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

Hypercholesterolemia and hypertension are two of the major risk factors associated with increased atherosclerotic vascular disease. An abnormal platelet function is one of the mechanisms proposed to participate in atherogenesis. This study was undertaken to find out whether hypercholesterolemia in hypertensive patients can change platelet lipid composition and reactivity. Twenty-nine untreated hypertensive patients were distributed into 3 age, body mass index and blood pressure-matched groups according to their plasma cholesterol levels (normal, borderline or elevated, group NC, BC and HC respectively). Their platelet lipid composition, cytosolic Ca2+ concentration, cyclic AMP content and aggregating response to ADP and collagen were determined. Platelet from group HC patients were characterized by reduced cyclic AMP content (evaluated in the presence and absence of a platelet phosphodiesterase inhibitor) and aggregating responses to ADP and collagen, increased palmitic acid content and decreased arachidonic, eicosapentaenoic and docosatetraenoic and pentaenoic acid content, resulting in a lowered polyunsaturated to saturated fatty acid ratio (P less than 0.001). In contrast, platelet cytosolic Ca2+ concentration, DPH steady-state anisotropy and cholesterol to phospholipid molar ratio were not significantly changed. This indicates that hypercholesterolemia is accompanied in hypertensive patients by marked changes in platelet fatty acid composition, cyclic AMP content and response to aggregating agents. These changes, which clearly differ from those induced by in vitro cholesterol loading, could reflect not only the balance between LDL and HDL stimulation but also an adaptation to hemodynamic perturbations.
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PMID:Biochemical and functional alterations associated with hypercholesterolemia in platelets from hypertensive patients. 132 32

The medical effects of modest weight reduction (approximately 10% or less) in patients with obesity-associated medical complications were reviewed. The National Library of Medicine MEDLINE database and the Derwent RINGDOC database were searched to identify English language studies that examined the effects of weight loss in obese patients with serious medical complications commonly associated with obesity (non-insulin dependent diabetes mellitus (NIDDM or type II), hypertension, hyperlipidemia, hypercholesterolemia, and cardiovascular disease). Studies in which patients experienced approximately 10% or less weight reduction were selected for review. Studies indicated that, for obese patients with NIDDM, hypertension or hyperlipidemia, modest weight reduction appeared to improve glycemic control, reduce blood pressure, and reduce cholesterol levels, respectively. Modest weight reduction also appeared to increase longevity in obese individuals. In conclusion, a large proportion of obese individuals with NIDDM, hypertension, and hyperlipidemia experienced positive health benefits with modest weight loss. For patients who are unable to attain and maintain substantial weight reduction, modest weight loss should be recommended; even a small amount of weight loss appears to benefit a substantial subset of obese patients.
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PMID:Beneficial health effects of modest weight loss. 132 66

The combined syndrome of android (upper body) obesity, diabetes, hyperlipidaemia and hypertension is discussed in terms of a deranged endocrine regulation of metabolism. The syndrome is characterized by insulin insensitivity and an increased control of metabolism by cortisol. The antagonism between the two hormones appears to be partly responsible for the hyperglycaemia, hypertriglyceridaemia and hypercholesterolaemia. The synergism between insulin and cortisol in stimulating energy deposition, associated with a decreased effect of corticotropin-releasing factor in stimulating energy expenditure, is likely to contribute to the development of obesity. The efficacy of D-fenfluramine in treating the obese-diabetic-hyperlipidaemic-hypertensive syndrome probably depends on its actions on the serotoninergic system in the hypothalamus which both decreases food consumption and tends to normalize hormonal balance through the hypothalamic-pituitary-adrenal axis.
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PMID:Neuroendocrine regulation and obesity. 133 26

In 1987, a cardiovascular risk profile was obtained on 836 workers of the National Electricity Co in Santiago. There were 714 males and 125 females, the mean age was 45 years (ES +/- 0.3). Hypertension (systolic pressure > 160 or diastolic > 90 mmHg) was present in 17% of subjects, hypercholesterolemia (> 240 mg/dl or > 220 mg/dl associated to 2 other risk factors) in 17%, obesity (> 20% above ideal weight) in 33% and 29% were smokers. An advice to stop smoking, changes in the casino menu and hypertension, obesity and hypercholesterolemia's control programs were offered. These were attended by 108 hypertensives, 141 subjects with hypercholesterolemia and 104 obese individuals with an attendance rate of 64%, 75 and 77% respectively. Measurements repeated 2 years later revealed a reduction in diastolic pressure of 3.3 +/- 1.1 mmHg (p < 0.004) only in adherent subjects. Cholesterol levels were reduced by 24 +/- 3 mg/dl (p < 0.001) with no differences for non participants, adherent and non adherent subjects. Adherent obese subjects reduced their weight by 2.2 +/- 0.4 kg (p < 0.001). There was no change in the number of smokers.
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PMID:[A 2-year follow-up of a program for the control of cardiovascular risk factors among asymptomatic workers]. 134 29

