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

A new system is proposed for treating the spectrum of patients with high blood pressure. It is based on studies of the renin axis using renin profiling, pharmacologic probes and our bipolar vasoconstriction-volume hypothesis. The new system does not require renin profiling, pharmacologic testing or a vasoconstriction-volume analysis for widespread application. But these procedures, whenever available, will make treatment more efficient and more certain, and at the same time provide better base line definition. In the new system, all patients, except the elderly and those with congestive heart failure, bradycardia or a history of asthma, are treated first with propranolol alone, a procedure which will diminish or normalize blood pressure in many patients with high and noraml renin levels. For nonresponders, diuretic therapy is then superimposed. Subsequently, a propranolol subtraction trial picks out the low-renin patients who will usually respond to a diuretic alone. This program is likely to be fully effective in possible up to 85 per cent of patients. For the residual smaller fraction, drugs such as hydralazine, methyl DOPA, clonidine, reserpine or guanethidine are then added in traditional trial and error fashion. The proposed system has the theoretic attraction for long-term commitment, implicit in antihypertensive therapy, of achieving blood pressure control in large fractions with one drug instead of two or with two drugs instead of three or more. Moreover, the large groups who respond to therapy with propranolol alone (most high-renin and normal-renin patients) or to diuretics alone (most low-renin patients) gain the advantage of simple, more specific, long-term (i.e., antirenin or antivolume) therapy. The use of propranolol alone has practical and theoretic advantages over diuretics. Control may be achieved with even fewer side effects and without hypokalemia and chronic dehydration with its possibly adverse consequences (hyperuricemia, azotemia, hyperlipidemia, hyperreninemia, increased blood viscosity). Also, propranolol provides more direct control of the increased peripheral resistance and of neurogenically-induced swings in blood pressure. At the same time, the new system efficiently exploits the long-term use of diuretic therapy alone in low-renin patients in whom volume excess seems a causal factor. And it tends to avoid the use of diuretics in high-renin patients and of beta-blockers in low-renin patients in whom these drug types may be contraindicated.
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PMID:Modern system for treating high blood pressure based on renin profiling and vasoconstriction-volume analysis: a primary role for beta blocking drugs such as propranolol. 1 Jul 30

The removal of uremic substances in hemofiltration, in contrast to hemodialysis, is achieved by means of a convective transport across membranes of high porosity. Since 1974, more than 30 patients with chronic renal insufficiency have been treated with regular hemofiltration three times weekly for four to five hours each. After completing a pilot study, a controlled study to compare hemodialysis and hemofiltration was initiated during January, 1978. A normalization of blood pressure in patients with severe hypertension, and remarkable stability of the circulatory system, even after dehydration in patients who had hypotension in spite of fluid overload, could be demonstrated. Hemofiltration is preferred, especially in older patients with cardiovascular or cerebrovascular problems, because of its lower frequency of hypotensive episodes compared to dialysis. An important aim--the miniaturization of the artificial kidney--has not yet been achieved, however, because of the necessity for an extensive monitoring system for the exact proportioning of the sterile substitution fluid. First results in the application of a fluid regeneration system consising of a charcoal cartridge and a bioelectric cell, for degradation of urea, are presented.
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PMID:Clinical and technical aspects of hemofiltration. 3 39

The transitive cerebral distension which is necessary for the neuro-surgeon during interventions is obtained by moderate controlled hyperventilation, deliberate arterial hypotension, application of the anti-sludge therapy for the cerebral microcirculation. Only the initial mannitol dose applied is useful for the subject with intra-cranial hypertension. Mannitol is not active in cases with cerebral oedema due to severe cerebral contusion. In such cases corticoids are the major therapeutic indication. The anti-sludge effects of mega-doses of thiamine in cases with severe disturbances in the microcirculation of basal nuclei and profound comatose conditions, makes possible to apply therapeutic dehydration and is associated with an increase in the resistance of the cerebral tissue to hypoxia. Volatile anesthetic agents increase the intra-cranial pressure in patients with expanding intra-cranial processes. Thiamine neuroleptanalgesia and synaptanalgesia, with or without xylocaine potentiation, have resulted in a satisfactory cerebral distension. Controlled hypotension and increased pressure are, for the time being, just a prospective field.
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PMID:[Current management of anesthesia and intensive therapy of expansive processes with intracranial hypertension]. 13 8

