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

Treating hypertension reduces morbidity and mortality. Unfortunately, hypertension often exists in patients with other medical conditions. In these patients, the selection of an antihypertensive agent is often influenced by the presence of the coexisting condition. Conversely, the treatment of the coexisting medical condition may be influenced by the presence of hypertension. Given the vast array of antihypertensive medications available today, appropriate treatment of both hypertension and coexisting conditions can be achieved with careful selection of medications. This review discusses factors to consider when treating elderly patients with hypertension with the following coexisting conditions: dyslipidaemia, glucose intolerance, sexual dysfunction, cardiovascular disease, pulmonary disease, renal disease and neuropsychiatric disorders. Hypothyroidism, hyperthyroidism and various states of high cardiac output may cause hypertension. These conditions should be identified, since they are often treatable with subsequent resolution of the hypertension.
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PMID:Treatment of hypertension in the presence of coexisting medical conditions. 801 53

Cardiovascular diseases are the leading causes of death in the United States, with hypertension being amongst the most prevalent of the cardiovascular risk factors. Improvement of hypertension management has, in consequence, received much attention. Extensive pre- and post-marketing experience with the transdermal formulation of clonidine marketed in the USA in the mid-1980s has now been accumulated. Transdermal clonidine is effective as monotherapy in mild-moderate hypertension, and in combination with diuretics, calcium antagonists and ACE inhibitors in more resistant cases. It controls blood pressure throughout the 24-h circadian cycle. It is effective and generally well-tolerated in adolescents, the elderly, blacks, diabetics, and subjects with chronic renal insufficiency. It has been used perioperatively and for suppression of adrenergic symptoms in subjects withdrawing from addicting substances. In comparison with oral clonidine, transdermal clonidine reduces the incidence and severity of such symptomatic side-effects as dry mouth, drowsiness, and sexual dysfunction. Minor skin reactions occur at the site of application of the transdermal patch with moderate frequency. Adherence to transdermal clonidine therapy is high, and patients commonly prefer it to oral therapy. Transdermal administration of clonidine is a useful therapeutic advance in the long-term management of hypertension.
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PMID:The USA experience with the clonidine transdermal therapeutic system. 819 27

In China, an estimated 30 million men have undergone vasal voluntary sterilization, and about 11.97% of Chinese couples rely on vasectomy, according to a 1990 survey. The no-scalpel vasectomy (NSV) and the percutaneous chemical vas occlusion methods are major developments in vasectomy technique with an effectiveness rate of over 98% for both. In a study in Thailand, complication rates were 0.4/100 cases for NSV and 3.1 for the incisional approach. Since 1971, over 10 million Chinese men have undergone NSV. Vas ligation is the most popularly used method in China. It has provided 98% of effectiveness in a comprehensive survey involving 64,656 vasectomies in 8 provinces. As an alternative to vas ligation, electrocoagulation creates a firm scar that effectively occludes the ends of the vas. The contraceptive efficacy of electric cautery was reported at 99.62%-100% in 7439 vasectomies during a period of 10 years; azoospermia and complication rates were 0% and 0.53%, respectively, in 1088 vasectomies. The complication rate was less than 2%, including hematoma, infection, painful sperm granuloma, epididymitis, and sexual dysfunction, in a comprehensive survey involving 179,741 vasectomies in 8 provinces. 2 large cross-sectional epidemiologic studies done in Sichuan Province showed that men with vasectomies were not at greater risk of coronary heart disease, hypertension, hyperlipidemia, and diabetes than men who had not undergone the procedure. Recently, 2 epidemiological studies conducted in the US suggested that vasectomy may be associated with an increased risk of prostate cancer. The risk of developing prostate cancer by the age of 80 is about 1 in 500 in Shanghai. Whereas approximately 1 of 11 men in the US will develop prostate cancer. It is possible that the disease goes undiagnosed, but a combination of diet and hormonal factors related to race may help explain some of the variation.
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PMID:Vasal sterilization in China. 822 55

Hypertension and diabetes mellitus are interrelated diseases that, if untreated, strongly predispose to atherosclerotic cardiovascular disease and renal disease. More than 3 million Americans have both hypertension and diabetes, which are particularly prevalent in the socioeconomically disadvantaged. Hypertension contributes substantially to morbidity and mortality in people with diabetes. This report is an update of the 1987 working group report on hypertension and diabetes and includes important new information on the management of hypertension in people with diabetes. Although treatment of hypertension in most people with diabetes does not differ from that in people who do not have diabetes, this report outlines some special considerations relevant to the presence of both diseases. Lifestyle modification is considered as an initial treatment modality or as an adjunct to pharmacologic measures. This report also includes a discussion of the treatment of hypertension and diabetes in children, an expanded review of sexual dysfunction, and an increased emphasis on the effect of hypertension and diabetes on target organs. A treatment algorithm represents a practical guideline for the physician. Since the previous report, there has been an increased awareness, through clinical trials and pharmacologic research, of the importance of flexibility in the use of antihypertensive drugs as well as a refinement of nonpharmacologic approaches in treating people with both hypertension and diabetes.
Hypertension 1994 Feb
PMID:National High Blood Pressure Education Program Working Group report on hypertension in diabetes. 830 22

