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

Hypertensive crises are now uncommon in developed countries, and few doctors will have experience in their management. A review of the drugs used by clinicians in Scotland suggests considerable diversity in approach but broadly follows the best advice that is available in the literature. For emergencies such as hypertensive encephalopathy and hypertension associated with aortic dissection in which irreversible damage would occur within hours if left untreated, patients should probably be admitted to Intensive Care Units and be given nitroprusside. Similarly nitroprusside or nitroglycerin would be appropriate choice for hypertension that is complicated by acute left ventricular failure. By contrast if the risk to the patient is measured in days rather than hours then oral therapy will be quite sufficient. Atenolol or nifedipine retard can safely be given as initial treatment for uncomplicated malignant hypertension, and nifedipine retard can be used for the milder cases of encephalopathy or heart failure. The use of sublingual drugs in the management of hypertensive emergencies and urgencies cannot be recommended as the fall in blood pressure is both unpredictable and uncontrolled with the consequent and unacceptable risk of organ ischaemia.
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PMID:Management of hypertensive crises. 760 39

A 13-year-old girl suffering from nephrogenic hypertension, treated with high-dose propranolol and other antihypertensive medication, developed acute hypoxaemia (oxygen saturation at 60% at 100% oxygen ventilation) shortly after induction of anaesthesia. The auscultatory findings first suggested bronchospasm; however, specific measures failed to improve pulmonary function. The planned procedure was delayed and further investigations showed acute left heart failure due to beta-blockade combining with general anaesthesia.
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PMID:[Left heart failure in anesthesia in a child pretreated with propranolol--case report]. 786 64

The effect of vascular endothelium, endocardium, and coronary endothelium on vascular tone and myocardial contraction-relaxation sequence in heart failure is discussed. Vascular endothelium affects underlying vascular smooth muscle through paracrine secretion of relaxing and constricting factors. In heart failure, systemic vasoconstriction results not only from neuroendocrine activation, but also from disturbed local endothelial control of vascular tone because of impaired endothelial-dependent vasodilation and because of increased plasma concentration of endothelin. Experimental evidence obtained in isolated cardiac muscle strips established the influence of endocardial endothelium on the duration of myocardial contraction and on the onset of myocardial relaxation. By analogy to vascular endothelium, both diffusible agents that abbreviate (endothelial-derived relaxation factor-like substance) and those that prolong (endocardin) myocardial contraction have been shown to be released from the endocardium. Similar agents are released from the coronary endothelium and, because of the close proximity of capillaries and myocytes, could exert a major effect on myocardial performance. Endothelial dysfunction and concomitant lack of release of myocardial relaxant factors could explain left ventricular relaxation abnormalities observed in the cardiac allograft or in arterial hypertension. Since endothelial-derived relaxation factor or nitric oxide mediates the coronary reactive hyperemic response, a negative inotropic action of nitric oxide could contribute to left ventricular failure when left ventricular wall stress is elevated, as occurs after myocardial infarction in the noninfarcted zone and during left ventricular volume or pressure overload in the absence of adequate hypertrophy.
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PMID:Endothelial control of vascular and myocardial function in heart failure. 794 59

There were 101 (4.6%) cases of malignant and accelerated hypertension among 2195 hypertensives patients treated in Department of Hypertension of National Institute of Cardiology between 1981 and 1990. Almost 30% of these patients were diagnosed as having secondary cause of hypertension. Comparison with control group of patients with moderate or mild hypertension revealed that malignant hypertensives had a shorter history of illness, lower level of education, higher evidence of smoking and over-consumption of alcohol. The systolic and diastolic blood pressure values were significantly higher in this group. The patients with malignant hypertension had significantly higher blood concentration of urea, creatinine and uric acid. Mild anemia was also present. Severe cardiovascular complications (myocardial infarction, stroke, encephalopathy, left ventricular failure) were observed in 44% cases of malignant hypertension. Due to efficacious hypotensive treatment blood pressure decreased significantly and biochemical indicators of renal function improved. Withdrawal of characteristic for malignant hypertension changes in fundoscopy was also observed. Results of this study indicate that prompt and aggressive treatment with normalization of blood pressure results in reversal of vascular lesions and permits recovery of cerebral and renal function.
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PMID:[Accelerated and malignant hypertension--clinical observation]. 802 29

