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

The effect of the cardioselective beta-adrenoreceptor blocking compound, metoprolol, was compared with methyldopa in the long-term management of hypertension. Thirty patients given metoprolol and twenty-six given methyldopa were treated for 2 years. The maximum dose of metoprolol was 200 mg twice daily (average 308 mg) and of methyldopa 1,000 mg twice daily (average 1,120 mg). Blood pressure was similar at entry to the study (metoprolol 177/110 mmHg and methyldopa 181/111 mmHg). After 2 years of treatment the blood pressure levels were again similar (metoprolol 149/91 mmHg and methyldopa 148/91 mmHg). Erect pressures were lower in the methyldopa group, but there was no difference between supine and erect blood pressure levels in those on metoprolol. At an exercise load of 300 and 600 kpm the increase in systolic pressure was significantly less in the metoprolol group. The proportional increase in systolic and diastolic pressure in response to a standardized stress situation was reduced by treatment with metroprolol but not by methyldopa. Tolerance to therapy did not develop in either group. The main difference between metoprolol and methyldopa was in the incidence and severity of side effects. Four patients were withdrawn from the metoprolol group. Seventeen were withdrawn from the methyldopa mainly because of side effects including drowsiness, depression, skin rash, and impotence. Six patients on metoprolol and seventeen on methyldopa continued on therapy although side effects were present. It is concluded that metoprolol and methyldopa lower blood pressure to the same extent, but metoprolol is advantageous because of a lower incidence of side effects.
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PMID:Long-term comparison of metoprolol and methyldopa in the treatment of hypertension. 737 74

In order to learn more about the patient-physician relationship, various aspects of information and communication, patient desires and complaints, a questionnaire form was mailed to three groups of male hypertensive patients. Group A consisted of 264 patients, response rate 61% (160 patients), originating from the employees' health service at two factories in Norway, and groups B (drug-treated) and C (not drug-treated) comprised 441 patients, response rate 82% (362 patients), and 328 patients, response rate 81% (265 patients), respectively, from the hypertension trial of the Oslo Study. Information and/or communication failure was observed in all groups, more in group A than in groups B and C. More information was wanted by 50--75% of the patients, especially in written form. More than one half of the patients expressed complaints which might have been misinterpreted as being due to drug treatment. With the exception of asthenia/drowsiness, impotence and podagra, which occurred more frequently in group B than in group C, the pattern of complaints was similar in these two groups.
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PMID:Patient reaction to information and motivation factors in long-term treatment with antihypertensive drugs. 738 33

Background factors, which are causes of functional and organic impotence, of 729 impotent patients over 50 years old were evaluated. They were classified into 3 major categories, i.e., stresses at job, stresses at home, and diseases or accidents. Over 30% of the patients had 2 or more categories. A retirement from office and troubles at job were most frequent among stresses at job. As to stresses at home, marital problems such as wife's death and remarriage were most common. With respect to diseases or accidents, they were observed in 84 percent of all patients, and hypertension (HT) or diabetes mellitus (DM) were most common and the rate of medication was considerably high. The percent of clearly organic impotence was quite low (22%). Hormonal environment of 303 over 50 aged impotent patients was checked and compared with 120 impotent patients from 20 to 49 years old. Serum testosterone (T) levels in patients over 70 years of age decreased significantly. Lutenizing hormone (LH) and follicle stimulating hormone (FSH) levels in patients after age 50 progressively increased. Patients administered anti-androgenic agenst tended to show lower T and higher LH, FSH, and prolactin (PRL) levels than non-administered. Patients with psychotropic drugs showed significantly higher PRL levels. Hormonal therapy (mainly T replacement therapy) tended to be more effective in patients of low serum T levels before therapy. However, some patients with normal T improved. In 141 impotent patients, 83 cases of which were after age 50, the degrees of their penile arterial impairment were tested using penile brachial index (PBI) and pulse volume recordings (PVR). PVR waveforms were classified into 3 groups, i.e., normal, slightly abnormal, and markedly abnormal. PBI was significantly lower in abnormal groups than in normal group. Between each parameter of PVR and PBI, statistically significant correlation and relevancy were found. Crest time were significantly longer, and PBI and angle of rise significantly lower in over 50 aged patients than in 20-49 aged. We evaluated the risk factors to penile arterial impairment, such as DM, HT, smoking, and cardiovascular disorders. Each of these risk factors was minor to age factor itself. PVR proved to be useful, simple, and non-invasive method for the screening of vascular impotence. In conclusion, degenerative changes occur about hormonal environment and penile blood flow according to aging, and many kinds of background factors have direct or indirect influence to occurrence of impotence. We emphasize such matters should be considered at examination of middle-high aged impotent patients.
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PMID:[A study of middle-high aged impotent patients]. 747 17

