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

We evaluated the prognosis of acute porphyria among 206 adult Finnish patients with acute intermittent porphyria (AIP) or variegate porphyria (VP). The series represents all known patients with these porphyrias in Finland. Of the 47 patients who had a total of 117 acute attacks during the period 1967-1989, 6 died during an attack and 21 attacks were associated with paresis; the frequency of severe attacks was significantly smaller than before 1967 (p = 0.00002). Most pareses and deaths occurred because of a delay in diagnosis and inappropriate treatment of porphyria. For those patients who were symptom-free at the time of diagnosis (1365 follow-up years), the risk of the first subsequent attack was significantly smaller than for those who had had an acute attack before the diagnosis of porphyria (1047 follow-up years, p = 0.005). In addition, milder symptoms of porphyria were more common among those who had had previous attacks than among those who had not (p less than 0.00001). In AIP the risk of attacks correlated with the excretion of porphobilinogen in the urine during remission among adults (p = 0.03); a low rate of excretion predicted freedom from acute attacks. A regular use of many precipitating drugs was never associated with symptoms of porphyria. Two percent of the surgical operations and 4% of the pregnancies were associated with acute attacks. Nearly one-third of the women had symptoms of porphyria associated with the menstrual cycle, but these seldom proceeded to an acute attack. Forty-six percent of the women had used sex-hormone preparations regularly; 2 of them (4.5%) experienced associated acute attacks. Patients with AIP or VP showed increased incidences of hepatocellular carcinoma, and probably also chronic renal failure and hypertension.
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PMID:Prognosis of acute porphyria: occurrence of acute attacks, precipitating factors, and associated diseases. 154 56

Antihypertensive therapy should be directed toward reduction of all end-organ damage including congestive heart failure, left ventricular hypertrophy, coronary heart disease, myocardial infarction, cerebrovascular accident, and chronic renal failure. The Subsets of hypertension approach is based on pathophysiology, hemodynamics, risk factor reduction for end-organ damage, concomitant diseases and problems, demographics, adverse effects on quality of life, compliance, and total health care costs. This approach provides a more individualized and logical treatment of the hypertensive syndrome and addresses the metabolic and structural abnormalities that are present.
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PMID:New insights and approaches to reduce end-organ damage in the treatment of hypertension: subsets of hypertension approach. 157 52

Chronic renal failure is almost invariably accompanied by symptomatic anemia. It has been demonstrated that the primary cause of this anemia is inadequate production of erythropoietin by the diseased kidneys. The isolation of erythropoietin, followed by the cloning and expression of the human erythropoietin gene, made possible clinical trials of rHuEPO in uremic patients. rHuEPO produced dramatic increases in the hematocrit in almost all patients treated and also ameliorated many symptoms, such as lethargy, dizziness, and poor appetite, that had long been attributed to the effect of uremic toxins. Adverse effects of treatment with rHuEPO noted in the early clinical trials included hypertension, seizures, arteriovenous fistula or shunt thrombosis, and hyperkalemia. Further study of rHuEPO has shown that many of these side effects may be no more frequent in patients receiving rHuEPO than in other uremic patients not receiving rHuEPO. Reduction of the rHuEPO dosage and subcutaneous administration produce less rapid increases in the hematocrit and may lessen the incidence and severity of these side effects. rHuEPO therapy places great demands on both the body's iron stores and the capacity to rapidly transfer iron from storage sites to the erythroid progenitor cells. Thus, almost all patients treated with rHuEPO become iron deficient and require oral or parenteral iron replacement. Response to rHuEPO in uremic patients is diminished if the anemia is complicated by iron deficiency, inflammatory disorders, aluminum overload, or deficiency of folate or vitamin B12. rHuEPO therapy is safe and effective in the treatment of the anemia of chronic renal failure. The use of rHuEPO leads to enhanced quality of life and eliminates the need for red cell transfusions. In addition to hemodialysis patients, predialysis patients and those on CAPD benefit from and are candidates for rHuEPO therapy.
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PMID:Anemia of renal failure. Use of erythropoietin. 157 66

