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

The Age-Related Macular Degeneration Study-Krypton Laser (AMDS-K) is a multicenter controlled clinical trial designed to determine whether krypton red laser photocoagulation is of value in preventing visual acuity loss in eyes with macular degeneration that have either choroidal neovascularization 1 to 199 microns from the center of the foveal avascular zone or choroidal neovascularization 200 microns or farther from the foveal avascular zone center with blood and/or blocked fluorescence extending within 200 microns of the foveal avascular zone center. Recruitment ended in December 1987 after 247 patients had been assigned to photocoagulation and 249 patients had been assigned to no treatment. At 3 years after randomization, 49% (86/174) of treated eyes, in contrast to 58% (98/169) of untreated eyes, had lost six or more lines of visual acuity. The average visual acuity of treated and untreated eyes at that time was 20/200 and 20/250, respectively. The benefit of laser treatment was largest among patients without evidence of hypertension and diminished to no apparent benefit among patients who had highly elevated blood pressure and/or used antihypertensive medication. Treatment of lesions meeting the AMDS-K eligibility criteria in eyes of patients with no hypertension is recommended. However, treatment cannot be recommended uniformly for patients with definite hypertension having lesions similar to those of patients enrolled in the AMDS-K.
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PMID:Krypton laser photocoagulation for neovascular lesions of age-related macular degeneration. Results of a randomized clinical trial. Macular Photocoagulation Study Group. 170 1

Reported are 15 cases of age-related macular degeneration (AMD) complicated by massive subretinal and/or vitreous hemorrhage. Clinicopathologic correlation is presented in four of the seven cases studied histopathologically. Salient histologic findings include: subretinal and subretinal pigment epithelium (sub-RPE) fibrovascular scar in the posterior pole; discontinuities in Bruch's membrane with choroidal neovascularization; extensive hemorrhagic detachment of the RPE and sensory retina; and vitreous hemorrhage. In three cases, a choroidal artery, emerging from breaks in Bruch's membrane, had ruptured walls. The authors have reviewed the previously reported cases of AMD complicated by massive hemorrhage and found that 19% of the patients were taking Coumadin (warfarin) or aspirin treatment when the bleeding occurred. Forty percent had a positive history of systemic hypertension and cardiovascular diseases. Although the occurrence of hypertension is expected in the aged population with AMD, use of anticoagulants or antithrombotics by such patients may predispose them to serious ocular hemorrhagic complications.
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PMID:Massive hemorrhage complicating age-related macular degeneration. Clinicopathologic correlation and role of anticoagulants. 243 58

Data from the first National Health and Nutrition Examination Survey collected between 1971 and 1972 were used to determine what factors are associated with the prevalence of age-related macular degeneration. The study was limited to those who were at least 45 years old at the time of the ophthalmology examination. Stratified analysis, adjusting for age, showed that education, systolic blood pressure, past history of hypertension, cerebrovascular disease, and refractive error were all associated with macular degeneration. With the exception of education, these factors remained statistically significant when simultaneously entered into a logistic regression model. The frequency of consumption of fruits and vegetables rich in vitamins A and C suggested a negative association with the prevalence of macular degeneration after stratified adjustment for age. In a logistic regression analysis, adjusting for demographic and medical factors, the inverse association of vitamin C with age-related macular degeneration was no longer present. The frequency of consumption of fruits and vegetables rich in vitamin A remained negatively correlated with age-related macular degeneration even after adjustment for demographic and medical factors.
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PMID:Factors associated with age-related macular degeneration. An analysis of data from the first National Health and Nutrition Examination Survey. 342 Dec 36

