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

Malignant hypertension in an adolescent due to reflux nephropathy (RN) is rare. Here we are presenting such a case unassociated with the usual symptoms of hypertension. The problems of diagnosis, management, prognosis and prevention of RN are discussed with a review of relevant literature.
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PMID:Malignant hypertension due to reflux nephropathy in an adolescent (a case report). 178 33

A 38-year-old female presented for an optometric exam complaining that her "vision had occasionally gone blank while reading during the past 2 months". Although visual acuity was 20/20 in both eyes, hypertensive retinopathy was present in both eyes. Blood pressure was measured to be 210/142. After inadequate response to initial treatment, her family physician referred her to an internist. Ultimately, a four pound Sertoli-Leydig ovarian tumor was found to be causing malignant hypertension. Removal of the tumor and medical treatment of the hypertension cleared the hypertensive retinopathy within 4 months. Prompt optometric care led to the timely discovery of this tumor, and probably prolonged this woman's life. This case illustrates the valuable role optometric care can have in the management of hypertension from any cause. Coordination with the primary physician as to the status of the hypertensive retinopathy is an integral part of the total management. Retinal photographs at presentation and at various stages of treatment dramatically show how the level of fundus pathology is related to the level of hypertension.
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PMID:Hypertensive retinopathy caused by a rare ovarian tumor: case report and photo essay. 181 90

We measured plasma concentrations of immunoreactive endothelin-1 (irET-1) in the prehypertensive and hypertensive phases in spontaneously hypertensive rats (SHR) and in malignant hypertension caused by deoxycorticosterone acetate (DOCA)-salt administration in SHR. We also measured concentrations of this peptide in another model of malignant hypertension, the two-kidney, one clip (2K1C) renovascular hypertensive rats chronically given caffeine. Plasma irET-1 concentrations in young (6-week-old) and mature (18-week-old) SHR did not differ from those of age-matched Wistar-Kyoto (WKY) rats. Four weeks of treatment with DOCA-salt increased blood pressure, blood urea nitrogen, serum creatinine, and plasma irET-1 in SHR but not in WKY rats. Eight weeks of DOCA-salt treatment further increased these values in SHR. Plasma irET-1 concentrations were not increased in the 2K1C rats. Six weeks of caffeine administration increased blood pressure, blood urea nitrogen, serum creatinine, plasma renin activity, and plasma irET-1 in the 2K1C rats but not in the sham-operated rats. High-performance liquid chromatographic profiles of plasma extracts pooled from these rats with malignant hypertension showed that a major component of irET-1 eluted in the position of synthetic ET-1 (1-21). Furthermore, acute hypertension induced by angiotensin II or phenylephrine did not affect the plasma irET-1 concentration in rats. The results suggested that the plasma ET-1 concentration is increased in rat models of malignant hypertension and that the high blood pressure itself is not the main factor involved in the increase of plasma ET-1.
Hypertension 1991 Jul
PMID:Plasma immunoreactive endothelin-1 in experimental malignant hypertension. 186 Jul 18

A 44-year-old woman with scleroderma-like skin lesions and malignant hypertension following mammoplasty is reported. Sclerotic change is an unusual finding for ordinary finding progressive systemic sclerosis. On admission, she had severe high-renin hypertension and progressive renal failure, suggesting scleroderma renal crisis. With intensive treatment for hypertension including angiotensin-converting enzyme inhibitor, the blood pressure was well controlled. It was then suggested that she had malignant hypertension due to scleroderma after silicone injection, or the so-called human adjuvant disease after cosmetic surgery.
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PMID:A case of malignant hypertension and scleroderma after cosmetic surgery. 186 82

The frequency of renal vascular lesions (RVL) and their relevance in the progression of renal damage were evaluated by the Pathology Group of the "Gruppo Italiano per lo Studio della Nefrite Lupica" (GISNEL). Of 285 patients with lupus nephritis collected from 20 nephrology centers in Italy and classified according to World Health Organization (WHO) criteria, 79 cases (27.7%) with RVL were identified and classified as follows: (1) lupus vasculopathy (n = 27); (2) hemolytic-uremic syndrome/thrombotic thrombocytopenic purpura (HUS/TTP) malignant hypertension-like lesions (n = 24); (3) vasculitis (n = 8); (4) arterio-arteriosclerosis (n = 20). At the time of renal biopsy, patients with RVL had mean serum creatinine levels significantly higher than patients without RVL (201.8 +/- 195.9 mumol/L [2.2 +/- 2.2 mg/dL] v 108.1 +/- 108.0 mumol/L [1.2 +/- 1.2 mg/dL]; P less than 0.01). Hypertension was more frequent in patients with RVL than in those without (68.4% v 30.5%; P less than 0.01). The probability of kidney survival assessed according to the Kaplan-Meier method at 5 and 10 years was, respectively, 74.3% +/- 5.9% and 58.0% +/- 8.9% in patients with RVL, compared with 89.6% +/- 2.7% and 85.9% +/- 3.7% in patients without RVL. However, the two groups did not differ significantly as regards overall survival, the probability of survival at 5 and 10 years being 86.5% +/- 4.5% and 78.8% +/- 6.6% in patients with RVL and 92.2% +/- 2.2% and 83.3% +/- 4.4% in patients without RVL.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Renal vascular lesions as a marker of poor prognosis in patients with lupus nephritis. Gruppo Italiano per lo Studio della Nefrite Lupica (GISNEL). 186 81

