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

The value of radiological examinations in hypertension was analyzed in a series of 44 children. An i.v. urography had been performed in 43 cases with a pathological finding in 19 (44%). Renal angiography, employed in 19 cases, revealed abnormal findings in 12 (63%) patients. Micturating urethrocystography performed in 16 children gave no additional important information. The only complication noted was thrombosis of the femoral artery subsequent to renal angiography in one child less than one year of age. The diagnosis of hypertension based mainly on the i.v. urography in 12 cases but the renal angiography gave additional important information in 6 children. One child with obstructive hydronephrosis was also found to have a renal artery stenosis at renal arteriography. Based on these results, and particularly because secondary hypertension may frequently be treated surgically, we consider extensive radiological investigation with renal angiography is mandatory before receiving a final diagnosis of essential hypertension, and before starting long-term treatment.
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PMID:The radiological evaluation of children with hypertension. 51 Mar 18

Racial differences in prevalence of essential hypertension are well known. In order to explore these differences at an early age in terms of etiology, we investigated schoolchildren in an entire, biracial community. A sample of 278 children, stratified by diastolic (fourth-phase) blood pressure and specific for age, race, and sex, was reexamined 1--2 yr after initial observation for the following: (1) a physical examination and urinalysis to exclude secondary hypertension; (2) 24-hr urine sodium, potassium, plasma renin activity, and serum dopamine beta-hydroxylase; (3) 1-hr oral glucose tolerance test; and (4) heart rate and blood pressure at rest and under standarized physical stress. We found that 24-hr urine sodium was positively associated with blood pressure level as measured on the same day for the high blood pressure strata of black children. Urine potassium excretion was lower in blacks than in whites, although their intakes seemed equal. In the high blood pressure strata especially, black boys had lower renin activity than whites, and the resting-supine and stressed systolic blood pressures were higher in black boys than in any other group. In these black boys, resting and stressed systolic pressures were negatively related to plasma renin activity. On the other hand, dopamine beta-hydroxylase levels in white children were higher than in blacks for all blood pressure strata, and in the high blood pressure strata white children had higher 1-hr glucose levels and faster resting heart rates than black children. Different mechanisms may play a role in and contribute to the early stage of essential hypertension.
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PMID:Racial differences of parameters associated with blood pressure levels in children--the Bogalusa heart study. 51 82

In normal pregnant women the excretion of urinary kallikrein diminishes between the second and the third trimester and such reduction is maintained during the first ten days of puerperium. A comparison between normal women and those suffering from hypertension during the first, second and third trimester of pregnancy shows that, except for the first trimester, there exists a significant net reduction of enzyme excretion in the hypertensive cases. Dividing the patients according to the type of hypertension, it reveals that this phenomenon is unaltered for subjects having essential hypertension, while those affected by secondary hypertension or gestosis do not show any statistically significant variation in enzyme excretion from normal subjects.
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PMID:Variation of urinary kallikrein excretion during pregnancy and the effects of hypertension. 51 57

Aspects of primary or secondary hypertension in relation to oral contraceptive use and pregnancy are discussed. Possible mechanisms of oral contraceptive-induced secondary hypertension and contraindications to the pill are listed. Hypertension as a contraindication to pregnancy is weighed in relation to sterilization and cases of term pregnancies in hypertensive patients are cited. Misdiagnosis of secondary hypertension as toxemia in most pregnant patients with elevated blood pressure is characterized in a review of a clinical study involving 4273 patients (Table 1). A method for differential diagnosis of hypertension in pregnancy which includes ophthalmoscopic examination and urinalysis is outlined (Figure 1). Suggested treatment for the pregnant patient with hypertension is a low sodium diet for the first 20 weeks of pregnancy followed by the stepped care program (Figure 2). The most desirable therapy for pregnant women with toxemia are diuretics during the early pathological phase (sodium retention and edema) with edema in the periorbital areas and hands as diagnostic indicators for this phase. The efficacy of diuretics (alone or combined with hypotensive agents) in hypertensive patients is evaluated with regard to maternal and fetal risks. Indications for termination of pregnancy or induction of labor in hypertensive or toxemic women are summarized.
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PMID:Contraception and pregnancy in the young female hypertensive patient. 62 59

The spontaneous changes in renal plasma flow (RPF) were determined by sodium paraamino hippurate clearance (CPAH) in the individual kidneys of 71 patients with essential and secondary hypertension. These changes were expressed as changes in CPAH and as changes in CPAH per 100 ml Glomerular Filtration Rate (GFR = inulin clearance) for every individual kidney. Sixteen normal subjects were used as control. The RPF changes were measured between two consecutive 10 minute clearance periods during separated kidney function tests. In all the hypertensive groups studied, when RPF variability was expressed per 100 ml GFR, the variability was found to be two to five times greater than in normals. This findings suggests that in the hypertensive state the blood flow changes in the kidney are more labile than in normals. The high lability of renal blood flow could reflect and abnormality in renal vascular tone. This abnormality could be an important factor in the pathogenesis and maintenance of high blood pressure.
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PMID:High renal plasma flow lability in the kidneys of hypertensive patients. 68 55

