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

We investigated black/white differences in stroke rate (standardized morbidity), severity, and subtype, and the relative frequencies of 5 primary risk factors (hypertension, diabetes, myocardial infarction, other heart diseases, and transient ischemic attack [TIA]) using the Lehigh Valley Stroke Register. Blacks had a statistically significant higher, age-adjusted rate of stroke than whites. We found no differences in stroke severity using our measures but blacks had a statistically higher proportion of lacunar stroke, while whites had a higher proportion of embolic stroke. There were no differences in proportions of thrombotic stroke or intracerebral hemorrhage. The relative frequencies of hypertension, myocardial infarction, other heart diseases, and diabetes were higher for blacks, while the relative frequency of TIA was higher for whites. These observations are consistent with other reports that blacks have a higher frequency of stroke and tend to have more small-vessel cerebrovascular pathology than whites.
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PMID:Stroke in the Lehigh Valley: racial/ethnic differences. 277 Oct 65

The authors present their experience with abdominal aortic aneurysm during the last 12 years. From 1976 up to now they treated 70 patients with abdominal aortic aneurysms. Sixty-seven patients (96%) were male, while 3 (4%) female. Mean age was 65 years (S.D. +/- 7.97). 82% of the patients were heavy smokers. Sixty-five patients were treated by means of resection and vascular reconstruction. Their associated pathologies were: M.I. or severe heart ischemia 34 (52.3%), diabetes 13 (20%), hypertension 25 (38.4%), T.I.A. 6 (9.2%), renal insufficiency 13 (20%), and respiratory insufficiency 18 (27.6%). Results demonstrated a 12-year patency rate of 91.8%. Five high-risk patients were treated by means of "palliative" treatment. Associated pathologies and risk factors were: smoking 5 (100%), M.I. or severe heart ischemia 5 (100%), diabetes 2 (40%), hypertension 4 (80%), T.I.A. 2 (40%), renal insufficiency 2 (40%), respiratory insufficiency 3 (60%). Treatment consisted in the sac thrombosis by means of Gianturco-Wallace coils into the aneurysm (2 cases) and iliac artery ligation (3 cases). Both techniques allowed acute thrombosis of the aneurysm. Vascular supply to the lower limbs was performed by means of an axillo-bifemoral reconstruction in all cases. Long-term prognosis of these five patients was poor due to their general condition.
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PMID:[Surgical treatment of aneurysms of the abdominal aorta. Consecutive experience for 12 years]. 281 49

It is estimated that between 1971 and 1987 the number of carotid endarterectomies has increased from 15,000 to over 85,000 per year. Unless the procedure can be performed safely with a combined morbidity and mortality which is below the yearly risk of stroke (5%) for patients with symptomatic carotid artery disease, one should reconsider this operation as a therapeutic option. We review our experience with 891 carotid endarterectomies performed between January 1979 and June 1987. There were 579 (65%) men and 312 (35%) women of ages from 34 to 82 (median 65); risk factors included diabetes mellitus 213 (14%), hypertension 603 (68%), and smoking 630 (70%). Clinical presentation consisted of transient ischemic attacks 506 (57%), cerebral infarction with minimal neurological residual 252 (28%), stroke in evolution 3 (0.3%) and, asymptomatic stenosis 130 (15%). All patients were operated on under endotracheal anesthesia with transoperative monitoring of intra-arterial pressure, central venous pressure and arterial blood gases. Thiopental (3-5 mg/kg) and lidocaine (1 mg/kg) were given for induction and at 15 minute intervals during carotid cross-clamping. Intraluminal shunts were used in 13 (2%). A conventional (open) endarterectomy was performed in 561 (63%) and a limited endarterectomy (closed) in 330 (37%). Complications included 11 (1%) deaths, 26 (3%) developed a major neurological deficit that persisted, 30 (3%) had perioperative TIA's which resolved completely. Of the patients with preoperative neurological deficits, 33 (4%) recovered. Therefore, at one month after surgery, 854 (96%) were either as well or better than preoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pitfalls during carotid endarterectomy. 284 25

