UMLS:C0020538 - FACTA Search

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Query: UMLS:C0020538 (hypertension)
170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The aim of our study was to compare blood pressure (BP) measured by 24-h ambulatory monitoring in young and elderly hypertensives and to find a dependency between left ventricular mass (LVM) and different pressure ratios. We also estimated the calcium ionized concentration and serum lipids in all subjects. Two hypertensive groups divided accordingly by age were studied. The duration of hypertension was similar in both groups. The Oxford Medilog ABP was used for the arterial BP recordings. Mean arterial BP, BP loads and night/day mean arterial pressure ratio were evaluated. In both groups left ventricular mass index (LVMI) were calculated. The serum calcium ionized concentration (Ca++) was estimated and serum lipids were determined. We found 10 non-dippers in the young group and seven non-dippers in the elderly hypertensives. LVM and LVMI were comparable in both groups. We showed the correlation of the nocturnal mean arterial pressure with LVM in elderly hypertensives and the dependency of nocturnal BP load with LVM in this group. Serum calcium ionized concentration was significantly decreased in the elderly patients, and LDL-cholesterol was significantly higher in this group. We found a negative correlation between serum calcium and triglycerides in young and elderly hypertensives. We found more non-dippers in the young hypertensives and a positive correlation between LVM and nocturnal mean arterial pressure and nocturnal BP load in elderly subjects. These results suggest the cardiovascular prognosis is not good in both groups. The prognosis in elderly hypertensives was also worsened by the low serum calcium ionized and high LDL-cholesterol concentrations.
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PMID:Twenty-four hour ambulatory blood pressure monitoring in young and elderly hypertensive subjects. 978 97

One hundred thirty-four men and seventy-one women, unmedicated mild hypertensives, underwent 24-h ambulatory blood pressure (BP) monitoring (ABP) and completed standardized questionnaires measuring marital and job stress. Of these, 44.8% had daytime diastolic BP < 90 mm Hg; 96.1% had left ventricular mass index in the normal range (N = 176). Lower marital cohesion (Cohesion, subscale of the Dyadic Adjustment Scale) was related to elevated nighttime ABP (P < or = .05) and 24-h diastolic BP (P < .05). With low Cohesion (N = 83), more reported spousal contact was associated with elevated nighttime ABP (P < .031). The 7.3% of subjects with very low Cohesion demonstrated approximately 6 mm Hg elevation of all ABP variables, controlling for other significant variables (P < .05, except for nighttime SBP). This study shows an association between marital cohesion and ABP and suggests that marital factors may have a role in sustaining BP in early hypertension.
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PMID:Marital cohesion and ambulatory blood pressure in early hypertension. 1009 Mar 53

Ambulatory blood pressure monitoring (ABPM) is now very useful for assessing the blood pressure response to antihypertensive drugs. It gives accurate information on blood pressure profiles and provides more detailed information on first-dose effects, dose-response relationships, and the direction of action of antihypertensive treatment. However, ABPM studies will also allow new questions to be addressed. The reliability of ABPM measurements must receive more attention: validation of the different ABP monitors, evaluation of missed data, standardization of activities during the monitoring period. Concerning these technical problems, it seems reasonable to propose a control of quality of ABPM data in therapeutic trials. As a result of previous studies, it might be argued that ABPM should not obly be used to evaluate the effects of treatment, but also to improve the selection of patients for clinical trials who are hypertensive both in the clinic and during ABPM. Despite a generally good agreement between sthe effects of medication on clinic and ABP when analysed on a group basis, several studies have reported weak, insignificant correlations on an individual basis, indicating discrepancies between clinic and ambulatory pressures. Clinic pressures tend to overestimate the degree of blood pressure control during daily activities. Treatment produces a significant reduction in ABP in the 'true hypertensives', whereas in the other 'white-coat hypertensives' it has no effect. There is also a question of the duration of action of treatment: whether medication should be equally effective throughout the day and night or should be focused on moments when the pressure is highest. The value of blood pressure variability in therapeutic trials is not yet well known, and needs further evaluation. The definition of hypertension and normotension have traditionally been difficult and arbitrary when based on clinic blood pressure measurements, the difficulty is not removed when trying to achieve a definition of normal blood pressure by using ABPM, the predictive value of which is still being tested.
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PMID:Conduct of therapeutic trials. 1022 35

