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

This is a case report of a 37-year-old Japanese woman with primary aldosteronism who was found to have high plasma renin activity during toxemia of pregnancy and who died of a dissecting aneurysm of the aorta about 2 years later. The autopsy findings showed cystic medial necrosis in the aorta and a right adrenocortical adenoma. The dissecting aneurysm in this case is probably related to hypertension and cystic medial necrosis. A definite diagnosis of primary aldosteronism cannot be made during toxemia of pregnancy, and it is necessary to do serial determinations of plasma renin activity and plasma aldosterone concentration after delivery to confirm the diagnosis.
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PMID:Elevation of plasma renin activity during pregnancy and rupture of a dissecting aortic aneurysm in a patient with primary aldosteronism. 636 96

Hypertension may occur during pregnancy under different clinical circumstances. One cause is toxemia, a systemic disease unique to pregnant women, in which hypertension is associated with proteinuria, CNS irritability, hepatic and renal functional abnormalities, and, in fulminant disease, a consumptive coagulopathy. Since it is clear in the non-pregnant population that the vascular complications of hypertension can be prevented with antihypertensive therapy and since toxemia is the most common cause of maternal mortality, there is no reason not to treat pregnant women with hypertension.
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PMID:How should hypertension during pregnancy be managed? An internist's approach. 636 37

The best management of respiratory distress syndrome (RDS) is prevention. Prenatal administration of Cortico-steroids has been proved to be a valuable way for accelerating fetal lung maturation. In case of high risk pregnancy, however, where acceleration of lung maturation is most needed, there may be a relative contraindication for using steroids. According to the theory that the increase in the phospholipid component of surfactant may be mediated by intra-amniotic thyroxin administration, its use for accelerating human fetal lung maturation has been tested. Seven samples of amniotic fluid were obtained in order to determine the lung maturity in seven pathological pregnancies (pre-eclamptic toxemia, diabetes, infection, hypertension, placental insufficiency) prior to elective caesarean section. Since thyroxin does not cross the placenta, it has to be injected directly into the amniotic sac. 20 ml of clear fluid were obtained by amniocentesis prior to each injection of 250 micrograms of Levothyroxin through the same needle. Each of the infants was delivered before 34 weeks. Birth weights of the premature infants were between 1220-1870 grams. In all cases the Lecithin/Sphingomyelin Ratio (L/S) in amniotic fluid analysis was immature. After thyroxin administration L/S Ratio was mature in pharyngeal aspirate examination after delivery in 6 cases. RDS was seen in only one infant. The interval between intraamniotic administration of T4 and delivery ranged from 72 hours to 2 weeks in 6 cases. In one case with clinical and radiological signs of RDS the injection-delivery interval was less than 48 hours: the L/S Ratio in pharyngeal aspirate was immature 2,8 (normal greater than 3).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Prevention of hyaline membrane disease by intraamniotic administration of thyroxine]. 653 84

In a comprehensive population study of 1462 women ages 38-60 in Goteborg, Sweden, the prevalence of secondary hypertension was estimated to be 0.8% of the total population sample and 4.6% of those who were hypertensive (defined as systolic blood pressure or= 160mmHg or diastolic blood pressure 95mmHg or both or antihypertensive treatment irrespective of blood pressure levels. These figures were based on thorough clinical and laboratory investigations and a follow-up period of 12 years. Women with arterial hypertension reported a history of toxemia of pregnancy and a family history of hypertension more often than nonhypertensive women. In comparison with nonhypertensive women, in both untreated and treated hypertensive women, serum uric acid, urinary methoxycatecholamine excretion, body weight, and the prevalence of albuminuria were increased and serum potassium decreased (statistically significant differences).
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PMID:Prevalence of secondary hypertension in a population sample of Swedish women. 661 89

Risk factors for first nonfatal myocardial infarction (MI) in women younger than age 50 years were evaluated in a case-control study of 255 women with MI and 802 controls. The relative risk of MI increased with the amount smoked. The estimated risk of MI for current smokers of 35 or more cigarettes per day was ten times that of women who never smoked; an estimated 65% of MIs were attributable to cigarette smoking. The relative risk of MI increased markedly with increasing levels of total plasma cholesterol and decreasing levels of high-density lipoproteins, and the effects of the two factors appeared to be independent. Other factors significantly associated with MI were hypertension, angina pectoris, diabetes mellitus, blood group A, and a history of MI or stroke before age 60 years in a mother or sibling. Factors not significantly associated with MI were obesity, history of preeclamptic toxemia, and type A personality. Women who were postmenopausal appeared to have a lower risk of MI than premenopausal women of similar ages. Of the identified risk factors, the most prominent was cigarette smoking, a habit that is amenable to change.
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PMID:Myocardial infarction in women under 50 years of age. 664 58

