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

The conditions of depression, erectile dysfunction (ED), and cardiovascular disease may seem at a superficial level as independent medical problems managed by 3 separate and unrelated healthcare disciplines. Various studies, however, have revealed significant associations between depression and cardiovascular disease, ED and cardiovascular disease, and depression and ED. The purpose of this research was to identify whether the 3 medical conditions share mutually reinforcing associations and predictors. Population-based epidemiologic studies were utilized where possible. Variables including age, heart disease, hypertension, sedentary behavior, related medications, cigarette smoking, and abnormal lipids have been found to be highly associated with depressive symptoms, cardiovascular disease, and ED. It was concluded that all 3 medical conditions share many of the same risk factors and etiologic associations and may be best modeled in a 3-way holistic, mutually reinforcing relation. Of particular relevance, patients with sexual dysfunction have a likely comorbidity of cardiovascular disease and depression, as well as the potential increased risk for cardiac morbidity and mortality.
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PMID:The mutually reinforcing triad of depressive symptoms, cardiovascular disease, and erectile dysfunction. 1089 78

Sexual dysfunction is highly prevalent in both sexes and adversely affects patients' quality of life and well being. Given the frequent association between sexual dysfunction and cardiovascular disease, in addition to the potential cardiac risk of sexual activity itself, a consensus panel was convened to develop recommendations for clinical management of sexual dysfunction in patients with cardiovascular disease. Based upon a review of the research and presentations by invited experts, a classification system was developed for stratification of patients into high, low, and intermediate categories of cardiac risk. The large majority of patients are in the low-risk category, which includes patients with (1) controlled hypertension; (2) mild, stable angina; (3) successful coronary revascularization; (4) a history of uncomplicated myocardial infarction (MI); (5) mild valvular disease; and (6) no symptoms and <3 cardiovascular risk factors. These patients can be safely encouraged to initiate or resume sexual activity or to receive treatment for sexual dysfunction. An important exception is the use of sildenafil in patients taking nitrates in any form. Patients in the intermediate-risk category include those with (1) moderate angina; (2) a recent MI (<6 weeks); (3) left ventricular dysfunction and/or class II congestive heart failure; (4) nonsustained low-risk arrhythmias; and (5) >/=3 risk factors for coronary artery disease. These patients should receive further cardiologic evaluation before restratification into the low- or high-risk category. Finally, patients in the high-risk category include those with (1) unstable or refractory angina; (2) uncontrolled hypertension; (3) congestive heart failure (class III or IV); (4) very recent MI (<2 weeks); (5) high-risk arrhythmias; (6) obstructive cardiomyopathies; and (7) moderate-to-severe valvular disease. These patients should be stabilized by specific treatment for their cardiac condition before resuming sexual activity or being treated for sexual dysfunction. A simple algorithm is provided for guiding physicians in the management of sexual dysfunction in patients with varying degrees of cardiac risk.
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PMID:Management of sexual dysfunction in patients with cardiovascular disease: recommendations of the Princeton Consensus Panel. 1089 82

Sexual dysfunction is highly prevalent in both sexes and adversely affects patients' quality of life and well being. Given the frequent association between sexual dysfunction and cardiovascular disease, in addition to the potential cardiac risk of sexual activity itself, a consensus panel was convened to develop recommendations for clinical management of sexual dysfunction in patients with cardiovascular disease. Based upon a review of the research and presentations by invited experts, a classification system was developed for stratification of patients into high, low, and intermediate categories of cardiac risk. The large majority of patients are in the low-risk category, which includes patients with (1) controlled hypertension; (2) mild, stable angina; (3) successful coronary revascularization; (4) a history of uncomplicated myocardial infarction (MI); (5) mild valvular disease; and (6) no symptoms and <3 cardiovascular risk factors. These patients can be safely encouraged to initiate or resume sexual activity or to receive treatment for sexual dysfunction. An important exception is the use of sildenafil in patients taking nitrates in any form. Patients in the intermediate-risk category include those with (1) moderate angina; (2) a recent MI (<6 weeks); (3) left ventricular dysfunction and/or class II congestive heart failure; (4) nonsustained low-risk arrhythmias; and (5) >/=3 risk factors for coronary artery disease. These patients should receive further cardiologic evaluation before restratification into the low- or high-risk category. Finally, patients in the high-risk category include those with (1) unstable or refractory angina; (2) uncontrolled hypertension; (3) congestive heart failure (class III or IV); (4) very recent MI (<2 weeks); (5) high-risk arrhythmias; (6) obstructive cardiomyopathies; and (7) moderate-to-severe valvular disease. These patients should be stabilized by specific treatment for their cardiac condition before resuming sexual activity or being treated for sexual dysfunction. A simple algorithm is provided for guiding physicians in the management of sexual dysfunction in patients with varying degrees of cardiac risk.
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PMID:Management of sexual dysfunction in patients with cardiovascular disease: recommendations of The Princeton Consensus Panel. 1091 79

