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

Hypertension is a common disorder which affects over 40 million individuals in the United States alone. Systemic (idiopathic) hypertension is particularly prevalent in elderly women who seem to tolerate this affliction better than their male counterparts. Women with hypertension should be cautioned about the effects of estrogen-containing oral contraceptives which may cause a further elevation in systemic blood pressure. However, postmenopausal estrogen supplementation does not produce adverse effects on blood pressure and, in fact, may offer cardiovascular protection. Renovascular hypertension, particularly as a result of fibromuscular hyperplasia, is more prevalent in women than men. For women, as for men, tobacco abuse and advanced age are associated with an increased prevalence of atherosclerotic renal artery stenosis.
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PMID:Hypertension in women. 219 93

Many statistics demonstrate a definite improvement of myocardial infarction during hospitalization, especially a decrease in the mortality. It appears tempting to credit that improvement to the numerous modifications of the treatment of this dangerous disease in the last few decades. The study reported here indicates, however, that other factors must be taken into account. We compared the evolution of two groups of patients hospitalized for acute myocardial infection, 10 years apart: The first group (G1) of 731 patients corresponds to years 1970-1975; the second group (G2) of 729 patients, corresponds to the years 1984-85-86. During these ten years, mortality decreased by 38 p. cent, from 19.2 p. cent (G1) to 11.9 p. cent (G2). This decrease remains significant regardless of age and sex, except in two subgroups with the least number of patients, i.e. women under the age of 65 and men over 65. It should be noted that rhythm disorders occur with the same frequency in both sub-groups while atrio-ventricular blocks seem to have decreased. The difference in the mortality cannot be attributed to the patient's selection. In fact, in both groups, they are comparable regarding the men/women ratio, the age distribution and the presence of main risk factors (tobacco abuse, dyslipidemia, arterial hypertension, diabetes, heredity). The treatment results in many alterations especially concerning diuretics which seem to be used in approximately 30 p. cent of the patients in both groups. On the contrary, steroids, prescribed in 25.3 p. cent of G1 patients are abandoned; electro-systolic stimulation established in 21.2 p. cent of G1 patients, concerned only 4 p. cent of G2 patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Acute myocardial infarction. Different treatment, different prognosis?]. 332 15

Polyarterial arteriosclerosis is a problem facing more and more clinicians because of the technical advances in exploration and revascularization methods. Epidemiologic data are rare in this field except for Framingham's study. We are reporting here the results of a French epidemiologic study regarding a representative sample of a group of 11,000 active men and women, with age ranging between 25 and 65 years. Methodologic difficulties cannot be avoided, but a minimal estimation may be expressed: polyarterial pathology represents approximately 15 p. cent of the pathology in each case. Polyarterial pathology is as prevalent as monoarterial pathology with a 10 years delay between the two sexes. Coronary diseases are the most frequent and represent the initial location in two-thirds of the cases. The same risk factors are found, but their chronology is different: more than ever, age is an essential factor since there is a ten years difference. Hyperglycaemia in men, overweight in women are major factors as important as tobacco abuse in men, arterial hypertension and dyslipidemia in both sexes. Finally the type A behavior seems to occupy an even larger role in polyarterial patients of both sexes.
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PMID:[Polyarterial pathology. Epidemiological aspects]. 336 39

A total of 167 carotid endarterectomies by the eversion technique were completed in 158 patients at a teaching hospital during the 6-year period ending July 1995. The average patient age was 66 years with a range of 39 to 89 years, and 99 (63%) were male. General anesthesia was employed routinely, and temporary indwelling shunts, were not used. Indications for endarterectomy included hemispheric transient ischemic attack (43), amaurosis fugax (20), stroke (41), and asymptomatic stenosis (63). Associated patient risk factors were not significantly different for men and women, and included diabetes mellitus (22%), tobacco abuse (72%), hypertension (69%), hypercholesterolemia (76%), cardiac disease (54%), and renal disease (21%). One (0.6%) permanent operative stroke and two (1%) 30-day hospital deaths occurred. Vascular laboratory follow-up was accomplished by duplex scanning with a documented sensitivity of 98 per cent in detecting a > or = 40 per cent stenosis. Eighty-nine per cent (148) of the 167 endarterectomies were tested at least once postoperatively. Overall laboratory follow-up averaged 17 months and ranged from one to 69 months. Residual stenosis, included perioperative thrombosis, occurred in 8 (5%) arteries. Recurrent stenosis was detected in four (2%) cases at 9, 24, 54, and 66 months after endarterectomy. Statistical analyses failed to implicate any specific patient risk factor, age, sex, or operative indication relevant to recurrent stenosis. Residual stenosis was correlated with younger patient age (P = 0.002), female gender (P = 0.12), and endarterectomy on the right side (P = 0.008). Carotid eversion endarterectomy appears to be a universally applicable, safe, and durable operative technique.
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PMID:Technical results from the eversion technique of carotid endarterectomy. 861 62

