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

In patients with chronic lung disease, the response to exercise can be impaired by ventilatory and/or circulatory disturbances. The response to a standard exercise varies according to the load in relation to the maximum load the subject can tolerate. Thus it seems more suitable to study the maximum tolerated, i.e. maximum workload expressed as VO2 max. We compared the results of VO2 max and pulmonary haemodynamic variables in 43 patients with chronic bronchitis. VO2 max ranged from 0.720 to 3.010 l/min. The relation between VO2 max and pulmonary artery pressure at rest or its increase with low level exercise was very poor, but there was a trend towards an increase in pulmonary vascular resistance in patients with low VO2 max, although a number of patients with low VO2 max had normal pulmonary vascular resistance. The ratio between heart rate at maximum workload and maximum heart rate according to age (heart rate obs/pred) was above 95% in the patients with pulmonary vascular resistance above 250 dyn.s. cm-5; it varied widely in the patients with normal or slightly elevated pulmonary vascular resistance. When VO2 max was below normal, and heart rate obs/pred low, it is probable that the decrease in VO2 max was due to ventilation impairment, or to a lack of cooperation. Oxygen pulse at VO2 max was also reduced in patients with high pulmonary vascular resistance, but a large range of values was observed in the rest of the patients. A high oxygen pulse at VO2 max however allows to rule out severe pulmonary artery hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Is it possible to predict pulmonary arterial hypertension from an exercise test? 653 68

The use of theophylline in the treatment of chronic lung disease is wide spread thanks to the positive effects on the bronchial tree, on ventilation and on diaphragmatic contractile activity, which are well documented. On the other hand, the cardiovascular effects of this drug have not been studied much, particularly the effects on the hemodynamics of the pulmonary circulation. The latest studies were carried out by Parker (1966 and 1967) and by Jezek (1970) with heart catheterization and by Matthay (1978) with isotopic angiocardiography, but the problem has not been fully explored from the standpoint of pulmonary arterial hypertension. Therefore we are studying the effects of intravenous infusions of aminophylline in patients with chronic obstructive lung disease, trying to examine the effects of this drug on three different groups of patients: the 1st without pulmonary arterial hypertension; the 2nd with latent pulmonary arterial hypertension; the 3rd with evident pulmonary arterial hypertension. We consider pulmonary arterial hypertension as pulmonary arterial pressure greater than 20 mmHg at rest and pulmonary arterial pressure greater than 35 mmHg at the end of 8 min of exercise in the supine position, with 40 W load cycle ergometer. The experimental protocol includes the clinical and functional identification of subjects with chronic obstructive long disease, the performance of right heart catheterization and the cannulation of a peripheral artery, measuring all pressure levels, cardiac output, hemogasanalytic data and theophylline levels in steady state (20-30 min. after the end of invasive manoeuvres) at the 10th, 20th and 30th min after the end of an infusion of 10 mg/kg of aminophylline.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effects of theophylline-ethylendiamine on chronic pulmonary arterial hypertension secondary to chronic obstructive pulmonary disease. 653 71

An echocardiographic M-mode study has been performed on 58 patients with pulmonary arterial hypertension at rest or on exercise, with chronic lung disease, either obstructive (41 cases of COLD) or restrictive (17 cases of interstitial lung disease, ILD) in nature. The average Ppa was practically the same (i.e. 27.3 +/- 11.7 mmHg and 26.0 +/- 8.0 mmHg respectively) in the two groups of patients, even though the COLD patients were older than the ILD patients (58.7 +/- 9.3 vs 38 +/- 11 years). The echo detection of the pulmonary valve was successful in only 35% of COLD patients and in 86% of ILD patients (p less than 0.01). A multiple regression analysis disclosed a rather weak, but nevertheless statistically significant, correlation (p less than 0.01) between 1) Ppa and the ratio of right ventricular to left ventricular end-diastolic volume, and 2) between right ventricular end-diastolic pressure and septal systolic displacement. The standard error of estimated versus actual Ppa taking into account the ventricular and septal echo variables was as high as +/- 7.63 mmHg, thus preventing a reliable prediction of Ppa in individual cases. An echocardiographic pattern of pansystolic mitral valve prolapse was observed in 29% of ILD patients, but never in cases with COLD.
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PMID:Echocardiographic aspects of pulmonary arterial hypertension in chronic lung disease. 674 67

