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

Hypertension represents the upper 15-25% of the blood pressure distribution in industrialized countries. The trait is practically absent in primitive societies and is made manifest by diet and lifestyles in industrialized countries. High blood pressure is an important risk factor for strokes, heart disease and renal disease. The frequency of hypertension is higher among blacks than among whites in the USA. Various twin, family and adoption studies indicate a strong genetic effect on blood pressure. The genetic mechanisms are unknown. Membrane transport variability has been studied in red cells as a surrogate for analogous alterations in smooth muscle or renal cells. Among the various transport systems, erythrocyte sodium-lithium countertransport (CT) has been consistently elevated in variable proportions of Caucasian hypertensives. Genetic studies of countertransport levels have shown familial aggregation and higher concordance for monozygotic than dizygotic twins. Complex segregation analysis suggests the action of a major gene superimposed on a polygenic background. The postulated gene (B) raises CT activity and has a population frequency of 0.25. CT levels of the common AA homozygotes and AB heterozygotes cannot be distinguished from each other, whereas CT activity of BB homozygotes (6% of the population) is significantly elevated. Although the CT gene contributes only 2.7% to 3.5% of the variability of blood pressure over its entire range, 14% to 20% of persons with systolic hypertension (greater than 140 mmHg) are BB homozygotes rather than the expected 6% to 7%. A much lower frequency of elevated countertransport activity among black hypertensives suggests genetic heterogeneity in the pathogenesis of high blood pressure. Further investigations on the mechanism and genetic linkage relationships of the putative CT gene may aid in elucidating an important mechanism of blood pressure elevation and will allow molecular approaches in the future.
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PMID:Hypertension and the genetics of red cell membrane abnormalities. 245 Jul 24

The prevalence of hypertension among the elderly is high. Recent multicenter studies have shown hypertension, especially isolated systolic hypertension, to be a risk factor and treatment to be effective, if individualized. In addition, the presence of multiple complicating conditions and the need for multiple medications in the elderly increases the required medical knowledge base necessary to appropriately determine antihypertensive therapy. To assist the primary provider, an expert system has been developed that provides advice on therapeutic decisions for elderly patients (greater than 65 years old and less than 85 years old). It takes into account such factors as age, sex, lifestyle, site of care, nutritional status, physiologic and pathophysiologic changes, co-existing diseases, multiple drug use, and prior antihypertensive drug exposure and response. The system user enters patient characteristics, disease states, risk factors, relevant laboratory values, and prior drug therapy. The system responds with a set of recommendations of appropriate therapy individualized for the specific patient. To further assist the process, relative costs of therapy are also included. The system, consisting of over 200 rules, is currently undergoing validation by a panel of cardiologists. It is implemented in IBM's Expert System Environment (ESE) on the IBM 4341. The authors wish to acknowledge the contribution of the ESE software by the IBM Corporation.
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PMID:Antihypertensive therapy for the elderly: an expert system to assist therapeutic decisions. 246 92

Fifteen hypertensive patients were recruited from a geriatric medicine clinic for a "research project designed to evaluate a Behavioral Stepped-Care treatment program of high blood pressure (HBP)." All patients met the selection criteria of the Isolated Systolic Hypertension (ISH) in the Elderly (SHEP) clinical trial. During baseline, subjects recorded BP at home 9 times/day (3 times each, shortly after awakening, during the middle of the day, and within an hour of retiring) for 1 month and mailed that data to us daily. In addition, they came to the clinic weekly and had their BP recorded by a nurse. During treatment 1, systolic (SBP) feedback, they were trained to lower SBP at home using their sphygmomanometers. They also continued to monitor BP and to obtain weekly professional BP readings. During treatment 2 (relaxation), they were trained to relax; they followed the self-administration and data-collection protocol as in treatment 1. Each treatment phase lasted 3 months. Average monthly self-determined BP fell significantly from 166.4/85.8 (SBP/DBP) mm Hg during baseline to 153.3/81.2 by the end of the relaxation phase; average monthly professionally measured BP fell significantly, from 164.7/87.1 to 156.9/81.5. These findings show that a nurse-supervised, patient-administered behavioral treatment program of ISH can yield sustained, significant falls in BP.
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PMID:Behavioral treatment of isolated systolic hypertension in the elderly. 259 12

