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

Cardiovascular disease is the leading cause of morbidity and mortality in Western countries, and hypertension-related cardiovascular events affect about 37 million people per year worldwide. In this perspective, treatment of hypertension is a reference illustrating strategies of cardiovascular prevention. Hypertensive patients are at increased risk of undergoing a cardiovascular event throughout their lives, and treatment of high blood pressure is one of the most effective strategies to reduce global cardiovascular risk. However, due to its multifactorial pathophysiology and frequent association with other important risk factors and clinical conditions such as dyslipidemia, diabetes, left ventricular dysfunction, and renal impairment, treatment of hypertension requires an integrated approach, including life-style measures, antihypertensive drugs and other therapies (statins, ASA, etc.). Nonetheless, worldwide, general practitioners continue to focus on managing a single risk factor, e.g. blood pressure, rather than on overall cardiovascular risk profiles. Another debated issue is whether it matters how blood pressure is lowered in hypertensive patients at high risk. In other words, are the latest antihypertensive drugs more effective than older blood pressure strategies in terms of reduction of cardiovascular events? The recent results of the ASCOT Study address these controversial issues and throw new light on the management of cardiovascular risk in hypertension.
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PMID:Integrated cardiovascular risk management for the future: lessons learned from the ASCOT trial. 1664 Jan 73

We aimed to identify predictors of mortality and length of stay-in hospital in older surgical patients. In 294 patients (mean age 74.1+/-6.4 years, 153 men), consecutively admitted to four surgery units of a university-teaching hospital to receive elective surgery (ES, 56.5%) or urgent surgery (US, 43.5%), the following variables were evaluated: demographics, clinical history (hypertension, diabetes mellitus (DM), coronary heart disease (CHD), heart failure (HF), cerebrovascular accidents, chronic obstructive pulmonary disease (COPD), active neoplasm, cognitive impairment, immobilization, pressure ulcers), physiopathology (Acute Physiology and Chronic Health Evaluation, APACHE, II), cognition/function (Short Portable Mental Status Questionnaire, SPMSQ; activity of daily living, ADL; instrumental activity of daily living, IADL), comorbidity (Cumulative Illness Rating Scale, CIRS, 1 and 2) and anesthesiology (American Score Anesthesiologist, ASA). The vital status of the patient at 1 month after discharge and the duration of hospitalization were recorded. One-month mortality rate was 6.1%. Low hemoglobin and body mass index (BMI) values, increasing ASA score, and, only in US patients, ADL dependence and higher CIRS 1 score, were independently predictive of mortality. Low hemoglobin levels and, only in ES patients, higher CIRS 1 score were associated with prolonged hospitalization. Prognostic indicators specific to older people have limited value in mortality models in elderly surgical patients.
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PMID:Predictive factors of clinical outcome in older surgical patients. 1687 Feb 78

Use of pancuronium or vecuronium with the priming principle was evaluated in regards to hemodynamic changes and adequacy of relaxation for a rapid induction-endotracheal intubation sequence with sufentanil in 24 ASA Class III-IV patients undergoing cardiac surgery. Twelve patients taking beta-blockers (groups B-P and B-V) were compared with 12 patients not receiving beta-blockers (groups NB-P and NB-V). Patients randomly received vecuronium or pancuronium (15 microg/kg), followed in 4 minutes by sufentanil 5 microg/kg and another 85 microg/kg of the appropriate relaxant through a central vein. Intubation was possible in all patients at 90 seconds with good-to-excellent conditions. Heart rate (HR) remained statistically elevated after induction (90 +/- 10 beats/min) and intubation (105 +/- 10 beats/min) only in group NB-P (baseline 74 +/- 12 beats/min). The NB-P group also had an elevated blood pressure after the priming dose. No significant hemodynamic changes were found in the other groups in mean arterial pressure, pulmonary artery diastolic pressure, systemic vascular resistance (SVRI), or cardiac index (CI). When used with vecuronium, sufentanil in a dose of 5 microg/kg provided adequate anesthesia to avoid the hypertensive, tachycardic response that frequently occurs following a rapid intravenous (IV) induction, without unduly depressing cardiac output or arterial pressure. Two patients had evidence of respiratory difficulty after the priming dose, associated with transient tachycardia and hypertension which resolved after induction. Using the priming principle, either pancuronium or vecuronium rapidly provided relaxation in patients with cardiac disease. Chronic beta-blocker therapy was able to attenuate the tachycardia from pancuronium and was not associated with bradycardia when used with vecuronium. In patients with cardiac disease not on beta-blockers, pancuronium was associated with tachycardia. Therefore, vecuronium appears to be more suitable for these patients.
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PMID:Influence of beta-blockers on vecuronium/sufentanil or pancuronium/sufentanil combinations for rapid induction and intubation of cardiac surgical patients. 1717 50

