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

Congenital coarctation of the aorta and acquired idiopathic obstructive aortitis result in systemic hypertension in children. The incidence of the former disease decreases--and that of the latter condition increases--from Europe to India to Thailand. The clinical profile of coarctation of the aorta as seen in India is similar to that described in the Western literature. Patients with idiopathic obstructive aortitis are generally desperately sick because of cardiac failure or neurological complications. Although it appears to be the result of an inflammatory process, the cause of aortitis is not known. Unless the clinical characteristics of the acute illness are defined investigations are not likely to help in establishing the cause of idiopathic obstructive aortitis.
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PMID:Systemic hypertension and aortic obstruction in children. 722 82

Presented is a unique case of accelerated hypertension in a 26-year-old black man. Clinically, the patient was found to have a left renal artery lesion and lateralizing renal vein renins. At surgery, a stenosing lesion was found in the artery supplying the upper pole of the left kidney. This was caused by a densely fibrotic mass involving the main renal artery. Microscopy revealed a necrotizing arteritis with no other arteries involved. This case of primary necrotizing arteritis of the main renal artery appears to represent a new entity because of its pathological and clinical differences with the known forms of large vessel arteritis. It is possible that this may represent a particularly acute and necrotizing stage of Takayasu's aortitis, or an extremely rare case of classical periarteritis nodosa confined solely to the main renal artery. The renin tissue assays document the hyperreninemia produced by arterial stenosis. The differential diagnosis of the lesion is considered, and the pathophysiology of hypertension due to large vessel arteritis is discussed.
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PMID:Primary necrotizing arteritis of the main renal artery presenting as accelerated renovascular hypertension. 734 49

We reported a rare case of marked dilatation of the bilateral common carotid artery (CCA) associated with stenosis of the left middle cerebral artery (MCA). A 64-year-old female was admitted with right hemiparesis and dysarthria. She was hospitalized 2 years ago for cholecystitis. For 5 years, she has been under medical treatment for hypertension, diabetes mellitus, hyperlipidemia, cardiac failure associated with hypertrophic cardiomyopathy, and atrial fibrillation. Brain CT scan showed infarction of the left corona radiata. Angiography revealed marked dilatation of the bilateral CCA and the internal carotid artery (ICA), moderate dilatation of the innominate artery and the right subclavian artery, kinking of the right CCA, diverticular outpouching of the left ICA, and stenosis of the right external carotid artery and the left MCA. Breast CT scan revealed moderate dilatation and marked calcification of the ascending aorta and the aortic arch. Laboratory examination did not show any sign of inflammation, rheumatoid factor (RA), antistreptolysis-O (ASLO) and antinucleotic antibody. Based on the clinical course, radiological findings and laboratory data, possible diagnosis of the dilatation of the bilateral CCA was discussed with particular emphasis on arteriosclerotic aneurysm and aortitis syndrome.
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PMID:[Marked dilatation of the bilateral common carotid artery: a case report]. 773 79

The incidence of restenosis after a first successful percutaneous transluminal angioplasty of a native renal artery and the clinical and angiographic variables that may influence its occurrence were studied in 104 hypertensive patients. Angiograms obtained immediately before and after angioplasty and, in 92 patients, 8.8 +/- 6.0 months after angioplasty were interpreted separately by two observers. Stenosis severity was classified into five grades, and restenosis was defined by a stenosis one grade or more higher at follow-up than immediately after angioplasty. Interobserver concordance for etiology, stenosis grade, and other angiographic items yielded kappa coefficients in the range of 0.328-0.942. Sessions were organized to reach a consensus in each case. Ostial stenoses were more frequent in patients with atheromatous stenoses, and branch stenoses were more frequent in those with fibromuscular dysplasia. There was no significant difference between the 15 patients (16%) with restenosis and those without concerning sex distribution, mean age, mean blood pressure, plasma creatinine level, and etiology distribution. Truncal stenoses were less prone to restenosis than ostial or branch stenoses (12% versus 35%, respectively; 95% confidence interval of difference, -0.6% to 47%). In patients with atheromatous stenoses, aortitis or aortic ectasia were associated with a high restenosis incidence (35% when present versus 8% when absent; 95% confidence interval of difference, 5% to 48%). In conclusion, restenosis was observed in one sixth of patients after a first successful renal angioplasty; its incidence was low in patients with truncal stenoses and high in those with severe aortic atheroma. Automated renal artery stenosis quantification methods are needed to standardize stenosis description.
Hypertension 1993 Jan
PMID:Restenosis after a first percutaneous transluminal renal angioplasty. 841 28

