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

Knowledge of daily blood pressure profiles is now an important factor in the management of hypertension. We recently analyzed the relationship of casual blood pressure (CBP) to 24-hour blood pressure (24-h BP) in 9 hypertensive patients and 11 normotensive subjects. A 24-hour ambulatory blood pressure monitoring apparatus (24-h ABPM, A & D Co.) was used to monitor 24-h BP. Data were divided into daytime mean blood pressure (daytime mBP), night mean blood pressure (night mBP), and 24-hour mean blood pressure (24-h mBP). In each subject, the 24-h ABP pattern was highly reproducible. Analysis of CBP disclosed that both the systolic blood pressure (SBP) and diastolic blood pressure (DBP) correlated more closely with 24-h mBP than with any other parameter. In view of the high incidence of cerebral infarction during night time or rest, prior knowledge of a blood pressure change pattern from daytime mBP to night mBP in individual patients is important in the prevention of this condition. The degree of decrease from daytime mBP to night mBP varied greatly among individuals, being higher in hypertensive patients than in normotensive subjects. The degree of this change in blood pressure was difficult to predict based on the CBP change pattern following postural change or 5-min rest. In some cases, 24-h ABPM data were within the hypertensive range (systolic greater than 160 mmHg, diastolic greater than 95 mmHg) for many hours, even though CBP was within the normal range. On the other hand, the duration of this sustained hypertensive level during 24-h ABPM was sometimes short, even in subjects with elevated CBP. To deal with such discrepancies between CBP and 24-h ABPM, the duration of the sustained hypertensive level during 24-h ABPM should be given high priority in assessing the severity and prognosis of hypertension.
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PMID:Management of hypertensive outpatients: clinical evaluation of casual and 24-hour ambulatory blood pressure. 182 Apr 38

The term transient ischaemic attack (TIA) does not correspond to findings of new examination methods and is rather a matter of convention. The authors examined 19 patients with the diagnosis of TIA by CT and found in five a cerebral infarction. The dependence of cerebral infarction in TIA on age, sex, risk factors (hypertension, diabetes) and the duration of clinical symptomatology was not significant.
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PMID:[Cerebral ischemic infarct in computer tomography imaging in the diagnosis of transient ischemic attacks]. 182 68

To determine the influence of age on atrial fibrillation as a risk factor for cerebral infarction, the Austin Hospital Stroke Unit Register from 1977 to 1990 was reviewed. There were 2279 patients with cerebral infarction (excluding lacunar infarction syndromes) with a mean age of 68.3 years who were identified as subjects, and 800 patients with pseudostroke and lacunar infarction syndromes with a mean age of 64.7 years who were identified as controls. Data concerning potential risk factors for stroke (including sex, age, atrial fibrillation, cardiac disease, hypertension, diabetes, peripheral vascular disease and smoking) were analyzed using multivariate regression techniques. It was found that atrial fibrillation was a significant risk factor for cerebral infarction (excluding lacunar infarction) for all age groups, after adjusting for the effects of other risk factors (P less than .001). However, when age was stratified into four groups, the age-specific odds ratios for atrial fibrillation were not significantly different and no significant interactions between atrial fibrillation and age or other risk factors were found (P greater than 0.1). It was concluded that, although with increasing age atrial fibrillation becomes a more frequent cause of stroke, its potency as a risk factor does not increase correspondingly. There was no significant influence of age on the relationship between atrial fibrillation and cerebral infarction.
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PMID:The influence of age on atrial fibrillation as a risk factor for stroke. 182 37

