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

Pressor effects of noncardioselective beta-blockers have been demonstrated in situations of increased sympathetic activity; however, data are limited and the clinical significance of this finding is in doubt. The present study was performed to supply data about the effect of noncardioselective beta-blockers on the stress of acute hospitalization. Of 2,989 patients acutely admitted to a 50-bed unit of general internal medicine in a 647-bed teaching hospital, 234 had used beta-blockers without intrinsic sympathicomimetic activity (ISA) for at least six weeks because of mild hypertension; 199 were evaluable, 56 using nonselective, 143 using selective beta-blockers. The authors found a marked pressor effect of noncardioselective beta-blockers as compared with selective (mean arterial pressure 125 versus 102 mm Hg, p less than 0.001). In the patients who could continue their outpatient medication this effect could be attributed to an overall increase of total peripheral resistance and disappeared within five days of admission. In the patients admitted because of unstable angina pectoris (nonselective n = 15, selective n = 48) myocardial oxygen demand as estimated by the double product (systolic blood pressure heart rate) was significantly higher in the nonselective group (12.926 versus 9.581 mmHg.beats/min, p less than 0.01). The present study supports the need for more controlled data to determine the ultimate place of noncardioselective beta-blockers in situations of increased sympathetic activity.
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PMID:A pressor effect of noncardioselective beta-blockers in mildly hypertensive patients during acute hospitalization. 230 5

Accelerated atherosclerosis occurs in chronic renal failure. The role of percutaneous transluminal coronary angioplasty (PTCA) in chronic renal failure patients requiring dialysis has not been characterized. We studied 17 chronic dialysis patients requiring PTCA over a 6-year period. Their mean age was 60 years, four were diabetic, eight had severe hypertension, and seven had unstable angina. Angiographic success was achieved in 47 of 49 (96%) stenoses attempted, including multivessel PTCA in 12 patients. There was one procedural death, two non-Q wave myocardial infarctions following PTCA, and one additional in-hospital noncardiac death. The 15 survivors were asymptomatic on discharge (mean stay 11 days), but recurrent angina developed within 6 months in 12 patients. Angiography in 11 of these 12 patients demonstrated restenosis of 26 of 32 (81%) dilated sites. Repeat PTCA in six patients was followed by return of angina in four patients with restenosis in 11 of 12 sites. Bypass surgery was ultimately performed in four patients with long-term angina relief. During follow-up (mean 20 months), seven patients died (five from chronic renal failure, two cardiac deaths). Thus although PTCA in chronic dialysis patients is technically feasible and provides relief of angina, aggressive restenosis limits the long-term benefit. Coronary bypass surgery may be the preferred therapy for this unique patient group.
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PMID:Short- and long-term outcome of percutaneous transluminal coronary angioplasty in chronic dialysis patients. 230 93

In a consecutive series of 4,697 patients undergoing coronary artery bypass surgery, these risk factors were found to be significant for increased postoperative mortality: age greater than 70, female sex, unstable angina, prior myocardial infarction, hypertension, diabetes mellitus, and ejection fraction less than .40. A comparison by year (1980-1988) revealed a steadily increasing incidence of these risk factors. Future analysis of coronary artery bypass mortality should include risk-factor stratification.
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PMID:Coronary artery bypass surgery: emerging trends in mortality. 232 52

To assess the possible progression of coronary artery disease after percutaneous transluminal coronary angioplasty (PTCA) and its relation to risk factors and restenosis, 124 patients who underwent a first successful PTCA were studied. All had routine follow-up angiography 5 to 8 months after PTCA. Restenosis was defined as a 30% decrease in diameter stenosis or a return to greater than 50% stenosis, and progression (in any nondilated site) as a 20% decrease in diameter stenosis, assessed by a video-densitometric computer-assisted technique. Univariate and multivariate analysis with respect to progression was carried out for age, sex, initial unstable angina, previous myocardial infarction, diabetes mellitus, hypertension, hypercholesterolemia (greater than or equal to 6.2 mmol), smoking habits, Jenkins' score, dilated artery and restenosis. Forty-one patients (33%) had restenosis, and 23 (19%) had evidence of progression; 20 (87%) of these latter patients had restenosis and 3 (13%) did not. Univariate correlates of progression were: previous myocardial infarction (p less than 0.05), higher Jenkins' score (p less than 0.0003) and restenosis (p less than 0.0001). Restenosis was the only multivariate correlate (p less than 0.00003). Progression at routine angiography after PTCA is not rare, and appears to be related to both the initial extent of coronary artery disease and restenosis.
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PMID:Risk factors for progression of atherosclerosis six months after balloon angioplasty of coronary stenosis. 232 59