Medicare's End-Stage Renal Disease (ESRD) Program makes renal replacement services accessible for the majority of Americans with renal failure. National data from Medicare demonstrate complex and variable patterns of use of renal replacement services among US racial and ethnic groups. The black population has consistently suffered from a greater than 3.5-fold higher rate of treated ESRD than has the white population. The rates of hypertensive, diabetic, and glomerulopathic ESRD are all substantially greater in blacks than in whites, and hypertension has accounted for a far greater proportion of ESRD in blacks than any other diagnosis. There is a paucity of national data on the occurrence of ESRD in Hispanic Americans. However, data from Texas strongly suggest that the incidence rate of treated ESRD is much higher in Mexican Americans than in non-Hispanic whites. Higher rates are apparent for each of the three most important causes of ESRD: hypertension, diabetes, and glomerulonephritis. Native Americans experience ESRD at a rate intermediate between those of whites and blacks, but their rate of diabetic ESRD is higher than in either blacks or whites. However, considerable diversity exists among Native American tribal groups. Significant barriers to the acquisition of preventive care have been identified, especially for blacks. While these barriers to preventive care are accompanied by a significantly impaired health status of the black American population, a specific causal relationship between impaired access to care for blacks and their predisposition to ESRD has not been established.
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PMID:End-stage renal disease in US minority groups. 158 26

A 1987 questionnaire sponsored by the Health and Welfare Ministry concerning the clinical subsets and severity of systemic lupus erythematosus (SLE) was distributed to 93 medial facilities. A clinical analysis of the outcome and treatments was accomplished on one thousand six hundred and fourteen SLE patients fulfilling ARA criteria. The outcome was evaluated into 6 categories, namely; complete remission, incomplete remission, no change, gradual worsening, rapid worsening and unknown. Treatments included (1) anti-inflammatory drugs, (2) initial dose of prednisolone (PSL) below 29 mg/day, (3) initial dose of PSL from 30 to 59 mg/day, (4) initial dose of PSL above 60 mg/day, (5) pulse therapy, (6) immunosuppressants, (7) plasmapheresis, and (8) hemodialysis. Statistical significances were determined with ridit analysis. The severity of the disease for 1,614 SLE patients was evaluated by the judgement of each medical facility independently, separating it into 3 grades. As a result, 16.8% was evaluated as severe, 54.6% was evaluated as moderate, and 28.6% was evaluated as mild. Clinical subsets were divided into 3 categories according to the outcome; (1) those with high complete remission rates (serositis, convulsion, oral ulcers, unconsciousness, hemolytic anemia and so on), (2) those with high incomplete remission rates (lupus nephritis, digital gangrene, hypertension, peripheral neuropathy, erythema, Raynaud's phenomenon and so on), and (3) those with high rates of no change or worsening (aseptic bone necrosis, pulmonary hypertension, pneumonitis, chronic renal failure and so on). SLE patients with persistent proteinuria below 3.4 g/day, pulmonary hypertension, or pneumonitis treated with large doses of PSL such as an initial dose of PSL above 60 mg/day and/or pulse therapy had a significantly higher remission rate than those treated with small dosages of PSL. Hereafter, the establishment of modes of treatments for increasing the remission rates of intractable clinical subsets in highly desired.
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PMID:[Studies on clinical subsets and severity of systemic lupus erythematosus based on a 1987 questionnaire conducted in Japan--clinical analysis of the outcome and treatments in clinical subsets]. 160 13

