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

An association between high blood pressure and the coronary-prone (or type A) behaviour pattern, established as risk factors for myocardial infarction and sudden death, has been postulated on the basis of similar psychophysiological mechanisms involving the sympathetic nervous system. Psychodynamic personality profiles and type A behaviour assessment have therefore been related to biochemical markers of sympathetic overactivity, but type A behaviour scores were generally found to be low in hypertensive subjects - and lowest in those with high plasma noradrenaline. However, projective assessment of reactions to frustration during everyday stress indicates that hypertensive patients with high plasma renin activity as well as high noradrenaline have less externalized but more internalized aggression, and are submissive yet have a stronger need to resolve conflicts immediately. These incompatible tendencies result in chronic frustration. A similar high degree of suppressed anger is shared by patients at risk for coronary heart disease, and high renin patients have a higher incidence of critical cardiac events. This suggests the possibility of a 'hypertensive coronary-prone personality'. Because of their excellent antihypertensive response to chronic beta-blocker therapy, it is conceivable that high renin patients benefit most from the cardioprotective potential of beta-blocker-based antihypertensive therapy.
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PMID:Personality, coronary-prone behaviour and adrenergic factors in essential hypertension: possible implications for cardiac prevention. 613 18

Mesoblastic nephroma is a distinctive pathologic renal tumor with unique clinical, therapeutic, and prognostic patterns. This report reviews 51 patients (2.8% of 1905 patients submitted to NWTS with renal tumors) with this diagnosis from the NWTS contrasting this disease entity with Wilms' tumor. There were 33 males and 18 females, predominantly term babies born after uncomplicated pregnancies. The mean age at tumor excision was 3.44 +/- 0.6 mo (one child 9 yr). A palpable mass was the predominant presentation in 48 patients and in addition hematuria (9), hypertension (2), vomiting (3), and jaundice (1) were noteworthy. Diagnostic studies included IVP (49 positive, 2 negative) and ultrasound (15 positive, 1 negative). Adequate operative excision was achieved in 43 of 51 patients while 8 children had local extension and 10 had tumor spillage. Operation alone (23), predominantly since 1978, surgery plus chemotherapy (24), prior to 1978, and surgery, chemotherapy, and radiation therapy (4), prior to 1976, were the modes of therapy. The follow-up ranges from 4 mo to 11.5 yr. Survival was excellent; 50 patients survive (98%), only 1 dying of sepsis. These data suggest that mesoblastic nephroma contrasts with Wilms' tumor in that it occurs in a younger age group, has a benign biologic behavior, and a more favorable outcome. Aggressive multimodal treatment though utilized in the early years of the study is not essential to achieve this outcome.
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PMID:Therapy and outcome in 51 children with mesoblastic nephroma: a report of the National Wilms' Tumor Study. 629 97

The authors present a group of 48 patients with stress ulcers (36 men, 13 women) average age 56.2 years. The analysis of the cases allowed to establish, for the first time in medical literature, a correlation between the etiology, the symptomatology and the moment of onset of the haemorrhage, with important practical implications in the adoption of a treatment regime. These considerations permitted us to delineate four categories of stress ulcers: The first category included stress ulcers caused by a cerebral lesion and manifested through cerebral hypertension. The upper digestive haemorrhage occurred within 24-48 h after the aggression and required the correction of the cerebral hypertension and of the anaemia. The second category comprised stress ulcers brought about by a hypovolaemic shock through myocardial infarction, burns, frost-bite and multiple traumas. Haemorrhage in the upper digestive tract appeared within 3-6 days after the moment of aggression and required surgical control unless it was caused by myocardial infarction. The third category was represented by post-operative stress ulcers. These forms occurred usually late, between the eighth and the thirty-seventh day after the aggression, and were due to the super-imposition of the septicaemia on the post-aggressive systemic reaction. The chief aim of treatment here was the surgical control of infection. The fourth category encompassed the stress ulcers occurring after protracted coma, especially in patients with ventilatory assistance. In these conditions, the ulcers of the digestive tract and the consequent haemorrhage represented terminal elements of irreversible diseases, in which no treatment was effective.
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PMID:Stress ulcers in intensive care (etiology, symptomatology and therapy). 633 Aug 27

Aggressive behavior in mice caused a vast release of renin into the plasma. The present data support previous findings that the main sources were the submaxillary gland and kidney. In addition, unidentified salivary glands capable of releasing renin into the saliva were demonstrated by alpha-adrenergic stimulation. The role of these glands in generating plasma renin is unknown. Experiments were performed that strongly support the possibility that aggression-provoked salivary renin may be transferred by bites from one animal to another.
Hypertension
PMID:Increase in plasma renin in aggressive mice originates from kidneys, submaxillary and other salivary glands, and bites. 633 48