To compare the newer inductor of platelet aggregation cationic propyl gallate (CPG) with adenosine diphosphate (ADP) for the examination of aspirin (ASA) effectivity with optical aggregometry. In total,116 patients were prospectively enrolled with a stable cardiovascular disease, taking ASA 100 mg/day for >or=1 month. The control group consisted of 62 healthy volunteers. A platelet aggregation was investigated by optical aggregometry (aggregometer LASER 4x; BIO ART, Sint-Katelijne-Waver, Belgium). CPG and ADP were added as aggregating agents. The measured parameters were CPG-slope (%/min) and ADP max (%). Using the CPG-slope values from the control group, the CPG-slope cut-off value was determined to define a laboratory ASA-noneffectively treated patient. The values from control group followed a normal distribution (Shapiro-Wilk test). We calculated the cut-off value using the 1-tailed 95% confidence interval. The CPG-slope cut-off value was 79 %/min for an ASA-effectively treated patient. We marked the patients as laboratory ASA-noneffective treated when the CPG-slope was >79%/min. In the same way we defined the cut-off value for ADP-max. We identified the aspirin treatment as ineffective when the value of ADP-max was >62%. The values of CPG-slope and ADP-max were in close correlation in the group of patients treated with aspirin with a highly significant correlation index (r=0.671, P<0.001). By CPG-induced optical aggregation, 33,6% were ASA-noneffectively treated patients. When using both inductors, the proportion of ASA-noneffectively treated patients was 25%. Using both tests, 72.4% of patients were equally divided. ASA-noneffectively treated patients were commonly more obese (46.2%), had hypertension (94.9%) and hypercholesterolemia (73.7%), and were less commonly treated with statins (30.8%) than the aspirin effectively treated patients (42%, 88.2%, 59.2%, and 42.1%, respectively). The detected differences were not statistically significant. Cationic propyl gallate is an optimal inductor for optical aggregometry to monitor laboratory effectiveness of aspirin therapy in routine clinical pratice. The determined high prevalence of laboratory aspirin ineffectiveness highlights the clinical importance of the problem. This study brings attention to the importance of controlling cardiovascular risk factors.
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PMID:Comparison of cationic propyl gallate and adenosine diphosphate for the measurement of aspirin effectivity with optical aggregometry. 1790 May 12

Preoperative co-morbidities such as known coronary artery disease have commonly deemed a patient at 'high risk' for primary elective Total Hip Arthroplasty (THA). We prospectively collected data on 1744 patients who underwent primary elective THA between 1998 and 2004; 273 had a history of cardiac disease defined as a previous hospital admission with a diagnosis of angina pectoris or myocardial infarction; 594 patients had hypertension defined as that requiring treatment with antihypertensives. We also had data on preoperative age, sex and body mass index (BMI). There was no statistically significant increase in early mortality at three months with a history of cardiac disease or hypertension and this remained so when adjusting for the other factors in a multivariate analysis. Sex or BMI also did not have a statistically significant effect on the risk of death within three months. Increasing age was the only significant risk factor for early mortality (p<0.001). Longer-term mortality at two and five years in relation to these factors was also examined. Statistical analysis revealed that coronary history now showed a highly significant association (p<0.001) with long-term mortality in patients who survived more than three months. This remained significant (p=0.002) when adjusted for the other factors. Hypertension continued to have no effect, as did BMI. Age remained a significant risk factor and ASA was also a predictor of death, as has been previously shown. The overall long-term mortality following THAwas less than expected from the normal population, even in the subgroup with a coronary history. This study will assist clinicians when advising patients who have one of these common risk factors when seeking primary elective THA.
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PMID:Does a history of cardiac disease or hypertension increase mortality following primary elective total hip arthroplasty? 1848 80

A 25-year-old female patient developed headache and papilledema under sulphasalazine treatment for ulcerative colitis. The patient met the International Headache Society's criteria for idiopathic intracranial hypertension. Sulphasalazine was discontinued and the patient was given azathioprine for ulcerative colitis and acetazolamide for intracranial hypertension. Three weeks later, her examination was normal and lumbar puncture revealed an opening pressure of 180-mm H(2)O. Sulphasalazine is a product of 5 aminosalicylate (5 ASA) and there seems to be a relationship between the administration of sulphasalazine and the onset of intracranial hypertension symptoms. Early diagnosis of intracranial hypertension is important in patients with ulcerative colitis receiving 5 ASA treatment to prevent visual complications.
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PMID:Drug induced intracranial hypertension associated with sulphasalazine treatment. 1864 79