The prevalence of high blood pressure increases with age and, in elderly subjects, it is a major risk factor not only for cardiovascular diseases but also for other diseases including vascular dementia. Data concerning mortality are more controversial, but it is known that up to the age of 90, mortality is increased in hypertensive subjects. Two pathological conditions can be distinguished, systolo-diastolic hypertension with a systolic pressure above 160 mmHg and diastolic pressure above 95 mmHg and systolic hypertension alone when the systolic pressure is above 160 mmHg and diastolic below 95 (or 90) mmHg. The European working party on high blood pressure in the elderly (EWPHE) and the Medical Research Council trial of treatment of hypertension in older adults have demonstrated the beneficial effect of treating systolo-diastolic hypertension. Active therapy significantly reduces the risk of mortality due to cardiovascular disease, notably myocardial infarction, and in morbidity due to left ventricular failure and non-mortal cerebral vascular events. The current debate centers on the pressure level which should be attained, especially in patients with a history of ischaemic cardiopathy. Treatment of elderly patients with systolic hypertension alone is also probably beneficial, although only the systolic hypertension in the elderly program (SHEP) was able to demonstrate a significant reduction in cerebral vascular events and in the incidence of myocardial infarction, even in subjects over 80. A multicentric European study (Syst-Eur), which includes patients treated with calcium inhibiteurs and conversion enzyme inhibiteurs, is being conducted in order to confirm the beneficial effect of treating systolic hypertension in subjects over 60. In addition, this study also includes a complementary project specifically designed to evaluate the effect of treatment on vascular dementia.
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PMID:[Treatment of arterial hypertension in elderly patients. Value and indications]. 817 61

The weights of the individual carotid bodies and cardiac ventricles were obtained at necropsy in five series of subjects. The first comprised 10 cases free of cardiopulmonary disease to act as controls. The second consisted of 10 cases of pulmonary emphysema. The third was composed of 8 cases characterized by sustained alveolar hypoxia due to causes other than pulmonary emphysema. The fourth comprised 10 cases of systemic hypertension or severe left ventricular failure. The fifth was made up of 10 cases of diseases of the liver or alimentary canal. The study confirmed that enlargement of the carotid bodies is common in cases of pulmonary emphysema or sustained alveolar hypoxia with right ventricular hypertrophy. It is also common in cases of systemic hypertension with left ventricular hypertrophy. It was also revealed that enlargement of the carotid bodies may occur in cirrhosis of the liver. We believe this to be the first report of that association.
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PMID:The carotid bodies enlarge in some cases of cirrhosis of the liver. 820 96

This article is directed primarily to primary care physicians. The challenge is to suspect, diagnose, and treat pulmonary arterial hypertension when treatment is most effective and before the effects of cor pulmonale become fully manifested. A good history and physical examination should be followed by electrocardiographic and roentgenographic evaluations. Of additional value are arterial blood gas measurements, two-dimensional echocardiography, first-pass radionuclide angiography, and catheterization of the right ventricle. Chronic obstructive pulmonary disease (COPD) is one of the more common etiologies of pulmonary hypertension and cor pulmonale. COPD is most common in the elderly and cor pulmonale is fairly common among those with COPD; therefore, hypoxic pulmonary hypertension and the resultant cor pulmonale occur mostly in older patients. Because early signs are nonspecific, diagnosis and treatment are often delayed until the pulmonary disorder is severe. Thus it is imperative that the primary care physician be cognizant of this serious problem. Standard treatment of left ventricular failure (ie, "congestive heart failure") could have adverse effects in patients with cor pulmonale.
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PMID:Pulmonary hypertension and cor pulmonale. 821 54

Phaeochromocytoma is a rare, autonomous catecholamine secreting tumour of the sympatho-adrenergic system. Due to the continuous or phasic secretion of catecholamines from the tumour, patients present with hypertensive crisis, episodic or sustained hypertension or arrhythmia. Excessive intraoperative hypertension unable to control by usual methods should be considered to be a phaeochromocytoma. Surgical removal of identified lesions should be performed under controlled conditions and after sufficient preparation of the patient. Preoperative alpha-adrenergic blockade with prazosin and phentolamine allows an increase in intravascular volume and affords some protection against excessive intraoperative hypertension. The use of beta-adrenergic antagonists is only recommended in patients with arrhythmia (especially tachycardia) and after induction of alpha-adrenergic blockade. For operation of phaeochromocytoma, modified neuroleptic anaesthesia is a useful anaesthetic technique. Intraoperative hypertension is controlled with sodium nitroprusside and phentolamine. Intravascular volume is substituted under CVP or PAP control, and epinephrine or norepinephrine are used if necessary. During the postoperative period, hypotension or hypertension or left ventricular failure may occur. In an own study, 9 patients with phaeochromocytoma were investigated, 7 patients with other operations of the adrenal glands served as controls. Despite specific preoperative preparation and intraoperative use of antihypertensive drugs, excessive increases in blood pressure could not be avoided in some cases. Extremely high plasma levels of catecholamines up to the factor 1,000 of the normal range were found. Even in controls, considerable increases in blood pressure and catecholamine levels were observed.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Anesthesia for patients with pheochromocytoma. Our own results and a review]. 829 3

