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

The antihypertensive effects of intravenous labetalol were evaluated in 59 patients with hypertensive crises or severe hypertension in need of rapid lowering of blood pressure in a multicenter study. Patients appearing with a supine diastolic blood pressure 125 mm Hg or greater, or a supine systolic blood pressure of more than 200 mm Hg received an initial mini-bolus injection (20 mg) of labetalol. This was followed by repeated incremental doses of 20 to 80 mg given at 10 minute intervals to achieve a supine diastolic blood pressure of less than 95 mm Hg or decrease 30 mm Hg or greater, or a satisfactory decrease in systolic blood pressure. Patients were stratified into those who had taken antihypertensive medication within 24 hours and those who had not. The initial mini-bolus injection caused rapid but not abrupt reduction in blood pressure; the baseline mean blood pressure decreased 23/14 mm Hg. Further injections were needed in the majority of patients (mean: 197 mg). The blood pressure reduction after the last dose of labetalol was 55/33 mm Hg. In pretreated patients and in those who had no medication for 24 hours prior to the intravenous labetalol, the response was similar. Heart rate decreased 10 beats per minute in the total population. In patients pretreated with beta-adrenergic blockers, blood pressure response was similar to that in the total group (59/35 versus 55/33 mm Hg), but heart rate remained essentially unchanged. The dose required to achieve the therapeutic effect was less in pretreated patients than in untreated patients, but the duration of action was shorter. No serious adverse effects were encountered even in patients with concomitant diagnoses of acute left ventricular failure, myocardial infarction, stable congestive heart failure, atrial fibrillation, angina pectoris, acute stroke, transient ischemic attack or encephalopathy. Labetalol is a safe and effective treatment for a rapid blood pressure reduction in hypertensive emergencies.
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PMID:Intravenous labetalol in the treatment of severe hypertension and hypertensive emergencies. 613 20

Brain-stem auditory evoked potentials (BAEPs) are relatively resistant to alteration by barbiturate drugs, but the effects of the high doses that are used clinically to produce deep barbiturate coma for the treatment of intracranial hypertension and postischemic anoxic encephalopathy on BAEPs are unknown. We gave high-dose pentobarbital infusions to mechanically ventilated rats while recording serial BAEPs from the scalp. Pentobarbital progressively suppressed and then abolished all peaks. First the later waves, then all but the first wave, and finally all waves were abolished at intravenous doses of 120, 220, and 260 mg/kg, respectively, in addition to the initial anesthetic dose of 60 mg/kg i.p. The changes were at least partially reversible; peaks returned in reverse order of their disappearance. Peak latencies increased with dose. The results show a significant effect of pentobarbital on BAEPs in the rat, suggesting that BAEPs may be useful in assessing the depth of and recovery from barbiturate coma.
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PMID:Brain-stem auditory evoked potentials in rats with high-dose pentobarbital. 620 58

Twelve scleroderma patients with hypertension, seven of whom had malignant hypertension and renal failure of scleroderma renal crisis, were treated with captopril. The first dose lowered mean pressure in all patients by 21.3 mmHg; in 6 patients it relieved encephalopathy. Blood pressure was controlled in all patients. Two of 7 patients with scleroderma renal crisis had improvement in renal function; the 5 patients who did not have malignant hypertension improved or stabilized. Despite good pressure control, however, renal failure developed in 5 patients with scleroderma renal crisis. The data indicated that captopril is effective antihypertensive therapy in scleroderma and, when given early, may prevent renal failure and death.
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PMID:Variable response to oral angiotensin-converting-enzyme blockade in hypertensive scleroderma patients. 627 17

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

The association between admission coma score and eventual outcome was assessed using a coma scale developed for children with a variety of central nervous system injuries. As opposed to the Glasgow coma scale, this scale does not demand assessment of verbalization, and thus can be applied to the preverbal or previously intubated child. Cortical function is graded from 6 (purposeful, spontaneous movements) to 0 (flaccid), and brainstem function is graded from 3 (intact) to 0 (absent and apneic). Maximum total score is 9. In 91 children treated for intracranial hypertension, the association was moderately good. The scale was better in predicting the outcome of patients with hypoxic encephalopathy and head trauma than that of patients with Reye's syndrome, meningitis, or encephalitis. No child with a score of less than 3 survived in spite of intensive therapy. Most of these children were flaccid with depressed or absent brainstem reflexes. No child with flaccidity on admission survived.
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PMID:Coma scale for use in brain-injured children. 650 97

