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

4 kinds of progestin only oral contraceptives (OCs) and numerous combined OCs containing ethinyl estradiol (EE) or occasionally mestranol and either norgestrel or norethindrone are currently available in Australia. All progestins except norgestrel are effective in vivo after metabolism to norethindrone. Mestranol is effective in the human after demethylation to EE. The main side effects of OCs, including menstrual disturbances and changes in weight and mood, are primarily of nuisance value. Menstrual blood loss with OCs is almost invariably less than during spontaneous menses, but breakthrough bleeding and midcycle spotting may cause concern in patients. Amenorrhea and weight gain are rare with low dose pills. Approximately 6 in 1000 women remain anovulatory for 12 months or more after discontinuing OCs, but it is not yet know whether the amenorrhea is related to pill use and it is usually corrected by induction of ovulation. Cardiovascular side effects including venous thrombosis and pulmonary embolism are seen less frequently with new lower dose pills. The effects of OCs on the cardiovascular system are complex and depend on the interaction of estrogen and progestin. Amounts of estrogen and progestin should be the lowest possible to prevent ovulation, and routine monitoring should be provided for all women using pills. Older high dose formulations altered lipid metabolism in the direction of greater risk of coronary heart disease. Although research suggests the lowest dose triphasic pills have no significant effect, not enough large studies have been done with matched controls. Any effects on carbohydrate metabolism of the low dose pills are apparently minor and of little clinical significance. Insulin dependent diabetics with adequate supervision may safely use low dose pills. Combined OCs reduce the incidence of endometrial and ovarian malignancy. No relationship between OCs and the risk of breast cancer has been demonstrated except possibly in women under 35 when the cancer developed. The risk of intraepithelial neoplasia may be increased in women taking OCs for more than 8 years. Data on drug interactions are inconclusive, but women on rifampicin should use some other method. Absolute contraindications to OCs include breast cancer, history of deep venous thrombosis or pulmonary embolism, active liver disease, use of rifampicin, familial hyperlipidemia, previous arterial thrombosis, and pregnancy, while relative contraindications include smoking, age over 35, hypertension, breastfeeding, and irregular spontaneous menstruation. Progestin only OCs have a higher rate of failure and irregular bleeding than combined pills and their main use is for breastfeeding women and those with contraindications to estrogen. The pill of 1st choice should be a triphasic low-dose formulation.
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PMID:Oral contraceptives. 650 52

Thromboembolic events are thought to occur with increased frequency in Cushing's syndrome due to the predisposing factors, obesity, hypertension, a raised haematocrit and major surgery plus a 'hypercoagulable state'. To examine this postulate further we have studied 43 patients with Cushing's syndrome retrospectively and 10 patients prospectively to determine the incidence of arterial and venous thrombosis, both spontaneous and post-operative. Arterial events were noted in four cases (9%) and deep vein thrombosis or pulmonary thromboembolism (PTE) occurred in six cases (11%). Post-operative PTE occurred in 2.7% of all operations. These vascular complications tended to occur in the older patients with Cushing's syndrome. In our series, clinically significant thromboembolic episodes appear no more common than expected and the indications for prophylactic anticoagulation (the older and more obese patients) may not be different from other patients undergoing major surgery. An incidental finding was of a greater frequency of hypertension in Cushing's patients due to an adrenal adenoma.
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PMID:Thromboembolic complications in Cushing's syndrome. 662 1

This is a summary discussion of the 3 types of OCs (oral contraceptives) (combined, sequential, and progestogen-only), their mechanisms of action, their relative effectiveness, and the side effects they cause. It is certainly safer for women to take OCs than to become pregnant, judging from maternal mortality statistics. This is especially true for developing countries. However, hypertension is increased 3-fold, deep venous thrombosis 5-fold, and cerebrovascular disease 4-fold in OC users. The majority of the known side effects are attributed to estrogen, although progestogen is not without blame. The major side effects mentioned, in addition to those listed above, are migraine, diabetes, carcinogenic effects, and possible teratogenic effects. Drug interactions with different drugs may reduce the effectiveness of the OC estrogen, thereby resulting in pregnancy. Estrogen also interacts with other drugs.
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PMID:Oral contraceptives, side effects and drug interactions. 723 87

