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

A patient with intractable congestive cardiac failure secondary to renovascular hypertension and severe coronary artery disease was infused with the competitive antagonist of angiotensin II, saralasin acetate. The infusion produced an impressive increase in cardiac output and left ventricular stroke work index in parallel with a striking decrease in the systemic and pulmonary vascular resistance, the coronary resistance, and the myocardial oxygen consumption. It is suggested that angiotensin inhibition may present advantages over other forms of treatment of congestive cardiac failure in selected cases.
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PMID:Angiotensin II inhibition. Treatment of congestive cardiac failure in a high-renin hypertension. 57 78

This report describes the clinical and necropsy findings in a fatal case of coronary atherosclerotic heart disease with thrombosis occurring in a Nigerian. This entity is very rarely seen in indigenous Africans, except in the setting of hypertension, diabetes mellitus or high socioeconomic status.
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PMID:Fatal coronary atherosclerotic heart disease in a Nigerian case report with necropsy findings. 61 Nov 70

To date, there is little information available on stroke risk factors in a major ethnic minority such as Mexican-Americans (M-A) in the USA. Forty-three M-A patients were admitted to The Methodist Hospital and Ben Taub General Hospital (Houston) for a 12-month period, with diagnosis of atherosclerotic stroke. Thrombosis was diagnosed in 31 patients (72%), embolism from atherosclerotic sources in seven (16.4%), and parenchymal hemorrhage in five (11.6%). Hypertension was a common risk factor in all groups, being higher in hemorrhage followed by thrombosis and embolism. Arteriosclerotic heart disease was a common risk to all stroke types. TIAs, hyperlipidemia, diabetes, associated atherosclerotic lesions, smoking, obesity, erythrocytosis and sedentary life were significantly associated with embolism; less so with thrombosis or hemorrhage. Gout was only associated with thrombosis. These results indicate similar risk factors for Anglo-saxons and M-A in the USA with some minor differences between the Mexican and the USA stroke series.
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PMID:Risk factors in stroke in a Mexican-American population (Houston). 61 32

To compare angiographically-determined coronary artery disease in diabetic patients with controls, 1,653 patients coming to cardiac catheterization were reviewed retrospectively to find 37 diabetic and 79 control patients matched for sex, age (+/- 3 years), and risk factors (hypertension, hyperlipidemia, and smoking). The severity of coronary artery disease was assessed using an angiographic grading system. The following results were obtained: 16 of 37 diabetic patients (43%) had three-vessel disease compared to 20 of 79 controls (25%). Seventy-six of 111 (68%) diabetic vessels were diseased compared to 110 of 237 control vessels (46%) (P less than 0.005). The total coronary score reflecting total extent of disease for diabetic patients was 371 (mean 10.0 +/- (SEM) compared to 594 for controls (mean 7.5 +/- 0.7, (P less than 0.01). Diabetic patients had a statistically similar number of diffusely diseased vessels as controls (28% vs 22%). There were only three of 76 diabetic vessels (4%) considered inoperable compared to seven of 110 (6%) control vessels. We conclude that diabetic patients with chest pain have more coronary artery disease than nondiabetics, but no more diffuse or inoperable disease.
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PMID:Diffuse coronary artery disease in diabetic patients: fact or fiction? 61 80

Although many patients with coronary artery disease (CAD) have a positive exercise test without pain, the frequency and significance of this "silent" ischemia is unclear. Therefore, we studied 122 consecutive clinically stable patients with angiographically defined CAD (greater than 75 per cent luminal stenosis) and a positive exercise test. Seventy-eight patients had pain or anginal equivalent during or after a positive exercise test; 44 did not, including 32 (26 per cent) with no symptoms at all. Patients were evaluated as to age, sex, prior myocardial infarction, congestive failure, hypertension, diabetes mellitus, and digoxin or propranolol therapy--in addition to anginal symptoms before, during, or after the exercise itself. Extent of CAD, presence of collaterals, and left ventricular ejection fraction were also determined. All exercise tests were evaluated for evidence of ST-T abnormalities or prior infarction on the control ECG as well as peak heart rate during exercise and post-exercise degree of ST segment depression. There were no significant differences between patients with and without exercise-induced pain in regard to any of the clinical and angiographic features noted above, demonstrating that "silent" myocardial ischemia during or after exercise testing is not uncommon and is not readily attributable to any obvious clinical or catheterization findings. Further studies are necessary to determine if patients with evidence of "silent" myocardial ischemia are especially prone to sudden death.
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PMID:"Silent" myocardial ischemia during and after exercise testing in patients with coronary artery disease. 63 80

The most important factors in the prognosis of coronary artery disease are the number of arteries severly obstructed, significant involvement of the left main coronary artery, and generalized impairment of left ventricular function or ventricular aneurysm. Other prognostic influences at least partially independent of these factors are the severity of functional impairment imposed by angina pectoris, electrocardiographic evidence of left ventricular hypertrophy or conduction defects, hypertension, and diabetes. Candidates for bypass operation have a better prognosis than noncandidates, but difference in left ventricular function is responsible. Refinement of prognostic precision will depend largely on future improvement in measurement of obstructive disease and left ventricular function serially and better knowledge of the cause or causes of coronary artery disease.
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PMID:Natural history of obstructive coronary artery disease: ten-year study of 601 nonsurgical cases. 67 85