This review summarizes selected topics discussed at one of the major congress events in cardiovascular medicine in Great Britain in 1989. The congress was attended during its five days duration by 800 participants from nearly 40 countries. The scientific programme, consisting of invited state-of-art lectures, was divided into following basic topics: coronary heart disease including risk and prevention, arhythmias, hypertension, heart failure, structural heart disease, cardiac imaging and costs-effectiveness of cardiology. The aim of the review is to bring nearer the creative atmosphere and the very advanced postgraduate level of this cardiologic meeting. Due to the actual medico-social importance of current strategies in management of ischemic heart disease and malignant arrhythmias in Czechoslovakia, special interest is devoted to these problems. Based on congress lectures an overview of the atherosclerotic plaque pathology and resulting therapeutic and prognostic implications for the management of unstable angina and myocardial infarction is given. Selected aspects of thrombolytic therapy and its impact on coronary vessel wall and myocardium are discussed, too. Some contemporary problems and updated concepts of both drug and intervention treatment of malignant ventricular arrhythmias are highlighted in a more extensive way, confronting congress speakers and recent publications.
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PMID:[Cardiology '89. Present trends in cardiovascular medicine at the Congress of Cardiology '89 in London April 1989]. 233 60

Neutrophils, a source of proteolytic enzymes and oxygen free radicals, have been shown to participate in animal models of myocardial ischemic injury. To characterize neutrophil activation in human ischemic heart disease, a specific neutrophil elastase-derived fibrinopeptide in plasma was measured in 25 patients with stable angina pectoris, 29 patients with unstable angina pectoris, 17 patients with acute myocardial infarction and 22 control subjects. Mean plasma levels (+/- standard error) of a neutrophil elastase-derived fibrinopeptide (B beta 30-43) measured by a specific radioimmunoassay were fivefold higher in patients with acute myocardial infarction (877 +/- 337 pmol/liter, p less than 0.02) and 13-fold higher in patients with unstable angina (2,277 +/- 613 pmol/liter, p less than 0.006) as compared with control subjects (172 +/- 74 pmol/liter). Mean plasma levels of peptide B beta 30-43 in patients with stable angina (676 +/- 334 pmol/liter), although higher than in control subjects, were not significantly increased (p = 0.64). Total leukocyte counts were 11.0 +/- 0.6 x 10(6)/ml in those with acute myocardial infarction, 9.2 +/- 0.7 x 10(6)/ml in those with unstable angina, 7.1 +/- 0.3 x 10(6)/ml in those with stable angina and 7.7 +/- 0.4 x 10(6)/ml in control subjects. Although total leukocyte counts in patients with unstable angina pectoris and acute myocardial infarction were higher (p less than 0.01) than in patients with stable angina or in control subjects, elevations in peptide B beta 30-43 levels were independent of the differences in both leukocyte count and absolute neutrophil count as well as in history of smoking, hypertension, diabetes mellitus or treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Increased neutrophil elastase release in unstable angina pectoris and acute myocardial infarction. 234 35

173 patients, aged 46.8 years on the average, were examined in the first 3 months after onset of angina pectoris. 97% of them presented at least one of risk factors (smoking, arterial hypertension, overweight, dyslipoproteinaemia), in 79% two or more risk factors were present simultaneously. A greater than 70% stenosis of one coronary artery was present in 51%, in 10% the stenosis was smaller than 70%, in 4% the coronary arteries were intact. In 131 patients without a history of myocardial infarction, vasospastic angina, overweight, and simultaneous presence of 3 or 4 risk factors occurred more frequently than in 42 patients with a history of myocardial infarction. In the first month, complications were registered only in patients with unstable angina pectoris (5 out of 41, i.e., 12%). During the later period of follow-up in 102 patients, complications occurred in 5% and complete clinical remission was registered in 35%. In patients with remission, positive exercise tests and haemodynamically significant stenoses of 2 or 3 coronary arteries were less frequently found on initial examination than in patients with sustained angina pectoris.
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PMID:New-onset angina pectoris: initial characteristics and results of a 6 to 12-month follow-up. 235 Sep 72

