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

Stroke is a major clinical problem in hypertension. Cerebral hemorrhage has become considerably less frequent since treatment of hypertension has become more widely used. Antihypertensive treatment has also reduced the incidence of lacunar stroke, which is a result of hypertensive vascular disease of small arteries. Cortical cerebral infarction due to embolus from extracranial arterial atheromatous plaques is now the most common clinical cause of stroke. Drug treatment for hypertension has probably not reduced the incidence of this type of stroke. Cigarette smoking is also associated with an increased incidence of stroke; the incidence is related to the amount smoked, and former smokers continue to be at increased risk for up to 10 years.
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PMID:Stroke as a clinical problem in hypertension. 169

The changing pattern of cardiovascular disease during the last 30 years in Japan is described. The most striking change was a reduction in deaths caused by hypertensive cerebral hemorrhage. There was no increase in ischemic heart disease in the rural area studied but such a trend was shown in the urban area. A change in risk factors for cardiovascular disease, reduction in blood pressure, and increase in serum cholesterol were more marked in the rural than the urban area. Institution of a hypertension control program and marked changes in lifestyle, including diet, could explain the relatively rapid change in the frequency and the type of cardiovascular disease, particularly cerebral stroke. The prevention of atherosclerotic complications such as cerebral infarction and ischemic heart disease is becoming a more important task in preventive cardiology.
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PMID:Changing pattern of cardiovascular disease in the Japanese population in relation to hypertension control programs. 170 34

The aim of this study is to describe the clinical characteristics and the pathological mechanisms of carotid transient ischemic attacks (TIA) in 117 patients which were hospitalised for such symptoms. Our results show a male predominance, except for age group under 40 and over 79 years. The principal cardiovascular index and risk factors are: arterial hypertension, smoking, hyperlipidemia, vascular intermittent claudication and hematocrit greater than 46%. Amongst our patients, 17% with hemispherical and mixed TIAs had a cerebral infarction proved by CT-Scan, the recent aspect and localisation of which were compatible with symptoms. The atherosclerotic causes are more frequently associated with mixed and retinal TIAs than hemispheric TIAs. This fact may be attributed to a larger proportion of stenotic atherosclerotic lesions by mixed TIAs than hemispheric ones. The cardiac embolic pathogenic mechanism is responsible for 11% of TIAs if considered individually; of 5% if associated with carotid atherosclerosis.
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PMID:[Transitory carotid ischemic attacks: clinical and pathogenic aspects]. 172 4

Cardiovascular disease is the third most common cause of death in Tshepong Hospital in the western Transvaal, and the most common cause of death in patients older than 35 years. A prospective study was undertaken which included limited necropsies in 90 of the 167 cardiovascular disease deaths over 1 year. A reliable mortality pattern for cardiovascular deaths is described. Additionally, attention is paid to co-existing conditions. Conditions relating to cardiovascular disease, such as hypertension, benign hypertensive nephrosclerosis, atherosclerosis and obesity, were also evaluated. Cerebrovascular conditions were found in 32% of cardiovascular deaths. Intracerebral haemorrhage was found in 50% and cerebral infarction in 29% of cases. Fifty-seven per cent of cardiovascular deaths were due to cardiac conditions, the most common being pulmonary hypertension (31%), dilated cardiomyopathy and chronic rheumatic valvular disease (17% each) and hypertensive heart disease (14%). Forty-nine per cent of subjects were hypertensive, while 40% exhibited benign nephrosclerosis and only 3% of the examined vessels had signs of severe atherosclerosis. Tuberculosis was present in 13% of cases. The clinical diagnosis was the same as the final necropsy diagnosis in 38% of cases. These results emphasise the importance of performing necropsies to obtain reliable mortality statistics.
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PMID:Cardiovascular causes of death at Tshepong Hospital in 1 year, 1989-1990. A necropsy study. 173 52

Stroke is a major cause of mortality and morbidity in black Africans. The MEDUNSA Stroke Data Bank (MSDB) was established in 1984. Its goal is to gather data on all aspects of cerebrovascular disease in South African blacks, and it is supported by modern investigative techniques such as computed tomography (utilised in 82.2% of cases). The majority of the patients (71.2%) had cerebral infarction. Certain features, such as the importance of hypertension and increasing age as risk factors, were found to be similar to Western stroke populations; also, probable or definite cardiac source for cerebral embolism was present in 46% of the patients. In contrast, however, other features, such as transient ischaemic attacks, peripheral vascular disease, coronary artery disease and lacunar strokes, occurred far less frequently than is reported in Western patients. It is hoped that the MSDB will lead to a better understanding of cerebrovascular disease in blacks and possibly to in-depth comparative studies of the ubiquitous problem of atherosclerosis.
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PMID:The MEDUNSA Stroke Data Bank. An analysis of 304 patients seen between 1986 and 1987. 174 43

