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

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

In 214 patients with healed myocardial infarction an assessment was made of the prognostic value of risk factors relating to early postoperative cardiac decompensation which occurred in 50 cases. A significant influence was shown by age (greater than or equal to 75 years), pre-existing heart failure and load insufficiency, hypertension (greater than or equal to 180/95 mm Hg), advanced arteriosclerosis with cerebrovascular and renovascular symptoms, infections with fever or septicemia, emergency operations, lang-lasting surgery, decrease in blood pressure during operations (greater than or equal to 70 mm Hg systolic) and postoperative anemia (less than or equal to 3.5 millions erythrocytes/cmm). The postoperative cardiac failure took a lethal course in 60%. Pathogenetically, the discrepancy between O2-requirement and O2-supply in the previously damaged myocardium is of essential importance during the postoperative stress period.
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PMID:[Risk factors and pathogenesis of postoperative cardiac decompensation (author's transl)]. 81 21

Ambulatory care services have been reorganized in a New York City hospital. A newly developed Neighborhood Family Care Center (NFCC) replaced the outpatient clinics. The NFCC and both inpatient and emergency services are totally integrated so as to overcome many of the deficiencies that previously existed in ambulatory care, such as inferior quality of care, minimal academic involvement, fragmentation of services, overspecialization, and unresponsiveness to patients' needs. A review of all patients admitted to the Adult Medical Service has shown a statistically significant decrease in admission rates for diabetic coma-acidosis, severe hypertension, congestive heart failure, cerebrovascular accidents, and severe asthma during the 18 months following the reorganization of ambulatory care. Analysis of cost effectiveness of these changes on the utilization of hospital beds indicates the potential for reduced expenditures of limited health care dollars.
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PMID:Reorganization of ambulatory health care in an urban municipal hospital. Primary care and its impact on hospitalization. 82 56

From 1965 to 1974, 53 children with coarctation of the aorta (COA) and an associated ventricular septal defect (VSD) underwent cardiac catheterization. Thirty-one patients presented with congestive heart failure. Twenty-five of 27 patients (92%) who underwent cardiac catheterization under age 3 months had either systemic hypertension, a systolic gradient across the coarctation greater than 20 mm Hg or both. Pulmonary hypertension was present in all 25 patients. COA repair was performed in 39 patients and there were seven deaths. Of the 32 survivors, 23 have no residual gradient; six are normotensive but have a mild residual gradient; three are hypertensive or have a gradient greater than 20 mm Hg. Repair of the VSD or pulmonary artery banding has been performed in 11 of 44 patients who survived infancy. Spontaneous closure of the VSD has occurred in three cases and 25 patients have a small VSD that does not warrant surgical repair. Surgical repair of COA during infancy may be unavoidable but conservative medical management of the associated VSD is often successful.
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PMID:Coarctation of the aorta with ventricular septal defect. 83 Feb 7

Interruption of the aortic arch, studied in 10 patients, was associated with a variety of other cardiac anomalies in 8 patients and was an isolated anomaly in 2. Clinical and angiographic evaluation in the former group revealed congestive heart failure and generalized cyanosis in early infancy, pulmonary and systemic arterial hypertension and a variety of intracardiac and aortic shunt. The two patients with an isolated anomaly had clinical and hemodyanmic features not dissimilar from those of severe coarctation but interruption of the aortic arch was demonstrated on aortography. Surgical treatment was successful in four of the eight infants with associated anomalies and in both children with the isolated defect. Postoperative angiography revealed several related complications and the status of the aortic reconstruction. Clinical angiographic recognition of this lesion is important because operative intervention has been successful in an increasing number of patients.
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PMID:Interruption of the aortic arch: preoperative and postoperative clinical, hemodynamic and angiographic features. 84 42

Left ventricular function was assessed by measuring sytolic time intervals in insulin-requiring diabetics with and without significant microangiopathy. The results were compared with those in normal controls. Significant microangiopathy was defined as proteinuria over 3 g/24 h or proliferative retinopathy. Left ventricular function was also assessed one and a half years later by echocardiography in four patients with microangiopathy. Patients with angina, previous myocardial infarction, hypertension, and alcoholism were excluded. All had normal electrocardiograms and chest radiographs. Diabetics with microangiopathy had impaired left ventricular function, whereas those with uncomplicated diabetes had normal function. This finding supports the existence of a specific diabetic cardiomyopathy due to microangiopathy rather than the metabolic defect. The association of microangiopathy and impaired left ventricular function may explain the high immediate mortality and the high incidence of cardiogenic shock and congestive heart failure after myocardial infarction in diabetics.
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PMID:Diabetic cardiomyopathy: the preclinical phase. 86 81