Using Brattleboro rats with and without hereditary diabetes insipidus (DI, non-DI), blood pressure, water intake and the excretion of water, sodium, potassium and osmotically active substances were measured in intact individuals and in animals subjected to unilateral nephrectomy at the age of 23 or 80 days. The development of blood pressure (BP) changes, determined in unilaterally nephrectomized animals at the age of 4--6 months, depended on the age at which the kidney was removed. After nephrectomy at the age of 25 days, hypertension developed only in DI females given 0.6% NaCl solution to drink. The BP of those which drank water was unaffected. Unilateral nephrectomy at the age of 80 days produced a slight BP increase in females irrespective of whether they drank water or 0.6% NaCl, but in males only if they drank 0.6% NaCl solution. No hypertension was observed in intact animals. No relationship was found between water intake and the blood pressure level. The BP increase in water-drinking females uninephrectomized at 80 days was accompanied by a raised urine flow and raised excretion of osmotically active substances. Sodium losses in DI animals were greater than in non-DI animals and the urinary sodium concentration, in maximum dehydration, attained minimum values in DI and maximum values in non-DI animals. Unilateral nephrectomy at 25 days increased sodium losses in all the animals except non-DI females, but when performed at 80 days, only in DI males. No relationship between these results and BP changes was found. The possible relationship of the extrarenal consequences of absence of vasopressin to the development of experimental hypertension are discussed.
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PMID:Blood pressure and water and electrolyte intake and excretion in rats (Brattleboro strain) after unilateral nephrectomy. 14 74

A patient with a vipoma of the pancreas and persistently elevated blood levels of vasoactive intestinal polypeptide (VIP) had watery diarrhea, hypokalemia, and achlorhydria (WDHA syndrome). In the untreated state, the diarrhea was never profuse. Fecal volumes ranged from 0.16 to 1.24 L/day. Attempts to correct the dehydration by fluid and electrolyte loading resulted in a massive increase in fecal water and electrolyte loss. Prednisone cured the diarrhea and was associated with a decrease in plasma VIP levels. The patient had a marked circulatory disturbance with systemic arterial hypotension and cutaneous vasodilation that caused a subnormal body temperature. Removal of the tumor led to a dramatic change in the patient's circulation. Generalized vasodilation with systemic venous and arterial hypotension gave away to vasoconstriction with severe venous and arterial hypertension. Central venous pressure rose from -4.4 to +4.0 cm H2O and arterial pressure rose from 80/55 to 195/110 mm Hg. These changes might explain the unexpected and sometimes fatal heart failure that has complicated the removal of these tumors from some patients.
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PMID:Vipoma of the pancreas: observations on the diarhrhea and circulatory disturbances. 43 2

Radioimmunoassay of plasma arginine-vasopressin (AVP) in regularly dialyzed patients with chronic renal insufficiency revealed a parallel increase of AVP and plasma osmolality (POsm) before dialysis (4.16 +/- 0.36 pg/ml and 312.6 +/- 1.80 mOsm/1) and their parallel declin to the normal range (1.93 +/- 0.27 pg/ml and 292.0 +/- 1.27 mOsm/1) during dialysis. Plasma AVP correlated with POsm before and after dialysis (r = 0.611 and 0.453, p less than 0.01 and less than 0.05 respectively). The increase of AVP before dialysis was lower than would correspond to the rise of POsm and lower than that recorded in healthy subjects during dehydration. Statistical correlation between plasma AVP and indicators of body fluid volume changes between or during dialysis were not proved. We found statistical correlation between the mean blood pressure and AVP before dialysis (r = 0.468, p less than 0.05). These findings suggest that in chronic renal insufficiency changes of POsm remain primary regulating factor of AVP secretion. The expansion of extracellular fluid volume has probably only a modifying effect. It remains to be elucidated whether the revealed statistical relationship between the mean blood pressure and AVP before dialysis plays also a pathogenetic role in the development of hypertension in chronic renal insufficiency.
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PMID:Plasma concentration of antidiuretic hormone in patients with chronic renal insufficiency on maintenance dialysis. 44 6

