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

Age-specific risk of recurrent stroke for various risk factors, calculated independently, was estimated using the first year of data from the Lehigh Valley Stroke Register. The register is based on a population of more than one-half million. Among the risk factors examined, the highest overall risk of recurrent stroke, 41.4, occurred with a history of at least one transient ischemic attack (TIA). After myocardial infarction (MI), the relative risk of a recurrent stroke was 8.0, while with all other heart diseases combined it was 8.4. With diabetes, the relative risk of a recurrent stroke was 5.6; with hypertension, it was 4.5. The relative risk increased with age after TIA and MI, but not for other heart disease, diabetes, and hypertension, except in the 85+-year-old age group.
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PMID:Stroke in the Lehigh Valley: risk factors for recurrent stroke. 382 48

Possible effects of chronically elevated serum cholesterol and triglyceride levels on measurements of cerebral blood flow were investigated by between-group comparisons of individuals, with and without hyperlipidemia, among 56 neurologically normal elderly volunteers and among 102 age-matched patients with symptoms of transient ischemic attacks (TIAs). Results demonstrated significantly higher levels of serum cholesterol and triglyceride among the TIA patients compared with randomly selected age-matched normal controls of similar educational and environmental backgrounds. Cerebral blood flow levels were reduced among groups of TIA patients with elevated levels of either cholesterol or triglycerides compared with the TIA patients with normal lipid levels. Similar trends were seen among normal volunteers, but these did not reach levels of statistical significance because of the limited numbers available. Analysis of frequency distributions for risk factors other than hyperlipidemia indicated that hypertension, atherosclerotic heart disease, diabetes mellitus, and cigarette smoking were also more prevalent among TIA patients than among age-matched normal controls.
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PMID:Hyperlipidemia is a risk factor for decreased cerebral perfusion and stroke. 382 97

The prognosis of 27 patients with moyamoya disease was studied. The ages at onset ranged from 11 months to 4-11/12 years. Follow-up study was performed within 4 years from the onset in 13, 5 to 9 years in 5, and 10 to 15 years in 9. Transient ischemic attacks (TIA) occurred most often during the first four years and decreased thereafter. Intellectual deterioration and neurologic deficits increased with time. Outcome included no sequelae in five (19%), occasional TIA or headache alone in nine (33%), mild intellectual and/or motor impairment in seven (26%), requirement for special school or care by parents or institutions after reaching the teen years in three (11%), continuous 24-hour care in two (7%), and death in one (3%). Poor prognosis was correlated with an early age at onset and hypertension.
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PMID:Prognosis of occlusive disease of the circle of Willis (moyamoya disease) in children. 388 Apr 14

A comparative study of the prevention of recurrences of cerebral transient ischemic attacks during a 6-month observation period was conducted in 73 patients treated with a combination of acetylsalicylic acid and dipyridamole (ASAD, 1,050 mg + 150 mg/day) and in 65 patients treated with pentoxifylline (PTX 1,200 mg/day, Trental 400 t.d.s.). The patients were randomly assigned to the treatments. Risk factor analysis showed high prevalence of arterial hypertension, hyperlipidemia and smoking in these patients. The two groups were matched in terms of age, sex, blood pressure and site of TIA origin (carotid 63% in the ASAD, 65% in the PTX group). 23 ASAD patients and 9 PTX patients suffered a recurrence. There were 4 nonfatal stroke events with ASAD and 2 with PTX. 80 recurrent TIAs were recorded in 19 ASAD patients compared with 19 such episodes in 9 PTX subjects. The morbidity rates (life table analysis) were significantly lower (p less than 0.05) in the PTX group. The results of the study point to a preventive effect of PTX in terms of the reduction in TIA recurrences.
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PMID:Preventive treatment of cerebral transient ischemia: comparative randomized trial of pentoxifylline versus conventional antiaggregants. 388 Dec 63