Fractal analysis is a new tool allowing to study the complexity of cardiovascular variability. This approach may be useful for investigating regulatory mechanisms. In fractal terms, homeostasis required an optimal organisation of complexity (beta coefficient close to 1): conversely, some pathological situations have proven to be associated with an altered organisation of fractals (beta coefficient different from 1). Our study aimed at determining if hypertension was associated with an alteration of the fractal component of blood pressure (BP) or heart rate (HR) variability. Eighty-eight subjects referred for high BP entered the study. BP was measured in ambulatory conditions by an automatic device during 24 hours (ABP). BP and HR were then recorded beat-to-beat by a Finapres and an ECG during 30 minutes at rest. The beta coefficient was obtained by coarse-graining spectral analysis from the BP and RR interval time series. This method has proven its interest for breaking down cardiovascular variability into an harmonic component and a non harmonic one, this latter containing fractal elements. Spontaneous baroreflex sensitivity was assessed by the method of sequences. The percentage of fractals contained in BP and RR signals remained relatively stable despite the increasing severity of hypertension. A significant but loose correlation was found between the beta coefficient of RR and ABP (r = 0.23, p = 0.053 with systolic ABP; r = 0.25, p = 0.03 with diastolic ABP). No correlation could be disclosed between ABP and the beta coefficient of BP. The beta coefficient of RR was significantly correlated with the spontaneous baroreflex sensitivity (-0.59, p < 0.0001). It is concluded that it is rather the complexity of HR signal than that of BP which is altered during hypertension. This may suggest that some regulatory processes are lost or less efficient. The correlation reported between the baroreflex gain and the beta coefficient of RR interval may reflect, in fact, an alteration of the parasympathetic drive. Globally, these results emphasise the importance of HR and probably cardiac output in the pathophysiology of high BP.
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PMID:[Fractal analysis and arterial hypertension]. 1048 77

The resistant hypertension has been differentiated in true resistant hypertension and white-coat resistant hypertension by using ambulatory blood pressure monitoring. White-coat resistant hypertension was defined as high clinic blood pressure, despite triple treatment for at least 3 months, but day-time blood pressure values < 135/85 mmHg. The aim of this study was to evaluate the presence of different clinical characteristics between two types of resistant hypertension. The study group consisted of 49 patients with essential hypertension, resistant to an adequate and appropriate triple-drug therapy, that included a diuretic, with all 3 drugs prescribed in near maximal doses and that had persistently elevated clinic blood pressure (> 140/90 mm Hg), for at least 3 months. They represented the 2% of 2500 hypertensive outpatients that referred at our Hypertension Unit. Patients with white-coat resistant hypertension (n=19) were older (p<0.05) than those with true resistant hypertension (n=30). The sodium intake (p<0.05) and alcohol intake (p<0.05) were significantly higher in patients with true resistant hypertension than in those with white-coat resistant hypertension. The renin plasma activity and plasma aldosterone were higher (p<0.05) in patients with true resistant hypertension than in those with white-coat resistant hypertension with normal plasma electrolyte balance. There were no significant differences in mean values of office systolic and diastolic blood pressures between white coat resistant hypertensives and true resistant hypertensives (165+17 vs 172+28 and 98+12 vs 102+14 mmHg). Day-time and night-time ambulatory 24-h-systolic and diastolic blood pressures were significantly higher in the true resistant hypertensive patients when compared with white-coat resistant hypertensives (153+15 vs 124+10 mmHg and 97+9 vs 76+6 mmHg all p<0.001). Day-time and night-time ambulatory 24-h-heart rate were significantly higher in the true resistant hypertensive patients when compared with white-coat resistant hypertensives (79+11 vs 71+9 beats/min; p<0.01; 68+9 vs 60+6 beats/min, p<0.001). The ABP readings were analysed by a Fourier series with 4 harmonics. According to the runs test both two groups of patients showed a circadian rhythm for both systolic and diastolic blood pressure. The nocturnal fall in SBP, DBP and HR was not different in both groups of patients. In conclusion, our findings showed that true resistant hypertensive patients were characterized both by higher heart rate and higher plasma renin activity values as an expression of a possible increased sympathetic activity. Thus, the combination of ABPM with the assessment of the clinical characteristics allow to differentiate better the true drug-resistant hypertension from the white coat resistant hypertension.
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PMID:Ambulatory blood pressure monitoring and clinical characteristics of the true and white-coat resistant hypertension. 1133 87

