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

Uncontrolled hypertension increases the workload of the left ventricle causing the development of hypertrophy and an increase in myocardial oxygen consumption that may precipitate ischemia because of inadequate oxygen delivery related to accelerated coronary atherosclerosis. Control of the hypertension should prevent the further development of hypertrophy, delay the development of fibrosis and possibly also slow the rate of development of atherosclerosis. Furthermore, when myocardial function is impaired because of hypertrophy or other myocardial diseases, the level of blood pressure becomes an important determinant of left ventricular performance. Regardless of the level of arterial pressure, vasodilator drugs that lower arterial pressure may result in marked improvement in left ventricular performance and relief of symptoms of left ventricular failure. Therefore, control of blood pressure in the presence of heart disease may involve treatment of normotensive patients to bring them into a lower normotensive range as well as the more traditional treatment of hypertensives to bring them into the normotensive range. Although this scenario is consistent with conventional wisdom and clinical experience, intricacies of the relationship between hypertension, hypertrophy, myocardial oxygen delivery, atherosclerosis and intramyocardial blood flow distribution remain poorly understood. Until these aspects of the natural history of heart disease are better worked out therapy will remain largely empirical.
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PMID:Heart disease in the hypertensive patient. 14 Feb 80

1. In 27 severe primary hypertensive patients nifedipine (10 mg), administered orally, induced prompt (-21% of control at 30 min) and persistent (-17% at 120 min) fall of mean arterial pressure mediated through reduction of peripheral vascular resistance with rise of cardiac output. 2. The sublingual route (nine cases) showed more rapid onset of action and equal antihypertensive effectiveness. 3. In five patients with hypertensive crisis and acute left ventricular failure, the drug strikingly reduced systemic and pulmonary arterial pressures and relieved pulmonary oedema. 4. Prompt efficacy, ease of administration, absence of important side effects indicate that nifedipine may be a useful therapeutic agent in severe hypertension and in critical conditions that require rapid lowering of blood pressure.
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PMID:Haemodynamic effects of a calcium antagonistic agent (nifedipine) in hypertension: therapeutic implications. 28 70

A patient treated for hypertension with labetalol developed left ventricular failure. When the drug was withdrawn and the BP controlled with 2 other agents, the signs of heart failure regressed. The ill effects in this case could have been because the beta-blocking effects of labetalol are 4 to 6 times greater than the alpha-blocking effects. Caution should be exercised when prescribing this drug for patients with heart failure or with previous symptoms.
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PMID:Left ventricular failure with labetalol. 51 38

Situations requiring immediate lowering of systemic blood pressure are infrequent. Certain clinical syndromes resulting from or complicated by severe hypertension demand vigorous, usually parenteral, antihypertensive therapy. Such syndromes include (1) diastolic hypertension accompanied by sudden disruption of cerebral function, (2) dissecting or leaking aortic aneurysm; (3) accelerated or malignant hypertension, (4) toxemia of pregnancy when either the fetus' or the mother's life is immediately threatened, (5) some instances of diastolic hypertension and acute left ventricular failure, (6) uncontrolled hypertension in the patient who requires emergency surgery, (7) refractory elevation of the diastolic pressure in the kidney transplant patient, and (8) refractory hypertension complicating myocardial infarction or angina. Drugs useful in acutely lowering blood pressure include diazoxide, sodium nitroprusside, methyldopa intravenously, reserpine intramuscularly, and trimethaphan camsylate intravenously. Use of furosemide reinforces the hypotensive effect of these agents. Theoretical advantages and disadvantages of these agents are not always encountered in clinical use.
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PMID:Hypertension crisis. Recognition and management. 57 54

In 10 patients with arterial hypertension and left heart failure the hemodynamic effect of 14-hydroxy-3-beta-[4-O-methyl-alpha-L-rhamnopyranosyl)oxy]-14beta-bufa-4,20,22-trienolide (Ky 18, meproscillarin, Clift) was compared with placebo in a double-blind study. 15 min after oral administration of meproscillarin there was an increase of cardiac output and stroke volume by up to 25%. Heart rate, arterial blood pressure and left ventricular filling pressure remained unchanged.
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PMID:[Preliminary hemodynamic studies on the activity of meproscillarin (author's transl)]. 58 May 88

