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

82 initially normotensive pregnant women with no known history of renal disease were seen at monthly intervals from 16 weeks' amenorrhoea onwards, and their blood-pressure (B.P.) was measured sitting and lying on their left side. 15 developed hypertension (B.P. greater than 135/85 mm Hg lying on the left side) in late pregnancy. When these women were compared with the 67 who remained normotensive throughout, their B.P.s were found to be significantly higher even in early pregnancy, although individual patients were not always separable in this way. When B.P. measured in this rigidly standardised manner was compared with routine antenatal clinic values, it was apparent that the latter did not detect the difference between the two groups. Women who develop hypertension in the third trimester of pregnancy (pre-eclampsia) may represent a separate group from entirely normal pregnant women from the beginning of pregnancy.
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PMID:Predicting the development of pregnancy-associated hypertension. The place of standardised blood-pressure measurement. 6 80

The use of oral contraceptives should at all times be under physician's control. Most contraindications and complications from oral contraceptives are now a thing of the past, when higher doses were prescribed. However oral contraceptives are still responsible for many side effects and complications. Some of these are gastrointestinal problems; menstruation disorders, such as spotting or amenorrhea; decreased libido; increase in body weight; mastodynia; blood coagulation effects; lipid and carbohydrate metabolic effects; ophthalmological and dermatological problems; and, possibly, an increase in susceptibility to some infectious diseases. Patients with hypertension; with heart or hepatic diseases; with a history of family thrombolic accidents; with diabetes; or hyperthyroidism should utilize another form of contraception. Oral contraceptives are totally contraindicated for obese or emotionally depressed people, for pregnant or nursing mothers, for women with uterine or breast cancer, and for adolescents.
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PMID:[Principle complications and contraindications of the use of oral contraceptives]. 15 84

The role of plasma volume in hypertension in pregnancy (pre-eclampsia) was investigated. Significant volume expansion from non-pregnant levels (16.5 +/- 1.60 ml/cm height) was present throughout pregnancy in 189 normal women, reaching 23.1 +/- 1.21 ml/cm at 33-36 weeks amenorrhoea. In another 40 initially normotensive pregnant women who developed hypertension, similar early volume expansion was followed by significant volume contraction in the third trimester, before evaluation of blood pressure in 29 (20.6 +/- 1.26 ml/cm), after it in 11 (18.6 +/- 1.27 ml/cm). Equivalent volume contraction was present in another 44 women studied only after hypertension developed in the third trimester. Oedema had no value as a clinical sign. In another 30 women with chronic hypertension, blood pressure was inversely related to plasma volume (r = 0.822) and to fetal growth (r = -0.710), which was directly related to plasma volume (r = 0.701). Plasma volume depletion plays a significant role in hypertension in pregnancy.
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PMID:Plasma volume contraction: a significant factor in both pregnancy-associated hypertension (pre-eclampsia) and chronic hypertension in pregnancy. 53 21

A 17 year old female patient with hypertension, amenorrhoea and hirsutism was found to have subnormal levels of plasma and urinary cortisol, significant plasma levels of Reichstein's compound S and 21-deoxycortisol, high urinary levels of THS and pregnanetriolone as well as elevated levels of plasma and urinary testosterone. Treatment with 0.5 mg/day of dexamethasone or 25 mg/day cortisone reduced her hypertension and restored her menstrual cycles, but also resulted in the development of moon face, body striae and a gain in weight. Lower doses of cortisone were without effect. The deficient cortisol production coupled with the presence of unusual intermediates such as Reichstein's compound S and 21-deoxycortisol can be explained by a shift in the substrate specificity of 11beta-hydroxylase from C-21-hydroxylated substrates (i.e. compound S) to C-21-deoxy substrates (i.e. 17-hydroxyprogesterone).
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PMID:A case of adrenogenital syndrome with aberrant 11beta-hydroxylation. 57 62

Epidemiological studies of the complications and sequelae of oral contraceptives, IUDs, and sterilization are reviewed. The author also assesses the risks associated with each method. Thromboembolism, cerebrovascular disorders, myocardial infarct, breast, liver, and other neoplasms; other liver and gallbladder diseases; hypertension; postcontraceptive amenorrhea, temporary infertility, congenital abnormalities, and a variety of side effects have been reported for oral contraceptives. For IUDs, the chief dangers are those of ascending infection and its long-term effects on fertility, and the danger to the developing fetus and the mother when pregnancy occurs with the IUD in place. Mortality from sterilization is about 7 per 100,000 patients. The author compares pregnancy-associated mortality with rates for the various contraceptive methods, and concludes that, although contraception is not without risk, the risk for all methods is less than that of pregnancy.
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PMID:[Complications and late sequelae of contraception including sterilization (proceedings)]. 57 23

A 40-year-old patient with a ten-year history of acromegaly had persistent disease despite prior treatment with conventional pituitary radiotherapy and two transsphenoidal hypophysectomies. Initial evaluation showed characteristic acromegalic features, hypertension, amenorrhea, inappropriate diaphoresis, and poorly controlled diabetes mellitus despite isophane insulin suspension daily. Growth-hormone levels were high and did not suppress with glucose load. Treatment with bromocriptine was associated with prompt improvement in glucose intolerance, with elimination of insulin requirement within 72 hours of institutions of this therapy. Blood pressure normalized; inappropriate diaphoresis disappeared. Within three months ovulatory menses were noted to resume for the first time in ten years. There was progressive improvement in the soft-tissue changes of acromegaly. The growth-hormone levels fell within three hours after the first dose of bromocryptine and remained suppressed throughout her six-month course of therapy.
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PMID:Complete remission of acromegaly with medical treatment. 76 12