The incidence of diabetes mellitus is increasing at an alarming rate, and diabetic men already make up a quarter of the men in our own specific medically-oriented population of erectile dysfunction. The incidence of sexual dysfunction in men with diabetes approaches 50%, and this is only slightly lower in diabetic women. Hypertension is a frequent risk co-factor, being seen between 40% and 60% of diabetics in the literature. Obesity and hyperlipidemia are other frequent co-factors. Interestingly, these risk factors are the same as those for coronary artery disease. The final common pathway for most of these factors is endothelial cell dysfunction.
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PMID:Sexual dysfunction in the diabetic patient. 1178 48

Sexual dysfunction has a high prevalence among hypertensive men, and hypertension per se, regardless of drugs, has been suggested to affect sexual function. The available studies have not clarified which factors play a major role in the pathogenesis of sexual dysfunction in hypertensive men. Neurovascular factors, however, seem to be especially important, (in particular defective nitric oxide activity), although hormonal and psychogenic factors cannot be excluded. Further studies are needed to answer the important question of whether erectile dysfunction seen in hypertension may be one expression of vascular disease and target organ damage. The incidence of sexual dysfunction is exacerbated by antihypertensive drug treatment. There is evidence that some classes of drugs, such as diuretics, centrally acting sympatholytic drugs, and b-blockers have a greater impact on sexual function than other classes, such as calcium antagonists and angiotensin converting enzyme inhibitors. Present evidence on the effects of angiotensin II antagonists is limited, but some data suggest that sexual function in men receiving these drugs not only is not altered, but even improves. Since sexual function is an important aspect of quality of life for the individual, it is important in treating hypertension to ensure that the drugs used have the lowest possible potential for causing sexual problems. This ensures the best balance between therapeutic efficacy and quality of life, which is essential for compliance.
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PMID:Effects of antihypertensive therapy on sexual activity in hypertensive men. 1200 2

Priapism is a common complication of sickle cell disease (SCD) that could lead to erectile dysfunction and psychosocial problems. Treatment of established fulminant priapism is usually not satisfactory. It is therefore important to prevent this complication of SCD. The alpha-adrenergic agonist etilefrine (50-100 mg/d) produced a good clinical response in 13 of 18 (72%) adults who have recurrent priapism; 17 had SCD and one sickle cell trait. After a follow-up of 1-48 months, none of the 18 people on etilefrine developed hypertension or sexual dysfunction. Similar efficacy and safety profiles of the drug have been reported previously.
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PMID:Etilefrine for the prevention of priapism in adult sickle cell disease. 1218 Oct 66

A critical evaluation of hormonal contraceptives is presented. The pills have been used for more than 100 million women all over the world. During the 25 years of their commercialization, there has been an improvement in their composition, today being considered almost perfect. The side effects can be summarized in 3 groups: endocrine-sexual such as vomiting, headaches, menstrual irregularity; systemic such as thromboembolism, sodium retention, hypertension; and general such as irritability and sexual dysfunction. The pills have some protective effects in the endometrium against cancer, and also against pelvic inflammations. They also can be used to treat uterine bleeding and endometriosis.
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PMID:[A critical evaluation of hormonal contraceptives]. 1228 72