Overt diabetic nephropathy is a well-established clinical picture characterized by macroproteinuria and irreversible decline of glomerular function. The first phase of renal involvement has been widely investigated in the last decade in the hope to individuate early lesions. Five stages of glomerular damage have been identified by morphological abnormalities and clinical tests. Although renal hypertrophy, hyperfiltration, and microalbuminuria are present in all diabetics at onset, subsequent evolution shows different patterns: some patients may present no further progression, while others show a rapid and irreversible decline of kidney function. This suggests that other factors, i.e., risk factors, may play important roles in the renal involvement in diabetics. The predictive role of microalbuminuria and of hyperfiltration was investigated, and, so far, only an albumin excretion rate above 30 micrograms/min had been proved to be associated with a decline of renal function. Actually no practical hints can be given to prevent the disease apart from persistent strict glycometabolic control during the course of diabetes. Antihypertensive treatment can slow glomerular damage when overt diabetic nephropathy and hypertension are present. Aggressive treatment in the early phases of renal involvement might change the natural history of the disease.
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PMID:Etiology, diagnosis, and prevention of renal involvement in insulin-dependent diabetes mellitus. 640 Apr 50

To identify significant predictors of early and late mortality, multivariate discriminant analyses were applied to the clinical outcome of 175 consecutive patients with thoracic aortic aneurysms operated upon over a 20 year span. Only atherosclerotic and degenerative aneurysms were included; the patients were segregated into two groups according to location of the aneurysm. The ascending aortic aneurysm group consisted of 124 patients, 85% of whom required concomitant aortic valve replacement. There were 51 patients in the descending aortic aneurysm group. Mean follow-up was 4.9 years (maximum of 19 years), with a total of 860 patient-years of follow-up. Multivariate analyses revealed that surgical priority and advanced age were independent determinants of hospital mortality in the ascending group; for the descending group, surgical priority and the presence of congestive heart failure were the strongest predictors of hospital mortality. Late mortality in the ascending group correlated with advanced age. Hypertension and the presence of preoperative congestive heart failure were independent determinants of late mortality in the descending group. Several variables did not have any independent bearing on hospital or late mortality, including etiology and location of the aneurysm, previous myocardial infarction, chronic lung disease, and concomitant aortic valve replacement. High-risk subgroups of patients with thoracic aortic aneurysms can be identified by these variables. Aggressive medical plus surgical management and operation prior to aneurysm rupture is necessary to improve both early and long-term survival rates.
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PMID:Degenerative and atherosclerotic aneurysms of the thoracic aorta. Determinants of early and late surgical outcome. 650 14

Suppressed aggression and activity of the sympathetic nervous system were assessed in two risk groups for essential hypertension, viz. 24 borderline hypertensives (18 men, 6 women, age range 18-24, 18 with a family history of hypertension) and 24 normotensive offspring of hypertensive parents, and in a control group exactly matched for age, sex and socioeconomic status. In the Rosenzweig Picture-Frustration test, both potential hypertensive groups were significantly less aggressive compared with the controls, and additionally the borderline hypertensives internalized their aggression. Plasma noradrenaline concentrations, as a marker for sympathetic nervous system activity, increased significantly before and during mental stressors (Stroop colour-word conflict test, mental arithmetic) in both groups, whereas in normotensive controls no significant increase occurred. These findings point to a psychosomatic factor in the development of essential hypertension.
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PMID:[Aggression inhibition and increased sympathetic nervous reactivity in the development of essential hypertension]. 651 85

Monitoring of intracranial pressure has become increasingly widespread in a variety of conditions. The information gained has allowed for the development of certain principles of management in patients with presumed or potential intracranial hypertension. These principles are applicable whether ICP monitoring is employed or not. Aggressive management of severe intracranial hypertension may improve survival; however, data from several studies are inconclusive. The author attempts to review developments in the field and assess the impact of this modality of therapy in pediatric neurosurgical practice.
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PMID:Intracranial pressure monitoring in perspective. 678 25

In the diabetic patient, the foot is particularly vulnerable to disorders resulting from vascular insufficiency, neuropathy, and infection. Without proper treatment, these disorders can lead to serious disability or amputation. Hyperglycemia, smoking, hypertension, and obesity contribute to the development of foot lesions. Early recognition of pedal lesions allows institution of measures (eg, special shoes, fitted inserts) that reduce risks of serious disorders. Patient education regarding foot care also plays an important role in prevention and management of disease. Aggressive treatment of infection and local care of lesions prevent extension of disease to adjacent areas. In cases of established infection or occlusive vascular disease amenable to bypass procedures, surgical intervention is frequently necessary. When amputation is required, rehabilitation professionals can assist the physician in patient education regarding personal care and readjustment.
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PMID:Foot disorders in diabetics. Source of serious morbidity. 688 95

Hypertensive and duodenal ulcer patients were compared with physically ill patients at admission and discharge on personality traits and states of anxiety and depression. Both the hypertensive and ulcer patients were less dominant and more anxious than the control group at admission, while depression differentiated only the hypertensive group. The hypertensive patients were more depressed and more anxious than the ulcer patients at admission. At discharge, both experimental groups remained less dominant than the control group and the hypertensives remained more anxious and more depressed than the ulcer and control groups. Low dominance was correlated with high blood pressure and high extrapunitiveness was correlated with E.C.G. abnormality in the hypertensive patients. The results are discussed with respect to the role of aggression and low dominance in these 'psychosomatic' disorders.
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PMID:Psychological characteristics of hypertensive and ulcer patients. 707 56


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