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

Making a definite diagnosis of Cushing's syndrome is a challenging problem. Unsuspected Cushing's syndrome occurs in 2-3% of patients with poorly controlled diabetes, 0.5-1% with hypertension, 6-9% with incidental adrenal masses, and 11% with unexplained osteoporosis and vertebral fractures. The increasing recognition of this syndrome highlights the need for a simple, sensitive, and specific diagnostic test. Patients with Cushing's syndrome consistently do not reach a normal nadir of cortisol secretion at night. The measurement of late-night salivary cortisol levels might, therefore, provide a new diagnostic approach for this disorder. Salivary cortisol concentrations reflect those of active free cortisol in plasma and saliva samples can easily be obtained in a nonstressful environment (e.g. at home). Late-night salivary cortisol measurement yields excellent overall diagnostic accuracy for Cushing's syndrome, with a sensitivity of 92-100% and a specificity of 93-100%. Several factors can, however, make interpretation of results difficult; these factors include disturbed sleep-wake cycles, contamination of samples (particularly by topical corticosteroids), and illnesses known to cause physiologic activation of the pituitary-adrenal axis. In this Review, we discuss the methods and value of measuring salivary cortisol for the diagnosis of Cushing's syndrome, and put forward some recommendations to maximize accuracy of results.
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PMID:Late-night salivary cortisol measurement in the diagnosis of Cushing's syndrome. 1844 40

Modafinil is a wake-promoting agent that is pharmacologically different from other stimulants. It has been investigated in healthy volunteers, and in individuals with clinical disorders associated with excessive sleepiness, fatigue, impaired cognition and other symptoms. This review examines the use of modafinil in clinical practice based on the results of randomized, double-blind, placebo-controlled clinical trials available in the English language in the MEDLINE database. In sleep-deprived individuals, modafinil improves mood, fatigue, sleepiness and cognition to a similar extent as caffeine but has a longer duration of action. Evidence for improved cognition in non-sleep-deprived healthy volunteers is controversial.Modafinil improves excessive sleepiness and illness severity in all three disorders for which it has been approved by the US FDA, i.e. narcolepsy, shift-work sleep disorder and obstructive sleep apnoea with residual excessive sleepiness despite optimal use of continuous positive airway pressure (CPAP). However, its effects on safety on the job and on morbidities associated with these disorders have not been ascertained. Continued use of CPAP in obstructive sleep apnoea is essential. Modafinil does not benefit cataplexy.In very small, short-term trials, modafinil improved excessive sleepiness in patients with myotonic dystrophy. It was efficacious in fairly large studies of attention deficit hyperactivity disorder (ADHD) in children and adolescents, and was as efficacious as methylphenidate in a small trial, but has not been approved by the FDA, in part because of its serious dermatological toxicity. In a trial of 21 non-concurrent subjects, with 2-week treatment periods, modafinil was as effective as dexamfetamine in adult ADHD. Modafinil was helpful for depressive symptoms in bipolar disorder in a trial that excluded patients with stimulant-induced mania. A single dose of modafinil may hasten recovery from general anaesthesia after day surgery. A single dose of modafinil improved the ability of emergency room physicians to attend didactic lectures after a night shift, but did not improve their ability to drive home and caused sleep disturbances subsequently.Modafinil had a substantial placebo effect on outcomes such as fatigue, excessive sleepiness and depression in patients with traumatic brain injury, major depressive disorder, schizophrenia, post-polio fatigue and multiple sclerosis; however, it did not provide any benefit greater than placebo.Trials of modafinil for excessive sleepiness in Parkinson's disease, cocaine addiction and cognition in chronic fatigue syndrome provided inconsistent results; all studies had extremely small sample sizes. Modafinil cannot be recommended for these conditions until definitive data become available.Modafinil induces and inhibits several cytochrome P450 isoenzymes and has the potential for interacting with drugs from all classes. The modafinil dose should be reduced in the elderly and in patients with hepatic disease. Caution is needed in patients with severe renal insufficiency because of substantial increases in levels of modafinil acid. Common adverse events with modafinil include insomnia, headache, nausea, nervousness and hypertension. Decreased appetite, weight loss and serious dermatological have been reported with greater frequency in children and adolescents, probably due to the higher doses (based on bodyweight) used. Modafinil may have some abuse/addictive potential although no cases have been reported to date.
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PMID:Approved and investigational uses of modafinil : an evidence-based review. 1872 34

