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

Antihypertensive treatment is known to reduce mortality in severe hypertension and cardiovascular morbidity in mild and moderately severe hypertension, for example, from stroke and left ventricular failure. However, treated hypertensive patients still have significantly higher mortality and morbidity than matched control subjects. In particular, risk of coronary heart disease is affected little by antihypertensive treatment. There may be several explanations for these less than optimal results. For example, blood pressure may not have been brought down to strictly normotensive levels or an antihypertensive agent, which adversely affects serum lipoproteins, may have been used, thereby offsetting the intended therapeutic effect. Doxazosin, a new selective alpha 1-inhibitor, offers both effective antihypertensive action and a favorable lipid effect. Both of these effects could have a positive impact on risk of coronary heart disease and therefore may prove to be more effective than previously used antihypertensive treatments.
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PMID:Implications of doxazosin therapy on risk of coronary heart disease. 290 59

We describe a patient with multiple extra-adrenal paragangliomas who presented with clinical features of a dilated cardiomyopathy. Hypertension was not a major feature of the illness despite excessive catecholamine secretion by the tumours. Following surgical resection the changes of dilated cardiomyopathy did not regress on echocardiography and the patient died of left ventricular failure.
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PMID:Multiple extra-adrenal paragangliomas associated with catecholamine cardiomyopathy. 292 87

Nowadays, acute rupture of the cardiac free wall is, after cardiac failure, the second most frequent cause of hospital deaths consecutive to acute myocardial infarction. This mechanical complication of myocardial infarction is usually beyond surgical treatment in patients with sudden cardiac arrest at the time of rupture. However in about 30% of the cases the rupture may be subacute and amenable to surgical treatment provided the condition is rapidly diagnosed. Diagnostic criteria are clinical (abrupt fall in blood pressure, often preceded by recurrent thoracic pain, associated with venous hypertension in the absence of left ventricular failure), haemodynamic or angiographic but mainly echocardiographic (pericardial effusion with or without intrapericardial mass suggesting a blood clot). Attention should be paid to certain subgroups at risk, notably women under 70 and patients with prolonged or recurrent anginal pain.
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PMID:[Acute and subacute ruptures of the free wall of the heart in acute myocardial infarction]. 295 Apr 67

108 patients (88 male, mean age 50 years, 20 female, mean age 49) having coronary heart disease (40), cardiomyopathy (39), hypertension (9), valvular disease (9), pulmonary diseases (5) and without cardiac diseases (6) underwent chest plain radiographs in standing and recumbent position immediately before being investigated invasively by left and right heart catheterisation, angiocardiography and coronary angiography. Two experienced radiologists evaluated the plain films with special reference to the findings of the heart and lung vessels, particularly the pulmonary veins. Dilatated veins of the upper lobes were observed more often if the radiograph was obtained from the recumbent patient. A significant close correlation with increased LVEDP was, however, revealed in both positions. A possible simulation of pathological dilatation of the venous trunci of the upper lobes merely due to the redistribution of the blood flow in the horizontal position was excluded. The results show that reliable conclusions can be drawn concerning chronic left ventricular failure if the characteristic pulmonary vein findings are visualised in patients both in the standing and in the recumbent position.
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PMID:[Are thoracic radiographs in the recumbent position useful in the diagnosis of chronic left heart insufficiency? Comparison of x-ray findings with left ventricular hemodynamics]. 302 43

Hypertension-induced morbidity and mortality can be positively affected by antihypertensive treatment. This was first shown in malignant phase hypertension and it is now clearly established that not only total mortality but also morbidity from stroke, left ventricular failure, and progressive renal failure can be positively affected by pharmacological lowering of arterial pressure. Benefits of treatment for coronary artery disease are less obvious. In spite of the positive effects of antihypertensive therapy briefly mentioned here, recent data from several centers show that hypertension-induced risks in treated hypertensive patients are not reduced down to the level seen in comparable normotensive subjects. There could be several reasons for this. Some of the hypertension-induced cardiovascular changes are irreversible, or that antihypertensive pharmacological agents may have some adverse effects that would partially offset the advantages obtained through a reduction in blood pressure, or that treated arterial blood pressure usually has not been brought down to strictly normotensive levels. Therefore, the risks associated with hypertension have not been lowered to those seen in normotensive subjects. This latter point assumes particular significance in view of some recent suggestions that a too drastic lowering of blood pressure in hypertensive subjects may be associated with an increased risk, particularly for coronary artery disease mortality.
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PMID:What are we really achieving with long-term drug therapy? 306 92

