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

The hospital mortality was evaluated for 21 days in all patients with a first attack of acute myocardial infarction (AMI) in Israel. Total mortality was 21.1 percent. The following factors were associated with relatively better prognoses: age, young; sex, male; marital status, married; ethnic origin, European; site, subendocardial; history of smoking, and, to a certain degree, hypertension; low levels of white blood cells, blood sugar, serum transaminase and cholesterol; and anticoagulant therapy.
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PMID:Factors affecting immediate mortality of patients with acute myocardial infarction: a nationwide study. 114 51

In 301 patients admitted to an intensive-care unit because of acute myocardial infarction a prognostic analysis was undertaken, based on 21 parameters (history, condition on admission, laboratory results) and related to ultimate outcome. Although some parameters were singly of prognostic value, discrimination analysis markedly improved predictive value. A prognostic index was constructed from seven easily available parameters: age, pulmonary congestion, leucocytosis, peripheral vasoconstriction, systolic blood pressure, site of infarct and hypertension. For those in a low-risk class (index less than 60, death-rate up to 5%), duration of stay in the intensive-care unit may be shortened and rehabilitation measures accelerated. Those at moderate risk (index 60-90, death-rate up to 25%) require careful monitoring. The highest risk classes (index 90-120, death-rate up to 90%; and index more than 120, death-rate more than 90%) require specially intensive and long-term monitoring, and various procedures for assisted circulation and possible cardiacsurgical intervention should be considered from the outset.
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PMID:[A prognostic index in acute myocardial infarction: discrimination analysis of clinical parameters on admission to hospital (author's transl)]. 119 64

Three patients are presented in whom an isolated inversion of the U wave preceded by several hours typical electrocardiographic changes of an acute myocardial infarction. The association of transient hypertension and an acute U-wave inversion during this period of myocardial ischemia is discussed. It is suggested that within the appropriate clinical context an isolated U-wave inversion may portend an acute myocardial infarction.
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PMID:Isolated U wave-inversion in acute myocardial infarction. 122 69

This letter was written in response to the paper by Mann et al. (British Medical Journal 2: 241-245, 1975) which reported an association between oral contraceptive (OC) use and acute myocardial infarction. Rosenberg et al. found that among 34 patients with myocardial infarction, 4 were current users of OCs and 2 used other estrogen-containing drugs. Among 1213 reference women the use was 79 and 26, respectively. The "relative risk" for OC users was 1.9 (95% confidence interval) and for other estrogen users it was 2.8 as compared with nonusers. When standardized for age these estimates became 2.2 and 2.1 and when standardized for the effects of cigarette smoking, history of hypertension, angina, and/ or diabetes the summary rate-ratio estimate for OC users decreased to 1.3 and left essentially unchanged the estimate for other estrogen users. These results are compatible with a modest increase, if any, in risk of myocardial infarction in premenopausal women associated with estrogen use, such as that reported by Mann et al.
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PMID:Letter: Myocardial infarction and estrogen therapy in premenopausal women. 126 57

To examine whether atrial natriuretic factor (ANF) is secreted adequately in the early phase of myocardial infarction, plasma ANF concentration and clinical parameters, including hemodynamic variables, were studied in 118 patients with acute myocardial infarction (AMI). The patients were divided into 2 subgroups according to the absence (group A, n = 41) or presence (group B, n = 77) of a history of valvular heart disease, previous myocardial infarction, hypertension, or renal failure. Although no significant difference in atrial pressure after the infarction was found between the 2 groups, the plasma ANF level was significantly lower in group A than in group B (76 +/- 6 vs. 185 +/- 26 pg/ml; mean +/- SEM, p < 0.01). Plasma ANF was correlated with pulmonary capillary wedge pressure in group B (r = 0.54, p < 0.001), whereas no relationship with hemodynamic parameters was observed in group A. In 56 of the 118 patients (group A, n = 18; group B, n = 38), the pulmonary arterial plasma level was significantly higher in group A (p < 0.05), whereas the difference was not significant in group B. Seven of the 8 expired cases among these 56 patients had peripheral plasma ANF levels of more than 150 pg/ml, which were higher than those in pulmonary arterial plasma. These observations suggest firstly that the plasma level of ANF is lower in patients with a new onset of myocardial infarction compared to those with a history of cardiac or renal diseases, and secondly that stimulated ANF release originates not only from the right side of the heart, but also from additional site(s), particularly in patients with chronic ventricle overload and a poor prognosis.
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PMID:Plasma atrial natriuretic factor in patients with acute myocardial infarction. 128 94

