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

Our knowledge of the disease burden components of tropical populations is fragmentary. Historically, the infectious diseases have been emphasized but, as some populations have undergone socio-economic changes, vital statistics have described a change in the pattern of disease. The picture is of a decline in infectious and a rise in chronic non-communicable disease. We focus here on the emergence of chronic cardiovascular diseases, and use hypertension as the paradigmic example. Early blood pressure surveys showed a virtual absence of hypertension among rural Africans and moderate prevalences in the Caribbean. Prevalence was highest among US and UK blacks. In a recent comparative study of blood pressure and its determinants in Nigeria, Jamaica and the US there was a steep gradient in prevalence from 15% through 26% to 33%. Body mass index and salt intake were the major determinants, accounting for 70% of the variance in hypertension prevalence. Additional information on mechanism comes from the exploration of the renin-angiotensin system across these populations. Angiotensinogen levels rise steadily from Africa to the US and are modestly associated with body mass index (BMI), and even more modestly with polymorphisms of the angiotensinogen gene. 30% of the variation in angiotensin-converting enzyme levels is attributable to the insertion/deletion polymorphism, and angiotensin-converting enzyme levels are modestly related to BMI and blood pressure. Thus, the steep gradient in prevalence is not attributable to the genetics as manifested in the renin-angiotensin system. The usefulness of these and other data on cardiovascular diseases include planning for primordial prevention in Africa and amelioration of existing epidemics in the Caribbean, the US and the UK. Additional long term surveillance data to define the burden and distribution of causes are necessary in Africa. Lastly, education and advocacy to transfer the information to policy makers and planners is required.
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PMID:Emergence of Western diseases in the tropical world: the experience with chronic cardiovascular diseases. 983 Feb 10

Peripheral arterial disease of the lower limbs is a manifestation of atherosclerosis, and may also affect other vascular territories such as the coronary and cerebral arteries. Progressive narrowing of the vessels up to total occlusion can present as intermittent claudication or pain at rest, with or without cutaneous lesions. Patients with intermittent claudication are at a low risk of amputation, and the symptom has to be regarded as a warning signal for myocardial infarction and stroke. Nevertheless, if the patient's walking distance is too limited to allow a near-normal life, symptomatic treatment to improve quality of life should be considered. Treatment may consist of walking exercise, surgical or interventional radiological revascularisation, or, in some cases, administration of vasoactive drugs. Antiplatelet agents should be administered in an attempt to limit disease progression and prevent cardiac and cerebrovascular complications, together with active measures to reduce established risk factors such as smoking, diabetes, hyperlipidaemia, and arterial hypertension. The presence of pain at rest indicates that a lower limb is jeopardised, especially when the criteria for critical ischaemia have also been met. These criteria include the presence of chronic (lasting for more than 2 weeks) symptoms of ischaemia at rest and a systolic blood pressure less than 50 mm Hg or 30 mm Hg at the ankle or big toe, respectively. In such a situation, revascularisation should be attempted whenever possible. If this is not possible or if the procedure has failed, prostacyclin administered intravenously for days or weeks is an alternative. After revascularisation, early reocclusion may be prevented by administering anticoagulants and late reocclusion by antiplatelet agents, in conjunction with eradication of risk factors. In all situations, therapeutic decision-making should be undertaken in a multidisciplinary setting and should include the following: specialists in angiology (an internist) and interventional radiology; a vascular surgeon; an orthopaedic surgeon, if necessary; and diabetes and infectious disease specialists.
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PMID:[Drug treatment strategies for peripheral obliterative arteriopathy]. 984 99

In the last 40 years Brazil has experienced both a demographic and an epidemiological transition. Life expectancy has increased and fertility rates have declined. Cardiovascular disease (CVD) has become the leading cause of death, as infectious disease incidence declined. Hypertension is the leading reason for disability benefits and a key factor for cardiovascular disease morbidity and mortality. Hypertension prevalence in Brazil ranges from 5% to 40%, depending on the region of the country and the population subgroup. Risk factors for hypertension are older age, higher body mass index, black ethnicity, high salt and alcohol intake, acculturation of native populations, and additionally, for women, oral contraceptive use. Although there are nationally issued guidelines for hypertension treatment, outcome studies evaluating such programs are scarce. Information available from selected populations suggest that hypertension awareness, treatment and control rates are very low. There is a need for development and implementation of primary prevention programs with adequate evaluation mechanisms to reduce the burden of the disease in the years to come.
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PMID:Status of health and prevalence of hypertension in Brazil. 992 12