Transient ischaemic attacks are common, having an incidence of at least 50 per 100,000 population per annum, and the risk of stroke and/or death is about 10% per annum. Death is more often due to the complications of coronary artery disease than cerebrovascular disease. The most important issues in management are distinguishing transient ischaemic attacks from several other causes of 'transient focal neurological attacks', and managing the risk factors for vascular disease in general, particularly hypertension. The utility of specific 'antithrombotic' treatments is still uncertain, but for long term use aspirin seems to be the most promising. The only dose so far tested in clinical trials has been about 600mg twice daily but lower doses may theoretically be as, or more, effective. Trials of aspirin and other antiplatelet agents, and also of carotid endarterectomy and extracranial-to-intracranial bypass surgery are continuing and should be strongly encouraged. Although transient ischaemic attacks recover - by definition - in 24 hours, the pathophysiology, natural history, and treatment of focal cerebral ischaemia which recovers in a matter of days or weeks is probably rather similar.
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PMID:Transient ischaemic attacks. Current treatment concepts. 389 4

A study was undertaken to observe the long-term clinical behavior of the contralateral, asymptomatic carotid artery of patients after unilateral carotid endarterectomy (UCE). A consecutive series of 182 patients undergoing UCE were followed up for 1 to 9 years (mean 4.2 years). The operated artery was symptomatic in 169 cases (92.8%) whereas in 13 (7.2%) it was asymptomatic but stenotic. Follow-up included an accounting of all hemispheric or focal neurologic events in the territory of the nonoperated artery, as well as associated cardiovascular risk factors. A total of 11 patients (6%) suffered stroke (CVA) and six (3.3%) had transient ischemic attacks (TIAs) in the distribution of the nonoperated carotid artery. By life-table analysis, major neurologic symptoms developed in 11.6% of patients within 5 years. Hypertension was an important prognostic factor: significantly more hypertensive patients had late contralateral neurologic symptoms (p less than 0.05, chi square). The cumulative incidence of CVA and TIA in these patients was 17.3% by life-table analysis at 5 years vs. 9.1% for normotensive patients. Since only a small proportion of the patients studied had a high-grade stenosis of the nonoperated artery, no conclusions could be made regarding its prognostic importance. The relevant published studies are discussed and compared with this report. Guidelines for the management and follow-up of the patient after UCE are discussed.
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PMID:Contralateral neurologic symptoms after carotid surgery: a nine-year follow-up. 395 58

The antihypertensive effects of intravenous labetalol were evaluated in 59 patients with hypertensive crises or severe hypertension in need of rapid lowering of blood pressure in a multicenter study. Patients appearing with a supine diastolic blood pressure 125 mm Hg or greater, or a supine systolic blood pressure of more than 200 mm Hg received an initial mini-bolus injection (20 mg) of labetalol. This was followed by repeated incremental doses of 20 to 80 mg given at 10 minute intervals to achieve a supine diastolic blood pressure of less than 95 mm Hg or decrease 30 mm Hg or greater, or a satisfactory decrease in systolic blood pressure. Patients were stratified into those who had taken antihypertensive medication within 24 hours and those who had not. The initial mini-bolus injection caused rapid but not abrupt reduction in blood pressure; the baseline mean blood pressure decreased 23/14 mm Hg. Further injections were needed in the majority of patients (mean: 197 mg). The blood pressure reduction after the last dose of labetalol was 55/33 mm Hg. In pretreated patients and in those who had no medication for 24 hours prior to the intravenous labetalol, the response was similar. Heart rate decreased 10 beats per minute in the total population. In patients pretreated with beta-adrenergic blockers, blood pressure response was similar to that in the total group (59/35 versus 55/33 mm Hg), but heart rate remained essentially unchanged. The dose required to achieve the therapeutic effect was less in pretreated patients than in untreated patients, but the duration of action was shorter. No serious adverse effects were encountered even in patients with concomitant diagnoses of acute left ventricular failure, myocardial infarction, stable congestive heart failure, atrial fibrillation, angina pectoris, acute stroke, transient ischemic attack or encephalopathy. Labetalol is a safe and effective treatment for a rapid blood pressure reduction in hypertensive emergencies.
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PMID:Intravenous labetalol in the treatment of severe hypertension and hypertensive emergencies. 613 20

