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

In this symposium an extensive review of the basic role of health education for the prevention of cardiovascular diseases, has been made. Principles and methods have been analysed in the light of recent advances in primary and secondary prevention of rheumatic heart disease, ischemic heart disease and hypertension. The cardiologist's role in health education of individual subjects and of high-risk target groups or of the whole community, has been stressed. Recent trials have shown that it is possible to achieve behavioural changes and a reduction in the levels of risk factors in a good proportion of participants. It should be possible to bring up children virtually free from risk factors. Cardiologists on their own are unlikely to succeed in a program of prevention. They need the help of many others including public health workers, sociologists, nurses and above all, general practitioners. Cardiologists however have responsibility for leadership and for providing background knowledge. Cardiologists need to be educated and motivated. Health education should be founded on a scientific basis and should be organized in an efficient and planned fashion. Medical and post-graduated schools, hospital institutions and cardiological associations must be specifically involved in preparing the cardiologists for this specific task. On the other hand, dedicated teams or sections in the cardiological departments must be activated to promote, coordinate and carry out specific programs of health education for preventing cardiovascular diseases. The attention of governmental authorities should be drawn to the theoretical and practical importance of health education in preventive cardiology, especially in connection with the planning, organization and direction of health education at the regional and national level.
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PMID:[Health education as the principal element of prevention in cardiology: methods of intervention. Conclusions and operative suggestions]. 688 67

A total of 14,500 E.C.G. tracings were reviewed to determine the incidence of bifascicular block and those patients were followed up to assess prognosis. Forty patients with bifascicular block (complete right bundle branch block associated with left anterior hemiblock), diagnosed with standard E.C.G., according to Medrano's criteria from January 1978 to September 1980 were studied in our Service. The incidence of this intraventricular conduction defect was 0.0033 (3.3 per thousand). Males predominated over females at a rate of 2.4 to 1. This block was more frequent from the sixth to the ninth decades of life. Thirty five percent of the patients had no evidence of cardiovascular pathology; 32.5 percent had high blood pressure, 2.5 percent had coronary heart disease, 2.5 percent rheumatic heart disease, 5 percent chronic pulmonale, and 37.5 percent had diabetes mellitus as an associated finding. During the follow up which covered 20.2 months/patient, only one patient developed junctional rhythm and periods of asystolia and syncope; this case was treated with a permanent pacemaker with good results. Two patients died, one from digitalis intoxication and the other at home, the cause was not determined. It is necessary to study this conduction defect with longer follow up periods and according to the underlying heart disease, in order to assess properly the prognosis and behavior of this conduction defect.
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PMID:[Bifascicular block: long-term follow-up. Report of 40 cases]. 708 98

During the last 4 years 2040 patients with myocardial infarction were admitted to the C.C.U. of the National Institute of Cardiology. Thirty five patient under 40 years of age were studied. Three had Rheumatic heart disease and in 32 the etiology of the myocardial infarction was probably coronary atherosclerosis. The 32 cases under 40 years of age were compared to a group of patients with myocardial infarction older than 40 years of age. A great predominance of myocardial infarction was found in young males which were heavy smokers. There were no significant differences with the presence of obesity and arterial hypertension. In the younger group, myocardial infarction were more frequent in those with intellectual activity and in taxi drivers. The early hospital course was better in the young group they did not have cardiac failure, cardiogenic shock and none died. However, in the long term follow up the younger group had more P.V.C. and ventricular tachycardia. The cardiography of the younger showed an important predominance of lesions in the left coronary artery. It is concluded that in young people, myocardial infarctions seems to occur primarily in smokers with stress in their Kind of living. These patients seem to have less complications in the early and long term courses. However, more cardiac rhythm disorders are present.
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PMID:[Myocardial infarction in patients below the age of 40 (author's transl)]. 711 66

The present study was designed to examine whether the left atrium is dilated in paroxysmal atrial fibrillation or not. Left atrial dimension (LAD) on M-mode echocardiogram was (1) 23.3 +/- 0.7 mm (mean +/- S.E.) in 24 normal subjects, (2) 30.5 +/- 0.7 mm in 58 patients without atrial fibrillation who had hypertension and/or ischemic heart disease, (3) 35.5 +/- 0.9 mm in 27 patients with paroxysmal atrial fibrillation of whom 23 had non-rheumatic cardiovascular diseases and 4 had idiopathic atrial fibrillation, (4) 40.5 +/- 1.1 mm in 38 patients with persistent atrial fibrillation of whom 30 had nonrheumatic cardiovascular diseases and 8 had idiopathic atrial fibrillation, and (5) 53.3 +/- 2.0 mm in 17 patients with persistent atrial fibrillation who had rheumatic heart disease. LAD showed a stepwise and significant increase from the first to the fifth group. LAD of patients with paroxysmal atrial fibrillation was not related to either the number or duration of paroxysms. These results indicate that the left atrium is slightly dilated in patients with paroxysmal atrial fibrillation.
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PMID:Left atrial enlargement in patients with paroxysmal atrial fibrillation. 717 76

