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

Plasma renin activity (PRA) was measured in 38 cases of aortitis syndrome. The values of resting peripheral vein blood PRA were 32.2 +/- 4.2 (SE) mmug/ml. These values were 3 times higher than those of normal subjects. Hypertension due to renal arterial stenosis was observed in 18 cases. Their resting PRA values were 41.2 +/- 6.0 mmug/ml, while in the remaining 20 patients without renovascular hypertension those values were 24.2 +/- 5.4 mmug/ml. The patients belonging to aortic arch type or extensive type had 2 times higher PRA values than those of abdominal type. The patients with stenosis or obstruction of common carotid arteries had significantly higher PRA values than the patients without these lesions. Hyperresponse of renin secretion to upright posture was also observed in the same patients with carotid artery stenosis. Abnormal renin release in Takayasu's arteritis disappeared after denervation of the carotid sinus nerve. The present study suggests that the unstable state of carotid sinus reflex is the main cause for the hypersecretion of renin.
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PMID:Elevated plasma renin activity in aortitis syndrome. 0 6

Fifty patients, ages 54-79, with ischemic hemispheric strokes productive of hemiparesis, at a minimum, underwent standardized neurological evaluations, computed tomographic scanning and cerebral angiography (N = 38) or carotid ultrasound (N = 12) within 5 h of onset. A second scan was performed at 5-7 days. Clinical scores were not associated with a history of, or the presence of: hypertension, smoking or cardiac disease, including atrial fibrillation, nor with severe internal carotid artery stenosis or occlusion. Clinical scores were adversely affected by early scan abnormalities (especially mass effect), lesion size, intracranial arterial occlusions, elevated serum glucose levels and the subsequent development of hemorrhagic infarction. Glucose levels correlated with infarct size and the development of hemorrhagic infarction. Delayed intracranial arterial filling and collateral flow were associated with reduced infarct size but did not confer clinical protection. We believe that combining the initial glucose level and scan results has prognostic significance, and early angiography is valuable in characterizing infarct etiology and assessing clinical severity.
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PMID:Clinical-radiographic correlations within the first five hours of cerebral infarction. 141 33

Patients presenting with symptoms suggestive of amaurosis fugax, or with findings of Hollenhorst plaques on fundoscopy are frequently referred for duplex evaluation to detect possible carotid artery disease. To better determine the reliability of monocular visual loss and the presence of Hollenhorst plaques for predicting the presence or significance of carotid artery stenosis, we prospectively studied 66 patients with these ocular signs and symptoms. After evaluation, the patients were categorized as follows: 34 of 66 (52%) patients had amaurosis fugax, 23 (35%) had asymptomatic Hollenhorst plaques, 7 (11%) had retinal artery occlusion, and 2 (3%) had venous stasis retinopathy. All patients were evaluated ophthalmologically, with carotid duplex scanning and spectral analysis. A stenosis of greater than 60% was regarded as significant. The presence of risk factors including hypertension, diabetes, a history of CVA or TIA's, tobacco use and hyperlipidemia was recorded. There were no statistically significant differences (p greater than 0.05) in the incidence of atherosclerotic risk factors between the four groups. Patients with amaurosis fugax were more likely to have a significant carotid artery stenosis than those with asymptomatic Hollenhorst plaques or retinal artery occlusion (53% vs 9% vs 0% respectively) (p less than 0.006). We conclude that routine carotid duplex scanning is indicated in all patients with amaurosis fugax in view of the frequent association with significant carotid stenosis (53%). However, the presence of Hollenhorst plaques in the absence of visual symptoms appears not to have a significant association with carotid disease and may not necessarily require routine screening unless other risk factors for carotid stenosis are present.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Correlation of ophthalmic findings with carotid artery stenosis. 152 43

Recent reports of the risk of asymptomatic carotid stenosis have been compromised by flawed patient selection or the performance of a large number of carotid endarterectomies during follow-up. We report the natural history of a randomly selected group of asymptomatic patients (n = 188; 114 males and 74 females) with documented carotid artery disease who were prospectively followed without intervention for up to 8 years. Risk factors included ischaemic heart disease in 17%, diabetes in 10%, hypertension in 46% and 88% were smokers. The degree of internal carotid stenosis was classified by duplex scanning and a total of 259 vessels had evidence of atherosclerosis. Study end-points included TIA, CVA and death. At mean follow-up of 4 years 3% of the 96 patients with internal carotid artery stenosis of less than 50% had died and 2% suffered a stroke. Six per cent of patients with a stenosis of 50-79% had died and 4% and 2% had suffered a CVA and TIA, respectively. In the 59 patients with greater than 80% stenosis 7% had suffered a TIA and an additional 7% a CVA, while 2% had died. None of the patients suffering a stroke had an antecedent TIA. Though the incidence of ischaemic events is significantly higher in patients with greater than 80% stenosis the incidence of unheralded stroke remains low. We therefore continue to recommend a conservative approach to the management of asymptomatic carotid stenosis.
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PMID:Asymptomatic carotid stenosis: a benign lesion? 155 61

