Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To examine the clinical outcome for patients with myocardial infarction and to analyze clinical predictors for long-term prognosis, 1,000 patients were studied retrospectively. Between January 1983 and December 1987, 1,002 consecutive patients with myocardial infarction, who resided in the Kyoto and Shiga districts, were reviewed after coronary arteriography, but in two patients medical records were not located. During 3.3 +/- 2.0 years, 75 patients died of cardiac causes and 301 experienced cardiac events (death, reinfarction, and revascularization). Overall 5-year cardiac mortality was 8% and cardiac event rate was 35%. Among determinants of age, smoking, hypertension, diabetes mellitus, heart failure, postinfarction angina, serious arrhythmia, mitral regurgitation, digitalis and diuretics administration, ejection fraction (EF), left main trunk disease, and number of diseased coronary arteries selected by univariate analysis, multivariate analysis revealed that heart failure, EF, number of coronary vessel disease, diabetes, and mitral regurgitation were the important predictors of cardiac death. For cardiac events, multivariate analysis demonstrated that the number of diseased coronaries, postinfarction angina, and left main trunk disease were significant predictors. Therefore, impaired left ventricular function and myocardial ischemia appear to be important markers for cardiac death, but impaired left ventricular function does not appear to be a predictor for cardiac events. The data obtained in this study will be useful in the assessment of patients with myocardial infarction and will be of clinical significance in predicting mortality and cardiac events.
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PMID:Long-term prognosis after myocardial infarction: univariate and multivariate analysis of clinical characteristics in 1,000 patients. Kyoto and Shiga Myocardial Infarction (KYSMI) Study Group. 816 71

Mitral annular calcium (MAC) is a condition that often occurs in patients with systemic hypertension. To evaluate the effectiveness of nifedipine in preventing MAC, 223 patients with systemic hypertension of recent onset and without MAC were selected and randomly enrolled in 3 groups: group 1 (76 patients) received nifedipine; group 2 (72 patients) received enalapril; and group 3 (75 patients) received atenolol. After 5 years, these treatments significantly reduced systolic (p < 0.001) and diastolic (p < 0.05) blood pressure (BP) in 3 treated groups. M-mode echocardiography revealed MAC only in 2 patients in the nifedipine group (2.6%), in 13 in the enalapril group (18%) and in 15 in the atenolol group (20%). The degree of MAC was mild (< 5 mm) in the 2 patients in group 1, in 5 of the 13 in group 2, and in 6 of the 15 in the group 3, whereas it was severe (> 5 mm) in the remaining 8 in the enalapril group and in the other 9 in the atenolol group. There was also a significant correlation in the degree of MAC, left atrial enlargement and mitral regurgitation. In addition, atrial fibrillation and atrioventricular conduction defects were associated with severe MAC. These results indicate that nifedipine is an effective drug both in the long-term management of systemic hypertension and in preventing or delaying MAC.
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PMID:Slowing of mitral valve annular calcium in systemic hypertension by nifedipine and comparisons with enalapril and atenolol. 821 84

One hundred and four patients with Williams-Beuren syndrome were investigated from 1958 to 1992. Follow-up ranged from 1 to 32 years (mean 13), during which time 10 patients died and 17 were lost to follow-up. Seventy-six patients were in NYHA classes I and II and one was in class III. When first investigated, blood pressure was raised in 82% of the patients; at the latest evaluation 52% suffered from high blood pressure. Right heart catheterization was performed in 100 patients and repeated in 19; left heart catheterization was performed in 85 patients and repeated in 21. Right ventricular pressure ranged from 20 to 140 mmHg (mean 45), the mean pressure decreased from 66 mmHg to 50 mmHg (P < 0.006), the average value of the 19 patients in whom the measurements were repeated. The supravalvular aortic gradients ranged from 0 to 110 mmHg (mean 27), and the mean value of the 21 patients with repeated catheterization increased from 13 to 27 mmHg (P < 0.03). Twenty-nine patients underwent operative repair, two patients died peri-operatively. Pre-operative aortic gradients ranged from 40 to 110 mmHg (mean 76), postoperative gradients from 0 to 90 mmHg (mean 15). Forty-one adult patients were reevaluated. Doppler investigation revealed mild aortic insufficiency in eight patients and severe mitral regurgitation in one. In 32 patients, bicycle exercise testing was normal.
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PMID:Williams-Beuren syndrome: a 30-year follow-up of natural and postoperative course. 829 25

