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

An estimated 25% of the overall population of the United States and 55% to 60% of the population aged 65 to 74 years are hypertensive. Many patients with hypertension, particularly elderly patients, also take nonsteroidal anti-inflammatory drugs (NSAIDs), the most commonly prescribed analgesic medications in the United States. It is estimated that as many as 20 million patients and 12% of the population aged > or = 60 years are taking concurrent NSAIDs and antihypertensive medication. This overlap is significant, because NSAIDs inhibit eicosanoid synthesis and can thus limit the effectiveness of antihypertensive drugs that exert all or part of their blood-pressure-lowering action through the stimulation of eicosanoid synthesis or release. Overviews of clinical trial data indicate that the blood pressure of patients with controlled hypertension can be raised by 3 to 6 mm Hg during concurrent treatment with NSAIDs, which can produce a significant increase in subsequent stroke, end-stage renal disease, or congestive heart failure. The incidence of these sequelae increases with age. Clinicians should have greater awareness of the potential impact of NSAIDs on blood pressure control, especially in high-risk patients such as the elderly and those with chronic pain or uncontrolled hypertension. Unless an NSAID is deemed absolutely necessary, the clinician should consider alternative analgesics that do not affect prostaglandin synthesis. These include acetaminophen, tramadol, and, in some cases, narcotic analgesics.
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PMID:The impact of nonsteroidal anti-inflammatory drugs on hypertension: alternative analgesics for patients at risk. 966 55

The aim of our study was to investigate the effect of intracerebroventricular (i.c.v.) administration of very low doses of opioid antagonists on the pain threshold, arterial blood pressure and body temperature of spontaneously hypertensive rats (SHR) with chronic pain. We found that low doses of i.c.v. administered naloxone hydrochloride (0.3 microg) or naloxone methiodide (0.4 microg) produce paradoxical hypoalgesia. Similar results were not observed following i.c.v. administration of nor-binaltorphimine (0.6 microg). A paradoxical increase in the severity of hypertension followed i.c.v. opioid antagonist administration. This suggests an involvement of the opioid system in the mechanisms of blood pressure control. The paradoxical results obtained both for pain threshold and blood pressure after low doses of some opioid antagonists seem to confirm the role played by opioid autoreceptors in these effects. Existence of autoreceptors is suggested. Results obtained following i.c.v. administration of nor-binaltorphimine also suggest a role for the kappa autoreceptor (OP2) in the regulatory mechanisms of thermoregulation.
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PMID:Paradoxical effects of intracerebroventricular low-dose opioid antagonists in SHR with chronic pain. 1042 25

Acute pain increases blood pressure by increasing sympathetic activity, but the role of chronic pain on blood pressure is less well understood. Hypertension and co-existing musculoskeletal problems are two of the common conditions for which antihypertensives and analgesics are prescribed together. Among analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs) are most frequently prescribed. NSAIDs decrease the synthesis of prostaglandins (PG) by inhibiting cyclo-oxygenase, an enzyme essential for transformation of arachidonic acid into PGs. The PGs are important in control of blood pressure by virtue of their effects on the kidney and blood vessels. Among the NSAIDs, indomethacin, naproxen and piroxicam have the greatest, and sulindac the least, pressor effect. The NSAIDs antagonize the antihypertensive effect of diuretics, beta-blockers and ACE inhibitors more than that of calcium-channel blockers. The elderly and those with salt-sensitive hypertension experience greater rise in blood pressure with NSAIDs. Physicians should avoid NSAIDs and instead use alternative analgesics such as acetaminophen and physical therapy for control of pain. If necessary, the dose of the antihypertensive medications may have to be increased for better control of blood pressure. It is commonly believed that acute pain increases blood pressure. The effect of chronic pain is less well understood. Certain analgesics may affect blood pressure and may interfere with the effects of antihypertensive therapy. Since both pain and hypertension are common, it is important that their relationship be well understood by the primary care physicians.
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PMID:Effect of pain and nonsteroidal analgesics on blood pressure. 1060 51