We propose a generation of Polysomnography (PSG)-derived measures that can quantify temporal patterns of sleep, and investigate the role of these measures as predictors of hypertension. We also investigate the influence of age on these measures as compared to traditional indices. We perform cross-sectional analyses of the association between hypertension status with traditional PSG and novel measures using adjusted and unadjusted logistic regression models. Our findings suggest that when adjusted for common confounders such as age, gender, race and Body Mass Index (BMI) the new features that quantify the variability of the sleep process are more strongly associated with hypertension as compared to traditional PSG indices, and are not as strongly influenced by age as are the traditional indices. The result implies that the regularity of sleep dynamics may be an important feature associated with hypertension. These measures may provide a powerful tool for discriminating individuals at risk for comorbidities, such as hypertension, associated with sleep disturbances.
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PMID:Novel polysomnography derived features as biomarkers for sleep dynamics. 1916 84

Patients with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTSs) have a considerably higher prevalence of cardiovascular disease (CVD) than the general population in old age. Many hypotheses have been created to explain traditional clinical risk factors of CVD, including age, male gender, cigarette smoking, inheritance, high blood pressure (BP), obesity, elevated fasting plasma glucose, diabetes mellitus, dyslipidemia, decreased physical activity and metabolic syndrome; or nontraditional risk factors such as oxidative stress, inflammation, vascular calcification, malnutrition, homocysteine and genetic variation. Although these risk factors are important in CVD pathophysiology and clinical presentation, there is still no single theory sufficient to provide an adequate explanation for all the properties of CVD. We speculate that by causing nocturia-induced sleep disturbances, BP variability, increased sympathetic activity, non-dipping BP variations; BPH may be an insidious risk factor for CVD. Benign prostate hyperplasia may be related to increased BP, coronary ischemic hearth disease or other cardiovascular pathologic conditions. This attention on BPH may produce a new approach to the diagnosis and treatment of CVD. Although the underlying mechanisms are still exactly unclear, further prospective randomized controlled studies are needed to identify if patients with BPH/LUTS is higher risk for CVD.
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PMID:An insidious risk factor for cardiovascular disease: benign prostatic hyperplasia. 1935 54

Renovascular hypertension in children is usually asymptomatic and diagnosed incidentally. Behavioral changes have not yet been well recognized as a part of the clinical spectrum of renovascular disease in children. We surveyed all children diagnosed with renovascular hypertension in our institute over a 15-year period. Eleven children were identified, of whom five (45%) had abnormal behavior, which had preceded the diagnosis of hypertension by 3-12 months. The symptoms included restlessness, sleep disturbances, temper tantrums, hyperactivity, aggressive behavior and attention deficit. In three children all behavioral symptoms disappeared following blood pressure normalization, and, in the other two a significant improvement was noted. It was concluded that behavioral symptoms may be a common and early manifestation of renovascular hypertension. Awareness of this association may bring about earlier diagnosis of the disease and prevent end-organ damage as well as unnecessary investigations for behavioral abnormalities.
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PMID:Changes in behavior as an early symptom of renovascular hypertension in children. 1944 79

Obstructive sleep apnea (OSA) is a common and debilitating condition characterized by recurrent episodes of upper airway obstruction, resulting in intermittent occurrence of apnea-hypopnea. Clinical features include snoring or disturbed sleep, reduced concentration and memory, mood disorders, and excessive sleepiness (ES). Left undiagnosed and untreated, OSA may have detrimental consequences, including cardiovascular (CV) morbidity and mortality, decreased health-related quality of life, and increased incidence of motor vehicle accidents. As most individuals affected by OSA will initially present in the primary care setting, primary care physicians have the opportunity to recognize the condition and refer patients for treatment when necessary. Management of the condition should include lifestyle changes and continuous positive airway pressure (CPAP) treatment if required. Wakefulness-promoting agents may be considered if ES persists despite CPAP. Effective intervention for OSA not only provides symptomatic benefits, but also improves hypertension and reduces the risk for fatal and nonfatal CV events associated with the condition.
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PMID:Obstructive sleep apnea (OSA) and excessive sleepiness associated with OSA: recognition in the primary care setting. 1964 Dec 66

