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

Ambulatory blood pressure monitoring is a useful procedure in the diagnosis and management of hypertension, in the assessment of anti-hypertensive drugs and as a means of predicting outcome in hypertension. With ambulatory blood pressure monitoring is possible to detect usual variability of blood pressure, circadian rhythms and the response to environmental influences in both normotensive and hypertensive subjects. A number of clinical conditions are better evaluated with this procedure than with conventional measurements, eg white-coat hypertension (the rise of blood pressure in the physician's office), borderline hypertension, episodic hypertension and secondary hypertension. Multiple readings improve the precision of the estimate of blood pressure profile of the patient and allow a precise evaluation of blood pressure load to which a patient is exposed throughout 24 h. Ambulatory blood pressure monitoring is closely related to the incidence of cardio- and cerebrovascular events and to the prevalence and the degree of target-organ damage. Casual and ambulatory blood pressure readings are not alternative but complementary tools for clinical management of hypertension and for assessment of the prognostic risk of hypertension.
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PMID:Clinical utility and prognostic value of ambulatory blood pressure monitoring. 177 20

Renal transplantations were performed using stroke-prone spontaneously hypertensive rats (SHR) and Wistar-Kyoto rats (WKY) as kidney donors and bilaterally nephrectomized F1 hybrids, bred from SHR x WKY parents as renal graft recipients. Recipients of renal grafts from adult, naive SHR but not from adult normotensive WKY kidney donors developed post-transplantation hypertension. Permanent blood pressure normalization by antihypertensive treatment in adult SHR kidney donors, as well as the young, prehypertensive age of SHR kidney donors reduced but did not prevent the development of post-transplantation hypertension. Increasing renal perfusion pressure in WKY kidney donors (chronic 2-kidney 1-clip renovascular hypertension) also resulted in post-transplantation hypertension in recipients of the non-clipped kidneys. Blood pressure remained normal in recipients of renal grafts from young WKY kidney donors. These data suggest that SHR kidneys carry a genetic defect which can give rise to post-transplantation hypertension and which therefore may also play a role in the development of hypertension in naive SHR. In addition, secondary hypertension-induced renal damage may also contribute to post-transplantation hypertension in recipients of renal grafts from hypertensive donors.
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PMID:Post-transplantation hypertension in recipients of renal grafts from hypertensive donor rats. 179 3

The term 'secondary hypertension' includes a variety of aetiological processes with no obvious common feature apart, perhaps, from the loss of normal blood pressure regulatory factors. It has been suggested that all forms of secondary hypertension, including renal/renovascular, accelerated phase, glucocorticoid and mineralocorticoid excess, phaeochromocytoma and toxaemia in pregnancy are associated with the loss of the normal nocturnal fall in blood pressure. The evidence for this view appears strongest for glucocorticoid-induced hypertension, but for most other forms the available data are conflicting and are mostly based on small numbers of patients without adequate control populations. Sleep is a powerful determinant of the nocturnal fall in blood pressure but few studies have addressed the quality of sleep in groups of patients who are often sick and/or hospitalized. Abnormalities in sympathetic drive (e.g. autonomic neuropathy and phaeochromocytoma) can abolish the nocturnal blood pressure reductions, and activation of the sympathetic nervous system may be a critical factor in determining the normal diurnal changes in blood pressure. As approximately 20% of patients with 'essential hypertension' have a blunted fall in nocturnal blood pressure it seems unlikely that ambulatory blood pressure could ever be useful in screening for secondary hypertension.
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PMID:Ambulatory blood pressure monitoring in secondary hypertension. 179 8

