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

Beta-adrenergic blocking agents are commonly used for the management of hypertension, cardiac arrhythmias, and angina pectoris; several of these agents are now available for clinical use (1-5). A significant side effect of these agents in patients experiencing reversible airway obstruction is that they block the effects of beta-adrenergic agonists and can precipitate or worsen bronchospasm (6-8). Labetalol, a new adrenergic antagonist with both alpha- and beta-adrenergic blocking effects, has been shown to have certain advantages for the management of hypertension and is widely used for this purpose in many countries (9). To evaluate its effects on airway resistance in patients with obstructive lung disease, the authors conducted two separate clinical studies. This article summarizes the results of these trials.
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PMID:The use of labetalol for the treatment of hypertension in patients with reversible airway obstruction. 383 98

Although special residency programs preparing internists for primary care have been in existence for a decade, little is known about whether these tracks have achieved their goals. As part of a multicenter evaluation of ambulatory care at four university hospitals, 1,040 patient care encounters were reviewed for 16 primary-care and 41 traditional medicine residents. Using a chart-based audit, the authors examined 16 discrete items of patient care to assess resident management in the following areas: screening for colorectal carcinoma, management of hypertension, benzodiazepine drug prescribing, and management of chronic lung disease. Their hypothesis that primary care residents would score higher than traditional medicine residents in the areas of screening, prevention, and prescribing of drugs was not supported. There was no association between type of training and performance of a task with the following exception: second-year primary care residents screened for colorectal carcinoma in 86% (126) of patients whose charts were audited, while second-year traditional medicine residents did so in 77% (160) (P less than 0.025). This difference was not maintained when the residents were reaudited 1 year later. Both groups of residents scored high in all areas with the following exceptions: documentation of the amount of sedative dispensed and immunization of susceptible patients against pneumococcus and influenza. The ambulatory practices of both groups of residents exceeded expectations, probably because of the wider influence of primary care training.
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PMID:Comparing ambulatory care practices of primary care and traditional medicine residents. 401 Mar 63

Magnetic resonance imaging (MRI) was used to examine the right ventricle and pulmonary arteries in 17 patients with pulmonary artery (PA) hypertension documented by cardiac catheterization. The study population consisted of 7 patients with primary pulmonary hypertension, 7 with Eisenmenger's syndrome and 3 with pulmonary hypertension secondary to lung disease. The MRI studies of patients were compared with those of 10 normal volunteers. Multislice gated transaxial images encompassed the right ventricle and central pulmonary arteries, showing the severity of right ventricular (RV) hypertrophy in proportion to the elevation of PA pressure and reversal of septal curvature when PA pressure approximated systemic pressure. End-diastolic RV wall thickness and mean pulmonary pressure correlated well (r = 0.79). MRI showed enlargement of PAs in all patients with PA hypertension. A magnetic resonance signal was present in the PAs throughout the cardiac cycle in patients with severe PA hypertension (more than 90 mm Hg) and was absent during systole in normal subjects. A signal within the PAs in systole is consistent with decreased flow velocity in patients with severe PA hypertension. MRI was useful in detecting each of the congenital anatomic defects in patients with Eisenmenger's syndrome. This study indicates the potential of MRI for evaluating the severity of PA hypertension by providing direct measurements of RV wall thickness and PA diameter and by detecting abnormal intraluminal signal intensity during the cardiac cycle.
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PMID:Magnetic resonance imaging in pulmonary arterial hypertension. 407 27

The frequencies of several factors, including major physical disease, in employed and unemployed men enrolled in the British Regional Heart Study (BRHS) have been compared. The BRHS is a prospective study of cardiovascular disease in middle-aged men selected at random from general practices in twenty-four towns. The unemployed group was subdivided into those who said they were unemployed because of ill-health and those who regarded their unemployment as not due to illness. The ill unemployed reported a much higher rate of doctor-diagnosed illnesses than the not-ill unemployed or the employed. The frequencies of bronchitis, obstructive lung disease, and ischaemic heart disease were higher in the unemployed than the employed, with the highest rates in the ill unemployed. The frequency of hypertension was the same in employed and unemployed men. Cigarette smoking and heavy drinking were apparently more common among the unemployed, but after adjustment for social class and town of residence only smoking was slightly higher among the unemployed. Use of tranquillisers was three to four times more common in the ill unemployed than in the not-ill unemployed or the employed. In this study, the unemployed had far more chronic physical illnesses than the employed, whether or not the employed men regarded themselves as ill. Studies of the health consequences of unemployment must allow for the pre-existing state of health, and evidence on the state of health cannot rely solely on self-reporting of illness.
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PMID:Health of unemployed middle-aged men in Great Britain. 612 28

