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Query: UMLS:C0020473 (hyperlipidemia)
 15,891 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In practice, some of the major problems for the physician who treats hypertension are patients who are resistant to treatment or who have other complicating risk syndromes. Therefore the overall efficacy of an antihypertensive agent must include an assessment of effect in patients with serious ancillary problems. In this article, doxazosin is reviewed for its efficacy in the treatment of severe essential hypertension and specific complications or conditions of mild or moderate essential hypertension, namely, left ventricular hypertrophy, hyperlipidemia, noninsulin-dependent diabetes mellitus, renal insufficiency, pheochromocytoma, chronic obstructive pulmonary disease, peripheral vascular disease, and smoking. Doxazosin is particularly efficacious in many specific subgroups of patients with hypertension, and the results of relevant studies are discussed.
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PMID:Efficacy of doxazosin in specific hypertensive patient groups. 182 52

Persons with either borderline or established hypertension should always be instructed in a series of general measures. These include a reduction of overweight, dietary salt restriction, no smoking, whenever possible discontinuation of oral contraceptives, appropriate physical exercise, and treatment, primarily by diet, of a coexisting hyperlipidemia. Such non-pharmacologic measures may often improve the potential risk constellation and in some persons with borderline or mild hypertension even normalize the blood pressure. Pharmacotherapy is recommended only in selected cases with persistent borderline blood pressure elevation but, on a partly empirical basis, appears usually to be indicated for established hypertension of greater than or equal to 160/95 mm Hg. The coexistence of diabetes mellitus or renal functional impairment and advancing age of a patient deserve special consideration in the choice and/or dosage of antihypertensive drugs. Failure to achieve satisfactory blood pressure control through general measures and appropriately dosed triple drug therapy (including a diuretic, a betablocker or other sympatholytic or calcium antagonist, and (di)hydralazine, prazosin or endralazine) calls for thorough reevaluation of the situation. Causes which may simulate or induce resistant hypertension include technical problems with measurement, oral contraceptives, insufficient patient cooperation, sodium fluid volume retention, insufficient pharmacotherapy, drug interactions, "office hypertension" with satisfactory blood pressure in the patient's daily environment, and potentially operable causes such as renal artery stenosis or pheochromocytoma. If none of these factors is present, persistent uncontrolled hypertension can very often be treated satisfactorily with newer potent drugs such as the convertase inhibitor captopril as first choice agent in women, or the direct vasodilator minoxidil as the preferred agent in men. Together with the necessary steps to improve patient compliance, including increased blood pressure measurements by the patient himself, practitioners can now rely upon effective therapeutic tools. The present social and economic burden resulting for the individual and the public from neglected therapeutic opportunities, from excess morbidity and early death due to inadequately treated hypertension, can and must be reduced in the interests of the community at large.
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PMID:[Long-term treatment of hypertension in 1983]. 641 60

We report the case of a 60-year-old man with recent onset of poorly controlled diabetes mellitus, frequent anginal chest pains, paroxysmal hypertension, hyperlipidemia, and mild renal insufficiency. The patient was found to have pheochromocytoma of the left adrenal gland, resection of which resulted in total resolution of diabetes, hypertension, chest pain, hyperlipidemia and renal failure.
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PMID:Insulin-requiring diabetes mellitus, hyperlipidemia, and anginal chest pains as prominent features of pheochromocytoma. 938 71

We present the patient with 1-month history of mild hypertension, who was admitted to our department with suspicion of coronary heart disease. He had family history of hypertension and coronary heart disease, hyperlipidaemia and he has been smoker for several years. During the diagnostic exertion test chest pain together with an unusual high blood pressure was found (240/140 mmHg). The results of catecholamines and their metabolites in 24-urine collection, abdominal ultrasonography and NMR revealed pheochromocytoma in the left adrenal gland, which was removed successfully. Particular clinical examination allowed to include the patient to the group with low-symptomatic pheochromocytoma. Abdominal USG, which had been done prior to the exertion test, didn't reveal any incidental tumor in the adrenal glands. The abnormal hypertensive reaction during exertion test was the main decision of the urine catecholamines and their metabolites determination. Pheochromocytoma should be included to the differential diagnosis in all patients with chest pain and high blood pressure during diagnostic exertion test.
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PMID:[Low-symptomatic pheochromocytoma]. 1195 7