Many factors are to be considered in maintaining normal blood pressure. Authors study the behavior of urinary kallikrein (U.K.) and plasma dopamine-beta-hydroxylase (DBH) activity in various forms of hypertension. The values of U.K. excretion in normals were 20.5 +/- 1.8 E.U./24 h. In essential hypertensive patients (9.4 +/- 2.0 E.U./24 h) U.K. decreased, while in secondary hypertension it was significantly higher (33.8 +/- 3.0 E.U./24 h). Plasma DBH activity in essential hypertensive patients (17.72 +/- 2.33 I.U./ml) was similar to controls (20.22 +/- 1.39 I.U./ml); in secondary hypertension the mean values of plasma DBH were decreased (12.31 +/- 2.55 I.U./ml). No correlation between U.K. and plasma DBH activity was observed in normals and in various forms of hypertensive patients. U.K. seems a more reliable factor than plasma DBH in defining the different types of hypertension.
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PMID:Urinary kallikrein excretion and plasma DBH activity in hypertension. 74 55

Hypertension secondary to segmental renal ischemia caused by segmental renal artery stenosis has been relieved by nephrectomy, partial nephrectomy, excision of atrophic segments, or repair of the segmental vessels. This is a report of hypertension caused by stenosis of a segmental renal artery and cured by simple ligation of the stenotic artery.
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PMID:Correction of renal hypertension by ligation of stenotic segmental renal artery. 84 6

Renal artery stenosis, either fibromuscular or atheromatous, is probably the most common cause of secondary hypertension in man. Both of these diseases are active, ongoing processes that may be ameliorated but not cured by medical or surgical treatment. The clinical history and examination of the patient with hypertension may help differentiate renovascular hypertension from essential hypertension. The presence of a systolic-diastolic or continuous bruit is often an indicator of severe renal artery stenosis. Systemic hypertension is the physiologic consequence of significant renal artery stenosis. Knowledge of the basic concepts of the renin-angiotensin-aldosterone system, as has evolved from experimental models of renovascular hypertension, forms the basis for understanding the process of evaluation and treatment of such patients. The treatment of choice for the patient with severe hypertension and a functionally significant renovascular lesion is surgical--both in terms of successful treatment of hypertension and improved long-term prognosis. Diligent periodic reevaluation of these patients as well as those with less severe hypertension who are receiving medical treatment enables the physician to select the proper management that offers optimal control of patient blood pressure and avoids target-organ damage to the kidneys, central nervous system, or cardiovascular system.
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PMID:Management of the patient with renovascular hypertension. 92 May 87

The prevalence of primary and secondary hypertension was determined in a random sample of 7455 Swedish men aged 47 to 54 years. Three hundred and sizty-one men were undergoing treatment for hypertension. Seven hundred and ninety-eight men who had blood pressures above 175/115 mm Hg at preliminary screening were recalled for further blood pressure measurements. Those on treatment and all the untreated men whose blood pressures were still over 175/115 mm Hg then underwent extensive investigation for secondary hypertension. Renal parenchymal hypertension was found in 25 (3-6%) patients, renovascular hypertension in four (0-6%), and other forms of secondary hypertension in 11 (1-6%). The investigation led to surgical treatment in only two cases (0-3%). The low prevalence of secondary hypertension, especially surgically curable forms of hypertension, makes routine screening for these cases unnecessary, at least when patients with hypertension have been found at screening. These data must be taken into account in planning community control programmes in hypertension.
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PMID:Prevalence of primary and secondary hypertension: studies in a random population sample. 96 30

Mineralocorticoids are out of the causes of secondary hypertension. Excess production of mineralocorticoids induces sodium and fluid retention, loss of potassium and metabolic alcalosis. The diagnosis of mineralocorticoid syndromes depends on the interpretation of the functional status of the renin-mineralocorticoid-system, which is in part responsible for the maintenance of normal blood pressure. The classical representative of this group is the syndrome of primary aldosteronism. Causes of mineralocorticoid syndromes associated with hypertension are: 1. autonomous production of mineralo-corticoids by an adrenal adenoma or by idiopathic bilateral adrenal hyperplasia; 2. deficiency of adrenal 17-alpha-hydroxylase or of 11-beta-hydroxylase; 3. secondary aldosteronism associated with primary reninism, or renal arterial stenosis; and 4. pseudo aldosteronism due to excessive ingestion of licorice. Malign or essential hypertension may also often be followed by secondary aldosteronism.
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PMID:[Mineralocorticoid syndromes and hypertension]. 96 85


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