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)

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.
 ...
PMID:Hypertension and insulin resistance. 128 47

The treatment of high blood pressure with beta-blocking and other antihypertensive agents has been associated with a decrease in the incidence of stroke, progression of hypertension, heart failure, left ventricular hypertrophy, retinopathy and renal failure. Although hypertension increases the risk for developing coronary disease, the risk is heightened markedly if coexistent hyperlipidemia, smoking or glucose tolerance is present. Thiazide diuretics, primarily used as antihypertensive agents, compromise glucose tolerance and are associated with increases in plasma cholesterol, triglycerides and low density lipoprotein levels. Nonselective and beta 1-selective beta blockers have also been associated with increases in plasma triglycerides and very low density lipoproteins, as well as with decreases in high density lipoprotein levels. The effects of various antihypertensive agents on lipid levels, lipid metabolism, carbohydrate metabolism, left ventricular size and atherogenesis are discussed.
 ...
PMID:Effects of beta blockers and other antihypertensive drugs on cardiovascular risk. 288 79

The efficacy and side effects of the combination therapy of thiazide and furosemide administered to patients with refractory heart failure, for a prolonged period of time, were assessed. Thirty-two patients were hospitalized during the years 1985-1991. Left heart failure (left ventricular ejection fraction (LVEF = 22.4% +/- 6.6%) was present in 26 patients, right heart failure in 3 patients, chronic renal failure, cirrhosis and bilateral pleural effusion were present each in one patient. Chlorothiazide 0.5 g daily was added to conventional therapy. Patients were monitored closely during hospitalization and later as outpatients. During hospitalization, addition of chlorothiazide caused a reduction of 4.8 +/- 4.0 kg in patients' weight, serum potassium decreased from 4.4 +/- 0.6 to 4.0 +/- 0.5 mmol/l (P < 0.005) and serum sodium from 139.0 +/- 4.7 to 136.8 +/- 5.5 mmol/l (P < 0.05). The duration of the combined therapy was 17.2 +/- 19.1 months. Thirteen patients had short treatment (1.6 +/- 0.8 months) and 19 patients had prolonged treatment (26.5 +/- 19.0 months). No specific characteristics distinguished patients in both groups. Thiazides were discontinued in 19 patients, 10 of which had side effects. In only 5 of the 19 patients treated for the prolonged period had thiazides to be discontinued because of side effects. Addition of thiazides to furosemide is efficacious in severe heart failure. The combination should be started during hospitalization. Many patients can be maintained on this combination for a prolonged period of time on an ambulatory basis.
 ...
PMID:Prolonged therapy by the combination of furosemide and thiazides in refractory heart failure and other fluid retaining conditions. 759 35

Hypertension is a major risk factor for vascular disease-cerebral, cardiac and peripheral. The systolic blood pressure is the most important prognostic factor. An extensive work-up searching for a cause is not indicated. Controlling hypertension has been shown to decrease incidence of stroke, heart failure, myocardial infarction and sudden death. Thiazide and beta-blockers have stood the test of time and have the best track record in preventing complications of hypertension. Surrogate endpoints of therapy, such as effect on insulin resistance, are interesting from an academic point of view. But they are no substitute for randomised clinical trials and the real endpoints of stroke, myocardial infarction and sudden death.
 ...
PMID:Hypertension and heart disease. The need for clear thinking. 837 90

1. The effects of prolonged chlorothiazide treatment of left ventricular failure on cardiac hypertrophy, circulating vasoactive hormones and exchangeable body sodium were examined in rats with chronic myocardial infarction induced by left coronary artery ligation. Chlorothiazide therapy commenced either immediately or 2 weeks after infarction. For 4 weeks, the rats were given either chlorothiazide (50 mg day-1 kg-1) in their drinking water or drinking water alone. 2. Cardiac weight increased in untreated rats with infarction in comparison with sham-operated controls, indicating the presence of chronic left ventricular dysfunction, although exchangeable body sodium, plasma renin activity, plasma vasopressin and plasma osmolality remained unchanged. 3. Chlorothiazide raised haematocrit and plasma renin activity equally in rats with and without infarction, although exchangeable body sodium, plasma vasopressin and plasma osmolality were not changed by the treatment. Plasma atrial natriuretic peptide was 2-fold higher in rats with infarction and this response was not affected by chlorothiazide treatment. Chlorothiazide therapy did not prevent or reverse cardiac hypertrophy. 4. Chronic diuretic therapy in this experimental model of heart failure did not reduce extracellular sodium, plasma vasopressin or the extent of ventricular hypertrophy, possibly because the condition was associated with activation of the renin-angiotensin system.
 ...
PMID:Cardiomegaly and vasoactive hormones in rats with chronic myocardial infarction: long-term effects of chlorothiazide. 869 3