Oral contraceptives have been implicated as a causative factor of venous thrombosis and thromboembolism. Compounds containing over 50 mcg of estrogen have developed this complication most frequently. Steroid hormones have a marked influence on liver function. Large doses have caused cholestasis and hepatocellular damage. Disturbances in carbohydrate metabolism have been recorded. Lipid metabolism have also been shown to be disturbed with increased serum levels of triglycerides and low density lipoproteins. A rise in the cholesterol serum level seems to be correlated with the progestogen content of the compound. The ''minipill'' with a small dose of progestogen alone had been effective by alteration of the cervical mucus. The ''one-a-month pill'' is a combination of a long-acting estrogen, quinestrol, and a chorter acting progestogen, qunigestanol acetate. It has not been as acceptable or as effective as combined compounds. The ''morning-after'' pill consists of large doses of stilbestrol. The method has been effective but when de-ethylstilbestrol has been given to a patient already pregnant to prevent an early spontaneous abortion, adenocarcinoma of the cervix or vagina has been reported. Hypertension has been more common with increased duration of pill use. High dosage of progestogens and increasing age of patients have increased the incidence of hypertension. Cerebrovascular disease had also been more frequent among pill users. An increased incidence of gallbladder disease and of gallstones has been shown in pill users. Urinary tract and vaginal infections were reported more often in pill users. Increased sexual activity may have been a factor in this relationship. Resumption of ovualation after discontinuation of oral contraceptives usually follows within 4-6 weeks. In about 1% of patients amenorrhea and anovulation result for 6 months or more. This is often accopanied by galactorrhea. There is evidence that mestranol is demethylated to ethinyl estradiol in the liver. Progesterone seems to interfere with conversion. Therefore ethinyl estradiol is preferred as a compound of the pill. Also the different progestogens used are metabolized in the liver to norethisterone before they exert their biological effects. Several drugs, as ampicillin and barbiturates, have been shown to interfere with the efficacy of oral contraceptives. It is concluded that the overall results have shown oral contraceptives to be an excellent form of contraception with minimal and acceptable side effects and the least metabolic disturbance.
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PMID:Current status of oral contraceptive. 82 61

Types of oral contraceptives, their mode of action, choice of dosage, side effects, and contraindications are summarized for the general clinician. A 50 mcg dosage of estrogen in a combination formula appears to be the minimum dose necessary for consistent protection from pregnancy although some compounds with less estrogen but a more powerful progestin appear to provide good protection. These lower dose estrogen formulations may be advised if estrogen-related symptoms such as nausea or breast soreness are encountered. In amenorrheao r symptoms of estrogen deprivation 80-100 mcgs of estrogen may be required. Although there is a risk of thromboembolic disease, hypertension, carbohydrate and lipid metabolic effects, gallbladder disease, hepatoma, and possible post-pill amenorrhea, these problems can be minimized by careful screening of patients. Benefits include decreased incidence of ovarian cysts, benign breast neoplasia, menstrual disorders, premenstrual syndrome, iron deficiency anemia, sebaceous cysts, and acne (due to decreased sebum production with estrogen adminsitration). Patients need to be reminded that the morbidity and mortality associated with pregnancy exceed that attributed to oral contraceptives.
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PMID:Oral contraception. 83 94

The case of a 35-year-old woman who demonstrated androgenic obesity, absence of ovulation, and amenorrhea is examined. This patient showed arterial hypertension, diabetes mellitus, hirsutism, and anovulatory cycles. A very high concentration of estrone was noted in the urine, originating in the adrenal glands. These indications are generally considered during evaluation of breast or uterine cancer threat. Administration of dexamethasone led to a decrease in urinary estrone to insignificant levels. Stimulation with human chorionic gonadotropin caused an increase in ovarian activity. The disruptions this patient suffered were attributed to hormonal imbalances attributed to her obesity, primarily in regard to estrogen metabolism.
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PMID:[Uncommonly high concentration of estrone of adrenal origin in a case of androgenic obesity, anovulation and amenorrhea]. 90 13

An extensive review of the literature, supplemented by experimentation on progestagen-only minipills taken continuously finds the 4 most effective progestagens. They were tested for 4358 cycles in 483 women. In general lynestrenol and norethisterone acetate give fairly regular cycles with a longer menstrual period. Intermenstrual bleeding is frequent at the beginning but tends to regulate itself. D-norgestrel seems to give shorter cycles with less intermenstrual bleeding. NOrgestrienone gives longer cycles with less bleeding. Problems include spotting or amenorrhea which are often worrisome for the patient. The advantage of the minidose progestagen-only pill is that it has no estrogen and therefore can be used when estrogen is contraindicated: in the case of tumors, history of thromboembolism, disorders of lipid metabolism, fibromatosis, mastitis, prediabetes, and arterial hypertension.
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PMID:[Oral contraception by means of progestagen-only micropills taken continuously in the light of four recent trials (author's transl)]. 102 28


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