The antihypertensive properties of a new long-acting, angiotensin-I-converting enzyme (ACE) inhibiting agent, (2S,3aS,7aS)-1-(N2-nicotinoyl-L-lysyl-gamma-D-glutamyl) octahydro-1H-indole-2-carboxylic acid (CAS 116662-73-8, DU-1777), were investigated orally in various experimental models of hypertension in comparison to a standard ACE inhibitor, lisinopril. The hypotensive potency of DU-1777 was not as marked as that of lisinopril in renin-dependent hypertensive models, i.e., two-kidney one-clip renal hypertensive rats (2K-1C RHR) (ED-20mmHg: 3.1 versus 1.0 mg/kg) or two-kidney two-clip renal hypertensive dogs (2K-2C RHD) (ED-20 mmHg: 2.5 versus 1.0 mg/kg), though the actions of the two drugs were both long-lasting and dose-related. When spontaneously hypertensive rats (SHR) were used, however, DU-1777 was as active as lisinopril (ED-20 mmHg: 17.9 versus 13.6 mg/kg). The most distinguishing results with DU-1777 were its hypotensive effects in renin-independent hypertensive models. In contrast to lisinopril, the drug produced a sustained and dose-related hypotensive effect in DOCA salt hypertensive rats (DOCA-HR) and one-kidney one-clip renal hypertensive rats (1K-1C RHR). There exists an inconsistency between the long duration of the agent's hypotensive action in all tested hypertensive models and its short duration of ACE inhibiting activity as demonstrated both in vivo and ex vivo. The sustained antihypertensive action of DU-1777 cannot be reasoned solely with respect to ACE inhibition, suggesting some additional mechanisms of action yet to be defined.
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PMID:Antihypertensive properties of a new long-acting angiotensin converting enzyme inhibitor in renin-dependent and independent hypertensive models. 757 46

Atrial fibrillation (AF) predisposes to stroke, particularly in patients with rheumatic heart disease, congestive heart failure, arterial hypertension, diabetes mellitus or uncontrolled thyrotoxicosis. In those with rheumatic heart disease it is usual to give warfarin to reduce the incidence of stroke, although there has been no randomised controlled trial on which to base this approach. Whether patients with non-rheumatic AF should be anticoagulated was unclear when we tackled this subject five years ago. This article reviews the evidence from recent randomised controlled trials and considers whether anticoagulation with warfarin, or antiplatelet therapy with aspirin, should now be routine for patients with non-rheumatic AF.
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PMID:Warfarin or aspirin for non-rheumatic atrial fibrillation? 763 36

We studied 3,942,868 Medicare patients (comprised of elderly and disabled) discharged with cardiovascular disease (CVD) during 1987, of which 41,095 (1%) had a drug disorder. Among this small subgroup, the percent of those overlapping with an alcohol and/or mental disorder is 33% for the elderly and 47% for the disabled. The presence of a drug disorder discharge diagnosis is associated with an excess of 329,650 days of hospital care and +174,498,071 in hospital charges as illustrated by a 51% increase in average annual days in the hospital for the elderly, and a similar 61% increase for the disabled. The concomitant increase in average annual discharges offers an explanation. Clinical progression in drug disorder severity (six categories were defined) is associated with increasing lengths of stay; for example, drug dependence comorbidities present longer lengths of stay than drug abuse comorbidities. Among the 12 categories of CVD defined, patients with rheumatic heart disease, hypertensive heart disease, hypertension, and other venous disorders were those whose length of stay experienced the largest percent increase when a drug disorder was present. When drug disorders compete with alcohol and/or mental disorders in a general linear model predicting average annual length of stay, they remain significant at the p < .001 level.
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PMID:Drug disorders and cardiovascular disease: the impact on annual hospital length of stay for the Medicare population. 776 47