Thirteen patients presented with brief, repetitive, stereotyped transient ischemic attacks, large artery atherostenoses or occlusions with impaired collateral flow to a cortical perfusion borderzone, and orthostatic hypotension (OH). OH was caused by diabetes mellitus, aging, and treatments for ischemic heart disease and hypertension. Medical management of OH often eliminated the need for stroke prevention measures such as surgery or anticoagulation. Focal cerebral hypoperfusion from the combination of occlusive vascular disease and OH may be an underreported, treatable cause of TIA and stroke.
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PMID:Orthostatic hypotension as a risk factor for symptomatic occlusive cerebrovascular disease. 290 10

One hundred and seventy eight patients admitted to hospital with acute cerebral infarction or transient ischaemic attack were studied to determine if their treatment had been changed during the previous three weeks and to compare their blood pressure after the stroke with premorbid values. Blood pressure measurements taken within one year before the stroke were available for 100 patients; seven of these had had a recent change in antihypertensive or diuretic treatment. Of these, three patients who had started taking frusemide because of hypertension and one whose dosage of a reserpine combination drug had been increased experienced an appreciable decrease in blood pressure immediately after the stroke; they also showed signs of haemoconcentration. The change in treatment probably contributed to the stroke in these four patients. The other three showed a smaller decrease or even an increase in blood pressure and no signs of haemoconcentration; the relation between the change in treatment and stroke is less likely in these patients. The use of high ceiling diuretics such as frusemide in the treatment of hypertension may induce hypovolaemia and hypotension, resulting in cerebral ischaemia, and are therefore best avoided in such treatment.
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PMID:Contribution of inappropriate treatment for hypertension to pathogenesis of stroke in the elderly. 309 13

Results are presented of a retrospective analysis of 651 carotid endarterectomies in 605 patients with carotid territorial transient ischemic attacks (TIAs). All operations were performed by the same surgeon in a community hospital from 1963 to 1986. Arteriographic findings consisted of carotid stenosis of 50% or greater in 88.5% of patients and stenosis less than 50% and/or an ulcerated plaque in the remaining 11.5%. Medical risk factors were detected in 92% of patients; hypertension, peripheral vascular disease, and coronary atherosclerosis were most prevalent. All operative procedures were conducted with the patients under general anesthesia, routine shunting, and arterial closure without a patch. The perioperative stroke rate was 1.5% (10 patients); the morality rate was 0.8% (three deaths from myocardial infarction and two from stroke) for a combined stroke and mortality rate of 2.0% (13 of 605 patients). Follow-up (mean 61.8 months) was possible in 570 (96%) of the patients surviving operation without a perioperative stroke. The cumulative probability of late stroke (i.e., cerebral infarct ipsilateral to the operated artery) was 2.5% at 5 years and 8.1% at 10 years. When the perioperative stroke-mortality rate (2.0%) is combined with the data for late ipsilateral stroke, the 5- and 10-year probabilities of ipsilateral stroke were 4.5% and 9.9%, respectively (mean 1% per year for 10-year period). Coronary atherosclerosis accounted for 43% of late deaths and 16% of strokes. The perioperative stroke-mortality rate of 2.0% in this group of patients falls within the acceptable range for carotid endarterectomy in patients with TIA.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Carotid endarterectomy in patients with territorial transient ischemic attacks. 317 81

In a prospective study of postoperative complications, strokes occurred in 6 out of 2463 patients (0.2%) who underwent non-cardiac, non-carotid artery surgery. The patients who experienced cerebrovascular accidents, including three cases of transient ischemic attack, were significantly older than the rest of the group (mean age 79 years versus 65 years) and had manifestations of atherosclerosis in at least one organ preoperatively. Significant predictors of risk for postoperative cerebrovascular accidents were previous cerebrovascular disease, heart disease, peripheral vascular disease, and hypertension. Cerebrovascular accidents occurred late in the postoperative period, 5-26 days after surgery, and were not directly related to surgery and anesthesia. They were more frequent after acute than after elective operations. Precipitating factors for some of the stroke incidents were rapid atrial fibrillation and postoperative dehydration.
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PMID:Postoperative cerebrovascular accidents in general surgery. 321 96

