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

The clinical behaviour and mean peak serum aspartate aminotransferase (SGOT) values of 106 patients admitted to a coronary care unit with acute myocardial infarction who displayed acute systolic hypertension were studied. Another 106 normotensive patients with acute myocardial infarction acted as controls. Neither group had established hypertension. The mortality rate, incidence of cardiac failure, major arrhythmias, and mean peak SGOT were significantly greater in the hypertensive group, within which the duration of hypertension was correlated with mean peak SGOT levels--through there was no definite relation between the height of systolic or diastolic pressure and SGOT. Transient systolic hypertension after acute myocardial infarction was therefore associated with a relatively poor prognosis, but our observations suggest that patients with a systolic blood pressure of at least 170 mm Hg might benefit from early hypotensive treatment.
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PMID:Prognostic significance of acute systolic hypertension after myocardial infarction. 113 58

In 1961, blood pressure was measured in the 40-69-year-old segment of the population of Evans County, Georgia. Mortality was monitored for up to ten years. The relationship found between hypertension and mortality is characterized in this report by four parameters: attributable risk, prevalence, population attributable risk, and population attributable fraction. Attributable risk of death, a measure of the over-all impact of hypertension on those in each race-sex group with hypertension, is high in white males, black males, and black females, and is lowest in white females. Population attributable risk, a measure of the impact of hypertension on each entire race-sex group, is highest in black males and females due to the high prevalence of hypertension in blacks. It is somewhat lower in white males and lowest in white females. The fraction of all deaths attributable to hypertension (population attributable fraction) is highest in black females and lower in the other three groups. The population attributable fraction (ranging from 0.26 to 0.54 for systolic hypertension) is of such magnitude that if the 50% reduction in mortality achieved in the Veteran Administration Cooperative Study could be repeated in the general population, life expectancy after 40 years of age could be substantially increased.
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PMID:Attributable risk, population attributable risk, and population attributable fraction of death associated with hypertension in a biracial population. 117 73

A study of the catecholamines passage with urine in patients of advanced age with systolic hypertension has revealed features specific for the activity of their sympathico-adrenal-system by comparison with that in patients with hypertensive disease (with systolic-diastolic pressure rise) and in persons of the same age with normal pressure. In systolic hypertension an inhibition of the mediatory link finding its expression in a decreased noradrenaline excretion, was noted, while that of adrenalin remained normal which led to a fall in the ration noradrenaline/adrenalin. Inasmuch as adrenalin causes chiefly the rise of systolic pressure and noradrenaline -- that of diastolic it may be presumed that the established features of the sympathico-adrenalin activity appear to be a factor contributing to the systolic nature of the hypertension under review, which stems primarily from other major pathogenetic factors. At the same time in subjects of advanced age the reactivity of the mediatory link in systolic hypertension remains intact, this manifesting itself in a significantly increased noradrenaline passage, as compared to a low initial level following administration of insulin.
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PMID:[Sympathico-adrenal system in elderly patients with systolic hypertension]. 119 52

Despite the availability of numerous antihypertensive agents, a concerted research effort to develop new approaches to hypertension treatment is necessary. Published results of large multicenter trials emphasize the benefits of available treatments in highly selected patients. A critical look at the results shows that treatment failure is frequent and side effects are common. In the Systolic Hypertension in the Elderly Program, 28 to 35% of patients did not reach the goal blood pressure, 13% stopped treatment because of side effects, and 21% required medication other than a diuretic and a beta-blocker. Basic research may bring forth novel concepts of treatment, such as neutral endopeptidase inhibition, renin inhibition, or new techniques such as gene therapy. In the meantime, among many other lines of research, type 1 angiotensin II-receptor antagonists represent a promising new group of agents for the vast majority of hypertensive patients who are renin-dependent. A different global approach to hypertension management is also needed. Because hypertension is a heterogeneous disease, individual sequential monotherapy or the "N of 1" trial aim to select the most effective drug for each patient. To achieve the accurate assessment of drug efficacy that is a prerequisite for this approach, the number of blood pressure measurements before and during drug administration must be increased. For this purpose, self-blood pressure measurement and teletransmission of results to the physician will provide a major treatment advance.
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PMID:Improving hypertension treatment. Where should we put our efforts: new drugs, new concepts, or new management? 129 Jun 21

Treatment of hypertension in the elderly has so far mainly been based on clinical judgment and very few large controlled trials. During the last year several large new trials have been published, the so-called STOP-Hypertension, SHEP, and MRC trials. All have shown that drug treatment of hypertension in the elderly (65-85 years) with permanent diastolic hypertension or isolated systolic hypertension reduces stroke incidence. Most patients have needed combined drug treatment with diuretics and beta-blockers. When thiazide diuretics are used, serum potassium should be followed very closely and most likely amiloride should be added to the thiazide therapy, since this was done both in the STOP and the MRC trials. Since many elderly patients with hypertension suffer from other diseases that might represent contraindications to thiazide diuretics or beta-blockers, the choice of drug must be made after careful clinical evaluation. With the newer classes of antihypertensive agents (calcium antagonists, ACE inhibitors and alpha-blockers) side effects are probably seen less often, but long-term data on morbidity and mortality are still lacking.
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PMID:Treatment of hypertension in the elderly--what have we learned from the recent trials? 129 75

To quantify the association of abnormal glucose tolerance with hypertension, a population based study was carried out in subjects aged 30-65 years with oral glucose tolerance and blood pressure measurement compared with clinic based known diabetics. In males, subjects with diabetes (newly diagnosed and clinic based) had increased systolic and diastolic blood pressure with clinical significance compared to normal. The diastolic blood pressure in diabetic males was higher than normal but was not different from IGT. In females, the differences were observed between normal vs IGT, and diabetes. The differences were independent of age and obesity. The prevalence of hypertension also increased in diabetic patients, especially for systolic hypertension.
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PMID:Abnormal glucose tolerance and blood pressure in Khon Kaen. 130 23