alpha(1)-Adrenoceptor antagonists are useful antihypertensive agents for patients with hypertension who have hyperlipidemia, benign prostatic hyperplasia, or pheochromocytoma. The purpose of this study was to evaluate the effect of the alpha(1)-adrenoceptor antagonist, doxazosin mesilate, on cerebral blood flow (CBF) and flow velocity in the common carotid artery in patients with hypertension and chronic cerebral infarction. Doxazosin mesilate (1 mg/day) was orally administered for 4 to 8 weeks to 7 patients with hypertension 4 weeks after the onset of cerebral infarction. We determined blood pressure, heart rate, CBF measured with autoradiography single photon emission computed tomography (SPECT) with N-isopropyl-p-[(123)I] iodoamphetamine ((123)I-IMP) as a tracer, and the maximum, minimum and mean flow velocities in the common carotid arteries measured with duplex carotid ultrasonography before and 4 to 8 weeks after the beginning of treatment. Mean CBF was defined as the mean count of tracer from the 8 regions of interest (ROIs) in the frontal, parietal, occipital, and temporal cortices of the cerebral hemisphere. Values were analyzed with paired t tests. With administration of doxazosin mesilate, systolic pressure significantly decreased from 152 +/- 11 to 137 +/- 7 mmHg (p<0.01), but diastolic pressure and heart rate were unchanged. Mean CBF was improved significantly from 32.0 +/- 4.1 to 34.7 +/- 4.1 mL/100 g brain/min (p<0.01) in the ipsilateral cerebral cortex and from 32.6 +/- 6.2 to 36.2 +/- 5.1 mL/100 g brain/min (p<0.05) in the contralateral cerebral cortex. The maximum, minimum, and mean flow velocities in the bilateral common carotid arteries were not changed significantly. In the present study, the improvement of mean CBF in the ipsilateral and contralateral cerebral cortices was demonstrated in patients with hypertension and chronic cerebral infarction after the treatment with doxazosin mesilate. Doxazosin mesilate might be an effective antihypertensive agent for hypertensive chronic cerebral infarction.
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PMID:The effect of doxazosin mesilate on cerebral blood flow in patients with hypertension and chronic cerebral infarction. 1960 21

Primary aldosteronism characterized by the overproduction of aldosterone by the adrenal glands, is sometimes accompanied by autonomous cortisol secretion. In this study, we retrospectively analyzed 8 cases of primary aldosteronism (PA) with subclinical Cushing's syndrome (SCS). A total of 71 patients with PA underwent surgery at Jikei University Hospital from 2004 to 2013, and 8 of them were diagnosed with coexistent SCS. Four patients were male and four were female. The mean patient age was 56.9 years. One of the patients also had pheochromocytoma in the adrenal gland on the ipsilateral side. All patients had hypertension, 6 had hypokalemia, 5 had diabetes mellitus, and 3 had hyperlipidemia. All patients had autonomous cortisol secretion as shown in 1 mg- or 8 mg-dexamethasone suppression tests even though baseline cortisol levels were normal. Adrenal venous blood sampling with adrenocorticotropic hormone (ACTH) stimulation was performed on 5 patients, but the localization of PA could not be detected in 1 patient. Adrenocortical scintigraphy revealed suppression of the contra-lateral adrenal uptake in all 7 patients. Six patients including one patient who showed complete suppression of the contra-lateral adrenal uptake in adrenocortical scintigraphy, and 2 patients, whose ACTH levels were less than the detection limit, received postoperative steroid hormone replacement. In the literature, SCS co-existed in approximately 8. 6% of the patients with PA. In our study, SCS co-existed in approximately 11.3%. The degree of the autonomous secretion of cortisol varied with the patient, and some cases are accompanied by Cushing's syndrome. Therefore, it is important to analyze the autonomous cortisol secretion even in patients with PA.
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PMID:[Clinical Evaluation of Primary Aldosteronism with Subclinical Cushing's Syndrome]. 2608 19

Pheochromocytoma is a rare adrenal gland tumor that is often difficult for physicians to diagnose because of its general, nonspecific complaints. Diagnosis is particularly difficult in patients with neurofibromatosis 1, because pheochromocytoma in these patients will mimic other cardiovascular abnormalities. The authors report the case of a 60-year-old woman with an extensive history of hyperlipidemia, malignant hypertension, coronary artery disease, and neurofibromatosis 1 who was referred for an elective cardiac catheterization as a result of an abnormal stress test. The patient returned to the hospital 3 days after the procedure complaining of increased angina and palpitations. While hospitalized, she developed severe episodic hypertension. A computed tomographic scan revealed bilateral adrenal masses. Findings of biochemical and imaging evaluation confirmed the diagnosis of bilateral pheochromocytoma. Early screening of pheochromocytomas in high-risk populations is essential for prompt diagnosis and successful management.
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PMID:Pheochromocytoma Diagnosis After an Abnormal Stress Test: Case Report and Review of the Literature. 2611 Nov 42