Obesity continues to be a serious cause of morbidity and mortality globally and particularly in North America. Primary manifestations of obesity include obstructive sleep apnea (OSA) and depression associated with a decrease in immune defense mechanisms, possibly related to increased cytokine levels. Secondary manisfestations of obesity possibly result from a cascade of events and include insulin resistance/ hyperglycemia, hyperlipidemia, and hypertension-all of which comprise metabolic syndrome. This paper reviews sleep disturbances in general and OSA in psychiatric patients, particularly those who are obese.
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PMID:Obstructive sleep apnea, hypoxia, and metabolic syndrome in psychiatric and nonpsychiatric settings. 1972 76

Elderly populations are susceptible to many non-communicable diseases, including diabetes. Lack of awareness regarding disease status and risk factors increase complications and mortality. We conducted a cross-sectional community-based study of 1633 randomly selected participants aged 60 years and above in urban and rural areas in the Kathmandu Valley of Nepal. Study goals were: (i) to determine the prevalence of diabetes in elderly subjects as diagnosed prior to and during the study, and (ii) to identify and compare the determinants of diabetes as diagnosed prior to and during the study. A structured questionnaire was used to collect information regarding prevalence and potential determinants of diabetes diagnosed during and before the survey. Anthropometric measurements, blood pressure measurements and fasting blood sugar tests were also measured. Risk factor analysis was done using multinomial logistic regression; subjects with no diabetes constituted the reference group. We detected an overall diabetes prevalence of 25.9%, 17.3% diagnosed during the survey and 8.6% previously diagnosed. Age, disturbed sleep, and family history of hypertension were marginally significantly (p < 0.10) associated with diabetes diagnosed in the survey. In contrast, education, exercise, health perception, family history of hypertension, having a caretaker at night, receiving help from friends when seeking health care and mean waist circumference were significantly (p pounds 0.05) or marginally associated with diabetes detected before the survey. The high prevalence of diabetes in the elderly population studied, and the low level of prior diagnosis, identify an important public health problem. There is a need for improved screening of diabetes and improved health care and education in the elderly. There is also need for better understanding of risk factors associated with previously undiagnosed diabetes.
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PMID:Prevalence and determinants of diabetes among the elderly population in the Kathmandu Valley of Nepal. 1976 35

Sleep-disordered breathing (SDB) is a medical condition that has increasingly recognized adverse health effects. Obesity is the primary risk factor for the development of SDB and contributes to cardiovascular and metabolic abnormalities in this population. However, accumulating evidence suggests that SDB may be related to the development of these abnormalities independent of obesity. Periodic apneas and hypopneas during sleep result in intermittent hypoxemia, arousals, and sleep disturbances. These pathophysiologic characteristics of SDB are likely mechanisms underlying cardiovascular and metabolic abnormalities including hypertension and other cardiovascular diseases, altered adipokines, inflammatory cytokines, insulin resistance, and glucose intolerance. Treatment of SDB with continuous positive airway pressure reverses some but not all of these abnormalities; however, studies to date have demonstrated inconsistent findings. Weight loss strategies, including diet, exercise, medications, and bariatric surgery, have been evaluated as a treatment strategy for SDB. In preliminary studies, dietary intervention and exercise reduced severity of SDB. One study demonstrated improvements in SDB severity using the weight-reducing medication sibutramine. In morbidly obese subjects, bariatric surgery effectively induces weight loss and improvement in SDB severity and symptoms, but long-term benefits remain uncertain. Large randomized trials are required to determine the utility of these strategies as long-term approaches to improving SDB and reducing associated complications.
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PMID:Sleep-disordered breathing and obesity: pathophysiology, complications, and treatment. 1995 45

Hypertension (HP) is a serious condition affecting about one quarter of all adults, both men and women. Genetic and environmental factors are of importance in its aetiology, while psychosocial factors may also play a role. This study focused on psychosocial factors and examined the association among reduced psychological well-being, anxiety, sleep disturbances and HP by comparing people with HP and the general population. A national survey of 12,166 individuals (hypertensives n = 2047; rest of population n = 10,119) was conducted using two-step multiple logistic regression with an odds ratio and a 95% confidence interval. The study is in accordance with Swedish legislation pertaining to ethics. Reduced psychological well-being, anxiety and sleep disturbances were higher in the HP group and, in addition, reduced psychological well-being was, still higher in the presence of severe anxiety and serious sleep disturbances. These three factors are of major importance for HP, but it is difficult to know whether they are causes or consequences. In order to prevent HP, support for people who exhibit such risk factors should be a matter of high priority.
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PMID:The association among hypertension and reduced psychological well-being, anxiety and sleep disturbances: a population study. 2010 43


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