We report a case of severe hypertension in the newborn period due to obstruction of the right renal artery. The baby presented with polyuria leading to dehydration and was found to have hyponatraemia and severe renal salt loss. When sudden malignant hypertension is induced in experimental conditions, a high pressure diuresis and increased angiotensin II production are found. These findings could explain the renal salt loss, notwithstanding the effects of secondary hyperaldosteronism and hyper-reninaemia.
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PMID:Renovascular hypertension: a rare cause of neonatal salt loss. 186 85

The renal histopathology of essential malignant phase hypertension in two groups of black South Africans was studied. The first, an autopsy series, consisted of material obtained in 1956-1961, a period when adequate antihypertensive therapy had not yet become generally available. The second group, a renal biopsy series, was from an era when effective antihypertensive therapy was available (1979-1989). The study showed that the clinical and histopathological changes of malignant hypertension were similar in both the pre-treatment and treatment eras. Fibrinoid necrosis was found in 92% of the autopsy sections and 44% of the biopsies. While mucinous, onion-skin and fibrotic changes of the blood vessels were commonly found, they were not invariably present and could not be considered the histopathological hallmark of malignant nephrosclerosis. It was often impossible on histological examination to distinguish malignant nephrosclerosis arising de novo from that superimposed on long-standing previous benign hypertension. Replication of internal elastic lamina, which has been considered a marker of long-standing previous benign hypertension, was a nonspecific finding and was frequently observed in young hypertensive subjects with a short clinical history. When fibrinoid necrosis is present, diagnosis of malignant nephrosclerosis can be made with confidence in black South Africans.
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PMID:The renal histopathology of essential malignant hypertension in black South Africans. 187 49

The discovery and clinical availability of ACE inhibitor drugs is a triumph of rational drug development and a land-mark in biochemical pharmacology and hypertension research. The clinical pharmacological properties and haemodynamics of the clinically available drugs, captopril and enalapril, are reviewed, as is their therapeutic efficacy in African patients with essential and renal hypertension and chronic congestive heart failure. ACE inhibitors act as balanced arteriolar vasodilators and venular dilators and do not excite a reflex tachycardia in contrast to other vasodilator drugs. Their efficacy is, at least in part, dependent on plasma renin activity, which is low in Blacks and in Africans. Consistent with this, is the poor response to ACE inhibitor monotherapy of essential hypertension in controlled studies in Africans. However, the compensatory neuroendocrine activation which occurs in malignant hypertension, renal failure and congestive heart failure and concurrent diuretic therapy appears to enhance the clinical response to ACE inhibitors in African patients.
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PMID:Angiotensin converting enzyme inhibitors in cardiovascular and renal disease in Africans: a review. 190 20

Official recommendations for handling of hypercholesterolaemia are based on the comprehensive knowledge of serum cholesterol values in the healthy population as knowledge of blood pressure is desirable. To question this premise, both observational and interventional trials concerning the two risk factors are compared. Apparent similarities are produced by the fact that in hypertension trials control persons often are treated in the condition of normal care, whereas in lipid trials they are not. Early hypertension studies confirm beyond any doubt that the profit of hypotensive drugs is much higher than that of any cholesterol-lowering measure. The difference is most striking in the high-risk groups, comparing the treatment benefit in malignant hypertension with the hitherto poor results in familial hypercholesterolaemia. The author suggests a thorough analysis of all screening tests and interventional recommendations in medicine, aiming to allocate only a limited proportion of the normal population to regular medical supervision. There hypercholesterolaemia will have its modest place. Instead of intensified screening and drug treatment of healthy individuals, general advice for nutritional changes seems more reasonable.
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PMID:[Hypercholesterolemia and hypertension--equivalent risk factors?]. 195 90

To differentiate the functional changes from the organic changes in malignant hypertension, the author studied the changes in the blood vessel of ocular fundus by ophthalmoscopical and histopathological methods using malignant strain of stroke-prone spontaneously hypertensive rat (M-SHRSP; Okamoto, K et al., 1986), an animal model of human juvenile malignant hypertension, in which the systolic blood pressure elevates rapidly with age and death appeared by the 15th month of life, if they are untreated. Fundus changes progressed with age and duration of hypertension and they altered from functional changes to organic ones. In M-SHRSPs with age of 8 weeks, systolic blood pressure was 220mmHg or more and retinal arterioles showed generalised narrowing but no dye leakage was recognized by fluorescein angiography (FAG). Dye leakage was observed on the 9th week of age. Death of M-SHRSP appeared, after the 13th week of age, coincidentally with appearance of wide retinal edema. Papilledema appeared often in this period. Little histological change was found in the retinal arterioles in spite of severe and marked ophthalmoscopic changes. No feature of angionecrosis was observed in the retina while it was recognized in choroidal arteriole with thrombosis. The fundus changes in M-SHRSP were ophthalmoscopically classified by using scores as following. Grade 0: normal fundi, Grade I (score 1): slight generalized narrowing, caliber irregularity and tortuosity of the retinal arterioles, slight retinal edema and choroidal changes. Grade II (score 2): moderate generalised narrowing, caliber irregularity, tortuosity of the retinal arterioles, moderate retinal edema and choroidal ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Ophthalmological study on the M-strain of stroke-prone spontaneously hypertensive rat (M-SHRSP) (1). Classification of hypertensive fundus changes in M-SHRSP]. 204 25


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