The composition and use of oral contraceptives (OCs) have changed since their cardiovascular side-effects were established 20 years ago. This report describes the risk of idiopathic venous thromboembolic (VTE) events (deep vein thrombosis [DVT] and/or pulmonary embolism [PE]) in association with current use of combined OCs among 1143 cases aged 20-44 and 2998 age-matched controls, as evaluated in a hospital-based, case-control study in 21 centres in Africa, Asia, Europe, and Latin America. OC use was associated with an increased risk of VTE in Europe (odds ratio 4.15 [95% CI 3.09-5.57]) and in non-European ("developing") countries (3.25 [2.59-4.08]). Risk estimates were generally higher for DVT than for PE but no consistent trend by certainty of diagnosis (definite, probable, possible) was found. Increased risk was apparent within 4 months of starting OCs, was unaffected by duration of current episode of OC use, and had disappeared within 3 months of stopping OCs. Relative risk estimates of VTE associated with OC use were unaffected by age of user, by history of hypertension (excluding hypertension in pregnancy), or in any consistent way by smoking. However, in both groups of countries increased body mass index (BMI) was an independent risk factor for VTE, and OC-associated odds ratios were higher among those with a BMI above 25 kg/m2 than among those with smaller BMIs. OC-associated risk estimates were high among women in Europe with a history of hypertension in pregnancy. Odds ratios associated with the use of OCs containing a third-generation progestagen were higher than those observed with progestagens of the first (norethindrone type) and second (norgestrel group) generation. Odds ratios associated with first and second generation progestagens tended to be lower, though not significantly, when used in combination with low (< 50 micrograms oestrogen) rather than higher oestrogen doses. This study confirms an association between OC use and VTE in Europe and the developing countries, although overall risk estimates associated with use were lower than demonstrated in most previous studies of non-fatal idiopathic VTE.
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PMID:Venous thromboembolic disease and combined oral contraceptives: results of international multicentre case-control study. World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. 1056 Jun 79

The aim of this study was to evaluate the effect of lacidipine and nifedipine on lower limb veins. Forty hypertensive patients, aged 30-50 years, with no deep venous thrombosis, venous insufficiency, or hypothyroidism underwent double-blind treatment with placebo (1 week), lacidipine 4 mg once daily (1 week), and slow-release nifedipine 20 mg twice daily (1 week) in randomized sequence. Echo-color Doppler examination of superficial, deep, communicating, and perforating veins of the legs was performed. The results showed venous insufficiency and hypertension after 1-week administration of lacidipine (5 and 15%, respectively) and nifedipine (10 and 25%, respectively) and only two cases (5%) of venous hypertension during placebo administration. Lower limb edema was observed in two patients (5%) during treatment with nifedipine slow-release (SR). The hemodynamic effects of lacidipine and nifedipine were reversible but may contribute to the mechanism of lower limb edema.
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PMID:Effects of lacidipine and nifedipine on lower limb veins in nonphlebopathic patients. 760 97

Ten days after surgical treatment of a gastric perforation a 70-year-old woman developed progressive dyspnoea and hypertension without any signs of deep vein thrombosis. Emergency echocardiography revealed acute cor pulmonale with a dilated right atrium and ventricle, as well as paradoxical ventricular septal motion. In addition it demonstrated an elongated, extremely mobile thrombus stuck in a patent foramen ovale with most of it floating in the right atrium, the remainder in the left atrium. Within 2 hours of the ultrasound examination she went into fulminant pulmonary embolism with circulatory arrest and paradoxical embolization from the atria to the brain, after which the intraatrial thrombus was no longer detectable. She was successfully resuscitated and thrombolysis was immediately started with tissue-plasminogen activator (100 mg over 90 min), with ensuing stabilization of the circulation. The patient was gradually weaned off the ventilator over the following few days, but she died 10 days after the resuscitation from the severe cerebral damage.
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PMID:[Transient thrombus in patent foramen ovale with pulmonary and paradoxical embolization]. 824 45

