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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Renal hypertension can usually be recognized only by examining all the features of the hypertensive illness. On the other hand, the investigation of a case of hypertension whose genesis was previously unclear can lead to the diagnosis of a hitherto unrecognized renal disease. The blood pressure values found in patients with renal hypertension are of widely differing degrees of severity. Slight rises in blood pressure (e.g. 140/90 mm Hg), can be a sign of renal disease in adolescent patients. 10-15% of the cases of chronic renal hypertension develop into malignant hypertension. High diastolic values above 120 mm Hg without renal symptomatology and without reduced renal function speak against a primary renal cause of the rise in blood pressure. The finding of hypertension developing during the course of renal disease is, with respect to the hypertensive cardiovascular complications, just as important as in the case of essential hypertension. Complications which can occur during renal hypertension include cardiac insufficiency, hypertensive encephalopathy, retinopathy, hypertensive crises and acceleration of the renal disease.
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PMID:The clinical picture of renal hypertension. 119 21

Regional myocardial perfusion was measured in 164 patients at coronary arteriography. Washout of xenon-133 from multiple areas of the heart was monitored with a multiple crystal scintoooillation camera after tracer injection int the left or right coronary artery. Rate constants of radioisotope clearance were computed by monoexponential analysis of the initial portion of each washout curve. Regional myocardial blood flow rates in ml/100 g.min were calculated by the Kety formula. The pattern of local myocardial perfusion rates was compared to the coronary arteriogram obtained during the same study. In patients with normal coronary arteriograms, the average mean myocardial perfusion rate in the left ventricle (LV) significantly exceeded that of the right ventricle and the right atrial area. Mild heterogeneity of local myocardial flow rates in the LV was observed. In patients with essential hypertension, aortic stenosis, and aortic insufficiency, the average LV perfusion rates were similar to those of subjects with normal coronary arteriograms, pressures, and ventriculograms. The mean LV perfusion rates were significantly reduced in patients without coronary disease who had cardiomyopathy and cardiac failure.
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PMID:Studies of regional myocardial perfusion in patients with coronary atherosclerosis, using xenon-133 and a multiple crystal scintillation camera. 120 99

The effect of some clinical peculiarities of the disease upon the restoration of the patient's capacity for work was studied along with the factors increasing the risk of repeated disablement after resuming the professional functions. The discussion is based on the results obtained in an out-patient study of 285 males who have been employed before their myocardial infarction in administrative-managerial jobs. Three groups of factors characterizing the functional state of the cardiovascular-system in the pre-infraction, acute and post-infarction periods are distinguished. It was demonstrated that the functional state of the heart when the patients resumed their work was characterized by the degree of chronic coronary and cardiac insufficiency, the scope of every-day physical activity, and was one of the essential criteria for the evaluation of the degree of rehabilitation. The first group of factors (essential hypertension, chronic coronary insufficiency preceeding the development of myocardial infarction) and the second group (clinical and anatomical peculiarities of acute myocardial infarction) are of secondary importance in determining the degree of rehabilitation. At the same time, the functional background of the cardiovascular system teinted prior to the infarction and the depth of the infarction, as well as the reduced level of the heart's functional capacity before resuming the professional functions, belong to the factors that increase the risk of secondary disablement in persons who have resumed working after a sustained myocardial infarction.
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PMID:[Factors affecting restoration of work capacity after myocardial infarct]. 123 May 26

Angiotensin-converting enzyme (ACE) inhibitors are established in the treatment of hypertension and heart failure; both conditions are complicated by resistance to insulin-mediated glucose disposal. The defect in essential hypertension is both tissue and pathway specific, i.e., confined to nonoxidative (glycogen synthetic) routes of intracellular glucose utilization in skeletal muscle, whereas heart failure and non-insulin-dependent diabetes mellitus (NIDDM) are associated with more widespread abnormalities of carbohydrate and lipid metabolism. Thus, the mechanisms of the insulin resistance in hypertension, NIDDM, and heart failure are fundamentally different, so metabolic responses to drug therapy may not be the same in all insulin-resistant states. There have been conflicting reports about the effects of ACE inhibitors on insulin sensitivity and glycemic control. A number of studies, both with captopril and with enalapril, have shown small increases in insulin sensitivity, and there is evidence that this is due to enhanced glucose uptake into skeletal muscle. The interpretation of these studies, however, is often compromised by poor trial design, lack of full placebo data, various indirect measurements of insulin sensitivity, and heterogeneous patient populations in whom the biochemical mechanisms of insulin resistance (and drug responses) may not be the same. Overall, there probably is a modest class effect of ACE inhibitors that enhances insulin-mediated glucose disposal; the mechanism of this effect is likely to be a combination of increased muscle blood flow, local renin-angiotensin system blockade, and elevated kinin levels.
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PMID:Angiotensin-converting enzyme inhibitors and insulin sensitivity: metabolic effects in hypertension, diabetes, and heart failure. 128 42

Insulin resistance and hyperinsulinemia is now recognized in non-insulin-dependent diabetes, essential hypertension, obesity, atherosclerotic heart disease, dyslipidemia, heart failure, and in heavy smokers. Several mechanisms have been proposed to explain hyperinsulinemia, insulin resistance and its relationship to hypertension; reduced sodium excretion, activation of the sympathetic nervous system, increased activity of the sodium/hydrogen pump, and stimulation of cellular growth. Some of the nonpharmacological methods to control hyperinsulinemia are of benefit in the management of hypertension, most notably weight loss, exercise program, and reduced salt intake. High-fiber and reduced-protein diets also reduce hyperinsulinemia. Thiazide diuretics can result in insulin resistance, and insulin secretion may be inhibited, possibly associated with concomitant hypokalemia. beta-Blockers result in some reduction of glucose tolerance and mask some of the features of hypoglycemia. Angiotensin-converting enzyme (ACE) inhibitors and alpha-receptor blockers do not effect insulin resistance; probably the same is true for calcium antagonists. Although the effect on risk factors should not be discounted, it is the effect of treatment on hard end points, cerebrovascular accidents, myocardial infarction, or death that is most important. Evidence in hypertension is at present restricted to diuretics and beta-blocking drugs.
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PMID:Hypertension and insulin resistance. 128 47