Even in the presence of normal blood pressure (B.P.) in both arms in some individuals, abnormal B.P. and circulatory disturbances can be found in the brain and lower extremities. The author discovered the following five types of abnormal B.P. in the brain in the presence or absence of normal B.P. in the arms: unilateral cephalic hypertension; bilateral cephalic hypertension; unilateral cephalic hypotension; bilateral cephalic hypotension; mixed cephalic hypertension and hypotension. When the B.P. of the head exceeds about 160 mm Hg, patients experience sensation of increased pressure buildup in the head to moderate headache. When it exceeds over 220 mm Hg, most of them experience severe headache in that side of the head. When the B.P. is very low (less than 30 mm Hg in both sides), majority of the subjects experience sleep disturbance pattern, mainly insomnia and some develop excessive sleepiness; difficulty in concentration and easy forgetfulness of recent events; various degrees of irritability. They are often associated with injury of neck-shoulder area with the presence of spastic muscles in the area. Relaxation of the spastic muscles by acupuncture, TES or soft laser beam from He-Ne (7 approximately 15m Watts) often change the abnormal cephalic B.P. toward normal. Among individuals with cephalic hypotension some of them develop eye problems. Blind patients with macular degeneration and retinitis pigmentosa often have severe cephalic hypotension and reduced blood flow. Improvement of B.P. and blood flow induced by safe and effective electrical stimulation resulted in significant improvement in vision. In some patients, abnormal B.P. and blood flow of the brain are dependent on the position of the head and neck which can be classified as "Cephalo-cervical Position Dependent Dysfunction Syndrome" which interferes with the function of some of the internal organs. In many psychiatric patients with schizophrenia or severe depression, cephalic B.P. and blood flow are often reduced significantly with additional abnormal function of pancreas, thyroid gland or liver. These abnormalities can explain some of the abnormal behavior, particularly when hypoglycemia, decrease in serotonin level and decreased circulation in the brain coexist.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Non-invasive circulatory evaluation and electro-acupuncture & TES treatment of diseases difficult to treat in Western medicine. 614

Diabetes affects the microcirculation, the large arteries and occasionally the large and small veins, by inducing vessel wall sclerosis. The degree of stiffening produced is linked to its duration. The ability of the diabetic's circulation to distribute blood is affected, especially during increased blood flow. In most tissues this causes no serious burden, but three tissues are unusually susceptible to disturbance--the retina, renal cortex, and peripheral nerve. They develop serious problems in many longstanding diabetics. Damage to the kidney appears to be linked to its unique combination of high blood flow rate and precise control of intraglomerular filtration pressure. As renal arteriolar intima hyalinizes, the glomerular mesangium increases in volume. Diabetic renal changes appear to become irreversible when a critical stage, manifested be albuminuria and hypertension, is reached. The resulting renal failure is associated with clumpy deposits of type IV collagen in the cortex, suggesting that local microvascular autoregulation has been lost. The retinal circulation forms late in fetal life in a process in which local oxygen tension controls new vessel formation. In adult diabetics, local retinal oxygenation is disrupted by a condition called capillary closure, and intraretinal microaneurysms form. In advanced retinopathy, new microvessel systems grow into the vitreous through defects in the internal limiting membrane, producing hemorrhage and vitreous opacification. Macular degeneration is also seen in older diabetics, suggesting that the choroidal circulation may also be compromised. Evidence for a microcirculatory role in diabetic peripheral nerve damage is not as conclusive as for the kidney and retina. The longest peripheral nerves are typically the most affected. Recent studies suggest that nerve damage can be produced by a disturbance in local pressure-flow relationships combined with epineurial mechanical constraint. Hypotheses about the pathogenesis of diabetic vascular sclerosis are reviewed, including collagen-stiffening, elastin degeneration, hemorheologic burden, metabolic disruption, increased permeability, and auto-immune disturbance.
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PMID:The microcirculation in diabetes. 640 Apr 26

Forty-four unselected patients with amaurosis fugax (AF) have been followed for 4.6 years (mean 2.6). Thirty per cent had atheromatous lesions, 20% had miscellaneous diagnoses (temporal arteritis 5, transitory ocular hypertension 2, glaucomatous iritis 1, benign intracraniel hypertension 1), 50% consisted of young, mainly women, in whom no cause was found. Prior to AF 2 had hemiplegia, 4 TCI, one optic atrophy and suspicion in 3. None died, one developed hemiparesis and one macular degeneration. An individual conservative attitude to AF seems justified in this material.
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PMID:Amaurosis fugax. A unselected material. 663 19