This multicenter, randomized, double-blind, parallel group study was undertaken to determine the effectiveness of selected antihypertensives (doxazosin, amlodipine, enalapril, and bendrofluazide) in maintaining 24-hour control of blood pressure (BP). The predictive value of ambulatory (A)BP versus clinic (C)BP measurements as a method for detecting patients with hypertension was also evaluated. A total of 204 patients were screened and of these 110 were diagnosed as mild to moderately hypertensive with clinic diastolic BP 100-110 mm Hg (> or =95 mm Hg in patients with coronary heart disease risk factors). The 4 antihypertensives were all equally effective at controlling BP over 24 h, as shown by 24-hour ABP measurements. The incidence of adverse events was similar for all 4 treatment groups; headache was the most common event, being reported by 22 patients (20%). There was a clinically relevant reduction in total cholesterol for the doxazosin (-15.4 mg/dl) and amlodipine (-11.6 mg/dl) treatment groups in comparison with enalapril and bendrofluazide. Our results from ABP measurements suggest that the antihypertensives studied are effective first-line therapy in the regulation of hypertension and that ABP is a reproducible measure. ABP may also be useful in identifying patients with various types of high BP, for instance those with 'white coat' hypertension, enabling more accurate screening and diagnosis.
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PMID:A comparison of selected antihypertensives and the use of conventional vs ambulatory blood pressure in the detection and treatment of hypertension. 1157 40

This study investigated the differences in the effect of an angiotensin converting enzyme inhibitor (ACEI) compared with an angiotensin receptor blocker (ARB) on blood pressure (BP) and pulse pressure (PP) measured in the clinic (CBP and CPP, respectively), at home (HBP, HPP) and with ambulatory monitoring (ABP, APP). Twenty-seven hypertensive patients were randomised to receive lisinopril (20 mg) or losartan (50 mg) for 5 weeks, and were subsequently crossed-over to the alternative treatment for a second 5-week period. Measurements of CBP, 24-h ABP and 5-days HBP were performed before randomisation and at the end of each treatment period. All measurement methods showed that lisinopril was more effective than losartan in reducing BP. However, the difference between the two drugs was demonstrated with greater precision using HBP (P<0.001) than 24-h ABP (P<0.01), whereas the poorest precision for demonstrating this difference was provided by CBP (P<0.05). Lisinopril was also found more effective than losartan in reducing HPP (P=0.01) and 24-h APP (P=0.03) whereas no such a difference was detected using measurements of CPP. It was concluded that the antihypertensive drugs may differ in their effects not only on BP, but also on PP. HBP monitoring appears to be as reliable as 24-h ABP monitoring in detecting differences in the effect of drugs on both BP and PP. Clinic measurements seem to be the least reliable method, particularly in the detection of differences in PP.
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PMID:Assessment of drug effects on blood pressure and pulse pressure using clinic, home and ambulatory measurements. 1242 Jan 98