Concerning the pathogenesis of toxemia there is little psychosomatically oriented research. 1. Etiology of toxemia. There is an elevated reactability of arterioles and consequently of the blood pressure on vasomotoric stimulation, which makes one think of a stress hypothesis. Excessive psychosocial distress is very hard to be grasped and quantified, even for scientific purposes. Therefore there are no greater sociological studies including extreme groups, for instance unmarried juvenile pregnant women. Their elevated risk of toxemia should be predictable by means of psychosocial factors. These expectations were raised by research dealing with psychology of personality and some endocrinological studies.--2. Therapy of toxemia. Some psychosomatical aspects can be considered in practice. a) Employing the manifold drug therapies, for instance of high blood pressure in late pregnancy, it is necessary to enlighten on possible side effects, to avoid unnecessary fears, favoring hypertension. b) Hospitalization without drug therapy, which for instance aims at tranquilization, should not go along with social isolation.--One-sided dietary rules as well as exaggerated invitations to reduce weight often by failing cause feelings of insufficiency and guilt. This kind of distress causes vegetative reactions and is of disadvantage for all kinds of toxemia. This is pointed out by animal experiments and successes of psychotherapy in cases of light hypertension during late pregnancy.
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PMID:[Gestosis and psychosomatic aspects]. 666 34

A case of toxemia misdiagnosed as idiopathic thrombocytopenic purpura is presented. An unusual temporal relationship between the fall in platelets and the appearance of hypertension was the cause of the confusion. A rise in platelets following glucocorticoid administration is discussed.
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PMID:Toxemia of pregnancy masquerading as idiopathic thrombocytopenic purpura. 668 29

Pregnancy complicated by hypertension is commonly associated with placental insufficiency, thereby resulting in fetal growth retardation. Furthermore, reduced utero-placental blood flow has been recognized in cases of severe preeclampsia with hypertension. Thus, it must be assumed that histological as well as ultrastructural findings in hypertensive placentas are due to the occlusion or narrowing of the uteroplacental vasculature as well as placental ischemia. Microscopically, these placental changes include infarcts, increased syncytial knots, hypovascularity of the villi, cytotrophoblastic proliferation, thickening of the trophoblastic basement membrane, obliterative enlarged endothelial cells in the fetal capillaries and atherosis of the spiral arteries in the placental bed. In addition, ultrastructural features are characterized by a decreased number of syncytial microvilli, proliferation of cytotrophoblastic cells, focal syncytial necrosis, thickening of trophoblastic basement membrane and narrowing of the fetal capillaries, as a number of studies have demonstrated. These placental abnormalities can be seen not only in human toxemia, but also in animals with experimentally induced toxemia or with spontaneous toxemia.
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PMID:Morphologic changes in the hypertensive placenta. 675 49

Survey about the combination of chronic hypertension and pregnancy. In contrary to the definition usually used in pregnancy blood pressure more than 140/90 mm Hg (18,7/12,0 kPa) is defined as hypertension. The incidence rate of chronic hypertension in fertile women in 3 percent. Superimposed toxemia is the most common complication. Significant correlation exists between diastolic blood pressure and perinatal mortality and intrauterine growth retardation. Hemodynamic changes are characterized by elevated total peripheral resistance and decreased plasma volume. Initially cardiac output is elevated, but more and more decreased, if the hypertension has been manifesting for some time. In pregnancy there should be an etiologic differentiation. An intensive team work between physicians and obstetricians is necessary for therapy. Principles of treatment generally accepted are phases of physical inactivity and avoidance of an excessive increase of body weight. No salt restriction. The opinions about the necessity of normalization of blood pressure during pregnancy by drugs are controversial. The recommendations of administration of antihypertensive drugs seem to succeed, because in controlled studies there was a decreased perinatal mortality.
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PMID:[Chronic hypertension and pregnancy]. 682 43

A toxemia-like syndrome was induced in pregnant beagles by intraperitoneal inoculation of concentrates prepared from placentas of patients with preeclampsia-eclampsia and hydatidiform mole, which contained an agent, Hydatoxi lualba, that stained in a unique fashion with toluidine blue-O-. The pregnant dogs inoculated with either of these concentrates progressively developed hypertension, eyeground changes consistent with hypertensive retinopathy, proteinuria, disseminated intravascular coagulation, and hepatic dysfunction in addition to intrauterine growth retardation and intrauterine fetal death. Hepatic periportal hemorrhage and glomeruloendotheliosis, lesions usually seen in preeclampsia-eclampsia, were also noted to occur in pregnant beagles inoculated with these concentrates. A significant increased sensitivity to angiotensin II infusion was also noted. The toxemia-like syndrome did not develop in pregnant beagles when inoculated in a similar fashion with concentrates prepared from placentas from normal term pregnancies which were free of Hydatoxi lualba or in nonpregnant beagles inoculated with concentrates containing Hydatoxi lualba. Although the agent was not injected in pure form, the inoculation of concentrates containing Hydatoxi lualba appears to be required for the manifestation of the toxemia-like syndrome.
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PMID:Experimental induction of a toxemia-like syndrome in the pregnant beagle. 684 42


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