A 65-year-old man with long-standing hypertension developed cardiogenic shock due to the onset of left ventricular outflow obstruction and severe mitral regurgitation after surgical repair for abdominal aortic aneurysm. This complication occurred in the early postoperative period and reversed immediately after treatment with intravenous verapamil.
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PMID:Reversal of cardiogenic shock and severe mitral regurgitation through verapamil in hypertensive hypertrophic cardiomyopathy. 832 4

We investigated the incidence and mechanism of pulmonary artery hypertension (PAH) in a consecutive series of patients with aortic stenosis who were undergoing diagnostic cardiac catheterization. Forty-five patients with severe aortic stenosis were divided into two groups: group 1 comprised 13 patients (29%) with PAH (pulmonary artery systolic pressure > 50 mm Hg); group 2 comprised 32 patients (71%) without PAH. Group 1 patients had a higher incidence of congestive heart failure, a lower left ventricular ejection fraction and cardiac index, and more mitral regurgitation as compared with group 2 patients. Of the 13 group 1 patients, 8 had a transpulmonary gradient (pulmonary artery mean pressure--pulmonary capillary wedge pressure) > or = 10 mm Hg, consistent with reactive PAH. We conclude that PAH frequently accompanies aortic stenosis and is often reactive.
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PMID:Pulmonary artery hypertension in severe aortic stenosis: incidence and mechanism. 841 10

Mitral valve prolapse (MVP) is considered to be the most common valvular heart lesion in adult females of reproductive age. Our report reviews the obstetrical performance and outcome of 34 pregnancies in 15 women with MVP. In 12 (80%) patients cardiac lesion was suspected due to enigmatic dyspnoea and palpitation during antenatal period. Four mothers required propranolol for cardiac arrhythmias. However, all of them tolerated pregnancy and labour well. Four pregnancies (11.8%) ended in spontaneous abortion and 1 mother had intrauterine fetal death due to severe pregnancy-induced hypertension. There were 25 (73.5%) term and 3 (8.8%) preterm neonates without congenital abnormality. One preterm neonate had tracheo-oesophageal fistula and died 6 hours after corrective surgery. The mean birth weight of 2.8 kg was appropriate for mean gestation of 38.5 weeks when compared to the Institute's reference neonatal weight curve. Infective endocarditis prophylaxis was recommended in cases having mitral regurgitation and complicated delivery. Awareness of this common cardiac lesion, thorough cardiovascular examination during pregnancy, early detection and treatment of cardiac arrhythmias if any, are the essential steps to prevent rare but dreaded maternal complications.
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PMID:Pregnancy in association with mitral valve prolapse. 848 69

Physicians should be concerned about contraception for women with mitral valve prolapse (MVP), hypertension, and angina pectoris, because pregnancy places an extra burden on the cardiovascular system (e.g., about 50% rise in blood volume and cardiac output and a large increase in extravascular fluid) and the chosen contraceptive method could cause adverse circulatory effects. Nonpregnant hypertensive should be treated with hygienic measures (e.g., weight reduction and restriction of sale) before physicians prescribe drugs (e.g., diuretics and beta blockers). Oral contraceptives (OCs) tend to induce only small increases in blood pressure. Further, hypertension in women causes less target organ damage than it does in men in the same age group. Therefore, OC use in nonsmoking, hypertensive women has little clinical effect, although physicians should monitor their blood pressure of these patients. Safe alternative contraceptives are progestin-only OCs and the IUD. MVP usually has benign clinical symptoms, so it generally does not pose a risk during pregnancy. Coagulation problems do occur, however, in a small number of MVP patients, thereby making those who use Ocs more vulnerable to thromboembolism. As long as an MVP patient does not have clinical symptoms (e.g., mitral regurgitation) or does not smoke, she can use OCs. MVP patients can use the IUD, but those with mitral regurgitation should take antibiotics during insertion to avoid systemic infection. Pregnant women with true angina are at increased risk of myocardial infarction (MI). Women who experience MI during pregnancy face an infant mortality rate of 34%. Women with angina and no other risk factors can use OCs, especially because of their potential antiatherosclerotic effect. The IUD and progestin implants are safe and effective contraceptive choices for women with angina caused by coronary atherosclerosis. In many women with cardiovascular conditions, the risk of pregnancy is frequently greater than the risks linked to contraceptive use.
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PMID:Considerations for contraception in women with cardiovascular disorders. 851 45