The coronary heart disease (CHD) risk function associated with baseline serum cholesterol levels among women and older hypertensives was determined for the 5455 participants who were randomized in the Hypertension Detection and Follow-up Program (HDFP), referred to usual care in 14 US communities, and followed for the years 1974 through 1979. The risk of fatal CHD in relation to serum cholesterol for those under age 65 appeared as strong in women as in men in age- and race-adjusted analyses stratified by serum cholesterol levels; however, there was no association of serum cholesterol levels with combined fatal plus nonfatal incident coronary events for these women, adjusting for other major risk factors and covariables. There was no association of serum cholesterol with fatal or combined fatal plus nonfatal CHD events in either adjusted or unadjusted analyses for older hypertensive women. In contrast to the findings for women, serum cholesterol levels were strongly predictive of fatal plus nonfatal CHD in both younger and older hypertensive men, controlling for the effects of other factors such as age, antecedent history of antihypertensive medication, and presence of comorbidity. This study, based on the experience of the usual care group within the HDFP, was observational in nature. Clinical trials of specific regimens of serum cholesterol lowering in hypertensives are required definitively to determine their efficacy and safety for these high-risk patients; however, the experience within the HDFP indicates the desirability of detection and prudent management of hypercholesterolemia in older as well as younger male hypertensives.
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PMID:Serum cholesterol and coronary heart disease risk in female and older hypertensives. The experience under usual community care in the Hypertension Detection and Follow-up Program. 134 58

In the 1970s in the Diet-Antismoking Trial, of the Oslo Study, colleagues and I found that the majority of high-risk men with elevated serum cholesterol and elevated triglyceride concentrations had impaired fibrinolytic capacity. Later on, both our group and others found a similar negative correlation between serum triglyceride levels and fibrinolytic capacity. Furthermore, in a prospective study of dietary intervention in individuals with both elevated cholesterol and triglyceride levels, we found that dietary lowering of serum triglyceride levels was significantly and positively correlated with an improvement in fibrinolytic capacity. In another study, we made the same observation for the coagulation factor VII-phospholipid complex: the more the triglycerides were reduced by diet, the greater was the change in factor VII complex. This correlation was highly significant and independent of changes in serum cholesterol. Platelet function is also influenced by dietary habits, but except for the effects of a fish oil-enriched diet, few data are available about the dietary effects on platelet function. It seems, however, that in individuals with elevated lipid levels and elevated blood pressure, increased platelet reactivity is a highly prevalent finding. Many of the hemostatic risk variables are associated with the so-called "metabolic risk syndrome" characterized by an increase in serum insulin level, together with increased relative body weight, mild hypertension, hyperlipidemia, and physical inactivity. This syndrome can often be influenced favorably by life-style changes. A controlled study with interventions in diet and activity level has just been started by our group.
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PMID:The influence of dietary change on hemostatic risk variables. 134 3

In the present study, arteriosclerotic change of the aorta was induced in rats. The effects of manidipine hydrochloride on the resulting hypertension and arteriosclerotic change were studied. In endothelium-injured cholesterol-fed Goldblatt 2K1C rats, moderate elevation of blood pressure was noted at 3, 4, and 5 weeks. Laboratory studies performed at the end of 6 weeks also showed hypercholesterolemia, accompanied by a reduction of triglycerides and HDL cholesterol. Regular doses of manidipine (200 or 500 mg/kg) resulted in a dose dependent inhibition of the blood pressure elevation and a reduction of HDL cholesterol, but had no effect on cholesterol or triglyceride levels. Morphological studies in endothelium-injured rats afflicted with hypercholesterolemia and hypertension, showed medial thickening and intimal hyperplasia. Hyperplasia of the intima was a result of excessive proliferation of the smooth muscle cells. These cells showed an unusually large number of fat droplets and were considered indicative of atheromatous plaque formation. In rats treated with manidipine, hyperplasia of the media was completely suppressed while hyperplasia of the intima was reduced by a minimum of 50%. This study demonstrated that hypercholesterolemia and hypertension produced arteriosclerotic change in endothelium-injured rats, which was inhibited by manidipine. It is not known whether antiarteriosclerotic action was involved in the antihypertensive effect of manidipine.
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PMID:Manidipine inhibits the progression of hypertension and atherosclerosis in endothelium-injured and cholesterol-fed Goldblatt 2K1C rats. 134 87