We analyzed the serum concentrations of lipids and lipoproteins and the prevalence of other risk factors in a case-control study of 304 consecutive Chinese patients with acute stroke (classified as cerebral infarction, lacunar infarction, or intracerebral hemorrhage) and 304 age- and sex-matched controls. For all strokes we identified the following risk factors: a history of ischemic heart disease, diabetes mellitus, or hypertension; the presence of atrial fibrillation or left ventricular hypertrophy; a glycosylated hemoglobin A1 concentration of greater than 9.1%; a fasting plasma glucose concentration 3 months after stroke of greater than 6.0 mmol/l; a serum triglyceride concentration 3 months after stroke of greater than 2.1 mmol/l; and a serum lipoprotein(a) concentration of greater than 29.2 mg/dl. We found the following protective factors: a serum high density lipoprotein-cholesterol concentration of greater than 1.59 mmol/l and a serum apolipoprotein A-I concentration of greater than or equal to 106 mg/dl. The patterns of risk factors differed among the three stroke subtypes. When significant risk factors were entered into a multiple logistic regression model, we found a history of hypertension, a high serum lipoprotein(a) concentration, and a low apolipoprotein A-I concentration to be independent risk factors for all strokes. The attributable risk for hypertension was estimated to be 24% in patients aged greater than or equal to 60 years. In this population, in which cerebrovascular diseases are the third commonest cause of mortality, identification of risk factors will allow further studies in risk factor modification for the prevention of stroke.
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PMID:Hypertension, lipoprotein(a), and apolipoprotein A-I as risk factors for stroke in the Chinese. 192 51

Clinical findings and cranial CT scan identified stroke in 315 admitted patients at Taichung Veterans General Hospital from January 1, 1989 to December 31, 1989. Hemorrhage was found in 137 cases and infarction in 178 cases (thrombosis in 124 cases, embolism in 54 cases). Most cases with stroke (72.4%) were distributed in ages between 55 and 74 years. The mean age of patient with cerebral infarction was 64.8 years, which was about 3.3 years higher than those with cerebral hemorrhage (mean age 61.5 years). The control group consisted of 117 persons (matched in age and sex) who had no history of stroke. In comparison of the five risk factors (hypertension, diabetes mellitus, atrial fibrillation, transient ischemic attack, and smoking) between the patients and the controls, we found that cerebral thrombosis was significantly associated with hypertension, diabetes mellitus, and smoking; cerebral embolism with hypertension, atrial fibrillation, and transient ischemic attack; and cerebral hemorrhage with hypertension only.
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PMID:[The effects of hypertension, diabetes mellitus, atrial fibrillation, transient ischemic attack and smoking on stroke in Chinese people]. 184 32

CAA is the infiltration of leptomeningeal and penetrating cortical vessels with amyloid, sparing the subcortical regions and the systemic vasculature. It occurs with increasing frequency after the sixth decade. The major clinical manifestation of CAA is lobar intracerebral hemorrhage, which can be sporadic or hereditary. CAA has also been associated with normal aging, Alzheimer's disease, cerebral infarction, and periventricular demyelination. Biochemical studies have shown that the amyloid deposits in the brains of patients with normal aging, sporadic CAA-associated hemorrhage, hereditary cerebral hemorrhage, and Alzheimer's disease are identical. The exact mechanism by which CAA produces lobar hemorrhages and the role of CAA in the development of dementia are unclear. Biopsy of the involved cerebral cortex and leptomeninges is the only definitive way to diagnose CAA. Acute management of CAA-associated lobar hemorrhage consists of aggressive control of associated hypertension and supportive care. Surgical removal of the hemorrhage has not been shown to improve survival. Antiplatelet and anticoagulant therapy should be avoided in elderly patients with known CAA.
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PMID:Diagnosis and treatment of cerebral amyloid angiopathy. 186 14

The effect of serum cholesterol on aortic, cerebral, coronary and femoral atherosclerosis as well as on the incidence of cerebral and myocardial infarctions were analyzed in 3,236 consecutive autopsies in the elderly. Serum cholesterol levels declined over the age of 80 in both genders. The cholesterol levels of females were significantly higher than that of males in each age group from the sixties through the nineties. The increase in serum cholesterol was correlated with the progression of coronary atherosclerosis in both genders, but not with cerebral or femoral atherosclerosis. Slight progression of aortic atherosclerosis was observed when serum cholesterol was over 160 mg/dl. Cholesterol induced progression of coronary atherosclerosis was found in cases with hypertension, but not in the normotensive group. In accordance with the progression of coronary atherosclerosis, the incidence of myocardial infarction increased with an elevation of serum cholesterol levels, and this relationship between myocardial infarction and cholesterol levels was found only in patients with hypertension. No correlation was found between the incidence of cerebral infarction and serum cholesterol levels. It was concluded that hypercholesterolemia in the elderly is a risk factor of myocardial infarction in cases with hypertension, but is not a risk factor of cerebral infarction.
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PMID:[Cholesterol, atherosclerosis and cerebro-cardiovascular complications in 3,236 elderly autopsy cases]. 187 Feb 84