Migrant farmworkers lead a hard life filled with strenuous work, stress, and anxiety about employment; live under substandard conditions; and rarely get the health care they require. Preventive care is a luxury they cannot afford. Year-round nutritious meals are rarely possible, due to long working hours, traveling, and living in housing without adequate cooking and refrigeration facilities. Children may attend up to six or more schools during the course of a school year. Crowded housing conditions support the invasion of parasites, infectious diseases, and viral infections. Dermatological conditions from working around a wide variety of plants, dirt, and in the sun are frequent. Exposure to pesticides, herbicides, and other chemical additives creates the likelihood of acute reactions, such as headaches and rashes, and also puts workers at risk of developing chronic diseases as the level of exposure rises because of accumulation and mix of various chemicals. Yet, we know little about the health status of this population. We are unable to estimate crude death rates, age-specific death rates, or prevalence rates of most common causes of death, such as heart disease,cancer and stroke. There is no information about occupational accident rates, infectious disease rates, or even postneonatal mortality. We do know that when migrants go to a clinic, they are often likely to have the chronic conditions of hypertension or diabetes. They present symptoms of acute conditions such as dental problems, dermatitis, otitis media among children, and acute upper respiratory infections. Women frequently need obstetrical care, reflected (ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Health status and needs of migrant farm workers in the United States: a literature review. 1012 52

Pheochromocytoma is observed with higher frequency in patients with von Recklinghausen neurofibromatosis. We report a 36 years old female with von Recklinghausen neurofibromatosis who developed mild hypertension during the fourth month of pregnancy. A cesarean section was performed at 37 weeks of pregnancy. Thereafter, the patient presented severe hypertensive and hypotensive crises, sinus tachycardia and fever. No evidences of an infectious disease were found. Abdominal ultrasound examination showed a right adrenal mass of 7 x 5 cm. High levels of urinary cathecolamines confirmed the diagnosis of pheochromocytoma. After three weeks of prazosin therapy, the patient was operated. During the surgical procedure, an encapsulated pheochromocytoma was found and excised. A right renal atrophy and renal artery thrombosis were also found and a nephrectomy was done. Postoperative evolution was uneventful and the patient remains with normal blood pressure levels six months after the operation.
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PMID:[Pheochromocytoma and von Recklinghausen neurofibromatosis: postpartum crisis and renal artery thrombosis]. 1034 81

Mortality statistics show that there has been a significant change in the leading causes of death in Jamaica over the last 50 years, characterized by a decrease in the infectious diseases and those due to undernutrition and an increase in the non-communicable diseases. The various patterns of this epidemiological transition worldwide are outlined and the characteristics of this 'new' epidemic are discussed. Data are presented from the findings of the recent multi-country study of hypertension and diabetes, including Jamaica, which shows that as the body mass index (BMI) increases across the African diaspora, so does the prevalence of hypertension and diabetes. Among the Jamaican population studied, the prevalence of hypertension was 19.1% among males and 28.2% among females. Reported prevalence of previously diagnosed diabetes was 5.3% in men and 10.4% in females. The gender differences are in part explained by the differences in mean BMI which were 23.8 and 27.9, respectively, for males and females. 30.6% of males and 64.7% of females were either overweight or obese, with obesity prevalent in 7.2% of the males and 31.5% of the females studied. The increasing prevalence of obesity across the Caribbean is cause for concern as it significantly impacts on the demand for health and medical care. The identification of these reversible risk factors should be used to inform public policy to tackle what will be a growing concern.
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PMID:Chronic diseases: the new epidemic. 1036 25

Human immunodeficiency virus-associated nephropathy (HIVAN) develops more often in HIV-infected blacks than whites. Blacks also show marked familial clustering of other causes of end-stage renal disease (ESRD), particularly diabetes mellitus-, hypertension-, and systemic lupus erythematosus-associated ESRD. We compared the family history of ESRD in 201 blacks with ESRD caused by HIVAN (cases) to that of 50 HIV-infected blacks without renal disease (controls) to determine whether HIV-associated ESRD shows familial aggregation. Cases were identified using the Southeastern Kidney Council/ESRD Network 6 Family History of ESRD database. Cases initiated dialysis between September 1993 and October 1998. Controls were consecutively identified, HIV-infected blacks with serum creatinine concentrations of 1.3 mg/dL or less and no proteinuria, treated in an infectious disease clinic during September 1998. Cases and controls had similar mean ages and family sizes. First- or second-degree relatives with ESRD were reported by 24.4% of the cases compared with 6% of the controls (P = 0.004). Logistic regression analysis, controlling for sex, family size, and age, showed cases were 5.4 times more likely than controls to have close relatives with ESRD (P = 0.007). The 49 HIVAN cases who reported a positive family history had a mean of 1.2 additional relatives with ESRD per case (60 total relatives with ESRD). HIVAN was not listed as the cause of ESRD in any of the 27 relatives who underwent dialysis in Network 6 facilities. We conclude that ESRD clusters in the families of nearly 25% of blacks initiating renal replacement therapy for HIVAN. This familial aggregation of ESRD appears to be independent of HIV infection. Although environmental factors cannot be excluded, it is possible an inherited susceptibility to renal failure is present in many blacks with HIV infection who subsequently develop nephropathy.
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PMID:Familial clustering of end-stage renal disease in blacks with HIV-associated nephropathy. 1043 Sep 71