The etiology of chronic congestive heart failure (CHF) after repair of tetralogy of Fallot was determined in 102 patients consecutively catheterized 1 to 12 years postoperatively. Chronic CHF was observed in 36/102 patients. The most prevalent abnormality leading to congestive failure (31/36) was a large residual ventricular septal defect alone or in combination with other lesions. All postoperative patients with pulmonary to systemic flow ratios greater than 2:1 (25/102) had congestive failure and evidence of biventricular dysfunction. Significant tricuspid regurgitation (N = 11) and persistent systemic to pulmonary artery shunts (N = 6) contributed to volume overload and congestive failure in the patients with large residual ventricular septal defect. Isolated severe residual right ventricular outflow tract obstruction was a common cause of chronic CHF. Pulmonary artery hypertension was present in 20/36 patients with CHF. The increased pulmonary pressure was not wholly due to an increased pulmonary flow since 7/20 patients had pulmonary vascular resistance greater than 3 mm Hg/L/min/m2. Our findings indicate that persistent or chronic congestive heart failure in postoperative tetralogy of Fallot patients requires bilateral cardiac catherterization since an identifiable and surgically correctable lesion is nearly always present.
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PMID:Chronic congestive heart failure after repair of tetralogy of Fallot. 87 25

There has been a long-held belief that lithium salts cannot be used in the presence of thiazide diuretics. Recently, however, thiazides have been demonstrated to be not only safe, but actually indicated in two situations in which lithium salts are used. The first is in the treatment of lithium-induced nephrogenic diabetes insipidus and the second is in severe manic depressive illness in which high doses of lithium do not produce therapeutic serum or intraeythrocytic lithium concentrations. This new information now makes it possible for some manic depressive patients with serious medical illnesses (such as hypertension or congestive heart failure), in whom thiazide diuretics are routinely used, to be treated cautiously with lithium carbonate. This paper analyzes data from 13 patients taking lithium carbonate and varying doses of chlorothiazide in order to indicate the approximate magnitude of downward adjustment of daily lithium dose which the clinician must make to safely give 500, 750, and 1,000 mg/day of chlorothiazide.
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PMID:Adjustment of lithium dose during lithium-chlorothiazide therapy. 88 23

The performance of an urban Canadian family practice in the detection, evaluation, treatment, control and follow-up of hypertension for a 10-year period 1965-74 was reviewed. Vigorous case-finding and treatment were followed by good control of hypertension in 67% of cases and a significant decrease in mortality from stroke and congestive heart failure. It is strongly suggested that the proper location for dealing with hypertension is the primary-care practice and that the general practitioner deserves greater assistance from clinical specialists, health foundations and ministries of health in attacking this problem.
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PMID:Hypertension in a family practice. 90 91

The subsequent course of 173 women with severe congestive heart failure hospitalized within 6 months of delivery has been analyzed after 4 to 7 year follow-up periods. Forty-seven normotensive women and 50 women hypertensive only during the initial 48 hours have little long term morbidity. Thirty-six women with hypertension initially improved, but many are now showing enlarging cardiac silhouettes. Morbidity is increasing in this group. A similar, less severe pattern is developing in 36 women with intermittent hypertension. The uniquely high incidence of this condition in Zaria is associated with several locale factors. These Hausa-Fulani women eat large quantities of a local lake salt, kanwa, for 40 days postpartum. The syndrome is markedly more common in the hot rainy season, when evaporative water loss is less, than in the dry season. The first postpartum days are spent confined to bed in a small heated room. Once or twice daily the new mother is given hot baths with branches which have been dipped in boiling water. The combination of excessive sodium intake and diminished evaporative water excretion seems to precipitate failure in both normotensive and hypertensive patients.
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PMID:The evolution of peripartal heart failure in Zaria, Nigeria. Some etiologic factors. 92 45


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