Angiotensin-converting enzyme (ACE) inhibitors act by lowering the level of angiotensin II. The therapeutic benefits of these drugs and their potential side-effects therefore result from suppression of the physiological effects of angiotensin II. It is rational to prescribe an ACE inhibitor when the renin-angiotensin system is activated, as in renin-dependent essential hypertension, malignant hypertension and hypertension associated with heart failure. The beneficial effects of ACE inhibitor must be weighed against the special risks of renovascular hypertension: risk of renal artery thrombosis in case of unilateral stenosis and risk of renal failure if the stenosis is bilateral or affects a solitary kidney. In some situations the renin-angiotensin system is not directly involved in hypertension but may play a local haemodynamic role, as in some cases of primary or diabetic nephropathy. In such case the ACE inhibitors are thought to exert a protective effect. ACE inhibitors were reputed to be less effective in the elderly than in younger patients, but we now know that they can be prescribed with equal success in both instances to reduce peripheral resistance and improve regional blood flow as well as arterial compliance. Finally, ACE inhibitors can be prescribed, albeit with limited effectiveness, when the renin-angiotensin system is not activated, as in low renin hypertension and idiopathic hyperaldosteronism due to adrenal hyperplasia. They are ineffective in case of Conn's adenoma and contra-indicated in pregnant women.
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PMID:[For which hypertensive patient should angiotensin-converting enzyme inhibitor be prescribed or forbidden?]. 129 38

Angiotensin converting enzyme inhibitors are utilized in the treatment of essential hypertension and of chronic cardiac failure. They are also employed in the treatment of the myocardial lesion of ischemia-reperfusion, which involves oxygen free radicals. In the present study we investigated the possibility of three angiotensin converting enzyme inhibitors (captopril, enalapril, lisinopril) to act as hydroxyl radical scavengers. The rate constants for reactions of those compounds with .OH were determined using the deoxyribose method. All there compounds proved to be good scavengers of .OH with rate constants of about 10(10)M-1s-1 and are iron chelators specially enalapril. The fact that captopril possesses a thiol group does not confer an higher antioxidative capacity. These results suggest that scavenging of oxygen free radicals may be a possible mechanism contributing to the therapeutic effect of angiotensin converting enzyme inhibitors.
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PMID:[Angiotensin-converting enzyme inhibitors as neutralizers of hydroxyl radical]. 132 14

The effects of carvedilol, a nonselective beta-blocker with peripheral vasodilator action, on left ventricular function and mass in essential hypertension were studied in 14 patients with diastolic filling abnormalities. Treatment produced significant decreases in blood pressure (systolic: 168.4 +/- 10.5 to 154 +/- 17.2 mm Hg, p less than 0.005; diastolic: 101.6 +/- 8.6 to 95.3 +/- 11.6 mm Hg, p less than 0.025), left ventricular mass (316.7 +/- 85.8 to 276.8 +/- 84.9 g, p less than 0.05), and left ventricular mass index (157.9 +/- 42.4 to 131.6 +/- 34.6 g.m-2, p less than 0.025). There were coincident improvements in the parameters of diastolic left ventricular filling (E/A ratio: 0.66 +/- 0.14 to 0.80 +/- 0.26, p less than 0.025; mean E descent velocity: 245 +/- 130 to 264 +/- 70 cm.s-2, p less than 0.05). No significant alterations in systolic function were observed, although three patients with systolic impairment improved to normal during treatment. Two other patients, however, were withdrawn from the study because of hypotension and cardiac failure. In conclusion, carvedilol is effective in the treatment of hypertension and produces adequate blood pressure control with a percentage reduction in left ventricular mass. The associated changes in diastolic function may be due in part to the mass reduction, but no direct relation has been established, and the effect of afterload reduction on diastolic left ventricular filling remains important.
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PMID:Effect of carvedilol on left ventricular function and mass in hypertension. 137 51

In untreated essential hypertension cardiovascular structural changes will develop after some time. In arteries and arterioles, thickening and reduced compliance of the vascular wall is noted and in the left ventricle, myocardial hypertrophy. Both types of changes will enhance the risk of ischemia and of developing cardiac complications, i.e. coronary heart disease, myocardial infarction and heart failure. Methods for measurement of vascular and cardiac hypertrophy are reviewed and the value of echo-cardiographic evaluation of the hypertensive patient is stressed.
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PMID:[Cardiovascular changes in arterial hypertension]. 146 23

Adrenaline, noradrenaline and dopamine excretion was investigated in essential hypertension (n = 20), atherosclerotic heart failure (n = 20, NYHA class II and III), chronic angina (n = 10) and in healthy controls, in four time intervals: between 600-1200, 1200-1800, 1800-2400, 2400-600. Fluorimetric method of Anton and Sayre was employed. In patients with essential hypertension the circadian rhythm of adrenaline, noradrenaline and dopamine excretion was maintained but in all time intervals excretion of dopamine was decreased. In individuals with congestive heart failure due to atherosclerosis and in patients with ischemic heart disease, physiological circadian rhythm of adrenaline and noradrenaline excretion was found to be abolished. This was not the case with dopamine excretion which was undisturbed.
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PMID:[Hypertension, heart failure and angina pectoris. Diurnal rhythm of urinary excretion of catecholamines]. 164 Jun 65


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