Circadian blood pressure variability was recorded in patients with primary hypertension and with different forms of secondary hypertension using ambulatory 24-h blood pressure measurement. A group of 20 patients with different forms of secondary hypertension was compared with a matched group of patients with primary hypertension. Although the mean 24-h blood pressure was not different between the two groups, the patients with secondary hypertension had significantly higher systolic blood pressure during sleep and higher systolic and diastolic blood pressure in the early morning, compared with the primary hypertension group. This nocturnal blood pressure fall was then investigated in various groups of patients with different forms of secondary hypertension and compared with normotensives and patients with primary hypertension. Patients with mild primary hypertension (n = 152) and with severe primary hypertension (n = 30) had the same blood pressure fall (14-16 mm Hg systolic and diastolic) during the night (23:00-05:00 h) as normotensives (n = 20). However, in patients with renoparenchymal hypertension (n = 29), renovascular hypertensions (n = 20), hyperaldosteronism (n = 6), and hyperthyroidism (n = 14), the nocturnal blood pressure fall was significantly (p less than 0.01) reduced. One patient with coarctation of the aorta and nine patients with primary hyperparathyroidism and elevated blood pressure had a normal circadian blood pressure profile with a normal nocturnal blood pressure fall. The heart rate decrease during the night was equal in all patient groups. Ambulatory blood pressure measurement allows blood pressure recording under everyday conditions, including nighttime. In primary hypertension the blood pressure variability exhibits the same circadian variation as in normotension, showing a marked nocturnal fall.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Circadian blood pressure rhythm in primary and secondary hypertension. 179 27

The response to sublingual nifedipina was observed in 7 pediatric patients with renal disease and acute severe hypertension. Average dose used was 0.21 mg/kg, and an initial rapid response was evidenced as early as 3 minutes post administration. The greatest hypotensive effect was seen during the first 30 minutes, but continued its effect up to 60-120 minutes. The drug was well tolerated, of rapid action and results suggests it is efficient in the management of children and adolescents with acute secondary hypertension. No mayor adverse effects were encountered.
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PMID:[The use of sublingual nifedipine in pediatric hypertensive patients at the Hospital de la Capital]. 181 4

Previous studies, including our own, have demonstrated that muscle sympathetic nerve activity (MSNA) is increased in patients with essential hypertension compared with normotensive subjects. However, the features of sympathetic nerve activity are still unknown in secondary hypertension. We examined MSNA in eight patients with renovascular hypertension and in 11 patients with primary aldosteronism. Twenty patients with essential hypertension and 20 normotensive subjects who were age-matched to the patients with renovascular hypertension and those with primary aldosteronism were also studied. The MSNA of a bundle of the tibial nerve was recorded by microneurography in supine subjects and expressed as both burst rate (bursts/min) and burst incidence (bursts/100 heart beats). Plasma renin activity and the plasma concentration of angiotensin II and aldosterone were also measured. MSNA was increased in the patients with renovascular hypertension compared with the patients with primary aldosteronism and those with essential hypertension and the normotensive subjects (p less than 0.01 for each). MSNA was decreased in the patients with primary aldosteronism compared with those with essential hypertension (p less than 0.01), and it was smaller than in the normotensive subjects (p less than 0.1). Furthermore, MSNA, plasma renin activity, and the plasma concentration of angiotensin II decreased significantly in five patients with renovascular hypertension 4-10 days after successful percutaneous renal angioplasty. Thus, the changes in MSNA seem to characterize the pathophysiology of renovascular hypertension and primary aldosteronism. Activation of the renin-angiotensin system may be involved in the increase in the central outflow of sympathetic nerve activity, thus exacerbating hypertension in patients with renovascular hypertension.
Hypertension 1991 Jun
PMID:Muscle sympathetic nerve activity in renovascular hypertension and primary aldosteronism. 182 57

Secondary hypertension represents about 5-10% of all forms of hypertension, renal and renovascular being the commonest forms. Renal artery stenosis is the principal cause of renovascular hypertension due to atheromatous disease or fibromuscular dysplasia. Rapid sequence intravenous pyelogram, isotope renogram, captopril test and digital subtraction angiography or conventional arteriography, are the diagnostic procedures in the diagnosis of renal artery atenosis. Hypertension is also very common in parenchymal renal disease, mainly in chronic renal insufficiency. In this condition, the mechanism is more related to volume dependent factors than in renovascular hypertension which is mainly renin dependent. In the treatment of renal or renovascular hypertension the same type of drugs have been generally used as in essential hypertension although with some specific indications like the use of angiotensin-converting enzyme inhibitors in unilateral renal artery stenosis or furosemide in case of renal insufficiency. Revascularization by angioplasty or surgical bypass, may be indicated in renovascular hypertension.
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PMID:[Hypertension from the nephrologist's point of view]. 183 18