Hypertension and hypercholesterolemia frequently coexist and may require concomitant drug treatments. The efficacy and safety profile of lovastatin given in the presence of antihypertensive medication was evaluated using patient subgroups identified in the Expanded Clinical Evaluation of Lovastatin (EXCEL) Study. The EXCEL study examined 8,245 patients with moderate hypercholesterolemia randomly assigned either to a group treated with lovastatin (20-80 mg daily) or to a group given placebo for 48 weeks. After adjustment for patient characteristics, pairwise comparisons were made between patients taking no antihypertensive agents (n = 3,772) and those taking either calcium antagonists (n = 446), selective beta 1-adrenergic receptor blockers (n = 326), nonselective beta-adrenergic receptor blockers (n = 219), potassium-sparing diuretics (n = 187), thiazide diuretics (n = 126), or angiotensin converting enzyme inhibitors (n = 171). The placebo-corrected dose-dependent effect of lovastatin on the percent change from baseline in low-density lipoprotein cholesterol was not attenuated in any subgroup and was slightly enhanced in the calcium antagonist subgroup (-29% to -44%, p = 0.06) when compared with patients taking no antihypertensive agents (-24% to -40%); this difference, however, was only of borderline significance. Patterns of lovastatin-induced increase in high-density lipoprotein cholesterol and decrease in triglycerides were not consistently different among the subgroups. Examination of mean changes in serum transaminases, mean changes in creatine kinase, and the proportion of patients discontinuing therapy for clinical adverse experiences did not indicate the presence of an interaction.(ABSTRACT TRUNCATED AT 250 WORDS)
Hypertension 1992 Mar
PMID:Lovastatin and coadministered antihypertensive/cardiovascular agents. 134 57

The results of epidemiologic studies on the efficacy of different strategies of prevention or improvement of the prognosis of coronary artery disease are generally expressed in terms of percentage reduction of risk; for example, the treatment of hypercholesterolaemia reduces the risk of coronary death by 21%. In order to improve the assessment of the efficacy of these approaches the authors propose to take into account the number of subjects which needs to be treated each year to prevent one cardiovascular event more than the control group (for example, in hypercholesterolaemia, 1,736 patients). This number depends on the reduction of risk and also on the incidence of complications in the control group. Using this method, the authors classified different therapeutic strategies in order of their efficacy: thrombolytic therapy in the acute phase of myocardial infarction, then aortocoronary bypass grafting of left main coronary or triple vessel disease, secondary prevention with stopping smoking, and betablocker therapy. Finally, primary prevention with anti-smoking campaigns, treatment of hypertension and hypercholesterolemia. Based on this figure and knowing the annual cost of patient treatment, it is possible to calculate a cost-effectiveness ratio for each of these therapeutic interventions.
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PMID:[How to evaluate the cost/effectiveness ratio of different therapies of coronary disease]. 134 16

Arterial hypertension is a major risk factor for atherosclerosis. The mechanisms involved include elevation of blood pressure, increased velocity of the sphygmic wave and increased blood flow turbulence. These hemodynamic features however do not fully explain the link between hypertension and atherosclerosis. An important role is also played by humoral factors including catecholamines, the renin-angiotensin-aldosterone system, serotonin, endothelin, platelets and endothelium-derived growth factors. Furthermore in the last few years great relevance has been attributed to hyperinsulinemia (accompanied by hypercholesterolemia and hypertriglyceridemia) that is frequently found in hypertensive subjects. Several recent reports on the antiatherogenic effect of some antihypertensive agents that could slow down the progression of atherosclerotic lesions in hypertensive subjects are promising.
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PMID:[Hypertension and arteriosclerosis]. 136 25


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