Two hundred and ninety one patients admitted with atrial fibrillation through the emergency room of a regional hospital in the year 1993 were reviewed to evaluate the presenting features and in-hospital treatment of patients with symptomatic atrial fibrillation. The incidence of atrial fibrillation increased with age (mean age was 73 +/- 12 years) and the ratio of female to male was 1.8:1. The commonest presenting features were palpitation (42.3%), dyspnoea (38.1%) and heart failure (16.4%). The most frequently associated cardiac conditions were hypertension (28.9%), atherosclerotic cardiovascular disease (24.7%) and rheumatic heart disease (17.5%). Pulmonary diseases (18.6%), diabetes mellitus (12.7%) and thyrotoxicosis (6.2%) were the principal associated non-cardiac conditions. Thromboembolic complications were found in 15 patients at presentation (5.2%). Cardiac enzyme assessment was investigated in two thirds of the patients (68.1%), while thyroid function test (59.5%) and echocardiography (29.6%) were less commonly investigated. Digoxin was still the most popular drug used for ventricular rate control, and cardioversion was performed in only 6.9% of patients. Antithrombotic therapy was used in 5.8% of patients only although it was clinically indicated in more than half of the patients (52%). Contraindications of anticoagulation were found in 23 patients (7.9%), including a history of gastrointestinal or cerebrovascular bleeding, active bleeding, chronic renal failure and poor drug compliance. The mean hospital stay was 5 +/- 4 days, compared to a mean stay of 2.7 days for other medical patients. Fourteen patients (4.8%) died during hospitalisation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Presentation and management of patients admitted with atrial fibrillation: a review of 291 cases in a regional hospital. 778 42

Fifteen per cent of cerebrovascular accidents have a cardiac origin, two thirds of which are due to atrial fibrillation (AF). The Framingham study showed the risk of an ischaemic cerebral event to be increased by 5.6 in AF unrelated to rheumatic heart disease and by 17.5 when AF is associated with valvular heart disease. The risk of embolism is higher in elderly subjects and in those with underlying cardiac disease. Other high risk conditions include hypertension, diabetes, hyperthyroidism and cases with echocardiographic changes: left atrial dilatation, pre-thrombotic state or intra-atrial thrombus, atheroma of the ascending aorta. This stratification of risk should be taken into account when deciding on treatment. Conscious of the importance of the risk of embolism in AF, several authors have undertaken, over the last few years, randomised studies of the prevention of thromboembolic complications of AF: the AFASAK, BAATAF, SPAF and SPINAF trials. All showed the unquestionable efficacy of warfarin, even at low doses, at the price of a haemorrhagic risk of less than 2% per year for severe haemorrhages. A more recent study (SPAF II) confirmed the value of aspirin at the dosage of 325 mg/day which would seem to be a good alternative to anticoagulant therapy when this is contraindicated, although aspirin is less effective. The indications for anticoagulant therapy have become clearer since the publication of these results. Anticoagulant therapy is essential in permanent AF whether or not associated with rheumatic heart disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Thromboembolic complications of arrhythmia due to atrial fibrillation]. 778 20

Obstetrician-gynecologists reviewed patient records of women delivering during January 1986-December 1992 to determine the maternal mortality rate and trends and the causes of maternal deaths in the maternity ward at the National University of Singapore. There were 26,173 deliveries and 9 maternal deaths (a maternal mortality rate of 22.9/100,000). The causes of maternal deaths were pulmonary embolism (underlying condition, systemic lupus erythematosus [SLE]), hemorrhage from multiple sites (thrombotic thrombocytopenia), acute exacerbation of SLE with interstitial pneumonitis, pulmonary fibrosis (systemic sclerosis), fulminant hepatitis (prior hepatitis and liver disease), and cerebral embolism (rheumatic heart disease with mitral valve replacement). There were also three incidental maternal deaths bringing the maternal mortality rate up to 34.4/1000. The incidental causes of death included septicemia from perforated peptic ulcer (uncontrolled thyrotoxicosis), multiple metastases from lung cancer, and suicide (family dispute over adoption of newborn). A cesarean section preceded 4 (44%) of the 9 maternal deaths. Two of these deaths were incidental maternal deaths. Cesarean section was related to two of the remaining six (33%) deaths. These findings show that traditional direct causes of maternal death (hemorrhage, sepsis, embolism, or hypertension) were not responsible for the maternal deaths at this tertiary facility. Instead, the women tended to have medical conditions that placed them at high risk of death regardless of pregnancy status.
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PMID:Maternal mortality: evolving trends. 781 Nov 98


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