Coronary arteriography was performed because of suspected coronary disease in 239 women less than 45 years of age. Normal coronary arteries were found in 112 women, and a further 23 had insignificant stenosis (less than 50 percent narrowing of luminal diameter). Of the remaining 104 women, 56 had one vessel, 22 two vessel and 26 three vessel disease. Hyperlipidemia, hypertension, diabetes, smoking and a family history of coronary disease were significantly more frequent in women with significant stenosis than in women with normal arteries. Significant coronary disease was found in 55 percent (100 of 182) of women with more than two risk factors but in only 7 percent (4 of 57) of those with less than two risk factors (P less than 0.0001). Evaluation of symptoms and the resting electrocardiogram also discriminated between women with and without coronary disease, but exercise testing was of little value. Only 4 of the 46 women with previous myocardial infarction had normal or near-normal coronary arteries. Among women with segmental wall motion abnormalities on ventriculography, the site was anterior in 90 percent (19 of 21) of women who used oral contraceptive drugs but in only 60 percent (21 of 35) of nonusers (P less than 0.05). However, in most respects, coronary artery disease in young women does not appear to differ from coronary disease in other patients.
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PMID:Coronary artery disease in young women: clinical and angiographic features and correlation with risk factors. 67 35

Over a 12-year period, from 1965 to 1977, 43 women under 46 years of age were documented with angiographic evidence of coronary atherosclerosis at St Vincent's Hospital, Sydney. Twenty-five of the women were able to be followed up at a mean interval of 31 months. This group of young women with coronary artery disease was compared with an age-matched control group of 660 "healthy" women drawn from the general population. Hyperlipidaemia was present in 72% of patients and in 13% of controls. Seventy-three percent of patients were regular cigarette smokers compared with 21% of controls. Only one patient out of 43 showed neither hyperlipikaemia, nor hypertension, nor smoked cigarettes, and multiple risk factors were commonly present. The level of high density or alpha-lipoprotein was significantly reduced in young women with coronary artery disease. These results highlight the presence of classical risk factors in these young women, as well as the importance of alpha-lipoproteins.
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PMID:Coronary artery disease in young Australian women. 73 44

Ten patients with typical angina pectoris and without hypertension, congestive heart failure or other disease were treated with alternating four-week courses of metoprolol (alpha beta1 cardioselective beta-blocking agent), propranolol and placebo. Midway through each four-week period, drug dosage was doubled; thus, regimes were metoprolol, 150 and 300 mg/day, propranolol, 120 and 240 mg per day and placebo, 3 and 6 tablets per day. Serum concentrations of metoprolol increased with increasing dosage in a proportion very similar to that seen with propranolol. Statistically significant reductions in angina frequency/nitroglycerin consumption, and statistically significant increases in total work performed on a bicycle ergometer, were found with both active compounds when compared with placebo. No significant differences were noted between the two active compounds. Though most patients showed greatest improvement on the higher of the two drug dosages, three patients with metoprolol and two with propranolol responded best on the lower dose regime. Both compounds reduced heart rate at rest and during exercise. Neither reduced arterial pressure at rest, but both reduced arterial pressure during exercise. It is concluded that metoprolol is as effective as propranolol in the reduction of angina attacks and improvement in exercise tolerance during chronic therapy in patients with uncomplicated angina pectoris. It is now appropriate to study the effects of metoprolol in patients with coronary artery disease in whom the harmful effects of non-selective beta-blockade heretofore have precluded optimal therapy with beta-blocking drugs.
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PMID:Assessment of metoprolol, a cardioselective beta-blocking agent, during chronic therapy in patients with angina pectoris. 79 74

1. Study of a group of 50 patients suspected to have coronary artery disease. This is a complement to a previous study concerning "definite" coronary patients. 2. The method followed consisted in cross-examination of the files by three observers in order to separate the subjects who seemed really affected by coronary artery disease. This treble examination led to a rather restrictive selection. To facilitate the study, the patients were subdivided into 4 groups: patients with arterial hypertension, with diabetes mellitus, with cardiac failure, with a heart disease and miscellaneous patients. 3. The study of the 20 files which were discarded was peculiarly interesting as it provided the opportunity to underline the differential diagnosis either with common diseases (left ventricular overload, heart block, brain vascular accident), or with more specific diseases for Black Africa (endomyocardial fibrosis, aneurysm of the left ventricle, cardiomyopathy). In that respect, it is underlined that, in the absence of any anatomical or functional disease, the electrocardiogram of the healthy Black is identical to that of the White. 4. Study of the 30 patients considered as coronary made it possible to underline aetiological and epidemiological factors, although some are still lacking. However the facts observed could be compared with those reported in a previous work concerning 45 "definite" coronary patients. The overall documents thus gathered in 75 patients suggest that the African candidate to coronary artery diseases resembles his Occidental homologue, but that he might have kept a traditional diet.
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PMID:[Coronary diseases in the black African. Apropos of a 2d group of 50 patients. Diagnostic and epidemiological aspects]. 80 91


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