Although the healthy infant can tolerate the range of sodium intakes normally present in the variety of diets offered in Britain without developing hypernatraemia or evidence of serious disease, there is enough evidence to suggest that care is required in the amount of sodium given to babies. The consequence of excessive sodium intake may be short term or long term. The most common short term complication is hypertonic dehydration. In the long term, the fear is that high intakes of sodium in early infancy may predispose to hypertension in later life, though this is as yet unproven.
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PMID:Sodium intake and health in infancy. 56 78

The hemolytic-uremic syndrome consists of microangiopathic hemolytic anemia, acute renal failure, and thrombocytopenia following a prodromal illness of gastroenteritis or upper respiratory infection. The syndrome can present in dramatic fashion with severe abdominal pain and signs of peritonitis suggesting an acute surgical crisis. In a series of 25 patients, 40% had abdominal pain, 25% had abdominal tenderness, and 20% had peritoneal signs. Clues to diagnosis in the early stages of the acute illness were mild to moderate hypertension, abnormal peripheral blood smear, anemia despite dehydration, and proteinuria. Significant abdominal pain and x-ray evidence of colitis may occur before development of typical laboratory findings, and these were evident in at least one case. Three patients underwent laparotomy for suspected bowel perforation. Colitis without perforation was found in all cases. In the absence of documented perforation, toxic megacolon, or intussusception, the decision to perform laparotomy in patients with hemolytic-uremic syndrome who have signs of peritonitis must be individualized. Failure to recognize the underlying renal problem can lead to serious errors in fluid and electrolyte management and delay of appropriate therapy.
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PMID:Hemolytic-uremic syndrome: a diagnostic and therapeutic dilemma for the surgeon. 73 58

The renin-angiotensin-aldosterone system appears to function normally in uncomplicated diabetes mellitus. Alterations in this system, however, have been observed in several of the microvascular and electrolyte complications associated with this disease. Plasma renin activity (PRA) and aldosterone are decreased in diabetic with nephropathy and hypertension, in those with neuropathy including orthostatic hypotension, and in those with hypoaldosteronism. PRA is low in rats with uncontrolled, nonketotic diabetes, and pressor responsiveness to angiotension II is increased in patients with diabetic retinopathy. Potential mechanisms responsible for the decreased PRA include plasma volume expansion, hyalin destruction of the juxtaglomerular cells, defective synthesis of renin, and inadequate catecholamine stimulation of renin, and inadequant cathecholamine stimulation of renin release. In diabetic ketoacidosis, PRA and aldosterone are stimulated secondary to the associated dehydration with hypovolemia. This report reviews the current status of the function of the renin-angiotensin-aldosterone system in diabetes mellitus and proposes a possible role for the altered function of this system in the pathophysiology of several diabetic complications.
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PMID:Renin-angiotensin-aldosterone system in diabetes mellitus. 82 63

Effects of a single intravenous dose of highly purified staphylococcal enterotoxin A (SEA; 0.5 mg/kg) were studied in conscious rhesus monkeys. The mean survival time for four of five experimental monkeys was 8.7 h. Vomiting, pallor, abdominal distension, occasional diarrhea and dehydration were observed. Tachycardia and sustained hypotension developed prior to death. During vomiting, transient hypertension was induced.
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PMID:Cardiovascular and vomiting responses to a lethal intravenous dose of staphyloenterotoxin A in rhesus monkeys. 82 32


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