A consensus conference on stroke was held on March 22, 1991. Subjects on which consensus was reached were: There are different kinds of cerebral haemorrhage and infarction, which can be differentiated by computerized tomography, and this can have practical consequences. At clinical examination special attention should be paid to cognitive impairment. Angiography is indicated only if carotid surgery or unusual causes are considered. CSF examination and EEG are performed only on special indications. Cardiological consultation is necessary in young patients, or if clinical signs of cardiogenic embolism are present. Coumarin derivatives are prescribed in some of these cardiac causes of stroke, to prevent recurrence. There is as yet no effective medical treatment for cerebral infarction. In lobar and cerebellar haemorrhage surgical treatment may be indicated. In the acute phase of stroke it is always important to prevent aspiration pneumonia, pulmonary embolism and decubitus, and to care for muscles and joints. Advantages and disadvantages of gastric tube and indwelling catheter should be weighed. Treatment of hypertension after the acute phase is indicated to prevent recurrent stroke. After TIA and minor stroke, aspirin is prescribed, which reduces the risk of cerebral and myocardial infarction by 30%. Carotid endarterectomy in symptomatic patients with carotid stenosis of 70% or more, reduces the number of fatal or disabling strokes by 50%, if perioperative complications are less than 4%. Rehabilitation after stroke reduces disability and improves the adaptation of both the patient and his environment. The patient should be stimulated and supported; good information, including the family, is essential. Supplying aids and taking special measures should be done on individual basis, after a period of training.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Consensus cerebrovascular accident]. 174 34

We reviewed the prevalence of diabetes mellitus, hypertension and cigarette smoking in 176 Chinese patients with acute stroke, classified, on computed tomographic findings, as intracerebral haemorrhage or cerebral infarction. In all patients with no known history of diabetes, a 75 g OGTT was done 3-6 months after ictus and interpreted using WHO criteria. The overall prevalence of diabetes and impaired glucose tolerance (IGT) was 33.5% and 21.0%, respectively, with a higher prevalence being found in patients with cerebral infarction (P less than 0.05). Forty percent of those with diabetes were previously undiagnosed - all but 2 had ischaemic stroke. Compared to reported findings in the general population, an increased prevalence of hypertension, and possibly also cigarette smoking was found in patients with both stroke categories. On the other hand, significant hypercholesterolaemia was not found in patients of either category. In view of the high prevalence of undiagnosed diabetes among these stroke patients and the increased morbidity and mortality associated with diabetes mellitus, screening for diabetes is recommended especially in those with ischaemic stroke. If a fasting plasma glucose of greater than or equal to 6 mmol/l was used for the initial screening of undiagnosed diabetes in this group of patients, the sensitivity and specificity values would have been 78% and 94%, respectively. Whether this cut-off value can be cost-effectively employed for mass screening remains to be confirmed by studies involving larger numbers of stroke patients.
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PMID:High prevalence of undiagnosed diabetes among Chinese patients with ischaemic stroke. 175 84

Symptomatic dolichoectasia of the vertebrobasilar system was found in 23 patients (16 males and 7 females, mean age: 62 years) during a 13-year period. Arterial hypertension was noted in 20 cases and associated aortic ectasia in 4. The malformation was identified in all patients on CT completed by angiography in 19, MRI in 7. Autopsy was performed in 5 cases. Fourteen subjects (group 1) presented with a vascular event (ischemic in 13) affecting the brainstem and/or cerebellum. Nine other patients (group 2) had a chronic symptomatology resulting from compression of the cranial nerves, central nervous system and/or CSF pathway. Two patients died of stroke within the first month (rupture of the ectasia in one and occlusion in the other one). The 21 survivors were followed for a mean period of 45.3 months. Eight patients had a stroke, with a significantly higher incidence in group 1 than in group 2 (p less than 0.05). Ten patients (5 in each group) developed progressive dementia possibly resulting from multiple cerebral infarction, hypertensive leucoencephalopathy, and/or hydrocephalus. Twelve patients died during the follow-up (4 of stroke, 6 of profound mental and motor deterioration, one from ruptured ectatic aorta, and the last one of unrecognized cause). The actuarial survival rate was 60% after 3 years of follow-up. Except for the incidence of stroke, inaugural manifestations (stroke vs nervous compression) did not seem to influence the long-term prognosis.
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PMID:[Vertebrobasilar arterial dolichoectasia. Complications and prognosis]. 177 25

Several erythrocyte biophysical properties (erythrocyte deformability, erythrocyte aggregation and erythrocyte electrophoretic mobility) were investigated in patients with cerebral infarction and in individuals with risk factors of stroke (RFS population; RFSP). Blood viscosity, plasma viscosity, hematocrit, plasma fibrinogen level and yield shear stress (YSS) were also tested. In comparison with the results in a control group, erythrocyte deformability (erythrocyte length under a certain constant shear stress and erythrocyte filterability) was less in both the patient group and the group of RFSP and there is an accompanying increase of erythrocyte aggregation. Blood viscosity and fibrinogen level were higher in the patient groups. There was no correlation between erythrocyte deformability and other hemorheological parameters. Our results suggest that significant alteration of erythrocyte biophysical properties may be implicated in the pathogenesis of ischemic stroke. These abnormalities are associated with some of the risk factors of stroke such as hypertension, atherosclerosis and cardiovascular disorders.
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PMID:[Alteration of erythrocyte biophysical properties in patients with ischemic cerebrovascular disorders]. 181 80

Oren-gedoku-to is a Chinese medicine with hypotensive activity, hemostatic actions and the ability to augment cerebral blood flow. It is therefore expected to be useful in patients with hypertension and cerebrovascular accident (CVA). These effects of Oren-gedoku-to on platelet aggregation and coagulation-fibrinolysis were evaluated. A significant decline in platelet aggregation rate in both healthy control and patient plasma in response to Oren-gedoku-to was found. Maximal platelet aggregation time shortened, however, in healthy controls, but was prolonged in 8 of 20 patients with CVA, in particular those with cerebral infarction.
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PMID:Action of oren-gedoku-to on platelet aggregation in vitro. 181 25


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