentration of plasma AVP in patients with essential hypertension was the highest in stage III, the lowest in stage I, and middle in stage II. (4) The levels of plasma AVP in patients with malignant hypertension were significantly higher than that in patients with benign hypertension (P < 0.05). A positive correlation was found between the levels of plasma AVP and blood pressure (r = 0.3398, P < 0.01). (5) The concentrations of plasma AVP in hypertensive subjects with ventricular hypertrophy were higher than that in hypertensive subjects with out ventricular hypertrophy (P < 0.05). (6) The concentrations of plasma AVP in hypertensive subjects with heart failure were significantly higher than that in hypertensive subjects with out heart failure (P < 0.001). The results suggest that AVP has a role in the pathogenesis of hypertension, hypertension complicated with ventricular hypertrophy and hypertension complicated with heart failure. The levels of plasma AVP may be viewed as an index of the patient's condition in hypertensive subjects.
 ...
PMID:[The changes in plasma arginine-vasopressin in patients with essential hypertension and the correlation with patient's condition]. 824 27

Treatment of hypertension reduced markedly (by more than 40%) the prevalence of cerebrovascular attacks, the prevalence of cardiac failure, malignant hypertension and ophthalmological complications of hypertension. The impact of antihypertensive treatment on the incidence of ischaemic heart disease is less marked. The wide use of diuretics and beta-blockers is supported by the fact that large studies of antihypertensive treatment revealed that they reduced the cardiovascular mortality and morbidity in a marked way. On the other hand, diuretics exert a negative effect on insulin resistance, glucose tolerance, cholesterol and may lead to hypokalaemia and hyperuricaemia. Non-selective beta-blockers are not optimal from the aspect of the risk profile of hypertensive patients. Therefore there is justified hope that wider use of calcium antagonists, beta-blockers of the third generation, ACE inhibitors and selective alpha 1 blockers will have a greater impact on IHD, as these drugs do not exert a negative effect on metabolic risk factors. At present an individual approach to treatment which takes into account other diseases present or complications of hypertension, in particular diabetes and hyperlipoproteinaemia, is the basic approach so far and the basis of therapeutic tactics.
 ...
PMID:[Current trends in antihypertensive therapy: pro and con]. 837 69


<< Previous 1 2 3 4 5 Next >>