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

The frequency distributions of blood pressures in large populations fail to show two groups, one normotensive and the other hypertensive. In the spectrum of pressures, some people merely have higher levels than others and division of abnormal from normal is artificial and arbitrary, although it is useful for prognosis. The blood pressure of 140/90 as the conventional dividing line does not seem to be appropriate in pregnant women. From the standpoint of fetal prognosis, a level of 125/75 before the thirty-second week and 125/85 thereafter seems more reasonable. Moreover, those levels are close to the 120/80 that Robinson and Brucer specified as the upper limit of normal for all adults and are close to the 130/70 and 120/80 that the eminent British authority, F.J. Browne, used successively in the diagnosis of hypertensive disorders in pregnancy. If the standard of 125/75 were adopted, however, a quarter of all pregnant women would be hypertensive in the second trimester and half in the last month, which are disturbingly high proportions. For the diagnosis of preeclampsia, a rise in blood pressure probably is more significant than an arbitrary level. The usual blood pressure in midpregnancy merely defines the patient's place in the spectrum. Figure 9-1 indicates that in white nulliparas the diastolic pressure rises an average of 10 mm. Hg in the middle of the third trimester. If the mean and median are close together, greater increases would occur in half of the women. The classification of the American Committee on Maternal Welfare and of the Committee on Terminology of the American College of Obstetricians and Gynecologists specify increases of 30 mm. Hg or more in the systolic or 15 mm. Hg or more in the diastolic pressures as criteria of preeclamptic hypertension. pperhaps the rise in diastolic pressure should be set at some greater value. Our analysis of data made thus far cannot decide that issue. The next phase of the study will include analyses in individual women of the times, magnitudes, persistence or transience, and the like of changes in blood pressure, edema, and proteinuria. Such data will afford much more information than can be derived from the preliminary studies reported here. Although edema of the hands and face may be more common in preeclamptic than in normal women, such edema is so common in normal pregnancy as to suggest that it usually is normal. In our data, edema seems to bear no relation to hypertension or proteinuria. The triad of signs -- hypertension, proteinuria, and edema -- is generally accepted as characteristic, though far from specific for preeclampsia. Our data support Hytten's conclusion that edema should by dropped from the triad. There is some indication, however, that some edema is abnormal and that it is associated with an adverse effect when it coincides with proteinuria late in pregnancy.
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PMID:Blood pressure, edema and proteinuria in pregnancy. 9. Proposal for classification. 103 Jul 94

The ultrastructure of the arterial supply of the human placenta was studied in 15 pregnancies with severe fetal growth retardation. There were five patients with essential hypertension and superimposed pre-eclampsia, five patients with pre-eclampsia, and five patients with no hypertension. The patients were delivered by elective Caesarean section and biopsies of the placental bed were taken under direct vision. Extensive placental infarction was invariably present and the degree of infarction reflected the extent of pathological changes in the spiral arteries. In both hypertensive and normotensive patients the spiral arteries and basal arteries of the decidua showed occlusive atheromatous lesions with considerable fibrin deposition and accumulation of lipid-laden cells in both the intima and media of the vessel walls.
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PMID:The ultrastructure of the arterial supply of the human placenta in pregnancy complicated by fetal growth retardation. 103 83

1. Reversal of the normal diurnal blood pressure pattern has been demonstrated in women with severe hypertension and renal impairment in pregnancy (pre-eclampsia). 2. Maximum arterial pressure occurred at night in these women. The phenomenon was not due to hypotensive drug therapy or posture. Patients with uncomplicated essential hypertension in pregnancy retained a normal diurnal blood pressure pattern. 3. Nocturnal hypertension in pre-eclampsia is of theoretical interest and practical importance.
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PMID:Reversed diurnal blood pressure rhythm in hypertensive pregnancies. 107 9

Sera from 2,008 pregnant women were examined for the presence of complement-fixing platelet antibodies (CFPAb) and lymphocytotoxic antibodies (LCTAb). Women with antibodies in their serum were compared with women without antibodies. No clinical significance of CFPAb or LCTAb was found as regards pre-eclampsia, arterial hypertension, albuminuria, oedema, glucosuria, premature delivery, spontaneous onset of labor and abortion.
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PMID:Complement-fixing and lymphocytotoxic antibodies in serum of pregnant women at delivery II. Clinical observations I. 107 43