We present a case of stress-induced myocardial stunning, also known as Tako-Tsubo syndrome, in an anaesthetised patient undergoing arthroscopic replacement of the cruciate ligament. The patient's (44 y male, ASA class II) had a history of hypertension with no other known disease. He underwent a femoral nerve block with 20 ml of 0.5% ropivacaine before receiving a balanced general anaesthesia (propofol induction, sevoflurane maintenance, 10 microg/kg sufentanil). Ten min after the beginning of surgery during endoscopic intra-articular manipulation, the patient suffered from bradycardia and hypotension; following the administration of ephedrine and atropine, he developed tachycardia, hypertension and ST segment depression. Subsequently, his systemic blood pressure dropped necessitating inotropic drug support and--later--intraaortic balloon counterpulsation; a TEE revealed no evidence of hypovolemia, anterior and antero-septal hypokinesia with an ejection fraction of 25%. Surgery was finished whilst stabilising the patient haemodynamically. Postoperative cardiac enzymes showed little elevation, an emergency coronary angiogram apical akinesia with typical ballooning and basal hyperkinesias, compatible with Tako-Tsubo syndrome. The patient's postoperative course was uneventful. We theorize that stress caused by sudden surgical pain stimulus (introduction of the endoscope into the articulation), superficial anaesthesia and insufficient analgesia created a stressful event which probably might have caused a catecholamine surge as basis of Tako-Tsubo syndrome.
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PMID:Tako-Tsubo syndrome in an anaesthetised patient undergoing arthroscopic knee surgery. 1818 58

NSAIDs contain nonselective cyclooksygenase inhibitors (for COX-1 and COX-2), inhibitors to the preferential COX-2, the coxibs (sulphonamides, methylsulphones, phenylacethic acid derivatives) with 1000 fold selectivities for COX-2. COX-2 enzyme isoform are constitutively expressed in normal gastric tissue in animals and humans, in the cardiovascular system, renal, central nervous system and other. COX-2 is involved in the ischemic preconditioning mechanism and sulphones have a prooxidant activity. COX-2 inhibitors increased risk for thrombotic cardiovascular events. Long-term study VIGOR, CLASS, TARGET MEDAL revealed that celecoxib, rofecoxib, lumiracoxib, etoricoxib significantly reduced the risk of major gastrointestinal effects (ulcers, perforations, bleeding) than nonselective NSAIDs, but the rates of complicated upper gastrointestinal events were similar for etoricoxib and diclofenac. Only in VIGOR trial incidence of cardiovascular events was greater. No evidence that concomitant ASA reduced risk for cardivascular events. Potential differences in cardiovascular outcomes with the selective COX-2 inhibitors may be due to differences in the drugs molecular structures, pharmacokinetics and pharmacodynamics. In the "prothrombotic environment" contribution disorders in the balance between thromboxan A2 and prostacyclin, increased aggregation plaque, hypertension, endothelial cell dysfunction, impaired angiogenesis. Moreover COX-2 may plays a crucial role in atherosclerotic plaque stability or instability. The cardiovascular risk may be dose related and depends on duration therapy, variable selectivity for COX-2.
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PMID:[What is new about nonsteroidal antiinflamatory drugs?]. 1843 31

After induction of anaesthesia for lumbar disc herniation surgery, an ASA-1, 39-year-old woman presented an acute heart failure. A persistent hypotension with tachycardia was observed after a brief hypertension peak during orotracheal intubation. After electrocardiogram, echocardiogram and biologic dosages, the diagnosis seems to be coronary ischemia. Coronarography was normal; takotsubo syndrome diagnosis was made with typical ventriculographic aspect. Evolution at two days and one month was favorable.
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PMID:[Takotsubo syndrome: a young woman case]. 1867 31

A single pill containing a statin, thiazide diuretic, beta-blocker, angiotensin receptor antagonist, folate and ASA has been proposed for all people over age 55, with the aim of reducing cardiovascular disease by 80%. Unfortunately, there are insurmountable problems with choosing appropriate constituents of any such single remedy. Adverse effects, drug interactions, inter-individual variation in drug metabolism, and underlying causes of hypertension that differ between patients require individualized therapy. A single pill that will succeed in all patients is not only practically, but conceptually, an inappropriate approach for the prevention of cardiovascular disease.
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PMID:Polypill: for Pollyanna. 1870 2


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