In an attempt to elucidate the effects of two major risk factors of heart failure in humans, high blood pressure and coronary artery disease, renal hypertension and coronary artery constriction were induced singularly and in combination in rats, and the functional, structural, and biochemical alterations of the myocardium were examined 12-13 wk later. Renal hypertension (RH), coronary narrowing (CN), and their association (NH) resulted in left ventricular failure demonstrated by a significant increase in left ventricular end-diastolic pressure, a decrease in +dP/dt and -dP/dt, and a reduction in stroke volume and cardiac output. Measurements of ventricular loading documented that RH was characterized by elevations in systolic and diastolic wall stress of 42 and 160%, respectively. Corresponding changes with NH were 80 and 315%. CN was accompanied by an augmentation of diastolic wall stress only (280%). The abnormalities in mural stress were coupled with reductions in systolic and diastolic wall thickness-to-chamber radius ratios of 39 and 29% after CN. These anatomic parameters were preserved with RH, whereas the systolic wall thickness-to-chamber radius ratio was reduced 31% with NH. Structurally, multiple foci of replacement fibrosis were found with each intervention. The sites of tissue injury and their volume percent in the myocardium were comparable with CN and RH but were significantly more numerous and occupied a larger fraction of the ventricular wall in the presence of NH. Biochemically, the calcium dose-response curve of myofibrillar Mg2+ adenosinetriphosphatase (ATPase) activity did not vary with CN, RH, and NH. In contrast, a marked decrease in Ca2+ myosin ATPase activity was found in NH rats in association with a shift in myosin isoenzymes from V1 to V3. In conclusion, multiple physiological, morphological, and biochemical factors may participate in the generation of the abnormalities in ventricular loading with hypertension and/or coronary artery stenosis.
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PMID:Effects of hypertension and coronary constriction on cardiac function, morphology, and contractile proteins in rats. 836 72

The past and present clinical history of 13 patients with hemodynamic and angiographic diagnosis of chronic thromboembolic pulmonary hypertension (CTPH) was reviewed in order to investigate the reasons for failure of resolution of acute pulmonary embolism (PE) and findings useful for diagnosis of CTPH. All patients had chest radiograph, ECG, arterial blood gas analysis and pulmonary perfusion scintigraphy performed. Clinical assessment demonstrated that no patient had diagnosis and treatment of the several retrospectively identified episodes of PE (from 1 to 8); the lack of diagnosis was due to underestimation of symptoms and signs such as dyspnea (85%), pleuritic chest pain (31%) or phlebitis (46%) that were present months or years earlier. Alternative diagnoses erroneously made were dyspnea of unknown origin (5 cases), left heart failure (4 instances) and pneumonia (2 cases). Once CTPH has developed, chronic dyspnea (92%) and substernal chest pain (100%) are almost always present: chest radiograph and ECG show signs of chronic hypertension such as enlargement of hila (100%), right heart sections (77%), azygos vein (46%) and P pulmonale (67%), T inversion on right precordial leads (75%), S-T segment depression (75%), respectively. Perfusion scintigraphy shows severe perfusion impairment (55.7% of the total vascular bed) paralleled by severe hypoxia (standard PaO2 = 49 +/- 14.1 mm Hg). In conclusion, patients with PE who develop CTPH are not diagnosed and thus untreated because clinical symptoms and signs of acute PE have not been recognized. If CTPH develops, clinical assessment (including simple and noninvasive techniques such as chest radiograph, ECG and blood gas analysis) may show a quite characteristic pattern useful for diagnosis.
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PMID:From not detected pulmonary embolism to diagnosis of chronic thromboembolic pulmonary hypertension: a retrospective study. 846 23


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