One of every three patients with deep-vein thrombosis of the lower extremities will develop, within 5 years, post-thrombotic sequelae that vary from minor signs to severe manifestations such as chronic pain, intractable edema, and leg ulceration. The post-thrombotic syndrome (PTS) develops as a result of the combination of venous hypertension due to persistent outflow obstruction or valvular incompetence and abnormal microvasculature or lymphatic function. Among factors potentially related to the development of PTS, recurrent ipsilateral thrombosis plays a major role. Whether the extent and the location of the initial thrombosis are associated with the development of PTS is still controversial. The diagnosis of PTS can be accepted on clinical grounds for patients with a history of venous thrombosis. The combination of a standardized clinical evaluation with the results of compression ultrasonography and Doppler ultrasonography helps diagnose or exclude a previous proximal-vein thrombosis. Prevention of recurrent thrombosis and use of compression elastic stockings are the cornerstones of PTS prevention. The management of this condition is demanding and often frustrating. Although several surgical procedures have been tested, conservative treatment is largely preferable, as more than 50% of patients either remain stable or improve during long-term follow-up, if carefully supervised and instructed to wear proper elastic stockings. Clinical presentation helps predict the prognosis, being the outcome of patients who refer with initially severe manifestations more favorable than that of patients whose symptoms progressively deteriorate over time.
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PMID:The post-thrombotic syndrome. 1091 43

It is well-known that morphine is the king of analgesics. It is widely used, and administered in various ways for the control of acute and chronic pain states. There are, however, certain types of pain and certain clinical conditions in which morphine cannot be used due to the risk of possible complications. These are usually pain states associated with intracranial hypertension, the presence of serious respiratory problems, the onset of major opioid tolerance, persistent vomiting, and so on. The search for "alternative analgesics" has been in progress for a decade, alternatives that could be used alone or in combination for spinal administration in the treatment of complex chronic pain states and with a low incidence of secondary effects. Today, research is carefully assessing the clinical effectiveness and the side effects of a series of drugs for spinal administration, that is, epidural or intrathecal, such as the new narcotics, alpha-2 agonists, central muscle relaxants, calcitonin, and local anesthetics. In this alternative analgesic category we have to mention the somatotrophin-release inhibiting factor (SRIF), which is an ubiquitous native hormone with widespread, predominantly inhibitory actions, and octreotide, its synthetic analogue. In this article we review the literature on the natural drug and its synthetic analogue, paying particular attention to the problems connected with intraspinal administration and analgesic properties.
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PMID:The epidural and intrathecal administration of somatotrophin-release inhibiting factor: native and synthetic analogues. 1099 19

The treatment of chronic pain uses drugs from different pharmacological classes. Analgesics are the common basis of these treatments. Peripheral analgesics (or minor analgesics such as paracetamol) and non-steroidal anti-inflammatory drugs are used for moderate pain (grade I of WHO). Major analgesics, opioids, are used for more severe pain (grades II and III). When pain can be related to a precise cause or location, more specific drugs may be used. This is done in migraine, facial pain, muscular spasms, dental pain, local inflammation. Chronic pain of grades II and III is treated with opioids. According to the severity, agents of different powers are used: partial agonists, full agonists of receptors OP3 (mu) and OP2 (kappa). According to other pathological signs linked to pain, coanalgesic drugs may be used in association: psychotropic drugs, either psycholeptic drugs which act synergistically with analgesics and bring their own effects, anxiolytic and/or neuroleptic, or anti-depressants which inhibit the depression state that may be associated with pain. Corticosteroids are also very useful for the numerous effects they induce: inhibition of the inflammation process, CNS stimulation, analgesics in medullary, or plexus compressions and in elevations of intracranial hypertension. Moreover their metabolic effects may be useful in cachectic states. The pharmacological treatment of chronic pain of grades II and III poses the problem of chronic administration of increasing doses of opioids and of their coprescription, of acquired tolerance, of dependence and of toxicity induced by drug accumulation.
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PMID:[The pharmacologic basis of pain treatment]. 1187 92