A case-control study was planned as a part of the Casteldaccia Eye Study in order to investigate about risk factors of ocular hypertension and glaucoma. Cases were 44 subjects with glaucoma or intraocular pressure of 24 mm Hg or more. Controls were 220 subjects with intraocular pressure of 20 mm Hg or less and no signs of glaucoma. A number of environmental, behavioral, systemic and ocular variables were studied. Among the others we investigated the following: sunlight exposure, smoking, alcohol intake, pregnancies, systemic hypertension, diabetes, use of corticosteroids, refractive status, anterior chamber depth, lens nuclear sclerosis, iris color and texture. After univariate analysis the use of ocular corticosteroids and antibiotics, myopia, shallow anterior chamber and myopic macular degeneration were associated with ocular hypertension or glaucoma. However, the logistic regression showed that only the use of ocular corticosteroids (odds ratio = 7.79) and the myopia (odds ratio = 5.56) were independently associated.
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PMID:Risk factors of ocular hypertension and glaucoma. The Casteldaccia Eye Study. 792 48

A new method for the examination of choroidal morphology and hemodynamics by SLO-ICG videoangiography under induced hypertension by ocular ophthalmodynamography is presented. In 17 normal subjects, 32 patients suffering from exudative age-related macular degeneration and 13 patients suffering from subretinal fibrosis, the arterial blood vessels of the choroid were demonstrated in detail angiographically. Perfusion pressures of posterior ciliary arteries at their entry into the eye were also estimated. In the majority of patients in each group the central retinal artery was first filled with dye; in the central 40 degrees field 5-8 posterior ciliary arteries were detected; the arterial branches of the submacular choroid were supplied by a submacular ciliary artery in more than half of the cases; however, dye filling of the submacular choroid occurred later than in the surrounding choroid during reduction of intraocular pressure. ICG fluorescence angiography is compared to other angiographic examination methods of choroidal morphology and hemodynamics.
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PMID:[Hypertensive choroid angiography. Initial results]. 808 44

Early and late age-related macular degeneration (AMD) have a high prevalence in elderly patients but may be differentiated by medical or environmental factors, eg, hypertension, geographic area, or antioxidant agents. Because nuclear sclerotic cataract is associated with AMD both aging changes may share a common pathogenesis. The genetic predisposition for AMD is indicated by the identical appearance in monozygotic twins, but genetics may be also important for the explanation of the low incidence of late AMD in black individuals. Specific ocular characteristics like light or depigmented iris color, prolonged dark adaptation, and decreased foveal flicker sensitivity are also risk factors for AMD. Early AMD characteristics with high risk for late AMD are confluent drusen, focal hyperpigmentation, or atrophy and slow choroidal fluorescein filling. Therefore specific genetic, environmental, medical, and ocular characteristics determine the individual appearance and progress of AMD. The knowledge of these factors may result in new prophylactic and specific treatments for AMD.
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PMID:Prevalence of age-related macular degeneration. 1015 Aug 70

Recent population-based studies suggest that the fundus lesions of hypertension also occur in people without hypertension. In experimental studies, hypertensive lesions, which used to be the backbone of older classifications of the severity of hypertension, did not correlate sufficiently with severity to allow reliable grading. Hypertensive retinopathy, choroidopathy, and optic neuropathy are independent processes. Vascular narrowing appears to occur early in the disease process, whereas retinal hemorrhages and retinal lipid may occur later. Branch vein occlusion is a complication of hypertension, whereas open-angle glaucoma may not be. Choroidal neovascularization in the fellow eyes of patients with macular degeneration is associated with high blood pressure. Laser treatment for this disorder is less effective in patients with high blood pressure than it is in normotensive individuals, which suggests that choroidal neovascularization may be an expression of chronic hypertensive choroidopathy. Hypertensive optic neuropathy, a variant of ischemic optic neuropathy, has delayed onset compared with retinopathy and, in experimental studies, has not been linked to the severity of hypertension. Given these findings, it may be better to describe than to grade fundus lesions. In either event, it is important to take blood pressures accurately. Fundus lesions suggest high blood pressure. Sphygmomanometry is more specific and reliable than funduscopy in making that diagnosis.
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PMID:Ocular manifestations of systemic hypertension. 1038 39


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