That an elevated haemoglobin or haematocrit is a risk factor in stroke is suggested by the prospective epidemiological evidence from Framingham. Our own study of a series of patients with transient ischaemic attacks revealed that even when due allowance was made for interaction between haematocrit, hypertension and smoking, there was still evidence that both male and female patients had a higher haematocrit than age and sex matched controls. Toghi's autopsy study further shows that cerebral infarction is more frequently found in the elderly population in subjects with a high haematocrit, the effect being most obvious in the presence of severe cerebral atherosclerosis. Cerebral blood flow is inversely related to haematocrit, reflecting the physiological maintenance of oxygen supply according to the metabolic demands of cerebral tissue. When oxygen carriage is enhanced at high haematocrit, flow falls. This could however, predispose in the face of atheroma to thrombosis, a suggestion given some support by the finding that amongst TIA patients the greatest proportion with a haematocrit over 50 were found among those with thrombotic carotid occlusion. The effect of haematocrit on flow might become limiting when considering collateral flow, and flow in a maximally dilated vascular bed in the territory of recent infarction. This hypothesis is supported by the finding that the size of the cerebral infarct accompanying carotid occlusion is greater in patients with an elevated haematocrit.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[The hematocrit and cerebrovascular accidents]. 622 21

By means of a case-control study, social and biomedical factors were considered in relation to transient cerebral ischemic attack occurrence as determined by questionnaire and interview among a population of females ( greater than 50 years of age) residing in the city of utrecht and surroundings. Contrary to earlier expectations, a greater TIA risk was found associated with: lower systolic and diastolic blood pressure, a low-salt diet for high blood pressure, lower body weight, smaller body surface, and use of medicines for cardiac insufficiency/arrhythmias and chronic anxiety. The importance of hemodynamic processes (i.e. hypotensive episodes of cerebral circulation) for TIA within the general population is emphasized.
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PMID:Unexpected trends in the analysis of a questionnaire and interview procedure to detect transient cerebral ischemic attack in a female population. 627 71

This report describes the experimental design, methods, and baseline characteristics of patients enrolled in a Veterans Administration Cooperative Study on the effect of aspirin (325 mg t.i.d.) and dipyridamole (75 mg t.i.d.) (110 patients), or placebo (121 patients) on major vascular outcome variables in noninsulin-dependent diabetic patients with either a recent amputation for gangrene (n = 207) or active gangrene (n = 24). It also describes the baseline characteristics of the patients. A total of 231 patients of 563 screened (41%) were enrolled at 11 participating V.A. Medical Centers during a 39 month period. The median age at entry was 60 years, the median duration of diabetes was 10 years, and weight was 110% of desirable. All patients were men. Sixty-eight percent were treated with insulin and 32% with diet alone. Only 42% were smokers at entry, 40% had retinopathy, 61% sensory neuropathy, 42% hypertension, and 29% had a history of myocardial infarction, angina, and/or congestive heart failure. Thirteen percent had a history of cerebrovascular disease. Despite randomization, the treatment group had an increased frequency of a history of cerebrovascular disease (p = 0.01), diagnosed as stroke (p = 0.03), a finding suggesting that the treatment group was at a slightly increased risk for vascular disease upon enrollment in the study. Other baseline variables did not differ significantly between the two groups. This study should provide definitive data on the efficacy of these doses of antiplatelet agents in preventing further vascular disease in diabetic men with gangrene or recent amputation for gangrene, using death due to vascular disease and subsequent amputation of the opposite extremity for gangrene as major outcome variables. It should also give useful information on the effect of antiplatelet therapy on vascular outcome variables such as same side amputations, myocardial infarction, stroke, transient ischemic attack, retinopathy, and renal failure. Finally, the study should provide useful data on the natural history and significance of risk factors in this patient population.
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PMID:V.A. Cooperative Study on antiplatelet agents in diabetic patients after amputation for gangrene: I. Design, methods, and baseline characteristics. 637 22


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