The purpose of our article is to describe a patient with severe hypertension and moderate renal insufficiency, unstable angina, and a 6 cm abdominal aortic aneurysm. A previous aortogram had demonstrated severe bilateral renal artery stenoses. Cardiac catheterization demonstrated severe coronary disease. After cardiac catheterization acute renal failure and pulmonary edema requiring dialysis developed in the patient. In addition, evidence of impending myocardial necrosis developed. Because of the critical nature of the myocardial and renal ischemia it was necessary to perform combined myocardial and renal revascularization rather than staged procedures. At the time of coronary artery bypass grafting, a vein graft was anastomosed to the right coronary artery vein graft and tunneled through the diaphragm into the abdomen to revascularize both renal arteries. After surgery renal function gradually improved, and no further dialysis was required. The abdominal aortic aneurysm was repaired at a subsequent operation. At 2-year follow-up all grafts remained patent. The serum creatinine is 1.2 mg/dl. Although most patients with combined coronary artery disease and renal artery disease can be treated with staged operations, our procedure may be of value in patients in whom staged procedure are not feasible and in whom the infrarenal aorta is severely diseased or aneurysmal.
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PMID:Combined coronary artery bypass grafting and bilateral renal revascularization for unstable angina and impeding renal failure. 199 71

This is a study of type A behavior pattern in patients with coronary heart diseases (CHD). Type A behavior pattern (coronary-prone behavior pattern) has been recognized as a risk factor for CHD in western countries. Three hundred patients with new onset of CHD (243 cases of acute myocardial infarction and 57 cases of unstable angina pectoris) between 1981 and 1987 were analysed from the standpoint of behavior pattern. Type A behavior pattern assessed by Jenkins Activity Survey (JAS) was found in 64.6% of subjects and in 43.0% of healthy controls (p less than 0.05). Concerning occupational position, the majority of patients in the administrative class showed type A behavior pattern. Type A behavior pattern was not related with other traditional risk factors (hypertension, hypercholesterolemia and smoking) and was related with angiographically documented severity of coronary atherosclerosis. Emotional stress load by mirror drawing test (MDT) evoked more elevation of blood pressure and plasma catecholamine level in type A patients than in type B patients. A follow-up of post CHD patients, whose occupational position belonged to the administrative class and/or whose work load did not decrease after CHD, modification of type A behavior pattern seemed to be difficult. In conclusion, we consider that type A behavior pattern exists also in Japanese CHD patients, and plays an important role in the development of CHD.
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PMID:Type A behavior pattern as a risk factor for coronary heart diseases. 239 27

In order to determine those factors which influence long-term prognosis in patients with angina at rest associated with transient ST-segment changes, 217 patients undergoing medical treatment were followed for a mean of 39 months. All patients underwent coronary arteriography. Univariate analysis identified 12 variables significantly related to prognosis. These were disease of the left main coronary artery; the number of diseased vessels; left ventricular end-diastolic pressure; ejection fraction; baseline electrocardiogram; presence of prior myocardial infarction; ST-segment depression and ventricular arrhythmias during pain; disease of the proximal anterior descending coronary artery; crescendo angina; hypertension; and age. Use of the Cox regression model for survival analysis revealed only 3 variables which were independent predictors of prognosis. They were disease of the left main coronary artery; the number of diseased vessels and left ventricular end-diastolic pressure. The model allowed stratification of patients into 3 groups. Survival at 3 years was 98% in the low risk group; 82% in the intermediate risk group; and 58% in the high risk group. These data indicate that disease of the left main coronary artery, the number of diseased vessels and left ventricular end-diastolic pressure are the independent predictors of prognosis in angina at rest. These variables may allow stratification of patients into groups having different long-term survivals.
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PMID:Long-term survival and risk stratification in patients with angina at rest undergoing medical treatment. 249 23


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