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

The diagnosis of intracerebral hemorrhage (ICH) has become precise with the advent of computerized tomography (CT). Little, however, is known concerning the long-term prognosis. Seventy consecutive patients with primary intracerebral hemorrhage (all known etiologies except hypertension excluded) proven by CT scan were studied. Follow up, averaging 2 1/2 years, was successful in all cases. The status of alertness, EKG, and clinical impression on admission were significant prognostic factors. As expected, mortality increased with size of the hematoma and ventricular rupture. Acute in hospital mortality was 40%. Another 17% died during the long-term follow up, but none of them from cerebrovascular disease. Ninety-two percent of the survivors were ambulatory at follow up. Hypertensive intracerebral hemorrhages, unlike aneurysms, rarely, if ever, rebleed. Patients are not likely to have a second bleed in another location. Hypertensive intracerebral hemorrhage is more common in blacks, especially young adult males with severe hypertension, but overall mortality is lower than thought prior to the CT scan. Most survivors can achieve independence and deserve aggression rehabilitation efforts.
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PMID:Long-term prognosis of hypertensive intracerebral hemorrhage. 710 49

Experimental studies of personality as a psychological risk factor in essential hypertension are reviewed. While no single personality trait has been found to be consistently and specifically related to hypertension, a certain behavior pattern emerges from this literature. This pattern, which includes increased anxiety, inappropriate coping behaviors in socially distressing situations and, possibly, a negative cognitive set, is compared with experimental findings from social competence research. Considerable overlap between the pattern of behavioral characteristics of hypertensives and individuals who display deficits in social skills is noted. The flight/fight concept in stress research, the differentiation of assertion from aggression and inhibition and their physiological equivalents are integrated in a three-dimensional model of social functioning in hypertensives. The clinical implications of this conceptualization are discussed in reference to the need for more comprehensive behavioral approaches to hypertension management.
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PMID:Essential hypertension and social coping behavior. 720 58

An 11-year-old girl presented with acute renal failure and severe hypertension. The blood film showed thrombocytopenia, numerous fragmented red blood cells, and a reticulocyte count of 10%. An intravenous pyelogram showed a small contracted left kidney, and plasma renin activity was increased in the left renal vein. Treatment with minoxidil and propranolol controlled the hypertension. After nephrectomy the hypertension resolved. Light microscopical examination of the left kidney showed a segmental renal hypoplasia. Malignant arterial hypertension can provoke a syndrome of haemolysis and uraemia in children. Aggressive lowering of blood pressure leads to an improvement in renal function.
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PMID:Hypertension and segmental renal hypoplasia causing a syndrome of haemolysis and uraemia. 725 66

Patients with borderline hypertension are at a higher risk to develop sustained hypertension and its sequelae, higher cardiovascular morbidity and mortality. However, this excess risk is not overwhelming. Aggressive antihypertensive medication for all patients with borderline hypertension is not warranted. Only patients who are at highest risk for hypertension and its complications should be given small doses of antihypertensive monotherapy. The objective of the treatment is to lower blood pressure without side effects. Patients who are not chosen for treatment must be continuously managed. The management includes following the blood pressure trends, dietary sodium restriction, and control of overweight.
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PMID:Practical management of borderline hypertension. 736 82

Lower extremity vascular grafts, either vein or synthetic, fail for diverse reasons. Technical defects or poor surgical judgment doom a graft beyond any benefit pharmacotherapy can offer. Graft failure due to spontaneous thrombosis particularly affects prosthetic conduits, and use of antiplatelet agents (dextran, ASA) or anticoagulants (heparin, warfarin) is probably useful in this setting. An effective way to inhibit vein graft or anastomotic intimal hyperplasia remains elusive. Perhaps the most permanent and longstanding influence on lower extremity graft survival can be made through risk factor intervention aimed at arresting the progression of atherosclerosis. Aggressive treatment of hyperlipidemia, hypertension, smoking, and other known risk factors should be routinely and aggressively pursued in patients with lower extremity grafts, either autogenous or prosthetic. Lower extremity graft patency is optimally ensured by technically adept insertion of a proper autologous conduit in a well-selected patient. Pharmacotherapy may have a significant adjunctive role in the maintenance of graft patency, especially in high-risk settings such as limb salvage with associated poor outflow, a marginal vein graft, or the obligatory use of prosthetic material.
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PMID:Pharmacologic intervention to prevent graft failure. 763 20