Forty-five patients with symptomatic (20 with transient ischemic attack, 25 with minor stroke) greater than or equal to 75% stenosis of the cervical internal carotid artery had no endarterectomy and received only medical therapy because the surgical risks (severe cardiac disease, chronic obstructive pulmonary disease, hypertension or diabetes with systemic complications, aortic aneurysm) were believed to be unacceptable. During follow-up (mean 48 months), occlusion of the internal carotid artery developed without symptoms in two patients and with symptoms in three patients. The cumulative stroke and/or death rate was 24% at 2 years and 50% at 6 years. The ipsilateral infarct rate was 10% after the first year, but decreased markedly thereafter (2.4% per year), and one third of these infarcts were probably lacunes due to hypertensive small vessel disease. Overall, stroke related to previously symptomatic internal carotid artery stenosis was not the major problem during follow-up but was largely overcome by other strokes and cardiac death.
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PMID:Prognosis of high-risk patients with nonoperated symptomatic extracranial carotid tight stenosis. 333 90

The operative risks as well as the proper interval for patients undergoing staged contralateral carotid endarterectomies remain uncertain. The long-term incidence of stroke after bilateral carotid endarterectomy is also poorly documented. In this report the results of staged contralateral carotid endarterectomies performed by one surgeon in a consecutive series of 89 patients are analyzed. No deaths occurred after a first or contralateral carotid endarterectomy. Four (4%) neurologic deficits (three minor and one major) occurred after a first operation, whereas only one (1%) major neurologic deficit occurred after a contralateral carotid endarterectomy. Postendarterectomy hypertension was noted in 33 (37%) patients after a first operation, and in 62 (70%) patients after a contralateral carotid endarterectomy (p less than 0.00001). No correlation existed among the intervals between carotid operations and the incidence or duration of hypertension after a contralateral carotid endarterectomy. From our results we conclude that the staged contralateral carotid endarterectomy can be safely performed with a stroke-mortality rate approaching 1%. Postendarterectomy hypertension, although more frequent after the contralateral operation as compared with the first operation, has no correlation with the interval between procedures. After a staged bilateral carotid endarterectomy, only one (1%) patient experienced transient ischemic attack symptoms, but five (6%) patients suffered late stroke (four fatal).
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PMID:Operative and long-term results of staged contralateral carotid endarterectomy: a personal series. 334 Sep 93

The association between some hypothetical risk factors (previous TIA, hypertension, ECG ischemic abnormalities, diabetes, cigarette smoking, atrial fibrillation, hypercholesterolemia, hypertriglyceridemia, high hematocrit) and lacunar syndromes has been evaluated by a matched sample case-control study involving 108 consecutive, incident cases with lacunar syndrome and 216 hospital control subjects, matched for sex and age. A significant increase of Relative Risk (RR) has been shown for: 1. Previous history of TIA; 2. Hypertension; 3. Smoking; 4. Diabetes. No relevance was shown for: 1. Atrial fibrillation; 2. Hypercholesterolemia; 3. Hypertriglyceridemia; 4. High hematocrit. The analysis of the triplets of subjects (1 case + 2 controls) without hypertension showed a significant RR increase for: 1. Previous history of TIA; 2. Ischemic cardiac abnormalities; 3. Atrial fibrillation. Such findings support the hypothesis that, in a minority of cases with lacunar syndrome, the pathogenetic mechanism could be different from occlusion of penetrating arteries in hypertensive patients.
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PMID:Risk factors in lacunar syndromes: a case-control study. 335 7


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