A representative sample of elderly Coloured persons (over the age of 65 years) in the community underwent a medical and psychosocial assessment of prevalent physical disorders and resultant disability. This revealed that hypertension, visual impairment, osteo-arthritis and chronic lung disease were the most prevalent and disabling conditions, while hearing impairment and major neurological disorders played a lesser role. Most of the individuals claimed that they had little or no disability, while 10 felt they were only moderately disabled and 21 (14,9%) that they were severely disabled. The number of disorders ranged from 2,08 in those claiming no disability to 3,28 in those who were severely disabled. Profiles of the results of biochemical investigations resembled those of other aged populations, serum cholesterol, creatinine and alkaline phosphatase levels being raised. The pattern of medical care was also examined, including medication and the use of local facilities.
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PMID:The coloured elderly in Cape Town--a psychosocial, psychiatric and medical community survey. Part III. A survey of physical disorders and disabilities. 622 89

472 randomly selected men and women from the city of Lund were examined for disease in the heart, lungs and for hypertension. 163 men and 194 women who had no symptom or sign of disease were accepted for the further study. The prevalence of various exclusion criterias, such as symptoms and signs of heart disease, lung disease and other diseases which may possibly affect the ECG are reported as well as the distribution of blood pressures in the sample. A computer-averaged standard 12-lead ECG (leads aVL, I, -aVR, II, aVF, III, V1-V6) was recorded. All measurements of ECG-deflections have been made visually using a magnifying glass (6 times). ST-segments were classified according to the Punsar code by independent visual observers as well as by the computer. The mean frontal QRS-axis shifted to the left with advancing age, but the shift was statistically significant only in men. In both men and women there was a leftward shift of the mean frontal QRS-axis with increased weight, increased chest circumference and increased obesity index. The normal range of axis was found to be 0 degrees to 90 degrees in men and +15 degrees to 90 degrees in women. The problems concerning the definition of the electrical heart position is discussed. The concept of a Q-axis is introduced as an alternative way to indicate electrical heart position. There is a statistical significant relationship between the Q-axis and the QRS-axis in the frontal plane, although this relationship is not always apparent in the individual ECG. The presence or absence of a Q-wave in an individual lead was used to denote a lead as being a left ventricular lead or not. Using the Q-wave as a marker of heart position in the individual lead is more practical than to use the QRS-axis or the transitional zone. Duration and amplitude of the Q-wave have been measured. The upper limit of normal duration exceeded 0.03 s in leads aVL and aVF in men but not in women. The R-wave amplitudes proved to vary with age and heart position in men. In women variation of the R-wave amplitude was found with heart position but not with age.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:On the normal scalar ECG. A new classification system considering age, sex and heart position. 624 Jan 93

Many of the Nation's approximately 100 million workers are exposed to some kind of occupational health hazard: carcinogenic agents, pulmonary or other physical disease incitant, physical agents or job-related pressures of noise, crowding, or stress. Exposure to toxic chemicals or physical hazards can produce chronic lung disease, cancer, degenerative disease in a number of vital organ systems, birth defects, and genetic changes. These exposures are estimated to result in 100,000 Americans dying each year from occupationally related illnesses, with an additional 400,000 cases of occupationally related disease. Yet many workers are inadequately protected from common hazards. Recent experience has demonstrated that occupational hazards can be controlled by modifying the work environment, patterns of job performance, or both. Among the health protection measures available are those which: alter the work environment to prevent exposures and injuries; provide workers with special protective equipment; specify design and maintenance of equipment; and provide employees with proper training. Some companies have ventured into the health promotion arena and offered their employees worksite programs for promoting health through health education, physical fitness activities, stress reduction activities, and preventive medicine including screening for high blood pressure, high cholesterol, and other factors related to heart disease.
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PMID:Health protection: Occupational safety and health. 641 22

