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

Recent clinical research on the psychological treatment of cardiovascular diseases is reviewed in four categories: hypertension, cardiac arrhythmias, coronary artery disease, and peripheral circulatory disease. In the treatment of hypertension biofeedback of blood pressure, electromyography and galvanic skin responses both seem useful, as does systematic relaxation training of either an active or passive-meditative nature. Biofeedback of heart rate has shown some utility in treating premature ventricular contractions and sinus tachycardia. Supportive and educational group therapy for patients recovering from myocardial infarctions has shown some utility. In the treatment of Raynaud's disease, biofeedback of skin temperature is helpful. In no area has a large scale clinical trial been conducted, and only three controlled group outcome studies have been reported (two in hypertension, one in coronary artery disease). Overall, the evidence is impressive enough to warrant more systematic controlled investigation in all four areas.
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PMID:Psychological treatment of cardiovascular disease. 40 Jul 79

The treatment of high blood pressure prevents death from congestive heart failure, hypertensive nephropathy, and encephalopathy, and strokes from cerebral arteriolar disease (lacunes, hemorrhage from microaneurysms). However, atherosclerosis, manifested as coronary artery disease is just as frequent a cause of death in well-controlled hypertensives as in poorly-controlled patients. Increasing evidence suggests that increased blood velocity, by causing turbulence and high shear rates at the endothelial surface of arteries, may be important in the pathogenesis of atherosclerosis. Turbulence has been observed in cerebral berry aneurysms. In order to measure the effects of antihypertensive agents on blood velocity, a new method of analysing Doppler ultrasound velocity recordings has been developed. Studies in Rhesus monkeys show the following: In doses which reduce diastolic pressure by 13-28%, propranolol decreased mean blood velocity (MV) by 17%, clonidine decreased MV by 14%, while methyldopa increased MV 12%, and hydralazine increased MV by 52%. (p less than .00001). It is hypothesized that enlargement of berry aneurysms, the progression of cerebral atherosclerosis, and embolism from carotid lesions might all be decreased by the selection of antihypertensive agents which decrease blood velocity.
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PMID:Effects of antihypertensive drugs on blood velocity: implications for prevention of cerebral vascular disease. 40 9

10 cases of myocardial infarction in females (mean age, 41 years, 4 months) on estrogen/progestin compounds for oral contraception have shown up the determinant role of the associated atherogenic risk factors. All patients had 1 other risk factor. In 6 cases there was hyperlipidemia with a cholesterol of above 2.60 and hypertriglyceridemia in 1 case. A family history of coronary artery disease was present in 5 cases. There was heavy tobacco consumption in 8 of the 10 cases. All of these factors, especially in combination, increase the risk of infarction in a female on estrogen/progestin tablets and constitute a contraindication to their use. 2 of the patients had hypertension, 2 were obese, and 1 was a mild diabetic. There was no warning in 1 case in 2, and early dilatation in 4 of the 10 cases. Coronary arteriography on 5 of 7 patients so examined revealed coronary lesions involving 1 trunk. The histological appearances of the occluded segment of the left coronary trunk in the 27-year-old patient who died were those of an organized occluding thrombus, perhaps having developed over a slight thickening of the intima.
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PMID:[Myocardial infarct and oral contraception]. 41 87

An optimal diet cannot yet be defined. If we knew what an optimal diet was, additional research in nutrition would not be necessary. There is abundant evidence, however, that the usual American diet is not optimal and adequate reason to recommend modification. Current dietary recommendations were developed to prevent the occurrence of nutritional deficiency disease in the 1930's and 1940's. They have been largely successful. They were made, however, before any knowledge was available about the effects of diet upon chronic disease which now represent the primary health problems of the United States. Large amounts of data are available indicating the kids of recommendations which should be made to control hypercholesterolemia--a primary risk factor of coronary artery disease. These kinds of data together with less information upon diet and cancer, hypertension, obesity, diabetes, etc. lead to sensible and consistent dietary recommendations to moderate the dietary practices of most Americans.
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PMID:Optimal nutrition. 44 85

Contrary to the conclusion reached by A. Mitchell in an article recently publshed in the British Medical Journal, the present author contends that administering subcutaneous heparin before and after major surgery prevents the subsequent development of pulmonary embolus. The current author recommended the use of subcutaneous heparin for surgical patients with a history of untreated hypertension or coronary artery disease. During the last 7 years the author observed no infractions during the perioperative period among 50 patients who were treated with subcutaneous heparin. In addition, among another 34 patients, who received the treatment and who were followed-up after surgery, only 1 patient developed chest pains. Mitchell did not give sufficient weight in his conclusions to the results of a multivate trial of subcutaneous heparin treatment in which only 2 deaths occurred among the experimental patients and 18 deaths occurred among the control patients.
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PMID:Preventing postoperative thromboembolism. 46