The role of active and passive factors involved in the genesis of Pulmonary Arterial Hypertension (PAH) is analyzed in a group of eighty patients with several cardiopathies and pneumopathies. The group include: 20 patients with Chronic Obstructive Lung Disease (NODC), 20 with Diffuse intersticial pneumopathy (NI), 12 with Cardiorespiratory Syndrome of the grossly obese (OB), 6 with Pulmonary Embolism (TEP), 6 with Mitral Stenosis (CRI), 5 with Hypertensive Ventricular Septal Defect (CIV + HAP) and 11 patients with Pulmonary Arterial Hypertension of Unknown etiology (HAP-ED). For the analysis, the Harvey and Enson's formulas were used. The conclusions of the study are: 1) The compliance of the elastic arteries of the lung in the groups of NOC, NI and OB is normal but in the other groups seems to be modified. 2) In the groups of NI and OB the interrelationship of factors such as alveolar hypoxia and pulmonary wedge pressure (PWP) play the major role in the genesis of PAH, although the role of the PaCO2 in the OB group remains to be established. 3) In the groups of NOC, CRI and TEP the PWP is not determinant. The absence of a significant correlation between arterial oxygen unsaturation and pulmonary diastolic pressure in the NOC group suggests other factors. 4) The vascular structural damage seems to be the most important factor in the genesis of PAH in the HAP-ED and CIV + HAP groups.
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PMID:[Active and passive factors in the genesis of pulmonary arterial hypertension in various cardiopathies and pneumopathies]. 678 61

Clonidine hydrochloride (Catapres), a potent antihypertensive agent, has been in clinical use since 1974 in the United States. Clonidine, an alpha-adrenergic receptor agonist, stimulates central alpha receptors in the depressor site of the vasomotor center of the medulla oblongata and hypothalamus, which diminishes efferent sympathetic tone to the heart, kidneys, and peripheral vasculature with a concomitant increase in vagal activity. Hemodynamic and renal effects include reduction in supine and erect blood pressure, heart rate, total peripheral resistance, plasma renin activity, and urinary aldosterone and catecholamine excretion, with little effect on resting cardiac output, response to exercise, and preservation of renal function. Clonidine alone produces a significant reduction in mean arterial pressure in all degrees of hypertension during acute and chronic administration, with little or no tendency toward tolerance or postural hypotension. Its antihypertensive potency is enhanced with the concomitant use of a diuretic or vasodilator, and it may be used in place of a beta blocker with equal efficacy in the diuretic plus vasodilator combination. Serious adverse effects are uncommon, with more than 93% of patients tolerating the drug well. Sedation and dry mouth, the most common adverse effects, are usually related to dose and duration and are minimized by gradually increasing the dose and by taking the major portion of the twice-daily schedule at bedtime. Clonidine may be safely given to patients with congestive heart failure, ischemic heart disease, obstructive lung disease, chronic renal insufficiency, and diabetes mellitus. Clonidine is one of the most versatile and effective agents presently available for the treatment of hypertension.
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PMID:Clonidine hydrochloride. 704 65

During 1976-1988 we diagnosed sleep apnea syndrome (SAS) in 1,620 adult men and women monitored in the Technion sleep laboratories. Their age at the time of diagnosis ranged between 21 and 79 years. Fifty-seven patients (53 men and 4 women) had died by 1990, 53% due to respiratory-cardiovascular causes. The observed/expected (O/E) mortality rates, calculated for men only, revealed excess mortality of patients under 70 years old. Excess mortality was significant in the fourth and fifth decades (3.33, p < 0.002; 3.23, p < 0.0002, respectively). In patients older than 70 O/E was 0.33 (p < 0.0007). Hierarchical multivariate analysis with four fixed variables [age, body mass index (BMI), hypertension and apnea index] and four additional variables added manually one at a time (heart disease, lung disease, diabetes, apnea duration) was used to determine the predictors of death from all causes, cardiopulmonary causes and from myocardial infarction (MI). All four major variables were found to be significant predictors of mortality from all causes, in addition to lung disease and heart disease. Only age and BMI were significant predictors of cardiopulmonary deaths in addition to lung disease. Age, BMI and hypertension predicted MI deaths in addition to lung disease. These results were interpreted to suggest that SAS affects death indirectly, most probably by being a risk factor for hypertension.
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PMID:Mortality in sleep apnea patients: a multivariate analysis of risk factors. 938 Oct 62