The chest X-ray films of 251 patients with cardiovascular lesions, collected in the major hospitals of Papua New Guinea, were reviewed. Cor pulmonale (18%) and rheumatic heart disease (16%) were the predominant cardiac disorders, and cor pulmonale was the most common cause of cardiac failure (58%). Cardiomegaly or cardiac failure of unknown cause, possibly due to cardiomyopathy or myocarditis, made up 9% of the group and may be more important than has been thought previously. Aortic-arch calcification typical of atheroma was present in 21% of the patients, and is thus quite common, even though ischaemic heart disease remains very rare (1%). More than half of the patients with aortic atheroma had chronic lung disease, and though this could be explained by the coincidental frequency of both conditions, the possibility of an association or link in pathogenesis between them deserves further consideration. Anaemia was a common cause of cardiac enlargement (14%), and sometimes led to cardiac failure. Only 16 patients had hypertension (essential in 10 patients and renal in six), and this may indicate a change from the previously reported predominance of renal hypertension in Papua New Guinea towards a more equal incidence of the two conditions. Aneurysms of unknown cause were encountered in three fairly young patients. They had some resemblance to the aneurysms in arteritis of obscure origin described in Africa. There were also two dissecting aneurysms and one syphilitic aneurysm of the aorta. Congenital lesions (8%), pericarditis due to various causes (including tuberculosis), bacterial endocarditis (in four patients with rheumatic heart disease), and miscellaneous conditions made up the remainder of the series.
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PMID:Cardiovascular disease in Papua New Guinea. 644 34

To identify significant predictors of early and late mortality, multivariate discriminant analyses were applied to the clinical outcome of 175 consecutive patients with thoracic aortic aneurysms operated upon over a 20 year span. Only atherosclerotic and degenerative aneurysms were included; the patients were segregated into two groups according to location of the aneurysm. The ascending aortic aneurysm group consisted of 124 patients, 85% of whom required concomitant aortic valve replacement. There were 51 patients in the descending aortic aneurysm group. Mean follow-up was 4.9 years (maximum of 19 years), with a total of 860 patient-years of follow-up. Multivariate analyses revealed that surgical priority and advanced age were independent determinants of hospital mortality in the ascending group; for the descending group, surgical priority and the presence of congestive heart failure were the strongest predictors of hospital mortality. Late mortality in the ascending group correlated with advanced age. Hypertension and the presence of preoperative congestive heart failure were independent determinants of late mortality in the descending group. Several variables did not have any independent bearing on hospital or late mortality, including etiology and location of the aneurysm, previous myocardial infarction, chronic lung disease, and concomitant aortic valve replacement. High-risk subgroups of patients with thoracic aortic aneurysms can be identified by these variables. Aggressive medical plus surgical management and operation prior to aneurysm rupture is necessary to improve both early and long-term survival rates.
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PMID:Degenerative and atherosclerotic aneurysms of the thoracic aorta. Determinants of early and late surgical outcome. 650 14

Pulmonary circulation in the adult is a low pressure, low resistance system. Among the factors able to influence pulmonary arterial pressure the most important are hydrostatic pressure, intraalveolar pressure, left atrial pressure and alveolar gases, whilst the role of vasomotor tone is relatively limited. Granted that various hypertensive mechanisms can work jointly, the main forms of pulmonary arterial hypertension are the "passive" or "postcapillary" variety characterized by an elevated wedge pressure and the "precapillary" variety associated with a normal wedge pressure. The "precapillary" variety may be subdivided into hypertension due to increased blood flow, "obstructive" hypertension (e.g. thromboembolism), reactive hypertension (due to alveolar hypoxia) and hypertension transmitted from the bronchial circulation (bronchiectases?). In chronic lung disease pulmonary arterial hypertension is partly fixed and partly reversible.
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PMID:Mechanism of pulmonary arterial hypertension. 653 63


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