In 1985 we investigated the prevalence of high normal blood pressure in 6387 inhabitants (range 15-75 years old) of the city of La Plata and its progression to arterial hypertension after four years. High normal blood pressure was defined as a systolic blood pressure (BP) < 140 mmHg and diastolic BP between 85-89 mmHg (average value of two measurements) on one occasion. Arterial hypertension was defined as a systolic BP > or = 140 mmHg and/or diastolic BP > or = 90 mmHg, both as an average of two measurements on two occasions. High normal BP prevalence was 6.62%, being higher in men than in women (p < 0.0005, Table 1). General progression to hypertension was 41.79%, being higher in the older individuals (p < 0.0005). Of the 423 individuals with high normal BP (Table 2), 268 (63.36%) were found in 1989 (Table 3). They had an incidence of hypertension of 10.45% per year, also higher in older subjects (Table 4). There were no differences between sexes. Subjects with high normal BP who subsequently developed hypertension had higher systolic BP in 1985 than those who remained normotensive (p < 0.001, Table 5). Most of them progressed to mild diastolic hypertension (29.48%) or borderline isolated systolic hypertension (6.72%, Fig. 1). In this study, progression to arterial hypertension was higher than that reported in similar studies for general population in other countries.
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PMID:[Prevalence of high normal blood pressure and progression to hypertension in a population sample of La Plata]. 130 6

Choosing antihypertensive agents that protect patients against cardiovascular and other complications is a growing trend in the treatment of mild to moderate hypertension. Calcium channel blockers and angiotensin-converting enzyme (ACE) inhibitors are favored because they have neutral or positive effects on lipid levels and insulin resistance. The alpha 1 blockers, especially doxazosin mesylate (Cardura), are enjoying a resurgence in popularity because they have a beneficial effect on lipid levels. In terms of preserving patients' quality of life, the ACE inhibitors in particular have been shown to have a positive impact. It has been shown that systolic hypertension in elderly patients should definitely be treated, but the most appropriate agent has yet to be defined. Therapy should be tailored to the individual. The following questions should be considered when choosing an antihypertensive agent: (1) What are its side effects (especially metabolic ones)? (2) Does it require only once- or twice-a-day dosing? (3) Does it cause regression of left ventricular hypertrophy? (4) Does it prevent death from coronary artery disease? (5) How will it affect quality of life? (6) How much does it cost? The goal of therapy should be to provide adequate blood pressure control throughout the day, enhance compliance, and protect the heart, brain, and kidneys without adversely affecting metabolic state.
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PMID:Antihypertensive therapy. Current issues and challenges. 134 44

REASON FOR TREATMENT: In patients with asymptomatic high blood pressure, antihypertensive treatment is initiated for only one reason, to prevent the hypertensive sequelae of myocardial infarction, stroke and heart failure. MORBIDITY, MORTALITY AND SURROGATE ENDPOINTS: Only diuretics and beta-blockers have been shown to benefit hypertensive patients in terms of the hard endpoints morbidity and mortality. beta-Blockers and diuretics are cheaper than newer drugs and thus represent good value for money. It is not acceptable to use drug effects on plasma lipids or insulin resistance as measures of the effects on coronary heart disease, since dihydropyridine calcium antagonists improve these parameters while significantly increasing coronary heart disease events in the acute and chronic ischaemic situation. PATIENT PROFILING: Diuretics. Diuretics appear particularly suited to elderly hypertensives, especially those with isolated systolic hypertension, but they may increase cardiac events in younger and middle-aged diabetic and non-diabetic hypertensives. Angiotensin converting enzyme (ACE) inhibitors. ACE inhibitors are undoubtedly valuable in the presence of left ventricular dysfunction, and possibly in the diabetic in maintaining good renal function. beta-Blockers. beta-Blockers are particularly well suited to younger and middle-aged hypertensives at all blood pressure levels, especially white males; where ischaemia and/or stress is a factor, beta-blockers can significantly reduce the incidence of myocardial infarction and strokes. beta-Blockers benefit elderly hypertensives by preventing strokes and may prevent coronary heart disease if prescribed with a diuretic.
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PMID:The case for beta-blockers as first-line antihypertensive therapy. 135 11

SHEP (Systolic Hypertension in the Elderly Program) is a multicenter controlled therapeutic trial which included 4,736 subjects aged 60 years and over, who had isolated systolic hypertension at three consecutive visits at the outpatient clinic. The treatment, based on low doses of diuretic (chlorthalidone 12.5-25 mg daily) combined, when necessary, with a cardioselective beta-blocker (atenolol 25 to 50 mg daily), significantly reduced the incidence of cerebrovascular and coronary events; the relative risk reduction for total mortality was not statistically significant. The beneficial cardiovascular effects were observed in both sexes, and in the 80+ age group. These results show that this particular therapy applied to this form of hypertension decreases the risk of both coronary and cerebral events, as was already suggested by the meta-analysis of the controlled therapeutic trials performed with diuretics, beta-blockers and other older antihypertensive drugs in patients with permanent diastolic hypertension. They also show the limitations of this therapeutic strategy, which controlled only 50 percent of the patients who were, however, highly selected, especially concerning the absence of associated morbid conditions and treatments. The need for, and feasibility of, new controlled therapeutic trials comparing the mortality and morbidity associated with various new antihypertensive therapies must now be discussed.
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PMID:[Cooperative study of systolic arterial hypertension in the elderly patient (SHEP). Comments]. 136 12


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