Nineteen patients with severe essential hypertension or hypertension due to renal parenchymal disease were treated with intravenous clonidine. In 14 patients the elevated blood pressure was complicated by one or more crises: left ventricular failure in seven patients, encephalopathy in six, and subarachnoid hemorrhage, cerebral hemorrhage, dissecting aortic aneurysm, acute renal failure, and severe epistaxis, one episode each. Clonidine 0.15 or 0.30 mg, was given intravenously every 40 minutes until the diastolic blood pressure was decreased to 120 mm Hg or below. Blood pressure was taken every 10 minutes. Both systolic and diastolic blood pressure were reduced significantly after intravenous clonidine, the former by 96 mm Hg (P less than 0.001), the latter by 52 mm Hg (P less than 0.001) within a period of 40 minutes to 2 1/2 hours. The clonidine dose varied from 0.15 to 0.90 mg, mean 0.52 mg. Heart rate was decreased significantly by 20 beats/minute (P less than 0.001) by the drug. Serious side effects were not observed except for an episode of transient sinoatrial block. Renal function was not affected. Patients who were on chronic diuretic therapy prior to treatment with intravenous clonidine showed a significantly greater decrease in both systolic (P less than 0.01) and diastolic (P less than 0.001) blood pressure after the first clonidine dose. In one patient intravenous clonidine was not effective (i.e., blood pressure remained 200/150 mm Hg) in spite of a total clonidine dose of 0.9 mg. Two patients died, one from severe cerebral hemorrhage, the other from an extensive dissecting aortic aneurysm, but the fatal outcome was not related to clonidine.
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PMID:Evaluation of intravenous clonidine in hypertensive emergencies. 63 67

Myocardial performance in the immediate postoperative period was studied 49 cardiac surgical patients treated with nitroprusside alone. With a thermodilution catheter positioned in the pulmonary artery, cardiac output was calculated and cardiac index, systemic vascular resistance index, and stroke work index were derived before after treatment with nitroprusside. The drug was a administered to all patients because of elevated systemic vascular resistance index. Based on their mean arterial pressure and cardiac index before treatment, the patients fell into two groups. Group I patients (N = 25) had elevated mean arterial pressure and normal cardiac index. Group II patients (N = 24) had normal mean arterial pressure and subnormal cardiac index. Nitroprusside administration resulted in a significant reduction of systemic vascular resistance index in all patients. In Group I the mean arterial pressure was lowered significantly while cardiac index increased only slightly. In Group II there was no change in arterial pressure, but cardiac index improved significantly. The results not only confirm that nitroprusside is effective in managing postoperative hypertension, but also demonstrate that in patients with postoperative left ventricular failure, the drug can improve cardiac output by reducing systemic vascular resistance without significantly lowering arterial blood pressure.
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PMID:Improved myocardial performance in postoperative cardiac surgical patients with sodium nitroprusside. 64 13

In 25 patients, considered high surgical risks according to clinical criteria, systemic and pulmonary hemodynamic parameters were monitored using a flow-directed pulmonary arterial thermodilution catheter before, during and after major vascular surgery. During and after the operation, hemodynamic complications were observed in 13 patients. The following conditions were dealt with: hypovolemia, increased systemic vascular resistance, and left ventricular failure in hypervolemia and in normovolemia. Tachy-arrhythmias seen in six of the patients were associated with left ventricular failure, hypovolemia or normal hemodynamics. Operation for renovascular hypertension and thoracolaparotomy carried the highest risk. Two of the patients died from primarily surgical complications.
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PMID:Hemodynamic observation in relation to extensive surgical treatment of patients with increased operative risk. 67 47

Phentolamine (Regitine) at the dose of 0.3 mg/mn behaves as an arterial and, above all venous, vasodilatator agent, resulting in a marked and early lowering of the pulmonary pressures in acute oedema of the lung and in cardiac asthma. It was used alone in 47 attacks of acute severe left ventricular failure with very favourable results in 43 cases, as proved by the rapid improvement of the haemodynamic status and of the aicd-base balance. Under strict observation, tolerance has been excellent. This therapeutic method seems of great interest in the cases of acute pulmonary oedema with a maintained blood pressure level, and in the forms with severe arterial hypertension which might tolerate larger doses.
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PMID:[Phentolamine in treatment of acute left ventricular insufficiancies]. 81 43

Repeated recordings were made of the apexcardiogram throughout the first month after myocardial infarction in 30 patients. The classical timed intervals of the systolic wave are open to some criticism. The systolic waveforms are important. In the majority of transmural anterior infarctions there is a rounded appearance to the beginning of the wave which seems to prolong the electromechanical latency, followed by a late systolic bulge, or a domed waveform. This signifies a non-contractile area, and not neccessarily an ectasia. The early diastolic "peaktrough" appearance, found very frequently wherever the necrosis is situated, is indicative of asynergic contraction of the left ventricle. All of the diastolic phases are altered, probably by increased parietal stiffness: the TRI is lengthened; the "F" wave is flattened (and often absent later on in the condition), its duration is shortened over the anterior positions, and it may contain a shallow dip if there is LVF; the stasis wave is very feeble; the "a" wave is large when the infarct is extensive, or when there is LVF, or when there is longstanding hypertension. Enlargement of the "a" wave is especially indicative of a lowering of the performance of the left ventricle.
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PMID:[Phonomecanography in recent myocardial infarction. Ventricular mechanic curve]. 82 Feb 96


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