The sequential changes in blood pressure and electrocardiographic findings of populations living in three districts of Okayama prefecture, with differing environments and life styles, were analyzed during the seventeen year period from 1966 to 1982. Furthermore, factors influencing the causes of mortality among these populations were evaluated in 790 males and 1, 118 females (total 1,908), aged from 35 to 65 years at the beginning of the survey (1966). During the survey period 94 subjects moved out of the district and 210 subjects died, so that in 1982, 975 subjects (61.1%) could be examined. Cerebrovascular disease, cancer, and cardiac disease were the major causes of death in all these districts. A higher mortality from cerebrovascular disease was recorded in the mountainous district, with harsh weather and living conditions, in contrast to the other two lowland district. There was no significant difference in mortality due to cardiac disease among the three districts. In the mountainous district, the incidence of hypertension, especially systolic hypertension, was higher than in the other two districts throughout the whole of this survey. However, after 1980, the difference in the incidence of hypertension among the districts diminished sequentially. The incidence of hypertension was higher in the elderly than in younger subjects. However, even this age difference in incidence was seen to diminish sequentially, (especially for diastolic hypertension). The ratio of the number of people who were actually treated to the population who needed hypertensive therapy increased gradually, and in 1978 there was no significant difference concerning this ratio among the three districts. Finally over 80% of the subjects who qualified for antihypertensive therapy were treated continuously. The appearance ratio of abnormal ECG findings, (Minnesota Code, Code 3, Code 3 + 4, 5 and especially Code 4 and 5), increased in proportion to the increase of blood pressure in the hypertensive group. The sequential appearance ratios for the borderline hypertension and stage I hypertension groups showed an inverse relationship to that of the normal group. However the appearance ratios of stage II & III hypertension groups increased sequentially with no relation to that of the normal group. Subjects whose ECG showed ST-T changes without subjective symptoms apparently increased sequentially in all districts. The incidence ratios of angina pectoris and myocardial infarction showed no significant sequential changes. These results suggested that high blood pressure (both systolic and diastolic) was controlled fairly well in all age groups by therapy.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Sequential changes in blood pressure and electrocardiographic findings over seventeen years in three different regions in Okayama Prefecture]. 260 78

The associations of CHD, as defined by coronary arteriography, with hypertension history and causal blood pressure in 103 CHD cases and 103 non-CHD controls matching on sex, race, age(within 3 years)was studied. The odds ratio (i.e.OR) of CHD for patients with hypertension history is 4.64. For patients with higher causal blood pressure, it is 3.53 with both 99% confidence intervals not include 1. There are significant dose-response relationships between level of systolic hypertension and duration of hypertension with regards to odds ratio of CHD or the degree of coronary atherosclerosis. The relative risk of CHD may reduce 70-80% for hypertension patients by taking drugs to lower blood pressure. There are significant correlation between hypertension and myocardial infarction in clinical types of CHD. The CHD average incubation period caused by hypertension is 10 years. It is concluded that the relationship between hypertension and CHD is seemingly causality with part of patients suffering from other consequences.
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PMID:[Hypertension and angiographically defined coronary heart disease]. 261 69

It has long been established that hypertension is the major risk factor for stroke. Three Italian studies have been reviewed in order to examine different aspects of the problem. In the first study, the role played by the systolic, diastolic and systodiastolic components of hypertension in causing atherosclerotic damage of extracerebral and intracerebral arteries was examined. At the extracranial level, a significant correlation between systolic hypertension and atherosclerotic lesions was evident. The second study evaluated the risk of major stroke, myocardial infarction and death in patients with transient ischemic attacks and reversible ischemic neurologic deficits. Possible prognostic predictors of these events were thoroughly considered: Cumulative survival with the multivariate Kaplan-Meier analysis was significantly lower in hypertensive than in normotensive subjects, particularly for cerebral deaths and for all deaths. The third study was aimed at assessing the risk factors for transient ischemic attacks and stroke in young adults. Again, hypertension emerged as a fundamental risk factor, significantly more frequent in the subgroup of older patients than in the younger subgroup.
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PMID:Systemic hypertension as a treatable risk factor for cerebrovascular disease. 264 49