An 86-year-old man with previous normal renal function was hospitalized because of renal insufficiency. He had a long history of atherosclerotic heart disease, mild hypertension and pulmonary embolism, requiring anticoagulant therapy. In view of the normal-sized kidneys and absence of casts in the urinary sediment, a diagnosis of atheroembolic renal disease was made. The patient's renal function deteriorated, but he refused hemodialysis. Death occurred within a few weeks. At autopsy, severe aortic atherosclerosis was observed and atheroembolic renal disease was confirmed as the cause of renal failure. Occasionally, renal failure can be the sole manifestation of spontaneous atheroembolic disease. This possibility should be considered if the physician is called upon to establish the diagnosis when renal insufficiency develops in atherosclerotic patients.
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PMID:"Spontaneous" atheroembolic disease as a cause of renal failure in the elderly. 46 53

The comparative disposition of propranolol glucuronide (PG) and propranolol was determined in 35 patients with hypertension or coronary artery disease during initiation of propranolol therapy, during steady-state conditions, and after discontinuation of propranolol (dose range, 40 to 960 mg daily, every 6 hr). The 2.3-fold PG cumulation in plasma was identical to propranolol cumulation. PG plasma levels were about 4 times as high as propranolol levels over the whole dose range. Unexpectedly slow terminal elimination rate of propranolol (t1/2 approximately 16 to 24 hr) on discontinuation of propranolol appeared to be related to equally slow PG elimination. PG and propranolol could be detected in plasma and urine up to 3 to 5 days after propranolol discontinuation. The PG formed in man was deconjugated to propranolol in the dog after intravenous administration, suggesting that PG may serve as a storage pool for propranolol. Observations consistent with systemic and enteric deconjugation of PG, including enterohepatic recirculation, may, at least in part, explain the observed propranolol cumulation as well as the slow elimination of propranolol after its discontinuation. PG renal clearance (29 to 70 ml/min) and PG plasma levels were highly dependent on glomerular filtration rate, suggesting that PG may cumulate abnormally in patients with severe renal disease.
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PMID:Propranolol glucuronide cumulation during long-term propranolol therapy: a proposed storage mechanism for propranolol. 49 10

The prevalence of male pattern alopecia, coronary artery disease, hypertension and smoking habits were studied in 478 male Caucasian hospital in-patients, over the age of 20 years. No association was shown between coronary artery disease and either male pattern alopecia, premature male pattern alopecia or male pattern alopecia with a positive family history.
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PMID:Male pattern alopecia and coronary artery disease in men. 50 13

Ninety-three patients 65 years of age or older were studied to determine the incidence of dysrhymia following administration of 1 of 2 cholinesterase inhibitors, neostigmine or pyridostigmine. The ECG was then continuously monitored for 90 minutes. Neostigmine was associated with a higher incidence of dysrhythmia than was pyridostigmine. Neostigmine administered to patients with pre-existing coronary artery disease and/or conduction defects and to patients with hypertension was associated with a significantly higher incidence of dysrhythmia than was pyridostigmine when administered to patients with the same conditions. The incidence of dysrhythmia in patients who received a halogenated anesthetic was 5 times greater after neostigmine than after pyridostigmine.
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PMID:Cardiac dysrhythmia following reversal of neuromuscular blocking agents in geriatric patients. 56 56

Nine rural village communities in the jungle of Brunei, Borneo were studied to ascertain possible effects of rapid social change on the health of the inhabitants. The social mores and religious beliefs of the rural tribes--Iban, Dusun, and Punan--have undergone but little change over many hundreds of years. During the past three decades, however, enormous social pressures for change have envolved from extraordinary economic prosperity of the region, due to the exploitation of large discoveries of oil and gas. Much of the money has been invested in health care, with the result that malaria, typhus and other tropical scourges have been virtually wiped out. Child and maternal mortality have been reduced to the standards of some of the healthiest countries in the world. The young of the formerly illiterate population are being rapidly educated in new schools scattered throughout the nation. New roads are penetrating the jungle and a thriving lumber industry has been established. Motor boats for the rivers, T.V. and even a national airline have been added. Despite these incursions a vigorous proseletizing by the Moslem and to a lesser extent by the Christian church, the villagers have held tenaciously to their ancient animistic beliefs. Living in long houses, they have also been able to maintain a tightly cohesive patriarchal family structure. Against this background there is as yet little or no evidence of the major diseases of Western society--coronary artery disease and hypertension, although most forms of cancer are commonly encountered. Brunei offers a splendid opportunity to test the putative relationship of chronic vascular disease to social structure and a way of life. Future studies may be made prospectively as the almost inevitable breakdown of old customs and patterns of living occurs in the face of rapid modernization.
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PMID:A preliminary study in medical anthropology in Brunei, Borneo. 56 15


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