To evaluate the association between left ventricular false tendon (LVFT) and ventricular arrhythmias in acute myocardial infarction (MI) on the 1-st day of acute MI 71 patients were examined by 24-hour ECG-monitoring and M-mode, two-dimensional, Doppler echocardiography. LVFT was detected in 30 patients (42.3%). The frequency of left ventricular fibrillation, the number of patients with multiform ectopic ventricular beats (EVB), the number of single and pair EVB and runs of ventricular tachycardia were greater in group of patients with LVFT. 37 patients had Lown grades 1-2 (A) of arrhythmias, 34 patients had grades 3-5 (B). LVFT was revealed in four patients in group A (10.8%) and in 27 patients in group B (76.5%, p < 0.001). There were no significant differences between groups in left ventricular asynergy area and wall motion score, left and right ventricular, left atrium dimensions, left ventricular contractility indices, left ventricular walls thickness, frequency of mitral regurgitation. Multifactor analysis has shown significant relationship between Lown's class value and LVFT (p < 0.0001), Lown's class and arterial hypertension (p = 0.0376). Other 17 clinical factors were not connected with Lown's class value. Thus, LVFT was associated with severe ventricular arrhythmias in patients with AMI. This fact can be used as a predictor of these disturbances.
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PMID:Relationship between ventricular arrhythmias and left ventricular false tendons in acute myocardial infarction. 129 Jun 56

To elucidate the characteristics of acute myocardial infarction, preinfarct angina and postinfarct angina in diabetic patients, we compared 51 diabetics and 73 non-diabetics who had myocardial infarction and angiographically-proven coronary artery stenosis. There was no statistical difference between these 2 groups with respect to age, sex, histories of smoking, hypertension and hypercholesterolemia, and hemodynamic parameters. Mean of the number of diseased vessels and of the jeopardy scores were higher in diabetics than in non-diabetics (2.4 vs. 1.9, p < 0.01; 7.2 vs. 5.7, p < 0.02, respectively). The absence of preinfarct angina (59 vs 32%, p < 0.01) and typical chest pain of myocardial infarction was more frequent in the diabetic group than in the non-diabetic group (43 vs 15%, p < 0.005). Congestive heart failure was more common in diabetics than in non-diabetics (45 vs 14%, p < 0.005). Though there was no difference in the frequency of postinfarct angina between the 2 groups (54 vs 52%), painless myocardial ischemia during treadmill exercise tests was more frequent in diabetics than in non-diabetics (75 vs 30%, p < 0.025). Compared to diabetic patients with typical chest pain of myocardial infarction, diabetics without typical chest pain had preinfarct angina less frequently (82 vs 41%, p < 0.01), but had diabetic neuropathy (71 vs 43%, p < 0.05) and retinopathy (67 vs 32%, p < 0.025) more frequently. We concluded that diabetic patients with myocardial infarction frequently lack 1) preinfarct angina, and 2) typical chest pain of myocardial infarction. 3) They often suffer from congestive heart failure, 4) frequently accompanied by painless myocardial ischemia during exercise stress tests. Therefore, special attention should be paid for the management of diabetic patients with specific neuropathy and retinopathy.
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PMID:[Characteristics of acute myocardial infarction, preinfarct angina and postinfarct angina in patients with diabetes mellitus]. 130 56