Thiazide diuretics have antihypertensive efficacy equivalent to that of the other major classes of antihypertensive drug, and are at least as well tolerated as judged by discontinuation rates and measures of quality of life. They are effective when given once daily, require no dose titration, have few contraindications, and have additive effects when combined with drugs of other classes. The dose-response relation for blood pressure is flat, whereas the subjective and biochemical side-effects are dose-dependent. They should be prescribed only at low dosage. Treatment regimens based on low-dose thiazide prevent stroke, coronary events, heart failure and renal failure in hypertension, and have proven safety. Thiazides are inexpensive. Low-dose thiazides should be preferred for routine first-line treatment of hypertension unless they are contraindicated or there is a compelling indication for an alternative class of drug.
 ...
PMID:Thiazide diuretics in hypertension. 1042 3

In heart failure, sodium is retained by the kidneys despite increases in extracellular volume. There is activation of renin secretion, which culminates in the production of angiotensin II, causing vasoconstriction and aldosterone secretion. These synergistically produce an increase in tubular reabsorption of sodium and water. Diuretics are the mainstay of symptomatic treatment to remove excess extracellular fluid in heart failure. Diuretics that affect the ascending loop of Henle are most commonly used. Thiazide diuretics promote a much greater natriuretic effect when combined with a loop diuretic in patients with refractory edema. Recently, spironolactone, an aldosterone receptor blocking agent, has been recommended to attenuate some of the neurohormonal effects of heart failure. Regardless of the diuretic, patients need to be counseled on the importance of avoiding sodium in their diet
 ...
PMID:Balancing diuretic therapy in heart failure: loop diuretics, thiazides, and aldosterone antagonists. 1246 20

In series of papers the authors analyze the literature data concerned with clinical pharmacology of four main classes of diuretics and their use in long-term treatment of congestive chronic heart failure (CHF). Part I is devoted to basic clinical pharmacology of three main classes of diuretics -- loop, thiazide and potassium-sparing. The site of action in nephron, mechanisms and duration of action different loop and thiazide diuretics with emphasis to furosenide, torasemide, hydrochlorothiazide, metolazone and indapamide as well as contraindications and limitations for their use in the complex treatment of CHF are considered in detail. In long-term comparative studies showed long acting loop diuretic torasemide improved symptomatology and functional class of NYHA in patients with CHF in compared with furosenide. Thiazide-like diuretic indapamide does also act as vasodilator and decreases afterload of left ventricle of heart. But indapanide should be used with special caution because of their capacity to prolong the Q-T interval, which associates with polymorphic ventricular tachycardia, or torsades de poites.
 ...
PMID:[The place of diuretics in the treatment of chronic heart failure. Part I]. 1609 50

Cardiovascular disease is the leading cause of death and disability world-wide. Blood pressure, throughout the range seen in developed countries, is the most important risk factor for cardiovascular disease. Lowering blood pressure within the whole population by lifestyle interventions, such as reducing dietary salt intake and increasing the consumption of fruit and vegetables, will be of great benefit. Blood pressure-lowering trials also demonstrate immense benefits in preventing strokes, heart failure and coronary heart disease. There are no differences in outcome between the different methods used to lower blood pressure and the benefit is proportional to the degree of blood pressure-lowering. Thiazide diuretics are effective in lowering blood pressure and have been the most widely prescribed blood pressure-lowering drugs. They work by causing both sodium and water loss, but also cause potassium loss and a fall in plasma potassium levels. The latter may mitigate the beneficial effects from blood pressure-lowering. Some diuretics, such as spironolactone, affect the distal tubule and do not cause a fall in plasma potassium levels. However, spironolactone has endocrine side-effects associated with the fact that it is not specific for the mineralocorticoid receptor. The development of a more selective aldosterone antagonist without endocrine side-effects could be a major advance as it would be able to oppose the effects of aldosterone, both on sodium retention and potassium loss and the other vascular effects.
 ...
PMID:Importance of controlling blood pressure. 1620 51

The recommendations of the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), published in 2003, are largely relevant today. Lowering blood pressure (BP) to goal in hypertensive patients is of primary importance in reducing cardiovascular risk. Antihypertensive drugs vary in their efficacy to lower BP and can have BP-independent effects on cardiovascular events, as seen especially with regard to preventing heart failure and stroke. Thiazide-type diuretics were recommended as the preferred initial drugs for treatment of hypertension in most patients, and this is still an appropriate recommendation. Several other classes were recommended as next in priority, but beta-blockers should now have a lesser role in the management of uncomplicated hypertension. Although a new JNC report would be reassuring to practitioners and should include some changes since JNC 7, I consider most of the recommendations to still be relevant today.
 ...
PMID:JNC-7 guidelines: are they still relevant? 1817 84


1 2 3 Next >>