Hypertension is a frequent complication in patients with chronic renal insufficiency (CRI) and is associated with target organ damage, including left ventricular hypertrophy (LVH). To better assess hypertension in pediatric patients with CRI, we performed 24-h ambulatory blood pressure monitoring (ABPM) and evaluated the relationship between ABPM parameters and LVH in 29 children, mean age 12.4+/-3.8 years. There was no significant difference in the frequency of hypertension comparing casual systolic blood pressure (SBP) (21%) with the mean 24-h (21%) or daytime mean SBP (21%). However, diastolic hypertension was detected more frequently using ABPM: 24% for 24-h diastolic blood pressure (DBP), 14% for daytime DBP, and 7% for casual DBP. Nighttime systolic hypertension as well as diastolic hypertension was detected in 12 (41%) children. Seventeen (59%) patients had attenuated dipping for SBP and 9 (31%) had abnormal DBP dipping. Lower SBP dipping was associated with lower glomerular filtration rate (r=0.44, P<0.05). LVH was found in 6 (21%) patients. LVM index was significantly correlated with 24-h SBP (r=0.43, P<0.05). Multiple regression analysis confirmed that higher 24-h SBP was the only independent predictor for increased LVM index (P=0.001). No significant relationship was found between LVM index and office blood pressure. These results confirm a high prevalence of blood pressure abnormalities using ABPM criteria in children with CRI and suggest that ABP may better predict end-organ damage in these patients than casual BP.
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PMID:Office and ambulatory blood pressure elevation in children with chronic renal failure. 1257 4

Ambulatory monitoring of the blood pressure (AMBP) makes it possible to diagnose in hypertensive patients the so-called dipper phenomenon, i.e. a drop of the BP during the night provided that the patient is asleep. The absence of this phenomenon implies as a rule serious damage of the cardiovascular apparatus, brain or kidneys. By means of an apparatus ABP monitoring type 90207 of Space Labs. Inc. a group of 16 patients in regular dialysis treatment (RDT) was examined and the blood pressures were evaluated before and after dialysis. Patients with the dipper profile reacted more adequately during dialysis i.e. by a drop of the blood pressure due to the loss of excessive fluid which they retained during the interdialysis period, as compared with the group with a non-dipper profile which may be exposed to a greater risk of cardiovascular complications. The authors conclude that detection of the absence of the non-dipper phenomenon can reveal risk patients. AMBP can explain so-called paradoxical hypertension at the end of haemodialysis despite major removal of fluids by ultrafiltration, and that moxonidine participates in a significant way in the elimination of the non-dipper phenomenon.
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PMID:[Ambulatory monitoring of blood pressure in regular dialysis therapy]. 1279 47

Acute blockade of gamma-aminobutyric acid (GABA)-A receptors in the hypothalamic paraventricular nucleus (PVN) increases mean arterial pressure (MAP), heart rate (HR), and sympathetic nerve activity (SNA). However, the underlying neural mechanisms have not been fully determined. We tested the hypothesis that responses to GABA-A receptor blockade in the PVN require activation of local ionotropic excitatory amino acid (EAA) receptors. MAP, HR, and renal SNA responses to unilateral PVN microinjection of bicuculline methobromide (BIC, 0.1 nmol) were recorded before and after ipsilateral PVN injection of either vehicle (saline), the nonselective ionotropic EAA receptor antagonist kynurenate (KYN), the NMDA receptor antagonist D(-)-2-amino-5-phosphonopentanoic acid (AP5), or the non-NMDA receptor antagonist 2,3-dioxo-6-nitro-1,2,3,4-tetrahydrobenzo[f]quinoxaline-7-sulfonamide disodium (NBQX). Responses to PVN-injected BIC were unaltered by vehicle injection. In contrast, injection of KYN (7.2 nmol; n=4) nearly abolished ABP and renal SNA responses to BIC (P<0.01) and significantly attenuated (P<0.05) HR responses as well. Similarly, graded doses of AP5 (0.6, 3, and 6 nmol) and NBQX (0.26, 1.3, and 2.6 nmol) reduced responses to PVN-injected BIC in a dose-related manner, with the 3 nmol (n=7) and 1.3 nmol (n=6) doses producing maximal effects (P<0.05). KYN, AP5, and NBQX did not affect baseline parameters. Effects of a cocktail containing AP5 (3 nmol) and NBQX (1.3 nmol) were greater (P<0.01) than either antagonist alone and were not statistically different from KYN. These data indicate that cardiovascular and renal sympathetic responses to acute GABA-A receptor blockade in the PVN require local actions of EAAs at both NMDA and non-NMDA receptors.
Hypertension 2003 Oct
PMID:Sympathoexcitation by PVN-injected bicuculline requires activation of excitatory amino acid receptors. 1290 Apr 39

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