Endoscopic resection of the prostate is a well defined surgical procedure. Nevertheless, certain coagulation disorders (hypercoagulability with risk of deep vein thrombosis, haemorrhage) can raise special problems. In patients not given heparin prophylaxis, the incidence of deep vein thrombosis is 10% in transurethral resections of the prostate (TURP). The risk is higher for cancer. Among the diagnostic tools (D-dimer assay, continuous Doppler, pulsed echo-Doppler, thermography, plethysmography, ...) ascending phlebography or pulmonary angiography in case of suspected pulmonary emboli remains the gold standard. Haemorrhage is rarely related to defribination but frequently to dilution coagulopathy favoured by high blood pressure, resorption of irrigation fluid, deficient haemostasis with loss of coagulation factors or massive transfusions. Only clinically patent coagulation disorders leading to haemorrhage should be treated. For dilution coagulopathies and diffuse intravascular coagulation, treatment is based on viro-inactive fresh plasma infusion. Aprotinine is the first choice in case of fibrinolysis.
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PMID:[Coagulation disorders after endoscopic resection of the prostate]. 774 59

This survey aimed to estimate the rate of deep venous thrombosis (DVT) in an unselected population treated for peripheral vascular diseases. The study comprised 7533 patients on the nationwide Finnish vascular registry (FINNVASC) during two-years study period. Thirty-four (0.45%) patients were reported to have a postoperative thrombosis. Thirty-two (94%) of these had undergone vascular procedures involving the infrarenal aorta or arteries in the lower extremities. There was no difference in the occurrence of determinants (diabetes, hypertension etc.) when the group with postoperative DVT was compared to the rest of the patients on the registry. The procedures involving the lower extremity seem to carry a higher risk of postoperative DVT. In this type of surgery special attention should be focused on DVT prophylaxis.
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PMID:The incidence of postoperative deep vein thrombosis in vascular procedures. FINNVASC Study Group. 779 43

Ethinyl estradiol is the only estrogen form used in low-dose oral contraceptive (OC) pills. Progestogenic compounds used in OCs include norethindrone, norethindrone acetate, ethynodiol diacetate, norgestrel, levonorgestrel, and norethynodrel. The newest third generation progestins are desogestrel and norgestimate. The most important benefits associated with OC use are a decrease in benign breast disease, less incidence of ovarian and endometrial cancers, and a decrease in the incidence of pelvic inflammatory disease. The most serious risks to OC users who are over age 35 and smoke are deep vein thrombosis, pulmonary embolus, retinal thrombosis, or cardiovascular disease. Other risk factors for cardiovascular disease include obesity, diabetes, hypertension, increased serum cholesterol, and a family history of premature myocardial infarction. All users should have blood pressure checks 3 and 6 months after commencing pill use. OC preparations cause an increase in total cholesterol, triglycerides, low density lipoprotein (LDL), very low density lipoprotein (VLDL), and a decrease in high density lipoprotein (HDL), but norgestimate may actually increase HDL levels. Preparations with levonorgestrel may produce the greatest decrease in glucose tolerance, while those with 35 mcg of ethinyl estradiol and 0.5 mg of norethindrone have the least effect. OCs do not increase the risk of developing breast cancer, but can stimulate the growth of breast cancer once it has occurred. The incidence of gallbladder disease is increased slightly in OC using women who are predisposed. Hepatocellular adenomas are associated with combined OC use. Underweight women are more prone to side effects and need a very low potency preparation. A common problem encountered by patients on OCs is amenorrhea. This usually resolves after 3 cycles. Breakthrough bleeding is also very common. Post-pill amenorrhea is frequently found after stopping OCs. Combined oral contraceptives are a safe and effective contraceptive method for most women throughout their reproductive years.
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PMID:Combined oral contraceptive pills: a brief review. 783 35

The plasma Lp(a) concentrations were evaluated in several groups of patients. Groups with liver cirrhosis (n = 20), type-1 diabetes mellitus (n = 148), type-2 diabetes mellitus (n = 65), hypertension (n = 51), lung cancer (n = 48) and deep venous thrombosis (n = 31) were compared with a group of healthy volunteers (n = 69). Significantly higher median values were found in the hypertension (142 mgl-1 vs. 43 mgl-1, p < 0.001) and lung cancer groups (241 mgl-1 vs. 43 mgl-1; p < 0.0001). Significantly lower values were recorded in the group with liver cirrhosis (11 mgl-1 vs. 43 mgl-1; p = 0.02). But in this last group there were significant differences between patients in the Child-Turcotte severity stages A to C.
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PMID:The behaviour of lipoprotein(a) in patients with various diseases. 786 33


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