The purpose of the present study was to assess the prevalence of orthostatic hypotension and its associations with demographic characteristics, cardiovascular risk factors and symptomatology, prevalent cardiovascular disease, and selected clinical measurements in the Cardiovascular Health Study, a multicenter, observational, longitudinal study enrolling 5,201 men and women aged 65 years and older at initial examination. Blood pressure measurements were obtained with the subjects in a supine position and after they had been standing for 3 minutes. The prevalence of asymptomatic orthostatic hypotension, defined as 20 mm Hg or greater decrease in systolic or 10 mm Hg or greater decrease in diastolic blood pressure, was 16.2%. This prevalence increased to 18.2% when the definition also included those in whom the procedure was aborted due to dizziness upon standing. The prevalence was higher at successive ages. Orthostatic hypotension was associated significantly with difficulty walking (odds ratio, 1.23; 95% confidence interval, 1.02, 1.46), frequent falls (odds ratio, 1.52; confidence interval, 1.04, 2.22), and histories of myocardial infarction (odds ratio, 1.24; confidence interval, 1.02, 1.50) and transient ischemic attacks (odds ratio, 1.68; confidence interval, 1.12, 2.51). History of stroke, angina pectoris, and diabetes mellitus were not associated significantly with orthostatic hypotension. In addition, orthostatic hypotension was associated with isolated systolic hypertension (odds ratio, 1.35; confidence interval, 1.09, 1.68), major electrocardiographic abnormalities (odds ratio, 1.21; confidence interval, 1.03, 1.42), and the presence of carotid artery stenosis based on ultrasonography (odds ratio, 1.67; confidence interval, 1.23, 2.26). Orthostatic hypotension was negatively associated with weight. We conclude that orthostatic hypotension is common in the elderly and increases with advancing age. It is associated with cardiovascular disease, particularly those manifestations measured objectively, such as carotid stenosis. It is associated also with general neurological symptoms, but this link may not be causal. Differences in prevalence of and associations with orthostatic hypotension in the present study compared with others are largely attributed to differences in population characteristics and methodology.
Hypertension 1992 Jun
PMID:Orthostatic hypotension in older adults. The Cardiovascular Health Study. CHS Collaborative Research Group. 159 45

The clinical outcome of 99 patients who underwent combined single-stage carotid thromboendarterectomy and coronary artery bypass grafts in three different hospitals over a 15-year period was analyzed. Coronary revascularization was elective in 16 patients, urgent in 46 and emergent in 37 patients. Asymptomatic carotid artery stenosis of greater than or equal to 80% was detected in 79% of patients. Sequential reconstruction of the carotid artery circulation followed by restoration of the coronary circulation was performed in all patients by two separate surgical teams. The population included 79 men and 20 women, with a mean age of 67 +/- 6 years, of whom 53% had a previous myocardial infarction, 59% had hypertension and 49% had a history of smoking. Three or more coronary arteries were revascularized in 90% of patients. The overall major neurological complication rate was 25%, with an 11% stroke rate ipsilateral to the operated carotid. Other major complications included respiratory failure (5%), multisystem failure (8%), and myocardial infarction (8%). The overall mortality was 12%. Ten of the 12 deaths were directly related to the cardiac operation, and 2 died as a result of stroke. We conclude that a combined carotid and coronary artery operation results in a high morbidity and mortality in institutions with excellent records for each operation when performed separately. Whenever possible, these high risk patients should be carefully assessed regarding the need for both procedures, since prophylactic carotid endarterectomy has not been shown to significantly reduce the neurologic risk of coronary bypass.
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PMID:Combined carotid endarterectomy and coronary artery revascularization: a sobering review. 173 95

