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

Transmission of information in the brain is of a chemical nature. Neurotransmitters are present at very early stages of brain development, having trophic effects on maturation of target neurons as well as mediating the behavioral repertoire of the immature brain. Many centrally acting psychoactive drugs which are commonly used (also during pregnancy) for treatment of depression, asthma, hypertension, epilepsy, parkinsonism, hyperkinetism and other neurological and psychiatric disorders act directly on brain neurotransmitters (in particular monoamines) and behavioral states. Disturbances observed later in life in animals and man, as a result of early interference with brain neurotransmitters, using these drugs, are not gross physical malformations but are in fact subtle behavioral and neurological symptoms such as hyperactivity, emotional lability, attentional distractability and sleep disturbances, similar to symptoms observed in the minimal brain dysfunction syndrome.
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PMID:The role of the central monoaminergic system and rapid eye movement sleep in development. 309 90

The effects of nadolol (20 and 80 mg) on blood pressure and sleep parameters were assessed in six patients with mild hypertension. A 32-night experimental protocol in the sleep laboratory was instituted consisting of four placebo-baseline nights followed by 4 weeks of drug administration. Both doses of nadolol had a clear-cut and consistent lowering effect on blood pressure throughout the night and during the day, with a greater reduction noted with the 80 mg dose. In fact, blood pressure values were reduced to normotensive levels. Neither dose had a disrupting effect on sleep, whereas the 80 mg dose improved sleep efficiency and also had a rapid eye movement-enhancing effect. This absence of sleep-disrupting effects is attributed to nadolol's low level of lipophilicity and lack of intrinsic sympathomimetic activity. The clinical significance of the lack of sleep disruption and possible improvement of sleep with nadolol is discussed in light of the well-recognized sleep disturbances produced by other beta-blockers.
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PMID:Effects of nadolol on blood pressure, sleep efficiency, and sleep stages. 337 87

Twenty-two children prenatally exposed to clonidine and no other hypotensive drugs were compared at a mean age of 6.3 +/- 1.6 years to a non-exposed control group, matched for degree of maternal hypertension, sex, birthweight and gestational age. There were no differences in head circumference, neurological findings, school performance and a number of behavioural characteristics except for a marginal excess of hyperactivity and an excess of sleep disturbances in the study group. It is questionable whether the differences represent a direct effect of clonidine on prenatal development but the dose-effect relationship and the fact that the same effects have been found in rats suggest that this may be so.
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PMID:Is clonidine a behavioural teratogen in the human? 373 18

The development of beta-adrenoreceptor-blocking drugs provided an important group of agents to treat the cardiovascular disorders hypertension, angina pectoris, and cardiac arrhythmias and to manage patients with thyrotoxicosis. For clinical purposes, these drugs can be divided into two groups, that is, those with intrinsic sympathomimetic activity (ISA) and those without (non-ISA). The non-ISA drugs include propranolol, which is noncardiac selective: labetalol, which is noncardiac selective with alpha blockade: and and metoprolol and atenolol, which are cardiac selective. The drugs with ISA include pindolol, oxprenolol, and alprenolol which are noncardiac selective, and practolol which is cardiac selective. These drugs resemble isoprenaline in chemical structure, but their interaction with the beta-adrenoreceptors causes no response or only a slight response if the drug has ISA. By occupying the receptors, they block excitation by noradrenaline released from the sympathetic nerves and by adrenaline from the adrenal medulla. Drugs with ISA appear to depress cardiac activity and to interfere with bronchodilator drive less than do non-ISA drugs. Beta-blocking drugs differ considerably in their bioavailability because of differences in the rate and extent of metabolism in the first past through the liver after absorption from the gut. The therapeutic dose range varies widely for those with low bioavailability but is more predictable for those with high bioavailability. The drugs also differ in plasma protein binding and in their receptor affinities. In addition to their usual adverse effects, which include exacerbation of cardiac failure, bronchospasm, sleep disturbances, and Raynaud's phenomenon, concern has arisen about possible ocular and mucocutaneous side effects with beta-blocking drugs. This is a recognized problem with practolol, and it is not certain whether it occurs with other beta-blocking drugs. A double-blind study reported here of 110 matched patients, 36 of whom were on pindolol for more than 2 years, did not reveal any evidence of oculomucocutaneous problems related to drug treatment.
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PMID:Clinical pharmacology of adrenergic-adrenoreceptor-blocking drugs. 612 97