Angiotensin I-converting enzyme (ACE) inhibitors have been proven to be highly effective and are for the most part the drugs of choice in the treatment and control of hypertension, congestive heart failure, and left ventricular dysfunction. Despite this, questions regarding side effects and compliance with this traditional pharmacological strategy remain. In view of these observations, coupled with recent advances in gene-transfer technology, our objective in this study was to determine whether the expression of ACE could be controlled on a permanent basis at a genetic level. We argued that the introduction of ACE antisense to inhibit the enzyme would be a prerequisite in considering the antisense gene therapy for the control of hypertension and other related pathological states. Retroviral vectors (LNSV) containing ACE sense (LNSV-ACE-S) and ACE antisense (LNSV-ACE-AS) sequences were constructed and were used in rat pulmonary artery endothelial cells (RPAECs) to determine the feasibility of this approach. Infection of rat RPAECs with LNSV-ACE-S and LNSV-ACE-AS resulted in a robust expression of transcripts corresponding to ACE-S and ACE-AS, respectively, for the duration of these experiments, ie, 8 consecutive passages. The expression of ACE-AS but not of ACE-S was associated with a permanent decrease of approximately 70% to 75% in ACE expression and a 50% increase in the B(max) for the AT(1)s. Although angiotensin II caused a concentration-dependent stimulation of intracellular Ca(2+) levels in both ACE-S- and ACE-AS-expressing cells, the stimulation was significantly higher in ACE-AS-expressing RPAECs. In vivo experiments demonstrated a prolonged expression of ACE-AS transcripts in cardiovascularly relevant tissues of rats. This was associated with a long-term reduction in blood pressure by approximately 15 mm Hg, exclusively in the spontaneously hypertensive rat. These observations demonstrate that delivery of ACE-AS by retroviral vector results in a permanent inhibition of ACE and a long-term reduction in high blood pressure in the spontaneously hypertensive rat.
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PMID:Sustained inhibition of angiotensin I-converting enzyme (ACE) expression and long-term antihypertensive action by virally mediated delivery of ACE antisense cDNA. 1050 86

The human genome contains at least 80,000 genes, and each carries out its unique biologic function in the human body. Gene mutation and variation may result in hereditary disease, cancer, hypertension, and even susceptibility to infectious diseases. A complete compilation of all human genes (the human genome) should allow a better understanding of the role of specific genes in diseases and, consequently, better design of effective treatments. The human genome project (HGP) is scheduled to be completed in 2003. This article reviews the novel technology used in the HGP and the new information that will be generated. The results will influence medical practice greatly. Indeed, as in the forthcoming era of genomic medicine, a battery of gene tests is likely to be as routine as blood chemistry tests are today. The impacts are to be felt soon and medical professionals should be ready to grasp and apply new knowledge as it becomes available to better serve their patients. We also describe how the findings from the HGP might be used to solve locally important medical problems, using the examples of genomic research in liver and nasopharyngeal cancers. Finally, because the HGP has raised many new ethical, legal, and social challenges that should often take precedence over the problems of technology, an overview of these issues is also provided.
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PMID:Impact of human genome research on medicine--the initial Taiwan experience. 1077 24

Healthy People 2000, the national strategy for improving the health of individuals in the United States, provides direction for the prevention of chronic illnesses, injuries, and infectious diseases by specifying desired outcomes for specific populations. The authors focus on outcomes for several illnesses and conditions known to significantly affect the health of women who are menopausal or postmenopausal. These include osteoporosis, hypertension, cardiovascular disease, stroke, diabetes mellitus type 2, congestive heart failure, and obesity. Suggestions for advanced nurse practitioner assessment and intervention are provided for the reader.
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PMID:Is anyone listening? Does anyone care? Menopausal and postmenopausal health risks, outcomes, and care. 1077 59


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