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

Briefly trained physicians assistants using protocols (clinical algorithms) for diabetes, hypertension, and related chronic arteriosclerotic and hypertensive heart disease abstrated information from the medical record and obtained history and physical examination data on every patient-visit to a city hospital chronic disease clinic over a 18-month period. The care rendered by the protocol system was compared with care rendered by a "traditional" system in the same clinic in which physicians delegated few clinical tasks. Increased thoroughness in collecting clinical data in the protocol system led to an increase in the recognition of new pathology. Outcome criteria reflected equivalent quality of care in both groups. Efficiency time-motion studies demonstrated a 20 per cent saving in physician time with the protocol system. Coct estimates, based on the time spent with patients by various providers and on the laboratory-test-ordering patterns, demonstrated equivalent costs of the two systems, given optimal staffing patterns. Laboratory tests were a major element of the cost of patient care,and the clinical yield per unit cost of different tests varied widely.
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PMID:Quality, efficiency, and cost of a physician-assistant-protocol system for managment of diabetes and hypertension. 0 25

Clinical, experimental and pathologic studies strongly indicate that hypertension is a major factor in coronary heart disease, sudden death, stroke congestive heart failure and renal insufficiency. The deleterious effect of the elevated blood pressure on the cardiovascular system appears to be due mainly to the mechanical stress placed on the heart and blood vessels. Humoral factors and vasoactive hormones such as angiotensin, catecholamines and prostaglandins may play a role in the pathogenesis of hypertensive cardiovascular disease but this role has not yet been defined and is probably secondary. Hypertension and the resulting increase in tangential tension on the myocardial and arterial walls, leads to the development of hypertensive heart disease and congestive heart failure as well as hypertensive vascular disease that affects not only the kidneys but also the heart and brain. Hypertensive vascular disease involves both large and small arteries as well as arterioles and is characterized by fibromuscular thickening of the intima and media with luminal narrowing of the small arteries and arterioles. The physical stress of hypertension on the arterial wall also results in the aggravation and acceleration of atherosclerosis, particularly of the coronary and cerebral vessels. Moreover, hypertension appears to increase the susceptibility of the small and large arteries to atherosclerosis. Thus the patient with hypertension is a candidate for both hypertensive and atherosclerotic vascular disease of the coronary and cerebral vessels leading to occlusive disease of both the large and small arteries and resulting in myocardial infarction and stroke. Other major complications of hypertensive vascular disease include rupture and thrombotic occlusion of blood vessels, especially in the brain. Disease of the arterial media, which begins in childhood with the deposition of calcium in the vessels, may be an important cause of arterial hypertension. This form of hypertension may manifest itself in adults as arteriosclerotic hypertension and lead to cardiovascular complications very similar to those of essential hypertension. The relation of arteriosclerotic hypertension to nutritional factors, including dietary salt intake, deserves study.
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PMID:Role of hypertension in atherosclerosis and cardiovascular disease. 13 91

The role of hypertension in cardiovascular disease was studied in the hypertensive coarcted monkey during the feeding of an atherogenic and nonatherogenic diet. During the 15-month period of observation, half of the hypertensive coarcted monkeys developed cardiovascular disease which included heart failure, ischemic heart disease, stroke, and sudden death. There were no cardiovascular complications in the control normotensive monkeys except for one cholesterol-fed animal. The incidence of ischemic heart disease and sudden cardiac death was higher in monkeys with both hypertension and hypercholesterolemia than in those with hypertension or hypercholesterolemia alone. Postmortem studies revealed that the former monkeys had both hypertensive and atherosclerotic heart disease, whereas the monkeys with hypertension or hypercholesterolemia had either hypertensive or atherosclerotic heart disease. Hypertensive heart disease was characterized not only by hypertrophy of the left ventricle but also by focal myocardial degeneration and fibrosis and by focal thickening and narrowing of the small coronary arteries, particularly the sinus node artery and the atrioventricular node artery. The finding of transmural myocardial infarction in two monkeys with patient coronary arteries suggests a possible role of coronary artery spasm in ischemic heart disease in hypertension. The cerebral vascular complications of hypertension included hypertensive encephalopathy, transient "ischemic" attacks, and hemorrhagic stroke. The complications were associated with severe hypertension and with hypertensive vascular disease or hypertensive and atherosclerotic vascular disease of the cerebral arteries.
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PMID:Role of hypertension in ischemic heart disease and cerebral vascular disease in the cynomolgus monkey with coarctation of the aorta. 14 28