The care of the elderly covers a wide spectrum: 1, The prophylaxis of the relatively healthy olds. 2, The somatic, psychic and social care of the handicapped aged. 3, The treatment of special illnesses in old age. The gerotherapy must consider the characteristics of the biological age and the degree of the multimorbidity. I. General principles of therapy. The guide-lines of gerohygiene (diet, physical and mental activity, limitation of alcohol and sexuality, regular medical check-ups for registration of risk factors) have to be taken into consideration. The existing multimorbidities in high age should not be treated simultaneously in a polypragmatic way, but according to the prevailing illness with the least possible medicine. II. Special principles of therapy. In the early stage of heart insufficiency in long-lived persons low doses of Digoxin should be used. For aged with kidney insufficiency Digitoxin is preferable. Even in over 90 year old heart patients with the life threatening AV-block the implantation of the intracardial pacemaker is indicated. The myocardial infarction in very old patients developes mostly atypical and should not be treated with coumarin. The more severe hypertension in old age can be treated with low doses of beta-blocking substances in combination with a potassium saving diuretic and low doses of cardiac glycosides. Finally, the frequent sleep disturbances and their therapy in old age are mentioned. The brain function of elderly people depends on the quality of cardiac output and circulation.
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PMID:[Problems of therapy in very old age (author's transl)]. 612 34

Clinical and polygraphical (EEG, EOG, EMG, ECG, REG) studies of nocturnal sleep and of the hemodynamics were carried out in 60 patients with dyscirculatory encephalopathy induced by hypertension and atherosclerosis. The findings obtained demonstrate that the clinical picture in these patients is always characterized by sleep disturbances which decrease the level of their diurnal wakefulness and their capacity for work. Hemodynamic disturbances responsible for sleep disorders are in turn maintained by the latter which leads to the formation of the vicious circle. This is also supported by the fact that compromized cerebral circulation causes changes in the activity of the structures involved both in sleep-wakefulness function and the regulation of the cerebral and systemic hemodynamics. Hence, deviations in the nocturnal sleep pattern attended with pronounced alterations in the cerebral hemodynamics may contribute to the development of acute disorders of the cerebral circulation. The authors recommend correcting not only the disrupted structure of sleep but also the cerebral circulation with relation to he sleep-wakefulness cycle.
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PMID:[Nocturnal sleep and cerebral hemodynamics in different sleep stages and cycles among patients with early manifestations of cerebral circulatory insufficiency]. 650 76

Over an 18 month period, 19 patients were referred for assessment of excessive daytime sleepiness and/or loud snoring. Respiratory studies during sleep were performed in 14 of these patients with additional features such as disturbed sleep, observed apnoea during sleep, morning headache, mental and personality changes, hypertension and cardiac failure. Nocturnal respiratory studies undertaken for periods of 4-8 hours confirmed a diagnosis of the Sleep Apnoea Syndrome in eight patients. In these patients apnoeas, lasting from 30-144 seconds, occurred frequently during sleep (from 35-291 episodes per patient). In one severely affected patient, tracheostomy abolished all symptoms. The use of conservative therapy such as weight loss, protriptyline or a neck collar, highlighted the inadequacies of current medical treatment. Awareness of the symptom complex and potential complications of the Sleep Apnoea Syndrome is important because the diagnosis may easily be missed if the patient presents with one or two isolated complaints.
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PMID:The importance of suspecting sleep apnoea as a common cause of excessive daytime sleepiness: further experience from the diagnosis and management of 19 patients. 693 67