Changes in carbonic anhydrase (CA) activity have been associated with metabolic diseases like diabetes mellitus and hypertension. To explore the exchange of H+ for Na+ and 22Na+, the sodium pool, CA activity and H2O content in erythrocytes from the two groups of diabetic chronic renal failure (CRF) patients with and without hypertension before dialysis were studied. The results were compared with those from the normotensive controls. The CA activity was determined spectrophotometrically, the sodium pool by ouabain insensitive 22Na+ influx and the percent H2O content gravimetrically. The 22Na+ influx in CRF patients with hypertension was significantly higher (p less than 0.025) than in the normotensive CRF patients and the controls. The levels of CA activity (U/min/mL) and the percent H2O content were significantly different in the hypertensive and the normotensive CRF patients from the control group (2.24 +/- 0.69 and 67.11 +/- 1.33, 1.95 +/- 0.63 and 66.43 +/- 1.51, 1.44 +/- 0.07 and 63.61 +/- 1.72, respectively). The present study implies a relationship between the 22Na+ influx and CA activity in CRF patients with hypertension. The variation of CA activity may thus result in changes in H+ production and ultimately in the intracellular Na+ pool.
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PMID:Erythrocyte carbonic anhydrase: a major intracellular enzyme to regulate cellular sodium metabolism in chronic renal failure patients with diabetes and hypertension. 161 Mar 83

The epidemiology, clinical symptomatology, diagnosis and management of acute and chronic lead intoxication are reviewed. While acute lead intoxication has become rare, the elevated environmental lead burden is thought to play a causal role in hypertension. Lead may also be linked with neuropsychological disorders of children and possibly even chronic renal failure. The epidemiological and experimental evidence for this hypothesis is critically discussed.
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PMID:Lead intoxication--new insights into an old problem. 161 43

We report the case of an elderly black woman with a 20-year history of insulin-independent diabetes mellitus (IDDM), chronic renal failure, hypertension, proliferative retinopathy, and classical histologic features of diabetic glomerulosclerosis on renal biopsy. Repeat determinations of urinary albumin excretion rates failed to disclose significant microalbuminuria. This presentation should remind the clinician that a small minority of patients with IDDM of long duration may have severe diabetic glomerulosclerosis and renal insufficiency without detectable microalbuminuria.
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PMID:Diabetic glomerulosclerosis and chronic renal failure with absent-to-minimal microalbuminuria. 162 84

Clinical, biochemical, radiological and echo-cardiographic (echo) evaluation was done prospectively in 50 patients of untreated end stage chronic renal failure (CRF). While clinically congestive cardiac failure (CCF) was diagnosed in 24%, low ejection fraction on echo was found in only 16%. Echo in these cases showed evidence of cardiac chamber dilatation in most (mean LVID (D) 54.1 +/- 6.51 and (S) 36.4 +/- 6.9 mm, but parameters of cardiac functions were normal in most. Mitral annular calcification (MAC) was detected on echo in 26%. On comparing patients with MAC (Group I) and those without MAC (Group II), the aetiological factor found more frequently in Group I was diabetes (61.5% vs 35.1%, P less than 0.05). Clinical features such as older age (mean age 54 years vs 45.5 years), severe hypertension, and grade IV and above murmur (15.2% vs none) were more common among group I patients. However, the difference was not statistically significant. Parameters of calcium metabolism were similar in the two groups. Conduction disturbances (30.7% vs 5.4%) were significantly more common in Group I (P = 0.05). The mitral regurgitation due to MAC was of no haemodynamic significance. Complications of MAC syndrome were rare.
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PMID:Mitral annular calcification in untreated chronic renal failure. 162 45

Symptomatic pericardial effusion (PE) occurred in two of our patients with chronic renal failure (CRF) who had taken minoxidil for control of their hypertension. One of them died from the effects of cardiogenic shock due to cardiac tamponade. The 2 patients had taken minoxidil for over 3 months. Other patients who had CRF had not developed symptomatic PE while being treated with other anti-hypertensive agents. Our experience conforms with reports from elsewhere that minoxidil may cause PE. Therefore, patients with CRF who need minoxidil as an anti-hypertensive agent should be examined regularly for clinical evidence of PE.
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PMID:Pericardial effusion associated with minoxidil therapy: case reports. 163 46


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