About 10% of survivors of an acute myocardial infarction will die in the following year. Thereafter the risk declines but reinfarction is still an important cause of mortality and morbidity. The post infarction trials have clearly shown that the best proven agents to mitigate this toll are aspirin, beta adrenoceptor blockers, and verapamil (but not other calcium blockers, except diltiazem for non Q wave infarction). In the context of hypertension treatment these post infarction trials may have important lessons for drug selection and ancillary treatment since the majority of subjects will ultimately die of ischaemic heart disease. Although the newer agents such as ACE and renin inhibitors, newer calcium channel blockers and alpha blockers have many promising properties in terms of risk factor reduction, no convincing mortality data exists; it is needed. This review will deal with the known effects (both good and bad) of antihypertensive agents and will also review other drug strategies relevant to the hypertensive patient. It will also point out large areas of ignorance.
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PMID:The secondary prevention of myocardial infarction by drug treatment; excluding lipid lowering agents. 134 57

Carvedilol is a multiple-action cardiovascular agent that is both a beta-adrenoceptor antagonist and a vasodilator and has recently been made available for the treatment of mild-to-moderate hypertension. Clinical trials are ongoing to establish the efficacy of carvedilol in angina and congestive heart failure. beta-Adrenoceptor antagonists are known to reduce myocardial work secondary to reductions in heart rate and contractility; accordingly, they have been shown to be cardioprotective in animals and in humans. Because carvedilol has beta-adrenoceptor antagonist activity, it also should provide significant cardioprotection. The additional vasodilating activity of carvedilol, which will further reduce myocardial work by decreasing afterload and myocardial wall tension, should provide more salvage of ischemic myocardium than that afforded by a pure beta-adrenoceptor antagonist, such as propranolol. We investigated the ability of carvedilol and propranolol to reduce infarct size in experimental models of acute myocardial infarction in the rat, pig, and dog. The left anterior descending coronary artery was occluded for 30 (rat) or 45 min (pig) and then reperfused for 24 h (rat) or 4 h (pig). In the dog, the left circumflex coronary artery was occluded for 60 min and reperfused for 24 h. Vehicle, carvedilol, or propranolol was administered intravenously 15 min before ischemia (and, in the rat only, repeated 4 h after ischemia). An additional group of dogs was subjected to permanent left anterior descending coronary artery occlusion for 6 h, and carvedilol or propranolol was given 15 min after occlusion. Infarct size was examined on stained tissue sections using quantitative image analysis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Myocardial protection with carvedilol. 137 42

Epidemiological studies have demonstrated that, compared with the population as a whole, there is increased cardiovascular morbidity and mortality among lower socio-economic groups. To explore determinants of the increased risk within this group, a prospective 6.5 year investigation of a cohort of 416 middle-aged (40.8 +/- 9.6 years) male blue-collar workers was undertaken. In addition to established somatic and behavioural risk factors, psychosocial influences that measured chronic occupational stress in terms of an imbalance between high effort and low reward were assessed. Multivariate logistic regression analysis shows that hypertension (odds ratio (o.r.) 3.85; 95% CI 1.59-9.34), left ventricular hypertrophy (o.r. 3.62; 95% CI 1.06-12.37), hyperlipidaemia (o.r. 2.55; 95% CI 1.08-6.00), status inconsistency (measuring low reward at work) (o.r. 2.86; 95% CI 1.04-7.80) and 'immersion' (measuring high intrinsic effort at work) (o.r. 3.57; 95% CI 1.22-10.47) independently contribute to the prediction of fatal or non-fatal cardiovascular events (acute myocardial infarction, stroke). Expected probabilities of cardiovascular events are clearly elevated if the combined effects of left ventricular hypertrophy and psychosocial risks are analysed. In conclusion, increased incidence of cardiovascular disease among lower socio-economic groups is explained by a co-manifestation of established risk factors including left ventricular hypertrophy (by ECG) and psychosocial factors measuring chronic stress at work.
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PMID:The role of hypertension, left ventricular hypertrophy and psychosocial risks in cardiovascular disease: prospective evidence from blue-collar men. 139 66


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