Seventy-eight male diabetics with sexual dysfunction were evaluated by a thorough history, general physical, psychological, neurological and urological examinations, routine laboratory tests, and a duplex ultrasound scan with intracavernous injection of prostaglandin E1 (PGE1). The mean patient age was 55.9 years, and the average onset of sexual dysfunction was 10.0 years after the diagnosis of diabetes. Sixty-eight patients (87.2%) had moderate or severe cavernous arterial insufficiency. Older patients and those having a longer duration of diabetes had a higher incidence of cavernous arterial insufficiency. Cigarette smoking, hypertension, and alcohol abuse were also related to cavernous arterial insufficiency. There was no significant difference in cavernous arterial insufficiency between the insulin-dependent and the insulin-nondependent groups. There were significant differences of diameters and peak blood flow velocities of cavernous arteries between 78 diabetic impotent patients and 10 controls. These findings strongly suggest that the cavernous arterial insufficiency is closely related to the diabetic impotence. In addition, the prevalence of cavernous arterial insufficiency increases with age, duration of diabetes, cigarette smoking, hypertension and alcohol abuse, but it is not definitely correlated with the type of diabetes management.
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PMID:Penile blood flow study in diabetic impotence. 850 92

This study was designed to test the hypothesis that hydrochlorothiazide a diuretic used to treat hypertension depletes body zinc and thereby cause sexual dysfunction. Serum zinc and sexual dysfunction were measured in 39 middle aged hypertensive men who had been taking hydrochlorothiazide in average daily doses of between 25 and 50 mg daily for at least six months, and a control group of 27 unmedicated middle aged normotensive men. The medicated group had a higher incidence of sexual dysfunction (56 pc) as compared to 11 pc in the control group. The use of hydrochlorothiazide did affect serum zinc levels significantly in 20 patients. Sexual dysfunction occurred more often in older and overweight patients (p < 0.004). Three of the normotensive men experienced sexual dysfunction probably related to old age. Twenty two of the 39 on hydrochlorothiazide and experiencing sexual dysfunction were divided into two groups of 11 patients. Bloods were taken from the 27 normotensive and 22 hypertensive men receiving hydrochlorothiazide for the analyses of zinc. Subsequently one group of the patients were supplemented with zinc 500 mg daily for 30 days while the other group was supplemented with magnesium chloride 1 g daily for 30 days. The normotensive men were not treated. After 30 days, bloods were again taken from the three groups of analyses for zinc and magnesium. Serum zinc was significantly decreased (p < 0.05) by hydrochlorothiazide and a non significant decrease in serum magnesium (p = ns) was observed. After supplementation with zinc, the serum zinc levels returned to normal only in eight patients. There was improvement in the symptoms of sexual dysfunction in five patients. Two patients gained weight. Hydrochlorothiazide decreased serum zinc levels (p < 0.05) and was unchanged with magnesium supplementation but the serum magnesium returned to normal values. Improvement of symptoms of sexual dysfunction was positive in one patient. This study shows that low serum zinc levels may be associated with sexual dysfunction but the definitive role of zinc in the pathogenesis of sexual dysfunction will remain controversial.
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PMID:Zinc, hydrochlorothiazide and sexual dysfunction. 855 76

The costs of treating hypertension are out of control. The Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure and others recommend the use of diuretics and beta-blockers as first-line agents. Newer drugs such as calcium channel blockers, alpha-blockers, and angiotensin-converting-enzyme inhibitors have improved metabolic profiles, but have not been proved in long-term, randomized, controlled trials to reduce morbidity and mortality. Our General Medicine Clinic has gradually shifted toward prescribing the newer agents. We reviewed our drug use, evaluated the literature, and made recommendations in the form of guidelines. Clinicians' concerns included quality-of-life issues, sexual dysfunction, metabolic changes--lipids, potassium, insulin resistance--and others. These concerns were addressed, and a consensus was reached. Our goal is to streamline therapy, reduce costs, and provide proven effective medication.
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PMID:Cost-effective therapy for hypertension. 873 29

Sexual dysfunction has been identified in numerous controlled trials to be a frequent accompaniment to antihypertensive therapy. Issues of cause and effect are confused because hypertension itself can cause sexual dysfunction. It seems probable, however, that use of certain classes of blood pressure-lowering agents, notably non-cardioselective beta blockers such as propranolol, thiazide diuretics such as chlorthalidone and centrally-acting adrenergic agonists, is associated with an increased risk of sexual dysfunction. The implications of these data for compliance with antihypertensive therapy are considered.
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PMID:Sexual dysfunction as an obstacle to compliance with antihypertensive therapy. 928 9