Satisfactory erection with penetration can be obtained in impotent men by the oral or buccal administration of the alpha-adrenergic antagonist, phentolamine. This agent is also used in conjunction with papaverine HCl for intracavernous injection. The previous observation by Gwinup, that 50 mg of phentolamine HCl po, 1.5 hours before coitus resulted in erection in 11/16 patients, is confirmed. This study, using phenoxybenzamine as the placebo, was repeated with success in 36/85 (42.3%) patients. Because of cost and to decrease the waiting time, a buccal form of phentolamine mesylate was administered (20 mg) with erection and penetration in 21/69 (31.8%). There was no correlation between the degree of penile vascular insufficiency or age and the effectiveness of phentolamine. Buccal phentolamine is shown to increase flow velocity in the dorsal penile artery. Phentolamine produces minimal side effects, including hypertension in the subjects.
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PMID:Experience with buccal phentolamine mesylate for impotence. 751 75

We describe our experience using the nocturnal penile tumescence and rigidity monitor (NPTR) in 181 impotent patients referred to the specialized evaluation service in our Family Medicine Center, and review the literature. The 181 patients were referred to the center during 18 months. Their mean age was 53.5 +/- 9.45 years (range 26-76) and 92% were married; about a quarter (26.8%) suffered from impotence for 4-10 years. They were referred by urologists (54.7%), psychiatrists (24.3%), and general practitioners (13.8%). About a third had a normal rigidity, more than half had a normal base tumescence, but only a quarter had normal tip tumescence. Abnormal rigidity and tumescence was significantly associated with diabetes but not with hypertension. We conclude that family physicians have to be actively involved in and responsible for the diagnosis and treatment of impotent patients. Reading and interpreting NPTR is a simple as reading an electrocardiogram and can easily be performed in a primary care setting.
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PMID:Nocturnal penile tumescence and rigidity monitor--use in a family practice. 760 56

Pituitary adenomas are frequently encountered, benign intracranial tumours. Clinically classified according to their capacity to produce and secrete hormones, pituitary tumours are diagnosed from the clinical manifestations and biochemical findings of specific pituitary hormone overproduction or of impaired pituitary function due to pressure on normal pituitary cells, the pituitary stalk or the hypothalamus. Additionally, the tumour may result in neurological manifestations due to its effect as an intracranial space-occupying lesion. Pituitary adenomas may present acutely with pituitary apoplexy after intrapituitary haemorrhage or infarction. The subsequent hypofunction of the pituitary with concomitant neurological sequelae of an expanding intracranial mass are often associated with excruciating headache, diplopia and visual field defects. Gradually developing neurological deficits or secondary endocrine failure over several years may precede the recognition of non-secretory tumours (30-40% of pituitary adenomas) as well as some of the hormone-producing adenomas, especially when they expand beyond the confines of the sella turcica. Asymptomatic masses occur in the pituitary in 5-27% of unselected autopsy series. About 10-20% of pituitaries imaged as part of a brain study contain lesions 'consistent with a pituitary adenoma', with about half being pituitary adenomas ('incidentalomas'). Many advocate screening such cases for a wide spectrum of pituitary function abnormalities. Clinical judgement should be utilized to determine the extent of the work-up and the frequency of follow-up. Acromegaly, a clinical syndrome caused by excess growth hormone secretion, accounts for one-sixth of resected pituitary tumours. This disorder leads to chronic progressive disability and a shortened life span, with approximately 50% of untreated acromegalic patients experiencing premature death. The prevalence of acromegaly has been estimated to range from 50 to 70 per million, with the age of diagnosis usually between the third and fifth decades. Conditions associated with acromegaly include glucose intolerance, diabetes mellitus, lipid abnormalities, cholelithiasis, goitre, and hyperthyroidism, respiratory complications, hypertension, cardiovascular disease, and calcium metabolism abnormalities. An association between acromegaly and cancer, especially of the colon, is now recognized. Epidemiological series have indicated that cancer of the colon, breast and other types of malignancy are a cause of death with increased frequency in acromegalics compared with expected rates. Hypopituitary symptoms secondary to the mass effect of macroadenomas in acromegalic patients are common. Among premenopausal women, menstrual irregularities and galactorrhoea have been reported in 40-70%, while more than half of the men complain of impotence and decreased libido.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Clinical features and differential diagnosis of pituitary tumours with emphasis on acromegaly. 762 86