Clinical studies were performed on 7 renovascular hypertensive patients (3 male and 4 female, mean age 50.6 +/- 18.6) with bilateral renal artery stenosis. Duration of hypertension ranged from 2 months to 24 years (mean 6.1 +/- 8.2 years) before evaluation. All had stenosis or occlusion of both main renal arteries or these branches shown by arteriography. In 4 of the 7 patients atheromatous stenosis or occlusion was present; the remaining two had aortitis syndrome and one had fibromuscular hyperplasia. Of the 7 patients operated, two who had both negative renal renin study and ureteric catheterization study; one was failure after bilateral percutaneous transluminal angioplasty (PTA), and another one was improved after axillo-femoral bypass operation. In one patient with positive results of both studies an area of focal cortical atrophy was present in upper part of the left kidney. The patient, therefore, underwent partial nephrectomy the left kidney but failed to have decrease of blood pressure and was subsequently treated with antihypertensive medications. In the remaining four patients operated, two who had both positive renin and catheterization studies preoperatively were cured or improved after PTA in negative side and nephrectomy of positive side kidney. Other two patients with contradictory results of renin and catheterization studies underwent, PTA of the renal artery of the kidney with the highest renin levels. But their hypertension was maintained despite sufficient dilatation of the renal artery and PRA from the contralateral kidney was noted to be markedly increased after PTA. Therefore, nephrectomy of the contralateral nonfunctioning contracted kidney was performed.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical studies on renovascular hypertension with bilateral renal artery stenosis]. 851 43

A 36-year-old woman was delivered to our hospital with suspected aortic dissection from an outlying hospital in May 1994. She reported a history of acute and persistent thoracic and epigastric pain. The physical examination revealed a minor senso-motorical palsy of the left side as residuum after minor strokes occurring 12/93 and 4/94. Also, a marked hypertension (170/100 mm Hg) was present. The hematologic and blood chemical values were normal with a white cell count of 12,000, an erythrocyte sedimentation rate (ESR) of 19 mm/h and a c-reactive protein (CRP) of 2.2 mg/dl. The electrocardiogram was normal. Transthoracic- and transesophageal-echocardiography (TTE, TEE) revealed an eccentric thickening of the whole wall of the descending aorta up to the bifurcation with a stenosis at the side of the diaphragma. Those findings were confirmed by computed tomography. Because of the acute onset of symptoms and the results of the imaging procedures aortic dissection de Bakey type III was diagnosed and the patient was treated with beta-blockers. Symptoms were relieved over the following days. After 2 days a pleuric effusion developed and all inflammatory tests rose (fibrinogen 780 mg/dl, ESR 80 mm/hr, CRP 16 mg/dl). At this time the differential diagnosis of an arteritis was considered. A new TEE-study demonstrated no change, but now more attention was given to the fact that no dissection membrane could be visualized and all wall structures were thickened. In combination with the history of cerebral infarction due to carotid obstruction and the elevated laboratory values the diagnosis of Takayasu-aortitis was established and corticoid therapy was started. Within a few weeks the arterial changes diminshed markedly and the woman became free of symptoms. This case demonstrates the rare situation of an arteritis mimicking aortic dissection, in which the clinical course revealed the true diagnosis.
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PMID:[Takayasu arteritis--a rare differential diagnosis in aortic dissection. A case report]. 857 87