During the last decade there were extensive investigations in clinical and molecular andrology with emphasis on assisted reproduction, micromanipulation techniques of gametes, sperm/egg interaction, male contraception, diabetes mellitus, varicocele, andropause versus menopause, sexual dysfunction, associated hypertension/stress, prostatic carcinoma and molecular parameters of male reproduction. Sperm hyperactivation is a required step in capacitation sequence. Sperm motility is measured by videotape to evaluate the Straight Line Velocity (microm/s) (VSLI). Fertilization/embryonic development results from single sperm transfer (S-MIST) and multiple sperm transfer. Fertilization/embryo development is achieved by injection of immotile sperm into the perivitelline space. To assess sperm viability, a supravital stain suitable for use in combination with immunofluorescent assay, Hoeschst 33258, is used. The dye fluoresces with an intense blue when bound to DNA. To assess sperm plasma membrane integrity, a hypo-osmotic swelling test (HOST) is performed, using fluoresceinated D-mannose enriched albumin (FITC-DMA). The ability of sperm to swell under hypo-osmotic conditions indicates an intact membrane. A human protein, C-peptide, thought to be a useless byproduct of insulin may protect against devastating heart and nerve damage that diabetes causes. Human diabetics may benefit from the substance. Over 15 million Americans have diabetes, in which blood sugar levels rise out of control. There are two types of diabetics: Type I diabetics produce no insulin, the hormone that regulates blood sugar. Type II diabetics are unable to use their insulin properly. Diabetics are at great risk of heart disease and nerve damage, as arteries throughout the body leak and nerve-cell impulses fail. C-peptide is a byproduct of insulin production; it can be produced by the body or synthetically. Production of this protein is not induced by insulin, so diabetics who take insulin do not get C-peptide with it. Varicocele occurs unilaterally on the left side in 78% to 93% of men. Typically the presence of a varicocele is associated with an abnormal semen analysis (sperm density and morphology) and a decreased testicular volume on the affected side. Impaired sperm motility occurs in 89.5% of all varicocele patients. Varicocele ligation improves semen parameters in two thirds of patients. A few studies on andropause included sexual dysfunction, hormonal changes, medical/psychological correlates of impotence, ostenopenia/osteoporosis and bone loss; indices of bone remodeling, testosterone supplementation, androgen, negative feedback and hypothalamo-pituitary-testicular axis. Prostatic cancer is the second leading cause of cancer death for men between the ages of 60 and 80. Early detection involves a simple blood test for prostate specific antigen (PSA). Regular screening and early detection are essential. This is an important test because a high antigen count can be the only symptom. Since no screening is 100% accurate, physicians recommend both a PSA blood test and a physical examination. Although heredity plays a major role in whether a man will develop prostate cancer, men who lead healthy lives can dramatically reduce their chances of cancer: low-fat diet, eating plenty of fruits and vegetables and not smoking. Recent advances in molecular andrology include peptide hormone binding proteins; gonadotropin-releasing hormone (GnRH) agonists/antagonists analog; gonadotropins/their receptors; growth factors/reproduction; peptides as intratesticular regulators; molecular cloning of reproductive proteins/peptides. Gene cloning is applied for characterization/expression of genes coding. The interaction of gp120 with CD4 receptor plays a role in syncytium formation, apoptosis and CD4 cell deletion in human immunodeficiency virus (HIV) infection. The recombinant V3 peptide of fragment 307-330 of HIV-1 can induce sperm head agglutination. The generation process of react
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PMID:Recent advances in clinical/molecular andrology. 958 57

Erectile dysfunction (ED) has been defined by the National Institutes of Health Consensus Conference in 1993 as the inability to achieve and/or maintain an erection adequate for penetration and completion of satisfactory intercourse.1 Erectile dysfunction, the preferred term, is more accurate and less pejorative than impotence.An estimated 20-30 million American men are affected with ED of varying degrees of severity. The Massachusetts Male Aging Study published in 1994 reviewed 1,211 men between the ages of 40 and 70; 52% reported ED with 9.6% having mild, 22.2% moderate, and 17.2% complete or severe ED.2 The National Health and Social Life Survey, authored by Laumann et al.,3 reviewed a population of men and women between the ages of 18 and 59. Of note, female sexual dysfunction exceeded male sexual dysfunction, with 43% of women complaining of sexual function problems. Interestingly, except for lubrication, this seemed to decrease with age in women. On the other hand, 31% of the men complained of sexual problems that increased with age.Erectile dysfunction is an age-dependent problem. Approximately 2% of men are affected at 40 years of age and about 25% or more at 65 years of age.4 However, ED is not an inevitable result of aging. Rather, as a man matures it is most likely that he will experience more of the neurovascular insults resulting in ED.The development of an erection and satisfactory sexual function is a complex process. As suggested by Melman et al.,5 "Erection is truly at least a sensory-motor-neuro-hormonal-vascular-psycho-social-cultural-interpersonal event." There are two main classifications of ED, psychogenic and organic. Current thinking suggests that up to 80% of ED is primarily of organic etiology. Yet, there is always a psychogenic factor.6 Erectile dysfunction may signal serious underlying and potential life-threatening diseases, such as diabetes, hypertension, cardiovascular disease, peripheral vascular disease, and other neurologic and endocrine disorders. Therefore, questions regarding sexual function should be part of routine medical evaluation.
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PMID:Erectile dysfunction: a review of a common problem in rapid evolution. 1084 Feb 16


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