Critical care of a patient with SAH should focus on the prevention or immediate treatment of the common sequelae of this disorder that adversely affect outcome: vasospasm, rebleeding, hydrocephalus, seizures, and associated medical problems. The frequency of rebleeding can be lessened by early surgical or endovascular intervention. The extent of SAH on the CT scan can identify those patients at highest risk for vasospasm, and all patients must be closely monitored in the ICU with serial neurological examinations and transcranial Doppler studies. Regional CBF examinations and continuous EEG may also be helpful. Calcium channel blocking agents and volume expansion are recommended prophylatically for all patients. Aggressive hypertensive, hemodilutional, hypervolemic therapy (including pulmonary artery catheter placement) is indicated for symptomatic vasospasm. Transluminal angioplasty can be used in selected patients with vasospasm refractory to these measures. Hydrocephalus can occur in the days, weeks, or months following SAH and is treated effectively with external (acute hydrocephalus) or internal cerebrospinal fluid diversion. Seizures, which can cause intracranial and systemic hypertension, high cerebral metabolic demand, and delayed neurological injury, should be prevented with prophylactic use of anticonvulsants. In addition, early recognition and treatment of associated medical complications are critical. Novel endovascular approaches, meticulous surgical technique, and aggressive ICU care will undoubtedly lead to improved outcome following aneurysmal SAH.
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PMID:Critical care of patients with subarachnoid hemorrhage. 782 84

This review will address five selected conditions associated with variable degrees of renal insufficiency or renal failure. Early diagnosis, usually possible in the office setting, should encourage early treatment and/or referral that will be rewarded by substantial improvement or return of normal renal function. Hypertensive nephrosclerosis, particularly among black Americans, is now the second leading cause of end stage disease (ESRD) in the United States. Aggressive treatment of hypertension can prevent progression to renal failure. Obstructive uropathy is relatively common at all ages; if not corrected, it can progress insidiously, often without symptoms, to destruction of a kidney. Glomerulonephritis may involve the kidneys primarily or in association with a multisystem disorder. Early renal biopsy will help establish the pathologic diagnosis and guide subsequent therapy. The kidney is vulnerable to the nephrotoxic effects of numerous pharmacologic agents used commonly in the diagnosis and treatment of illness. Potential nephrotoxicity to a given class of agents must be recognized if progressive nephrotoxicity is to be avoided. Finally, the frequency of occlusive renovascular disease and ischemic nephropathy is on the rise as the US population increases in age. Several interventions are available for the treatment of ischemic nephropathy and for the prevention of ESRD associated with bilateral renal artery occlusion.
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PMID:Recognition and management of reversible renal failure. 793 14

Stable atherosclerotic plaques may become unsuitable at any time during the course of the disease. Unstable atherosclerotic plaques often rupture resulting in platelet activation and intravascular thrombosis which may lead to acute ischaemic syndromes. Factors which contribute to the plaque's instability are the amount of lipids contained in the central core of the plaque, the weakening of the fibrous cap of the plaque and pulsative stresses. Aggressive cholesterol reduction and control of factors which produce endothelial injury and contribute to the development and progression of atherosclerosis such as smoking and hypertension, and prevention of intravascular thrombosis such as aspirin, may prevent plaque rupture, intravascular thrombosis and acute ischaemic syndromes.
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PMID:Factors determining and prevention of atherosclerotic plaque rupture. 797 48

Eleven hours and 6 days, respectively, after childbirth 2 women exhibited hypertension and paroxysmal visual disturbances followed by tonic-clonic seizures and no other preeclamptic signs. Both developed partial epilepsy with occipital lobe seizures with no other neurologic defects. Neuroimaging showed no lesion during either the acute episode or 3-5 year follow-up. Selective vulnerability of the occipital lobes during eclamptic hypertensive encephalopathy was the probable pathophysiologic mechanism. Aggressive antihypertensive treatment during the acute phase may have exacerbated the risk of permanent cerebral damage.
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PMID:Occipital lobe epilepsy: a chronic condition related to transient occipital lobe involvement in eclampsia. 802 11

Atherosclerosis is the principal cause of diabetic morbidity and mortality. Diabetic dyslipidemia, obesity, and hypertension are significant contributing factors in the acceleration of the atherosclerotic process. Regardless of the type of diabetes, increased levels of very-low-density lipoprotein triglyceride, modified levels of low-density lipoprotein cholesterol, and decreased levels of high-density lipoprotein (HDL) cholesterol are the main lipoprotein abnormalities in diabetic patients. These abnormalities can be improved in part by glycemic control, but additional intervention may be needed. Diet and exercise are important elements in the management of dyslipidemia, but lipid-lowering drugs (especially fibrates and HMG-CoA reductase inhibitors) also may be necessary for the control of diabetic dyslipidemia. Based on these findings, the American Diabetes Association Consensus Panel and the revised treatment guidelines of the National Cholesterol Education Program recommend treatment of hypertriglyceridemia/low HDL cholesterol as a risk factor of coronary heart disease in diabetic and nondiabetic individuals alike. Aggressive treatment is recommended, therefore, particularly in diabetic patients and in all patients with existing vascular disease.
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PMID:Prevention of atherosclerosis in diabetes: emphasis on treatment for the abnormal lipoprotein metabolism of diabetes. 826 43


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