The elucidation of inducible cyclooxygenase (Cox-2) dependent inflammatory pathways led to the development of specific Cox-2 inhibitors, the coxibs. These agents include the currently available celecoxib and rofecoxib and such second-generation agents as parecoxib, valdecoxib, and etoricoxib. The therapeutic advantage of coxibs is founded primarily in their lack of significant gastrointestinal (GI) side effects. Clinical trials have demonstrated the efficacy of coxibs to be completely comparable with traditional nonsteroidal anti-inflammatory drugs (NSAIDs), and pharmacoeconomics suggest favorable cost/benefit ratios with these agents compared with traditional NSAIDs, related to their reduced GI complication profiles and lower indirect costs associated with disability. Although several clinical questions remain (eg, use with low-dose aspirin, risk of thrombosis, myocardial infarction, edema, and hypertension), the emergence and clinical utility of coxibs is likely to continue on the basis of their efficacy and relative GI safety advantage. Although newer, more specific Cox-2 inhibitors may alter the choice, it is likely that this class of anti-inflammatories will become (if they have not already) the drugs of first choice in the treatment of acute pain, chronic pain, and most rheumatic conditions in the 21st century. In addition to the treatment of rheumatic conditions, it is possible that coxibs will also be of clinical utility in protection against malignant transformation and Alzheimer disease.
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PMID:Cox-2 inhibitors: today and tomorrow. 1200 72

Abdominoplasty and liposuction guidelines are just two of the guidelines that can be accessed and used to enhance patient care. Guidelines also can be used to increase your knowledge about many other health care topics. The NGC has approved guidelines for managing chronic pain, as well as guidelines on chronic diseases (e.g., diabetes mellitus, hypertension, chronic obstructive pulmonary disease). Many patients have chronic diseases, and you or your family members also may be affected by chronic disorders. These guidelines provide you with a quick overview of evidence-based treatment protocols. These guidelines are not a panacea for evidence-based practice, but using them is one way that perioperative nurses can enhance their clinical skills. Though not everyone has personal Internet access, most health care facilities do or can make access a reality. Other options include medical or public libraries. Then one simply has to access the NGC web site and join other professionals in improving the quality and timeliness of patient care.
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PMID:Evidence-based practice guidelines--one way to enhance clinical practice. 1208 6

In the beginning of the 21st century, a need for a different medical approach arises among the medical systems in the world. This new attitude, beyond laboratory tests, imaging procedures, and pharmacological treatment, emphasizes the significance of the role of the patient, and transfers the control to the patient himself and his/her family. This is the biopsychosocial medical approach. In such a system the medical staff considers not only the traditional biological factors, but also the mental and environmental factors, when it plans the treatment course. The lack of consideration of the real medical and psychological needs of the patient can result in misuse of essential resources. It can also lead to the frustration of the patient and the medical personnel. Clinical psychophysiology is a treatment implementation of the biopsychosocial approach, and it is supposed to meet the biological and psychological needs of the patient. The biopsychosocial method integrates physiological treatments and behavior-cognitive care. The article describes in detail various processes of the clinical psychophysiology, according to the current professional literature. We conclude that the clinical psychophysiology might be useful in treating many problems in primary medicine, such as chronic pain, hypertension, sleep disturbances, and attention disorders. The primary care system is the optimal place to practice the biopsychosocial method, and the challenge is to develop the appropriate doctrines, which would enable the medical staff to help the patients in need. In the article we discuss in details five strategies which allow broader use of the instruments of the clinical psychophysiology: 1) Expansion of doctors education; 2) Allied health professionals involvement; 3) Integration of behavioral medical treatment in primary care; 4) Causing effective modification with minimal medical staff contiguity; 5) Referral for follow-up treatment. The clinical psychophysiology, in the framework of primary care, is a powerful integration of the biomedical and bio-social models.
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PMID:[Clinical psychophysiology in the primary care system]. 1269 73

Chronic daily headache (CDH) is an important problem for clinicians. It is frequent in tertiary care structures, although at present there is no clear consensus about definitions and operational criteria. In fact, CDH is a group of headache disorders that includes chronic migraine (CM). CDH usually evolves from an episodic headache form, which was migraine in most cases. Several psychopathological factors (e.g. psychiatric comorbidity, personality traits or stressful life events) and some somatic disorders (e.g. like arterial hypertension, allergic condition, sleep disturbances) are frequent in CM patients. Caffeine consumption, alcohol overuse and medication overuse (abortive drugs for migraine) could favour chronicity. The possible role of these factors remains poorly understood. Prospective studies and research about the pathophysiology of chronic pain will lead to a better understanding of CM.
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PMID:Neurobiology of chronic migraine. 1281 2


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