We present the case of a 64-year-old alcoholic who had suffered two episodes of hemorrhage from esophageal varices. For control of variceal hemorrhage, he underwent a distal splenorenal shunt. His immediate postoperative course was complicated by the development of marked ascites and intermittent episodes of encephalopathy. Routine postoperative angiography was performed after 4 months and demonstrated a fistula between the left gastric artery and vein. Patency of the shunt was demonstrated by direct percutaneous splenoportography. Two months after this admission, the patient was readmitted with the complaints of anorexia and nausea. Marked encephalopathy was noted. Eight hours following admission, he developed acute abdominal distention and hypotension. An abdominal tap revealed bloody fluid, and the patient was immediately prepared for transport to the operating room. He suffered cardiac arrest during transport, and all efforts at resuscitation were unsuccessful. Although a postmortem examination was not performed, it is suspected the arteriovenous fistula resulted in severe portal venous hypertension leading to intraperitoneal rupture of one of the affected veins, producing a massive hemoperitoneum.
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PMID:Left gastric arteriovenous fistula after selective distal splenorenal shunt. 660 11

Based on the experience reported herein, the following conclusions have been made: (1) Although nonoperative means, including sclerotherapy, have an important role in the management of bleeding varices, they are not definitive means of treating recurrent variceal hemorrhage. (2) Because of the maintenance of hepatopetal flow and splanchnic venous hypertension, a selective shunt is associated with a lower incidence of encephalopathy and provides a better quality of life than does a nonselective shunt. Thus, an elective distal splenorenal shunt is the elective operation of choice for recurrent variceal hemorrhage. (3) Nonselective shunts can be performed with similar expectation of patient survival as selective shunts, but because of increased encephalopathy, should be reserved for emergency operations, in cases of unsuitable venous anatomy, and in those patients with intractable ascites. (4) A well-conceived elective shunt procedure can be performed with low operative mortality and long-term patency, results in significant survival, and is still considered the "gold standard" for treatment of variceal bleeding.
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PMID:Selective and nonselective shunts for variceal bleeding. A prospective study of 103 patients. 661 Oct 93

Malignant hypertension still constitutes a medical emergency, particularly when complicated by renal failure, encephalopathy, or left ventricular failure. A shift to the right of the autoregulatory curve of cerebral blood flow (and probably of renal blood flow) is known to occur in patients with hypertension. Local cerebral edema, complicating the malignant phase, is likely to aggravate this trend. While inadequate or tardy treatment leads to encephalopathy, renal and cardiac failure, over aggressive treatment may also result in damage to brain, heart, and kidney. Recent reports of neurological damage, sometimes fatal, following aggressive hypotensive treatment suggests the need for a reappraisal of current practices. More investigation is needed to determine the effects of the various classes of antihypertensive drugs on organ perfusion, particularly of brain, heart, and kidney, in both normal and hypertensive humans. Other hypertensive crises include raised arterial pressure in association with acute dissection of the aorta and in the presence of stroke or subarachnoid hemorrhage. While there is agreement about the need for urgent hypotensive treatment in patients with aortic dissection, there is no information with which to base rational decisions in the management of high arterial pressure in the acute phase of stroke or subarachnoid hemorrhage.
Hypertension
PMID:Management of hypertensive crises. 662 56

Nine children treated for acute leukemia or lymphosarcoma developed subacute encephalopathy starting with listlessness, depression and impairment of speech. Walking difficulties, ataxia, spasticity and sphincter disorders developed later. Transient intracranial hypertension and abnormal movements respectively developed in two patients. EEG frontal slow waves, raised CSF protein, abnormal white matter radioisotope uptake and CT scan hypodensity with patchy contrast enhancement were evident at the onset. Later, dilated ventricles and calcification appeared in the younger patients. Post-mortem neuropathological studies of three patients disclosed predominantly perivascular myelin loss in areas of white matter necrosis, abnormalities of small vessels and numerous axonal swellings. The spinal cord showed secondary degeneration of the corticospinal tracts. Analysis of the aetiological factors in this series points to the prevailing danger of cranial radiotherapy, probably increased by the young age of patients and by associated drug administration.
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PMID:Necrotising leukoencephalopathy complicating treatment of childhood leukaemia. 669 15

Using a novel method of electrophoresis, patients with atherosclerotic and hypertonic dyscirculatory encephalopathy were examined for protein fractions of their blood serum. Various kinds of dysproteinemia and dyslipoproteinemia were recorded, with their manifestations being particularly pronounced in cerebral atherosclerosis with the syndrome of arterial hypertension. Clinical improvement following the therapy was usually accompanied by the normalization of the protein spectrum of blood serum. The results obtained may be utilized in the differential diagnosis and the evaluation of the therapy efficacy.
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PMID:[Serum protein fractions in patients with dyscirculatory encephalopathy in atherosclerosis and hypertension]. 670 69


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