Hypertension is more common in persons with both insulin-dependent and noninsulin-dependent diabetes. Pathophysiologic mechanisms that result in an increased prevalence of essential hypertension in noninsulin-dependent diabetes, premature diastolic hypertension in insulin-dependent diabetes, and systolic hypertension in both forms of diabetes are described. Aggressive treatment of the hypertension associated with diabetic nephropathy will result in a deceleration of renal decompensation. The commonly used antihypertensives that successfully treat hypertension in the non-diabetic population often have unacceptable side effects in the diabetic population. Rational approaches to the treatment of diabetic hypertension in general and in circumstances unique to the hypertensive diabetic individual are described.
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PMID:Hypertension in the person with diabetes. 265 May 43

Control of hypertension in the elderly has been shown to reduce cardiovascular morbidity. Although it is not known if this is also true for isolated systolic hypertension, drug treatment should be considered for systolic pressures over 170 mm Hg that cannot be controlled with nondrug therapy. The diuretics, calcium channel blockers, and the ACE inhibitors are very effective and generally well-tolerated therapy for the elderly. It may be necessary to combine two of these agents for some patients. Beta blockers are particularly useful for patients with ischemic heart disease or prior myocardial infarction. Beta blockers are the only agents which have been shown to be cardioprotective. For all antihypertensive agents, the elderly should be started on low doses. The drugs should then be titrated slowly if necessary. It is common for the elderly to respond to lower dosages than younger patients, and they should be monitored carefully for adverse reactions to medications. Antihypertensives should be administered once or twice daily whenever possible. If these principles are considered, most patients can be effectively controlled with a minimum of side effects.
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PMID:Antihypertensive therapy in the elderly. 266 39

Data from several long-term clinical trials, including the European Working Party on Hypertension in the Elderly, indicate that lowering blood pressure in patients 60 years of age and older is beneficial when those patients have diastolic/systolic hypertension. Overall cardiovascular complications are reduced, and the incidence of congestive heart failure and cerebrovascular complications is decreased. Diuretics--with or without a potassium-sparing component--were used as initial therapy in these major clinical trials. The results of these studies provide a basis for treating elderly hypertensive patients over the age of 60.
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PMID:Results of treatment of the elderly hypertensive. 268 Jul 78

Diabetes may be associated with systolic hypertension secondary to atherosclerosis, renal hypertension secondary to diabetic nephropathy, and essential hypertension. The latter is by far the most prevalent, and a wealth of epidemiologic data suggests that such an association is independent of age and obesity. Considerable evidence indicates that the link between diabetes and essential hypertension is hyperinsulinemia. Thus, when hypertensive subjects, whether obese or of normal body weight, are compared to age- and weight-matched normotensive controls, a heightened plasma insulin response to a glucose challenge is found consistently. A state of cellular resistance to insulin action subtends the observed hyperinsulinism. With the use of the glucose clamp technique coupled with tracer glucose infusion and indirect calorimetry, it can be shown that the insulin resistance of essential hypertension is located in peripheral tissues (muscle), is limited to nonoxidative pathways of glucose disposal, and is directly correlated with the severity of hypertension. The reasons for the association of insulin resistance and essential hypertension can be sought in at least four general types of mechanisms--sodium retention, sympathetic nervous system overactivity, disturbed membrane ion transport, and altered muscle fiber composition. Physiologic maneuvers such as caloric restriction in the overweight individual and regular physical exercise can improve tissue sensitivity to insulin; good preliminary evidence shows that these measures can also lower blood pressure in both normotensive and hypertensive individuals. A strong case can therefore be made for the use of physiologic intervention in the treatment of essential hypertension.
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PMID:The association of essential hypertension and diabetes. 268 84


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