In a six month period at the Kenyatta National Hospital, 46 patients (30 males) with chronic renal failure (CRF) and 22 healthy subjects have had a clinical and echocardiographic study of their cardiovascular systems. The patients with CRF were further classified as stable or in end stage renal disease (ESRD), the latter group requiring dialysis. Hypertension and circulatory congestion were the commonest clinical cardiovascular findings in patients with CRF. The patients with ESRD had significantly higher blood urea nitrogen and serum creatinine than the ones with stable CRF. Echocardiographically right ventricular size, left atrial size, aortic root diameter, left ventricular internal diameters, left ventricular end diastolic and systolic volumes, stroke volume, cardiac output, left ventricular posterior wall and interventricular septal thickness, ejection time and mitral and aortic peak flow rates were significantly higher in patients with CRF than in controls. In contrast, the circumferential fibre shortening and the ejection fraction were reduced in patients with CRF. Global left ventricular dysfunction was found in 47.8% of the patients. Using doppler flow studies, valvular incompetence was detected in a number of patients, mitral regurgitation being found in 84%.76% of the patients with CRF had varying degrees of pericardial effusion. The echocardiographic abnormalities and the pericardial effusions responded six weeks of haemodialysis in a variable manner.
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PMID:The spectrum of echocardiographic findings in chronic renal failure. 851 37

The purpose of this study was to demonstrate the special features of cardiovascular effects in connective tissue disorders through a group of fifteen cases observed over a period of ten years. The group consisted of eleven cases of Marfan syndrome (or Marfan-like syndrome), two cases of pseudoxanthoma elasticum and two cases of Ehlers-Danlos disease. The cardiovascular lesions were as follows: 1) dissection of the ascending aorta which was confirmed and had been treated surgically in 2 cases; 2) aneurysmal dilatation of the ascending aorta in 5 cases; 3) moderate mitral valve prolapse, which was isolated in 2 other cases; 4) distention of the mitral valve in 2 cases; 5) mitral valve prolapse combined with tricuspid valve prolapse in 1 case; the mitral incompetence was severe and made it necessary to carry out mitral valve replacement; 6) moderate aortic valve prolapse combined with tricuspid prolapse in a case of type-I Ehlers-Danlos disease; 7) Fallot's tetralogy combined with Marfan's syndrome and treated surgically in one case; 8) severe hypertension with abnormalities of the iliac and renal arteries in one case of elastic pseudoxanthoma elasticum. In three cases complications occurred leading to death, extension of the dissection of the abdominal aorta and global recalcitrant heart failure respectively. The outcome in the other 12 cases, with a mean follow-up time of 3 and one half years (range: 3 years to 7 years) was not marked by complications.
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PMID:[Cardiovascular manifestations of hereditary dysplasias of connective tissue]. 851 93

Eighty seven of 100 consecutive recruits referred for cardiac assessment of fitness to serve had heart murmurs. Seven of these were rejected as having significant cardiac disease. One with a diagnosis of hypertrophic cardiomyopathy would have been placed at considerable risk had he been exposed to the physical stress of military training. The remaining 6 rejected had conditions which could have been worsened by the stress of military training and/or required intensive cardiac follow-up. These included 3 individuals with aortic regurgitation, 1 with atrial septal defect, 1 with ventricular septal defect combined with a small atrial septal defect and 1 with post rheumatic fever mitral regurgitation. Thirteen patients we assessed because of other cardiac problems including repaired congenital heart disease and hypertension. The rejection rate in this group was high at 10 out of 13. The majority of those referred (83/100) were found to be fit for military service. Five of these required advice on antibiotic prophylaxis but the majority had totally unrestricted service. Although most recruits who present with cardiac "problems" will be fit for service, important and potentially fatal conditions can be detected. Therefore vigilance must be high amongst examining doctors and suspect individuals referred for appropriate assessment.
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PMID:Potential recruits referred for cardiac opinion review of 100 consecutive cases--a waste of time or an investment? 856 46


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