A 43-year-old white man with a history of cigarette smoking, hypertension, nephrolithiasis, and cervical degenerative arthritis was hospitalized for sudden-onset severe, substernal, and pleuritic chest pain with epigastric radiation. Despite evaluation, the cause remained unclear and the patient expired on hospital day 5. Autopsy revealed acute Stanford type A aortic dissection, hemopericardium, and hemothorax. Grossly, the aorta and its branches, including uninvolved medium-sized arteries, displayed extreme mural fragility. Microscopic examination showed a primary lymphoplasmacytic aortitis-periaortitis without giant cells. Rents within the tunica media, medial-adventitial inflammation, and elastic fiber disruption were limited to sites of gross aortic dissection. Muscular arteries showed patchy, chronic arteritis-periarteritis without giant cell infiltrate or aneurysm formation. This case documents an unusual association of primary lymphoplasmacytic aortitis and aortic dissection.
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PMID:Lymphoplasmacytic aortitis and acute aortic dissection. An uncommon association. 861 57

Takayasu's arteritis is a chronic inflammatory disease that primarily affects young women. Cardiac involvement is infrequent and it includes aortic regurgitation, pericarditis, angor pectoris or myocardial infarction due to coronary narrowing and cardiac heart failure due to coronary involvement and/or high blood pressure. A patient with Takayasu's aortitis and angina pectoris due to severe narrowing of the left coronary arterial ostia is described.
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PMID:[Coronary involvement in Takayasu's arteritis]. 908 97

The results of clinical observation of 35 patients with aortitis syndrome (AS) in childhood, obtained by a nationwide survey in Japan, are reported. The male to female ratio was 1:2.5, the estimated age of onset averaged 10.2 years, and the duration from the estimated age of onset to the diagnosis averaged 15 months. In HLA examination A24, Bw52, Cw7 and DR2 were relatively common. Arterial lesions tended to extensively involve the aortic arch and its branches. Fever was the most frequently noted clinical symptom, followed by abdomen, joint and muscle pain. The physical findings in order of frequency were impaired circulation of the upper extremities, cardiac and vascular murmurs, hypertension, impaired cerebral circulation, visual disorder and impaired circulation of the pulmonary artery. The murmurs were found not only over the chest wall but also over the cervical area and abdomen. Pulselessness of the upper extremities occurred in 66% of patients. Percutaneous retrograde aortography and/or intravenous digital subtraction angiography to make the final diagnosis was employed except for three cases. There were not any specific abnormal signs in laboratory data. Steroid hormones were administered in 34 cases, and immunosuppressive agents in 8 cases. Five cases had percutaneous transluminal angioplasty to the right renal artery as an interventional treatment. The high frequency of abdominal pain is considered to be one of the characteristics of AS in childhood. The high frequency of pulselessness of the upper extremities and cardiac and vascular murmurs in this report is considered significant for the diagnosis of AS in childhood.
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PMID:Aortitis syndrome in children: clinical observation of 35 cases in Japan. 914 Dec 73

Twenty-five patients with stenosis of the abdominal aorta were observed during the last twenty years. The etiology was a congenital malformation in 20 patients (80%) and an inflammatory aortitis in five (20%). All patients had associated lesions of the renal artery(ies) and 10 had lesions of the digestive arteries, especially of the superior mesenteric artery. All patients had arterial hypertension but none complained of circulatory impairment in the lower limbs or in the digestive area. Aorto-aortic by-pass was performed in six patients. The lesions of the renal artery(ies) (37 kidneys at risk) were treated by nephrectomy in three cases and vascular repair in 34 cases. Four reconstructions of the superior mesenteric artery were carried out simultaneously. There was no postoperative mortality in the current series. After surgery, arterial hypertension was cured in 83.3% of the patients and improved in 12.5%; only one patient was unchanged. In three patients, deterioration of the repair of the renal artery led to repeat surgery. Aortic repair is to be performed in tight stenoses only (pressure gradient > 30 mmHg) and as near to the puberty age as possible.
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PMID:[Stenoses of the abdominal aorta in young patients]. 950 54


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