Several links have been established between sexual dysfunction and heart disease. Indeed, many risk factors for developing sexual dysfunction are shared by coronary artery disease: age, smoking, diabetes, hypertension, and hypercholesterolaemia. It should also be borne in mind that in men several cardiac drugs are responsible for erectile dysfunction (ED). Lastly it should be remembered that treatment of ED may be associated with cardiovascular side-effects. Data from the literature show that men with coronary artery disease, hypertension or diabetes have an up to fourfold higher risk of developing ED than have age-matched controls. Thiazide diuretics and beta-blockers are the most common drugs that produce ED. Current therapies for ED are safe and effective in the large majority of patients with cardiovascular disease. However, the concomitant use of nitrates and sildenafil may be life-threatening, and nitrate therapy is therefore contra-indicated in patients taking sildenafil--and vice versa.
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PMID:[Incidence and treatment of sexual dysfunction in heart disease]. 1240 76

Sexual dysfunction associated with hypertension or antihypertensive therapies may impact the ability of patients to stay on therapy and lead to deterioration in patients' quality of life. Therefore, it is important for practitioners to become familiar with the wide variation in sexual side effects produced by antihypertensive agents and to discuss the potential occurrence of these side effects with their patients. In many cases, a change in the patient's drug regimen may help patients overcome specific sexual side effects experienced with certain treatments. Practitioners should consider selecting an antihypertensive therapy that is highly effective in lowering blood pressure but preserves patients quality of life. The effect of medications on sexual function remains controversial. Some blinded trials report little difference between placebo and specific medications, whereas other studies indicate that antihypertensive medications increase sexual dysfunction, which has an impact on quality of life. Recent evidence suggests that losartan, an angiotensin II antagonist, is not typically associated with development of sexual dysfunction and may actually positively impact several indices of sexual function (erectile function, sexual satisfaction, and frequency of sexual activity) as well as perceived quality of life. Thus, angiotensin II antagonists may offer a therapeutic option to prevent or correct erectile dysfunction in patients with hypertension. The favorable effects of these agents on sexual function may be related, in part, to their ability to block angiotensin II, which has recently become recognized as an important mediator of detumescence and possibly erectile dysfunction.
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PMID:Sexual dysfunction in patients with hypertension: implications for therapy. 1246 7

Our purpose was to determine the correlation among alcohol problems, certain health habits, and hypertension in a general internal medicine outpatient setting. Two-hundred eighty-seven patients who were undergoing complete examinations in a general internal medicine department of a large multispecialty clinic were asked to participate in a "lifestyle survey" interview, which included questions regarding social history, gastrointestinal complaints, anxiety/depression, sexual dysfunction, and the Alcohol Use Disorders Identification Test (AUDIT). Charts were screened for documentation of alcohol problems and the presence of hypertension. Correlations between alcohol problems (defined as an AUDIT score >/=8) and the presence of hypertension were made using chi-square tests for categorical variables and the t test for continuous variables. Of the 287 patients contacted, 12 refused, 3 were ineligible, and 29 had incomplete data precluding analysis, yielding a total of 233 patients (81%) who were included in the analysis. Sixty percent were female, 76% were white, and the mean age was 53 years. The overall prevalence of alcohol problems was 7.3% and less than one-quarter of those patients had chart documentation of an alcohol problem. Thirty percent of those patients had a diagnosis of hypertension. No statistically significant correlation between a positive AUDIT and hypertension was found. Failure to use seat belts (P = 0.020), history of smoking (P < 0.001), alcohol use within 24 hr of the office visit (P < 0.001), and self-reported family history of alcoholism (P = 0.012) were significantly more likely in patients with active alcohol problems. There was no difference in somatic complaints between patients with and patients without alcohol problems. We identified certain health behaviors which served as markers for patients with active alcohol problems in an outpatient setting. Physician diagnosis of alcohol problems (sensitivity of 24% in this study) may be improved with attention to such markers. Despite the known relationship of excess alcohol use and elevations in blood pressure, we found no statistically significant correlation between these variables in our study. Symptomatic concerns of the patient appear to be too nonspecific to distinguish patients with and without alcohol problems.
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PMID:Markers for Patients with Alcohol Problems in an Outpatient General Medicine Clinic. 1251 27


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