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

Treatment with desoxycorticosterone acetate (DOCA) and 1 per cent saline as drinking water for 21 days caused a significant and similar increase in blood pressure in haired mice, with a normal thymus function, as in nude mice with genetical aplasia of the thymus. After 57 and 78 days there was, however, a significantly more pronounced increase in blood pressure in haired than in nude mice. A marked degree of round cell infiltration around intrarenal vessels and degenerative changes including wedge-shaped infarcts were observed in the kidneys of the haired mice, commencing after 57 days of treatment, while no such changes were found in nude mice. Thymus grafting in nude mice, successively treated with DOCA and salt, conferred the ability to react with chronic hypertension and intrarenal vascular disease, equal to the reaction seen in haired mice. The present investigation has provided evidence for the existence of an initial thymus independent and a chronic thymus dependent phase of DOCA and salt hypertension in mice. It still remains an unsolved problem whether the secondary blood pressure fall observed in nude athymic mice is a direct consequence of the lack of perivascular cellular immune reactions, or caused by other defects in this strain of mice.
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PMID:Evidence for an initial, thymus independent and a chronic, thymus dependent phase of DOCA and salt hypertension in mice. 99 51

Autopsy observations suggested that lesions of hypertensive pulmonary vascular disease (HPVD) due to elevated venous pressure differ from those with arterial hypertension only. Clinical and pathologic features were reviewed in patients from the Hopkins autopsy files with proved pulmonary hypertension; 50 had venous HPVD due to left-sided congestive heart failure, 50 had arterial HPVD due to congenital malformations, and 15 had idiopathic pulmonary hypertension (IPH). The two forms of HPVD have consistent distinctive histologic changes. In venous HPVD intimal fibroelastosis (IFE) develops in veins and arteries with retention of normal lumen diameters. Intensity of IFE correlates with severity and duration of venous hypertension. Arterial HPVD has IFE in conducting arteries, but the characteristic lesion is cellular intimal proliferation in regulatory arterioles, producing progresssive irreversible lumenal narrowing. Glomoid and angiomatoid lesions appear with prolonged severe arterial hypertension. They do not occur in venous HPVD. Hypertensive arteritis may develop with either form of HPVD. IPH has arterial-type HPVD. IFE of venous HPVD appears to be a response to increased mural tension. Arteriolar intimal cellular proliferations seen in arterial HPVD may be produced by blood flow boundary layer separations. IPH may be explainable as protracted inappropriate pulmonary arteriolar constriction.
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PMID:The pathogenesis of the two forms of hypertensive pulmonary vascular disease. 99 86

A 51-yearold man with moderate intermittent hypertension had a rapidly progressive, profound dementia in the absence of significant localizing neurological signs. Postmortem examination disclosed the vascular alterations and diffuse white matter degeneration which characterize subcortical arteriosclerotic encephalopathy (SAE) or Binswanger's disease. The case underscores the need to consider vascular disease as an etiology of dementia -- even in the absence of focal neurological deficit.
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PMID:Subcortical arteriosclerotic encephalopathy (Binswanger's disease). A vascular etiology of dementia. 100 40

Serial, clinical, clinicopathologic and histologic studies performed simultaneously following onset of PS-AGN in children for a period of up to 144 months revealed no evidence of progression to chronic glomerulonephritis. Although acute morphologic changes were more severe in renal tissue obtained from patients with AGN following streptococcal upper respiratory infection than following pyoderma, the acute manifestations in both groups subsided 6 to 12 weeks after onset. Cumulative morphologic healing occurred in 20% of patients at 24 months, in 43% at 48 months after onset of PS-AGN; 1 patient who was unhealed at 49 months was lost to follow-up. In 2 patients (6%), acute histologic exacerbations without clinical signs occurred within 24 months after onset. Subsequent healing was documented histologically. Addis counts remained abnormal in a high percentage of patients throughout the 12 years of observation and did not correlate with the histologic findings of renal biopsy tissue. The occasional demonstration of renal vascular disease and/or hypertension may merely reflect the early development of spontaneous essential hypertension although the possibility of a relationship to the previous attack of PS-AGN is intriguing. This question cannot be answered at this time. Renal biopsy studies are more dependable than Addis counts in assessing the course of PS-AGN. The significance of persistence of immunofluorescent and/or electron microscopic changes (subepithelial dense deposits) many years after onset in 58% of 12 patients studied, at a time when a majority of patients (84%) revealed healing by light microscopy, remains to be assessed.
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PMID:Prognosis of acute poststreptococcal glomerulonephritis in childhood: prospective study and review of the literature. 100 3

1. The syndrome of malignant hypertension in man and animals has three fundamental components: high blood pressure, activation of the renin-angiotensin system and the rapid development of necrotizing arteriolar disease. 2. The high blood pressure can be associated with different conformations of the arteriolar microcirculation. The emergence of an arteriolar reaction pattern characterized by the formation of focal dilatations, with intervening constricted segments, is of fundamental pathophysiological importance. 3. Activation of the renin system is reflected in an increased renin secretion rate from the kidneys and an increased rate of angiotensin II generation in the pulmonary vascular bed. 4. The crucial pathogenetic process, leading eventually to severe arteriolar wall damage, is a penetration of plasmatic macromolecules into the wall of distended arteriolar segments, as observed in states of severe experimental hypertension. 5. Renin can induce vascular disease, but hypersecretion of renin is not a necessary condition for the development of hypertensive arteriolar necrosis.
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PMID:The renin-angiotensin system and the pathogenesis of vascular disease in malignant hypertension. 107 5