Assessment of the pathophysiologic changes associated with systemic hypertension has been limited by difficulty in justifying invasive studies of the left ventricle. Echocardiography, because it is notinvasive, offers an attractive method of assessing cardiac dimensions and function in hypertensive heart disease. Fourteen age-matched normotensive subjects and 31 patients with hypertension (but without clinical evidence of coronary artery disease) were studied before receiving any antihypertensive therapy. The patients with hypertension were classified into three groups on the basis of previously established electrocardiographic and chest X-ray criteria: group I, normal electrocardiogram and chest roentgenogram (13 patients); group II, left atrial abnormality by electrocardiogram and a normal chest roentgenogram (8 patients); and group III, left ventricular hypertrophy by electrocardiogram or chest roentgenogram, or both (10 patients). Mean arterial pressure increased significantly from group I to group II and from group II to group III (P is less than 0.01), and this increase was associated with a similar progressive increase in left ventricular mass assessed with echocardiogram (P is less than 0.01). A significant increase was also found in both posterior wall and septal thickness in groups II (P is less than 0.05) and III (P is less than 0.01). In association with this increased mass a significant decrease in ejection fraction and fractional fiber shortening was demonstrated in groups II (P is less than 0.05) and III (P is less than 0.01) although cardiac index was reduced only in group III (P is less than 0.05). Thus, increased ventricular mass can be identified with echocardiography at an early stage of hypertensive heart disease when only left atrial abnormality is identifiable with electrocardiographic criteria and decreased left ventricular performance occurs with increasing arterial pressure and left ventricular hypertrophy.
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PMID:Pathophysiologic assessment of hypertensive heart disease with echocardiography. 14 Jun 1

Sixteen acromegalic patients underwent echocardiography, phonocardiography, stress electrocardiography with Thallium perfusion scanning and gated radioisotope left ventricular angiocardiograms. Abnormalities consisting of increased echo left ventricular mass index, low velocity of circumferential fiber shortening or elevated pre-ejection period to left ventricular ejection time ratio were found in six patients with coexistent hypertension or coronary disease. Concentric left ventricular hypertrophy was also found in three patients with no known etiology other than acromegaly of greater than thirteen years' duration or with fasting growth hormone concentrations greater than 100 ng/ml. One of these three also had left ventricular dysfunction. Neither hypertrophy nor ventricular dysfunction was found in other acromegalics with shorter duration of disease or lower growth hormone concentrations or with normal growth hormone concentrations after therapy. A high prevalence of coronary artery and hypertensive heart disease is associated with acromegaly. A few patients with acromegaly have a specific, potentially reversible cardiomyopathy probably related to prolonged acromegaly or very high growth hormone concentrations.
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PMID:Cardiac size and function in acromegaly. 14 34

Stroke is increasingly becoming a major cause of death and morbidity in African population among most of which the frequencies of hypertension are considerable, although hard data based on community surveys are lacking and most of the information available is from hospital data. The epidemiology of stroke in the Africans is reviewed. The frequencies in hospital populations varied from 0.9% to 4.0% and stroke accounted for 0.5% to 45% of neurological admissions. There is male predominance in published series. The main risk factors are hypertension, diabetes mellitus and homozygous sickle cell disease (in children only). Ischaemic stroke is by far the commonest clinical type encountered. These conclusions are further supported by experience at Ibadan, of over 1100 Africans seen over 18 years reported briefly in this communication. The results of the first community study over a 2-year period on the incidence of stroke in an African Urban (Ibadan) Community are presented. The study was carried out as part of a multinational multicentric study initiated and sponsored by the World Health Organization. The male to female ratio was five to two. Incidence rates reached peaks in the eighth decade in males and in seventh decade in females and were higher in males in all age groups, and the rates are comparable with those recorded in European populations, except in those under the age of 40 in Ibadan, in which age-specific incidence rates are considerably lower than in European and Japanese populations. Hypertension, diabetes mellitus constituted the main risk factors. Mortality and recurrence rates are described and are similar to experience in the Caucasians. Hypertension in the Nigerians predispose to a high frequency of cerebrovascular disease other than through mainly cerebral atherosclerosis. With increasing longevity of Nigerians and other Africans, the mortality and morbidity caused by cerebrovascular disease would probably become of enormous dimensions and adequate control of high blood pressure on a community basis may be the only way of preventing this: this would be desirable as myocardial infarction in contradistinction to hypertensive heart disease is an uncommon complication of high blood pressure in the Africans and prevention of hypertensive heart disease as shown by experience elsewhere can be achieved by control of high blood pressure, which does not seem to prevent ischaemic myocardial disease.
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PMID:Stroke in the Africans. 41 66