A group of 29 patients with carotid artery stenosis was analyzed with the purpose of following-up the development of stenosis, and performing duplex scanner of carotid arteries. The follow-up was performed on the very first day of the study and six months later. There were 49 stenoses of internal carotid arteries in 29 patients. Carotid stenoses were classified into six categories. Most carotid stenoses were unchanged during the six month period (57.2%), or progressed (36.7%), but spontaneous regression was found in 6.1%. The ultrasonic characterization of carotid plaques was made in four types. Regression was noticed mainly in ulcerative plaques, while hard and fibrous plaques remained unchanged or progressed. Soft plaques progressed in all cases. Intraplaque hemorrhage was found in 2 patients. The most common risk factors for carotid atherosclerosis were hypertension, hyperlipidemia and cigarette smoking.
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PMID:Development of carotid stenosis. 175 45

The benefits of obtaining a routine screening carotid duplex scan have not been established for patients with peripheral vascular disease but no signs or symptoms of carotid artery disease. We retrospectively reviewed all carotid duplex scans (4,000) performed at our institution between 1985 through 1989 and found for analysis 91 scans in 78 patients who underwent a screening duplex scan because of the presence of peripheral vascular disease. Patients with carotid bruits, abnormal carotid pulses, and focal or nonspecific neurologic symptoms were excluded. Thirty-three percent of these patients had carotid stenosis of 16% to 50%, 14% had carotid stenosis greater than or equal to 50%, and 5% had stenosis greater than or equal to 75%. Individual risk factors for atherosclerosis, including elderly age, coronary artery disease, hypertension, diabetes, smoking, and a recent or past history of cardiac or vascular surgery, did not predict the detection of high-grade carotid stenosis. However, all 11 of the patients with carotid stenosis greater than or equal to 50% were 68 years of age and older, and this age range, in combination with the various risk factors, increased the incidence of significant carotid artery stenosis (greater than or equal to 50%) to as high as 45%. We conclude that routine screening carotid duplex scan is indicated in elderly patients (age greater than or equal to 68 years) with peripheral vascular disease, even in the absence of any signs or symptoms of carotid artery disease, when other atherosclerotic risk factors are present.
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PMID:Which asymptomatic patients should undergo routine screening carotid duplex scan? 186 41

We evaluated the association between alcohol consumption and carotid atherosclerosis in 261 consecutive patients greater than 50 years old admitted to our community-based primary-care center with first ischemic stroke; their characteristics were entered into a computerized data bank (Lausanne Stroke Registry). Reported regular alcohol consumption was compared with the presence and severity of internal carotid artery disease as assessed by duplex scanning with spectral analysis of the Doppler signal and real-time B-mode imaging at the level of the carotid bifurcation. We found an inverse linear relation between light-to-moderate alcohol intake (less than or equal to 4 standard drinks/day) and severity of internal carotid artery stenosis. No conclusion could be drawn for heavier drinkers because there were too few. A logistic regression model showed that hypertension, cigarette smoking, and age in men and diabetes mellitus and cigarette smoking in women strongly counterbalanced the potential benefit of alcohol consumption. Although regular alcohol drinking cannot be advocated on the basis of our findings, light-to-moderate consumption of alcohol is the first factor to be inversely associated with extracranial carotid atherosclerosis in symptomatic patients with cerebrovascular disease.
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PMID:Alcohol consumption and carotid atherosclerosis in the Lausanne Stroke Registry. 218 88

Eighty-one patients undergoing carotid endarterectomy were divided into two groups based on the degree of stenosis of the carotid artery. Group I, 37 patients, was defined as having severe carotid stenosis (greater than 70%). Group II, 44 patients, was defined as having mild (less than 40%) or moderate (40% to 70%) carotid artery stenosis. Both groups were evaluated for neurologic and psychologic changes in the postoperative period. Prospective analysis demonstrated no significant differences between groups I and II in the areas of cardiac disease, history of preoperative stroke, preoperative and postoperative hypertension, diabetes, or postoperative computed tomography changes. Group II had a significantly higher percentage of carotid artery ulceration (p less than 0.01). Postoperative analysis revealed 34 group I patients had 6 to 8 weeks of lethargy versus two group II patients (p less than 0.01). Eleven group I patients had headaches for the first week postoperatively versus three patients in group II (p less than 0.05). Four group I patients had paranoid ideation, and another four patients had clinical depression, but not one patient in group II (p less than 0.01) had these psychiatric disturbances. These data suggest that significant, reversible neurologic and psychologic changes can occur because of reperfusion after relief of severe stenosis of the carotid artery.
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PMID:Postoperative somnolence in patients after carotid endarterectomy. 235 8


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