The benefits of the treatment of hypertension currently consist of a substantially reduced incidence of premature stroke, left ventricular failure and malignant hypertension. The benefits for the individual are most clearcut in those who have already had severe or symptomatic hypertension. Older subjects who have a higher risk of stroke and heart failure also show more immediate benefits in terms of stroke and heart failure reduction. However, in the community as a whole, mild hypertensives account for over half the cardiovascular deaths attributable to high blood pressure. In such patients a more systematic approach to the use of non-pharmacological measures for both control of blood pressure and coronary heart disease, coupled where necessary with the judicious use of existing and new antihypertensive and lipid lowering drugs, offers the prospect for a new era of prevention in relation to hypertensive cardiovascular disease.
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PMID:Value of non-drug treatment and drug treatment in hypertension. 307 10

Both essential hypertension and the development of left ventricular hypertrophy are multifactorial. Several types of hypertrophy may develop. There is evidence that different agents used to treat hypertension may cause varying degrees of regression of left ventricular hypertrophy. In many instances in which regression of left ventricular hypertrophy has occurred in human subjects, there has been an associated improvement in echocardiographic evidence of ventricular function. Although most current evidence suggests that therapy should aim at both the control of blood pressure and the regression of left ventricular hypertrophy, one should be aware that an individual who is successfully treated for hypertension with a regimen that also produces regression of the compensatory left ventricular hypertrophy may be more susceptible to left ventricular failure if the severe hypertension should ever recur from whatever cause.
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PMID:Reversal of left ventricular hypertrophy by drug treatment of hypertension. 316 7

Chest X-rays were used to evaluate the hemodynamic status of 86 patients with acute myocardial infarction. The chest films, divided into three groups depending on the degree of pulmonary venous hypertension revealed: grade 1, pulmonary-venous congestion; grade 2, interstitial pulmonary edema; grade 3, diffuse alveolar edema. On clinical examination, four grades of congestive heart failure were distinguished in acute myocardial infarction. In 69% of our patients radiological and clinical grading of left ventricular failure led to precisely the same conclusions. Pulmonary capillary wedge pressure was measured in 31 patients with acute infarction. Radiological criteria of the degree of pulmonary vascular congestion, when related to pulmonary capillary wedge measurements, provide a basis for consistent therapy of left ventricular failure secondary to acute myocardial infarction.
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PMID:[X-ray changes in the thoracic organs in acute heart infarct]. 318 76

Nitroglycerin and the long-acting nitrates are beneficial in stable and unstable angina pectoris and acute myocardial infarction and as adjunctive therapy in congestive heart failure. Nitroglycerin compounds relax vascular smooth muscle, producing venous, arterial, and arteriolar dilatation. These actions are modulated by stimulation of intracellular cyclic guanosine monophosphate. Nitrate efficacy in ischemic heart disease is due to peripheral venous and arterial vasodilatation that results in decreased myocardial oxygen consumption. Nitrates also dilate coronary arteries and collaterals, reverse coronary vasoconstriction, and enlarge some coronary atherosclerotic lesions. Nitrates improve exercise performance in stable angina pectoris. Intravenous nitroglycerin should be used in the initial treatment of unstable angina. Nitrates may be beneficial in myocardial infarction for control of ischemic pain, acute hypertension, and left ventricular failure. In subjects with congestive heart failure, nitrates reduce symptoms and improve exercise tolerance. Nitrate tolerance is a problem with continuous nitrate therapy. Tolerance is most likely to occur with frequent dosing or the use of long-acting nitrates, particularly transdermal nitroglycerin disks, and can be prevented or reversed with intermittent-dosing regimens.
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PMID:A reappraisal of nitrate therapy. 327 14

The benefits of treating hypertension have been documented by several long-term studies that have shown a decreased incidence of morbidity and mortality associated with stroke, left ventricular failure, and renal insufficiency. With the large number of antihypertensive drugs currently available, several safety factors need to be considered when initially choosing a regimen so as not to adversely influence the potential benefits of blood pressure control. Antihypertensive agents should be chosen based on their hemodynamic profile, the absence of adverse metabolic effects and subjective side effects, and the presence of beneficial effects on the patients' quality of life. Thiazide diuretics and beta-blocking agents have often been recommended as initial therapy in patients with mild to moderate hypertension. However, thiazide diuretics may be less desirable in certain patients because of their effects on lipids, potassium, and glucose tolerance; beta-blocking agents are not ideal for some patients because of their effects on lipids, exercise tolerance, and overall quality of life. The angiotensin-converting enzyme inhibitors, selective alpha 1-blocking agents, and calcium channel blocking agents may be more appropriate for initial therapy of hypertension in many patients.
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PMID:Issues with antihypertensive therapy: safety perspectives. 328 Feb 82


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