The parameters of the functional evaluation of the penile arterial system in sexually active males are based on a minimal number of volunteers and impotent patients of neurogenic origin who are expected to have a normal vascular system. In order to investigate these parameters in 23 sexually active diabetic and nondiabetic males, penile arterial systems were evaluated by color Doppler ultrasonography. Parameters obtained from the cavernous arteries were arterial diameter (pre- and postpapaverine), diameter increase rate and systolic peak blood flow velocity. Systolic peak blood flow velocities in papaverine-induced erection were 36.75 (+/- 9.99) and 37.50 (+/- 13.18) cm/s for right and left cavernosal arteries, respectively, in nondiabetic 16 men. The mean cavernosal artery diameter changes were 89.23 and 77.93% for right and left cavernosal arteries. Systolic peak blood flow velocities were 24.57 (+/- 7.44) and 25.42 (+/- 9.45) cm/s and diameter increase rates were 78.57 and 37.50% for right and left cavernosal arteries in diabetic sexually active men. Sexually active diabetics have a significantly lower cavernosal artery peak blood flow velocity and diameter increase rate than nondiabetics (p < 0.01). Thus a subclinic dysfunction of erection might be introduced in diabetic males. In conclusion, each investigator should determine his own standards on sexually active subjects and on those with different etiologies such as diabetics mellitus, hypertension and hypercholesterolemia, contributing to erectile dysfunction.
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PMID:Evaluation of penile arterial system with color Doppler ultrasonography in nondiabetic and diabetic males. 765 8

The purpose of this study was: (1) to record GP opinions, practices and outcomes for the care of Type 2 Diabetes Mellitus (DM2), (2) compare practice facilities and process of care with a criterion of recommended competent care and (3) determine if there were any differences between vocationally registered and non-vocationally registered GPs. A random sample of 204 metropolitan doctors from 124 practices was selected and an audit performed on 467 of their patient records. GPs pursued good blood sugar control and advocated lifestyle changes before hypoglycaemic drugs. Over 80% regard uncomplicated DM2 as a condition for general practice management. However, only 15% conducted an annual diabetes check, 9% had a diabetic register, 6% a diabetic recall system and 8% used a diabetic health care checklist for monitoring their patients. The most commonly recorded processes of medical audit in the previous 12 months were: blood pressure (94%), duration of diabetes (72%), blood glucose (70%), diet (66%), body weight (56%), HBA1c (52%) and ophthalmoscopy (50%). The least commonly recorded processes of care were body mass index (5%), inspection of the feet (18%), enquiries about vaginitis or impotence (23%). The amount of exercise, alcohol and tobacco was recorded in only 34% of records. Hypoglycaemic drugs were used appropriately but the most commonly used drugs for treating hypertension in DM2 patients were thiazide diuretics and beta-blockers. Vocationally registered (VR) doctors had better records, higher process of care scores and more were willing to participate in the study than non-vocationally registered (NVR) doctors. However, there was no difference in metabolic control between patients from either group. The use of a Diabetic Health Care Checklist would improve diabetes care especially in the search for early complications and in the recording of HBA1c and other metabolic parameters. The drugs commonly used to control hypertension can have adverse effects on glucose and lipid metabolism and should be replaced with glucose and lipid neutral drugs.
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PMID:Management of type 2 diabetes in Western Australian metropolitan general practice. 773