The application of lung transplantation to the pediatric population was a natural extension of the success realized in our adult transplantation program, which began in 1982. Twenty pediatric patients (age range 3 to 18 years) have had heart-lung (n = 11), double lung (n = 8), and single lung (n = 1) transplantation procedures. The causes of end-stage lung disease were primary pulmonary hypertension (n = 7), congenital heart disease (n = 5), cystic fibrosis (n = 4), pulmonary arteriovenous malformation (n = 2), graft-versus-host disease (n = 1), and desquamative interstitial pneumonitis (n = 1). Four (20%) patients had thoracic surgical procedures before the transplantation operation. The survival was 80% at a mean follow-up of 2 years. Immunosuppressive drugs included cyclosporine (n = 9) or FK 506 (n = 11) based therapy with azathioprine and steroids. Children were followed up by means of spirometry, transbronchial biopsy, and primed lymphocyte testing of bronchoalveolar lavage fluid. The mean number of treated episodes of rejection was 1.4 at 30 days, 0.5 at 30 to 90 days, and 1.4 at more than 90 days, and the first treated rejection episode occurred on average 28 days after the operation. Obliterative bronchiolitis developed in four (25%) of 16 patients surviving more than 100 days. Results of pulmonary function tests have remained good in almost all recipients. The greatest infectious risk was that of cytomegalovirus: one death and one case of pneumonia. Posttransplantation lymphoproliferative disease was diagnosed in two (12.5%) patients; both recovered. The most common complications were hypertension (25%) and postoperative bleeding (15%). Early results indicate that lung transplantation is a most promising therapy for children with severe vascular and parenchymal lung disease.
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PMID:Pediatric lung transplantation. The years 1985 to 1992 and the clinical trial of FK 506. 767 72

The recognition that inhaled nitric oxide (NO.) selectively vasodilates the pulmonary vasculature and the fact that pulmonary artery hypertension appears to play a pivotal and central role in the clinical manifestations of adult respiratory distress syndrome have led to an explosion of interest in this treatment modality. Improved pulmonary function and reduced ventilatory support have been noted in some patients with acute lung disease treated with inhaled NO.. The efficacy of inhaled NO. in various animal models has been inconsistent. Although it appears likely that inhaled NO. will be a useful adjunct in the treatment of patients with acute lung disease, the appropriate role of inhaled NO. in the treatment of ARDS remains uncertain. In order for inhaled NO. to be clinically useful in patients, this modality will have to be combined with other treatments that alter the florid inflammatory response. One should anticipate the most benefit in patients in whom respiratory failure is secondary to pressure-driven pulmonary edema and true intrapulmonary shunt.
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PMID:Inhaled nitric oxide in acute lung disease. 770 94

Our objective was to examine the relationship of a self-reported physician diagnosis of arthritis with disability in elderly community dwelling women. Data from a representative sample of 1541 women aged 65 and above were analyzed to determine the prevalence and associations of a self-reported physician diagnosis of arthritis with other chronic conditions and difficulty performing physical activities. A history of physician diagnosed arthritis was reported by 902 (58.5%) women. Women with arthritis were significantly more likely to report fair or poor perceived health, as well as a physician diagnosis of angina, myocardial infarction, hypertension, diabetes, stroke, lung disease, and hearing and vision problems. After adjustment for age, race, education, marital status, and comorbid/geriatric conditions, arthritis was significantly associated with difficulty in the following 13 activities: raising arms, lifting < or = 10 pounds, walking 2-3 blocks, bathing or showering, climbing 10 steps, grasping, getting in or out of a bed or chair, dressing, using the toilet, preparing meals, doing personal shopping, heavy and light housework. We conclude that physician diagnosed arthritis is a common problem among elderly community dwelling women and is associated with difficulties in physical activity.
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PMID:The contribution of osteoarthritis to disability: preliminary data from the Women's Health and Aging Study. 775 25

Hereditary peculiarities in individual responses to environmental chemicals are a common occurrence in human populations. Genetic variation in glutathione S-transferase, CYP1A2, N-acetyltransferase, and paraoxonase exemplify the relationship of metabolic variation to individual susceptibility to cancer and other toxicants of environmental origin. Heritable receptor protein variants, a subset of proteins of enormous pharmacogenetic potential that have not thus far been extensively explored from the pharmacogenetic standpoint, are also considered. Examples of interest that are considered include receptor variants associated with retinoic acid resistance in acute promyelocytic leukemia, with paradoxical responses to antiandrogens in prostate cancer, and with retinitis pigmentosa. Additional heritable protein variants of pharmacogenetic interest that result in antibiotic-induced deafness, glucocorticoid-remediable aldosteronism and hypertension, the long-QT syndrome, and beryllium-induced lung disease are also discussed. These traits demonstrate how knowledge of the molecular basis and mechanism of the variant response may contribute to its prevention in sensitive persons as well as to improved therapy for genetically conditioned disorders that arise from environmental chemicals.
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PMID:Influence of heredity on human sensitivity to environmental chemicals. 778 56


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