A prospective study of cord blood for coagulability, evidence for disseminated intravascular coagulation (DIC), and hematocrit was done in 106 infants who were offspring of mothers with high-risk pregnancies (pre-eclampsia, diabets mellitus, third-trimester bleeders, severe erythroblastosis fetalis, maternal hypertension, fetal distress, and spontaneous premature labor). Significant changes of hypercoagulability (low AT-III and abnormal TEG) were seen in the third-trimester bleeder and premature labor groups which also had the highest incidence of IRDS and necrotizing. Infants undergoing "stress" (pre-eclampsia, fetal distress) had elevated levels of factors V and VIII but were not hypercoagulable or AT-III deficient. Except for mild thrombocytopenia, infants of the diabetic mothers, a group with increased thrombotic complications, did not show any cord blood abnormalities. Offspring of third-trimester bleeders were anemic. The EBF infants were also anemic, severely hypercoagulable, and showed coagulation changes compatible with severe liver disease and/or DIC. Mild changes compatible with intravascular coagulation were seen in six infants and were not related to the the development of IRDS.
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PMID:Cord blood coagulation studies in infants of high-risk pregnant women. 111 15

Between 1969 and 1971 4,749 antenatal patients were observed. Compared to the tables for ideal weights of the Metropolitan Life Insurance Company Statistical Bureau, 26.76 percent of the patients were above ideal weight and 11.35 percent of the patients were obese. It was found that complications and illnesses during the pregnancy increased progressively with weight groups above the ideal weight. Hypertension was five times as frequent in obese women than normal, edema and proteinuria were common. Pre-eclampsia was more common in the obese. Varicosities occurred much more often in the maternity cases above normal weight and with obesity.
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PMID:[Pregnancy in obese women (A'uthor's transl)]. 114 May 48

A retrospective study of 84 women under age 45 years suffering myocardial infarction. These patients were found in the records of 24 hospitals is presented. 16 died in the hospital; 5 died subsequently; of the remaining 50 showed definite evidence and 13 possible evidence of myocardial infarction. Suitable controls were selected from patients with other disorders. Patients were interviewed in their homes, some additional information was supplied by the medical practitioner; and fasting blood samples were obtained from some at more than 6 months after the infarction. The proportion of patients who had used oral contraceptives during the month before admission was significantly higher among infarction patients than among controls (p less than .001). The relative risk was estimated as 4.5 to 1. The proportion of those who had ever used oral contraceptives was higher (p less than .01). Cigarette smoking was reported more often by patients with infarction than by controls. A higher ratio of patients with infarction than controls had been treated for hypertension, diabetes, preeclampsia, and obesity. Blood lipids were examined in 44 patients and 84 controls. Mean levels of serum cholesterol and serum triglycerides were definitely higher in patients who had had infarctions. The estimated yearly hospital admission rate for nonfatal myocardial infraction is 2.1 per 100,000 married women aged 30-39 years who do not use oral contraceptives and 5.6 per 100,000 for married women of this age who do. In the 40-44 year age group the rates are 9.9 and 56.9 per 100,000 respectively. Risk estimates suggest that the combined effects of factors is synergistic. When other risk factors exist, different methods of contraception are advised.
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PMID:Myocardial infarction in young women with special reference to oral contraceptive practice. 116 93

In view of the association between pre-eclampsia and disseminated intravascular coagulation, three patients presenting with severe pre-eclampsia before the 28th week of pregnancy were treated with heparin. In all three patients, there was deterioration of hypertension and proteinuria that necessitated the withdrawal of treatment after five to six days. During treatment, serum and urinary fibrinolytic degradation products (FDPs) continued to rise or remained unaltered, plasminogen levels showed a steady fall, and the platelet count remained at a reduced level. These data suggest that heparin was an ineffective form of treatment and did not prevent the intravascular fibrin deposition associated with severe pre-eclampsia.
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PMID:Failure of heparin therapy to affect the clinical course of severe pre-eclampsia. 118 91

One hundred pregnant patients weighing 80 kg or over at the 14th week of pregnancy were studied during their antenatal period and delivery. The incidence of pre-eclampsia, hypertension, pyelitis of pregnancy and operative delivery was higher in overweight patients than in an equivalent number of patients of average weight also studied. The age-related difference in antenatal weight gain in obese patients was confirmed. Two maternal deaths occurred among the overweight patients.
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PMID:Pregnancy in the overweight Nigerian. 119 6

Seven hundred sixty-seven oxytocin challenge tests (OCT) were performed on 333 high-risk maternity patients. All of the patients had pregnancies complicated by diabetes mellitus, suspected postmaturity, preeclampsia, intrauterine growth retardation, hypertension and other disorders. In conjunction with OCT, 24-hour urinary estriol determinations were performed. Negative OCT's were reassuring for fetal well-being. There were 26 positive OCT's on 24 patients. A positive test was significant in identifying endangered fetuses existing in a markedly unfavorable environment. In our experience, we found the OCT more reliable and more predictable than urinary estriol determination. The oxytocin challenge test proved to be significant in the successful management of these 333 high-risk patients.
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PMID:Oxytocin challenge test in high-risk pregnancy. 125 May 37


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