Macroscopic and light microscopic features of regional ischemic infarcts of retina in autopsy eyes are described. Lesions were found throughout life span, most patients having significant primary or secondary vascular disease (younger had systemic hypertension, rheumatic heart disease, vasculitis or sickle hemoglobinopathy; most older patients had arteriosclerosis). Diabetes mellitus and infarction of other organs (including brain) also were common. Topographically almost all lesions were found in posterior fundus; most were temporal and involved anatomical macula. Microscopically there was destruction of inner retinal layers with preservation of outermost cells of inner nuclear layer; occasionally ganglion cell layer was relatively spared.
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PMID:Regional ischemic infarcts of the retina. 108 10

The effect of neonatal thymectomy on the degree and prognosis of hypertension and on the vascular lesions in rats with renal hypertension was studied. There were no differences between thymectomized and sham operated hypertensive rats. The degree of hypertension, the frequency of spontaneous death and heart infarcts were the same in both groups. The occurrence and degree of perivascular cell infiltrations, deposits of perivascular connective tissue and fibrinoid degenerations of the media were found to be the same in both the thymectomized and the sham operated hypertensive animals. The results do not support the assumption that delayed type immune reactions are important in the pathogenesis of hypertensive vascular disease in renal hypertensive rats.
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PMID:Influence of neonatal thymectomy on blood pressure and hypertensive vascular disease in rats with renal hypertension. 109 29

In conclusion, patients on chronic maintenance dialysis have an increased incidence of death from cardiovascular disease. Hypertension plays a major role, and these patients must be carefully monitored for complete control of blood pressure. Adequacy of ultrafiltration to maintain normal extracellular volume is an essential part of the dialytic treatment. Hypertensive patients should be screened for excessive renin secretion because of its possible role in unresponsive hypertension in patients on dialysis. Nephrectomy should be used when necessary, where dialysis and antihypertensive medication have not adequately controlled blood pressure. Patients must be monitored for the presence of pericardial disease to avoid subsequent pericardial effusion and the development of constrictive pericarditis with its adverse effect on myocardial function. When constrictive pericarditis is present, it obviously should be relieved by appropriate surgery. Efforts should be made to minimize cardiac output in hemodialysis patients. Whether or not routine transfusions to maintain a higher hematocrit are indicated is a question that cannot yet be answered. However, patients with marginal cardiovascular function who are accepted on hemodialysis and must have an arteriovenous shunt should be supported in any manner to minimize an increase in cardiac output. Early and aggressive treatment of known episodes of sepsis is important in the elimination of valvular endocarditis in this patient population. Perhaps one of the finer indicators of adequacy of hemodialysis will be K rate and peak immunoreactive insulin levels. Continued abnormality of these parameters may contribute to cardiovascular disease. Clearly, further study of the effect of abnormal carbohydrate metabolism on lipid metabolism is in order. Serum triglyceride, serum cholesterol and lipid electrophoretic pattern should be followed to evaluate the beneficial effects of drug therapy and changes in dialytic technique on the development of cardiovascular disease. Careful monitoring of calcium, phosphorus, bone films and parathyroid hormone levels is indicated to assess parathyroid status. The use of aluminum binders and parathyroidectomy to prevent vascular and myocardial calcification is important in the therapy of these patients. The use of cardiac catheterization, coronary artery arteriography, and possibly cardiac vascular repair, should be considered in the chronic hemodialysis patient with coronary artery disease if he is otherwise well. Adequacy of hemodialysis perhaps can be evaluated through its effect on all of the above parameters. Whether or not changes in artificial kidney treatments can correct the final vascular disease remains to be seen.
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PMID:Cardiovascular disease in uremic patients on hemodialysis. 109 1

In summary, a prognostic and therapeutic evaluation of 227 patients first seen from 1967 to the end of 1969 with a follow-up of 4-7 years was made. The results are indeed depressing. In spite of close follow-up and systematic treatment with modern antihypertensive agents, the mortality of patients having hypertension with superimposed arteriosclerosis was 27% (15 to 56) for males as contrasted to 3% (2 of 75) for females. Since the last casual blood pressure in both living and deceased patients of the mixed group were similar, the level of blood pressure following treatment could not be incriminated for the deceased patients. An exaggerated systolic and pulse pressure cold pressor response emerged as an important indicator of presence of arteriosclerosis alone. When hypertension and arteriosclerosis coexisted there was also exaggeration in diastolic cold pressor response. A further exaggeration in systolic and diastolic cold pressor response was seen in the decreased as compared to living male patients, a finding which appears to have grave prognostic significance for coronary heart disease and stroke. Thus a marked exaggeration in both systolic and diastolic cold pressor response in males might prove to be the single most important predictor of premature death from atherosclerotic vascular disease. A further analysis of the deceased male patients having hypertension and superimposed arteriosclerosis, indicates that treatment of hypertension may prevent oeath from stroke but not form coronary heart disease. Two-thirds of the deaths occur suddenly and only one-third of the deceased patients reached the hospital befor dying. In view of these distressing findings a plea for early detection and treatment of hypertension, prior to the development of superimposed arteriosclerotic changes, particularly in males, is made.
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PMID:Prognostic and therapeutic considerations in pure hypertension vs hypertension and superimposed arteriosclerosis. 112 46

From two groups of diabetics, i.e. an "invesitgation-group" of 40 cases and a "comparison-group" of 55 cases, the following characteristics of a state preliminary to proliferative diabetic retinopathy are resulting: early commencing of angiopathy by means of proteinuria (nephropathy), progression of retinopathy (pre-stage), pronounced progressiveness of the accompanying nephropathy and arterial hypertension, and finally uncommon diabetic heredo-familiarity. They all permit permature conclusion on proliferative retinopathy (and glomerulosclerosis).
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PMID:[Pre-conditions of proliferative diabetic retinopathy (author's transl)]. 114 87


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