All autopsies on Black patients who died of heart disease at Baragwanath Hospital were examined for the years 1959, 1960 and 1976. The commonest form of heart disease encountered in South African Blacks is undoubtedly hypertensive heart disease and by far the majority of these cases are of essential hypertension. There appears to have been a slight rise in the incidence of hypertension. Rheumatic heart disease is extremely common, and affects young people, who often have advanced valvular lesions by puberty. The incidence of idiopathic cardiomyopathy does not seem to have altered materially, although there has perhaps been a slight drop, which may be accounted for by the tendency of clinicians to place cases of congestive cardiac failure with mild hypertension in the hypertensive group rather than in the idiopathic cardiomyopathy group. There was a significant alteration in the incidence of myocardial infarction; in 1959 and 1960 these cases comprised less than 1% of all cardiac deaths but in 1976 they comprised nearly 12%. There has also been a dramatic fall in the incidence of cardiovascular syphilis.
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PMID:The changing pattern of heart disease in South African Blacks. 60 91

Using the life table method, 962 cases of infarction, 279 cases of hemorrhage, and 243 cases of undetermined type of stroke, occurring in Manitoba between Jan 1, 1970, and June 30, 1971, were analyzed for factors affecting survival. Survival until Dec 31, 1973, was found to be adversely affected by the presence of coma or unconsciousness and the absence of localizing signs and symptoms. Also, the prognosis was poor if the heart was enlarged on the x-ray film or the ECG was abnormal. On the other hand, the presence of individual clinical entities such as hypertension, hypertensive heart disease, myocardial infarction, atrial fibrillation, or diabetes did not affect the survival significantly. These findings will help in predicting the prognosis and in planning for management of stroke cases.
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PMID:Prognostic factors in the survival of 1,484 stroke cases observed for 30 to 48 months. II. Clinical variables and laboratory measurements. 63 54

In concert with literary data during a mass X-ray examination in 1961 we established in 5,517 men of the district Wurzen a frequency of hypertension of 13.6% and in 1971 in the same group of test persons a frequency of hypertension of 19.4%. The percentage of the pathological cardiovascular X-ray findings was in normotonus 10.4% in 1961 and 11.2% in 1971, in hypertension 22.3% in 1961 and 27.5% in 1971. The dependence on the age of the test persons, on the degree of severity of hypertension, and particularly on the duration of the hypertension is clear. For prevention of a hypertensive heart disease the early recognition of a hypertension and an early therapy are necessary. On the basis of our studies the making of cardiovascular X-ray findings from photofluorograms is not suitable as screening test for the hypertension. The value of blood pressure controls in mass X-ray examinations must be emphasized. Important is the collection of cardiovascular X-ray findings from photofluorograms of the thorax for the establishment of a hypertensive heart disease, of not recognized vitia and age-conditioned cardiac and vascular changes. It implies an optimum use of the material collected in the mass X-ray examination.
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PMID:[Behavior of hypertension and cardiovascular findings in hypertension within an observation period of 10 years (the Wurzen study 1961-1971)]. 64 45

The sensitivity of two strains of rat to the hypertensinogenic action of DOC was studied. Hypertensive cardiovascular disease was evident within 3 weeks of implantation of DOC pellets in sensitized female rats of the Sprague-Dawley and Long-Evans strains. Cardiac and renal hypertrophy due to DOC treatment was evident in both strains of rat. The DOC treatment also resulted in a significant decrease in absolute adrenal weight. These results, which indicate that Long-Evans rats are not resistant to DOC-induced hypertension, contrast with previous reports by others. An explanation of the discrepancy may be the use of free DOC rather than DOC acetate in the present study.
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PMID:The occurrence of 11-deoxycorticosterone (DOC)-induced hypertension in the Long-Evans rat. 71 Mar 67


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