To identify the clinical correlates of recurrent heart failure hospitalization in a large urban hospital serving predominately African-American patients, and to provide further insight into modifiable risks for heart failure readmissions, a retrospective period prevalence review of the records of all adult patients admitted with a primary diagnosis of heart failure (International Classification of Diseases-9 code 428.0) between January and December 1995 was performed. The main outcome was the number of heart failure hospitalizations over 12 months. Twelve hundred patients were identified. Mean age was 64 +/- 16 years, 94% were black, 57% were women, and 40% were > or = 65 years old. Ninety-eight percent had a history of systemic hypertension and 55% had uncontrolled hypertension. Other comorbidities were left ventricular (LV) hypertrophy (64%), coronary artery disease (52%), and tobacco abuse (28%). Sixty-five percent of patients were on angiotensin-converting enzyme (ACE) inhibitors, 51% on calcium antagonists, and 8% on beta blockers. Most patients had suboptimal dosing of ACE inhibitors and there was inappropriate use of calcium antagonists in 56% of patients with moderate or severe systolic dysfunction. Diabetes mellitus and echocardiographic wall motion abnormality were independently associated with frequent admissions for women but not for men. Medication-related increase in heart failure hospitalization was seen for calcium antagonists in patients with severe LV dysfunction (odds ratio 2.24, 95% confidence intervals 1.0 to 5.03; p <0.03). Uncontrolled hypertension, underdosing of ACE inhibitors, and overuse of calcium antagonists in patients with significant LV dysfunction are potential targets for intervention.
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PMID:Gender differences and practice implications of risk factors for frequent hospitalization for heart failure in an urban center serving predominantly African-American patients. 1023 94

With low rates of the risk factors for cardiovascular disease as recently as 40 years ago, the rates of cardiovascular disease (CVD) in American Indians and Alaska Natives were exceedingly low. Despite recent large-scale efforts to eliminate health disparities in ethnic and minority populations, the impact among American Indian and Alaska Natives to date has been relatively limited. Indeed, over the past several decades the incidence and prevalence of cardiovascular risk factors has risen significantly, including the development of an epidemic of diabetes. Evidence suggests that these higher rates of cardiovascular risk factors, including tobacco abuse, diabetes, high blood pressure, and elevated cholesterol levels, may be placing an inordinate burden of cardiovascular disease on the American Indian and Alaska Native population. The rates of heart disease and stroke among American Indians and Alaska Natives are now higher than in the general U.S. population as well as in U.S. whites. Recent evaluations suggest that these rates are also higher than among other ethnic or racial populations in the United States. Additionally, American Indians and Alaska Natives have been found to have a substantially higher proportion of premature death from heart disease when compared with other ethnic and racial populations. A number of recent prevention initiatives and focused clinical efforts are making promising strides toward reduced disparities in cardiovascular health with primordial, primary, and secondary cardiovascular prevention efforts along with enhanced early identification and therapeutic intervention for more favorable cardiovascular outcomes in the future. In order to reach our goals of heart-healthy and stroke-free American Indians and Alaska Natives, implementation of an aggressive, reasonably resourced, systemic plan of coordinated health promotion, risk reduction, and disease control efforts are necessary, with appropriate policy and legislative support.
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PMID:Cardiovascular health among American Indians and Alaska Natives: successes, challenges, and potentials. 1638 20

Coronary artery disease (CAD) and erectile dysfunction (ED) are both highly prevalent conditions that frequently coexist. Additionally, they share mutual vascular risk factors, suggesting that they are both manifestations of systemic vascular disease. The role of endothelial dysfunction in CAD is well established. Normal erectile function is primarily a vascular event that relies heavily on endothelially derived, nitric oxide-induced vasodilation. Accordingly, endothelial dysfunction appears to be a common pathological etiology and mechanism of disease progression between CAD and ED. The risk factors of diabetes mellitus, hypertension, hyperlipidemia, obesity and tobacco abuse contribute to endothelial dysfunction. This article reviews the role of vascular endothelium in health, the abnormalities resulting from vascular risk factors, and clinical trials evaluating the role of endothelial dysfunction in ED.
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PMID:Linking erectile dysfunction and coronary artery disease. 1639 38