In a group of 132 randomly selected male patients with the admission diagnosis arterial hypertension in a cardiological rehabilitation clinic, nightly monitoring was performed with Mesam 4 with records of the metabolism laboratory values and sleep disturbances longitudinally. Desaturation indexes of > or = 10/h after manual correction for plausibility revealed a total prevalence of 27.3% in the case of breathing disturbances. The prevalence increased to 52% in the over 55 year-old patients with a Broca index of > or = 120% in comparison to merely 15.4% in standard weighted, comparable age group. No differences were found in the laboratory values. These results again show the frequent occurrence of the combination adiposity, hypertension, and sleep apnea syndrome which has often been missed previously in specialist rehabilitation clinics.
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PMID:[Prevalence of sleep apnea syndrome with primary arterial hypertension in a cardiologic rehabilitation clinic]. 761 99

We have performed a study assessing the prevalence of sleep-disordered breathing in a large US trucking company using a validated portable monitor (MESAM-4) and a validated symptom questionnaire. Three hundred eighty-eight drivers with a mean age of 36 years filled out the questionnaire. One hundred fifty-nine drivers with a mean age of 35 years spent the night at the terminal hub where they underwent monitoring for identification of sleep-disordered breathing. The drivers also had blood pressure recorded while awake, seated, and after 15 min of quiet rest. Seventy-eight percent of the drivers had an oxygen desaturation index (ODI) > or = 5 per hour of sleep; 10% had an ODI > or = 30 per hour of sleep. There was a significant difference in the body mass index (BMI) between drivers with ODI < 5 and drivers with ODI > or = 5 (25.7 +/- 6.0 kg/m2 in drivers with ODI < 5 vs 29.0 +/- 6.3 kg/m2 in drivers with ODI > or = 5, p < 0.001). Sixteen percent of all drivers tested were hypertensive. Twelve percent were unaware of their hypertension. Hypertensive drivers were significantly more overweight (p < 0.0001), slept more restlessly (p < 0.04), took more naps (p < 0.03), and woke up more frequently during the night (p < 0.005). About 20% of drivers presented symptoms indicating very regular sleep disturbances. Drivers who had been with the company for more than 1 year were more likely to present daytime fatigue, daytime tiredness, unrestorative sleep, hypertension, and higher BMI. Long-haul truck drivers have very irregular sleep/wake schedules and a high prevalence of sleep-disordered breathing. Chronic sleep/wake disruption and partial, prolonged sleep deprivation may worsen sleep-disordered breathing. This combination of problems may impact significantly on the daytime alertness of truckers.
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PMID:Sleep and sleep-disordered breathing in commercial long-haul truck drivers. 775 Mar 18

Depression is a common condition in the geriatric population. A retrospective study of 30 elderly patients suffering from neurotic depression, who were admitted consecutively to a general hospital psychiatric ward, showed a predominance of females (n = 21) over males (n = 9) and young-old (65 to 74 years, n = 22) more than old-old (75 years or over, n = 8). Their ages ranged from 65 to 85 years with a mean of 71.6 years, SD 5.5 years. Co-existing physical disorders were present in every patient, the average being 1.8 per patient, and half (n = 15) had two or more physical disorders. Cardiovascular diseases (e.g. ischaemic heart disease and hypertension) and diabetes mellitus were present in about seven-eighths of the patients. The two commonest symptoms were low mood (n = 18, 60%) and vague somatic complaints inexplicable by any physical pathology (n = 19, 63%). Sleep disturbance bothered 12 patients (40%), while nine (30%) had attempted suicide. Twenty patients (67%) were prescribed antidepressants and 13 (43%) received benzodiazepines in low dosages, mainly as hypnotics. Electroconvulsive therapy was necessary for two patients with high suicidal risk. The mean duration of admission was 15.3 days, SD 12.9 days.
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PMID:Neurotic depression in the elderly. 794 52


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