The clinical presentation of hypertension was studied prospectively in 328 hypertensives referred to Soba Hospital, Khartoum, Sudan. The mean age of the patients was 48 years, and the major symptoms were cardiac and neurological. Only about a third of these patients were on regular medications at the initial visit. Secondary hypertension was detected in only 5% of patients. The prevalence of smoking and alcohol consumption was very low. Renal and cardiac complications were commonly encountered as part of the presentation, while retinopathy was infrequent. These findings are similar to those reported in black hypertensives in Africa but are distinct from the presentation of hypertension in US blacks.
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PMID:The clinical presentation of hypertension in Sudan. 184 42

This study investigated the release of prostacyclin (PGI2) and thromboxane A2 (TXA2) from the aortic walls of various experimental hypertensive rats, e.g. spontaneously hypertensive rats (SHR), Dahl salt-sensitive (Dahl S) rats, deoxycorticosterone (DOCA)-salt hypertensive rats and renovascular (2-kidney, 1-clip (2K1C) and 1-kidney, 1-clip (1K1C] hypertensive rats. The PGI2 generation was increased significantly in these hypertensive models, irrespective of the hypertensive mechanisms, when they developed established hypertension. Dahl S rats, having an impaired PGI2 production on a low salt diet, restored PGI2 generating capacity to the control level of Dahl salt-resistant rats when they were fed a high salt diet and developed salt-induced hypertension. On the other hand, the TXA2 generation in the vascular walls was enhanced particularly in rat models for genetic hypertension, and this system was unaltered in the models for secondary hypertension, e.g. DOCA-salt and renovascular hypertension. Thus, it is suggested that the elevation of blood pressure is associated with an increase in vascular PGI2 production, and that the increased vascular TXA2 production is a characteristic feature of genetic hypertension.
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PMID:Vascular eicosanoid production in experimental hypertensive rats with different mechanisms. 187 Nov 82

Renovascular hypertension is most frequent causes of secondary hypertension. Although angiography of renal artery is reliable procedure for the diagnosis of the renovascular hypertension, it is expensive and invasive. We report two cases which become possible to make diagnosis of the renovascular hypertension by measurement of velocity of segmental or interlobar artery using 2-D color Doppler method. Case 1: 39 year-old male was hospitalized because of hypertension (200/130 mmHg). Ccr was 82 ml/min. 2-D Doppler test demonstrated that the Vmax, the Vmin and the Vmin/Vmax of the right segmental artery were 40 cm/sec., 24 cm/sec. and 0.60, respectively. The Vmax, the Vmin, and the Vmin/Vmax of the left segmental artery were 42 cm/sec., 22 cm/sec. and 0.52, respectively. Renal angiography shows right renovascular stenosis. After percutaneous transluminal angioplasty, the blood pressure became normal and Vmin/Vmax ratio of the right segmental artery was down to 0.52. Case 2: 46 year-old male was hospitalized because of chronic renal failure (Ccr: 14.6 ml/min) and uncontrollable hypertension. 2-D Doppler test demonstrated that the Vmax, the Vmin, the Vmin/Vmax ratio and the acceleration of the right segmental artery were 10 cm/sec., 6 cm/sec., 0.62 and 1.7 m/sec.2, respectively. The Vmax, the Vmin, the Vmin/Vmax ratio and the acceleration of the left interlobar artery were 8 cm/sec., 5 cm/sec., 0.63 and 0.8 m/sec.2, respectively. Renal angiography shows bilateral renovascular stenosis. Thus, the elevated value of Vmin/Vmax ratio (over 0.6) (mean value: 0.43 +/- 0.08, when Ccr is over 70 ml/min, whereas 0.32 +/- 0.11, when Ccr is under 30 ml/min) and decreased acceleration (under 2.0 m/sec. 2) of the segmental or the interlobar artery seems to be helpful for the diagnosis of renovascular hypertension.
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PMID:[Two cases of renovascular hypertension detected by 2-D Doppler method]. 187 62


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