Peripheral arterial disease (PAD), a major cause of disability, loss of work, and lifestyle changes in the United States, is defined as obstruction of blood flow into an arterial tree excluding the intracranial or coronary circulations. PAD is mostly silent in its early stages, but when lesion obstruction exceeds 50%, it may cause intermittent claudication with ambulation. Further disease progression typically leads to rest pain or frank tissue loss. However, some patients may remain asymptomatic with severe disease because of extensive collateralization in the lower extremity. Estimates of the prevalence of intermittent claudication vary by population, from 0.6% to nearly 10%; the rate increases dramatically with age. Approximately 20% to 25% of patients will require revascularization, while fewer than 5% will progress to critical limb ischemia. Limb loss, although rare, is associated with severe disability and an overall poor prognosis, with 30% to 40% mortality in the first 24 months after limb loss. As with coronary artery disease, the most common cause of symptomatic obstruction in the peripheral arterial tree is atherosclerosis, a systemic inflammatory process in which cholesterol-laden plaque builds up in the artery and eventually blocks the lumen. Typical risk factors include age, gender, diabetes, tobacco abuse, hypertension, and hyperlipidemia.
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PMID:Epidemiology and pathophysiology of lower extremity peripheral arterial disease. 1647 7

Nondrug therapy of hypertension really does work but requires strong motivation by both patient and physician. In addition to global health benefits, prescription of weight loss, exercise, moderation of salt and alcohol intake, Dietary Approach to Stop Hypertension (DASH) eating plan, and tobacco avoidance can decrease the risk for normotensive and prehypertensive patients of developing fixed hypertension. Initiating and maintaining a healthy lifestyle may be sufficient to avoid pharmacologic therapy for some patients and is a valuable adjunct to drug therapy for most. Blood pressure lowering can be achieved by weight reduction (5-20 mm Hg/10 kg), DASH eating plan (8-14 mm Hg), dietary sodium reduction (2-8 mm Hg), increased physical activity (4-9 mm Hg), and moderation of alcohol consumption (2-4 mm Hg). Combination of two or more modalities may have an additive benefit. Cessation of tobacco abuse not only has global health benefits, but may reduce blood pressure.
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PMID:Nonpharmacologic therapy for hypertension: does it really work? 1705 93

Classically, there have been three well established major cardiovascular risk factors, hypercholesterolemia, hypertension and tobacco abuse. With accumulating clinical evidence, diabetes can now be added as a fourth major risk factor. Much interest in various other risk factors and possible causative factors has been generated, but it should be remembered that of all these, low density lipoproteins (LDL) remains the gold standard for evaluating risk. The common perception is that only caucasians in the western world have significant cardiovascular (CV) risk. However, much clinical information to the contrary has accumulated and now it is realized that many other ethnic groups also have significant CV disease, such as in India, especially in the urban population. Dyslipidemias of specific lipoproteins and their treatment is an important part of understanding and managing CV disease and risk. Various plasma factors such as homocysteine and lipoprotein (a) [(a)] have been considered to have definite associations with CV disease, but any treatment benefit remains in doubt. In addition, inflammatory risk factors are considered to be of significant clinical interest, especially high sensitivity C-Reactive protein (hsCRP). Where do these factors fit into routine clinical practice still awaits clarification. Only two of these inflammatory risk (Lp-factors can be tested commercially on a routine clinical basis and these are hsCRP and Lipoprotein-associated Phospholipase A2 Lp-PLA2). Their clinical utillity is not established and acceptance is limited: some third party health coverage organizations refuse to pay for such analyses. In the past, women have been looked upon as not having significant CV disease. More recently, evidence suggests that women may have more CV disease than men, and that physicians may have failed to realize this and act accordingly. The true situation is that women have less CV disease than men prior to menopause and then they slowly catch up. However, some women under age 50 have an especially malignant form of CV disease and in these cases, myocardial infarction mortality is twice that of men. The explanation and management is the subject of much clinical investigation. In both India and the western world, perhaps the most important medical problem is the metabolic syndrome (MS) and this combination of CV risk factors multiplies the significance of each. For the difficult patient not tolerant of or sufficiently responsive to conventional therapy, alternative diets and medications can frequently offer just enough benefit in lowering LDL to allow the patient to attain their target level. Future treatments undoubtedly will involve genetics, but for now, aggressive medication use can favorably modify risk although not eliminate it.
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PMID:Evaluation critique of state of the art dyslipidemia management in general and with a special emphasis on the Indian population. 1912 29


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