To find out whether the high blood glucose values sometimes found in the first stage of ischemic stroke have any prognostic value, we considered 76 patients hospitalized within 24 h of an acute cerebral infarction, documented by CT brain scan and/or necropsy, whose fasting blood glucose was recorded before any treatment was given. The patients were sorted into 3 groups: diabetics, normoglycemic non-diabetics and hyperglycemic nondiabetics. On the CT findings cases with large cortical and/or subcortical infarcts were analyzed separately from those with lacunar infarcts. The clinical symptoms on admission proved to be more severe (p less than 0.02) and 30-day mortality higher (p less than 0.02) among the hyperglycemic non-diabetics, who also showed a highly significant (p less than 0.00001) preponderance of large cortical and subcortical infarcts over lacunar infarcts. Multivariate analysis, which took account of variables of known relevance to the prognosis of cerebral infarction (age, sex, arterial hypertension, severity of the clinical pattern, type of brain lesion), confirmed the statistically discriminant power, in terms of mortality, of belonging to the hyperglycemic nondiabetic group. The results of the study confirm that hyperglycemia at stroke onset in nondiabetic patients is an adverse prognostic factor and suggest that it may be a reaction to stress, depending on the size of the infarcted area.
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PMID:Hyperglycemia at ischemic stroke onset as prognostic factor. 187 6

Among 535 cases of simple CABG, cerebral infarction was complicated in 5 cases (0.9%). Their mean age (65.2 years old) was high, and 80% of them had the history of hypertension or diabetes mellitus or both. The causes of the cerebral infarction were considered to be the embolism of atheromatous debris from the ascending aorta (3 cases), the cerebral hypoperfusion due to cerebral arterial disease and hypotension during cardiopulmonary bypass (1 cases), and the embolism of the left atrial thrombus formed during repeated supraventricular tachyarrhythmias (1 case). Both cases of the multiple infarctions were lost in-hospital 10 months and 21 months postoperatively. Two of the three cases of single infarction suffered from the permanent neurological deficits. To prevent cerebral infarction which might totally deprive of the efficacy of the CABG, it is important to check and properly manage the atheromatous change of the ascending aorta, the cerebral arterial disease, and also postoperative supraventricular tachyarrhythmias.
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PMID:[Cerebral infarction after coronary artery bypass surgery--its cause, management and prevention]. 187 99

A case of persistent primitive proatlantal intersegmental artery (PPPIA) is reported. A 65-year-old male with treated hypertension was admitted to our clinic complaining of dysarthria and hemiparesis of sudden onset two days after the ictus. CT revealed spotty low-density lesions in the left corona radiata and bilateral thalami with bilateral watershed infarction. MRI findings were also compatible with cerebral infarction. Left common carotid angiography demonstrated a large anastomosis between the external carotid artery and the vertebral artery at the proatlantal region. Neither of the vertebral arteries were visualized on digital subtraction aortography. All the blood circulation of the vertebro-basilar system was through this anastomotic artery (PPPIA). A flow study revealed hypoperfusion in the territory of the left middle cerebral artery on 133Xe SPECT. Bone window CT of cervical vertebrae revealed hypoplasia of the left transverse foramen in C2, C3, C4, C5, C6 vertebrae. This case is very suggestive of an anaplasia or hypoplasia of the vertebral arteries. The etiology of his left frontal infarction seemed to be a blood-stealing phenomenon of long standing, from the anterior to the posterior circulation through the PPPIA.
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PMID:[Persistent primitive proatlantal intersegmental artery (PPPIA) presenting with cerebral infarction]. 188 24


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