The purpose of this study was to evaluate the effects of the alpha 1-blocking agent terazosin on blood pressure (BP) and blood lipids in a large, variant population of patients with hypertension. A total of 16,917 patients with hypertension were evaluated at 2214 primary and community care facilities; 7808 of these patients had not been treated previously for hypertension; 3928 were switched to terazosin from another antihypertensive agent; and 5181 received terazosin in addition to an agent that had not controlled their hypertension. Terazosin produced highly significant reductions in systolic (-18.2 +/- 0.2 mm Hg) and diastolic (-13.2 +/- 0.1 mm Hg) BP when used as monotherapy (mean dose, 3.1 mg; range, 2 to 10 mg) without causing a significant increase in heart rate. Equal antihypertensive efficacy was demonstrated in men, women, blacks, and whites of all ages, with particular benefit to elderly patients (> or = 65 years of age) with systolic hypertension. Comparative studies indicated that terazosin had equal antihypertensive efficacy in combination with diuretics, beta-blockers, calcium channel blockers, and angiotensin-converting enzyme (ACE) inhibitors. Patients who had not responded to monotherapy with one of these classes of antihypertensive drugs showed significant reductions of BP after terazosin, in the following average doses, was added to diuretics, 3.1 mg; beta-blockers, 3.4 mg; calcium channel blockers, 3.3 mg; and ACE inhibitors, 3.4 mg. Terazosin produced highly significant reductions in blood levels of total cholesterol (-5.0%), triglycerides (-6.1%), and low-density lipoprotein cholesterol (-7.6%) without change in high-density lipoprotein cholesterol when used as monotherapy. Similar favorable effects on blood lipid levels were demonstrated when terazosin was used in combination with all other classes of antihypertensive drugs. The greatest reductions in blood cholesterol (-9.2%) were observed among patients with hyperlipidemia (total cholesterol > or = 240 mg/dL). Terazosin maintained its antihypertensive efficacy and was well tolerated by patients with a variety of concomitant diseases, including congestive heart failure, peripheral vascular disease, chronic obstructive pulmonary disease, benign prostatic hyperplasia, diabetes, and obesity. Adverse effects occurred in 17.9% of patients and caused 2.2% to drop out of the study. The most frequent adverse effects were dizziness (4.8%), headache (2.5%), and asthenia (2.4%). Only 0.4% suffered syncope and 0.2% impotence. These data demonstrate the usefulness of terazosin as monotherapy or add-on therapy for treatment of hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Alpha 1-blockade for the treatment of hypertension: a megastudy of terazosin in 2214 clinical practice settings. 792 16

A consecutive series of 15 impotent men (mean age: 53 (range 18-65 years)) underwent venous surgery for abnormal drainage of the cavernous bodies. During the follow-up period (mean 19 months (range 10-34)), 11 patients became potent and sexually active. Three of the impotent men had had a primary venous leakage of the corpora cavernosum, and all these three had to be re-operated. Two achieved full potency. The three postoperative failures in the 12 patients with the secondary type of venous impotence occurred in one heavy smoker, one patient with severe arterial hypertension and one continued to be impotent until his death eight months postoperatively. It is concluded that erectile impotence due to pronounced leakage of the cavernous bodies should be treated surgically, and that the longterm effect is acceptable.
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PMID:[Impotence and corpus cavernosum leakage. Results after surgical treatment]. 806 79


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